4.2.4. Lack of Sufficient Skills and In-Service Training
Healthcare delivery can be highly labor-intensive and frustrating if the healthcare worker is not well trained. The quality, efficiency, and equity of services are dependent on the availability of skilled and competent health professionals. It is essential that health workers are appropriately trained to deliver the required services according to set standards. 
Nurse (N5) indicated that: “our biggest challenge in the wards, is that we only have one nurse who is knowledgeable about TB. She is the only specialist in the wards; the rest of us know TB a bit because we read about it and from the experience that we have as nurses, even though some of us have attended workshops but I do not recall having to go for training. TB patients undergo different stages and it is important for us to understand them. Hmm some of the behaviors that we see in the wards shock us and we do not understand why patients could behave like they are insane.”
A study by ten Hoeve et al. [21], found that one of the independent functions of a nurse is education. According to a study that was done by WHO [1], healthcare professionals need to seek up-to-date scientific knowledge from national, and international, academic and research institutions, including professional associations. The findings of this study revealed that there was a lack of skills and in-service training in the wards. This finding concurs with those of a study conducted by Yang et al. [22], which indicated various barriers contributing to poor TB treatment, such as communication difficulties, low literacy level, inadequate knowledge, and low awareness of TB disease.