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1.0 Introduction
Chitungwiza Central Hospital (CCH) is a quasi-government non-profit making
organization under the Ministry Of Health and Child Welfare. It is committed to the
provision of quality health services, which are promotive, preventive, curative and
rehabilitative, advocating and facilitating the provision of cost effective services in a
conducive environment indiscriminately. To achieve this it has a purchasing function
which its main function is to procure all goods and services for the hospital. The
Purchasing function is part of the broader concepts of materials management or logistics
management, provides materials, products and services to the enterprises in such a
manner that input costs are optimized, the competitive advantage of the firm is enhanced
and the welfare of the general community is increased. It is there as a result of the State
Procurement Act which states that all government departments should have this function.
Though this function is there, Chitungwiza Central Hospital is facing a number of
operational challenges. Inadequate medications, lack of back-up spares for diagnostic
equipment, poor diet for patients, floor beds in wards are some the challenges hospitals
face in their quest to deliver quality healthcare to patients and Chitungwiza Central
Hospital is not exempted. Against this background, the research aims at assessing the
impact of the public procurement regulatory framework on the health delivery system in
1.1 Background of the study
Health institutions in Zimbabwe are generally faced with a number of operational
challenges. Inadequate medications, lack of back-up spares for diagnostic equipment,
poor diet for patients, floor beds in wards are some the challenges hospitals face in their
quest to deliver quality healthcare to patients.

Public procurement is not a new area in terms of research as there are a number of studies
conducted on the subject for instance, Lindskog, Brege and Brehmer (2010), Shui Hui (2010), Lawther and Martin (2005), Caldwell (2005), Tikkanen and Kaleva
(2011), Cabras (2011), and Walker and Bremmer (2010). These researchers focused
intensely on public procurement in general. The impact of public procurement policies
and procedures on health delivery system in Zimbabwe has not been adequately
developed and applied. There are some studies done in other countries on issues to do
with public procurement but there are no similar cases which were done in Zimbabwe.
Thus, generalization for example, „‟Procurement issues in Malaysia‟‟ to all public
procurement scenarios worldwide will result in a „narrow‟ approach being adopted.
Zimbabwe might not have the same challenges as Malaysia or China as nations vary
considerably. It can be noted that results of their investigations are context oriented.
In addition, resurgence of diseases like Cholera and Typhoid coupled with acute
shortages of drugs and medical equipment in some hospitals bring this research into
perspective. Also, this research come at a time when the Ministry of Finance, reiterated
the importance of efficiency and effectiveness in the service delivery (Chizu, 2011) . This
also coincided with the announcement by the State Procurement Board Chairman about
the need to improve competitiveness of tendering system (The Herald, 2011). The
resurgence of Cholera in 2008 which claimed thousands of lives and the recent Typhoid
outbreak in most parts of the country is a clear testimony of the challenges facing the
health industry. Late diagnosis of cervical and breast cancer in women add to the basket
of health challenges.
Further to this, the country‟s Tuberculosis (TB) Mortality rate remains high with the
nation ranked fourth in the world with reported cases of patients defaulting treatment
over allegations of high consultation fees at hospitals despite the free treatment policy
(Newsday, 2011) . Generally high acquisition cost of drugs, surgical and medical
equipment seem to be prevalent in most hospitals. Shortage of Anti-Retroviral drugs
(ARV) for HIV patients in hospitals and clinics remains a challenge. This is further
exacerbated by unavailability of doctors and under-equipped theatres and treatment
rooms. Floor beds in most hospital wards are seen scattered and perhaps an indication of

inadequate physical infrastructure. There are long queues in sections such as the Casualty
and Outpatients departments resulting in longer turnaround time for patients.
As for existing medical equipment, constant breakdown and lack of back-up spares to
restore the functionality of these machines have been noted especially X-ray Machines
and Laboratory Analyzers. There are also cases where patients are booked for X-rays or
other specialized tests to be done after a couple of days.
Regarding the issue of diet in hospitals, patients have been served in some cases, with
food which is not palatable and nutritious in line with their varying dietary requirements.
This was well noted in 2008 and 2009 where patients were mostly served with beans or
cabbages as relish consecutively.
Despite these challenges, there are even cases where the hospitals do have the funds but
there are no medicines or specialist modern equipment and this has been highlighted by
the Minister of Finance. Other cases involve cancellation of tenders for drugs whilst some
take longer to be finalized irrespective of dwindling stock levels.

1.2 Statement of the Research Problem
The health sector is facing a multiplicity of issues ranging from unavailability of critical
medicines, influx of unregistered medicines, expiry of some drugs in hospitals and clinics
to inadequate diagnostic equipment in the laboratories and X-rays. This was evidenced by
the health sector‟s failure to cope with recent outbreaks of Cholera and Typhoid. Despite
these challenges, there are cases where the hospitals have the funds but there are no
medicines or specialist modern equipment and this has been highlighted by the Minister
of Finance. Other cases involve cancellation of tenders for drugs whilst some take longer
to be finalized irrespective of dwindling stock levels which result in stock outs. This
negatively affect the service delivery to the patient.


1.3 Objectives
 To evaluate the impact of public procurement policies and procedures on health
service delivery.
 To assess the adequacy of procurement policies and procedures at Chitungwiza
Central Hospital.
 To examine the causes of the delay in procurement activities and their effects.
1.4 Research Questions
 How has the Public Procurement Act affected health delivery system at
Chitungwiza Central Hospital?
 To what extend are the procurement policies and procedures adequate for
Chitungwiza Central Hospital?
 What are the causes of delays in procurement activities?

1.5 Significance of the study
The rationale behind this study is to fulfill personal, academic and professional interest
1.5.1 The Organisation
To the government, this research will have the potential of changing the public
procurement terrain by enhancing efficiency and effectiveness in the system. Areas of
resource mobilization and allocation will be reconsidered resulting in mega savings in
resources and realization for Value for Money (VFM). The general well- being of
patients will be improved in hospitals and clinics. In essence, this research will unveil
areas where improvement is most and urgently required. And, for the institutions that are
used as case studies, the research will actually assist in the identification of all the
operational issues impacting the health delivery system at their hospitals. Employees of
these hospitals will have an honour or recognition of participating in a research that can
alter the history of the country in terms of health delivery.


Lastly, for the researcher, the approach of the case studies will enable full understanding
of the research problem. Skills for analyzing, assessing, investigating will be invaluable
for the researcher even for future studies.
1.5.2 The University
The research can be added to the library and can be used by other researchers and can be
used as empirical evidence by other researchers.
1.5.3 The Researcher
The researcher will bring a sense of achievement to the researcher. It will work as a
motivation tool as other researchers can make reference to the research on matters
pertaining to procurement and this will increase his confidence in the procurement field.
1.6 Assumptions of the study
 The information that will be used for this research is reliable, accurate, unbiased
and will be obtained from relevant authors, persons, and publication.
 Issues under investigation shall remain constant throughout the period of research
 The researcher shall get all the information needed for this research
 All the targeted participants will cooperate
 All participants will provide accurate information
 The research shall be carried out within the premises of Chitungwiza Central
1.7 Delimitations of the study
The major concerns of the study shall be the impact of public procurement policies and
procedures on health delivery system. The study shall be carried out at Chitungwiza
Central Hospital and shall consider an evaluation of the State Procurement Act.
1.8 Limitations
 The collection of data was difficult in areas that are governed by law and code of
ethics. However the researcher had to seek authority from the CEO who approved

the researcher to have access to the required data. Information that is considered
sensitive and confidential was difficult to deal with as respondents were not
willing to release such information but the researcher had to educate them on the
importance of the information as it was purely for academic purposes.
 Some respondents were not able to return the filled questionnaires on time. The
researcher had to persuade them to finish on time.
1.9 Definition of terms
Procurement :- it is that function that describes the activities and processes that are done
to acquire goods and services
Inventory:- these are goods in stock
Organisation:- might be used to replace the hospital.
Code of ethics:- these are standards, rules and procedures that govern the way goods are
Purchasing:- this is the process of ordering and receiving of goods and services (Benton,
CCH- will be representing Chitungwiza Central Hospital.
1.10 Summary
This chapter will explore the background of the study, statement of the problem,
significance of the study, assumptions, delimitations and limitations of the study.


Literature Review

2.0 Introduction

This Chapter critically assess and evaluate the published works of accredited scholars and
researchers, relevant and applicable in the public procurement. This Chapter is logically
organised in two parts namely, general public procurement perspective and health
procurement perspective.
To fully appreciate and understand the direction of this research, it is deemed crucial and
relevant to define public procurement in general and outline its context to give direction
to the academic audience.
2.1 Theoretical Literature
The review of literature by other authors will be reviewed under this heading. The
researcher started by defining procurement.
2.1.1 Conceptual Definition of Procurement

Procurement is the process of acquiring goods, works and services, covering both
acquisitions from third parties. It involves option appraisal and the critical “make or buy”
decision which may result in the provision of goods and services in appropriate
circumstances (PPB, 2003).

Procurement is to purchase the right quality of material at the right time, in the right
quantity, from the right source, at the right price. The main objectives of procurement
include: supplying the organization with a steady flow of materials and services to meet
its needs, to buy efficiently and wisely, obtaining by ethical means the best value for

every money spent, to manage inventory so as to give the best possible service to users at
lowest cost and protect the government‟s cost structure (Barly, 1994).

2.1.2 Definition of Public Procurement
Public procurement has been defined as, ‟‟ a process whereby public authorities-
including all levels of government and public agencies-buy goods and services or
commission work‟‟, Kastanioti et al.( 2012,p.1).
Public procurement can be described as centrally negotiated legal processes which are
guided by political decisions and practically implemented by various local purchasers. It
should be acknowledged that public procurement has both economic and social benefits,
but the social benefits of public procurement are primarily seen as indirect positive
effects from economic savings and environmental improvements (Björn Wickenberg
2004). Procurement is a potential instrument of integrating socially and economically
sustainable benefits to stimulate employment programmes.
According to Waara (2007), Public Procurement is any purchasing performed by any
public authority within the classical sector or within the utilities sector. The public
procurement rules applicable to purchasing entities also depend on whether the total
purchase value is over or below certain so-called “threshold values”, which differ as
regards goods, services and construction works. All procurements above the threshold
values apply procurement directives and must be advertised in the Supplement to the
Official Journal for public tenders. There are a number of different procurement
procedures to choose from, depending on whether it is a purchase above or below the
threshold values. Many minor purchases are subject to so-called “direct procurement”,
which do not have to be publicly advertised. However, due to principles of market
competition, direct procurement should not take place repeatedly, and purchases should
not be divided into smaller units in order to avoid exceeding the threshold values.

Again, according to Ghana Integrity Initiative (2007), Public Procurement “is the
acquisition of goods and services at the best possible total cost of ownership, in the right

quantity and quality, at the right time, in the right place for the direct benefit or use of
governments, corporations, or individuals, generally via a contract”. It can be said to be
the purchase of goods, services and public works by government and public institutions.
It has both an important effect on the economy and a direct impact on the daily lives of
people as it is a way in which public policies are implemented (Ghana Integrity Initiative,
It is interesting to note that purchasing by government departments and agencies
represent a substantial contribution to the country‟s Gross Domestic Product (GDP). In
most developed countries, it is estimated that GDP contribute about 10-15 percent while
in developing countries it is approximately 20 percent (Mukhopadhyay 2011). The funds
that are utilised in the procurement of goods and services are mainly harnessed from
income tax, companies‟ tax and duties on imports (Hui et al. 2011). In some countries the
parliament approves the budget prior to disbursements to individual government
departments. Generally the decision making process in public purchase is cumbersome,
tedious, complex and time –consuming primarily because of extensive authorisation
procedures and also multiple stakeholders (Van Weele (2005). Further, there is pursuance
of political, budget policy and public accountability objectives in public procurement as
given by Van Weele (2005) and it is of paramount importance to review these objectives.
2.2 Critical objectives in Public Procurement
Public procurement has its objectives and the researcher saw it worth to look in to these
2.2.1. Political Objectives
Political objectives play a pivotal role in shaping procurement policies and procedures in
the public sector. Issues relating to employment creation, development of and protection
of local industries are at the heart of government iniatives. The moves by the
Zimbabwean government to adopt the Look East Policy where certain products are
procured mainly from China clearly illustrate the encroachment of political objectives
into public procurement framework. This is a very contentious issue though defended by
the State Procurement Board (Langa 2012). The Indigenisation and Empowerment policy

where a certain percentage of the public tenders are reserved for local companies again
poses serious implications in public procurement. Indigenous companies should not be
synonymous to brief case companies whom when contracted fail to meet up to the
contractual obligations. The recent awarding of tender to a South African company by
Zimbabwe Electricity Supply Authority (ZESA) ignited debate and criticism in line with
the Indigenisation and Empowerment policy. Further, the Cabinet instruction for all
public institutions and parastatals that all vehicles should be procured from local
manufacturers such as Willowvale Mazda Motor Industries and Quest Motors, while
protecting local industries may impede service delivery particularly that the former
manufacturer was brought before the parliamentary portfolio committee on health for
failing to manufacture ambulances for hospital within the agreed time-frame
(Government of Zimbabwe 2011).
While political objectives may be addressed, issues relating to efficiency can be lagging
behind. Therefore a balanced approach needs to be adopted especially when political
objectives are at variance with economic objectives. It is imperative to take cognisance of
the fact that how suppliers are selected determine the performance of government
departments particularly that the Zimbabwe Finance Minister registered displeasure over
incomplete projects by contracted companies despite advance payments. Therefore,
performance of public hospital or any department hinges heavily on the competitiveness,
novelty and capability of its suppliers (Vonderembse and Tracey 1999).
2.2.2 Budget Policy objective
As mentioned earlier on, funds used for the procurement of goods and services are levied
from taxpayers. These funds are then passed through parliament for endorsement prior to
disbursements. Once approved, the budget for each department is like ‟‟a license to
spend‟‟ as noted by Van Weele (2005, p.341) What this entails is that all funds allocated
for that particular year must be exhausted failure of which may lead to the funds
reallocated for other purposes. Also, failure to appropriately and fully utilise the funds
will impact negatively on the next year‟s budget allocations (Van Weele 2005). And so,
the strategic role of purchasing in this regard is detrimentally and regrettably missing in

all government purchases. Savings through negotiations or use of innovative supply chain
strategies will not be credited to the respective department ( Van Weele 2005).
2.2.3. Public Accountability objective
The procurement activities by government institutions or agencies are under intense
scrutiny from the general public primarily because it involves the use of tax payers‟ funds
which parliament endorses (Erridge and Nondi 1995). The Office of the Comptroller and
Auditor General verifies all expenditure and that explains why government departments
must meticulously and religiously follow the laid down procurement policies and
procedures resulting in the officers discharging procurement duties to be ‟‟procedure
oriented rather than results oriented‟‟ (Van Weele 2005,p.342). The development of
stringent legal and policy framework is carefully crafted towards the achievement of an
economical, effective, transparent and efficient delivery system.
In some cases, the regulations are specifically designed to reduce fraud, corruption, abuse
of office through establishing an audit-trail procurement system (Mukhopadhyay 2012;
Lindskog, Brege and Brehmer 2010). Corruption has been of major concern particularly
in the public sector and for that reason it is necessary to briefly examine its extent and
implications. Corruption in the Public Sector
Despite the strict jurisdiction, incidences of fraud, bribery and corruption has been
unearthed either through audits or traps by the Anti-Corruption Units in various nations.
As claimed by Auriol (2006), the research conducted by World Bank uncovered that
about $US 200 billion per year are fleeced from government expenditure worldwide
through bribery and corruption. It will however, remain unclear as to what was the actual
purchase price because it is the biggest briber and not the most appropriate supplier who
is awarded the tender (Auriol 2006).
However, the emergence of corruption practices in many governmental departments,
everything else being equal, can be an indication of gross institutional performance gaps
or deficiencies and that probably explains why public officers circumvent the

procurement procedures. The probing question is why the institutions lacking in the first
instance (Aidt, Dutta and Sena 2008). Raymond (2008) strongly contends that corruption
is rife in developing countries than developed countries. Poverty and weak enforcement
of the procurement regulations could explain such as scenario. Whichever way one may
explain the reasons, corruption has far reaching effects particularly in public hospitals. In
some cases it takes the form of gifts, but, as noted by Brennan (2009) the value of gifts
could be borne proportionally by the patients in the form of higher prices. In addition,
evidence of corrupt tendencies frustrate donor support particularly vaccines and
pharmaceuticals supplies bringing fiscal pressure to the government to provide for any
procurement activity.
When corruption goes to astronomical levels as reported by World Bank, it necessitates
the review of ethics in purchasing. Ethics in Purchasing
Ethics is defined as, ‟‟the principles of conduct governing an individual or group; concern
for what is right or wrong, good or bad‟‟, Lysons and Farrington (2006,p.655).
The importance of ethics in purchasing has not been central as compared to other
established professions such as medicine, surgery, law, accountancy and architecture
(Lysons and Farrington 2006). For instance, a medical doctor or registered general nurse,
the right to practice is subject to appropriate professional membership. Malpractice in
these professions, unlike purchasing, has serious repercussions. Michael Jackson‟s
Physician, Dr Murray‟s practicing license was revoked when convicted of ethical breach.
Of course, there are reasons or developments highlighted below that necessitated the
pursuance of ethical codes in purchasing.
 Susceptibility of purchasing professional to corruption because of their position as
organisation‟s representative to the external suppliers and also the volume of
financial resources at their disposal.
 Importance of trust and unimpeachable level of integrity in maintaining and
sustaining relationships in the supply chain network.
 Demand for accountability and transparency by the stakeholders.

While there are professional bodies in the field of purchasing like the Institute of Supply
Management (ISM) in the United States of America and the Chartered Institute of
Purchasing and Supply (CIPS) in the United Kingdom that provide enough guidance on
ethical issues in procurement, they have not yet developed a comprehensive sanction
system for those who deviate from the prescribed code of conduct. Considering
purchasing being prone to corrupt activities, it is expected that penalties are attached to
malpractice particularly that there are far reaching effects in terms of service delivery.
The other reason given by Lysons and Farrington (2006) is that a conflict of interests may
arise in that the professional codes of conduct can be superseded by the organisational
ethics standards.
2.2.4. Competitive Objective
The underpinning principle of regulatory framework in both national and international
laws (including European Commission Directives) is to promote competition (Tadelis
2012). The establishment of legal system in public procurement is to impede preferential
procurement tendencies (Christopher 2005). When many players participate in tendering
undeterred, prices go down and Value for Money (VFM) is enhanced. This
competitiveness objective is contended by Caldwell et al. (2005, p.243) that in public
markets it is still difficult to achieve especially when tested against the economic models
of „perfect competition and low barriers to supplier entry or exit‟‟. It is therefore crucial
to evaluate the concept of Value for Money (VFM) because of its centrality to all
government purchases. Budgetary constraints are also critical to that concept.
2.2.5 Value for Money (VFM)
In order to fully understand the Value for Money concept in relation to public
procurement, it is essential to define it.
Definition of Value for Money:
“ Value for Money is the optimum combination of whole life costs and quality‟‟ UK
Government (2004, p.17)

From this definition, it is very important to underline that the VFM concept is premised
on the idea of whole or total costs and not on the lowest purchase price. The EC
procurement directives have taken cognisance of the total life cycle costs. Whole life
costs encompass the acquisition, possession, use and disposition of a commodity (Ellram
1994) of the Regulatory Framework
The highly prescriptive nature of the procurement policies and procedures have been
criticised mainly because of the burden it exerts on public institutions in the process of
acquiring commodities and also the suppliers participating in the tendering. The recent
Zimbabwean court case where the Minister of Energy and Power expeditiously procured
the much needed fuel amid revelations that the country‟s reserves had reached critical
levels, as a result, a criminal charge was filed against the Minister for failing to follow
procurement procedures. As such, the procedures and policies may not be consistent with
the urgency and criticality of the item required. Medicines, surgical consumables can fit
in that category where sickness cannot be postponed to a future date to allow complete
authorisation. Gerson (2004) as referenced by Cabras (2011) suggested public
procurement efficiency by reducing the number of inputs without compromising on
After considering the contribution of procurement, for instance, to the country‟s GDP, it
is of paramount importance to examine the strategic role of purchasing in enhancing the
competitiveness of an organisation.
2.3 Empirical Literature
2.3.1 Strategic role of purchasing in Enhancing Competitiveness
Over the past decades, purchasing in general was perceived to be not strategic in some
organisations and industry segments. This was evidenced in the employment of non-
purchasing staff who may not even ‟‟sit in a purchasing department and might not call the
process purchasing‟‟, Zheng et al. (2007,p.76). A Clinician performing procurement
duties was the scenario one could find in some organisations. A survey conducted by

Cammish and Keough (1991) unearthed that in some industries such as pharmaceuticals,
consumer products and laboratory suppliers, the strategic role of procurement appeared to
be marginalised.
Despite the above low perceived value of purchasing, the recognition of purchasing as a
strategic function has increased notably in recent years to reflect broad external and
internal business trends (Van Weele 2005). Deregulation of trade as a direct result of
globalisation by most governments has intensified competition hence need for exploiting
purchasing function in positioning the competitiveness of the organisation. The above is
further exacerbated by changing customer needs and preferences where customers
developed an extended value concept that incorporated flexibility, dependability,
convenience, novelty of their product or service (Van Weele 2005). Thus, the
procurement function in any organisation is strategically positioned to mitigate the
environmental and industry risks, Chen et al. (2004) as quoted by Lawson et al. (2004 ).
The work of Porter (1980); the Five Forces Model further uncover the strategic role of
purchasing in enhancing organisation‟s competitive position on the industry market. Out
of the five forces, two; the competitive nature of the industry and the bargaining powers
of buyers and suppliers are directly linked to the procurement department (Mol 2003).
Speckman, Kamauff and Salmond (1994,) also illuminated on the competitive and
strategic position of procurement in organisations in the light of the ‟‟new competition‟‟.
This concept is premised on the idea that companies or organisations will not tomorrow
compete in the same manner they did yesterday, hence exposing the strategic role
purchasing has in exploiting the unique competencies of the suppliers that keep them
competitively afloat (Speckman, Kamauff and Salmond 1994).
However, there is need to examine some of the key drivers that have triggered the
recognition of purchasing as a strategic function in both public and private sectors.
2.3.2 Key drivers for the recognition of purchasing
As mentioned earlier, globalisation and the demanding nature of customers have
unravelled the issue of cost management as a driver for the recognition of the purchasing
function. Also, the emergence of supply chain related risks necessitated the proper

positioning of purchasing department. Hence the two major drivers; cost and supply
chain risks need to be critically examined. Cost
The purchasing department is the conduit of expenditure of an organisation and for that
reason it will be suicidal if not catastrophic to neglect this department given the volume
of resources at their disposal. Governments are also reviewing their budgets upwards to
maintain accommodate additional expenditure. Analysis of a cost structure of either a
manufacturing or service organisation indicates a larger cost percentage of goods and
services (Van Weele 2005). Thus, the cost structure of an organisation necessitated the
recognition of purchasing in spearheading cost reduction. Involvement of suppliers in the
previously sacred territories of research, product or system design by the procurement
function signifies the importance of the department in terms of cost competitiveness. Supply Chain related risks
Due to globalisation, the diverse nature of business operations where organisations can be
supplied by seller who in turn is supplied by a manufacturer with facilities all over the
world means that many participants or even products are involved and this complicates
the entire supply chain. Even the patient, for instance, on Anti-Retroviral therapy in
Zimbabwe feel the impact of these supply chain related risks if the treatment delays to
reach the hospitals. In 1994, Toyota realised the importance of purchasing in maintaining
and sustaining supplier relations when fire gutted their factory destroying one essential
component that brought the entire supply chain to an instant halt. The resuscitation of
operations at Toyota following that incident unmasked the unique role of purchasing
(Wilding 2008). Therefore, the procurement function offset these supply chain related
risks and maintains competitiveness of the organisation.
Having assessed and evaluated public procurement literature from a general perspective,
the nature of procurement in the health sector can now be critically examined.
2.3.3 Public procurement in the Health Sector

As highlighted by the United Kindgom Office of Government Commerce (2008),
procurement is arguably one of the most important indispensable mechanisms to deliver
policy and this encompasses health delivery to citizens. Issues relating to provision of
affordable healthcare services to the patients are at the core of the health departments. In
recent years, health institutions around the globe faced challenges in terms of cost
containment of medical products, efficiency and budgetary constraints and
responsiveness in the medical supply chain (Saltman et al.1998 as quoted by Figueras,
Robinson and Jakubowski, 2005, Brennar, 2009). DeRoek et al. (2006) particularly
singled procurement of pharmaceuticals and vaccines as a challenge in low- and middle-
income countries. The rationale behind procurement challenges as noted by Woodle
(2000) could emanate from the historical assumption that the vaccines were donor-
supplied and as such were not budgeted for. But given the budgetary constraints on the
part on the donors, the procurement responsibility is now shifting to the government
(Cohen, Reeh and Neroutsos, 2011). Apart from low and middle-income countries, in
New Zealand, the growth of pharmaceutical expenditure has been a great source of
concern in hospitals (Tordoff, Norris and Reith, 2008). Further, in the UK, the
government through National Health Service (NHS) put measures and strategies that seek
to regulate expenditure in the health services. Some of the measures included
standardisation in the purchase of medical equipment and accessories (Clark 2011).
Ghana in the Medium –Term Health Sector Strategy also recognised the strategic role of
purchasing in reducing expenditure on drugs, surgical and other related hospital
consumables (Verhage et al. 2002). In South Africa, the Minister of Health reported a
reduction of the price of Anti-Retroviral drugs by more than half of the previous
expenditure (Albert 2010).
It is against this background that the World Health Organisation (2000) report inevitably
suggested strategic purchasing in the public sector as capable of improving medicines
availability and reducing costs of acquisition. This also coincided with the budget
statement by the Zimbabwe Finance Minister, Tendai Biti that ‟‟ efficient procurement is
key to service delivery (Government of Zimbabwe, 2012). World Health
Organisation(2006) further acknowledged the importance of purchasing and supply chain
management in ensuring availability of Vital, Essential and Necessary (VEN) drugs in

Africa. Pazirandeh (2011) argued that unavailability of drugs could be could be due to
uneven distribution within the supply chain network. This could be most relevant in
humanitarian situations than normal health care delivery in Africa but Tetteh (2009)
argued that even in normal situations, drug supply chains have a direct impact on
availability and affordability of medicines.
Therefore there are pertinent procurement issues in developing countries that were
highlighted by both World Health Organisation (2006) and Cohen, Reeh and Neurotsos
(2011) and these should be addressed to streamline procurement activities.
Key issues highlighted in the World Health Report (2006).
 Unclear tender specifications for products
 Inadequate tender terms and conditions.
 Procurement laws and regulations lack relevance in addressing purchasing of
 Lack of transparency, integrity and good governance.
 Co-ordination in the medical supply chain
 Inadequate use of Information Technology (IT) in the procurement of medicines.
Key issues reported by Cohen, Reeh and Neurotsos (2011)
 Technical competent procurement staff.
 Legal, policy, regulatory frameworks.
 Transparency and prevention of corruption in purchases.
 Budgetary issues (Financing).

After evaluating procurement in the health sector from a broad context, it is now
imperative to consider the procurement system in the health sector in Zimbabwe.
2.3.4 The Procurement System in the Health Sector in Zimbabwe
The Ministry of Health and Child Care (MOHCC) is responsible for ensuring service
delivery in all government hospitals and clinics nationwide. Its mandate is to ensure the

provision of quality and safe health services through a network of health facilities
organised throughout the country (MOHCC 2012). Adequate and constant supply of safe,
efficacious medicines, surgical sundries, laboratory reagents and diagnostic equipment
remain the top priority of the Ministry. The table below indicate the public health
facilities in Zimbabwe.
Table 1. Public Health Institutions
Provinces Primary

Harare 45 0 0 7 52
Manicaland 253 36 1 0 290
130 15 1 0 146
168 22 1 0 191
128 22 1 0 151
92 17 0 0 109
Mateleland South 105 18 1 0 124
Midlands 206 28 1 0 235
Masvingo 170 23 1 0 194
Bulawayo 34 0 0 7 41
Total 1,331 181 7 14 1,533

Source: Government of Zimbabwe (2008)

Procurement of drugs is initially through the National Government Medical Stores
(Natpharm) which procures all the medicines, surgical sundries and reagents on behalf of
the above public health institutions. In the event that Natpharm does not have the stocks
of the required item, the hospital can tender for the required items in tandem with the
Procurement Act and Regulations 171 0f 2002 together with further guidelines from the
Medicines Control Authority of Zimbabwe in the case of drugs. For the reason that
procurement is guided by the Procurement Act and Regulations, it might be necessary to
review briefly the tendering system in the country.
Four forms of tender namely Competitive, Informal, Special-Formal and Formal are
commonly used in government purchases by various hospitals. The distinguishing factor
among the various forms of tenders is mainly value of purchase and urgency of the item.
Competitive and the Informal Tenders are prescribed to be done by the individual
hospitals without the interference of the Government Tender Board (State Procurement
Board). The threshold limits for those tenders are $US 10,000 and 50,000.00.00
respectively. Any purchases that are outside these threshold limits are to be administered
through the State Procurement Board on behalf of the procuring entity. It is imperative to
note that the various health institutions mainly rely on Natpharm for the bulk of the
pharmaceutical items but unfortunately, the stock levels at Natpharm as shown by the
table below is a great cause for concern at all public institutions. Stock Status of Vital, Essential and Necessary (VEN) drugs at Natpharm
Table 2

Vital 63
Essent 21 56 62 23 16 16 18 16 16 28 34 34 38 40

ial % % % % % % % % % % % % % %

Source: Government of Zimbabwe (2008)

VEN is the classification of medicines and surgical consumables in the Essential
List of Medicines in Zimbabwe (EDLIZ).

 Vital Drugs means life saving drugs, non-availability may lead to
death/disability, optimum availability to be 100%
 Essential means non-availability of these drugs lead to pain, optimum
availability to be 80%
 Necessary means that these drugs are required but of lower priority than
the above drug classification.
From the above table, it is indicated that for all drug and surgical categories, stock levels
were well below the expected levels and what is more worrying is that the Vital Category
prescribed to be 100% has in 2007 dropped down to 23%, giving a variance of 73% and
these drugs a deemed life saving; non-availability has serious implications on the patient.
Thus, failure to provide drugs at public hospitals may also mean that patients will have to
source the drugs from the private pharmacies who may charge exorbitantly relative to
public hospital drug costs.
Therefore the procurement system in Zimbabwe depicts a semi-autonomous situation in
that the individual hospitals are responsible in part for the purchases because of the
involvement of Natpharm and the State Procurement Board.
2.4 Delays in Procurement activities
2.4.1 Bureaucracy


In discussing public procurement, bureaucracy cannot be left out since it ensures due
process and prevents some level of corruption. According to Weber (1920), bureaucracy
is an organizational form based on a hierarchy of offices and systems of rules with the
purpose of ensuring the permanence of the organization, even though employees within it
might come and go. The knowledge, practice and experience of the organization would
be preserved in files, thus ensuring permanence and continuity. The organization is
hierarchical, with one level subject to control by that above it. Everything done in the
name of the organization and its officials is recorded. The purpose of bureaucratic
structure is to attain the maximum degree of efficiency and to ensure the permanence of
the organization. Failure to do this leads to red tape, excessive procedures and obscure
and conflicting rules and regulations. All organizations are bureaucratic in the sense that
they all go through some sort of procedure for getting things done.

In state administration, bureaucracy has been used for denoting the prominent position
given by the centralized state power to permanently employed public officials and has
been applied as an instrument of critique against state power. It is the type of
administration in which the officials exert power in order to implement their own
interests. For example, the Encyclopedia of the Social Sciences, (1930:70-74) defines
bureaucracy as a system of government, which the control power is completely in the
hands of officials and that their power jeopardizes the liberties of ordinary citizens.
Bureaucracy is used to describe the rational organization. The usage is in accordance with
max Weber‟s ideal type, it denotes a form of organization characterized by a hierarchy of

Bureaucracy has the following features; the rules are known by all, the purpose of the
rules is clear and based on a valid theory of cause and effect, rules are consistent with
each other, it is clear when rules are to apply and the scope for subjective interpretation is
In view of the above definitions, bureaucracy is a system of government where
professional officers who perform rationalized functions in organizations, especially
public institutions go through laid down procedures in performing their duties. Thus

organization is said to be bureaucratized when its procedures for actions and decisions
have become formalized and impersonal through highly structured rules that are open.
Other characteristics of bureaucracy are rules which describe the duties of members of an
organization, a set of standard operating procedures, and impersonal relations between
members. In bureaucracy, initiatives and policy directions come mostly from the top
management. The growth of modern government has been intimately tied to the
development of bureaucracy and no modern state could operate without bureaucracy
because it checks the abuse of power and regulate people‟s activities and conducts in an
2.4.2 Effects of Bureaucracy in Public Financial Management

In public sector organization, bureaucracies produce unintended consequences which
may conflict with the goals of those in authority and inhibit the efficient and effective
operation of the organization. Bureaucracy can bring dictatorship of the officials,
problems of supervision, rules can become ends in themselves and rules can bring
inefficiency. One of the criticisms of bureaucracy is that some politicians use it to
maximize votes which eventually tend to be expensive (Lawton and Rose, 1994).
One of the effects of bureaucratic process is delay. Delay is the extra time taken to
complete a task beyond the planned period agreed upon especially a contract between
two or more parties. According to Antill and Woodhead (1989), one of the classifications
of delay is the origin. Delay can be caused by the owner of the contract, and in this case
the contractor receives a fair and reasonable compensation in cost and time. Antill and
Woodhead did tell the method to measure the reasonable compensation of delays in
contracts. They believe that inflation and interest rates should be used to measure
compensation since contractors borrow from banks and loans with interest. Delays due to
bureaucratic process affect health delivery since it adds more time of acquiring goods and
services. (Colander, 2001).

Procurement Act is aimed at reducing government expenditure and checking leakages of
government funds but bureaucratic process in procurement brings delays in procurement

activities, which eventually increases expenditure and has detrimental effect on health
delivery system.
2.5 Summary of Literature Review
This part summarises key issues highlighted in the Literature Review.
 Public procurement strategy or system reflects the political, budget policy,
competitive and public accountability objectives.
 The Value for Money (VFM) concept is central to all government purchases.
 The tight jurisdiction is also tailored to curb corruption in the public sector
and that corruption also affects adversely the health sector.
 Purchasing ethics seek to address the importance of trust, honesty, integrity,
accountability, transparency and competitiveness in the public procurement.
 Importance of strategic purchasing in view of costs and supply chain related
 Criticality of public procurement in the health delivery system.

From the Literature, it is evidenced that public procurement has been explored but
the researchers mainly focused from the general perspective and very few studies
has been done specifically in the health sector.



3.0 Introduction
This chapter explains the approaches the researcher used to gain information on the
research problem and includes the research design, study population and sample size,
sampling design and procedure, data collection methods, measurement of variables.
Procedure of data collection, data processing, analysis and presentation and anticipated
problems to the study.
3.1 Research design
This study used a case study research design involving both quantitative and qualitative'
methods because it provided detailed knowledge about the impact of the public
procurement policies and procedures on the health delivery system in Zimbabwe . The
qualitative approach was used to explain the events and describe findings using
interviews and documentary analysis.
3.2 Research Strategy: Case Study Approach
Since Public Procurement Act applies to all public institutions both the main stream
government and also parastatals. There are many hospitals in Zimbabwe and five Central
Hospitals which operate almost similarly and in the same environment. These central
hospitals are Parerinyatwa Group of Hospitals, Harare Hospital, Mpilo Hospital, UBH
and Cgitungwiza Cental Hospital. The researcher decided to use Chitungwiza Central
Hospital and generalise the findings on all Hospitals since they operate in the same
environment. All public hospitals receive funding from the fiscus and they operate using
the same Act hence the findings can be generalised to all the central hospitals.
3.2.1Definition of a Case Study:
A case study is a detailed intensive study of a unit, such as a corporation or a corporate
division, that stresses factors contributing to its success or failure. “ An empirical enquiry
that investigates a contemporary phenomenon in depth and within its real-life context,
especially when the boundaries between the phenomenon and context are not clearly
defined‟‟, Yin2009,p.18

The decision of the researcher to use this strategy is in tandem with the guidelines
provided by Yin (2009). The research strategy is most applicable when a ‟‟how‟‟ and
‟‟why‟‟ question is being asked about ‟‟a contemporary sets of events which the
investigator has little or no control‟‟, Yin 2009, p.13. Therefore the area under
investigation relates to the impact of the public procurement policies and procedures on
the healthy delivery system. The subtleties and intricacies of the health delivery system
necessitated the adoption of the case study approach so that a spotlight is concentrated on
the selected health facility (Denscombe 2007) which is Chitungwiza Central Hospital.
So, this method or research strategy lends itself to the intensive and in-depth analysis of
complex environments such as the one investigated (Bryman 2010).
There are benefits that were considered by the researcher when the case study strategy
was adopted.
 The approach can unravel the intricacies and subtleties of the health delivery
environment (Denscombe 2007).
 It offers an in-depth analysis rather than a ‟‟ superficial‟‟.
 Critical to the research is an understanding of the processes and relationships and
so, this method holistically considers all these important aspects of the research
(Denscombe 2007).
 Further to the above, the case study strategy investigates a phenomenon in its
‟‟natural setting‟‟ and not in an ‟‟engineered environment‟‟ (Yin 2009;
Denscombe 2007).
 The last advantage of this approach lies in its ability to infuse multiple sources
and methods of data collection like observation, interviews, questionnaires and
document analysis (Denscombe 2007).

3.2.2 Lack of access
The researcher has noted the importance of access to information regarding the
case and negotiated complete access to the hospital which was granted
unconditionally by management. Access to participants, minutes and policy
documents is critical in the data collection stage. The letter attached as Appendix
A confirms the approval.

3.2.3 Resource limitations
Case study approach, by its nature, is time-consuming and also requires resources.
The choice of a single case has taken consideration of these resources limitation.

3.3 Study Population
The researcher targeted to get the information from thirty people. Out of the thirty people
the researcher saw it necessary to use judgemental sampling method to come up with the
sample which was of twenty people. The people included in the sample are those who are
involved in the procurement process at Chitungwiza Central Hospital including those
from the buying department and those who sit in the procurement committee. Different
research instruments were applied to the different individuals with more than one
instrument being applied to some individuals. The population included those directly
involved in the procurement process and those who are the users of the products and or
services. The pollution included the procurement committee, the buying staff, user
departments like sisters from different wards and heads of other departments.
Table 1
1. Director of Operations 1
2. Director of Finance 1
3. Director of Human Resources 1
4. Director of Clinical Services 1
5. Principal Nursing Officer 1
6. Chairperson of the Procurement
7. Chief Procurement Officer 1
8. Sister-In-Charge (all wards) 7
9. Head of Canteen Services 1

10. Accountant (Expenditure) 1
11. Administration Manager 1
12. Chief Pharmacist 1
13. Assistant Pharmacist 1
14. Assistant Administrator 1
15. Assistant Stores Administrator 1
16. Assistant Procurement Officer 1
17. Assistant Accountant 1
18. Stores Manager 1
19. Chief Matron 1
20. Deputy Chief Matron 5

3.4 Sample
Trochim (2006) defined ‟sampling‟ as, „the process of selecting units (eg.people,
organisations) from a population of interest so that by studying the sample we may fairly
generalise our results back to the population from which they were chosen‟‟. This
explanation by Trochim (2006) was well represented by Saunders, Lewis and Thornhill
(2008) on the diagram below.
The researcher decided to use a sample of twenty as it gives a fair view of how those
involved in the procurement processes view the procurement process. The total number
of those involved is thirty and twenty is a good number to give the views of those
involved and make decisions based on that information.
The researcher‟s decision to use a sample emanated from impracticalities associated with
collecting data from the entire population, in this case, all hospitals and employees
working within those health facilities. Limitations in terms of time, resources and access
were central to the decision. The total number respondents selected is shown in Table 1

Table 2
Category of staff Population size Sample size
Directors and Top
Nursing Staff
8 5 25%
Managers and
Sisters In Charge
22 15 75%
Total 30 20 100%

Sample size
Table 3
Below is a table with all those who were interviewed and given the questionnaires.
1. Director of Operations
2. Director of Finance
3. Director of Human Resources
4. Director of Clinical Services
5. Principal Nursing Officer
6. Chairperson of the Procurement Committee
7. Chief Procurement Officer
8. Sister-In-Charge (Operating Theatre)
9. Head of Canteen Services
10. Accountant (Expenditure)
11. Administration Manager
12. Chief Pharmacist
13. Assistant Pharmacist
14. Assistant Administrator
15. Assistant Stores Administrator
16. Assistant Procurement Officer

17. Assistant Accountant
18. Stores Manager
19. Chief Matron
20. Deputy Chief Matron

3.5 Sampling Design and Procedure
Probability sampling focusing on random sampling technique was used to select low-
level staff to participate in the study. Non-probability sampling focusing on purposive
sampling technique was used to select high-level staff.
Probability (representational) sampling
In probability sampling, the chance of each case being selected is equal and as
highlighted by Saunders, Lewis and Thornhill (2008), this technique is most ideal when
the investigator assume that the sample selected will be representational. Surveys and
experiments are some of the strategies under probability sampling. In other words, this
method employs some form of random selection (Trochim 2006). Probability sampling
methods include random, simple, stratified and cluster.
Non-probability (judgemental) sampling
There are situations where the researcher was uncomfortable with random sampling
because of the impracticalities involved with probability techniques. As a result of this,
non-probability sampling was the most appropriate specifically the purposive sampling
technique. The decision of the researcher concerning the composition of the individuals
to be interviewed was based on the specialist knowledge of the respondents regarding
issues of public procurement policies and procedures and the general health delivery
system. Participants‟ capacity and their willingness in this research further necessitated
the -adoption of purposive sampling (Jupp 2006).
In summary, the decision to choose the non-probability sampling route heavily hinged on
feasibility and sensibility of data collection relative to the objectives of this research
(Saunders, Lewis and Thornhill 2007).

Having explained on the sampling methodology adopted for this case study, data
collection methods can then follow.
3.6 Data Source and Type
The study was both primary and secondary data. Primary data was collected from the
field using - questionnaires and interview guides while secondary data was collected from
available published records such as textbooks, journals, magazines, manuals and internet.
3.7 Data Collection Instruments
Data will' be collected using questionnaires covering all the aspects of the study variables
and guided questions were used for this study to collect data from low level staff. This is
because they will enable the respondents to express freely their opinion about the
variables under study. Interviews were also used to gather data from the respondents.
3.7.1 Interviews
Kahn and Cannel (1957) as referenced by Saunders, Lewis and Thornhill (2007, p.310)
defined an interview as, ‟‟a purposeful discussion between two or more people‟‟. Yin
(2009) simplified this by stating that an interview is a ’’guided conversation’’. Having
defined what an interview is, there are many types of interviews as depicted by the
diagram below but the focus of this research is on non-standardised type, specifically
one-to-one, face –to-face interviews.

The researcher decided to use this tool to gather the required information for the study.
The researcher decided to interview 15 members of those who are directly involved in the
procurement processes at Chitungwiza Central Hospital. Out of the 15 who were chosen
he managed to interview 12 members.

Below is the profile of those who were interviewed.
Table 4
1. Director of Operations
2. Director of Finance
3. Director of Clinical Services

4. Principal Nursing Officer
5. Chairperson of the Procurement Committee
6. Chief Procurement Officer
7. Sister-In-Charge (Operating Theatre)
8. Head of Canteen Services
9. Accountant (Expenditure)
10. Administrator
11. Chief Pharmacist
12. Stores Administrator

Profile of the Interviewees

3.7.2 Questionnaires
A questionnaire is a data collection tool, designed by the researcher and whose main
purpose is to communicate to the respondents what is intended and to elicit desired
response in terms of empirical data from the respondents in order to achieve research
objectives (Mugenda & Mugenda, 2003). Questionnaires can cover a large number of
people and a researcher can use them to reach a wide geographic coverage. They are
relatively cheap and no prior arrangements are needed before posting. They avoid
embarrassment on the part of the respondents as it allows them to consider responses,
especially where there are pre-coded options. They also allow for possible anonymity of
respondent and have no interviewer bias if administered correctly. Interviewer bias is the
opinion or prejudice on the part of an interviewer which is displayed during the interview
process and may affect the results of the interview (Kothari, 2004; Cooper & Schindler,
2006). Questionnaire Design

The importance of questionnaire design, layout and thoroughness of pilot testing cannot
be over-emphasised. Validity and reliability of data collected and the response rate hinges

heavily on these important core aspects of the questionnaire: design, layout and pilot
testing (Saunders, Lewis and Thornhill 2007). In fact, Ford (1994), concurred by
emphasising on the relevance of good question formulation, further indicating the
criticality of designing the questionnaire in a way that the respondent will interpret the
questions in exactly the same manner the researcher intended.
Therefore, the three aspects of the questionnaire: design, layout and pilot testing need to
be thoroughly considered. Design and layout of the questionnaire

Starting with questionnaire design, the researcher considered the pitfalls of poor design in
that it can affect the response rate and reliability of data. The drafting of the questions
started with a thorough review of the research problem, aims and objectives of the
research so that only relevant and necessary questions are included. And so, the design of
the questionnaire included open, scaled and ranked questions with the majority of them
being closed (yes/no) questions.

The researcher‟s strategy of including more closed questions was premised on the
assumption that they are relatively easy for the respondent to answer considering the busy
schedules some of the clinicians have. While open questions are most ideal in soliciting
qualitative data, they have a tendency of producing data which is difficult to analyse.
Instructions to complete closed questions included ticking the box that represented the
respondent‟s answer. To avoid the frustration in answering closed questions, an option of
‟‟Other‟‟ was provided to broaden the respondent‟s options.

In addition, filter questions were also reasonably employed to reduce frustration and
confusion by allowing respondents to avoid unnecessary questions. Further to the above,
scaled questions were fairly used to measure the respondent‟s priorities while ranked
questions were also used for the same purpose.


It is also crucial to indicate that the author noted the importance of avoiding leading
questions, jargon and to use a friendly, polite and persuasive tone in the design of
questions. Structure and layout of questions
Structure and layout of the questionnaire is indispensable to the success of the research
and for that reason, the researcher adopted the following layout:

1. Introduction

An ‟‟introduction‟‟ was inserted right at the beginning in the main body of the questions.
The rationale being that a separate introductory letter may get lost. The short introduction
explained the purpose of the research, why it was of paramount importance to be
completed. Assurances of confidentiality and anonymity were offered given the nature of
the study which may include very sensitive issues. Instructions on how to complete and
return the questionnaire were also contained in the introductory part. That information
highlighted will increase the response rate (Saunders, Lewis and Thornhill 2007).

2. Sub-heading

Sub-headings were employed to clearly direct the respondent. The sub-headings were
addressing the three objectives of the research. Pilot Testing
It will be a rare scenario if a customer purchases any electrical appliance without being
tested for functionality. It is in the same vein that Saunders, Lewis and Thornhill (2007)
prescribed pilot testing before the final questionnaire draft is used to collect data for the
reason that the suitability and reliability of questions asked. In view of the above, three
knowledgeable people in the area of investigation were given the draft and the following
were highlighted and incorporated into the final draft after the pilot testing.

 Some of the questions appeared to be vague and so, they were re-written so that the
respondent is clear on what is being asked.
 The pilot test unearthed that there was need to broaden the respondent‟s view by
including a ‟‟None of the above‟‟ on closed questions, giving also enough space for
the respondent to describe.
 Also, questions that appear to be too technical were re-organised so that the
respondent could interpret them in the same way intended by the researcher.
 Additional questions were added to incorporate issues that are pertinent to the
research aims and objectives.

After the amendments to the questionnaire, it was distributed to twenty people personally
and expected to be completed in two weeks. The period of two weeks was to given ample
time for the respondents to unhurriedly complete the questionnaire, giving enough detail
where necessary. The researcher chose to hand-deliver the questionnaire in an effort to
overcome potential difficulties in terms offering face to face explanation. This way, the
respondents can also be persuaded and reminded about completing the questionnaire
(Walliman 2010).

3.8 Procedure of data collection
A letter of authorization from the CEO was provided as a request for permission to
conduct the study. A covering letter accompanied the questionnaires explaining the
purpose of the study and the questionnaires was distributed directly to the respondents in
their respective areas for filling and was collected after two weeks following its dispatch
and filling. The data collected was edited and decisions made on whether to use it or not
3.9 Document Analysis
The study will also review existing literature related to the study problem and variables in
form of reports, journals, websites and databases to gain information on the topic.
Documents such as hospital management meeting minutes that were generated weekly,
letters, memoranda, departmental reports, strategic and business plans provided
invaluable data relating to the issues investigated. While it is true that these documents

were not specifically produced for the case study, they provided quite useful data worthy
following up with interviews. The researcher reviewed these documents with full
knowledge that they were intended for another purpose (Yin 2009).

3.10 Data Analysis
Two types of analyses was conducted and these are quantitative and qualitative analysis.
The following sub- sections explains the analyses, in detail.
3.10.1 Quantitative Analysis
Quantitative data was collected, edited and coded. Two types of analyses was computed.
The first will include descriptive statistics (frequencies and percentages) and the second
will include inferential statistics (correlations). The frequencies and percentages were
used to determine the respondents' views on each of the study variables. Pearson
correlation tests was used to test for significant relationships between the variables.
3.10.2 Qualitative Analysis
In qualitative analysis, content analysis was used to edit the data and reorganize it into
meaningful shorter sentences. This will then be presented as quotations to supplement the
quantitative data in order to have a clearly interpretation of the results.
3.11 Anticipated Problems to the Study
1. These include financial problems in terms of photocopying, secretarial services,
transport costs.
2. Inadequate time to exhaustively conduct the research since it is done in the course
of the semester. This was overcome by putting more effort and spending
conducting research.
3. The research will encountered problem of non responses from some respondents.


This chapter began by stating the philosophies employed in carrying out the research. A
detailed explanation of why that philosophy was chosen then followed. Tools for
gathering data were discussed but the data analysis and results were not demonstrated
here as there are dealt with in the next chapter which is chapter four.

4.0. Introduction
This Chapter simply presents the qualitative and quantitative findings extracted from the
questionnaires, interviews and hospital documentation. First, the response rate for both
questionnaires and interviews will be given, followed by the profile of the respondents
and thereafter, presentation of findings on an issue by issue basis. Pertinent issues that
emanated from the research will be presented in turn.

4.1. Questionnaire response rate
Starting with questionnaires, twenty were distributed with fifteen being returned and fully
completed from the respondents. This represented a response rate of 75 percent. The high
response rate could be attributed to the proper design, layout and distribution strategy
adopted by the author. Ample time were given to the respondents and often reminded
weekly about completion of the questionnaires.
The table below simply summarises the questionnaire response rate.

Table 4.1. Questionnaire Response Rate
Name of Respondents Sent
% Response
Purchasing, Operations/Admin
and Clinical staff
20 15 75
Total 20 20 100


It is also imperative to indicate that the questionnaire itself was sub-divided into four
categories namely: the profile of the respondent, role of procurement, tendering and
procurement, and ethics. These categories reflected key issues noted in the Literature
Review and also the research objectives.
4.2. Interview Response Rate
Switching to interviews, the author selected fifteen individuals for interview and twelve
were successfully interviewed, translating to an 80 percent response rate. Setting of
flexible appointments well ahead of the actual interview date could be attributed to the
high response rate especially for busy clinical and administration staff.

4.3. Profile of the Respondents
The profile of the questionnaire respondents is summarised on figure 4.2 below.
Table 4.3.1. Profile of the Questionnaire respondents

Question Response category N % Cum %
Gender Male 11 73.3 73.3
Female 4 27.7 100.0
Total 15 100.0
Employment period 1 - 5 yrs 2 13.3 13.3
6 -10 yrs 10 66.7 80.0
<10 yrs 3 20.0 100.0
Total 15 100.0
Position Non-managerial 0 0 0
Lower management 0 0 0
Middle management 15 100
Top management 0 0 100.0

Total 15 100.0

While the majority of the respondents were males (73 percent) and the rest females (27
percent), the author assumed that their composition will be of no effect to the research

4.3.2. Employment Period (Experience)
The selection and distribution strategy of the questionnaires was purposively crafted with
the view of soliciting rich information from experienced people and that is why the
‟‟employment period‟‟ was included in the questionnaire.
The graph below (figure 4.3.2) shows the employment period of the respondents.

4.3.2. Bar Graph Showing Employment Period

The time that respondents have been in the hospital can be a measure of their level of
experience. Figure 4.3.2 above revealed that most of the respondents have a length of
service of 6 to 10 years (66.7percent), followed by those with more than 10 years
(20.0percent) and then those with 1 to 5 years (13.3percent).
1 - 5 6 - 10 10+

Employment period (years)

Coming to the profile of the interviewees, it was the decision of the researcher to target
only senior managers with both clinical and operational knowledge of the hospital with a
bias towards procurement-related issues. These individuals, in the view of the author,
could not be adequately serviced by the questionnaire hence need to interview them.

4.4. Profile of the Interviewees
1. Director of Operations
2. Director of Finance
3. Director of Clinical Services
4. Principal Nursing Officer
5. Chairperson of the Procurement Committee
6. Chief Procurement Officer
7. Sister-In-Charge (Operating Theatre)
8. Head of Canteen Services
9. Accountant (Expenditure)
10. Administrator
11. Chief Pharmacist
12. Stores Administrator

Thus, the interview conducted aimed at taping into the invaluable experience of the above

4.5. Research Findings
A summary of the questionnaire responses will be provided first, followed by
presentation of key themes that appeared outstanding from questionnaires, interviews and
hospital documents that were analysed.


4.5.1. Summary of Questionnaire Responses
Question Response Category N % Cum %
Is procurement
Yes 15 100.0 100.0
No 0 0.0 100.0
Total 15 100.0
To what extent is it
Lesser extent 0 0.0 0.0
Greater extent 15 100.0 100.0
Not sure 0 0.0 100.0
Total 15 100.0
Are procurement laws
and regulations
Yes 13 86.7 86.7
No 2 13.3 100.0
Total 15 100.0
Describe the tendering
process at your
Efficient 3 20.0 20.0
Competitive 1 6.7 26.7
Effective 2 13.3 40.0
Transparent 9 60.0 100.0
Total 15 100.0
Do you sometimes
purchase products
without going to
Yes 5 33.3 33.3
No 10 66.7 100.0
Total 15 100.0
Most common tender
Competitive 10 66.7 66.7
Informal 5 33.3 100.0

Special-formal 0 0.0 100.0
Formal 0 0.0 100.0
Total 15 100.0
Question Response Category N % Cum %
Number of people
involved in tendering
or procurement
1 - 3 0 0.0 0.0
4 - 6 0 0.0 0.0
7 - 9 0 0.0 0.0
10+ 15 100.0 100.0
Total 15 100.0
Why are they involved
in the tendering /
procurement process?
Transparency 14 93.3 93.3
Expert knowledge 1 6.7 100.0
Total 15 100.0
Most important factor
in tendering /
procurement process
Price 5 33.3 33.3
Quantity 2 13.3 46.6
Quality 2 13.3 59.9
Conformance 3 20 79.9
Back-up availability 2 13.3 93.2
Delivery period 1 6.7 6.7
Total 15 100.0
Structure of
procurement system
centralised 14 93.3 93.3
De-centralised 1 6.7 6.7
Total 15 100.0


4.6. Importance and Relevance of Procurement
The significance of procurement as an important business lever was reiterated by all the
15 questionnaire respondents as shown on the above table. In fact, one of the
interviewees indicated that procurement ‟‟ is the heart of all operations and failure of
procurement will paralyse the whole system of departments‟‟. Another respondent,
illuminated on the importance of purchasing by saying,‟‟ it‟s actually the engine of the
organisation‟‟. Minutes of weekly hospital management meeting under the ‟‟action slot‟‟
put purchasing department as responsible for the sourcing all drugs, surgicals and
laboratory reagents reported to be out of stock.
Regarding the issue of relevance of procurement regulations to the health sector, the
following bar graph (figure 4.6.1) summarises the questionnaire responses.

Bar Graph Showing Distribution of Procurement Regulations Relevancy and

Figure 4.6.1
Yes No


From the Bar Graph above, 86.7percent responded ‟‟ Yes‟‟ to the relevance of the
procurement regulation to the hospital with 13.3percent indicating a ‟‟No‟‟ on the same
issue. However, the main reason indicated by the respondents for the ‟‟ Yes‟‟ answer was
‟‟transparency‟‟. The regulations foster transparency in the entire procurement system.
The interview response corroborated with the questionnaire outcome by indicating that
while they are relevant, they are not appropriate to the unique needs of the hospital. One
of the respondents added that,‟‟ the idea of these regulations was to promote transparency
in the whole purchasing process and to make sure they are the guidelines for every
institution. However, I think these regulations need to be reviewed especially looking at
the hospital set-up‟‟.

4.7. Supplier Selection
Suppliers for pharmaceuticals, medical equipment, detergents, laboratory reagents, linen,
haberdashery etc, were primarily selected on the basis of the lowest purchase price upon
solicitation of three quotations. Questionnaire respondents clearly ranked price as the
main variable in the selection of suppliers. Further to the above, a sample of purchase
documents (Comparative Schedule) were selected covering drugs, surgical consumables
and laboratory reagents and the following findings were noted.


4.7.1. Pie Chart Showing the Factors Considered in the Supplier Selection

Out of 100 purchase documents from January to the 5
of August 2013, 83 were
considered on the basis of the purchase price and only 1 had quality ticked as the
variable. 9 purchase documents were selected on the basis of the supplier‟s reputation
while 1 was on the availability of stock from the supplier. The remaining purchase
documents did not indicate the factor (s) considered in the award of the tenders to the
The dominance of purchase price as a key supplier selection factor has been echoed by
one of the interviewee who highlighted that,‟‟ according to the regulations, the main
variable for selecting a supplier is the lowest bidder. If you could consider other variables
just like reputation, quality that invites serious explanation from Auditors. When we look
at the lowest bidder, it means the quality is compromised. Almost 20 percent of the
suppliers end up with price variations. Every suppliers in the market now know that the
government regulation need to select the lowest price and fail to supply‟‟. Another
Not Indicated
Percentage of purchase documents under
same selection criteria

respondent, concurred by indicating that,‟‟ sometimes we are forced to buy cheaper
versions of equipment which are not usually the best versions that we can get‟‟
In addition, minutes of the hospital management meeting held on the 16
of January 2007
recommended to the Procurement Committee that they should consider other variables
like‟‟ existing stock‟‟ in selecting suppliers. Evidently the background of that
recommendation has issues relating to delays in delivery of commodities hence need to
consider availability of a product. Minutes of management meeting also held on the 31

of July, 2012 reported that ‟‟suppliers are not delivering in time‟‟ further indicating that
the Ultra-sound scan machine and the Full Blood Count (FBC) machine were not
functional. Regarding the ultra-sound scan machine, the spares were said to be
unavailable by the Hospital Equipment department. Obviously, it is an issue missed in the
selection of suppliers where back-up services (including availability of spares) should
have been incorporated.

4. 8. Purchasing Cycle
The significance of the hospital purchasing cycle is that it affects the responsiveness of
the services to the patients against the assumption that sickness cannot be postponed to a
later date when all the services and products are available. Thus, the hospital‟s
purchasing cycle has three important stages: Request for Quotation (RFQ), Tendering and
Ordering. The following flow chart summarises the purchasing cycle.

4.8.1. Flowchart of the Purchasing Cycle
Stage 1 – Request for quotation

Identification of need (User department)
Pharmacy / laboratory / General Stores
Head of Department’s approval

Stage 2 – Tendering

Accountant’s approval
Director of operations
Chief executive officer
Director of finance
Floating of Tenders
Tender Opening (Appending of Signatures on Quotations)
Preparation of Comparative Schedules
Adjudication of Procurement Committee
Formal 90days
Informal 14days
Competitive 7days

Stage 3 – Ordering

Source: Own depiction based on interviews and hospital documentation
Director of Operations
Director of Finance
Chief Executive Officer
Purchase Order Generation (Accountant Expenditure)
Delivery (14 – 30) days
Inspection of Products (Stores, Requesting Department, Procurement Committee)

Starting with Stage 1 (Request for Quotation), it is very much clear that for the process to
be completed about seven signatures should be appended to give full authorization to be
next stage which is the tendering. Again on tendering, the process as indicated above
seems long and winding particularly if the tender avenue pursued is Informal (14days) or
Formal (90days). The entire process of tendering passes through 8 phases up to the Chief
Executive Officer who approves the adjudication documents. After that, comes ordering
which is the final stage. Research also uncovered that the existing Procurement Act of
2001 suffocated the hospital operations especially during the hyper-inflationary period in
2008 prior to dollarization.
Thus, it becomes imperative for the researcher to establish the supply lead-time given the
long procurement cycle indicated above. In view of that, a sample of 19 purchase
documents was selected to provide an indication of the supply lead-time and so the table
below indicate the sampled documents and the corresponding supply-lead time.

Table: 4.8.2. Showing Supply Lead-Time
Purchase Document Number and Item
Supply Lead- Time
Dental Cartridges 49
Sutures Material 78
Crepe bandages 29
Hand paper Towels 61
Blue Ball Pens 43
X-ray films (blue) 15
Oxygen Flow meters 239
Endotracheal tubes 33
5% Dextrose 108
Brown Shoes 199
Linen Savers 41
3ml syringes 24
Methyldopa 250mg tablets 254
Repair of Incinerator 37
Abdominal swabs 150
Latex Examination gloves 18
Anaesthetic machines 134

Theatre Pendants and LED lights 321
Hospital beds &Mattresses 305

Average Lead Time 112.5263158

Line Graph: 4.8.3. Representing the Supply Lead Time as Given Above.

From the above line graph, the average supply time is 112 days. What this entails is that
from the time when purchase documents are forwarded either to the Procurement
Committee, that is, for competitive tenders or State Procurement Board (Formal and
Special- Formal tenders) to the actual delivery, it took an average period of 112 days. For
medical equipment, the supply lead-time range from 134 to 321 days. Involvement of the
State Procurement Board in the Formal or Special tenders which is normally the avenue
for medical equipment because of their high value could explain the longer supply period.
This shows that the whole purchasing cycle is netted with bureaucratic rigidities that
unnecessarily lengthen supply lead-time. Extensive authorisation protocols are translating
to late deliveries. The fact that most medical equipment are sourced from Germany,
China, Spain and United Kingdom explains the period considering that most of the
equipment is bulky and heavy for air transport and that they can only be manufactured
upon receipt of an order.
1 3 5 7 9 11 13 15 17 19
Lead time (days)
Lead time (days)

However, of great concern regarding the entire purchasing process are three issues that
were highlighted: the length of the process itself, the composition of the adjudication or
the procurement committee and the involvement of external parties that include the State
Procurement Board and the Ministry of Public Works. These issues will be looked at in
that order.

a) Length of the Tendering Process
The length of the process itself has been an issue from both questionnaire and interview
respondents. When asked to describe the hospital‟s tendering process as depicted on table
4.4.1, the doughnut below shows how the questionnaire respondents felt about the
Figure 4.8.4. Doughnut Showing Description of the Tendering Process

From figure 4.8.2 shown above, 60 percent described the tendering process as
transparent, 20 percent as efficient, 7 percent as competitive and 13 percent as effective.
That also coincided with the view explained by one the interview respondents, Prince

who said that in government procurement system,‟‟ efficiency is secondary to
transparency. At times efficiency suffers because suppliers are selected on the basis of the
being cheaper. This situation, to some extent, seems to be attributed by auditors who
prescribe and enforce that the procurement process be meticulously and religiously be
followed. Many respondents decried the straitjacket nature of the procurement process
particularly to emergent needs of the health facility. This also was evident to the question
that asked why multiple players were involved in the procurement process. 14 people
from the questionnaire indicated ‟‟ transparency‟‟ and 1 indicated ‟‟ expert knowledge‟‟.

The issue of multiple players explained on the last part of the paragraph above emerges
as one of the major contributors of the long purchasing cycle. Multiple players are a
means of inserting checks and balances in the entire procurement process. There are also
situations where, the State Procurement Board must be involved to do tender
administration when threshold limit surpass the Competitive limit which normally fall
under the hospital.

b) Composition of the Procurement Committee
Regarding the selection of the Procurement Committee, the Procurement Regulations 171
of 2002 give the discretion to the accounting officer or the head of an institution to
choose a committee and so, the composition of the hospital procurement committee
includes mainly clinical staff that happens to be heads of departments. Commenting on
the composition of the Procurement Committee, E as one of the interview respondents
said that ‟‟ these people are not experts. They are selected on the basis of being senior
members of staff‟‟. So, what then is the role of the procurement professionals if they are
not directly involved in the Procurement Committee- mere order placing and expediting?
This will be critically discussed in the next Chapter. Therefore, the composition of the
committee may be a limitation considering the narrow selection criteria where emphasis
is on purchase price.

c) Involvement of External Parties

The issue of multiple players is not only internal but also external in the sense that there
is need to involve the State Procurement Board for Formal and Special-Formal Tenders
to do the entire administration and finalization of the tenders. While the process can be
expedited, the interview respondents hinted that, more often than not, this board is
overwhelmed and cannot process all the forwarded purchase documents within the
expected time-frame. This has resulted in the institution adopting the Competitive route
because of its responsiveness hence the diagram below represented the most common
type of tender as given by questionnaire respondents.

Figure 4.8.4. Tender Types Competitive Tender
Threshold limit as given by Procurement Regulations of 171 of 2002, is $ US
10,000.00. This type of tender is administered by the hospital subject to
availablity of 3 competitive quotations. Informal Tender
Competitive Informal Special-formal Formal

Tender type

If the value exceed $US 10,000.00 but does not exceed the $300,000.00, the
hospital must invite tenders through the newspaper. Normally the tender runs for
7 days before closure. Special –Formal
When the hospital requires products exceeding the above limit urgently, special –
formal route is the option. This tender is administered on behalf of the hospital by
State Procurement Board. Formal
The threshold limit is the same as Special-Formal. The only difference is that this
tender runs for 90days before closing and is conducted by State Procurement
Board on behalf of the institution.

For the institution‟s construction work, there is need to involve the Ministry of Public
Works to approve all architectural plans and to supervise all works. Involvement of
Ministry of Public Works (MPW) has been seen to be slowing the pace of construction at
the hospital. Documents originating from the hospital in the form of minutes of meeting (
17 July 2012) supported that view when they unravelled that the construction of the
teaching classroom could not be finalised due to the need seek concurrence from the
MPW despite availability of funds from the donor.
Furthermore, the purchasing cycle or the procurement process has been noted to have
impacted adversely on the quick utilisation of funds particularly with reference to the
threshold limits for various tenders. This is confirmed by one of the interview respondent
F who uncovered that:
„'You can only know that the value exceed the threshold limit after tendering and you
have to re-start the process. Ministry of Finance at times say to us you can buy these
items while funds are available but if the process take longer than a year, the funds at are
availed during the fiscus will fall away on the 31
of December. So we‟ll lose out and at
the same time you‟ll have asked the supplier outside the country to orders for you and
end up cancelling‟‟. This has been quite true regarding the various medical equipment

that has been procured under the Ministry of Finance‟s Target Procurement approach
where most of the equipment ordered mid-year in 2011 was delivered towards the end of
2012. The budget for that equipment was provided for in 2011 but the invoices
accumulated in 2012. The implication therefore is that current 2012 budget will be
exhausted by invoices that were supposed to be catered for by the previous year‟s budget.
By its nature, medical equipment like Theatre Pendants, LED lights, Patient Monitors and
Laparascopy is highly specialised and in most instances, production only commence upon
confirmation of an official order.

4.9 Conclusion
The central issue on carrying out the research was to assess the impact of public
procurement policies and procedures on the health delivery system and in this chapter
data was gathered, and analysed. This information will be used in the next chapter to
draw conclusion.



5.0 Introduction

It is the basis the desktop research findings as outlined in Chapter two Literature Review
and findings, analysis and conclusions in Chapter four that a comprehensive summary,
conclusion and recommendations will be given. These conclusions were based on the
study findings and were reflecting the instruments used in the study. Each objective was
concluded. Recommendations were basically the probable solutions to the assessment of
the impact of public procurement policies and procedures on health delivery system in
Zimbabwe. This Chapter presents the major research conclusions drawn and
recommendations to the findings.
5.1 Summary
The study was centered on assessing the impact of public procurement policies and
procedures on the health delivery system in Zimbabwe. The researcher selected of the
five referral public institutions in Harare, Chitungwiza Central hospital as a case study.
In chapter 1 background of the study was cited. The main cause for concern being many
challenges which the health sector is facing indicated in the Ministry of Health and
Welfare (2012) report. Research questions and objectives were also established in this
chapter. Limitations were identified as the collection of information and resource
constraints. The researcher also went on define major terms to be used found in the study.
The researcher reviewed the literature associated with the study to shed some clarity and
light on the study. Other studies from other nations like United Kingdom and information
from the WHO reports were also looked at. This was meant to find information as to
other nations and researchers have dealt with similar problems encountered in
procurement. Literature reviewed formed the basis upon the methodology was designed.

The tools used were the questionnaires and personal interviews. The questionnaire was
chosen because it was capable of producing good results since no names were required
and the information could be treated with confidentiality. The researcher could
physically/personally distribute the questionnaire to individuals concerned. The interview
technique was chosen to solicit information from respondents because the interviewer
could clarify any contextual meanings to the respondents to avoid misinterpretations.
Room for probing was provided using the interview.
The study was mainly centred at Chitungwiza Central Hospital purchasing function and
those who are directly involved with purchasing decision. The response rate from
participants was 75%. Data was analysed using graphs, tables and figures where possible.
The findings from the data collected were presented in chapter four on tables, pie charts
and graphs. Discussions on the data collected were also made in chapter four. These were
the basis upon which conclusions and recommendations of the study were made.
5.2 Conclusions drawn
Objective (a): To evaluate the impact of public procurement policies and procedures
on health service delivery.
It was found out that the procurement policies and procedures have an impact on health
delivery system in Zimbabwe. The study reviewed that not only is purchasing policies
and procedures key to increased health service delivery but it also enhances
competiveness of an institution. The Public Procurement Act is impacting negatively on
health delivery system as it does not consider the urgency of the products. It requires
three quotations even when the supplier is a monopoly and the process of seeking for
approval from the government takes a lot of time. It was also found that other laws like
the look east policy is also affecting health delivery system as the government is
encouraging buying from countries like China.
Objective(b): To assess the adequacy of procurement policies and procedures at
Chitungwiza Central Hospital.

The study reviewed that the procurement policies and procedures were not adequate.
These procedures needs to be reviewed as they are affecting health delivery system. An
example was cited were the thresh hold for a competitive tender is US$10 000 but you
may require drugs which exceed that amount. Also these procedures require three
quotation and it does not give a provision for a monopoly market where there will be only
one supplier. The Procurement Act is not adequate as highlighted by some of the
respondents who said that the Procurement Act does not allow purchase of vehicles from
other companies other than from Mazda Motors even when it is expensive to buy from
Mazda. The Act is affecting negatively the health system in Zimbabwe as it is rigid.
Another example cited was that of sub standard ambulances which are assembled by
Mazda Motors as compared to other ambulances which are being manufactured by other
Objective (c): To examine the causes of delays in procurement activities and their
The study also found out that one of the causes of delays in procurement activities is
bureaucracy . Bureaucracy was cited as one of the causes in delays where many people
have to approve for a single purchase even when the products and or services are urgently
needed. The research revealed that when the head of the institution is not available no
purchases are made as they he is the one who does the final approval.
A lot is required to improve public procurement through emphasizing timeliness,
appropriateness and proper planning so as to achieve the overall concept of "value for
money". Therefore procurement staff and the clients they serve need to get acquitted with
the regulations and apply them with utmost good faith so as to have smooth operations.
5.2 Recommendations
In light of the discussions, findings and the conclusions, the following recommendations
are hereby coined;
5.2.1 Amendment of the Public Procurement Act

The procurement procedures and policies need to be consistent with the urgency and
criticality of the item required. Medical surgical consumables may fit in that category

were sickness cannot be postponed to future date to allow complete authorization for
procurement. Gerson (2004), suggested public procurement efficiency by reducing the
number of inputs without compromising quality.

The Public Procurement Act must be amended to address the eminent difficulties facing
smooth implementation. To improve on compliance of entities in the region PPA must, as
a matter of urgency, expedite action on the review process of the Procurement Act of
2002. The proposed increase in thresholds will give Procurement Entities greater control
over procurement decision to reduce lead time.
Government should endeavour to review the Act to limit the number of steps in
procurement process so as to reduce the level of bureaucracy in the system. Bureaucracy
delays the smooth procurement process and eventually affects public financial
management since it adds more cost to suppliers and government if they are to pay
interest rate. Again, the review is in right direction since people complained on the total
threshold of entities‟ head. It is therefore important to increase the threshold.

Insufficient budget and inconsistencies in disbursements disturb health delivery systems.
Consideration need to be in innovative strategies of supplementing financial resources
such as Public Private Partnerships (PPPs). PPPs may be considered in view of costly
medical equipment like the Magnetic Resonance Imaging (MRI) and medical laboratory
5.2.2 Proper Planning
A lot is required to improve public procurement through emphasizing timeliness,
appropriateness and proper planning so as to achieve the overall concept of "value for
money". Therefore procurement staff and the clients they serve need to get acquitted with
the regulations and apply them with utmost good faith so as to have smooth operations.
Enforcing Accountability to Reducing Corruption in Procurement

Corruptions and bribes are widespread in government contracts. In public procurement,
any violation of standard procurement principles and procedures is considered willful

and, therefore, construed as fraudulent and causing financial loss to the state. To prevent
corruption in public procurement PPA should seriously enforce blacklisting bidders who
have contravened the provisions of the Act and take disciplinary action against public
officials who engage in irregularities.
5.3 Further research study
This research provides a general notion though it is good starting point but it is not
sufficient. Mol (2003)states that current literature on purchasing lack frameworks leading
to borrowing of theories form strategic management. Thus the researcher recommends
further study in theory formulation on the impact of public procurement policies and
procedures on health delivery system .
5.4 Chapter summary
This chapter looked at major conclusions and recommendations by the researcher and
opened avenues for future research.