Procurement Processes at Gwanda Provincial Hospital, Matebeleland South Province, Zimbabwe, 2012; a Descriptive Cross Sectional Study

Research Article

Austin J Public Health Epidemiol. 2015;2(1): 1018.

Procurement Processes at Gwanda Provincial Hospital, Matebeleland South Province, Zimbabwe, 2012; a Descriptive Cross Sectional Study

Chimberengwa PT¹, Masuka N², Gombe NT¹, Tshimanga M¹ and Bangure D¹*

1Department of Community Medicine, University of Zimbabwe, Zimbabwe

2Provincial Medical Director, Matabeleland South Province, Zimbabwe

*Corresponding author: Donewell Bangure, Department of Community Medicine, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe

Received: February 06, 2015; Accepted: April 17, 2015; Published: April 20, 2015


Introduction: Gwanda Provincial Hospital received one million eight hundred dollars from treasury in 2011 through Targeted Approach. By year end, the hospital experienced stock-outs of essential goods, medicines and surgicals. A routine audit carried out in 2012 exposed procurement irregularities. We conducted this study to evaluate adherence to procurement and accountability by public health officials in the institution.

Methods: We conducted a descriptive cross sectional study at Gwanda Hospital. We used interviewer administered questionnaires, key informant interviews and desk review of records for data collection.

Results: Fifty seven primary respondents were interviewed and we reviewed 47 procurement documents. The majority were nurses (29.8%), 53% were females. The median age in service was 10.5 years (Q1=4; Q3=17). Fiftyeight percent had low knowledge on procurement processes. Legislation and policy documents on procurement were not easily accessible. Key procurement committees were non functional while inter-departmental communication was poor. Procured goods were reported to be of poor quality.

Conclusion: The hospital did not getting value for money during Target Approach. Administrative controls on procurement processes were not followed. There was no proper procurement planning. Procurement trends were not being utilized to inform decision making. As a result of this study, staff trainings on procurement were conducted while standard operating procedures on procurement were developed. This study is the first published document on understanding procurement processes in Zimbabwe public health delivery at a tertiary referral institution. The study will add to existing knowledge on improving accountability of public health managers in resource poor settings.

Keywords: Procurement processes; Gwanda Hospital; Targeted Approach; Tenders


CBU: Centralized Buying Unit; CC: Commissioning Committee; CI; Confidence Internal; DMO: District Medical Officer; GTB: Government Tender Board; GPH: Gwanda Provincial Hospital; HAS: Health Services Administrator; HoD: Head of Department; MoHCC: Ministry of Health and Child Care; MTC: Medicines and Therapeutic Committee; PBA: Purchase out of Best Advantage; PFMS: Public Finance Management System; PMD: Provincial Medical Director; PTC: Procurement and Tender Committee; RC: Receiving Committee; SWOT: Strength, Weaknesses, Opportunities, Threats


Public procurement is the process of acquiring goods and services to meet the needs of the end user in the right quantities, right conditions, delivered to the right place, for the right cost and the right goods using public funds [1,2,3]. The aims of public procurement are to get the best value for money; efficient and effective use of resources; transparency; provision of resource accountability and utilization; ensuring monitoring and evaluation [2,4-6].

Where procurement is done according to sound policies, there is potential benefit to the economy and these help in wealth distribution [6,7]. In the health sector, ensuring availability of effective medicines for priority health problems remains a challenge while there is widespread concern over efficiency of public procurement in Africa [8,9]. Procurement is done through tenders; formal, special formal tenders, approved list tenders and Purchase out to Best Advantage (PBA) [2,5,10,11].

This enables companies to bid, enhancing competitive advantage and thus the goods procured will be cheaper, but satisfying value for money [12]. When proper procurement procedures are followed, the processes are auditable, verifiable and transparent [7].

Procurement in Zimbabwe is guided by legislative policies, acts of parliament and supporting documents. These include the Zimbabwe Procurement Act; Public Finance Management Act; Secretary for Health Guidelines for Procurement; Treasury Instructions; Accounting Officers’ Instructions on Procurement and Ministerial circulars [2,10,13]. In the Ministry of Health and Child Care (MoHCC), procurement is done in designated cost centers by procurement committees. These are the: Procurement Tender Committee (P.T.C), Centralized Buying Unit (C.B.U), Commissioning Committee (C.C), Receiving Committee (R.C) and the Medicines and Therapeutic Committee (M.T.C) [2,5,10]. At the Provincial Health Services the Medical Superintendent and the Provincial Medical Director (P.M.D) are Sub-accounting officers at these cost centers [2].

In the year 2011, the Government of Zimbabwe, aiming at revitalizing health delivery system that had nearly collapsed during the height of economic meltdown, embarked on a Targeted Approach Program. The health institutions were funded from Treasury to renovate dilapidated health infrastructure, purchase medical equipment and to procure medical and surgical consumables. Gwanda Provincial Hospital (G.P.H) was allocated a sum of US$ 1.8 million under Targeted Approach Program. This was in addition to a yearly Treasury approved budget allocation of US$ 443 260.00, disbursed through Public Finance Management System (P.F.M.S) and gross institutional user fees collections amounting to US$ 242 404. 00. Commodities inclusive of medicines, surgical consumables and hospital plant equipment were procured through the tender procurement processes.

Routine internal audits carried out in January 2012 by the Office of the Auditor General revealed irregularities in the tendering processes during Targeted Approach Program at the hospital with allegations that the Government of Zimbabwe was prejudiced about three hundred thousand dollars. Complaints were raised by user departments within the institution that procured goods did not meet stipulated specifications and were sub-standard. The end users reported that they had minimal input in the procurement process. By year end, 2011 the hospital had run out of vital and essential medicines in the pharmacy department. There reportedly were food shortages for hospitalized patients.

We therefore carried out this study to identify the possible reasons for poor adherence to procurement procedures at Gwanda Provincial Hospital? There are no studies that have been published that evaluate the procurement processes in public health delivery system in Zimbabwe. This study will add knowledge and appreciation of procurement processes in public health delivery sector, in a tertiary health centre in a rural resource poor setting in Zimbabwe.

Materials and Methods

We conducted a descriptive cross sectional study at G.P.H. An Ishikawa (cause and effect) diagram (Figure 1) was used as the framework for identifying factors that influence the procurement processes. It depicts how factors such as human, material and financial resources, policies and procedures and environmental factors may contribute to poor performance of procurement system in a tertiary health centre.