PUBLIC PROCUREMENT MANAGEMENT, LOGISTICS MANAGEMENT AND

EFFECTIVE HEALTH CARE SERVICE DELIVERY IN WESTERN UGANDA;

A CASE OF RUKUNYU HEALTH CENTRE IV IN KAMWENGE DISTRICT

BY
ALINAITWE RAJAB
2019/MBA/023/PS

A RESEARCH PROPOSAL SUBMITTED TO THE FACULTY OF BUSINESS AND

MANAGEMENT IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
THE AWARD OF THE DEGREE OF MASTER OF BUSINESS ADMINISTRATION
OF MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY

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 MAY, 2020Table of contents
Table of contents...............................................................................................................................i
Chapter one: introduction.............................................................................................................1
1.0 Introduction................................................................................................................................1
1.1 Background to the Study...........................................................................................................1
1.2 Statement of the Problem...........................................................................................................9
1.3 Purpose of the study.................................................................................................................10
1.4 Research Objectives.................................................................................................................10
1.5 Research Questions..................................................................................................................11
1.6 Significance of the study..........................................................................................................11
1.7 Scope of the Study...................................................................................................................12
1.7.1 Time scope............................................................................................................................12
1.7.2 Content scope........................................................................................................................12
1.7.3 Geographical scope;..............................................................................................................12
1.8 Justification of the Study.........................................................................................................12
1.9 Conceptual framework.............................................................................................................14
CHAPTER TWO.........................................................................................................................16
LITERATURE REVIEW............................................................................................................16
2.0 Introduction..............................................................................................................................16
2.1 Theoretical Review..................................................................................................................16
2.1.1 Agency Theory......................................................................................................................16
2.2 Public Procurement..................................................................................................................17
2.2.1 Procurement Planning...........................................................................................................19
2.2.2 Procurement Control.............................................................................................................19
2.2.3 Procurement Monitoring.......................................................................................................20
2.3 Logistics Management.............................................................................................................21
2.3.1Distribution............................................................................................................................22
2.3.2 Procurement lead time for drugs...........................................................................................23
2.3.3Storage of drugs.....................................................................................................................24
2.4 Effectiveness of health care service delivery...........................................................................25
2.4.1 Health financing....................................................................................................................25
2.4.2 Availability of medicines / Drugs and medical facilities......................................................27

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2.4.3 Existing infrastructure..........................................................................................................27
2.5 Public Procurement Management and effective healthcare service delivery..........................28
2.6 Logistics management and effective healthcare service delivery............................................29
2.7 Public Procurement Management and Logistics Management on effective healthcare service
delivery..........................................................................................................................................30
CHAPTER THREE.....................................................................................................................32
METHODOLOGY......................................................................................................................32
3.0 Introduction..............................................................................................................................32
3.1 Research design.......................................................................................................................32
3.2 Study population......................................................................................................................33
3.4 Sample Size and selection.......................................................................................................33
Table 3.1: Determining accessible population and Sample Size...................................................34
3.5 Sampling Techniques and Procedure.......................................................................................34
3.6 Data collection methods..........................................................................................................35
3.6.1 Interview...............................................................................................................................35
3.6.2 Observation...........................................................................................................................35
3.6.3 Documentary Review...........................................................................................................36
3.6.4 Focus group Discussions......................................................................................................36
3.6.4 Survey...................................................................................................................................37
3.7 Data collection Instruments.....................................................................................................37
3.7.1 Interview guide.....................................................................................................................37
3.7.2 Observation plan.................................................................................................................38
3.7.3 Documentary review guide...................................................................................................38
3.7.4 Focus group discussion plan.................................................................................................38
3.7.5 Questionnaire........................................................................................................................39
3.6 Data Sources............................................................................................................................39
3.6.1 Primary documents...............................................................................................................40
3.6.2 Secondary Documents..........................................................................................................40
3.7 Research Procedure.................................................................................................................40
3.7.1 Units of observation and analysis.........................................................................................41
3.8 Quality control of the research instruments.............................................................................41
3.8.1Validity of the of the Questionnaire.......................................................................................41
3.8.2 Reliability.............................................................................................................................42

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3.9 Procedure for Data Collection.................................................................................................42
3.10 Data Analysis.........................................................................................................................43
3.10.1 Quantitative data analysis:..................................................................................................43
3.10.2 Qualitative data analysis.....................................................................................................44
3.11 Measurement of Variables......................................................................................................44
3.12 Ethical Considerations...........................................................................................................44
3.13 Limitations of the study.........................................................................................................45
References......................................................................................................................................46
APPENDIX I QUESTIONNAIRE................................................................................................47
Appendix II; interview guide.........................................................................................................50
Appendix III; BUDGET FOR RESEARCH PROPOSAL............................................................51
APPENDIX 4; RESEARCH WORKPLAN..................................................................................52

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Chapter one: introduction
1.0 Introduction
The public procurement management in Ugandan Ministry of Health is concerned with
procurement of drugs, equipment, facilities and services as all these are accompanied by logistics
management which in turn focus on effective health care service delivery as illustrated in the
conceptual framework in figure 1.1. Therefore this study will focus on examining the
relationship between public procurement management and logistics management on the effective
health care service delivery in western Uganda focusing on Rukunyu Health Centre IV as the
case study. Hence this chapter presents the background to the study, statement of the problem,
purpose of the study, research objectives, research questions and significance of the study, scope
of the study and lastly the conceptual framework while as underpinning the clear understanding
of the research phenomena under investigation.

1.1 Background to the Study

Public procurement is regarded as formalized procedures or rules or laws that are defined as
offering a high level of transparency, accountability and value for money in the application of a
procurement budget which produce an articulated result, in the form of an integrated system of
decisions. In the above definitions of procurement system, it is clear that the key issues are; (i)
planning on acquisitions of goods and services; (ii) determination of required standards; (iii)
methods; these are applied differently to the procurement of medicines; facilities and equipment;
human resource expertise and services. Some were procured by national agencies, others by
district, and others by the health facility itself (Mintzberg, 2018). On the other hand, Public
Procurement seen as a process of obtaining goods and services from preparation and processing
of a requisition through to receipt and approval of the invoice for payment that commonly
involves purchase planning, standards determination, specifications development, supplier
research and selection, value analysis, financing, price negotiation, making the purchase, supply
contract administration, inventory control and stores, and disposals and other related functions
leading to procurement efficiency or inefficiency depending on the type of government and
environment within which the system is operated. For instance, Public Procurement (PP) as a
function of government includes decisions about the services that have to be delivered to local
authorities and the communities they serve (Hughes, 2018). It is utilized not only to secure goods
and services required by public sector organizations for their missions and to support services
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provided to taxpayers, but it is also used to implement national policies and to achieve social and
other objectives (Bryson, 2019).

Logistics management deals with the planning and control of material flows and related
information in organizations, both in the public and private sectors. Generally speaking, its
mission is to get the right materials to the right place at the right time, while optimizing a given
performance measure (e.g. minimizing total operating costs) and satisfying a given set of
constraints (e.g. a budget constraint). Logistics is one of the most important activities in modem
societies (Jonsson, 2018). It is constructed on subsystems which in turn contain a collection of
interrelated components. The relationship between the subsystems and components takes the
form of coordination and exchange of materials and information.

Public Procurement management is now recognized in major institutions as an area for reducing
costs and adding value aiming at improving effective healthcare service delivery especially in the
medical sector (Bailey et al., 2005). Logistics management of the procured goods and service of
the organization is now seen as dependent of the purchasing activity which regarded as an
important part of efficient health care service delivery in form of efficient drug management and
supply and is critical for all levels of health care institutions. An effective procurement process
coupled with logistics management ensures the availability of the right drugs in the right
quantities, available at the right time, for the right patient and at reasonable prices, and at
recognizable standards of quality in turn leading to effective healthcare service delivery (WHO
2017). If a health institution is to perform by delivering value in terms of efficiency,
effectiveness of healthcare service delivery, it is important for the institution to manage where
value is created and where value is potentially lost in procurement (Lynch, 2019).

In the African context, over the past few years, many countries have been awakened on the
importance of effective management of the public procurement process at both central and local
government levels, and its subsequent contribution to improved service delivery. Procurement; a
function that was traditionally viewed as a clerical and reactive task has since positioned itself
among core organizational functions, and its management is becoming increasingly critical for
the well- functioning of any organization. In Ghana, perhaps, the country is said to save over
$4billion dollars in procurement every annual year because of the enactment and following of the
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procurement procedures including procurement management. All this money was wasted before
(Ghana Public Procurement Authority (PPA) Annual Report, 2019). For the case of Kenya,
public procurement system has underwent significant developments (Nautheimer, 2017). From
being a system with no regulations in the 1960s, and a system regulated by Treasury Circulars in
the 1970s, 1980s and 1990s, the introduction of the Public Procurement and Disposal Act
(PPDA) of 2005 and the Procurement Regulations of 2006 has introduced new standards for
public procurement in Kenya. In line with the country’s public procurement reform agenda,
Kenya in 2006 committed itself to become one of the 22 countries participating in the pilot
testing a new Methodology for Assessment of National Procurement system (version 4)
developed by the OECD-DAC Joint Venture for Procurement (Ansoff, Declercket. Al, 1976).
After these reforms in Kenya, they has been significant improvement in the public sector
procurement and service delivery compared to the pervious un regulated and corrupt system in
Kenya. However in Tanzania, Mlinga, (2018) found out that ineffectiveness in public
procurement management is due to lack of improved systems of logistics management which is
coupled with incompetent personnel armed with skills and experience to manage the system
hence impacting service delivery. A study by Oluka and Basheka (2012) in Uganda identified
major determinants of procurement contract management as: Lack of political will to monitor
contracts; lack of capacity in contract management and monitoring of various stakeholders, and;
lack of integrity in the contract management process. These findings offer a useful foundation for
policy and practical improvement in this important area.

In Uganda, Health care services are delivered by both public sector (government) and private
entities that include private-not-for-profit (PNFP) and private-for-profit (PFP) organisations as
well as complementary health service providers such as the traditional medicine providers. The
public health facilities make up 55% of the total health care facilities in Uganda, while PNFP and
PFP make up 16% and 29%, respectively. In Uganda’s health service delivery structure, the
national level stewardship functions are performed by the Ministry of Health (MoH). In the
public sector, health services are delivered through the national referral hospitals, regional
referral hospitals and district health services. The national referral hospitals are autonomous and
have a target population of 10 million people. They provide referral services for the regional and
general hospitals across the country. National referral hospitals are expected to offer highly
specialised medical and surgical services, advanced diagnostic services, advanced research and
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training for medical doctors, nurses and paramedical officers such as orthopaedic officers and
laboratory technologists. For the Regional hospitals, these are located in each of the 14 health
zones and have a target population of 2 million people since they provide referral services and
supportive supervision to the district level hospitals within each health zone. Services expected at
the regional hospitals include specialized medical and surgical care, basic research, and training
of nurses and paramedical officers.

For the case of Rukunyu HC IV in Kamwenge District, this is under the district-level health
service that includes the district health management team, general hospitals and an array of
primary care facilities (also known as health centres (HCs). The district health service is under a
District Health Officer who is appointed by and accountable to the district local government.
Because the decentralized system of governance adopted in 1995 devolved most functions and
powers to districts, the district health services are administratively independent of regional
hospitals and report directly to the MoH. Rukunyu HC IV has a target population of 500,000
people it is estimated to provide preventive and general medical and surgical services, with
limited specialist services. It has provisions for an operating theatre, in-patient and laboratory
services, and is a referral facility for 20-30 level II and III primary care facilities under its
jurisdiction. This level IV primary care facility is staffed by nurse aides, qualified nurses, clinical
officers and doctors, although the majority does not have doctors.

The current public procurement management framework in Ugandan ministry of Health begins
with the public procurement and disposal authority as the overall governing entity of all
procurement regulations, policies, monitoring and coordination for the public sector. Focusing on
local governments especially in the health sector department, procurement of drugs and medical
supplies is at the centre of ministry of health as the funding agency and National Medical Stores
as the main supplier. At the district level the Chief Administrative Officer is the overall
accounting officer of all funds disappeared from the ministry of health. For other procurements
like infrastructural development like health centre buildings, theaters, incities, walk ways
construction and supply of other capital equipment, their procurement follows the general
existing procurement framework as laid down by the PPDA Act. All districts in Uganda have
procurement and disposal units that are responsible for controlling, coordinating and
implementing the procurement function and under these PDU, there is a smaller committee
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called the contracts committee that consists of different heads of departments and it’s responsible
for the evaluation, award and recommendation to the CAO for award of contract. All
procurements at the districts originate from the user departments like health in this study that
identifies their procurement requirements and forwards them to the PDU for approval and
implementation. For the case of drugs and supplies to health centres, the procurement function
begins at the individual health centre IIIs that identifies their drugs and supplies needs in every
quarter or year and forwards them to the district health office for approval and later sent to NMS
for delivery of the requested drugs and supplies or to the PDU unit in case of capital
infrastructural development.

The above systems are guided by the different laws and executed by different/various agencies or
organizations. This was summarized in the table 1.1.
Table 1. 1; procurement system for rural health centre IIIs in Uganda
System Law Implementer
1 Procurement of drugs PPDA Uganda National Medical Stores
(NMS)
2 Procurement of equipment PPDA District Authorities, Health Facility
and facilities (HCIII)
3 procurement of human Employment Act, District Authority
resources Public Standing Order
4 procurement of services Relevant Laws Health Facilities (HCIIIs)
(cleaning, utilities, security
e.t.c.
Source; Complied by the author

It could be noted in Table 1.1 that there are several procurement systems. The implementer
carries out the procurement following the relevant laws. Most of the procurement is done by the
agencies above the HCIIIs facility. Besides laws, HCIIIs don’t have the capacity to procure most
drugs and facilities. Medical supplies are a key input for the efficient operation of Health
Facilities. Uganda currently has 2,941 Health facilities distributed in the various regions. The
Facilities include Hospitals, HC IVs, HC III and HC II. National Medical Stores (NMS) is
mandated to procure, store and distribute Essential Medicines and Medical Supplies to all these
Facilities including the police, army and prisons. The medicines are distributed to all the

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Government hospitals and health centers on a routine basis against the orders made to them by
the health facilities (Bukhala, 2003). All medicines and medical supplies are also embossed by
NMS with a seal “UG NOT FOR SALE” to ensure that medicines and medical supplies
delivered are not stolen and sold on the open market. The “LAST MILE DELIVERY SYSTEM”
is used for medicines and other medical supplies to ensure that medical supplies reach the END
USER at all government health facilities across the country safe and on time. Medicines and
other medical supplies Delivery Schedules are published to make the delivery of medicine
predictable throughout the year. NMS ensures effective Management of stock so that health
facilities do not run out of medicines and other medical supplies.

Basic Kits which contain the basic Medicines are supplied to all health center IIs and IIIs across
the country. The kit is revised every year to make it relevant to the local situation and delivery is
done once in every two months to all government health centers IIs and IIIs. HC IVs and
hospitals submit their medicine orders and these are supplied to them once in two months (Bi-
Monthly) as per delivery schedule (Odhiambo and Kamau, 2013). Health facilities order for
drugs and medical supplies from NMS offices. They have a great influence on the supply chain
due to the role they play to enhance accuracy in forecasting their needs as well as timely
preparations and submission of their orders to NMS.

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 d on the existing legislations/laws; PPDA ACT, NMS Act, Local Government Act, Accounting Regulations, Constitution
Step
Ministry of Finance Planning 3 Economic
and Ministry
Development
of Public
(Funding
ServiceInstitution)
& District Service Commission Step 1
(Employment Act) Procurement of human resources
Medical resources
Non-medical resources

National Drug Authority

District role procurement & supervision

Health Centre III

Step 8 Procurement of Equipment and Facilities National Medical Stores
Healthcare Service Delivery
Procurement of Services, goods & locally

Step 4
Step 2 Ministry of Health
(Budgeting/ Procurement Planning/ Implementation)

Step 2
Step 7

Step
Procurement of Drugs and5Supplies

figure 1. 1; current existing framework of public procurement system for health services in Uganda

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All these are carried out b
From the above Figure 1.1 above; it could be seen that the public procurement system in Uganda
begins with the Ministry of Health and Ministry of Finance Planning and Economic
Development that do the budgeting and funding of the procurement of the drugs following the
PPDA under the Uganda National Medical Stores (NMS), facilities and equipment at national
level, while the District Authorities, do the procurement of local Procurement of equipment and
facilities governed by the PPDA Act like Health Facility (HCIII) renovation, construction, and
purchases of utilities and services, procurement of human resources under the Employment Act
and Public Standing Order and lastly procurement of services (cleaning, utilities, security) is
done by the Health Facilities (HCIIIs) under the relevant Laws. It could be noted that there are
several procurement system; however most of the procurement is done by the agencies above the
HCIVs facility. The implementer or supervises the procurement following the relevant laws.
Other systems where the HCIV facility does the procurement are services which have their
guiding laws and tariffs already established. For instance electricity water could have the tariffs
and related matters established. For instance electricity, water has the tariffs and related matters
established while as electricity, water laws and tariffs and related matters established. They are
monopolies.

The above procurement system of public goods and services are intended to achieve effective
health care service delivery (Appiah, 2014). Therefore it’s against this background that this study
is set to analyse the effect of public procurement management, logistics managment on effective
health care services in western Uganda. The dissatisfaction raises the question of public
procurement management, logistics management and effective health care services since
the mission of the MoH is to provide the highest possible level of health services to all people
in Uganda through delivery of promotive, preventive, curative, palliative and
rehabilitative health services at all levels. Thus in undertaking its mission, Rukunyu HC IV in
Kamwenge District must undertake public procurement management through procurement
planning, procurement control and procurement monitoring coupled with logistics management.
This is all done in the name of delivering service that is timely, conforming to standards, safe,
accessible to all people and complete. However, this is not the case in reality. For instance, in
2016, government released 250 million for procurement works on the an extension of the general
ward at this health centre IV, extension of children’s ward, Construction of Intensive Neonatal

8
Care Units, on the other hand there was construction works for face lifting Rukunyu HC IV
which were started with extension of general Inpatient ward and construction of a water-borne
toilet are ongoing, Constructed one block of a 2 stance pit latrine for IPD at Rukunyu HC IV,
recruited more Health Workers with support from MoH and partners to raise staffing level from
75% to 83% and lastly launched the district laboratory hub at Rukunyu HC IV with a motorcycle
allocated to the hub rider with support from MoH through Baylor-Uganda. As result of this
upgrade which costed over UGX 250 million, several complaints have come from many patients
(New Vision, 2018). All these are indicators of ineffective healthcare service delivery. The
existing situation dismay however appears that the public procurement management done in
form of procurement planning, procurement control and procurement monitoring and logistics
management has not led to effective health care service delivery at Rukunyu HC IV in
Kamwenge District hence prompting the researcher to carry out this study.

1.2 Statement of the Problem

In the wake of globalization and increased role of private sector in governance, public
procurement and logistics management features as an important market-based incentive for
promoting service delivery. Indeed, all government agencies in Uganda recognize that effective
public procurement as an essential for delivering public services, since includes much that
supports the work of government. According to the PPDA Act 2003, Ministry of Health
(Rukunyu HC IV) is one of the government institutions is mandated to engage in public
procurement management which involves procurement planning, procurement control and
procurement monitoring in efforts to deliver quality services to people that are timely, effective,
high standard, credible and safe.

Despite the fact that Ministry of Health (Rukunyu HC IV) undertakes such efforts, the existing
situation however, seems to be unsatisfying. For instance, in 2012/13 budget, the district health
office had to construct For instance, in 2016, government released 250 million for procurement
works on the an extension of the general ward at this health centre IV, extension of children’s
ward, Construction of Intensive Neonatal Care Units, on the other hand there was construction
works for face lifting Rukunyu HC IV which were started with extension of general Inpatient
ward and construction of a water-borne toilet are ongoing, one block of a 2 stance pit latrine for

9
IPD at Rukunyu HC IV for two years at a cost of UGX 250 million, these structures up to now is
not constructed as planned. In addition, over the on the 10 litter bins which were distributed in
the Health centre facility to promote responsible solid waste management which costed over
UGX 19 million, 111 are reportedly delivered and even most of those delivered seems to be
missing (New Vision, 2018). Others are concerning the poor state of most of the existing wards
that had been planned to be improved and poor health conditions, extortion of money from
Patients, Rampant absenteeism of staff during working hours, shortage of drugs the second cycle
of drug supply, Breakdown of equipment, Shortage of blood, Extortion-rampant; not all planned
products and services procured, existence of non-qualified staff running sensitive departments in
health centers under Rukunyu HC IV (Transparent International, 2018). If this problem is not
settled, it is likely to affect health care service delivery at the health centre. Therefore, if this state
of affair continues, it is likely to affect so much health care service delivery. It is from this
background that the researcher get interest to investigate whether public procurement
management and logistics management in one way or the other have a relationship on effective
health care service delivery in western Uganda.

1.3 Purpose of the study

The purpose of this study will be to examine the relationship between public procurement
management and logistics management on the effective health care service delivery in western
Uganda.

1.4 Research Objectives

i. To examine the relationship between Public Procurement Management and effective
healthcare service delivery in western Uganda.
ii. To examine the relationship between logistics management and effective healthcare
service delivery in western Uganda.
iii. To examine the combined effect of Public Procurement Management and Logistics
Management on effective healthcare service delivery in western Uganda.

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1.5 Research Questions
i. What is the relationship between Public Procurement Management and effective
healthcare service delivery in western Uganda?
ii. What is the relationship between logistics management and effective healthcare service
delivery in western Uganda?
iii. What is the combined effect of Public Procurement Management and Logistics
Management on effective healthcare service delivery in western Uganda?

1.6 Significance of the study

To the stakeholders; This study may of great benefit to the stakeholders since it proposes a
model of procurement system of medicals which emphasizes the importance of granting
individual rural health centre IVs autonomy to make their own procurement, financial and
clinical decisions as a way of improving their efficiency and effectiveness. The model will be
premised on strategic thinking and it is about re-writing the rules of the competitive game and to
envision potential futures, which are significantly different from the present. The model develops
a strategic foresight capacity for the rural health centre IVs to explore all possible future to
foster decision making in Procurement of drugs, equipment and facilities, procurement of human
resources and lastly procurement of services (cleaning, utilities, security).

To the policy makers; the study findings and recommendations of this study may guide the
health sector in policy formulation as regards public procurement, logistics management and
health care service delivery since it may anticipate that the findings and policy recommendations
generated from the study may be of invaluable input to the stakeholders of the health sector in
general both in Uganda and elsewhere; and also to other organizations.

To the academicians; This proposal will be beneficial to future researchers who might be
interested to conduct research in a similar field since it will not only provide relevant literature
for the study, but also study gap that needs to be filled hence creating an improvement in the area
of procurement and general management and hence hoping to be of importance because it may
foster the creation of new knowledge and awareness in the area of procurement management in
the health sector both in the private and public sectors.

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1.7 Scope of the Study
The study scope is in the following areas of content, geographical and time scope.

1.7.1 Time scope

A period of five (5) years from 2015 to 2020 will be considered. The justification for this time
scope will be based on the assumption that 5 years will be relatively enough average time to
analyze the different changing trends in the levels of health care service delivery and also it will
be within that period that the general public complains more about the dissatisfaction of health
care at the different rural health centre IVs.

1.7.2 Content scope

The study will be confined to: the public procurement management; logistics management and
effective health care service delivery in western Uganda. The focus on these aspects will be
hinged on the fact that healthcare service delivery at the rural health centre IVs will be measured
according to the different themes on the above content.

1.7.3 Geographical scope;

Rukunyu HC IV in Kamwenge District will be used as the case study institution. The choice of
this health centre IV will be based on the fact that there was an extension of the general ward at
this health centre IV, extension of children’s ward, Construction of Intensive Neonatal Care
Units, on the other hand there was construction works for face lifting Rukunyu HC IV which
were started with extension of general Inpatient ward and construction of a water-borne toilet are
ongoing, Constructed one block of a 2 stance pit latrine for IPD at Rukunyu HC IV, recruited
more Health Workers with support from MoH and partners to raise staffing level from 75% to
83% and lastly launched the district laboratory hub at Rukunyu HC IV with a motorcycle
allocated to the hub rider with support from MoH through Baylor-Uganda. There are provisions
for laboratory services for diagnosis, maternity care and first referral cover for the sub-county.

1.8 Justification of the Study

Previous studies that have been carried out by other authors as regards Public Procurement
management, Logistics management and effective healthcare service delivery in Uganda seem to

12
have been limited to the Private health institutions and other government health institutions but
not within Kamwenge District. They were also conducted using other dimensions of Public
Procurement, thus the rationale behind the choice of this study will be to empirically establish
the relationship between Public Procurement management, Logistics management and effective
healthcare service delivery in western Uganda focusing on the case of Rukunyu HC IV in
Kamwenge District. Therefore the result of this study is hoped to contribute positively to the
field of Public Procurement management, logistics management and effective health care service
delivery in western Uganda and other health institutions that may have access to read this
research proposal.

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 1.9 Conceptual framework
The conceptual framework reflects the study variables which explain the research issue at hand.
Therefore this framework presented below shows the independent variables of public
procurement management and logistics management whereas effective health care service
delivery as the dependent variable.
Public Procurement Management
Procurement planning
Needs identification
Budgeting Effective Health Care Service
Procurement procedure selection delivery
Procurement control
Supplier selection Health financing
Cost control Outpatient and in-patient rates treated
Procurement Audits Number of medical staff available
Procurement monitoring Accessibility/ closeness of the health Centre to the patients
Availability of the basic medical equipment and supplies for usage
Procurement implementation
Availability
Social accountability tools & action of medicines and supplies
Immunization
Regular reporting & surveillance coverage rates for antigens
Number of deliveries and mortality rates
Availability of utilities like water, electricity and blood transfusion

Logistics Management

Demand forecasting
Order processing
Distribution/ transportation
Storage/inventory management
Information flow
Procurement lead time

Figure 1.1; A conceptual Framework for the understanding the relationship between Public
Procurement Management, Logistics Management and effective healthcare service delivery in
Western Uganda.
Source; Adapted and modified from Agaba and Shipman (2003).

14
From the conceptual framework in figure 1.1 above, it is hypothesized that Public Procurement
Management and logistics management have a combined relationship with effective health care
service delivery in Uganda. if the Health Centre undertakes public procurement management in
form of procurement planning that includes needs identification, budgeting and procurement
procedure selection; procurement control that includes supplier selection, cost control and
procurement audits and lastly procurement monitoring that includes procurement
implementation, social accountability tools & action and regular reporting & surveillance
coupled with logistics management is hypothesized in form of demand forecasting, order
processing, distribution/ transportation, storage/inventory management and information flow can
influence the level of effective health care service delivery in terms of outpatient and in-patient
rates treated, number of medical staff available, accessibility/ closeness of the Health Centre to
the patients, availability of the basic medical equipment and supplies for usage, availability of
medicines and supplies, immunization coverage rates for antigens, number of deliveries and
mortality rates and availability of utilities like water, electricity and blood transfusion.

15
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction
The study investigates the relationship between public procurement management, logistics
management and effective healthcare service delivery in Uganda with special focus to Rukunyu
HC IV in Kamwenge District. This reviews the theoretical and related literature concerning the
research variables and including literature review as per objective by objective. The review is
conceptualized under the objectives of the study and focuses on Public Procurement
management, logistics management and effective healthcare service delivery. These are
considered as the pillars of the study.

2.1 Theoretical Review

The study will be underpinned by both the Agency.

2.1.1 Agency Theory

The agency theory was first formulated in the academic literature in the early 1970s (Ross, 1973;
Jessen & Mechling, 1976). This theory has become part of the standard equipment of cultural
economics (Ginsburgh, 2006). It models the interaction of the two sets of people who include the
principle on the other hand and the agent on the other hand (Ricketts, 2002). The principal is the
individual who hires another individual or organization called agents to act on its behalf.
Therefore in the agency relationships, one party (the principal) delegates work to another party
(the agent) (Jensen and Meckling, 1976; Ross, 1973; Eisenhardt, 1989). When the agent is acting
for the principal it resembles behaviors such as performing for the benefit of the principal or
acting as the principal's representative or employee (Mitnick, 1973). As Eisenhardt (1989, p. 58)
points out, while the profit maximization approach and self-interest persists, the focus of agency
theory centres on determining the most efficient contract governing the principal-agent
relationship.

16
Barlie and Means (1932) posit that in order to match the safeties of the agent and the principal,
an all-inclusive contract is written to address the attentiveness of both the agent and the principal.
They further explain that the connection is further reinforced by the principal engaging an expert
to screen the agent. This situation is also reinforced by Coarse (1937) who upholds that the treaty
provides for clash steadfastness between the agent and principal, the principal regulates the work
and agent assumes the work. He however, suggests that the principal suffers avoidance which
denies him or her from furthering from the work of the agent. Nevertheless, the theory
recognizes the incomplete evidence about the relationship, interests or work performance of the
agent described as opposing selection and ethical hazard. Coarse (1937) explains that moral
hazard and adverse selection affects the output of the agent in two ways; not doing exactly what
the agent is appointed to do, and not possessing the requisite knowledge about what should be
done. This therefore, affects the overall performance of the relationship as well as the benefits of
the principal in form of cash residual.

The exponents of the theory contend that here are three ways in which agents may differ from
their principals. First, the agents may have diverse favorites from their principal, such as
readiness to work. Second, agents may have different inducements from the principal. Agents
may have a different palisade in the outcome or may receive different payments than the
principal. Third, agents may have evidence that is unavailable to the principal, or vice versa.
These types of discrepancies may give rise to problems concerning to watching, inducements,
harmonization, and approach (Michael et al, 2005). This idea thus, cherishes that despite the fact
that the Health sector may have procurement plans, controls and monitoring, it is easy to fail out
to effectively deliver services in donor aided projects in the required quality, time and costs
because the agents may work first to fulfill their own interests as regards fiscal benefits and so
many others. The theory however, fell short on explaining how public procurement management
in terms of monitoring can be handled to lead to effective healthcare service delivery. It is so
much theoretical when it comes to agents and principals and doesn‘t exactly explain who these
are in an institution.

17
2.2 Public Procurement
Generally speaking, the public procurement is the process of buying goods and services from the
private sector by government agencies (Bryson, 2010). Public procurement or government
purchasing is a complicated process consisting of several various phases with different sets of
procedures governing those phases. In contrast to the private sector, government agencies would
not enter into contracts with other parties when and how they prefer. The procurement
regulations or laws established by policy makers is the institutional framework within which
procurement professionals and program managers implement their authorized and funded
procurement programs or projects/ activities (Bryson, 2010). Procurement regulations set out the
legal, institutional and regulatory framework to secure fiscal transparent and public
accountability in Ghana’s procurement system. The Act establishes five basic principles upon
which the procurement system is based (World Bank, 2003). These pillars are: the legal and
institutional framework; standardized procurement procedures and tender documents;
independent control system; proficient procurement staff; and anti-corruption measures
(Brammer, et. al., 2010).

A procurement system in Uganda is quite different from other procurement systems in other
different countries. It involves advising the central Government, Local Governments and
statutory bodies on all procurement system and disposal policies, principles and practices;
monitoring and reporting on the performance of the procurement system and disposal systems in
Uganda and advise on desirable changes; Set training standards, competence levels, certification
requirements and professional development paths in consultation with competent authorities;
Prepare, update and issue authorized versions of the standardized bidding documents, procedural
forms and any other attendant documents to procuring and disposing entities; Ensure that any
deviation from the use of the standardized bidding documents, procedural forms and any other
attendant documents is effected only after the prior, written approval of the Authority;
(Hendrick,2010), it is systematic ,deliberate and continuous (Glaister and Falshaw, 1999).
Procurement system are an important part of efficient health care service delivery in form of
efficient drug management and supply and is critical for all levels of health care institutions. An

18
effective procurement process ensures the availability of the right drugs in the right quantities,
available at the right time, for the right patient and at reasonable prices, and at recognizable
standards of quality (WHO 2007). This is however a generic definition , as compared to
Mintzberg (1994) who defines procurement system as a formalized procedures or rules or laws
that are defined as offering a high level of transparency, accountability and value for money in
the application of a procurement budget which produce an articulated result, in the form of an
integrated system of decisions.

It can be as institutional arrangements required to ensure the proper implementation of these

rules (Wilkinson and Monkhouse, 1994), but is considered by Campbell (1993) who considers
procurement system as a procurement legal framework that encompasses the laws, regulations
and policies that are put in place to govern an organization or an activity. The definition by
Campbell (1993) however does not explain what happens to the legal framework that
encompasses the laws, regulations and policies that are put in place to govern an organization or
an activity. However basing on this study it is evident that the above is not true for the Rural
health centre IVs service delivery since a number of gaps are found lacking like rampant
absenteeism of staff, shortage of drugs, breakdown of equipment, lack of ambulance, funding
shortfalls’, shortage of blood, basic equipment is wanting like needles, scissors and
thermometers and misuse of hospital ambulances in health centres which are contrary to the
principles and five rights of an effective public procurement system like right quantity, right
time, right quality, right source and right place. Therefore having public procurement
management in place alone cannot contribute to effective and efficient health care service
delivery in rural health centre IVs.

2.2.1 Procurement Planning

Agaba & Shipman, (2017) assert that procurement planning is the process used by institutions
whether public or private institutions to plan procuring activity for a definite period of time. This
is commonly accomplished during the costing process. Each year, departments are required to
financial plan for staff, expenses, and purchases. This is the first step in the procurement
planning process. Economic commission of Africa (2019) defines procurement planning as the
purchasing function through which organization obtain products and services from external
suppliers. A good procurement plan will go one step further by describing the process you will

19
go through to appoint those suppliers contractually. Whether you are embarking on a project
procurement or organizational procurement planning exercise, the steps will be the same
(Nakamura, 2019). First, define the items you need to procure.

2.2.2 Procurement Control

Procurement control according to Kalokota and Robinson (2019) flinches in selection of
suppliers since it is important to achieve better control and process tracking of the whole
procurement process. Suppliers need to be precisely capable, have a knowledgeable profile and
have distribution capability. To control the procurement process, the procuring entity must think
about what the service to provide, the establishment to buy from and the methodological
capability to produce it well and the hands-on capability to execute it well (Basheka, 2008).
These and other questions are what this study endeavored to answer as regards healthcare service
delivery in western Uganda. At the end of the study, it will be the task of the this study to find
out whether the procurement process is not well followed and the profile of some contractors and
purchasing firms is still being doubted which will lead to the actual cause of inefficiency in
healthcare service delivery of health services at the health centre IV.

Thai (2014) ascertained that to measure effectiveness and ensure proper procurement controls, it
is a matter of getting the right tools established and in place. It includes steering periodic supplier
audits to correct compliance errors. Such audits should not simply be corrective, but should
discourse the fundamental issues that produce the errors. Nakamura (2014) in agreement with
Lisa et al (2017), procurement controls must look forward to noticeably reduce costs. A
procuring entity can reduce costs by simply catching errors that result in over-billing. Basheka
(2008) argued that top management support is needed to disallow services purchasing without
the involvement of service professionals to help develop contracts, service-level agreements, and
supplier performance metrics. Controls should therefore be emphasized in organizations so as to
improve service delivery. Put the best people in services supply management. Without this
commitment to getting the best people in services supply management, failure is inevitable. Any
organization needs some trailblazers to set the standard, people who know what is possible and
can develop a vision for formalizing services. The literature therefore misses vital areas of
concern for this study for instance when bids are required to be done, who enforces the policies
and procedures and if they are loopholes in the procedures, what are the corrective actions that

20
must be undertaken. These and other questions are too important for this study to be conducted
and answer them accordingly.

2.2.3 Procurement Monitoring

Mlinga (2019) discovered that monitoring of public procurement is a nonstop process of
ensuring that: a procurement system in use in the country is properly instigated to meet the
proposed objectives; obstacles towards achieving intended objectives are known and moderated;
and response is provided to all those involved in the system for further enhancement. It is
recognized that without effective monitoring arrangements of contracts for goods, services and
works are unlikely to bring best value for money (Thai, 2019). All strategic contracts will be
monitored to ensure that all of the requirements of the organization are met; including individual
users needs set out within the specifications. Key performance indicators will be an important
element of the monitoring arrangements (Derbyshire Constabulary, 2019). With key performance
indicators, the study wants to understand whether health sector especially Health IVs have
implemented their procurement plans and contracts, it has performance indicators or
specifications and designs put afore for contractors before implementation. At the end of the
study, it will be in position to realize whether most of the performance indicators are put on
paper but not well implemented.

According to Basheka (2008), many governments departments are good at coming up with annul
procurement work plans but their efforts on how to control their implementation and monitoring
is less emphasized at the end leaves the system as if it has no procuring authority. Therefore,
monitoring has been receiving serious attention as it is adduce to reflect the programmers’
outcomes and impacts. Cloete (2019) adds that monitoring and supervision of contractors,
supplied goods and services, technical ability is too important for improved healthcare service
delivery. This is too fundamental if systematic collection of data is done on the basis of specified
indicators to determine levels of progress and achievement of goals and objectives.

2.3 Logistics Management

Logistics management deals with the planning and control of material flows and related
information in organizations, both in the public and private sectors. Generally speaking, its

21
mission is to get the right materials to the right place at the right time, while optimizing a given
performance measure (e.g. minimizing total operating costs) and satisfying a given set of
constraints (e.g. a budget constraint). Logistics is one of the most important activities in modem
societies (Jonsson, 2018). It is constructed on subsystems which in turn contain a collection of
interrelated components. The relationship between the subsystems and components takes the
form of coordination and exchange of materials and information.

The term Logistics in ancient times was frequently used in connection with the art of moving
annies and supplies of food and armaments to the war front. Its use can be traced back to the
seventeenth century in the French army. Logistics is defined as planning, implementing, and
controlling the physical flows of materials and finished goods from the point of origin to the
point of use to meet customer’s need at a profit Kotler, Philip. (2001). The logistics management
activities typically include inbound, outbound transportation management, fleet management,
warehousing, materials handling, order fulfillment, logistics network design, inventory
management, supply demand planning and management of third party logistics service providers.
The American Council of Logistics Management (2019) also defines logistics as the process of
planning, implementing and controlling the efficient, cost effective flow and storage of raw
materials, in-process inventory, finished goods and related information from point of origin to
point of consumption for the purpose of conforming to customers’ requirements.

The aim of the system is to supply customers efficiently with their required products. Each
subsystem controls the size of die flow of materials through the system via storage,
transportation and various stages of handling and value adding. The logistics systems do not only
consist of flows of materials, components and products which are processed and distributed to
customers, but also include supply chain flows of spare parts and return flows of defective and
used products and packaging (Jonsson, 2018). Therefore the mission of logistics is to get the
right goods or services to the right place, at the right time, and in the desired condition, while
making the greatest contribution to the firm. Logistics is the engine that drives the entire logistics
cycle with three essential logistics data elements such as; stock on hand, losses and adjustments
and consumption, the type of reporting format may determine the lead time, data may be
aggregated across and between levels and reporting and feedback facilitates logistics decision

22
making. Transportation and inventories are the primary cost-absorbing logistics activities since
each represents one-half to two-thirds of total logistics costs.

2.3.1 Distribution
The supply chain component of distribution and logistics to be efficient, it has to respond to
short-term changes in demand or supply quickly and to handle external disruptions smoothly
(Lee, 2004). Hence an efficient supply chain has to be responsive to changes in the market.
Responsiveness requires that accurate information and implementation of the strategic plan is
available to facilitate decision-making. Information technology can help to collect process and
share information. Timely flow of information facilitated by collaborative inter linkages enables
supply chain members to be responsive to customer’s needs and act very fast (McCarthy and
Golicic 2018). Indeed, TecNet Consultation (2018) observes that distributions of essential
medicines in developing countries is becoming increasingly complex, and as diseases span the
poorer populace, availability and access are critical to the welfare of a healthy nation. If these
drugs do not arrive at their destination on time, the process will come to a halt and links within
the supply chain will break, causing problems for other entities down the chain. The complex
nature of the drug distribution asserts that availability of essential drugs and supplies in the
public health sector is a continuing problem due to a combination of problems which ought to be
tackled urgently to avert disastrous outcomes through supply chain accountability (Fundafunda,
2017) while agreeing with Copacino (1996) therefore argues that the distributions if well
managed will enhance efficient flow of drugs and help to avert health problems amongst the rural
poor.

In my own opinion for effective health care service delivery to take place at health centre IVs,
the distribution function must be well coordinated with proper information management and
proper distribution channels with well trained personnel to handle, quantify, dispense and
prescribe the drugs and other medical supplies. And if the above is maintained then we will
experience timely and qualitative delivery plus availability of medical supplies.

23
2.3.2 Procurement lead time for drugs
Procurement practices relate to the process of obtaining supplies for a firm and author further
defines the dimensions of procurement practices as strategic purchasing, purchasing knowledge
and skills (Carr and Smeltzer, 2017). He further emphasizes that such strategies lower costs and
improve procurement efficiencies. For the purpose of this study, the researchers focus on two
aspects of procurement practices: the amount of Professionalism of the purchase managers, and
the degree to which purchasing serves strategic (longer term) goals. It is hoped that proper
implementation of these strategies will lead to cost efficiency and effectiveness. Ntayi et al.,
(2008) argues that the more professional the purchase organization is, the better it was able to
adapt to changing circumstances, and the more effective and efficient the supply chain was.
Procurement system as an instrument can be used to realize social and economic objectives that
are much wider than mere efficiency in the use of public money (Martin, 2016). Timeliness is
one of the other aspects that is considered during the procurement process and this is given due
consideration by Thai (2001) and Callender and Schapper (2019). They emphasis that as a
function of Government, procurement has to satisfy requirements for goods, works, systems, and
services in a timely manner. One of the basic rules of procurement is that in the end, it is
important to think in terms of the total cost of ownership, which includes not only the purchase
price, but also time expected in the goods, services or works is therefore an important element
that should be born in mind during the planning process for any procurement.

This timeframe translates into the concept of procurement lead time which is the period of time
between the recognition that something must be purchased and the time when that thing is
available for use (DOD, 2016). In contrast, procurement lead time may not be the measure of
effective health care service delivery at health centre IVs but other factors like reorder levels,
order quantities, minimum levels, maximum levels, average monthly consumption and buff
stocks and economic order quantities must be put into consideration as they a key to maintaining
and managing the drug stocks in these centres. It may take very short procurement lead time for a
particular supply but finds no single available stock and in the end the patients suffer or die.
Therefore an effective procurement system must consider the above stock valuations in order to
have effective health care service delivery in health centre IVs.

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2.3.3 Storage of drugs
Storage of drugs relates to all mechanisms an organization puts in place to provide safe custody
of drugs that is received and not yet used in the supply chain. Storage of drugs also relates to
drug management and/ or archiving drug. Its involves the creation, receipt, maintenance, use and
disposition of drugs, including the processes for capturing and maintaining evidence of
information about drugs activities and transactions in form of drugs, (ISO 15489: 2001 Standard
as cited by Mabonga (2018). This indicates that information storage is a crucial component of the
supply chain process that promotes accountability, effective monitoring and control of
organization operations for effective service delivery management. The storage function is a very
curial element in the procurement system of drugs and medical supplies at health centre IVs that
goes beyond management, archiving, issuing but also must look at the storage environment,
safety of the drugs and the staff in the store, security, quality control, stock taking and stock
checking all of which must be considered while implementing a sound procurement system that
would effectively serve the clients in the health centre IVs.

2.4 Effectiveness of health care service delivery

There are multiple reasons for disorganization of practice, one of the areas of major concern is
the belief that a large proportion of the health budget not only continues to go to the hospitals
which are mostly located in towns leave peripheral units and HCs depleted of health resources
but also are completely inadequate. Together with poor motivation of staff due to low salaries,
led to a feeling that the general standard of care and services particularly in government owned
units had fallen drastically and there is a general feeling among health care providers and
consumers that NGO and private health facilities are offering better quality services than
government owned units (Okello et al., 2018). They further noted that generally the proportion of
skilled personnel to unskilled personnel decreases as the level of complexity of the health unit
falls. The lower units were predominantly staffed by unskilled ward maids/dressers that formed
40% of the work force who are usually school dropouts that got trained on the job and are
reported to run most of the lower unit levels because trained nurses were not available. There is a
large body of informal sector practitioners, who are the major providers of health care to the

25
poor, especially in rural areas, but lack knowledge which is essential for designing a need-based
pro-poor health system. It is also observed that there is lack the capacity both in terms of
technical and institutional human resource areas in the Uganda health system, which created an
informal class of health practitioners with less professional background including knowledge and
practices on common illnesses and conditions.

2.4.1 Health financing

Health financing has been defined by Kutzin (2017) as the function of a health system concerned
with the mobilization, accumulation and allocation of money to cover the health needs of the
people, individually and collectively, in the health system. A good health financing system raises
adequate funds for health, in ways that ensure people can use needed services, and are protected
from financial catastrophe or impoverishment associated with having to pay for them; and it
provides incentives for providers and users to be efficient (Yates, 2019). Financial planning in
the health care industry is increasingly a key factor in overall quality management as the amount
of funding available dictates the range and quality of services that can be offered (Haines and
Cassels, 2015). This is particularly true for HCIII which almost entirely depend of government
resources for their operations, which implies that the specialties offered at these hospitals are
those that can comfortably be sustained by the available resources from government.

In contrast to the above, it is not only about how much funds have been disbursed to health
centre IVs but how effective they have been utilized and on which prioritizes. This means that
the little public funds that are sent down must optimum used and show value for money within
the available budget, and any increase within the budget should only improve more on the
existing system. Therefore the procurement system I propose must operate on the value for
money principle in order to have proper and effective public fund utilization in health centre IVs.
Health financing provides the resources and economic incentives for the operation of health
system and is a key determinant not health system performance in terms of equity, efficient, and
health outcomes (Schieber, Baeza, Kress and Maier, 2016). World Health Organisation has
identified sustainable financing as one of the critical determinants of equitable access to
medicines. Emphasis is put on insisting that the team responsible for procurement planning of
strategic public health supplies should carry out a review of all sources of financing that was

26
come available during the lifetime of the strategic plan and verify conditions for using these
funds. Health financing can be mobilized from internal or external sources with due
consideration for sustainability considering issues like how long the financing was available, the
amount of funds available and whether any conditions are attached. In addition to government
spending made through the health budget, the overall health financing system in Uganda includes
certain expenditures on health made by other ministries, as well as a number of private sources
such as on-budget contributions from donors. This study considered the sources of financing to
include Government, user fees, donor funds, health insurance schemes and public private
partnerships which must be geared towards effective health care service delivery at health centre
IVs.

2.4.2 Availability of medicines / Drugs and medical facilities

Most studies have stated that one of the most important aspects for facility users in Africa is the
stock of drugs available (Jitta et al. 2019). Therefore, in addition to service use statistics,
facilities were surveyed for their availability of key drugs and supplies, as well as staff numbers,
to see if there were obvious differences between facilities that might explain their desirability to
potential users. Since significant funds are invested in pharmaceuticals, they tend to be in the
focus of the health care system, and the fact that a major proportion of the resources for health
care are invested in a commodity like drugs makes such an item extremely highly valued. Instead
of regarding pharmaceutical therapy as one among many components of the health care system,
drugs instead become central. Drugs become powerful, and they distort the interest from
preventive interventions, primitive health care services and other therapeutic interventions.

However the above studies only focus on drugs availability at health centre IVs without
considering their quality, type of drugs, disease pattern and level of qualification of the health
workers yet there are those drugs that can only be administrated by qualified medical doctors that
are not catered for in the health centre III structure, these studies also rule out the emphasis on
preventative mechanisms and only focus on drug availability at health centre IVs and also fail to
address the availability of other supplies like detergents, cotton, mattresses plus utilities like
water and electricity that can form the intergroup part of effective health care service delivery at
the health centre III.

27
2.4.3 Existing infrastructure
However, there are many possible barriers to the use of services beyond their perceived
popularity. Distance and transportation problems in particular may affect utilization rates, and so
it is important to look beyond simple use rates to help guide policy on where improvements are
needed. Looking at this indicator in combination with the number of deliveries can help illustrate
the importance of distance or transportation barriers with regard to others which could be
classified as internal barriers to the facility influencing its popularity (such as perceived low
quality, or informal costs charged in a facility). In general it appears that many people travel
outside their local area to reach the more popular services, which would indicate transportation is
not necessarily as important as the perception of the facility. However, it is unknown how far the
average travel distance was, as these data were not available. Access to treatments is poor, and
many people die from infections for which treatments or prophylaxis should be available readily
(Shabbar et al., 2017). Willingness to travel appears to be linked with the popularity of the
service, but this finding in itself still leaves unclear how much of facility utilization can be
attributed to ease/difficulty of transportation from surrounding areas, as opposed to internal
factors affecting the popularity of the facilities.

2.5 Public Procurement Management and effective healthcare service delivery

The availability of human resources, medical resources, infrastructure and medicines in public
health facilities cannot be detached from the associated procurement system process. The process
of procurement system determines how, where and when the human resources, medical
resources, infrastructure and medicines would be accessed through the health system (Stephanus,
2009). Improving the availability of human resources, medical resources, infrastructure and
medicines in government hospitals through efficient procurement practices in government health
facilities was used as a case study by Olum (2011) who researched on the effect of procurement
system on effectiveness of healthcare financing in Kenya. The study sought to establish effect of
procurement system on effectiveness of healthcare financing in public health sector in Kenya,
establish the influence of internal funding on procurement performance in public sector in
Kenya, to examine the effect of quality sourcing on procurement performance in public sector in
Kenya and to establish the influence of transparency on procurement performance in public
sector in Kenya. It was established that the level of effectiveness of healthcare financing in
Kenya can be enhanced through procurement system within the health sector. The
28
incompliance’s to procurement system in public sector leads to poor procurement performance
and hence affecting service delivery, affecting the level of availability of medicines in health
facilities, affecting the drug supply management system in health facilities, to examine the
medicines challenges in health facilities and affecting the drugs procurement and availability of
medicines through procurement in health facilities.

However in reference to Olum (2011)’s study, he focused on procurement system specifically on

in compliances in the procurement process and the level of health funding both public and
private but did not look at the contribution of this funding to effective and quality of healthcare
service delivery. In additional, he did not talk about the contribution of other factors like quality
of drugs and services, infrastructure, human resource, medical equipment and supplies that the
current research considered to be part and key to effective and efficient healthcare service
delivery.

2.6 Logistics management and effective healthcare service delivery

The realization of procurement system for hospitals is hinged on the availability of finance for
procurement of health commodities, even distribution of health commodities, effective
supervision and constant monitoring and evaluation which are found crucial in effective and
efficient logistics management, which likewise determines the effective health care service
delivery and capacity. The interaction of these variables was considered by Kasule (2007) who
researched on assessment of Logistics Management and its impact on health care service
delivery in Mulago Hospital. The study focused on examining assessment of Logistics
Management and its impact on health care service delivery in Ugandan Health Service. It was
established that there was a significant relationship between Mulago Hospital’s evenly
distribution of health commodities and health care service delivery, effective supervision or
constant monitoring and health care service delivery. It was therefore recommended that for the
health care service delivery capacity and perceived quality to improve, there was need for the
Ugandan Health Service logistics or supply system as must to receive constant monitoring and
evaluation thus ensuring that there is effective top-down supervision in the system to bring up
efficiency coupled with enough funds that are secured from the government to procure health
commodities. However, Kasule’s study focused on logistics management that looks at the

29
movement, transportation, storage or ware housing and distributions of medical equipment, drugs
and essential commodities but did not consider the system of acquiring those essentials and also
how the system satisfies the end-users at rural health centre IVs .

Kasule (2007) restricted his research to Mulago hospital, however Zikusooka et. al., (2007)
expanded their scope by looking at financing of the health sector in Uganda. They looked at the
equitability of healthcare financing in Uganda and established that Uganda’s health sector was
significant under-funded, mainly relying on private sources of financing, especially out-of-
pocket spending. The study also established that Uganda’s current health financing is inequitable
and fragmented recommending that government should take explicit action to promote equitable
health care financing. The work of Kasule (2007) and Zikusooka et. al (2009) stress the
importance of increased and equitable government funding and logistics management to the
health sector, they however fall short of addressing the other logistics management and funding
options that are available to the health sector. As these two focused on the logistics management
and fair funding, it is evident that logistics management is part and partial of the entire
procurement system and so looking at it alone was not enough to draw conclusions of effective
healthcare service delivery as they are so many other parameters and players who contribute to it.
In reference to Zikusooka (2009)’s study, he hinged his work on increased and equitable
government funding but did not stress out how the existing little funding could contribute to a
minimum effective and efficient health care service delivery in order to promote value for money
principle and this did not explore the other aspects like procurement system that is being used to
acquire medical goods, equipment and services in the rural health centre IV.

2.7 Public Procurement Management and Logistics Management on effective healthcare

service delivery
Scarcity of drugs and the hospital cannot give all drugs to its people because of its limited
availability, and the pharmacy at the hospital sometimes receives drugs whose shelf life is short.
Availability of essential medicines in Northern Uganda was also researched on by Musoke and
Sodemenn (2016), among others. Much as Owuoth and Mwangangi (2011) assessed the
availability of vital and essential medicines at selected Health Centres II, III and IV in Gulu
District, the emphasis of Nantege (2011) was on the private sector. The latter’s research sought to

30
establish the effect of procurement management on the financial performance of bank in Uganda,
using FINA Bank Uganda Limited as a case study. It was established that procurement
management positively affected the performance of banks. The most significant attributes being
procurement system, legislation, procurement controls and monitoring. The significant of
procurement is emphasized by both Owuoth and Mwangangi (2011) and Nantege (2011), though
the latter goes a little further to suggest that the existing procurement controls should be
strengthened and the monitoring aspect be carried out be an independent entity. Owuoth and
Mwangangi (2011) and Nantege (2011) staged a good debate but it did not answer the questions
posed by the current study. They did not consider how to improve the availability of medicines in
government hospitals through efficient procurement practices while the works of Musoke and
Sodemann (2016) focused on the availability of medicines in Northern Uganda. The above works
did not consider whether the available medicines are used in a rational manner. This gap was
addressed by reviewing literature on rational use of medicines in the health sector.

The literature survey revealed that there had been studies concerning Procurement system,
legislation, logistics management and procurement of medicals in Uganda; however these studies
have not researched on how effective health care service could be delivered, logistics
management in rural health centre IIIs interacts with procurement legislation. This study was
therefore important as it focused on the effect of procurement system on the effectiveness health
care service delivery in Western Uganda with logistics management.

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 CHAPTER THREE
METHODOLOGY
3.0 Introduction
The purpose of the current chapter will be to provide a detailed explanation of the
methodological approaches that will be adopted. This will be necessary because the approaches
had to be justified. The chapter covers the research design, study population and sample,
sampling design and procedures, data sources and collection instruments, validity and reliability
of the research instruments, measurement of the research variables, data analysis, ethical issues,
and limitations of the study and delimitations of the study. The above sections are explained in
details one by one.

3.1 Research design

A research design functions as the research blueprint, and it articulates the strategies and tools by
and through which empirical data will be collected and analyzed (Creswell, 2003). It additionally
serves to connect the research questions to the data and articulating the means by which the
research hypotheses will be tested and the research objectives satisfied (Punch, 2000). This study
will adopt a cross sectional research design. Cross sectional designs are simple and least costly
alternative to use with larger area coverage, (Sekaran, 2003). Cross sectional design also allows
for a wider range of the sample to be studied at the same time and more data is covered within a
short period of time, (Sekaran, 2003). The cross sectional survey design will involve
triangulation (use of multiple data collection techniques simultaneously that is, utilizing both
quantitative and qualitative approaches at the same time. Quantitative paradigm will be used to
describe and test relationships and also examine cause and effect interactions among variables.
The cross-sectional design will be appropriate for the study.

The quantitative approach will be used to gather information for proper analysis and making
appropriate inferences, generalizations and conclusions to the population. Qualitative approach
will be also employed so as to capture the information on attitudes and behavior, hence
supplementing information from quantitative sources. The qualitative and quantitative data will
be used together in order to have a complete picture of the research study (Arya and Yesh, 2001).

32
Quantitative approach is an approach that produces discrete numerical data while the qualitative
approach produces textual and non-numerical data (Mugenda and Mugenda, 2010). The
advantages of using both approaches is that both help supplement each other as each method
checks on the other to reduce bias.

3.2 Study population

Kombe and Tromp (2006) defined population as a group of individuals, objects or items from
which samples are taken for measurement or a larger group from which the sample is taken. The
study population will constitute 290 people who will include the health centre in- charges, Health
Centre IV Management committees’, health centre and district PDU’s, Ward In-charge (s) and
general staff of the health centre IV. It will also some associated staff will be employees like
District director of health services, district finance office, and health centre IV procurement
personnel, staffs from the National Medical Stores, Ministry of Health and lastly the patients that
receive medical care from the health centre IV. Such people are available and work in and with
the health centre IV but they are not health workers. Roscoe (1976) observes that any number
beyond 50 respondents is substantive enough to provide scientific findings.

3.4 Sample Size and selection

A sample is a collection of some (a subset) elements of population (Amin 2005). A sample will
be obtained from the accessible population and contained known elements/respondents or
interviewees as per Mugenda & Mugenda approach (2015). A representative sample of 196
respondents will be selected from the entire population of 400 which will be based on the use of
Krejcie & Morgan table of 1970, to determine sample size from a given population. However the
study will also consider the use of other sampling techniques such as purposive sampling and
simple random to determine sample size from a given population. Therefore Table 3.1 below
shows the earlier anticipated sample size estimates as 196 which will be selected from the entire
study population which is 400.

33
Table 3.1: Determining accessible population and Sample Size
Sample Sampling technique
 Departments Population
Health Centre -in- Charges 1 1 Purposive
Health management committees 19 11 Simple random
Ward In-charge (s) 16 8 Simple random
7 Purposive
District PDU’s
7
District Health Office 29 10 Simple random
Health Centre Patients 316 147 Simple random
National Medical Stores 12 12 Purposive
 Total 0 0
Source: adapted from Krejcie & Morgan, (1970) and modified by the researcher

3.5 Sampling Techniques and Procedure

A sampling technique is a plan for obtaining a sample from a given population (Kothari, 2007).
The researcher will employ simple random sampling to select the Health management
committees, Ward In-charge (s), staffs from the District Health Office and the Health Centre
Patients who will participate in the study in order to eliminate bias because of the time frame and
the busy schedules of the staff both at the health centre IV and at the district. Simple random
will be a probability based sampling method in which every unit of the target population has an
equal chance of being selected. Purposive sampling will be used to ensure rich information for
in-depth study amongst the respondents that will include the Health Centre -in- Charges, the
staffs from the District Procurement and Disposal Unit and lastly the staffs from the National
Medical Stores.

Health Centre IV staff will be Purposively sampled and subjected to focus group discussions and
lastly district staff will also be subjected to the interviews since they level of working schedules
is tight upon the researcher’s working time. As a matter of emphasis, these will be purposively
sampled and selected which will also include member Medicines and Therapeutics Committees’,
PDU’s, Ward In-charge(s) and selected staff from NMS and MoH. This choice will be due to
their knowledge and input in public procurement system and their implementation, plus
procurement of medicals in health centre IV with regard to health service delivery within health

34
centre IV. For that reason I therefore, those who are not staff will not be included in the sample.
Such exclude categories will be patients, service providers, visitors, security personnel and the
like. These will be expected to have first-hand information regarding public procurement system
of drugs or medicals, equipment and facilities, human resources and procurement of services
(cleaning, utilities and security in the rural health centre IV.

3.6 Data collection methods

3.6.1 Interview
The choice of in- depth interview will be used to allow the cross-checking of the survey
results and to explain the realities behind the identified trends in the data ( Merriam, 2018).
This will be so because in – depth interviews can be used to gain a deeper insight into the
phenomenon that would investigate the studies. This view is supported by other authors (Rictchie
and Lewis, 2013). The in- depth interview will be used as one of the methods to enhance the
generation of insightful patterns that explained the statistical information that had been
collected using quantitative methods (Denzin and Lincoln, 2019) where respondents that will be
found in depth interviews applied an invaluable opportunity to discuss their experience. It will
be used to uplift for them to have someone listen to them with keen interest. This will be in line
with what other studies have concluded (Spradley, 2017). The study will employ this method
with the health centre III in - charges, district director of health services, district procurement and
disposal unit, officials from National Medical Stores and Ministry of Health. This method will
be best suited and it yield better results given that during interviews they can provide more
information beyond that will be demanded on the questionnaires.

3.6.2 Observation
The observation method will be used in this study. Observation requires the physical
involvement in order to get first hand impression of events, by acting as a specter or participant
in all activities (Ashoworth, 2015). It will be arranged to carry out observation especially of the
following things:-

35
 a) The physical appearance of the health centre IV how patients are served at Out Patients
Department.
b) Quality and availability of resources for patients use
c) Quality and availability of resources for health workers
The advantages with observation will be the ability to perceive reality from the view point
of someone ``inside” rather than external to it (Yin. 2013). In order to increase the reliability of
the observational evidence, the study will use more than one observer. An observation checklist
will be used as a guide in data collection, Health centre IV wards and facilities will be observed
together with the related activities as one of the methods of data collection. The focus will be on
the technical staff, medical personnel, support staff and the patients and caretakers. There will be
observation of rural health centre IV wards with on number of wards, availability of beds,
waiting/sitting space and facilities such as treatment rooms, pharmacy, stores, laboratories, staff
houses and ambulance will be also observed in the rural health centre IIIs visited. Observation
as a method will be very helpful in obtaining first-hand information. The checklist of what will
be observed will be compared with what has been included in each health centre for the last five
years, that will be, contents of HSSIP III.

3.6.3 Documentary Review

Documentary review will be based on the analysis of literary works of scholars, and it will be an
intensive exercise which involved deep analysis and interpretation of facts and Findings / records
of others (Mbabazi, 2018). Documents will be very useful and will be used carefully and
critically analyzed.

3.6.4 Focus group Discussions

Focus group discussions as a method will be also employed. This method will involve a
Homogeneous group of respondents in the discussion of issues of common concern through a
Moderator (Morgan, 2016). For the current study, a member of the research team will be the
moderator and between 5 and 8 staff who will take part as discussants. Through this method it
will be possible to gather data in the forms of opinions, on Public Procurement management,
logistics management and effective health care service delivery. In each case, the participants in

36
the Focus Group Discussion will be selected by the health centre IV administration while as
selection will be based on expertise or experience or both.
3.6.4 Survey
One of the main methods used to collect data will be the survey. A survey method will be used
because the population will be too large to observe directly (Mouton, 2016). Information will be
collected from 196 respondents. This number cannot be reached one by one. Through this
method, information on perceptions of 196 respondents will be obtained (Pout and Hungler,
2015). The information will be collected through self-administered questionnaires which will be
distributed to the respondents. This study will majorly employ the survey method because it will
be cheaper and convenient given its flexibility.

3.7 Data collection Instruments

3.7.1 Interview guide
An interview guide is a set of items that the study interviews about. It can have structured, semi-
structured or unstructured questions (Kombo and Tromp, 2006). An interview guide with pre-
determined set of open –ended questions will be followed and used during the interview to
enable cover the variables under study. The instrument will be followed by the study to ask
questions prompting responses from Key Informants who will be mainly health centre IV in -
charges, District Director of Health Services, District Procurement and Disposal Unit, Officials
from National Medical Stores and Ministry of Health. The study will use structured interview
approach. The tool known as the interview guide will be used in form of guide conversations
rather than structured queries (Yin, 2003). Therefore the following aspects will be noted:
a) Interviews will be conducted in all the health centre IV ;
b) The interviewees will be few, between 4 and 6 representing ward in-charges, health
centre IVs In - Charges, District Director of Health Services, Doctors, District
Procurement and Disposal Unit;
c) Staffs of National Medical Stores and Ministry of Health will be also interviewed.
The information obtained from the above interviews will be used to support the quantitative data.

37
3.7.2 Observation plan
To assist the observation method, an observation plan will be made. This will include a checklist
of items that will be observed. The purpose of the checklist will be to compare what will be
planned.

3.7.3 Documentary review guide

To support the interview and observation methods, a documentary review checklist and interview
will be used to gather and collect secondary data. This will involve analyzing documents mainly
the organization’s procurement reports for additional information which will be got from the
District Director of Health Services Office, reviewing procurement books, articles, and journal
articles published within the different university libraries with keen interest on the study
variables. This also will help the study to document literature as well as conceptualizing the
variables in the study. The instrument will be used in guiding the study to review relevant
documents in order to collect data required to answer the research questions (Punch, 2019).

3.7.4 Focus group discussion plan

The focus group discussion will be planned as follows:
a) Questions in the focus discussion guide will be formulated in line with the variables in
the three objectives of the study.
b) Health centre IV- In-charges will be contacted and dates fixed for both interviews and
Focus Group Discussions. To minimize expenses and inconveniences, it will be agreed,
days not exceeding four will be set for each Health centre IV to carry out the interviews
and FGD’s.
c) It will be planned to have in each FGD 8 to 10 participants drawn from various levels of
Health centre IV staffing.
d) Each FGD will be planned to last between 2 and 3 hours. This will be because only one
FGD will be held in each Health centre IV. So it will be surmised that sufficient time will
be needed to exhaust the discussions.

38
 e) In each FGD, the moderator will be a member of the research team. Beside the Principal
study, there will be four research assistants who helped in gathering data from the field.
These five people constituted what will be referred to as a research team in this.

The major advantage of this method will be that it will involve stakeholders who normally take
part in procurement of drugs, human resources, services, facilities and utilities. Secondly, it will
be possible to have information which will be obtained by use of a tool like a questionnaire.

3.7.5 Questionnaire
A questionnaire is a printed self-report form designed to elicit information that can be obtained
through the written responses of the subjects (Burns and Grove, 1993). The choice of the
research instrument will be dictated by the nature of research and respondents given that they
will be elite and capable of filling it. Furthermore questionnaires will be inexpensive to
administer and so felt respondents felt free to express their views and answer questions at their
own pace without fear or the dangers of information being linked back to them (Burns and
Grove, 2018). The study will use two sets of questionnaires namely self-administered and study
administered questionnaires as data collection instruments to respondents. A self-administered
questionnaire will be designed on a likert scale that will be used to collect data from respondents
who can write and read well. This will enable to reach a sparse population. The technique will be
also suitable since it will be time saving to both the study and the respondents; it will be cost
effective for the study and help to ensure confidentiality. The study will also use another research
instrument, namely the questionnaire which will have statements that will be scored in a Likert
scale (5: “Strongly Agree”; 4: “Agree”; 3: “Uncertain” 2: “Disagree”; And 1: “Strongly
Disagree”). The questionnaires will be designed to gauge the respondents’ perceptions, attitudes
and knowledge regarding procurement system, logistics management and effective healthcare
service delivery for health centre IVs.

3.6 Data Sources

This study will analyzed both primary and secondary data sources hence involving obtaining
information by studying written documents.

39
3.6.1 Primary documents
These will be contemporary accounts of health centre IV, written by either MoH. These original
documents will be obtained from the health centre itself or the district health office. The study
will review and analyze stock cards, delivery schedules, Public Procurement system and lists of
essential drugs among other primary documents. These documents will be reviewed to establish
facts relating to when the health centre placed orders, the delivery schedules and whether the
public Procurement system will be followed in procurement of drugs. Through this method, it
will be to possible gather information and data on Public Procurement system and its
implementation in the procurement of materials, drugs, human resources and facilities.

3.6.2 Secondary Documents

Secondary documents reviewed will be books, published reports, journal articles, bulletins,
Research reports and conference proceedings. Most of these will be accessed at Mbarara
University of Science and Technology (MUST) University Library, Uganda Management
Institute Library, health centre IV library, and others will be accessed using internet especially
the Google search engine. This study will be fit immensely from secondary document reviews
and these included World Health Organization Publications, Health Sector Procurement system,
Annual Health Sector Performance Reports, relevant Ministry of Health Reports, National
Health Policy, National health centre IVs policy, Journal articles, magazine articles and books.
These secondary documents will help to provide more insight into the health care system in
Uganda. Secondly, it will be possible to clarify concepts and theories on both Public
Procurement management, logistics management and effective health care service delivery.

3.7 Research Procedure

After underlying proposal for this research will be approved, permission will be sought and
further approval obtained from Uganda National Council for Science and Technology (UNCST)
and President’s Office for the subjects’ research to be conducted. The intention will be also
introduced the Health centre IV and permission sought from the district health office and Health
Centre In – Charges.

40
3.7.1 Units of observation and analysis
The main focus of the study will be the patients’, medical staff at the selected health centre IVs ,
district staff procurement department, district staff from the district director health services, staff
from national medical stores and the staff from the ministry of health. The units of observation
will be the selected health centre IV, in this health centre that perceives to experience the effect
of procurement system, logistics management and their effect on the effectiveness of health care
service delivery within health centre IVs in western Uganda.

3.8 Quality control of the research instruments

Getting valid and reliable data will be the main aspiration of the research. Triangulation of the
research techniques, where several methods of data collection will be employed will be done. All
data collection instruments will be analyzed to establish their consistency and validity.

3.8.1 Validity of the of the Questionnaire

A research can only be valid if it actually studied what it set out to study and only if the findings
will be verifiable (Saunders et. al., 2017). Content validity will be concerned with the extent to
which an instrument represents the factors under study (Pout and Hungler, 2015), and to this
end the questionnaire will include a variety of questions on the knowledge of the respondents as
regards public procurement management, logistics management and effective health care service
delivery and procurement of drugs, human resource and services. Questions will be based on
information gathered during the literature review to ensure that they will be representative of
what the respondents ought to know about procurement system, effective health care service
delivery and procurement of drugs, human resource and services.

Contents validity will be measured (Cooper and Schindler, 2008). This will involve consulting
expert in research to rate each item in the instrument in terms of relevance to the variables
studied (Robio et al., 2003). The study will employ two content experts as recommended by
Lynn (1986), which will be also be in line with Gable and Wolf (2013) who recommend
between 2 to 20 experts. The item-rating Continuum advocated by Davis (2012) will be used
where 4 = “highly relevant”; 3 = “quite relevant “, 2 = “somewhat relevant”; I = ‘not relevant”.

41
On other hand in order to test and improve the validity of the data collection instruments, the
researcher will avail the instruments to the respondents, who will look at the items and check on
language clarity, relevancy, content comprehensiveness and length of the questionnaire. The
following formula will be used to test the validity index.
CVI = Content Validity Index
CVI = No. of items regarded relevant by judges
Total No. of items judged
CVI = HR + QR
HR + QR + SR +NR

HR = Highly Relevant, QR = Quite Relevant, SR = Somewhat Relevant, NR = Not Relevant

3.8.2 Reliability
Reliability is the degree to which a data collection instrument consistently measures whatever it
is measuring (Amin, 2005) or reliability of data refers to whether repeating the same
measurement under similar conditions yields the same results (Kumar, 2015). To ensure
reliability, the internal consistency will be measured using the Cronbach alpha (Cronbach, 1951).
Reliability is defined as the degree of consistency with which an instrument measures the
attribute it is designed to measure (Polit and Hungler, 1995). It is therefore important that a
comprehensive protocol of the study is maintained, in case others may be interested in checking
its reliability (Sekaran, 2003). Reliability of the questionnaire will be measured with Cronbach’s
alpha statistics using SPSS 20.

3.9 Procedure for Data Collection

A study concept will be conceptualized and later a proposal will be prepared which will be
defended. Upon successful proposal defense, the university will issue a letter authorizing to
conduct the data collection exercise. The exercise will be preceded by training of research
assistants and preparation of the research instruments; this will be later followed by conducting a
pretest of the study instruments, after which the research instruments will be edited and
adjustments made after the pretest. The questionnaires will be given to the respondents and
where necessary, the questionnaires will be researcher administered. Contacts will be also made

42
with the respondents who will be meant to participate in the key informant interviews,
appointments secured, after which the interviews will be conducted directly by the researcher.
During the face to face interviews, the researcher will also take notes. The researcher too will
conduct documentary review and took notes, as well as taking note of the visual occurrences
under observation. In all data collection procedures, protocol will be observed by obtaining and
presenting permission letters to collect data both from Mbarara University of Science and
Technology and health centre IV to enable access to study elements and to convince the
responsible people to give the data. Presentation of research findings will be done and later a
write up of the thesis will be followed. Submission of complete thesis will be the last procedure
to be done.

3.10 Data Analysis

Data analysis is the process of bringing order, structure and meaning to the mass of information
gathered (Mugenda and Mugenda, 1999). Analysis involved both qualitative and quantitative
data. The data will be able to answer the research questions and hypotheses.

3.10.1 Quantitative data analysis:

The analysis of quantitative data encompasses calculations such as averages, totals as compared
to totals of responses expected. The process of data analysis will involve editing, examining the
collected raw data to detect errors and omissions and to correct where necessary. The first editing
will be done in the field and scrutinizing of the completed questionnaire. It will be done on a
daily basis after the interviews and at times on spot. After fieldwork, central editing will be also
done to review and edit when all questionnaires have been completed and returned to the
researcher. Corrections for wrong entries and omissions will be then done. After central editing,
questionnaires will be then brought back to where computer data entry will be done into a
statistical package for social scientist (SPSS) software version 20.

A statistical software SPSS will be used to capture data, data analysis and management. Tables
will be generated and these will be then exported from SPSS into the word document and
interpretation will be done. In addition, the study described or summarized data using descriptive

43
statistics. The researcher obtained measures of central tendency (mean, mode and median) as
well as measures of dispersion (standard deviation). The final outputs and selected summary
tables will be transferred into the main report, findings presented, interpreted and conclusions
deduced. In order to find out the degree, direction and strength of association between the study
variables, the researcher conducted Pearson correlations. To confirm the correlation results and
establish the effect of the independent variables on the dependent variable, the regression
analysis will be done.

3.10.2 Qualitative data analysis

The researcher organized and prepared the qualitative data for analysis by sorting and arranging
the data into various themes as it will be reflected in the key informant guide, while ensuring that
the themes reflected the study objectives and questions. The researcher read through all the data
to obtain a general understanding of the information collected, coded the responses, generated
themes for analysis and interpretation of the meaning of the data. The qualitative data will help to
supplement the data that has been generated quantitatively.

3.11 Measurement of Variables

To measure variables in a quantitative approach is to transform attributes of the conceptual
framework of variables studied into numerical quantities. According to Amin (2005, pg 261),
measurement is the process of transforming abstractly conceived concepts or variables into
numerical quantities.

3.12 Ethical Considerations

Several research ethics will be considered. The study will ensure informed consent of participant
and institutions will be involved, and inform them about the nature of the study. Research ethics
of confidentiality, openness and transparency will be also ensured. Therefore the study will
ensure that results of the study will be not compromised (Madsen, 2019), and guided by
scholars‟ principles, the researcher will be scrupulously honest and will not manipulate data
during collection and interpretation. The study will be conducted in natural settings of the study
sites. This will minimize interference by the researcher with the normal flow of work. Informed

44
consent protocols will be sought from relevant authorities in Uganda (MUST) by means of
obtaining an introductory letter; obtaining consent from the DHO; and lastly from the selected
HCIV, By means of an introductory letter that will accompany the questionnaires respondents
will be informed about the purpose of the study and will be assured of the safety and anonymity
of the information they provided. The field coordinator and all research assistants will be trained
in ethical issues by the investigator.

3.13 Limitations of the study

Because of their busy nature and the difficulty of fixing a common time-denominator, scheduling
interviews with Top Managers, Health centre IV in- chargers, MoH and NMS officials as well as
gathering Health centre IV medical staff for focus group discussions will be a hard obstacle to
overcome. This will be limitations overcome by investing more time in contacting them, making
more visits than have initially been anticipated and then exercising the greatest personal virtue;
patience. These intuitive efforts will be particular and necessary given that these respondents'
input will be deemed a critical contribution to the overall outcome of the research undertaking.

45
References

46
APPENDIX I QUESTIONNAIRE

MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY

FACULTY OF BUSINESS AND MANAGEMENT SCIENCES
MASTER OF BUSINESS ADMINISTRATION

A RESEARCH SURVEY ON PUBLIC PROCUREMENT MANAGEMENT, LOGISTICS

MANAGEMENT AND EFFECTIVE HEALTH CARE SERVICE DELIVERY IN
WESTERN UGANDA; A CASE OF RUKUNYU HEALTH CENTRE IV IN KAMWENGE
DISTRICT

May, 2020

Dear respondent,
Request to complete the Questionnaire below
I am a final year student at Mbarara University of Science and Technology (MUST) conducting a
purely academic research in partial fulfillment of the requirements for the award of a Master of
Business Administration. The research topic for this research is “Public Procurement
Management, Logistics Management and Effective Health Care Service Delivery in Western
Uganda; A Case of Rukunyu Health Centre IV in Kamwenge District”. This is to request you
to kindly complete the attached questionnaire. There is no right or wrong answer. You just need
to indicate how much you agree or disagree with each item by marking the answer that best
represents your views on every statement. Please answers to all the items on the questionnaire.
The information you provide will be used anonymously and for academic purposes only.

Thank you very much for accepting to complete the attached questionnaire.

Alinaitwe Rajab
MBA student

47
 The questionnaire

SECTION A: Personal variables

Under this section, please provide the most appropriate answer by ticking against the alternative
you most agree with

1 In which age bracket do you belong? 1. Below 20 _____ 2. 20-29 ____

3. 30-39 ______ 4. 40-49 ____
5. 50-59 ______ 6. 60+ _____
2 What is your sex? 1. Male ____ 2. Female ____

3 What is your current marital status? 1. Married_____ 2. Single _____

3 Divorced ____ 4. Widowed ___
4 Your religious affiliation 1. Catholic ___ 2. Anglican __ 3. Islam __
4. SDA___ 5. Pentecostal __ 6. Other____

5 Your highest education level attained
6 My category is
7 My Health Centre III is
1. primary ___ 2. Secondary ___ 3. Certificate__
4. Diploma ___ 5. Degree __ 6. Masters _____
7. Doctorate____
1. staff of HC____ 2. district official_____
3. client / patient____ 4. other _____
---------------------------------------------

SECTION B Public Procurement system

For the section below, mark [√ ]a response that best describes your view on each statement that follow:
1. Strongly Disagree 2. Disagree 3. Neutral 4. Agree, 5. Strongly Agree 1 2 3 4 5
8 I am aware of the public procurement
9 There is a specific law for public procurement
10 There is a specific policy concerning procurement
11 My health centre gets all drugs according to procurement law
12 All services at my health centre are obtained by procurement law
13 All utilities for my health centre are acquired according to procurement law
14 There is a committee which handles all procurement for the health centre
15 Procurement process is always followed at my health centre

SECTION C Logistics management

48
For the section below, mark [√ ]a response that best describes your view on each statement that follow:

1. Strongly Disagree 2. Disagree 3. Neutral 4. Agree, 5. Strongly Agree 1 2 3 4 5

26 Procured drugs are always transported to my health centre
27 My health centre necessities are transported at the same time
28 Drugs are well stored at the health centre
29 Supplementary releases are often made whenever there is need
30 There are people trained for handle health centre related logistics
31 Logistics management involving my health centre is very good

SECTION D Health care services

For the section below, mark [√ ]a response that best describes your view on each statement that follow:
1. Strongly Disagree 2. Disagree 3. Neutral 4. Agree, 5. Strongly Agree 1 2 3 4 5
32 Staff at my health centre are hard working
33 My health centre has enough staff
34 The staff at my health centre are well qualified
35 My health centre is kept clean both inside and outside
36 Public property at the Health centre are well maintained
37 The health centre provides very good counselling to clients / patients
38 There is excellent customer care at my health centre
39
My health centre gives good treatment to the sick
40
Immunisation is done very well at my health centre

SECTION E: Rating health care service provision

For the section below, mark [√ ]a response that best describes your view on each statement that follow:
1. Strongly Disagree 2. Disagree 3. Neutral 4. Agree, 5. Strongly Agree 1 2 3 4 5
41 Procurement system at my health centre is very good
42 The procurement policy is very good for my health centre
43 Officials who handle procurement for my health centre are honest
44 Logistics management is very good for my health centre
45 Health care service at my health centre is very good
46 Patients get all the information they need
47 Patients are always well treated at my health centre
48 Funding of my health centre by government is always very good
49 The staff at my Health Centre are hardworking
50 Staff at my Health centre are very caring
51 The number of staff at my Health Centre good
52 My Health Centre has all types of staff it needs
53 My Health Centre has all facilities needed to treat all patients
54 My health centre has all the buildings it needs
55 My health centre has all the equipment needed to treat all types of patients

THANK YOU

Appendix II; interview guide

49
Appendix III; BUDGET FOR RESEARCH PROPOSAL
UNIT
S/N ITEM QTY COST AMOUNT
1 Stationery      
  (a)   Papers 10 (Reams) 20,000/= 200,000
  (b)   Pens 10 500/= 5,000
  (c)   Pencils 6 200/= 1,200
2 Travel expenses     600,000
3 Secondary data-involved expenses   600,000/= 600,000
4 Secretarial Services      
  Binding 6 (copies) 15,000/= 90,000
  Photocopying   150,000/= 150,000
  Printing 5 (copies) x 160 pages 16,000/= 80,000
         
5 Miscellaneous   200,000/= 200,000
        1,926,200

50
APPENDIX 4; RESEARCH WORKPLAN
Activities/ Months Jan Feb March April May June July August Sept
Proposal Writing &

Presentation
Submission to Review

Ethical Committee
Data Collection
Data Analysis
Draft Report Writing
External Examination
Viva Voca

51