PROCUREMENT PLANNING AND HEALTH SERVICE DELIVERY AT MULAGO

NATIONAL REFERRAL HOSPITAL

BY

MUGUME MAUREEN
Ks18m15/207

SUPERVISOR

Mr. KISENYI VICENT

A RESEARCH PROPOSAL SUBMITTED TO THE SCHOOL OF BUSINESS AND

ADMINISTRATION IN PARTIAL FULFILMENT FOR THE AWARD OF A MASTER’S
DEGREE IN BUSINESS ADMINISTRATION OF
UGANDA CHRISTIAN UNIVERSITY

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 JUNE; 2020Declaration
I Mugume Maureen do hereby declare that, to the best of my knowledge and belief, the material

presented in this research proposal is my original work and has not been presented by me or any

other person for a degree or any other academic award in any Institution of higher learning.

Signed ……………………………………………………………………………………………..

Mugume Maureen
Ks18m15/207
Date ……………………………………………………..

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 Approval

I the undersigned do confirm that the work presented in this research proposal is out under my

supervision and hereby approve it for final submission

Signed ……………………………………………………………..

Mr. KISENYI VINCENT

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 TABLE OF CONTENTS
Declaration........................................................................................................................................i
Approval..........................................................................................................................................ii
CHAPTER ONE............................................................................................................................1
INTRODUCTION.........................................................................................................................1
1.1 Introduction................................................................................................................................1
1.2 Background to the Study...........................................................................................................2
1.2.1 Historical background.............................................................................................................3
1.2.2 Theoretical background..........................................................................................................8
1.2.3 Conceptual background..........................................................................................................9
1.2.4 Contextual background.........................................................................................................11
1.3 Statement of the problem.........................................................................................................13
1.4 Purpose of the Study................................................................................................................15
1.5 Research Objectives.................................................................................................................15
1.6 Research Questions..................................................................................................................15
1.7 Hypotheses...............................................................................................................................15
1.8 Conceptual Framework............................................................................................................16
1.9 Significance of the Study.........................................................................................................17
1.10 Justification............................................................................................................................17
1.11 Scope of the Study.................................................................................................................18
1.11.1 Content Scope.....................................................................................................................18
1.11.2 Geographical scope of the study.........................................................................................19
1.11.3 Time Scope.........................................................................................................................19
1.12 Operational Definitions of Key Terms..................................................................................19
CHAPTER TWO.........................................................................................................................21
LITERATURE REVIEW............................................................................................................21
2.0 Introduction..............................................................................................................................21
2.1 Theoretical review...................................................................................................................21
2.1.1 Public Value Theory..............................................................................................................21
2.1.2 Stakeholder Theory...............................................................................................................23
2.2 Procurement Needs Assessment and effective health service delivery...................................24

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2.3 The effect of requirements determination on health service delivery.....................................26
2.4 The effect of budgeting on health service delivery..................................................................28
2.5 Gaps in the literature review....................................................................................................29
CHAPTER THREE.....................................................................................................................31
METHODOLOGY......................................................................................................................31
3.0 Introduction.............................................................................................................................31
3.1 Research Design......................................................................................................................31
3.3 Study Population......................................................................................................................32
3.4 Sample Size and selection.......................................................................................................32
Table 1: Determining the accessible population and Sample Size................................................32
3.5 Sampling Techniques and Procedure.......................................................................................33
3.5.1 Purposive sampling...............................................................................................................33
3.5.2 Simple random sampling......................................................................................................33
3.6 Data Collection Methods.........................................................................................................33
3.6.1 Questionnaires......................................................................................................................34
3.6.2 Interviews.............................................................................................................................34
3.7 Data collection instruments.....................................................................................................34
3.7.1 Questionnaires......................................................................................................................34
3.7.2 Interview guide.....................................................................................................................35
3.8 Data Quality Control................................................................................................................35
3.8.1Validity...................................................................................................................................35
3.8.2 Reliability of the research Instrument...................................................................................36
3.9 Procedure of Data Collection...................................................................................................36
3.10 Measurement of Variables.....................................................................................................36
3.11 Data Analysis.........................................................................................................................37
3.11.1 Quantitative data analysis:..................................................................................................37
3.11.2 Qualitative data analysis.....................................................................................................37
3.12. Ethical Considerations..........................................................................................................38
REFERENCES..............................................................................................................................39
APPENDIX I: QUESTIONNAIRE..................................................................................................i
APPENDIX II: RESEARCH BUDGET..........................................................................................v

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 APPENDIX III: FRAMEWORK viCHAPTER ONE
INTRODUCTION

1.1: Introduction

Another factor that has an impact on procurement is procurement planning. According to

Mapulanga (2017), successful procurement has to be based on effective planning. Effective and

detailed planning can ensure that the procurement is in line with organizational needs. This is

because an organization is at risk of losing money when its planning is poor as it would mean

that not "urgent" items would be procured while necessary items would be starved out of cash.

One of the best procurement planning strategies is the use of budgets. According to Fisher and

Corbalán (2018) and according to the above-mentioned strategy, each department should indicate

what is needed as well as the estimated cost of the item, which should be procured.

Procurement budget should correspond to the revenues, which the company has set aside for the

procurement activities. Brochner, Camén, Eriksson and Garvare (2018) agree that budgeting is a

very important aspect of procurement. This is because it ensures that all the details of the items

to be procured are identified in advance before the procurement process begins. Successful

budgeting process not only involves the procurement department, but also other departments that

require having items and equipment. Rolfstam, Phillips and Bakker (2018) note that proper

specification of the equipment and items required by each department is necessary for

procurement planning. The departments have to provide budgets, which indicate the equipment

and the quality standards for suppliers to ensure that proper equipment is being acquired by the

institution (Procurement Policy Manual, 2018). Without adequate attention to planning

government procurements, the respective procuring agencies will only be left with ad hoc

procurement systems which cannot in most cases translate into value for money and will thus

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affect service delivery (Schiavo-Campo & Sundaram, 2017). Procurement planning can also help

in consolidation of similar procurement requests from different requesters into bigger tender

allowing wider competition, time-saving and considerable lower prices (Basheka, 2008).

As a result, procurement plans, therefore, saves time and money, serves as a conduit to achieving

organization's objectives, ensures compliance with regulatory policies and provides a framework

to guide procurement officers in the achievement of their tasks and duties and thus leading to

efficient and effective provision of health service delivery by proactively anticipating demand

and formulating ways of meeting expectations of clients. In this regard, procurement planning or

lack of it has a direct effect on health service delivery offered within institutions. Therefore this

is a study about the effect of procurement planning on health service delivery in Uganda focusing

on Mulago National Referral hospital as the case study. Procurement Planning will be the

independent variable whereas health service delivery will be the dependent variable. This chapter

presents the background to the study, problem statement, and purpose of the study, objective of

the study, research question, research hypotheses and scope of the study, significance of the

study, study justification, conceptual framework and operational definitions.

1.2 Background to the Study

This section will present the historical, theoretical, conceptual and contextual background

concerning the Procurement Planning and Health Service Delivery at Mulago National Referral

Hospital.

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1.2.1 Historical background

Over the last few decades, health has attained worldwide recognition as a crucial component of

human development and poverty eradication. This recognition springs, in part, from the

realisation, that one-third of the world population lacks access to essential medicines. This

critically contributes to further poverty, mortality, morbidity and indebtedness (WHO, 2014),

which is attributed to the act that developing countries have been awakened it on the importance

of effective management of the public procurement process at both central and local government

levels, and its subsequent contribution to improved governance of the public sector hence

affecting health 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

(Schiavo-Campo& Sundaram, 2018).

In European countries, poor procurement planning within the health sectors in the countries in

the past decade has been one of the major stumbling blocks to the effective health service

delivery of European countries and it has been clear that a number of these countries have not

paid adequate attention to the proper management of public resources (Basheka, 2014). An

efficient public procurement system is vital to the advancement of African countries and is a

concrete expression of the national commitment to making the best possible use of public

resources (Kabaj, 2017). The influence of New Public Management (NPM) philosophies in the

functioning of the public sector have been embraced procedurally by government departments in

several African Countries. A significant number of African countries have over the years adopted

measures aimed at decentralization of government, together with development planning and

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administration and this fashion became popular in the 1980s (Livingstone & Charlton, 2017). By

the late 1990s, the failure of the existing procurement systems to cope with the expansion in

government procurement requirements and to delivery of value for money had become generally

accepted among government and donor partners (Agaba & Shipman, 2017). In Kenya, never

before has there been a growing interest in procurement planning as discovered by the researcher

than it is today.

The Ghana Health Service (GHS) is a Public Service body established under Act 525 of 1996 as

required by the 1992 Constitution. It is an autonomous Executive Agency responsible for the

implementation of national policies under the control of the Minister for Health through its

governing Council. Ghana Health Service does not include Teaching, Private and Mission

Hospitals. The establishment of the Ghana Health Service was an essential part of the key

strategies identified in the health sector reform process, as outlined in the Medium Term Health

Strategy (MTHS), which are necessary steps in establishing a more equitable, efficient,

accessible and responsive health care system. As a result of decentralization and health sector

reform, services are integrated as one goes down the hierarchy of health structure from the

national to the sub-district. At the regional level, curative services are delivered at the regional

hospitals and public health services by the District Health Management Team (DHMT) as well as

the Public Health division of the regional hospital. The Regional Health Administration or

Directorate (RHA/RHD) provides supervision and management support to the districts and sub-

districts within each region. At the district level, curative services are provided by district

hospitals. Public health services are provided by the DHMT and the Public Health Unit of the

district hospitals. The District Health Administration (DHA) provides supervision and

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management support to their sub-districts. At the sub-district level, both preventive and curative

services are provided by the health centres as well as outreach services to the communities

within their catchment areas. Basic preventive and curative services for minor ailments are

being addressed at the community and household level with the introduction of the Community-

based Health Planning and Services (CHPS).

In Tanzania, procurement planning has part and parcel of their traditional planning function

namely; development planning and budgeting. The mandate for planning in local governments is

derived from the public procurement Act, 2004 and its regulations of 2005. User department

prepares an annual work plan for procurement based on the approved budget, which shall be

submitted to the procurement unit to facilitate orderly execution of annual procurement

activities. It is also stated that a procurement plan should be integrated into the annual sector

expenditure program to enhance financial predictability, accounting and control over

procurement budgets. The combined work plan for procuring entity includes details of activities

of works, services or supplies to be procured.

In 1997, Uganda initiated procurement reforms which culminated into the enactment of the

PPDA Act, 2017. Although the Act, was set up to have national (Central and Local) coverage,

only the Central Government procurement was under PPDA Act 2017 up to February 2006,

when the Local Government Act, Cap 243 section 91 – 94 were amended to harmonise the

Higher Local Government (HLG) procurement institutional arrangement, regulations and

procedures with those of the PPDA Act, 2017. This is currently the principal law governing

Procurement and Disposal in both Local governments and central government. It prevails over

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all regulations and guidelines relating to procurement at all levels of the public sector in Uganda.

It has created a new procurement framework intended to achieve some objectives. Firstly, is to

promote economy and efficiency in procurement and disposal activities of the local governments.

Second is to ensure public procurement and disposal is conducted in a fair, transparent and non-

discriminatory manner within a local government environment; and thirdly, to contribute towards

the creation of a sound business climate in Uganda.

A procurement plan must be integrated into the annual sector expenditure programme to enhance

financial predictability– Reg 62(2). A Procurement Unit shall use the combined work plan to

plan, forecast and schedule a PDE's procurement activities for the financial year Reg 62(3). In

the 2006 local Government Procurement Regulations, procurement planning was enshrined

under regulation 62 (5) which emphasizes issues that must be considered during the process of

planning which includes namely: (a) Aggregation of requirements; (b) Allocation of biddable

lots; (c) Use of framework contracts in procurement where appropriate;(d) Undertaking of

common or joint procurement with other PDEs (where possible);(e) Pre-qualification to cover

groups of contracts; and (f) Scheduling of available resources. As a result, the history of health

public service delivery in Uganda has been characterised by a history of ups and downs. From

the 1960s to the mid-1970s, Uganda had one of the most effective public service systems in sub-

Saharan Africa.

The country’s civil service in general and the health system, in particular, was one of the finest.

Uganda’s health sector used to work efficiently. There was an effective referral system from the

village dispensaries and district hospitals to the national referral hospital (Administrative reports

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Mulago national referral hospital, 1998). During the 1970s and early 1980s, many of these

institutional systems collapsed, resulting in substantial deterioration of the health outcome

indicators. While several reforms have been undertaken in the health sector like the procurement

reform, to improve health outcome indicators, progress has stagnated since the late 1990s. The

NMS was established by the National Medical Stores Statute, which came into effect on

December 03, 1993. The NMS replaced the Central Medical Stores (CMS), which was a

department within the Ministry of Health. The main concern, then, was that the functionality of

CMS was constrained by a lack of autonomy. Second, the fusion of money and medicines in one

institution the Ministry of Health was widely associated with inefficiency, lack of accountability

and the absence of institutional checks on the flow of pharmaceuticals and medical supplies. As a

major outcome, essential drugs/medical supplies were not reaching the people at the right time.

Nor were they being delivered in the right quantities via a supply-driven approach. To overcome

the anomalies associated with the old supply-driven CMS regime, government-created NMS in

1993. Through the NMS statute, the Ministry of Health delegated its drug supply function to

NMS.

Drug supply involves the identification of therapeutic needs, quantification of the current and

future needs, procurement, distribution and use. Like CMS, the NMS operates under the national

health policies defined by the line Ministry of Health. Unlike CMS, however, NMS works in the

context of the national drug policy that is enforced by the NDA. The NDA was created by the

National Drug Policy and Authority Act, 1993, and came into effect on the same day as the

NMS. In line with its mandate of enforcing the national drug policy, the NDA oversees the

quality-related operations of pharmacies including the NMS. The NMS is also different from

CMS in that it is an autonomous corporation created in the principle of demand (pull system) for

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medicines as opposed to the supply (push system) under the CMS regime. This autonomy

signifies the separation of money from medicine. Nonetheless, GoU remains committed to

improving the delivery of medicines and medical services to have effective service delivery but

the results have remained below the required levels and vice-versa; hence creating the

importance of the present study to examine the effect of procurement planning on healthcare

service delivery in Uganda focusing on the ministry of health particularly Mulago hospital.

1.2.2 Theoretical background

The study will be underpinned by the Public Value theory. The Public Value Theory was

formulated by Moore in 1995 to provide public sector managers with a greater understanding of

the constraints and opportunities within which they work, and the challenge to create publically

valuable outcomes. The Public Value Theory as formulated by Moore in 1995 to provide public

sector managers with a greater understanding of the constraints and opportunities within which

they work, and the challenge to create publically valuable outcomes. Public Value theory

envisages a manager's purpose as going beyond the implementation of policy and adherence to

institutional norms (Benington & Moore, 2010). In contrast, the public value concept is centred

on the needs of the public as citizens as well as consumers, the creation of value rather than

achieving targets, and public value is more than the aggregation of individuals needs with

deliberation as to what constitutes public value at its core. It includes seeking out opportunities to

make significant improvements to the lives of the public. Public procurement that includes

procurement planning unlike private enterprise, organizations providing public services is

directly accountable to citizens and their democratic representatives (Passmore & Coats, 2008).

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The public value theory relates to the current study in the following aspects; Procurement

activity is driven by the overall strategy, values, objectives and priorities of the organisation for

the benefit of the local population and this includes applying selection and award criteria that

take into account the compatibility of values, together with the general promotion of a public

service ethos by providers. Providers are encouraged to deliver broader public value to the local

community, such as economic, social and environmental benefits whilst providing quality and

value for money services and are expected to report progress through the publication of annual

Public Value Accounts; Procurement for the Health facilities has to go through the following

systems; to determine the extent to which compliance with the procurement legal framework in

state corporations contribute to improvement of Health Service Delivery in terms of provision of

better health services, quality drugs, increased health care efficiency, accountability and

increasing the level of customer satisfaction. Lastly, it relates to the current study in the

following aspects; Procurement for the Health facilities has to go through the following systems;

to determine the extent to which compliance with the procurement legal framework in state

corporations contribute to improvement of Health Service Delivery in terms of provision of

better health services, quality drugs, increased health care efficiency, accountability and

increasing the level of customer satisfaction.

1.2.3 Conceptual background

Odhiambo and Kamau (2015) defined public procurement as the purchase of goods and

contracting of infrastructural works and services using government funds as well as foreign loans

while as Public procurement is a central instrument by which governments ensures efficient

management of state resources and maintains a corruption-free procurement process (OECD,

2017).

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Oyando et al. (2017) referred procurement “as the process of acquiring goods/services either

through buying, leasing, renting, hire purchase or through any other legally acceptable means of

acquisition which is allowed by the procuring entity’s policy and the existing laws”.

Planning is a process that consists of many steps and the bottom line is that planning is not

concerned with future decisions but rather with the future impact of decisions made today (Thai,

2004).

Procurement planning is the process used by companies or public institutions to plan purchasing

activity for a specific period or is the primary function that sets the stage for subsequent

procurement activities while as Economic Commission of Africa (2016) defines procurement

planning as the purchasing function through which organization obtain products and services

from external suppliers. A mistake in procurement planning has wide implications for local

governance, measured from the two indicators of accountability and participation. (Agaba &

Shipman, 2017)

Shaw defines a service as a deed performed by one person for another (Shaw, 1990). Service is a

system or arrangement that supplies public needs, whereas delivery is a periodical performance

of a service.

Heskett (2017) defines service delivery as an attitudinal or dispositional sense, referring to the

internationalization of even service values and norms which includes customer care that involves

putting systems in place to maximise your customers' satisfaction with your business. Helmsing

(2015) in his study defines service delivery as a deliberate obligatory decision by the elected or

appointed officials to serve or deliver goods and services to the recipients. Therefore service

delivery is a system or arrangement of periodical performance of supplying public needs.

Helmsing in his study defines service delivery as a deliberate obligatory decision by the elected

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or appointed officials to serve or deliver goods and services to the recipients (Helmsing. A,

1995). Heskett (1987) defines service delivery as an attitudinal or dispositional sense, referring

to the internationalization of even service values and norms.

Health describes the ability of individuals and populations to ‘function in their environment by

developing physical, psychological and spiritual resources for living’ (Buetow & Kerse, 2016).

1.2.4 Contextual background

Mulago Hospital was founded in 1913 and is the main National Regional Hospital for the entire

country and a teaching hospital for the Makerere College of Health Sciences. It also serves as a

general hospital for the Kampala metropolitan. It is the largest public hospital in the country,

with 1,500 beds. Old Mulago was founded in 1913 by Albert Ruskin Cook. The New Mulago

facility was completed in 1962 while as in 2014, an average of 80 to 100 babies was delivered

daily, in the hospital's three maternity wards. The patient load in Mulago hospital continues to be

too heavy and affecting the quality of services. During FY 2014/15, the hospital attended to

829,817 outpatient visits; 761,573 inpatients; 61,568 emergencies; 28,759 total ANC visits;

39,081 deliveries; 11,120 postnatal visits; 1,738,652 lab tests; 33,949 X-rays; 27,142 ultrasound

scans; 49,680 immunization contacts; 13,397 major surgeries; 9,701 FP contacts. The bed

capacity rate for the hospital is 63% (Mulago Hospital Administrative, report, 2017/18).

Procurement planning in the health sector is a hierarchical approach with Ministry of health

being at the pinnacle and charged with the development of plans for the entire health sector.

To improve planning for essential medicines and health supplies, the Pharmacy Division in the

Ministry of Health set up the Quantification and Procurement Planning Unit (QPPU) in 2010.

The information compiled by the QPPU on national medicine needs to form the basis upon

which resources for health commodities were mobilized to ensure adequate supplies were

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available. This unit was responsible for estimating the number of drugs and medical supplies that

were required by each RRH and consequently, the number of funds that were to be allocated to

each of them during the preparation of the draft budget estimates for Ministry of Health. Under

this hierarchical approach to planning, the RRH's did not have procurement plans for

procurement of medicals; they just operationalized the Health Sector Procurement Plans as

developed by Ministry of Health via preparation of annual procurement plans that were based on

the funding that was indicated as available.

The current hierarchical approach to planning has removed the RRH's from direct participation

in the planning process, yet each region has its unique environment which may require each

regional referral hospital to have its Procurement plan. Furthermore, Ministry of Health through

the National Medical Stores statute of 1993 delegated the drug supply function to National

Medical Stores (NMS), an autonomous institution that replaced the former Central Medical

Stores (CMS) which was a department of the Ministry of Health. NMS is mandated to Procure,

Stores & Distribute Essential Medicines and Medical Supplies to all public health facilities in the

country, including RRH's. The latter therefore had no major role in the procurement of drugs and

medical supplies, as the determination of requirement was done by the QPPU in Ministry of

Health and the physical purchase was delegated to NMS. The role of Mulago National Referral

Hospital is confined to the preparation of annual procurement plans, ordering, receipt and storage

of the medicals. The National Referral Hospital is not involved in either the quantification or

procurement of drugs and medical supplies yet for the efficient supply of medicals; there should

be a strong link between forecasting, quantification, funding and procurement which is not the

case with the Mulago National Referral Hospital. This lack of harmonisation between the three

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aspects of hospital governance (Planning, Funding and Procurement) highlights the role of

hospital-level decision making and how it is shaped by the different stakeholders.

Furthermore, the determinant of the quantity and to some extent the quality of medicals to be

procured is the amount of funds that have been indicated as available to the National Referral

Hospital’s based on the requirements as estimated by the QPPU in Ministry of Health. This

similarly means that the National Referral Hospital is not involved in determining the number of

resources that are allocated to it for procurement of medicals. At the sector level, GOU funding

to the sector is still not adequate. Budgetary expenditure as a percentage of total government

expenditure stands at 8.58% on average, which is far below the recommended level of 15% as

agreed at the Abuja 2011 meeting. The allocation is, in reality, reducing from as much as 9.7% in

2004/2005 to 6.7% in 2015/16. The second Health Sector Strategic Plan of 2005/6 – 2018/10 had

targeted allocating at least 13.2% of the GOU budget on health by 2018/10, which target is not

achieved. Similarly, the third Health Sector Strategic and Investment Plan of 2010/11 – 2014/15

had targeted allocating a minimum of 15% of the GOU budget by 2014/2015 but it is also not

achieved as it stood at 6.7% in 2014/15, which is less than half of the desired target. This put into

question the Government’s commitment to providing adequate funding to the health sector in

general, and procurement of drugs and medical supplies in particular through budgetary

allocations as provided in the procurement plans. Therefore it’s upon this that the current

research study will focus on establishing the effect of procurement planning on health service

delivery in Mulago national referral hospital as the case study institution.

1.3. Statement of the problem

Procurement planning is one of the primary functions of procurement with the potential to

contribute to the success of the public institution's operations and improved service delivery

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(Basheka, 2008). Poor public procurement planning has affected and continued to have an impact

on health service delivery in Mulago National Referral Hospital due to insufficient medical

supplies and provision of quality procurement of works (Uganda Health Sector Strategic Plan III

2010 - 2017/18, 2017/18). The National Medical Stores (NMS) which was set up by the National

Medical Stores Act 1993 (Cap 207) as an autonomous body responsible for procurement, storage

and distribution of essential medicines and health supplies (EMHS), to all Public Health

Facilities in the Country and Uganda Health Services Commission under Act 525 of 1996,

constitution which was established as a Public Service body for the implementation of national

policies with the object to implement approved national policies for healthcare delivery in the

country, increase access to good quality health services and manage prudently resources

available for the provision of health service have failed their desired goals and objectives.

It was noted by NMS according to the Auditor-General Report 2016/17; 94% of the planned

medicines to be delivered to Mulago National Referral Hospital in cycle two as per their

procurement plan, was not received as per the EMHS quantities as planned and ordered for in

2013/14 and 2014/15; furthermore, 53% of the EMHS quantities for Mulago National Referral

Hospital did not receive the drugs that were planned and ordered for in the FY 2015/16;

Furthermore, 93% received less EMHS quantities than were ordered for during the three years

under review; 94% and 90% of National Referral Hospital received EMHS quantities that had

neither been planned nor ordered for in 2016/17 and 2017/18 respectively. Over 90% of the

planned of EMHS quantities for National Referral Hospital received EMHS quantities above

what had been ordered for during the 3 years under review (Auditor-General, report 2016/17).

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 Therefore this study is intended to establish the effect of procurement planning on health service

delivery in Uganda focusing on Mulago National Referral Hospital as the case study.

1.4 Purpose of the Study

The purpose of this study is to establish the effect of procurement planning on health service

delivery in Uganda focusing on Mulago National Referral Hospital as the case study.

1.5 Research Objectives

This study will be guided by the following research objectives:

i. To establish the effect of Procurement Needs Assessment on health service delivery at Mulago

National Referral Hospital.

ii. To establish the effect of requirements determination on health service delivery in Mulago

National Referral Hospital.

iii. To establish the effect of budgeting on health service delivery in Mulago National Referral

Hospital.

1.6 Research Questions

The study will aim at answering the following questions

i. What is the effect of Procurement Needs Assessment on health service delivery at Mulago

National Referral Hospital?

ii. What is the effect of requirements determination on health service delivery in Mulago

National Referral Hospital?

iii. What is the effect of budgeting on health service delivery in Mulago National Referral

Hospital?

1.7 Hypotheses

The study will be guided by the following hypotheses:

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 H1: Procurement Needs Assessment affects health service delivery.

H2: Requirements Determination affects health service delivery.

H3: Budgeting affects health service delivery.

1.8 Conceptual Framework

INDEPENDENT VARIABLE DEPENDENT VARIABLE

Procurement Planning Health Service Delivery

Procurement Needs Assessment

Pre-assessment Quality health care provision
Post-assessment The efficiency of health care provision
Requirements determination
Design specification Affordability of the health services
Performance specifications
Budgeting
Cost estimation
Forecasting

Source (Modification of Basheka, B., (2004; Procurement Planning and Local Governance: A
Factor Analysis Approach, Kampala: Uganda Management Institute);
Figure 1: Conceptual framework showing the effect of procurement planning (independent

variable) on healthcare service delivery (dependent variable) in Uganda.

From the conceptual framework in Figure 1.1 above; Procurement Planning is regarded as the

Independent Variable which is hypothesized in form of procurement needs assessment such as

pre-assessment and post-assessment; requirements determination in form of design specification

and performance specifications and lastly budgeting inform of cost estimation and forecasting

while as health service delivery in Uganda is the dependent Variable which is studied in form of

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the indicators of effective health service delivery such as quality health care provision, efficiency

of health care provision, affordability of the health services, timeliness of health services and

cost-effectiveness and lastly the procurement act and government policy as moderating variables.

1.9 Significance of the Study

This study may be considered beneficial in the following ways:

Firstly, the findings of this study will specifically help Ministry of Health understand the extent

to which the implementation of the procurement plan has impacted the provision of public health

care in the organization and if at all they will need to revisit their procurement planning if they

are to improve on service delivery.

Secondly, it will help policymakers to formulate ways on how to improve the public health

service delivery in the economy. The study will also act as a basis for further research to other

researchers in the field of Public health Service Delivery and procurement planning in Uganda.

Lastly, the research is important to the researcher as it is a requirement for the completion of the

degree in Purchasing and Supply. Furthermore, the findings of this study will add to the existing

body of knowledge hence being beneficial to other researchers as future references.

1.10 Justification

The irregularities relating to Stores and Procurement in recent the MDA’s Auditor’s report

amounted to SHS. 780,027.67 During the review period (MDA’s Auditor’s Report 2017/18). The

irregularities related to purchases not taken on ledger charge, contract variations, payments for

uncompleted works and fuel coupons not properly accounted for. Also, the failure to adhere to

the Public Procurement Act and store Regulations justify that Procurement Planning was done

without a laid down rules and procedures. According to the report, poor Procurement Planning

17
leads to the hasty adoption of Single Source Procurement without proper authorization from the

authorized agencies was the principal result of huge financial loss of SHS.13,306,102.80 for the

health sector alone in 2017/18. It is in the light of this that the researcher intends to examine the

impact of procurement planning in Mulago National Referral Hospital which has been chosen

due to limited timeframe for the completion and submission of the study. Therefore it is

imperative to establish the effect of procurement planning on health service delivery in Mulago

National Referral Hospital as the case study and yet no study had been undertaken on

understanding the effect between the two variables in this institution, which indicates that there is

need for a comprehensive study to establish the effect of procurement planning on health service

delivery in Uganda focusing on Mulago National Referral Hospital as the case study.

1.11 Scope of the Study

1.11.1 Content Scope

The research will focus on establishing the effect of procurement planning on health service

delivery. Procurement Planning is regarded as the Independent Variable which is hypothesized in

form of procurement needs assessment such as pre-assessment and post-assessment;

requirements determination in form of design specification and performance specifications and

lastly budgeting inform of cost estimation and forecasting while as health service delivery in

Uganda is the dependent Variable which is studied in form of the indicators of effective health

service delivery such as quality health care provision, efficiency of health care provision,

affordability of the health services, timeliness of health services and cost-effectiveness and lastly

the procurement act and government policy as moderating variables.

18
1.11.2 Geographical scope of the study

The study is will be at Mulago National Referral Hospital located on Mulago Hill in the northern

part of the city of Kampala, immediately west of the Makerere University College of Health

Sciences and approximately 5 kilometres (3.1 mi), by road, north-east of Kampala's central

business district

1.11.3 Time Scope

The research investigations will cover a period of 5 years (2013 to 2017). This is the period when

there have been procurement planning and health reforms within the hospital (Azhar, 2017).

1.12 Operational Definitions of Key Terms

Procurement Planning; is the process used by companies or public institutions to plan

purchasing activity for a specific period or Procurement planning is the process of determining

the procurement needs and the timing of their acquisition and funding such that the entire

operations are met as required efficiently.

Procurement; refers to a specific method of purchasing services which involve tendering for a

contract or the process of acquiring goods/services either through buying, leasing, renting, hire

purchase or through any other legally acceptable means of acquisition which is allowed by the

procuring entity’s policy and the existing laws”.

Service delivery; is defined as a deliberate obligatory decision by the elected or appointed

officials to serve or deliver goods and services to the recipients or an attitudinal or dispositional

sense, referring to the internationalization of even service values and norms.

Public Procurement; is defined as the purchase of goods and contracting of infrastructural works

and services using government funds as well as foreign loans or is a central instrument by which

governments ensures efficient management of state resources and maintains a corruption-free

19
procurement process or Public procurement concerns the acquisition of products, works and/or

services of significantly improved existing services and products or a new application of

organizational innovation for the provision of existing products and services.

20
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter presents literature which is reviewed concerning the study.

2.1 Theoretical review

Several theories have been put forward which have implications on planning and health service

delivery. The study will be underpinned by the Public Value theory.

2.1.1 Public Value Theory

The Public Value Theory was formulated by Moore in 1995 to provide public sector managers

with a greater understanding of the constraints and opportunities within which they work, and the

challenge to create publically valuable outcomes. Public Value theory envisages a manager's

purpose as going beyond the implementation of policy and adherence to institutional norms

(Benington & Moore, 2010). In contrast, the public value concept is centred on the needs of the

public as citizens as well as consumers, the creation of value rather than achieving targets, and

public value is more than the aggregation of individuals needs with deliberation as to what

constitutes public value at its core. It includes seeking out opportunities to make significant

improvements to the lives of the public. Public procurement that includes procurement planning

unlike private enterprise, organizations providing public services is directly accountable to

citizens and their democratic representatives (Passmore & Coats, 2008).

The public value theory relates to the current study in the following aspects; Procurement

activity is driven by the overall strategy, values, objectives and priorities of the organisation for

the benefit of the local population and this includes applying selection and award criteria that

take into account the compatibility of values, together with the general promotion of a public

21
service ethos by providers. Providers are encouraged to deliver broader public value to the local

community, such as economic, social and environmental benefits whilst providing quality and

value for money services and are expected to report progress through the publication of annual

Public Value Accounts; Procurement for the Health facilities has to go through the following

systems; to determine the extent to which compliance with the procurement legal framework in

state corporations contribute to improvement of Health Service Delivery in terms of provision of

better health services, quality drugs, increased health care efficiency, accountability and

increasing the level of customer satisfaction.

Secondly, the role of public managers specified by Moore (1995) as one of "explorers" and

"moral leaders" whose "ethical responsibility is to undertake the search for public value

conscientiously" radically changes the perspective of public procurement professionals. This

calls for a more dynamic approach whereby it is the responsibility of individual managers to

identify opportunities for creating public value and through the authorising environment gaining

the internal and external authority to progress these ideas. To do so, a key skill to be added to the

procurement manager's toolkit is political management skills. This approach concurs with the

views of those commentators (such as Lonsdale and Watson, 2005) who regard procurement as

primarily an exercise in managing conflict and power rather than a technical function.

Thirdly, the key role of the procurement function is to help deliver the strategic objectives of the

organisation and to enforce its values and to promote a public service ethos irrespective as to

whether a provider is from the public, third or private sector. Purchasing procedures, including

evaluation criteria and performance measurement, need to be built around this philosophy.

22
2.1.2 Stakeholder Theory

In this theory, Freeman (1984) was seeking to explain the relationship between the company and

its external environment and its behaviour within this environment. The author set out his model

as if a chart in which the company is positioned at the centre and is involved with stakeholders

connected with the company. In this model, company-stakeholder relationships are dyadic and

mutually independent (Frooman, 1999). According Savage et al. (2004), the basic premises of

Stakeholder theory are: the organization enters into relationships with many groups that

influence or are influenced by the company, for example, "stakeholders" following Freeman

terminology; the theory focuses on the nature of these relationships in terms of processes and

results for the company and for stakeholders, the interests of all legitimate stakeholder are of

intrinsic value and it is assumed that there is no single prevailing set of interests. The theory

focuses upon management decision making, explains how stakeholders try and influence

organizational decision-making processes to be consistent with their needs and priorities. In

terms of organizations, these should attempt to understand and balance the interests of the

various participants.

Friedman (2006) states that the organization itself should be thought of as grouping of

stakeholders and the purpose of the organization should be to manage their interests, needs and

viewpoints. There is a clear relationship between definitions of what stakeholders and

identification of who are the stakeholders. The main groups of stakeholders are Customers,

employees, local communities, suppliers and distributors (Friedman, 2006). This theory is

fuelled by the realization that in the contemporary business environment, it is not only the

individual businesses that compete as solely autonomous entities but also organizational

23
procurement processes compete in the environment as well (Drucker, 1998). This fact increases

the complexity of identifying and defining the key stakeholders associated with the business

processes. The stakeholder theory has been used as one of the primary theories to identify the

key stakeholders in various organizational studies (Tate, Ellram & Brown, 2009).

This theory is relevant in this study since it highlights the need for managing the relationships

formed with suppliers and how such relationships impact the performance of the firms under the

study. This theory informs procurement needs assessment, requirements determination and

budgeting since it involves the flow of procured materials from the supplier to the customer.

2.2 Procurement Needs Assessment and effective health service delivery

Procurement Planning entails the identification of what needs to be procured (which is the result

of a Needs Assessment), how the organizations needs can best be met, the scope of the goods,

works or services required, what procurement strategies or methods to be deployed, setting the

time frames, and the accountability for the full procurement process. According to (Ezeh, 2012)

Needs Assessment is “a systematic process for determining and addressing the needs, or gaps

between current conditions and desired conditions or wants. This is important in procurement;

because it is an effective tool to identify appropriate interventions or solutions by clearly

identifying the problem to ensure that finite resources (Prior Budget appropriations) are directed

towards developing and implementing a feasible and applicable solution for identified projects.

According to Johan, he who fails to plan for service delivery plans to fail to deliver services to

the public. And if it cannot be measured, it cannot be improved. If we only plan to comply with

regulations, we are not managers, we are robots. What we plan we must implement. What we

implement, we must monitor. We should not be afraid to ask the customer (citizens). They do

know best what they need and what they get. It is not always the same thing (Johan, 2018).

24
According to the (PPOA, 2018), the beginning of the procurement process is to need realization

and identification of the requirements. This is informed by the inventory status, projects plan,

production schedules, work plans, capital or operational requirements budgets and the

procurement plan. Establishment of the requirements is the foundation for conducting the market

survey to ascertain aspects such as prices, new products or alternative or substitute products, new

sources of supply, nature of competition and environmental aspects that may affect the supply

market. In a 2017 report, (Karin et al.) singled out non-adherence to procurement methods as a

major impediment to public procurement development in Kenya. They, however, did not specify

the stage of procurement where this happened. In as much as the above studies highlight the core

role of proper need assessment as a foundation for an effective procurement, they fail in bringing

to the fore the link between need assessment and institutional performance. Recent theorists also

point to the importance of public administration as a moral and ethical concern and recognize

that administrative action is permeated by moral choices and are therefore models of not only

technical and professional competencies but also of moral behaviour (Schlosser, 2018). Wogube

(2017) stressed out that Procurement planning sets in motion the entire procurement process of

acquiring services in local government, it also facilitates efficient and effective service delivery

in public sector organization (Wogube, June 2011). Effective procurement planning is an

important route towards securing the right service to be delivered to the public, and also

maximizing the level of service provision which can be achieved within the local Supporting

People. A procurement plan helps Procuring Entities to achieve maximum value for expenditures

on services to be delivered and enables the entities to identify and address all relevant issues

about a particular procurement before they publicize their procurement notices to potential

suppliers of goods, works and services (Mawhood, 2017).

25
2.3 The effect of requirements determination on health service delivery

According to Garvin (2018), determination of health service delivery are measured using five

different approaches namely; the transcendent approach; the product-based approach; the user-

based approach; the manufacturing-based approach; and the value-based approach. The

transcendent approach equates quality with innate excellence: The product-based approach

defines quality as a sum or weighted sum of the desired attributes in a product: The user-based

approach identifies a high-quality item as one that best satisfies consumer needs or wants.

Gronroos (2017) defined service quality as a measure of how well the service level delivered to

meet customer expectations. A common definition of service quality is that the service should

correspond to the requirements (Edvardsson, 2018). Despite rigorous academic debate and

attention to issues related to understanding service quality from an external customer's

perspective, research on the procurement needs domain is relatively new (Gremler et al. 1994).

Effective procurement planning and preparation will produce more efficient and economical

procurements, which will deliver goods, works and services in an acceptable and timely manner

(World Bank, 2016). A procurement plan is an integral part of the procurement process. It is one

of the essential tools in achieving the ultimate objectives of Public Procurement (Public

Procurement Authority (PPA), Act 663, 2018). Thus to achieve value for money (VFM), the

preparation of the procurement plan is inextricably linked with the entity's budget in which the

requirements of recurrent inputs of goods, works and services are listed and quantified in

monetary terms during a particular year (financial year). This plan serves as a check (control) on

frivolous, otherwise unplanned procurement activities and for that matter, its accurate

26
preparation with up-to-date inputs and with the engagement of necessary stakeholders are very

important steps towards the achievement of value for money for the state (World Bank, 2016).

Edvardsson (2018) contends that specification is an integral part of the procurement function.

Without a quality specification, the process can be filled with pitfalls and obstacles for the

purchasing department. He lists the characteristics of a good specification as follows; Identifies

the minimum requirements of the end-user, allows for a fair and open procurement process,

provides for testing/inspection to ensure the goods/services received meet the standard outlined

in the specification and provides equitable award at the lowest possible cost. Section 21 of Act

663 requires that procurement entities prepare a plan for their annual procurement for each fiscal

year. A procurement plan is essentially a time-bound activity, also serves as a means of

measuring performance against pre-planned activities vis-à-vis the set goals (PPA, Act 663,

2018). Also, Section 21 (5) states that "An entity shall not divide a procurement order into parts

or lower the value of a procurement order to avoid the application of the right procedures" hence

proper and adequate planning are very necessary for value for money for the state (PPA, Act 663,

2018). It has been seen from various authors that adequate procurement plan which may include:

detailed breakdown of the goods, works and services required, schedule of the delivery,

implementation or completion dates for all goods, works and services required. Also, the source

of funding, an indication of any items that can be aggregated for procurement through any

applicable arrangements for common use items, an estimate of the value of each package of

goods, works, services required and the source of funding as well as details of any committed or

planned procurement expenditure under existing multi-year contracts (World Bank, 2016).

27
2.4 The effect of budgeting on health service delivery

According to the PPDA Act (2017), purchases must be economical and efficient. This means that

they should be based on market prices and should be able to generate saving. It also means that

bad practices such as irresponsible procurement leading to wastage, wear and tear of stocks,

over-invoicing, unplanned expenditure, shortage of goods when needed, poor quality products

and similar factors to be avoided. The PPOA prepares and updates a Market Price Index (MPI) to

be used by the Procuring Entity (PE) periodically. The Procurement Plan (PP) must be integrated

into the budgetary processes based on the indicative or approved budget, as stipulated in the

PPDA (2018). The budget, as well as the procurement plan, are to be based on realistic cost

estimates derived from the market research database which is to be compiled and updated

regularly by the procurement unit in line with regulations, PPDA (2018). Costs are one of the

factors that are concerned with the customer perspective but the price is not seen as the only

parameter for costs.

According to the Judiciary Strategic Plan (2012-2016), it intends to institutionalize results-based

budgeting, and establish a financial management and accountability capacity to meet regulatory

standards and customer needs. Specifically, the Judiciary plans to develop and operationalize

value-for-money standards, trails and indicators for a forensic audit, train procurement

committees at the devolved units; and develop an annual procurement unit. In a 2017 Baseline

survey of prices of common user items, it was found that PE was buying at an average of 60%

above the prevailing market price (Kirungu, 2012).

28
2.5 Gaps in the literature review

The above literature review aims to analyse the studies carried out on procurement planning with

a special focus on, procurement needs assessment; requirements determination and lastly

budgeting on health service delivery in Uganda. Therefore, the study attempting to establish

these relationships is more necessary for developing the application of such relationships and

performance with a close link to the ministry of health. Lack of accountability creates

opportunities for corruption. Basheka (2014) argues that procurement planning is one of the

primary functions of procurement with the potential to contribute to the success of local

government operations and improved service delivery. It is a function that sets in motion the

entire acquisition/procurement process of acquiring services in local governments. Mullins

(2018) asserts that the contribution of procurement planning in facilitating efficient and effective

service delivery in public sector organizations is generally undisputed in both developed and

developing countries. Its contribution can be at both central and local government levels of

public sector management. This study reveals a significant positive effect of procurement

planning on health service delivery in Uganda. These results are compared to international

research findings, and suggestions are offered for management, policymaking, and future

research.

Whereas previous studies have always looked at procurement planning and its effect on health

service delivery, not all factors have been dealt with within the ministries in Uganda especially

the ministry of health. The Public Procurement Regulations of 2018 aimed to promote fairness,

accountability and procedures in procurement in public institutions with the main aim of

ensuring efficient use of public funds. However, studies reveal that even after the enactment of

the Regulations there are losses of public funds that can be attributed to public procurement.

29
Further, studies indicate dissatisfaction among stakeholders brought about by loopholes left by

the Regulations which may be used by dishonest people to make the process inefficient hence

creating the need to carry out this study and establish the effect of procurement planning on

health service delivery in Uganda focusing on Mulago National Referral Hospital as the case

study institution.

30
 CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter describes the methods that will be employed in conducting the study. The chapter

begins with research design, study population, sample size and selection, sampling techniques

and procedure, data collection methods and instruments and validity and reliability of research

instruments that will be used. It further describes the data processing and analysis that will be

employed in the study and concludes with the measurement of variables.

3.1 Research Design

The study will use a cross-sectional case study design. The cross-sectional survey will be used

because it captures the state of the variable at a particular point in time in different areas of an

organization. Therefore cross-sectional case study will involve triangulation (use of multiple data

collection techniques simultaneously) i.e. utilizing both quantitative and qualitative approaches

at the same time. Mugenda and Mugenda (1999), defined a quantitative approach as that

approach that produces discrete numerical data while the qualitative approach produces textual

and non-numerical data. They further state that the advantages of using both approaches are that

they help supplement each other as each method checks on another to reduce bias. A quantitative

approach will be used to gather information for proper analysis and making appropriate

inferences, generalizations and conclusions to the population (Mugenda and Mugenda, 1999). A

qualitative approach will be employed to capture the information on attitudes and behaviour

hence supplementing information from quantitative sources (Arya & Yesh, 2017).

31
3.3 Study Population

The study population will constitute 290 employees at both management and operations level.

Respondents will be selected from the departments of the Ministry of Health (Ministry of Health,

Human Resource Report, 2013) and Mulago national referral hospital. 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 the population (Amin 2005). A sample

will be obtained from the accessible population and will contain known elements/respondents or

interviewees as per Mugenda & Mugenda approach (1999). The sample size in this study will be

determined using three techniques: purposive, simple random and use of Krejcie & Morgan table

of 1970, to determine sample size from a given population. Table 1 below shows the earlier

anticipated sample size estimates as 165 which will be selected from the population of the

Ministry of Health which is 290.

Table 1: Determining the accessible population and Sample Size

Sample Sampling technique

 Departments Population
Political Heads 1 1 Purposive
Finance and Administration 39 11 Simple random
Community Health 26 8 Simple random
National Disease Control 7 7 Purposive
Clinical Services 29 10 Simple random
NMS 45 10 Simple random
Planning 80 66 Simple random
Human Resource Department 51 40 Simple random
Quality Assurance 12 12 Purposive
 Total 0 0
Source: Primary Data

32
3.5 Sampling Techniques and Procedure

3.5.1 Purposive sampling

Purposive sampling will be used to ensure rich information for in-depth study amongst the

respondents.

3.5.2 Simple random sampling

The researcher will employ simple random sampling to select respondents who will participate in

the study to eliminate bias. Simple random will be a probability-based sampling method in

which every unit of the target population will have an equal chance of being selected. Simple

random will be used to select respondents. Otherwise, Krejcie & Morgan table (1970) sampling

technique will be adopted and modified by the researcher, to ensure representativeness of the

sample and scientifically proven techniques of sampling.

3.6 Data Collection Methods

Data will be collected from primary and secondary sources. Primary data collected by the

researcher will reflect the individual viewpoints of the participants by administering

questionnaires and respondents interviews, using structured interview schedules. This is the most

important tool, therefore it has to be carefully presented in person, thus the research assistant

carefully administers the questions and records the response. Meanwhile, secondary data will be

collected using information that has already been produced by other authors to analyze and

interpret the findings to form new research through documentary review.

The following data collection methods will be used by the researcher.

33
3.6.1 Questionnaires

A questionnaire is a research instrument consisting of a series of questions and other prompts to

gather information from respondents (Kothari, 2005). In agreement with Kothari (2005) a

questionnaire with printed definite questions will be administered to the respondents. The

questionnaire will be structured because of its convenience and high probability of obtaining

valid information without fear or favour. The reason for selecting the questionnaire will be

because it is an appropriate method for collecting data, it offers greater assurance of anonymity,

can be filled at the respondent’s convenience hence increasing chances of getting valid

information and it is a cheap way of collecting data from a wide geographical area (Amin 2014).

On the other hand, the choice of the questionnaire method is premised on its convenience and

high probability of obtaining valid information without fear or favour.

3.6.2 Interviews

The interview data collection method will be employed, the interview will be tagged on the

research questions, which shall enable the researcher to triangulate her findings with those got

from the questionnaire. Through interviews, an in-depth inquiry will be realized; this will enable

the researcher to obtain qualitative data.

3.7 Data collection instruments

3.7.1 Questionnaires

Questionnaires will be administered to the different employees of the Ministry of Health. These

will be quantitative as the questions will be open-ended. It will be structured in five likely

standardized rating scale of 1+5 (1-strongly disagree, 2-disagree, 3-neither agree nor disagree, 4-

agree, 5- strongly agree. It will be used because of its convenience and efficiency in the

34
collection of both the qualitative and quantitative data (Sekaran, 2017, p. 69). The reason for

selecting the questionnaire will be because it is an appropriate method for collecting data, it

offers greater assurance of anonymity, can be filled at the respondent’s convenience hence

increasing chances of getting valid information and it is a cheap way of collecting data from a

wide geographical area (Amin 2014). On the other hand, the choice of the questionnaire method

is premised on its convenience and high probability of obtaining valid information without fear

or favour.

3.7.2 Interview guide

An interview guide with a 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 researcher to ask questions prompting responses from key informants (KIs) who will be

mainly members of top management in the Ministry of Health (refer to Appendix 2).

3.8. Data Quality Control

To ensure data quality control, the different data collection methods will help to check the

validity of the findings. The questionnaires will be pilot tested for their reliability. This will be

done to ensure that the questions asked will be properly understood by the respondents and to

avoid any ambiguity.

3.8.1 Validity

The validity of the instruments will be tested to determine whether research measures what it

intended to measure and to approximate the truthfulness of the results using the Content Validity

Index (CVI) which will be also done using expert judgment of the Research Supervisors taking

only variable scoring above 0.70 accepted for Social Sciences (Amin, 2005). The CVI will be

measured using the formula:

35
CVI = Number of items declared valid
Total number of items

3.8.2. Reliability of the research Instrument

The reliability of the instruments will be tested to determine its consistency or the degree to

which it measured the same way each time it will be used under the same condition with the

same subjects. This will be done by pilot-testing the questionnaire on a sample of 10 subjects in

the Ministry of Health and adjustments will be made to enhance its reliability. These 10 subjects

will not be part of the 165 respondents in the sample size. The internal consistency (reliability) of

the instrument will be measured using Cronbach's alpha coefficient taking only variables with an

alpha coefficient value more than 0.70 accepted for social research; (Amin, 2005) that will be

generated from SPSS.

3.9 Procedure of Data Collection

Data collection procedures to be used in the study will include administered questionnaires, face

to face interviews, taking notes from documentary review and focus group discussions. In all

data collection procedures, the protocol will be observed by obtaining and presenting permission

letters to collect data both from UCU, Ministry of Health and Mulago National Referral hospital

as the case study institutions to enable access to study elements and to convince the respondents

to give the data.

3.10: 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),

measurement is the process of transforming abstractly conceived concepts or variables into

numerical quantities. In this study, a Likert Scale will be used.

36
Data on key variables in the self and researcher administered questionnaires will be measured on

the Likely Scale (5, 4, 3, 2, 1) for strongly agree, agree, uncertain, disagree and strongly disagree

respectively. The respondents will select the response that best describes their reaction to each

statement and the responses will be weighed from one to five.

3.11: Data Analysis

Data collected from the field will be sorted, coded by assigning themes to the study variables and

later entered into a computer using statistical software called SPSS (Statistical Package for

Social Scientist) software to enable analysis. The data will be able to answer the research

questions and hypothesis.

3.11.1: 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 involves editing, examining the

collected raw data to detect errors and omissions and to correct this when possible. The first

editing will be done in the field and scrutinizing of the completed questionnaire. After central

editing, questionnaires will be then brought back where computer data entry will be done into a

statistical package for social scientist (SPSS) 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 data analysis, the research will use

Pearson Correlation Coefficients showing significant values, regression analysis, descriptive

tables showing means and standard deviation.

3.11.2. Qualitative data analysis

The researcher will organize and prepare data for analysis by sorting and arranging the data into

various themes as will be reflected in the key informant guide. The researcher will read through

37
all the data to obtain a general understanding of the information collected, code the responses,

and generate themes for analysis and interpretation of the meaning of the data.

3.12. Ethical Considerations

The importance of ethical considerations in social research cannot be overemphasized.

According to Cohen et al (2017), this helps in protecting the integrity of the research process and

the data obtained therein. On the outset, an introduction letter from the School of Management

Sciences, Uganda Christian University (UCU) will be obtained to authenticate the status of the

researcher as a registered member of the institution who will be required to conduct fieldwork to

the topic under investigation. This letter will then be used to obtain a research document from the

Head of the human resource at the Ministry of Health and Mulago National Referral Hospital.

To clear any misconceptions about the intentions of the study, a synopsis of what the research

entails and how the findings can be utilized will be given to the Ministry of Health

administration and respondents. To get informed consent, the researcher will also conscientiously

explain in person the purpose of the study and what contribution it hopes to give to the Ministry

of Health in general and External Studies in particular. The researcher will also deem it fit to

promise confidentiality to respondents so that they will speak freely without fear of being

identified as having provided information.

38
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 World Bank,(2000). Can Africa Claim the twenty-first Century?.

The World Bank, Washington D. C. APPENDIX I: QUESTIONNAIRE

May, 2020

Dear respondent,
Request to complete the Questionnaire below
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.

Mugume Maureen
MBA student

i
 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 1. Below 20 _____ 2. 20-29 ____

belong? 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 1. Married_____ 2. Single
status? _____
3 Divorced ____ 4. Widowed
___
4 Your highest education level 1. primary ___ 2. Secondary ___ 3.
attained Certificate__
4. Diploma ___ 5. Degree __ 6. Masters _____
7. Doctorate____
5 My category is 1. staff of HC____ 2. district official_____
3. client / patient____ 4. other _____

6. Period spent in the organization

Less than 2yrs
2-5years
6-10years
Over 10 years

ii
SECTION B; The effect of procurement needs assessment on health service delivery.
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
No Statements SD D NS A SA
8 Each user department prepares a multi annual work plan based on the 1 2 3 4 5
approved budget
9 Each user department at the hospital defines its procurement 1 2 3 4 5
requirements
10 The procuring unit at the hospital is responsible for dividing 1 2 3 4 5
requirements allocated to the single procurement process into separate
lots
11 Procurement planning in the organization entails consulting key 1 2 3 4 5
service stakeholders
12 Procurement planning drives expected results which impacts health 1 2 3 4 5
service delivery
13 I am aware of the public procurement 1 2 3 4 5
14 There is a specific law for public procurement 1 2 3 4 5
15 There is a specific policy concerning procurement 1 2 3 4 5
16 My hospital gets all drugs according to procurement law 1 2 3 4 5
17 All services at my hospital are obtained by procurement law 1 2 3 4 5
18 All utilities for my hospital are acquired according to procurement law 1 2 3 4 5
19 There is a committee which handles all procurement for the hospital 1 2 3 4 5
20 Procurement process is always followed at my hospital 1 2 3 4 5

SECTION C; The effect of requirements determination on health service delivery.

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
No Statements SD D NS A SA
21 There is matching procurement to funds or cash flow in the 1 2 3 4 5
hospital system
22 The hospital priotises the procurement requirements in its 1 2 3 4 5
systems
23 The hospital makes clear TOR or SOW of requirements 1 2 3 4 5
24 Planning and analysis is done before commencement of 1 2 3 4 5
specification development
25 The hospital budgetary proposals and seeks approvals 1 2 3 4 5
26 There is identification of sources of funding for the procurement 1 2 3 4 5

iii
SECTION D Health care service delivery
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. 1 2 3 4 5
Strongly Agree
27 Staff at my hospital are hard working
28 My hospital has enough staff
29 The staff at my hospital are well qualified
30 My hospital is kept clean both inside and outside
31 Public property at the Hospital are well maintained
32 The hospital provides very good counselling to clients / patients
33 There is excellent customer care at my hospital
34
My hospital gives good treatment to the sick
35
Immunisation is done very well at my hospital
36 Procurement system at my hospital is very good
37 The procurement policy is very good for my hospital
38 Officials who handle procurement for my hospital are honest
39 Logistics management is very good for my hospital
40 Health care service at my hospital is very good
41 Patients get all the information they need
42 Patients are always well treated at my hospital
43 Funding of my hospital by government is always very good
44 The staff at my Hospital are hardworking
45 Staff at my Hospital are very caring
46 The number of staff at my Hospital good
47 My Hospital has all types of staff it needs
48 My Hospital has all facilities needed to treat all patients
49 My hospital has all the buildings it needs
50 My hospital has all the equipment needed to treat all types of
patients

THANK YOU

iv
 APPENDIX II: RESEARCH BUDGET

UNIT
S/N ITEM QTY COST AMOUNT
1 Stationery      
  (a)   Papers 12 (Reams) 20,000/= 240,000
  (b)   Pens 10 1000/= 10,000
  (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
        0

v
 APPENDIX III: FRAMEWORK

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

vi