RA410.G5 0W7 bite C.1 G370377 University of Ghana http://ugspace.ug.edu.gh A COMPARATIVE STUDY OF PURCHASING AND STORES MANAGEMENT IN PRIVATE AND PUBLIC HOSPITALS A THESIS PRESENTED TO THE SCHOOL OF ADMINISTRATION, UNIVERSITIY OF GHANA, LEGON IN PARTIAL FUFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF BUSINESS ADMINISTRATION BY SAMPSON OWUSU-AFRIYIE JUNE 2001 University of Ghana http://ugspace.ug.edu.gh DECLARATION I, SAMPSON, OWUSU-AFRIYIE, hereby declare that this thesis, which is presented to the School of Administration, University of Ghana, Legon, in partial fulfillment of the requirement for the MBA Degree is entirely my own work and that no part of it has been presented for another degree elsewhere. < ^ f c 5 (SAMPSON OWUSU-AFRIYIE) SUPERVISORS University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT I would like to express my deep appreciation to all the people who made this study possible. I owe my gratitude especially to Dr. K. Adu Poku and Mr. Adjei Sefah, my supervisors who took time off their busy schedules to read through the entire work forme, giving me guidance, encouragement, and the searching criticisms and knowledgeable suggestions which followed each draft they read. I am also indebted to Mr. Isaiah Offeh Gyimah who gave me the advice and encoragement to pursue the MBA Programme, and to the Management of Kibi District, Koforidua Central, Holy Family and AGC Hospitals for their help in data collection. I owe my thanks to Miss Comfort Hannah Obesebea and Kwabena Aboagye who painstakingly and under pressure typed the entire work for me virtually at no cost. Lastly, I am thankful to Dr. I. R. Osabutey, Dr. Rahman, Sister Agnes Otu, Mr. John Ansah (Driver) and indeed the entire General Office Staff of Kibi District Hospital for their support and co-operation. Without their help and co-operation, this study would not have been possible. University of Ghana http://ugspace.ug.edu.gh DEDICATION This work is dedicated to my father Mr. Augustine Owusu-Afriyie who saw the potential in me and sent me to school. It is also dedicated to my wife, Mrs. Elizabeth Owusu- Afriyie for her moral, spiritual, social and financial support. University of Ghana http://ugspace.ug.edu.gh i i i ABSTRACT Every organization, be it primary, manufacturing, or service depends on materials and services to enhance its operations. Material requirements are either in their raw form, which are used as inputs in the manufacturing process or finished goods, which are used as consumables in the running of the organization. To ensure continuity of operations, organizations require systematic and regular supply of materials, which must be purchased and stocked to be issued, out when the need arises. Purchasing and Supply is therefore one of the basic and most important function of every organization. Indeed no organization can operate effectively and successfully without materials, equipment and services. In the public health institutions in Ghana, purchasing and stores management function has not been approached professionally as it should be. As a result most public hospitals such as Korle Bu Teaching Hospital have experienced malpractices in this area, which have attracted criticisms from the general public. Little has been heard about the private hospitals with regards to problems and malpractices in the field of purchasing and stores management. It is in the light of problems associated with purchasing and stores management in public hospitals that the researcher decided to undertake comparative study of purchasing and stores management of private and public hospitals to find out, first, which of the hospitals meets professionals standard in purchasing and stores management. Secondly, to make the necessary recommendations to be implemented by those institutions which do not meet the professional standard of practice in University of Ghana http://ugspace.ug.edu.gh order to improve the Purchasing and Stores Management functions to achieve efficiency and effectiveness. Purposive sampling technique was used to select two public and two private hospitals. The two public hospitals were Kibi District Hospitals, located at East Akim District of the Eastern Region, and Koforidua Central Hospital located at Koforidua also in the Eastern Region. The two private hospitals were Holy Family Hospital, located Nkawkaw in the Kwahu South District in the Eastern Region and Ashanti Goldfields Company Limited Hospital otherwise known as Ashanti Goldfields Company Hospital which is located at Obuase in the Adansi West District of the Ashanti Region and Ashanti Goldfields Company Limited Hospital otherwise known as A.G.C. Hospital which is located at Obuasi in the Adansi West District of the Ashanti Region. The former is owned and run by the Koforidua Diocese of the Catholic Church and the latter is owned and run by Ashanti Goldfields Company Limited a Mining Company in Ghana. Data for the study were obtained from both secondary and primary sources. The secondary sources included hospital reports, minutes of meetings, research findings, newsletters and newspapers. Primary data were collected through two main methods namely, personal interview using questionnaire as a guide and personal observation. The personal interview was the main method of data collection and personal observation was used as complementary method. Three officers of the Hospital, Administrator, the Purchasing Officer or the Supplies Officer/Stores Officer and Accountant from each of the hospitals were selected as the respondents for the personal interviews. The interview questionnaire was divided into two sections - one on purchasing and the other on stores management. The questionnaire and University of Ghana http://ugspace.ug.edu.gh interviews inquired about the availability of qualified purchasing and stores staff, authorization of purchases, purchasing initiation, segregation of stores, purchasing and accounting duties, availability of stores and purchasing departments, security at stores, availability of storage facilities, computerization of stores and purchasing functions, procedure for accepting goods to stores, supplier evaluation, registration of suppliers, assessment of stores performance and many others. Some of the questions were open-ended and others were closed-ended and multiple choice. The responses from the personal interview were recorded manually. Content analysis and descriptive statistics were employed to analyze the responses. The content analytical method was used for the open-ended questions. The statistical package for social sciences (S.P.S.S.) was used for the statistical analysis. The results indicated that Ashanti Goldfields Company Hospital met professional standards in almost all the indicators used in the study followed by Holy Family, and Koforidua Central and Kibi District Hospitals - in that order. Kibi District Hospital, one of the Public hospitals was most deliquent in the professional practices. Recommendations were made for implementation by the public hospitals in order to improve the purchasing and stores management to contribute to the efficiency and effectiveness of these hospitals. In addition, the Ministry of Health was advised to understudy in detail the Ashanti Goldfields Company Limited Hospital’s purchasing and stores management for possible adoption by all public hospitals. University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENT Acknowledgement 1 Dedication ii Abstract iii CHAPTER ONE Page 1.1. Background to the Study 1 1.2. Justification for Studying Purchasing and Stores Management In hospitals 4 1.2.1. Objectives of Purchasing and Supply Department 6 1.2.2. Functions of Purchasing and Supply Department 8 1.2.3. The role of Purchasing and Supply in Organisations 9 1.2.4. Responsibilities of Purchasing and Supply Professionals in an Organisation 11 1.3. The Purpose of the Study 14 1.4. Problem Statement 14 1.5. Objective of the Study 20 1.6. Significance of the Study 20 1.7. Research Question 21 1.8. Scope and Limitations 21 1.9. Organisation of the Study 22 CHAPTER TWO 2.1. Definition of Concepts 23 2.2. Procurement as a means of cost reduction and increase 26 Corporate profitability 2.3. Purchasing, Stores Management and Fraud 30 2.4. Problems in Purchasing and Stores Management 32 2.5. Attempts by Ministry of Health to address some of the problems 33 Associated with Purchasing and Stores Management in Public Health Institutions University of Ghana http://ugspace.ug.edu.gh 2.6. Procurement organisation and management in Ministry of Health 2.7. Theoretical Perspective 2.8. Stores Management in Organisations 34 40 47 CHAPTER THREE Research Methodology 3.1. Introduction 57 3.2. Re-statement of Major Research question 57 3.3. Research Design 57 3.4. Study population/organizational sample 57 3.4.1. Sample Method 57 3.4.2. Kibi District Hospital 59 3.4.3. Koforidua Central Hospital 59 3.4.4. Ashanti Goldfields Hospital 60 3.4.5. Holy Family Hospital 60 3.5. Research Setting 60 3.5.1. History of Kibi District Hospital 61 3.5.2. Role of Kibi District Hospital 62 3.5.3. Koforidua Central Hospital 62 3.5.4. History of Koforidua Central Hospital 62 3.5.5. Facilities at the Hospital 63 3.5.6 Role/Function of Koforidua Central Hospital 63 3.5.7. Ashanti Goldfields Company Limited, Corporate Profile 64 3.5.8. Ashanti Goldfields Company (A.G.C.) Hospital 64 3.5.9. Facilities at the Hospital 64 3.5.10. Mission of the Hospital 65 3.5.11. Holy Family Hospital (Nkawkaw) 65 3.5.12. History of the Hospital 66 3.5.13. Role of the Hospital 66 3.5.14. Mission of the Hospital 66 University of Ghana http://ugspace.ug.edu.gh 3.5.15. Facilities at the Hospital 67 3.6. Sources of Data 67 3.6.1. Primary data 67 3.6.2. Secondary data 67 3.7. Methods of data collection 69 3.7.1. Personal interviews 69 3.7.2. Questionnaire (interview guide) 69 3.7.3. Direct observation 72 3.8. Validity and Reliability of the Study 72 3.9. Data Processing and analysis 73 CHAPTER FOUR Page 4.0. Introduction 73 4.1. Re-statement of data collection methods and tools of analysis 74 4.1.1. Purchasing 75 4.2.1. Status of Purchasing in Hospitals 75 4.2.2. Purchasing Organisation 83 4.2.3. Procurement/Purchasing Process 86 4.2.4. Method of buying 95 4.2.5. Computerisation of Purchasing System 98 4.2.6. Problems hindering smooth purchasing function 99 4.3. Stores Management 99 4.3.3. Basic functions of stores 100 4.3.2. Stores Department 101 4.3.3. Storage Facilities 101 4.3.4. Physical address 102 4.3.5. Material Handling Equipment 103 4.3.7. Availability of trained stores staff 104 4.3.8. Procedure for accepting goods into stores 105 4.3.9. Procedure for stock withdrawal 106 4.3.10. Segregation of Duties 107 University of Ghana http://ugspace.ug.edu.gh 4.3.11. Stock Management Techniques 4.3.12. Monitoring of Supplies 4.3.13. Stocktaking 4.3.14. Identification and disposal of scraps obsolete and redundant items 4.3.15. Safety precaution measures against fire, loss and theft 4.3.16. Assessment of Stores efficiency 4.3.17. Stores Procedure Manual 4.3.18. Computerisation of Stores function CHAPTER FIVE 5.0. Introduction 5.1. Summary 5.2. Recommendations 5.3. Conclusion Appendix Acronyms References 108 109 110 113 114 115 116 117 117 117 133 137 University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 1.1. Expenditure on personnel emoluments, materials, and Overheads at Kibi Districts Hospital (1998 - 99) 3 Table 2.1 Schematic presentation of stores and procurement processes 68 Table 4.1. Purchasing Department 77 Table 4.2. Availability of Purchasing Officers 78 Table 4.3. Performances of procurement functions in the absence of Purchasing Officers 80 Table 4.5. Perception of Procurement function 83 Table 4.6. Centralisation and Decentralisation of Procurement function 85 Table 4.7. Circumstances under which invoices are approved 94 Table 4.8. Method of buying 97 Table 4.9. Computerization of Purchasing System 98 University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE 1.1. BACKGROUND TO THE STUDY Hospitals, be they private or public, are set up to achieve some objectives among which include satisfying clients, and improving the health status of the people within their catchment area. (Abebrese, 1998). Hospitals perform these roles through the provision of curative, preventive, promotive and rehabilitative health services. In all these activities, hospitals need resources including materials of all kinds, including drugs, medical equipment and consumables (Abebrese, 1998). These materials are used in the process of health care provision to satisfy the needs of customers (patients). It therefore implies that the success or failure of hospitals may depend largely upon the performance of the sections of the hospitals in charge of arranging for the supply of needed materials at all times. For the simple reason above, such responsibilities should always be entrusted in the hands of well-structured procurement, purchasing or supplies department for the efficient and effective realization of the hospitals’ objectives. Procurement as a management discipline has developed strongly over the past two decades especially within the manufacturing sector. Due to the increasing industrial competition, the manufacturing companies have given first priority to many issues such as cost reduction, quality improvement, and lead time reduction which are associated with efficient and effective purchasing management (Mensah, 1999) Compared to the manufacturing sector, organizations and institutions in the service sector, have lagged behind in the development of effective procurement and stores management system. In service organisations, procurement is regarded as an activity that is usually limited only to the placement of orders, invoice checking and documentation. The issue of strategic purchasing activities including planning, 1 University of Ghana http://ugspace.ug.edu.gh organising and system improvement are not given the required consideration (Mensah, 1999). Thus, procurement functions in most of the public hospitals are always found in the hands of Hospital Administrators and Medical Superintendents. In most of the public hospitals in Ghana, the status of supplies/purchasing activities are scattered throughout the organisation and not well managed to play the role of ensuring that these institutions obtain value for money for all the procurement it makes. Most public hospitals do not have well structured procurement departments headed by qualified personnel. Even though these hospital have stores department which are manned by stores personnel who are staff of Ministry of Finance, these personnel concentrate their function at the stores since they are not competent and skilful enough to handle procurement function effectively. The purchasing and supply function has therefore been taken over by other senior staff in the hospital who are not experts in the field (Mensah, 1999). There are also problems with the inventory control systems at of these public hospitals. Inventory levels are not monitored properly, as result, there are frequent shortages of essential materials and drugs in most hospitals especially the two teaching hospitals - Korle-Bu and Komfo Anokye (Daily Graphic, 22nd August, 1988 ppl5). This brings in its wake emergency purchases, which are expensive while patients’ lives can be lost if these items are not procured in time. Due to poor sourcing practices at these hospitals, sometimes the suppliers selected are not able to deliver the right quantity and quality of items ordered (Annual Report Kibi District Hospital). The resultant effects of these problems are that the purchasing function in most public hospitals is not managed to achieve the cost saving as emphasised by Mr. Kwame Peprah, the former finance minister. (Mensah, 1999). If 2 University of Ghana http://ugspace.ug.edu.gh well managed the expenditure savings can be utilised to employ more doctors and other health professionals that the Ministry of Health badly needs. As can be seen from the Table below, procurement of goods, consumables and medical equipment constitute the second highest cost of at the hospital after personal emoluments. Table 1.1. Expenditure on personal emolument, materials and overheads at Kibi Hospital, 1998 - 1999 EXPENDITURE ITEM 1998 1999 % 0 % Materials 120m 17.9 242m 27.4 Personal Emoluments 495m 74.1 536m 60.7 Overheads 53m 7.93 104m 11.7 Total 668m 99.93 882m 99.8 As can be seen from the above figures from Kibi Hospital, procurement of materials constituted 17.9% and 27.4% of the hospital’s expenditure in 1998 and 1999 respectively. It is in view of the problems confronting purchasing and stores management in public hospitals that the study is being undertaken to examine the procurement and stores management practices of some public hospitals to identify areas which need improvement so that recommendations for improvement can be made. The study also 3 University of Ghana http://ugspace.ug.edu.gh intends to examine the purchasing and stores management practices of some private hospitals to identify areas of strength that may be recommended for implementation by the public hospitals. The examination of procurement and stores management practices at the hospitals will be made against the standards prescribed by the Chartered Institute of Purchasing and Supply (C.I.P.S.) UK, the world’s professionally acclaimed institution regulating the standard of procurement practice. The study will focus on the entire procurement cycle- establishment of need, methods of purchasing, sourcing, and certification of invoices for payment. In the area of stores management, the study will focus on inventory system, stocktaking practices, inspection and quality control, performance measurement in stores management, security, the use of personnel in stores management and stores location system. 1.2. JUSTIFICATION FOR STUDYING PURCHASING AND STORES MANAGEMENT IN HOSPITALS Ghana’s long term vision for growth and development is captured in the document GHANA VISION 2020. It defines five main areas for priority attention in the medium to long term as follows: maximizing the healthy and productive lives of Ghanaians; distribution of the benefits of development; attainment of a national economic growth rate of 8%; reduction of the population growth rate from 3% to 2%; and, the promotion of science and improved technology as tools for growth and development. Taking inspiration from GHANA VISION 2020, the Ministry of Health published its Medium Term Health Strategy document in September 1995, for 1997 - 2001. Among other things, it set the direction and provided a framework for development in the health sector. The document identified priorities for health development as: 1. Improving access to the health services 2. Improving quality of the services 4 University of Ghana http://ugspace.ug.edu.gh 3. Improving efficiency in the use of resources needed for delivery of services. 4. Promoting linkages with other sectors involved in health delivery. 5. Health financing aspects of service delivery. It is because of the third priority, that is, efficiency in the use of resources needed for delivery of health services that the researcher intended to undertake the study to examine purchasing and stores management practices of public hospitals to identify areas which needed improvement and the necessary recommendations made for implementation to ensure efficiency in the use of health resources. Resources available to health sector have been shrinking over the years. For the last decade, government allocation to the Ministry of Health has been $6 per capita, compared with $10 in 1978. This has had a direct impact on the ability of the Ministry of Health to run an efficient and effective system. Insufficient amounts are spent on non-wage recurrent costs, leading to shortages of drug and other essential supplies and the persistence of weak logistic support system (Source: Health Sector 5 year Programme of work, Ministry of Health, Ghana). About 60% of recurrent budgets of most public hospitals is spent on the procurement of goods and services. Purchasing and stores management area has been identified as the number one area where a substantial amount of public funds go to waste in the form of fraud, misappropriation and other financial malfeasance (Sapati 2000). Studying the purchasing and stores management of hospitals will enable the researcher to identify the weaknesses in the system so that recommendations can be made as to how best to improve efficiency and effectiveness in the area of purchasing and stores management to cut down waste and fraud. 5 University of Ghana http://ugspace.ug.edu.gh 1.2.1 OBJECTIVES OF PURCHASING AND SUPPLY DEPARTMENT It is argued that purchasing policies and strategies should be based on the company objectives and strategies and that purchasing objectives must be in accordance with the overall company policy. One of the accepted definitions of purchasing objective is “to obtain materials of the right quantity, in the right quality from the right source, delivered to the right place at the right time at the right price”. This definition has been criticised by some purchasing practitioners as being rather simplistic and superficial. It is still seen as a valid statement because the definition does provide a practical framework and has been seen useful to many users. However, a good objective as outlined by Bailey et al (1994) are as follows, PRIMARY OBJECTIVES 1. To ensure the uninterrupted flow of production by obtaining and ensuring delivery of accepted quality of good and services, at the right time and price, 2. To develop reliable alternative sources of supply to meet company requirement, 3. To treat all prices and technical information submitted by suppliers as confidential in order to preserve a good business reputation and obtain competitive prices, 4. To comply in all respects, with the anti trust laws and with all other applicable laws without qualification or evaluation 5. To purchase efficiently and wisely materials and services by an ethical means for the company’s use at the maximum end-use value per amount spent 6. To resolve conflict on all purchased goods and services 6 University of Ghana http://ugspace.ug.edu.gh 7. To provide leadership in the standardization of materials, suppliers requirements, services and policies. 8. To provide leadership in the management of inventories of purchased goods so as to meet the use requirements of the company’s departments at the lowest possible cost 9. To maintain sound co-operative relationships with other departments, providing information and advice as necessary to ensure the effective operation of the organization as a whole 10. To develop staff, policies, procedures and organization to ensure the achievement of the foregoing objectives, 11. To diminish the cost of acquisition, improving operations and procedures. In addition to these broad objectives are some more specific objectives, among which are, 12. To select the best suppliers in the market, 13. To help generate the effective development of new products, 14. To maintain the correct value balance of an organization, 15. To protect the company’s cost structure, 16. To monitor supply market trends, 17. To negotiate effectively in order to work with suppliers who will seek mutual benefit through economically superior performance, SECONDARY OBJECTIVES There are secondary objectives that are supportive of other functions in the organization including the following: 18. To suggest to the engineering department materials or components which may improve the organization’s products. 7 University of Ghana http://ugspace.ug.edu.gh 19. To strive to introduce standardization in requirements to simply specifications and reduce costs of materials and number of types of inventory. 20. To furnish data in forecasting or assist in forecasting availability of materials and trends in prices. 21. To participate in make or buy decisions; 22. To serve sales personnel by bringing to their attention effective methods and techniques used by sales forces of suppliers and warn against obnoxious conduct observed on the part of such sales personnel. Adherence to these purchasing objectives would enable purchasing to function efficiently and effectively to enable the organization to attain its stated objectives. OBJECTIVES OF STORES MANAGEMENT Ammer (1978) stated that the objectives of stores management are fourfold. These include: 1. To have proper supplies when needed. 2. To carry out the buying and storage functions at the lowest possible cost. 3. To pay the lowest possible prices for purchased supplies that are consistent with other supplies management objectives and 4. To operate with minimum investment in inventory and other assets that is consistent with other objectives 1.2.2 FUNCTIONS OF PURCHASING AND SUPPLY DEPARTMENT The purchasing function has a complex network of relations in the company because it maintains relationship with nearly all departments within the company. It traditionally encompasses the process of buying. It involves determining the need, selecting the supplier, arriving at a proper price, specifying terms and conditions, 8 University of Ghana http://ugspace.ug.edu.gh issuing the contract or order and following up to ensure proper delivery. In short, Aljan (1983) says the purchasing function should obtain the proper equipment, material, supplies and services of the right quality in the right quantity, at the right price and from the right source. In this description, the purchasing function is regarded primarily as an operational activity. Types of activities, tasks and functions on a broad scale include: 1. Requirement determination in terms of required quality and quantities of goods and services that need to be bought. It involves functional co­ ordination with manufacturing, engineering, marketing, finance and quality control. 2. The procurement decision, involving makes or buys decisions, standards, vendor certification, value analysis, market trends, schedule, cost and budget consideration and capacity, control and opportunity alternatives. 3. The procurement process; which also involves source selection, soliciting bids, schedule, cost price analysis, negotiation, contract, expediting, term and conditions, specifications and contract administration. 4. Materials management, which also includes traffic and receiving, economic order quantity determination, inventory management and control, materials handling, scrap disposal and stores. 1.2.3 THE ROLE OF PURCHASING AND SUPPLY IN ORGANIZATIONS In general the scope of the purchasing function goes far beyond the activities of the purchasing department. In many companies, buyers buy various goods and services, therefore many other departments within the company are actively engaged in buying product and services. Limiting us to the role of the purchasing department in the 9 University of Ghana http://ugspace.ug.edu.gh purchasing process, one realises that this role varies from company to company and situation to situation. According to Lyson (1994), the purchasing roles in an organization can be grouped into three main categories. a. Organizational Roles i. Decision making which is often realised through purchasing’s involvement in strategic long term decisions, ii. Purchasing also contributes to the profitability of the organization by adding value as part of the value chain, iii. Purchasing also contributes to the design of organization structures through the centralisation of functions to obtain economies of scale, iv. Purchasing as an integrated activity has the role of showing its information and expertise with other links in the supply chain especially design, production and marketing, v. Purchasing as an integrated function also has the role of demonstrating professionalism with respect to expertise and service, b. Supplier Roles i. Purchasing’s role in organizations also entails the establishment of mutual relationships with suppliers through partnerships to achieve cost reduction and quality. ii. Purchasing also conducts negotiation to reconcile the views of suppliers’ staff and colleagues in the business area. iii. Purchasing also has the role of locating suppliers both local and national to supply goods and services required by the buyers’ organization. 10 University of Ghana http://ugspace.ug.edu.gh c. Operational Roles i. Communicate effectively with suppliers to reach favourable terms of business also forms part of the roles of purchasing; and ii. Lastly, but not the least, purchasing has the role of managing and controlling inventory where appropriate production line. 1.2.4 RESPONSIBILITIES OF PURCHASING AND SUPPLY PROFESSIONALS IN AN ORGANIZATION • Purpose In order for the company to maintain its position of leadership, it is imperative that we continually strive to balance cost, delivery and quality, in every area of our business operation as stated in the Policy And Procedure Manual for Purchasing and Material Control (1992). Materials and service acquisition cost account for substantial amount of operating cost and can provide an excellent opportunity for cost reduction and control. It is mandatory in purchasing that the responsibility for buying materials and services be assigned to a group of people skilled in negotiating, value analysis and other purchasing techniques. The primary responsibility of the provision for the purchase of materials, supplies and service is the objective that they will be available at the TIME, PLACE, QUANTITY, QUALITY AND PRICE consistent with the needs of the organization. • Scope It is of great importance that to realise that this policy applies to all purchases and purchase related documents prepared or for that matter processed within the organization. II University of Ghana http://ugspace.ug.edu.gh • Responsibilities These responsibilities among others can be seen in the following: 1. Those persons to whom authority has specifically been delegated by the Managing Directors or Chief Executives of their organizations are authorised to commit company or organizational funds for materials equipment, supplies and services, 2. The manager of purchasing and materials control has the responsibility for procurement of all goods and services, and to either provide the services for such procurement or give functional directions to others with delegated authority to perform such services, 3. Purchasing has the responsibility for obligating the company or organization and for making the final determination of sources of supply, quantity purchased delivery schedules and price negotiations, except where orders are so authorised by the manager of purchasing and materials control. These decisions will be made in conjunction with operation, marketing, inventory, accounting/finance and other departments. 4. All negotiations are to be handled by the appropriate purchasing personnel within their delegated authority, 5. Purchasing serves as the exclusive channel through which all requests regarding prices and products are handled. The purchasing department conducts all correspondence with suppliers involving prices or quotations. In cases where technical details are necessary, the user departments may correspond with suppliers regarding technical issues. In such cases, the purchasing department should be provided with copies of all such 12 University of Ghana http://ugspace.ug.edu.gh correspondence. Close communication and co-ordination between purchasing and the user departments must also be established, 6. Purchasing department is responsible for initiating and maintaining effective and professional relationships with suppliers, actual and potential, 7. All employees involved in purchasing activities will work to maintain and enhance their organization’s image by their personal conduct and method of doing business, 8. When suppliers’ sales representatives make personal sales calls, they are to be directed to call on the appropriate buyer at the time, 9. Purchasing personnel are to inform requesting departments whenever the quantity or specifications of materials requested are inconsistent with sound purchasing practices or market conditions, 10. Purchasing personnel are to seek to obtain and purchase all goods at the lowest possible total end-use cost, considering the guidelines of prices, service quality and delivery. 11. All employees engaged in purchasing activities will recognise and practice good public relations by all callers and visitors and treat visitors courteously. 12. Supplier selection and product purchased are to meet the basic policies and standard practices of the company; 13. Purchasing personnel will work to establish and encourage punctual delivery of specified goods and services in correct quantities. 14. The manager of purchasing and material control is to assume full authority to question the quality and kind of material asked for, in order that the best interest of the company may be served, 13 University of Ghana http://ugspace.ug.edu.gh 15. Purchasing personnel will negotiate the return of rejected equipment of supplies to suppliers; and 16. The manager of purchasing and materials control is to advise management of economic conditions and changes significant to the company long and short­ term interests. 1.3 THE PURPOSE OF THF STUDY The purpose of undertaking this study was to examine purchasing and stores management practices of some public hospitals in relation to professional standard of practice to identify areas where the private and public hospitals fell short and to offer recommendations and suggestions more suitable in rectifying problems associated with public hospital procurement and stores management systems. These recommendations if adhered to and properly implemented would reduce cost and inefficiencies, which were associated with the procurement and stores management practices of public and private hospitals. The procurement and stores management system of two private hospitals will also be examined for the purpose of comparison. 1.4 PROBLEM STATEMENT Every organisation, be it public or private depends on materials and services to enhance its operations. Material requirements are either in their raw form, which are used as inputs in the manufacturing production process or finished products, which are used as consumables in the running of the organisation. To ensure continuity of operations, organizations require a systematic and regular supplies of materials which must be purchased and stocked to be issued out when the need arises (Dery, 1996). Purchasing or procurement is therefore one of the basic and most important function of every organisation. Indeed organisations cannot operate effectively and successfully without materials, supplies and equipment. It is therefore often not 14 University of Ghana http://ugspace.ug.edu.gh surprising that, in almost all organizations over 50% of total budget allocation usually go into the procurement of materials, supplies and services (Lokko, 1994). This is especially common with manufacturing firms where revenues of these firms are derived from the sale of manufactured products. The ability of purchasing or procurement department to achieve its objective of ensuring continuity of supplies depends on how the function is professionally handled. As remarked by Lokko (1994), procurement is a professional game and must be played by professional players. The importance of a well-trained procurement manager can therefore not be over emphasised. Lokko (1994) in his study of procurement system of Volta River Authority (V.R.A.) revealed that the effectiveness and efficiency of the procurement system of the authority depended on the quality of the human resource assigned to the materials department. Top management turns to give attention to procurement and the importance of the procurement function is well understood by top management in the organisation. Most public health institutions in Ghana do not have well qualified personnel to manage the procurement and stores function to achieve their objective of ensuring the continuous availability of materials, consumables and equipment needed to enhance effective health care delivery. (Mensah, 1999) Most of the purchasing and store staff currently working in most of the public hospitals are not professionally trained. The research findings of Mensah (1999) revealed that the highest educational qualification of most supply officers who are directly responsible for most procurement activities is G.C.E. ordinary level, while about 85% of stores staff had only Middle School Leaving Certificates (M.S.L.C.). The study also revealed that the only opportunity for staff development of stores and procurement staff was for them to receive short refresher course just before promotion 15 University of Ghana http://ugspace.ug.edu.gh exams which could be three or four years interval. The opportunity for furtherance of course at the university, polytechnic and any other institutions of higher learning was non-existing. With the increasing competition at the market place, and the globalisation and the challenges posed by the world economic order, the proper management of purchasing and stores function requires personnel with academic qualification not less than Higher National Diploma in Purchasing and Supply or Graduate Diploma, awarded by the Chartered Institute of Purchasing and Supply (U.K.). The ability of purchasing and supply management staff to perform their functions effectively to affect the smooth running of their respective organizations depends on the status given to the department in the organisation’s organogram (Lokko, 1994). Most public hospitals in Ghana do not have purchasing department but have stores. Mensah (1999) revealed that most of the public hospitals in the Western region of Ghana do not have separate department responsible for procurement. Non­ procurement professionals who do not use workable strategies in sourcing for materials and relating effectively with suppliers therefore perform the function. Mensah (1999) further observed that, in most of the public hospitals, procurement committees consisting usually of the following perform the procurement function: (a) The medical superintendent in charge of the hospital (b) The Hospital Administrator (c) The Accountant (d) The Principal Nursing Officer (e) The Pharmacist in charge (f) One Medical Doctor from the clinical unit. (g) The Storekeeper. 16 University of Ghana http://ugspace.ug.edu.gh The medical superintendent is the chairman of the committee with the Hospital Administrator as the Secretary. The Storekeeper or (where there is a supply officer), is an ordinary member of the committee. One aspect of the committee system is that, although some of the members of the committee have first and doctorate degrees, they practice fidly in their various areas of specialisation and hence do have professional training in purchasing and stores management to exhibit sound proficiency on the procurement committee. Inventory management is a very important tool in stores management. Through proper inventory management organizations are able to ensure that the firm’s investment in stock is reduced to the minimum while stock out situations, obsolescence, and redundancy are reduced to the bearest minimum and at the same time maintaining high service level ( Jessop and Morrison, 1994). Proper inventory management seems to be lacking in most of the public hospitals in Ghana. A study conducted in Western Region about how the hospitals in the region are managing their stores revealed that most of the hospitals did not have clear cut stock control policies (Mensah, 1999). Although maximum, minimum and re-order stock levels were located on their tally cards, they were not in use and orders were made as and when needed without taking to account the stock control policy. There was absence of forecasting or projected future demands in the stores department. The only guide used for this purpose was the quarterly budget (and in some cases yearly) drawn by Health Services Administrators in running their respective hospitals. As a result of lack of clear stock control policies, most of these hospitals purchased their requirement only when the items run out of stock. Most of these items were bought under certificate of emergency, which almost invariably resulted in higher prices. 17 University of Ghana http://ugspace.ug.edu.gh For the efficient management of stores, adequate storage facilities should be provided at all the stores locations. These storage areas should be large enough and well equipped enough to permit a suitable arrangement of all supplies and to protect them from damage. Storage areas must be clean, organised and well lighted (Jessop and Morrison, 1994). Most public hospitals do not have adequate storage facilities to protect the stores against theft, obsolescence and redundancies. Mensah-Narh (1987), in his study of storage system of Ridge Hospital, revealed that the hospital did not have adequate storage facilities. The store was bursting at it beams of roof and that did not comply with storekeeping regulations regarding proper storage which helps to prevent deterioration, obsolescence and unintentional hoarding of supplies. This does not augur well for quality care and has other cost implications as well. One major flaw of stores management of public hospitals is the monitoring of supplies after they have been issued to the user departments or internal customers. In most of the public hospitals no mechanism exist to monitor the usage of the supplies after they have been issued to the user departments. As a result of lack of monitoring, some of the supplies find their way in the homes of the officers in charge of wards and other heads of departments. The supplies are sometimes misused since the wards in charges do not account for their usage. As revealed by Mensah-Narh (1987) in his study at the Ridge Hospital, even though all requisitions for stores were to be approved before the storekeeper issued out supplies, no effective measures were taken to find out how such supplies were used. As a result, when fresh requisitions were made, the Stores Officer only used his discretion to issue supplies. One factor necessary for the smooth operation of any organisation activities is on adequate number of qualified personnel capable of carrying out established plans, procedures and practices in efficient manner. Mensah-Narh (1987) further revealed 18 University of Ghana http://ugspace.ug.edu.gh that at Ridge Hospital where he conducted his study, there were only two people responsible for the management of the stores. The resultant effect of this problem was that one person did both the authorisation, issue and record keeping functions. This does not provide any control measure; incidentally, it was not peculiar to Ridge Hospital alone. In most of the District Hospitals in Ghana, there is only one Stores Officer who is responsible for procurement and all functions relating to stores keeping. Duties must be arranged so as to be complementary. The work of one person must be subject to automatic check by the work of another. Errors are bound to occur and the probability of fraud cannot be ruled out. Disposal of redundant, obsolescent, scraps and unusable store by sales serves as a potentially valuable source of income for most organizations (Jessop and Morrison, 1994). In addition to being a valuable source of revenue, disposal of unusable items helps to reduce the firms capital investment represented by inventory. Additionally, clearing the storehouse helps to make space available for other important items. Also, it reduces cost of storage such as electricity, labour, insurance, personnel, etc. Despite the benefits inherent in the disposal of unusable stores by sales, most of the public hospitals have heaps of these items in their storehouses and stockyards and are least prepared to dispose them off by sale. The reason cited for the lack of preparedness to dispose of the unusable items by sale was that the Stores Inspectorate and Audit Service rules for the sale of unserviceable goods are very complicated that sometimes management at the hospital prefer to let items rot, rather than to go through bureaucratic process to get the items auctioned (Mensah-Narh, 1987). 19 University of Ghana http://ugspace.ug.edu.gh 1.5 OBJECTIVES OF THE STUDY The objectives of this study were as follows: 1. To examine the purchasing and stores management practices of some selected private and public hospitals in relation to professional standard of practice. 2. To assess the status of purchasing and stores management in public and private hospitals. 3. To find out whether public and private hospitals have the requisite staff to manage the procurement and stores functions. 4. To find out problems facing the public hospitals in the area of purchasing and stores management. 5. To observe measures put in place at the storehouses to protect stores against theft, fire and other hazards. 6. To find out training and development programmes available for purchasing and stores management staff. 7. To suggest appropriate ways for improvement. 1.6 SIGNIFICANCE OF THE STUDY The study examined the purchasing and stores management practices of public and private hospitals in relation to professional standards of practice to identify areas where public hospitals were not doing well so that recommendations could be made as to how best to manage the function to achieve cost savings in procurement and stores management. Although this study is an academic exercise, the findings and recommendations can be of great benefit to students, government institutions and policy makers. It is the researcher’s view that the results would be beneficial to the academia — university 20 University of Ghana http://ugspace.ug.edu.gh community, in the sense that it would contribute to the existing works and knowledge on purchasing and stores management in public and private hospitals in Ghana. It is also hoped that procurement and supply chain practitioners, policy makers and importantly the Ministry of Health (MOH) would appreciate the information contained in this work to improve the purchasing and stores management functions. Last but not the least, this work served as a foundation stone upon which further studies could be undertaken in purchasing and stores management as management tool. 1.7. Research Question The major research question that the study intended to answer was whether purchasing and stores management practices of the selected public and private hospitals were consistent with professionally accepted practices using some indicators as outlined in the research methodology. 1.8. SCOPE AND LIMITATIONS The scope of the study covered the procurement and stores management of some selected public and private hospitals. The study in each hospital covered purchase initiation up to the issue of supplies to wards or user departments. The study also covered the assessment of availability of qualified staff to man the various areas of supply chain functions, availability of training and development programmes for stores and purchasing staff and the status of the purchasing and stores management in the hospitals. In an attempt to do these, the researcher had to work within certain limitations. A major one was the difficulty in obtaining research materials including proper receiving records covering the various dimensions of stores management. This is one problem faced by most government hospitals. 21 University of Ghana http://ugspace.ug.edu.gh Some of the respondents were also skeptical about the purpose of the study and this adversely affected this study since such people were reluctant to give the needed information. To address these problems, the researcher had to confine himself to the few available records and rely more on observation and records inspection. Next, funds, manpower, time and logistical constraints limited the scope of the study in terms of the data collected and the depth of analysis made. In spite of these drawbacks, it is hoped that the work would contribute in some way to the understanding of procurement and stores management practices in public and private hospitals and the way in which the implementation of standard practice of purchasing and stores management can make the function efficient. 1.10. ORGANIZATION OF THE STUDY The study was organized as follows: 1. Chapter One - This Chapter dealt with introduction to the background of the study, problem statement, objectives of the study, significance of the study, research question and limitation of the study. 2. Chapter Two - This chapter dealt with review of existing literature on the topic and theoretical perspective. 3. Chapter Three - Focused on research on Methodology issues considered here included research, design data collection methods, data analysis methods, and background of the selected hospitals and others. 4. Chapter Four - Focused on data presentation, analysis and findings. 5. Chapter Five - Summary, conclusion and recommendations of the study. 22 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO LITERATURE REVIEW 2.1. DEFINITION OF CONCEPTS PURCHASING Lyson (1990) defined organization purchasing “as that function responsible for obtaining by purchase, lease or other legal means, equipment, materials, supplies and services required by an undertaking for use in production” (P.l). In this definition, the term production as used by the writer is used in the economic sense of creating utilities, that is, goods and services that satisfy wants. It is not, therefore, confined to manufacturing output but also applies to servicing, distributing, etc. in organizations. The Oxford Advanced Dictionary (1998)defined procurement as “obtaining especially with care or effort,” and according to the Longman Dictionary, “it is a formal way of obtaining especially with effort or careful attention.” Also, purchasing has been defined by Fearon et al (1996) as a “function which constitutes the body of integrated activity that focuses on the procurement of materials, supplies and services need to reach organizational goal” (P.2). Weele (1992) provide a classic definition of the Procurement function as to “obtain materials of the right quality in the right quantity from the right source delivered to the right place at the right time at the right price. (P.2) Weele (1992) also defined purchasing as “obtaining from external source all goods and services which are necessary for running, maintaining and managing the company’s primary and support activities at the most favourable conditions” (P.4). As a way of summary, purchasing can simply be defined as the process by which an organization obtains materials, services and equipment needed to carry out its activities in order to achieve its objectives or goals. 23 University of Ghana http://ugspace.ug.edu.gh STORES MANAGEMENT Carter and Price (1993) defined stores as an area within organization where all kinds of materials needed for production, distribution, maintenance, packaging, etc. are received, stored, and issued. The stores function is therefore basically concerned with holding stocks, but stores management covers a great deal more than holding stocks. It covers the following activities: (a) Holding, controlling and issuing stocks (b) Control of all storehouse, stockyards and outside storage (c) Materials handling functions (d) Quality control activities (e) Training of stores staff (f) Clerical administration of stores operations. The Institute of Materials Management defined stores management as “the management process which integrates the flow of supplies into, through and out of an organization to achieve a level of service which ensures that the right materials are available at the right place at the right time, of the right quantity and quality and at the right cost (pp3 and 4). It includes the functions of procurement, supplies handling and storage, production and inventory control, packaging and associated information systems and their application throughout the supply and distribution sectors. Stores management thus further encompasses all the co-ordinated functions responsible for planning, acquisition, storage, movement, control and monitoring of supplies to optimise the usage facilities, personnel, capital funds and to provide customer service in line with organizational goals. The planning function involves the preparation of budgets and standardisation of specifications. 24 University of Ghana http://ugspace.ug.edu.gh Stores location, stores classification, coding and cataloguing, receipt of purchased items, inspection, storage or returns, protection of stores, issue of supplies to user departments, provision of cost data, stock records, disposal of obsolete, surplus or scrap material are the activities that comes under the storage function. The distribution and monitoring of stores involve the determination of the procedures and process of distributing supplies to the various user departments within the hospitals and the monitoring of how such items are being used. Stock control or inventory management involves the determination of stock levels (i.e. the minimum, re-order and maximum levels) and the quantity of stores to be brought at a time. PUBLIC HOSPITALS For the purpose of this study, public hospitals include all hospitals that are financed from the consolidated fund and donor supports collected by the government. They include teaching hospitals (e.g. Korle-bu Teaching Hospital and Komfo Anokye Teaching Hospital), Regional Hospitals (e.g. Effia Nkwanta Regional Hospital, Cape Coast Regional Hospital, Koforidua Central Hospital), District Hospitals (e.g. Kyebi District Hospital, Suhum District Hospital, and Tarkwa District Hospital). PRIVATE HOSPITALS Private Hospitals in Ghana can be broadly divided into three as follows: a. Private for profit b. Charitable Hospitals (Mission Hospitals) c. Those established by companies and organizations to cater for the health needs of their staff and dependants. 1. Private for profit - These are hospitals which are established with the aim of providing health care for profit and also complement government effort in 25 University of Ghana http://ugspace.ug.edu.gh providing health care services for Ghanaians. Examples of these hospitals include Nyaho Clinic, Women’s Clinic, etc. 2. Charitable Hospitals (Mission Hospitals) - These are hospitals established by church missions to complement government efforts in providing health care services for Ghanaians. Examples include Iran Clinic operated by the People’s Republic of Iran and various Catholic, Methodist and Presbyterian Hospitals spread over the country. 3 Industrial Hospitals Hospitals established by industrial concerns to cater for the health needs of their staff and dependants. Examples include Ashanti Goldfields Company Hospital, Trust Hospital, Volta River Authority Hospital, Valeo Hospital, Ghana Manganese Corporation Hospital at Nsuta and others. 2.2 PROCUREMENT AS A MEANS OF COST REDUCTION AND INCREASE CORPORATE PROFITABILITY Lokko (1994) emphasised that interest in procurement within organizations has increased in recent years and at least two reasons can be mentioned for this. a. Procurement’s share of a company’s turnover is usually large and so any improvement in procurement will substantially contribute to the profitability of the company. b. The introduction and implementation of the total logistics management concept is quite recent. Optimum adjustment of the in flow of goods to the requirements of the company will lead to a minimization of the cost of procurement and rejection of goods required for the production or sales process, or rendering of services. 26 University of Ghana http://ugspace.ug.edu.gh Reduction of operational costs is a key issue to any organization. Most companies, according to Lokko (1994), respond to this issue by: a. Finding further ways of reducing manpower cost either by introducing automation or contracting out certain activities which are not considered part of the core activities of the business such as security, clearing, cleaning, maintenance, transportation, and advertising. b. Review or reduce the number of facilities required to run the business. c. Introduce new technology to change the way products are made or the services are provided. d. Review of other operational costs. But Lokko (1994) contends that the issue of cost reduction can also be effectively tackled from the procurement angle. It is almost as though executives believe that purchase costs are inevitable, a function of market prices and there is not much one can do. But something can be done to achieve cost reduction through procurement. The example below is cited to buttress this point. For instance, through effective procurement activities, the Ghana Supply Commission has been able to save huge amounts of money for the nation in general. In 1983, the Ministry of Roads and Highways was to spend $2,928,445 on 43 Bailey bridges. When the Supply Commission processed the indent through the tender system, savings of $1,091,529.71 were made. This money was used in buying 11 more bridges of different sizes for the Ministry. In 1983 the Ghana Civil Aviation Authority was to utilize a £2.5m E.C.G.D. credit facility to purchase communication equipment for the Kotoka International Airport. The Commission was however able to procure enough 27 University of Ghana http://ugspace.ug.edu.gh equipment with the same amount of money for the Kumasi, Tamale and Sunyani Airports when tendering was used. Another example of the advantages of efficient procurement processes is when in 1984, the Commission was again able to make a savings of 018,459,145.90 which was used to procure stationery for the Ministry of Finance and Economic Planning. The original cost estimate by the Ministry had been 022,522,500 but was procured by the commission at 04,063,354. In general, the Supply Commission was able to make a saving of over 02.5b in 1992 on various procurement activities for the government of Ghana. (A paper delivered by a staff of Ghana Supply Commission during the annual conference of the institute of purchasing and supply on the topic “ the strategic role of procurement as aid to economic development.) Lokko (1994), in his study of procurement strategies of Volta River Authority (V.R.A.) revealed that 01,000,000 savings made by the materials management department reflected in the profit and loss statement as a profit. However, if the company sold 01,000,000 worth of electrical power, the contribution to profit would be less. Lokko further revealed that, even though the materials Management Department of the V.R.A. could not come out with clear cut figures, a lot of cost was slashed through: 1. The evaluation and tendering technique The right purchasing techniques and policies such as competitive bidding, a good vendor base, the use of a tender evaluation system and controls such as signing authorities, went a long way to illustrate the efficiency of the materials management department of V.R.A. when compared to other corporations. 28 University of Ghana http://ugspace.ug.edu.gh 2. Transportation and cost reduction - Transport services was purchased with much caution as any materials or services were purchased. The shipping unit of the materials management department was responsible for creating strategies for procuring transport services, arranging shipping terms, identifying and conducting transportation cost reduction project. The unit achieved cost reduction by the use of: i. Cost savings multi-modal arrangements with its shipping agents and freight forwarders. ii. Commodity rates - this is possible because shipments are repetitive and relatively large. These rates are obtained from the carrier. iii. Arranging special handling and packaging costs for fragile or unusual items. This cost was borne by the carrier at a much minimal cost. 3. The sale of surplus items - Surplus is usually associated with mistakes in over procurement, wasteful production processes and inefficiencies in general. It therefore turns to rarely receive the attention of management. This should not be the case because profits are maximized only when elements affecting cost are fully controlled. At VRA, all surplus items were sold to workers first where this was possible and the rest were sold to the public. This aided in the prevention of over stocking. It also reduced depreciation and tax expenses. Hence, according to Lokko (1994), the task of the Disposal supervisor is to ensure that surpluses are disposed of with optimum profitability. 29 University of Ghana http://ugspace.ug.edu.gh 4. Efficient Inventory Management The materials management department saved cost through the use of a well planned, controlled and efficient inventory policy. By controlling and regulating its block levels, the department cuts down cost on: i. Storage costs, and ii. Insurance costs - An additional stock of 050,000 for instance, would have been an additional asset on which premium must be paid. The effects of poor inventory control management is unfortunately not directly visible on the operating statement as a composite cost of inventory management. Nevertheless, this indirect cost, dispersed and hidden throughout the operating statement can have significant impact on profit. The responsibility of inventory management should therefore lie with top management that should carefully formulate and periodically review the basic policies and operating plans that constitute the framework within the inventory control operation functions. This is practiced by the VRA and is reflected in its organizational structure, with the head of the department being raised to the level of a Director. 2.3. PURCHASING. STORES MANAGEMENT AND FRAUD Purchasing of materials and services and stores management areas are where cost savings should be made. But in Ghana as far as public hospitals are concerned, purchasing and stores management area has been identified as the number one area of fraud and corruption. Mr. Brian Sapati, Acting Executive Director of Serious Fraud Office, disclosed this when presenting the annual report of his department for 1999.(Annual Report S.F.O. 1999) 30 University of Ghana http://ugspace.ug.edu.gh Mylton (2000) observed that purchasers could play a huge part in fighting fraud. He said that the purchasing profession can contribute to fraud prevention or reduction by controlling supply chain and supplier selection process, as well as separating tasks and policing staff. Sherwin (2000) partner in consultancy, Enest and Young’s Fraud Investigation Department and a co-ordinator of the survey, “Fraud - the unmanaged Risk”, said 60 per cent of 739 respondents world wide have suffered at least one case of fraud in the past. “Companies have to look at how buyers are monitored and how robust the controls are”, he added. The survey found that 43 companies including 12 in the U.K. had suffered more than fifty (50) cases of fraud in the past year and incurred losses of more than £625,000. Almost half of the cases involving firms in 23 sectors, concerned banking and financial services. According to Bryle (2000), there are a number of basic controls that can be introduced to supply chain processes that can help to reduce fraud risk. She mentioned in particular the segregation of duties especially between processing and paying of invoices. Bryle (2000), emphasised the importance of controls when selecting suppliers. She said “relationships between buyers and suppliers must be policed and staff should declare gifts. The survey found that large firms were more likely to employ certain fraud controls, such as hotlines for reporting suspected cases, awareness training and a clear policy on fraud. “The bottom line is that companies must educate people about fraud, said Peter Connor, Director of Corporate Investigations at Business Intelligence Firm is Risk Advising Group. 31 University of Ghana http://ugspace.ug.edu.gh 2.4. PROBLEMS IN PURCHASING AND STORES MANAGEMENT In December 1978, an adhoc group of experts convened by UNCTAD in Geneva listed the following constraints to improving efficiency in procurement with special regard to least developed countries. 1. First and foremost, lack of suitably trained personnel, under utilization of existing staff and unsatisfactory working conditions in the procurement function resulting in low morale. 2. High cost of freight, insurance and other services related to imports. 3. Unfavourable prices due primarily to small sizes of orders, and the monopolistic position afforded to suppliers through the existence of narrow trading channels. 4. Inadequate or outmoded government procurement regulations. 5. Increased “landed cost” due to port congestion, insufficient transport capacity and for land locked country delays and cost in transit movements. The group noted that if some of these constraints could be removed and procurement efficiency improved for instance by 5%, the resulting reduction in an import bill amounting to 20% of a country’s G.D.P. would be equivalent to a 1% increase in G.D.P. The group also pointed to the fact that better procurement would save money immediately, while the benefits of export promotion schemes generally take a long time to materialise. Purchasing today is still deeply surrounded by about the same troubles that appear in different forms and in different parts of the procurement process and its support services. These include inadequate qualified personnel, low status given to the procurement and stores management in most hospitals, lack of 32 University of Ghana http://ugspace.ug.edu.gh transparency in the procurement function, attempt by other professionals such as accountants to take over the procurement function (Mensah 1999). 2.5. ATTEMPTS BY MINISTRY OF HEALTH TO ADDRESS SOME OF THE PROBLEMS ASSOCIATED WITH PURCHASING AND STORES MANAGEMENT IN PUBLIC HEALTH INSTITUTIONS As a standard measure of combating malpractice in the supply contracts in government hospitals and enhancing health delivery in Ghana, the past Minister of Health, Honourable Samuel Nuamah Donkor, in the Wednesday 16th June, 1999, edition of the “Daily Graphic” stated the Ministry of Health new procurement methods for the supply of items. Mr. Nuamah Donkor further announced the formulated national procurement plans to serve as the basics for centralised procurement and supply of medical items to all government hospital in the country , as follows: 1. All public hospitals including Teaching and Regional Hospitals would be required to submit to the Ministry of Health (MOH) at the beginning of each year, their annual procurement plans which would include requirement of drugs and non drug items. 2. All inputs from the hospital as well as from others to be added to the list would be synthesised and merged to constitute the national procurement plans. 3. After this, an international competitive bidding system in which both local and foreign companies would be eligible to participate, would then be set in motion to select competent companies that can supply the required medical suppliers on time and at the lowest possible cost without sacrificing quality. 4. Such competitive bidding should normally take place and be completed for the procurement to be made for the hospital within the next quarter of the year. 33 University of Ghana http://ugspace.ug.edu.gh 5. Companies participating in the competitive bidding would, among other things be required to submit to the Ministry, copies of their performance bonds as well as samples of the items they intend to supply. 6. Such samples would then be taken through technical valuation by a committee of experts, comprising end users like surgeons, physicians, pharmacists, gynaecologists, ophthalmologists, nurses and others to ascertain their reliability and usefulness before any commitment is made to any supplier by the ministry. 7. The implementation and administrative steps will be taken by the ministry to ensure that bid winners supply directly to the respective hospitals to avoid over centralisation and concentration of supplies at the centre. 8. The institutionalisation of adequate checks to closely monitor such supplies to ensure that they conform with samples already evaluated and accepted. According to the Minister, it is generally believed that the above procurement strategies and policies would be aimed at ensuring the prevalence at all health institutions of uniform prices of drugs and other medical items to protect the people as opposed to the situation in which possibilities exist for imposition of varied and higher prices to the detriment of those seeking medical care in Ghana. 2.6. PROCUREMENT ORGANISATION AND MANAGEMENT IN MINISTRY OF HEALTH In addition to the strategies outlined above by the Ministry of Health to strengthen the procurement and stores management system within the ministry, a procurement procedure manual has been developed. The procedure manual was developed as part of the five year Medium Term Health Sector Strategy (MTHS), 1997 to 2001, for Ghana that identified procurement as one of the key areas for capacity building. The 34 University of Ghana http://ugspace.ug.edu.gh MTHS is based on a sector wide approach where financing will be channeled through a common fund, the health account. It has been planned to organize procurement under specific Ministry of Health (MOH) procedures. The most important aspect of the procurement reforms is the establishment of procurement unit within the Ministry. The procurement procedure manual also covers procurement of works and services. The manual stipulates how procurement should be organized at the national, regional, districts and hospital levels. National Level The newly established Procurement Unit (PU) which falls under the Stores, Supplies and Drug Management Division (S.S.D.M.) of Ministry of Health. Organisation Structure for procurement and supplies in Ministry of Health, Ghana STRUCTURE OF SUPPLY. STORES AND DRUGS MANAGEMENT DIVISION OF MINISTRY OF HEALTH GHANA 35 University of Ghana http://ugspace.ug.edu.gh S. S. D. M - Stores, supplies and Drug management The S.S.D.M. has the following objectives: 1. To establish the timely procurement of all consumable goods for the public health sector in optimal quantity, in the best possible quality and at the most competitive price. 2. To establish good storage and distribution system(s) for all goods with appropriate linkages with the procurement systems. 3. To establish, together with the Health Administration and Support Services (HASS) Human Resource Development Division (HRDD) and Policy, Planning, Management and Evaluation Division (PPME) the timely procurement and distribution of all equipment, works and services for the public health sector in optional quantity, in the best possible quality and at the most competitive price. 4. Together with other divisions to establish the timely mobilization of funding for procurement, clearing and distribution. 5. To establish a good management system for the cost recovery schemes. The supplies, stores and drugs management division has the overall responsibility for the Supply systems in the Public Health Sector, including procurement. The SSDM supervises guidance for the executive functions of storage and distribution delegated to the Central Medical Stores (CMS) and Procurement delegated to the Procurement Unit (PU) as well as to the lower levels. The main tasks of Procurement Unit, related to the above mentioned objectives are to: • Maintain and update the procurement procedures, including Standard Bidding Documents (SBDs). • Execute procurement on a national level, including 36 University of Ghana http://ugspace.ug.edu.gh - Preparation, implementation and monitoring of procurement plans Options appraisal of capital projects Preparation of bidding documents using standard bidding documents. Launching of tenders Evaluation of tenders - Facilitating Logistics e.g. clearing of goods - Monitoring contracts • Manage procurement through procurement agencies (including UN - agencies); • Co-ordinate emergency procurement and donations. • Provide training and supervise procurement at regional and district levels; • Advise on all procurement issues • Make necessary preparations for the MOH procurement committee; • Report to the auditor for post procurement review; and • Report to Director, S.S.D.M. The Procurement Unit reports to the Director S.S.D.M. and also assists the Director S.S.D.M. in his work in the Ministry of Health Procurement Committee that bears the end- responsibility for all procurement on behalf of MOH. The tasks of the MOH-Procurement Committee, which has the overall supervision of the procurement in Ministry of Health, are to: 1. approve the yearly procurement plan, 2. endorse every intended purchase beforehand, in or outside, the approved procurement plan; 3. endorse the Tender Documents (National and Regional level) 4. head the bid opening of tenders; 5. if applicable, give instructions on negotiations; and 37 University of Ghana http://ugspace.ug.edu.gh 6. make decisions on award/orders based on the Recommendations of Award or Proposals for orders/contracts. The MOH Procurement Committee consists of all the directors of the various divisions as members with Minister of Health as Chairman and Director of Supplies, Stores and Drugs Management as the Secretary. The Director of SSDM is assisted in his work by the Head of Procurement Unit. Regional and District Level The responsibility for procurement at the regional and district level lies with the Regional and District Health Administrations. Specific MOH Procedures for the procurement of goods have been described in the Financial Handbook of 1996 and Rules and Instructions for Accounting, Treasury and Financial Reporting of 1998 (ATF), both issued by MOH with the consent of the Ministry of Finance. The A.T.F. contains the ruling instructions for the Budget Management Centres (B.M.C.). However, it is the Financial Handbook that describes procurement more extensively including, for example, the role of procurement Committees. The following instructions have been extracted from the Financial Handbook. At all levels procurement committees will be formed. The procurement committees of Regional Health Administrations comprise (at least) the following members: • Regional Director of Health Services • Regional Health Services Administrator • Regional Accountant • Regional Supply Officer • Regional Pharmacist (is deputy Director of Pharmaceutical Services. The procurement committees of the hospital comprise (at least) the following members: • Medical Superintendent in charge • Hospital Administrator 38 University of Ghana http://ugspace.ug.edu.gh • Hospital Accountant • Hospital Supply Officer • Hospital Pharmacist The procurement committees of training institutions comprise (at least) the following members: • Principal • Representative of teaching staff • Accountant • Supply Officer • Hostel Warden The Procurement committees of the District Health Administrations comprise (at least) • District Director of Health Services • Accountant • Two other members of the District Health Management Team. Procurement Officer Another area covered by the Procurement Manual is the appointment of Supply or Procurement officer. The document emphasized that every health institution should appoint procurement or supply officer to execute the procurement function. The manual states that purchasing/procurement/supply officer should not have any storekeeping functions to ensure segregation of duties and internal control. Duties of Procurement Officer 1. Preparation of procurement plan 2. Sourcing items by using procurement methods 3. Evaluation of quotations 4. Contracting out services and works 39 University of Ghana http://ugspace.ug.edu.gh 5. Preparation and submission of annual report on the departmental activities Qualification for appointment as Supply Officer To qualify to be appointed as a procurement officer, the manual provides that the one must have one of the following: 1. First Degree Holder 2. HND in Purchasing and Supply 3. In-service Training in Standard operating procedures for procurement in Ministry of Health10. 2.7. THEORETICAL PERSPECTIVE THE PURCHASING (CYCLE) PROCESS 1. Purchase Requisition Purchasing process is initiated when Stores Department or the ultimate user department issues purchase requisition. In the Materials Requirement Planing (MRP) environment the planner releases a planned order authorising the purchasing department to go ahead and process a purchase order; 2. Purchase Order Specifications During this stage of the purchasing process, the purchasing requirements are determined and the company is also faced with the ‘make or buy’ question. It has to determine which products or activities will be produced or performed by the company itself and which products or activities will be contracted out. This contracting out issue starts by drawing up a specification of these items that will be purchased and consists of the following stages: a. Drawing up of functional specification. This describes the functions that the product must fulfil for the user. The advantages of such a specification as Weele (1997) puts it are: 40 University of Ghana http://ugspace.ug.edu.gh i. Potential suppliers are given the best possible opportunity to contribute their expertise. ii. New technologies can be used, technologies that the buyer is not familiar with; iii. It creates one standard, against which all concepts can be evaluated. b. Develop a ‘detailed technical specification’. This describes the technical properties and characteristics of the product. c. Define “logistic and maintenance specifications”. These describe how the product should be delivered, the conditions in which the product will be processed and requirements concerning maintenance and after sales service. 3. Supplier Selection After the purchasing requirements have been defined and described in the specifications, the buyer can start his market exploration. Identifying and selecting suppliers is a major responsibility of the purchasing department. When drawing up the technical specifications, the practical feasibility and costs are estimated. The extent of the market search and supplier evaluation will depend on the items to be purchased, whether the items have been bought before or not. In this direction, Robinson et al (1967) describes three buying situations as follows: i. Straight re buy - where repetitive purchasing of similar items is carried out from the same supplier; ii. Modified re buy - where the purchase is modified in some way, for example a revised specification is applicable; 41 University of Ghana http://ugspace.ug.edu.gh iii. New task - where no purchasing experience exists in respect of the particular item to be bought. For a new task buying situation the supplier evaluation criteria is a bit complex and sometimes demands visiting the potential suppliers to assess their ability to carry out the contract if they are awarded the contract. In this direction, Lyson (1990) recommended two main ways of evaluating suppliers. These are: a. Desk research - using published or unpublished data already in existence. Examples include company reports, balance sheet, strike records and others Desk research is undertaken to evaluate the financial position of a prospective supplier to find out whether she/he will be able to supply the items after the supply contract has been awarded. b. Field research - the purpose of this research is to obtain further data regarding the technical, production and managerial capabilities of a prospective supplier by a visit to his company. Field research is best undertaken on a team basis first to enable each member of the team to evaluate the supplier from a specialist view print; secondly, to share responsibility for the decision to approve or reject the supplier. Desk research should always precede field research. To facilitate the work of the appraisal team, checklist for supplier visit is prepared. Below is the checklist of areas, which warrants particular attention on visit to suppliers prepared by a sub-committee of the Institute of Purchasing and Supply. 42 University of Ghana http://ugspace.ug.edu.gh Personal attitudes: This area of the checklist asses the attitudes of the supplier’s company employees towards their work and this provides an indication of the likely quality of their outputs and service dependability. The state of morale will be evident from: i. An atmosphere of harmony or dissatisfaction among the production workers. ii. The degree of interest in customer service on the part of supervisory staff. iii. The degree of energy displayed and interest shown in getting things done. iv. The use of manpower - whether economical with everyone usefully busy or extravagant and costly with excess people doing little or nothing. Adequate and Care of Production Equipment Close observation of the equipment in a plant will indicate whether it is: i. Modem or antiquated; ii. Accurately maintained or obvious worn; iii. Well cared for by operators or dirty and neglected; iv. Of sufficient capacity to produce the quantities required; v. Of proper size or type to produce the buyer’s requirement; Technological know-how of supervisory personnel This segment of the checklist is intended to assess foremen, shop University of Ghana http://ugspace.ug.edu.gh superintendents and others to asses their technical knowledge and their control and improve operations or processes under their supervision. d. Means of Controlling Quality - Observation of the inspection methods will indicate their adequacy to ensure the specified quality of the product. Attention is given to the following: i. Whether the materials received are chemically analysed and physically checked. ii. Frequency of inspection during the production cycle. iii. Employment of such techniques as statistical quality control. iv. Available of statistical quality control. e. Housekeeping - A plant that is orderly and clean in its general appearance, indicates careful planning and control by management. Such a plant inspires confidence that its products will be produced with the same care and pride in their quality. The danger of breakdown, fire, or disasters will also be minimised with consequent increased assurance of continuity of supply. f. Competence of technical staff This segment is intended to assess design, research or laboratory staff knowledge of the latest materials, tools and processes relating to their products and on anticipated development in their industry. g. Competence of Management This segment is designed to appraise the executive personnel of the suppliers company. After the above exercise, some of the suppliers are selected and registered to form the supplier base of the institution. 44 University of Ghana http://ugspace.ug.edu.gh 4. Request for Quotation. For major items, it is usually desirable to issue a request for quotation. This is a written enquiry and is sent to enough registered suppliers to be sure competitive and reliable quotations are received. It should be noted that, this is different from a sales order. After the suppliers have completed and referred the quotations to the buyer, they are analysed for price, compliance to specification, terms and conditions of sales, delivery and payment terms. The quotations must be evaluated for technical suitability. The final choice is a compromise between technical factors and price. 5. Determining the Right Price This is a major responsibility of the purchasing department and is closely tied to the selection of suppliers. The purchasing department is responsible for price negotiation and will try to obtain the best price from the supplier. 6. Issuing A Purchase Order After the terms and conditions of the contract have been agreed and recorded, the order can be placed. A purchase order is a legal offer to purchase. Once accepted by the vendor, it becomes a legal contract for delivery of the goods according to the terms and conditions specified in the purchase agreement. The purchase order is prepared from the requisition or the quotation and from any other additional information needed. A copy is sent to the vendor, copies are retained by purchasing and are sent to other departments such as accounts, the originating department and receiving. 45 University of Ghana http://ugspace.ug.edu.gh 7. The Purchasing Agreement After bids have been received and evaluation done, the lowest evaluated bidder is selected, a contract will have to be drawn up. Depending on the industry, the contract may refer to specific additional terms and conditions. The technical content of the purchase agreement naturally depends on the product or project that is to be purchased. Specific commercial and legal terms and conditions will vary from contract to contract, differences being caused by purchasing policy, company culture, market situation, product characteristics, etc. Several important aspect of the purchase agreement also includes: price and delivery terms, terms of payment, penalty clauses and warranty conditions as well as other arrangements such as insurance and safety regulations, transfer of rights and obligations 8. Follow up and Delivery The supplier is responsible for delivering the items ordered on time. The purchasing department is responsible for ensuring that this is done. If there is any doubt that delivery dates can be met, purchasing must find out early enough so that corrective actions can be taken. This might involve expediting, transportation, alternative sources of supply, working with the vendor to solve his problems or rescheduling production. 9. Receiving and Accepting Goods When the goods are received, the receiving department inspects the goods to be sure that they are those ordered, are in right quantity and have not been damaged in transit. Using their copy of the purchase 46 University of Ghana http://ugspace.ug.edu.gh order and the bill of lading supplied by the carrier, the receiving department then accepts the goods and writes up a “receiving report” noting any variance. 10. Approval of Vendor’ s Invoice for Payment When the vendor’s invoice is received, there are three pieces of information that should agree: the purchase order, the receiving report and the invoice. The items and the quantities should be the same on all and the prices and extensions to price, should be the same on the purchase order and the invoice. All discounts and terms of the original purchase order must be checked against the invoice. Every step in the buying process must be executed carefully and systematically in order to provide the internal customer with what he/she needs: a product that is fit for its purpose, on time, in the required quantity and at a reasonable cost. 2.8. STORES MANAGEMENT IN ORGANIZATIONS Every organization recognises materials or stores as one of its most important assets, which invariably is equated to cash. Materials being the direct representation of cost investment requires attention and control, just in the same manner as cash is being strictly managed. The stores, function has been recognised by many organizations as the medium through which organizations obtain materials for their smooth operation. Being such a vital component in production, managers of organizations often assess their success or failure based on how efficient the stores function operates. 47 University of Ghana http://ugspace.ug.edu.gh The Stores Function The stores function in any enterprise is to assist in the production of goods and services. Some of the main objectives of the stores function in the view of Jessop & Morrison (1994) are summarized as follows: “To make available a balanced flow of raw materials, components, tools and equipment to meet operational requirements, provide maintenance materials, spare parts and general stores as required, to receive and issue work in progress as well as finished products and to accept and dispose of discarded and obsolete materials as they occur”. Apart from its primary objective of providing for operational activities, Morrison and Jessop (1994) further contend that the store function is also charged with the responsibilities of providing service to the various units of the organization. From the foregoing, one can thus describe materials or stores management as a process which covers all the activities of organizing, planning, controlling, storekeeping, liaising with the purchasing function, distribution and materials movement which are the necessary prerequisites for the attainment of organizational goals (Morrison and Jessop, 1994). Further to the above description of materials or stores management system, one can safely deduce that the achievement of a sound, effective and efficient materials management system by organizations lies with the ability to ensure that investment in stores is kept as low as possible whilst at the same time providing a service which is acceptable to the customer or the user department. The mechanism used to achieve these attributes is the application of the inventory control system (Chardwick, 1993) 48 University of Ghana http://ugspace.ug.edu.gh Jessop and Morrison (1994) stated stores responsibilities as follows: 1. Identification - It is the process of systematically depriving and describing all items of stock. It includes the preparation of a stores code or vocabulary, the adoption of materials specifications and the introduction of a degree of standardization. Design, planning or standards departments may do part of this work and the purchasing department also has an interest. 2. Receipt - It is the process of accepting, from all sources, all materials, equipment and parts used in the organization including supplies for manufacturing or operating processes, plant maintenance, offices, capital installations and finished products. 3. Inspection - Inspection, in this context, means the examination of incoming consignments for quantity and quality. Very often there is a separate inspection department which does this work, but otherwise goods are inspected by stores personnel. Whatever the system of inspection is force, it is the duty of the stores function to see that the inspection is done before accepting items into stock. Quality assurance activities and “co-maker” relationships between buyers and suppliers have reduced the extent to which the inspection of incoming goods is undertakings, but it remains on important activity. 4. Issue and dispatch - This is the process of receiving demands, selecting the items required and handing them over to users. It includes also, where necessary, the packaging of issues and the loading of vehicles with goods for delivery. 5. Stock records - These may be manual, or maintained on a computer, and record particulars of receipts, issues and balances of stock. When using the 49 University of Ghana http://ugspace.ug.edu.gh manual system, some of the forms used are as follows - shelf card, stock card, transfer notes, withdrawal (consumption voucher) service/fuel voucher, stock requisition, order form and others. 6. Stores Accounting - Stores accounting is the process of recording stock movements and balances in value. There are four main methods of pricing materials issues. These are cost price, average price market price and standard price. Cost pricing is the system of using the actual purchase price of goods issued, and it may be applied in two ways: First in, First out (FIFO) or Last in First out (LIFO) The most widely practiced of these two is first in, first out, whereby each consignment received has its own purchase price and issues are made at the price of the first consignment until that quantity is exhausted. Issues are then made at the price of the second consignment, and so on. Average Price - There are several kinds of average prices, such as simple average, weighted average, periodic average, moving average, but for present purposes it is sufficient to consider the weighted average, which is by far the most common. Market Price - Market pricing all material issues at the market price at the time of issue, and is sometimes referred to as “replacement price”. The method has the major advantage of keeping costs in line with correct prices. Unfortunately, during a time of using prices, the stock balance may be very much understated. If prices are falling rapidly, the stock remaining is seriously overvalued, and large sums have to be written off to reduce it to market value. 50 University of Ghana http://ugspace.ug.edu.gh Standard Price - is a predetermined price fixed on the basis of up to date knowledge of market prices and conditions. It is set for a given period of time, example, six or twelve months, and is kept fixed during that time, irrespective of the actual prices paid for receipts of material. At the end of the fixed period, the standard is reviewed, altered if necessary, and put into operation for a further period. 7. Stock Control - stock control is the operation of continuously arranging flows of materials so that stock balances are adequate to support the current rate of consumption, with due regard to economy. It includes the related process of provisioning, which is the means whereby instructions are given for the placing of orders. In some concerns production control department may take a large share in provisioning, at least as far as production materials are concerned. The two main inventory or stock control techniques are fixed order quantity and cyclical or periodic review. Fixed order quantity is where minimum re-order and maximum stock levels are determined and items which reach re-order levels are replenished with fixed quantities of items. Periodic or cyclical method is the one where stock levels are replenished. There is of course, the third method of stock control which is the visual method, example of visual method is two bin system being used by some supermarkets and other material concerns. 8. Stocktaking, Stock checking and Stock audit Stocktaking is the process of physical verification of the quantities and conditions of goods, usually on a periodic basis for the purpose of ensuring that an appropriate figure appears in the organization accounts. Stock checking is similar, but may be done on an adhoc basis for operational 51 University of Ghana http://ugspace.ug.edu.gh reasons. Stock audit involves an external agency, and the purpose is verification Jessop and Morrison (1994) stated the reasons for stock taking as: a) To verify the accuracy of stock records b) To support the value shown in the balance sheet by physical verification c) To disclose the possibility of fraud, theft or loss. d) To reveal any weakness in the system for the custody and control of stock. 9. Storage of Stock It is one of the basic duties of stores to unload and store all the goods delivered to the Store. Storage of materials entails the correct locations of goods in connection with suppliers’ instructions and requires skills and knowledge on the part of stores staff, bearing in mind that some materials need particular conditions of storage, e.g. must be kept dry, etc. it is the duty of stores do ensure that goods to not suffer damage or deterioration because of inefficient storage. 10. Security of Stores It is the duty of stores management to ensure that security is maintained at all times within the stores buildings and stockyards. The security element of the stores manager’s job covers not only theft, but also damage, fire and spillage. It also includes ensuring that all doors, windows and stockyard fencing are secured. 11. Materials handling - One of the basic jobs of any stores team is the handling of all materials, quickly and safely. Moving goods from the store to the 52 University of Ghana http://ugspace.ug.edu.gh factory or warehouse is a very important duty of the stores manager and his staff. RELATIONSHIP BETWEEN STORES AND OTHER MAJOR DEPARTMENTS The stores, by virtue of its functions, must be seen as providing a service to the rest of the organization in which it oper