Index

Abstract

Public procurement is a strategic partner in achieving the public good. The purpose of the study was to examine the public procurement in the health services. A mixed method approach through the survey with Pearson Correlation and Kendall Coefficient of Concordance aided the analysis of the study. The study found that training enhanced the application knowledge whereas documentation verification was a key compliance modality. The bureaucracy was a challenge while the Medical Superintendent and the hospital Administrator were the officers for policy approval and supervision of the Public Procurement Act. The paper suggests the need for regular training of staff and stronger stakeholder participation in the procurement processes.

Keywords:Public procurement, Health services, Compliance, Challenges., Mixed method, Application

Received: 5 July 2018 / Revised: 6 August 2018 / Accepted: 9 August 2018 / Published:15 August 2018

Contribution/ Originality

This study contributes to the existing literature on public procurement in the health services by focusing on the social and moral connotations in public procurement by public official's actions and inactions on the citizenry welfare.


1. INTRODUCTION

Hospitals operate to facilitate a healthier population to enhance productivity to boost any economy. Hospitals by their mandate are required to deliver services to the communities they serve. Arney and Yadav (2014 ) stressed that procurement plays a significant role in determining the availability of and the access to health commodities. Adusei and Awunyo-Vitor (2015 ) procurement are as essential as a function that both public and private institutions in their bid to acquire goods and services must be diligent and prudent as it affects the bottom line negatively if not done well. Uyarra and Flanagan (2010 ) indicated that public procurement is the acquisition of goods and services by government or public sector organizations. European Union (2017 ) emphasized that government procurement is important for both governance and business and this has also grown to become more and more complex. Thai (2009 ) suggested that public procurement must be seen in two ways with the internal demands in the form of many stakeholders expectations whereas transparency, integrity, accountability and exemplary behavior by actors as the external demands. The World Bank (2016 ) indicated that low-income countries have the highest share of public procurement in their economics at 14.5% of GDP, followed by upper-middle income countries at 13.6%. Hong and Kwon (2012 ) competitive advantage of firms has brought about the need for strategic procurement which focuses on long-term value creation and delivery.

Arrowsmith (2010 ) stressed that the legal framework through laws and regulations make sure that its application can bring about accountability, transparency, and integrity to protect the public purse. The Public Procurement Act (PPA), 2003 (Act 663) was enacted and made provisions in it for its application in the acquisition of goods and services. Arney et al. (2014 ) stressed that public procurement takes place in an environment surrounded by other systems as economic, political, social and legal systems where a change in any of these systems provides both opportunities and challenges for public procurement. One of the pillars of the Public Procurement Act 663, 2003 is to improve governance, value for money and prudent spending to ensure that developmental goals are achieved. There is no doubt that the provisions within the Act must be applied and adhered to by all entities under the Central government in the area of public procurement. It is not difficult to state that on paper the Act looks good but its application or misapplication is a major concern because of the outcomes. OECD (2010 ) stressed that a sound procurement system has to have a competent professional workforce equipped with the required skills and knowledge to make a public procurement efficient and effective.

Procurement and its management must be seen as a core function of public financial management and be treated with all seriousness to protect the public purse. An efficient and effective public procurement system significantly can influence the provisions of government services such as the building of hospitals and healthcare delivery. Thai (2009 ) indeed all governmental entities of rich and poor countries are struggling in the face of unrelenting budget constraints have led to public demand for increased transparency in public procurement.  Auditor General Report (2017 ) revealed that GH¢15,700.00 was the misappropriation of revenue, GH¢18,260.00 for procurement of sub-standard Out-Patient Department (OPD) forms and procurement of vehicle for the acting Chief Administrator all these happened at Korle Bu Teaching Hospital in Accra one of the 211 governments hospitals in Ghana. The procurement of the official vehicle was not in the hospital 2014 approved Procurement Plan and Budget and was not approved by the Board. Interestingly the official registered the vehicle in his name before reverting it into the hospital's name after using it for two and a half months. On the sub-standard forms, officials did not check the quality of items as against specification but went ahead to make full payment for the goods the hospital could not use. The report further disclosed that GH¢70.1million was mismanaged by some officials and financial irregularities in 2015 which cost the government almost GH¢53.2million. There is evidence of wasteful expenditure and loss of public funds. Almost fifteen years of the existence of the Public Procurement Act 2003, its implementation and operation had prevailed and made gains in some areas but its adherence is much to be desired.

The paper is not the first to be investigated on the public procurement practices in the health sector of Ghana empirically. However, it is the very first time that Oda Government Hospital is studied on its procurement practices with its adherence to the Public Procurement Act in the operations of the hospital based on a thorough search using the Google Scholar, RePEc, Econs Papers and other reputable databases. The significance of the study goes beyond using it as a reference material for academics, practitioners and policymakers in a sense that there are social and moral connotations to it. The public officials are privileged and placed in a position of trust to maintain the public trust and confidence in their stewardship of public procurement. Their calling must be the determination to protect the public purse but not to serve their self-interest so as to help the government to provide goods and service; and purchase goods, services, and capital assets.

Even with the existence of the Public Procurement Act, this is what is happening and the question is what would have happened without the Act. This is a worrying situation on how the public purse was misappropriated without considering the effects on the citizenry welfare; this motivated the study to explore the potency of the Public Procurement Act in terms of its application, compliance, and challenges at Oda Government Hospital in the Eastern Region of Ghana. The rest of the paper is organized as follows; section two considers the related literature while section three is on the methodology used. Section four presents the results and discussions whilst section five concludes the paper with recommendations.

2. RELATED LITERATURE

OECD (2017 ) irrespective of the importance of public procurement on government’s expenditure it is worrying as there is lack of transparency on the procedures for awarding the contract. Mahmood (2010 ) suggested that the quality of public administration could be improved through responsible accountability which is an integral part of good governance. Georghiou et al. (2014 ) indicated that there is the need for wider engagement on policy measures on public procurement. Tadelis (2012 ) public procurement regulations put certain constraints on contracts and awards mechanism that public procurement agencies can use. Onyinkwa (2013 ) compliance with the Act could be dependent on ethics and understanding of the Act. Onyango (2014 ) stressed that stricter compliance of laid down procurement procedure can lead to organizational performance thereby enhancing its profits. Oyuke and Shale (2014 ) firms must employ procurement practices that will contribute most to the attainment of corporate goals.  Habonimaa (2014 ) indicated that public procurement as resource allocation can have economic and political connotations.  It is no doubt that a strong and solid regulatory framework has the ability in strengthening procurement systems, the worrying issue is that it becomes sterile if not backed by efficient enforcement mechanisms as stressed by the WB (2016 ).

Shaw (2010 ) indicated that corruption and bloated prices by officials through public procurement as cited as a major challenge.  Adusei and Awunyo-Vitor (2015 ) revealed that well-managed procurement activity in the public sector has the potential to mitigate risk through a better allocation of risk. OECD (2017) stressed that more can be gained from honesty, professionalism through greater transparency, fair competition and zero corruptions by stakeholders. Thai (2009 ) pointed out that gaps in the procurement procedures motivate officials to be corrupt and take advantage of the deficiencies of the system. European Commission (2018 )  suggested that all procurement officers could be asked to sign a declaration for each procurement procedure to confirm they have no interest with any participating tenderer as a way to improve safeguards upon corruption. Arrowsmith (2010 ) stressed that collusion between parties in the procurement processes leads to bloated prices for work done and in some cases no work is done but payments have been made. OECD (2017 ) advised that some contractors will not bid for projects when they perceived the system will not be transparent and fair. Preuss and Walker (2011 ) individual factors and organizational factors if not managed effectively could hamper sustainable procurement.

3. STUDY AREA AND METHODOLOGY

3.1. Study Area

Oda is the Municipal capital of Birim Central Municipality in the Eastern Region where the Oda Government Hospital is located. The Municipality recorded 144,869 representing 6% of the Eastern Region’s total population, which is predominantly urban with 67.7% of the population residing in urban locations, Ghana Statistical Services (2014 ). The staff strength of Oda Government Hospital is two hundred and twenty-three (223).

3.2. Methodology

The study made use of mixed method design comprising quantitative and qualitative approaches. A single case study strategy was adopted by the study via a survey. The target population for the study comprises staff and management of Oda Government Hospital. Purposive sampling was used to select the ninety-five respondents from the various directories of the hospital. The data collection was through questionnaire administration on the staff and management while interviewing the Procurement Manager was through a structured interview guide.

The composition of the questionnaire consisted of four (4) sections which had open and close-ended questions in addition to a five-likert scale type of questions. The questionnaire had forty (40) questions in all. The questionnaire was self-administered due to the capacity of the respondents to fill it by themselves based on their literacy level and knowledgeable on the issues in the questionnaire. The questionnaire administration took place at the Oda Government Hospital and some took it home to fill it at their spare time. Prior to the fieldwork, a pilot study was done on the questionnaires by soliciting for comments from three experts on the topic which was helpful for the final output for the fieldwork. The fieldwork took two months to complete the distribution and collection of the questionnaires from the respondents. The scale reliability respectively for knowledge application on the Act and the challenges of the implementation of the Act were .947 and .976. All values are within the acceptable range and greater than the cut-off point of 0.70 as suggested by many researchers. This shows the reliability of the scale for internal consistency of this study. The interview guide contains eleven questions that were used for the conversation. It was a face-to-face interaction at the office of the Procurement Manager.

The data analysis of the quantitative data used descriptive analysis in the form of percentages and frequencies in analyzing the socio-demographics of the respondents while the Pearson correlation matrix and Kendall's coefficient of concordance helped the analysis. Correlations were computed among the ten themes on the application knowledge on the PPA on data for 95 respondents

The hypothesis of the study was constructed as:
Ho: There is no correlation between staff knowledge on the PPA and its application on the PPA
HI: There is a correlation between staff knowledge on the PPA and its application on the PPA
The analysis of the qualitative data was textual and interpretative. The study considered all the ethical issues and its compliance in conducting the research in terms of respondent's voluntary consent to be part of the study, assurance of their privacy in terms of confidentiality and anonymity.

4. RESULTS AND DISCUSSION

4.1. Demographic Data of Respondents

Ninety-five (95) respondents were the study sampled Female representation was 40% and 60% of males. This is evidence that Oda Government Hospital had more male workers as compared to female in relation to this study. In terms of age representation of 18-29 years had 20% with 30-49 years had 50% and 30% accounted for the over 50years. It can be inferred that the majority group of 50% can be with the hospital for a long time since they are not approaching the retirement soon. The hospital environment demands the right competencies of its staff to be able to carry out its mandate to the citizenry. Moreover, the respondent's ability to fill the questionnaire is dependent on their literacy level. It revealed that 36% had Diploma certification while 40% accounted for Bachelor Degree and 24% represented Master Degree Holders. Likewise, 60% of the sampled population had 1-5 years working experience while 30% with representation for 6-10 years and the over 10 years accounted for 10% of the sampled population. There is evidenced that the respondents had working experiences under their sleeves, which can be inferred that they can work with less supervision on the job.

4.2. Staff Application Knowledge of the Public Procurement Act (Act 663)

The discussion is on the mean score and how the themes are correlated using the Pearson Correlation Matrix. It is of the essence to indicate that the application of the Act would not make any positive and huge impact if implementers of the Act are not on top of issues in the appreciation of the Act. The twelve row of Table1 indicates the mean score of the ten themes with the highest mean score of 4.79 confirming that the respondents know that the Oda Government hospital applies the PPA as it was ranked first. The lowest ranked theme had a mean score of 2.63 indicating the need for a procurement plan before approval can be made on procurement was not popular among the majority of the respondents. The respondents indicated that except emergency goods and services all contracts awarded must go through the tender committee. The respondents were of the view that the procurement plan must be prepared and approved before the requisition must be put in for procurement this was not popular among the respondents.

Overall five of the themes had a degree of consensus ranging between 85.8% and 95.8% with four themes accounting for 60.8% and 70.6% and the other theme had 52.6%. This suggests that respondent's awareness, observation, and involvement in the application of the PPA at the Oda Government Hospital is high. This can be inferred that once the respondents are aware of the existence of the Act they will apply it in their department procurement activities. The results align with OECD (2010 ) indicating that efficient public procurement is dependent on competent workforce equipped with the fair knowledge to make a public procurement for efficient and effective.

Table 1 considers the Pearson Correlation Matrix and descriptive statistics of the staff knowledge on the PPA. The least correlation coefficient is .334** whiles the highest correlation coefficient is 1.000**. Correlations were computed among ten themes on the application knowledge on the PPA scales on data for ninety-five respondents. The results from Table 1 on the Pearson Matrix suggest that all the 45 correlations were statistically significant at p<. .01 at two-tailed. It indicates that 35 out of the 45 correlations r(95) was greater than or equal to .70, p < .01 while the other 10 correlations r(95) is between .334 and .681.

Table-1.  Result of the Descriptive statistics and Pearson Correlation Matrix on staff knowledge on PPA

 
     1
    2
     3
    4
   5
    6
   7
    8
    9
   10
1 Familiarity
1
2 Application
.334**
1
3 Contracts
.494**
.676**
1
4 Process
.681**
.490**
.725**
1
5 Supervision
.718**
.746**
.859**
.794**
1
6 Emergency
.681**
.490**
.725**
1000**
.794**
1
7 Approval
.811**
.507**
.750**
.908**
.868**
.908**
1
8 Evaluation
.715**
.839**
.760**
.783**
.909**
.783**
.873**
1
9 Quorum
.700**
.591**
.874**
.845**
.931**
.845**
.907**
.819**
1
10 Training
.643**
.832**
.876**
.738**
.928**
.738**
.791**
.910**
.844**
1
Mean
4.29
4.79
4.26
4.47
3.53
4.47
2.63
3.21
3.00
3.47
Standard deviation
.458
.410
.970
.502
1.236
.502
1.670
1.368
1.756
1.543
Ranking
3rd
1st
4th
2nd
5th
2nd
9th
7th
8th
6th

Note: **P < 0.01 level.

The correlation of emergency procurement does not go through tender and all contracts must pass through the procurement process had a correlation coefficient (r) equal to 1.000 indicating perfectly positive relationship suggest that the coefficient is significantly different from zero. It can be concluded that the staff of Oda Government Hospital are aware of the essence of emergency procurement processes. It seems that the more the staff are aware of the emergency goods and services the greater they will not bother themselves to take such procurement through the tender process. Attending training program me on the Act had a strong positive and a significant relationship with all the ten variables. This implies rejecting the Ho: and conclude that a respondent attending various training programs on the PPA influences his/her appreciation of the Act in terms of knowledge acquisition and applying it in the sense that to achieve its intended purpose. It is important to highlight that the appreciation of the importance of training reinforces the supervision of the procurement processes. In general, the results suggest that staff knowledge on the application of the PPA in Oda Government Hospital is fairly high to be a positive predictor that the staff will apply the PPA effectively all things being equal. The result affirms the views of Onyinkwa (2013 ) stressing that understanding of the Act leads to better compliance

4.3. Compliance with PPA by Oda Government Hospital

There is no doubt the importance of the PPA but is of no essence if it is not compiled by the government agencies and the state-owned enterprises. Figure 1 as revealed by the respondents indicated that all the respondents totalling ninety-five which is 100% stated categorically that to the best of their knowledge all procurement goes through verification of documentation from suppliers of goods and service; and contractors. This is of the essence to make sure that the right thing is done from the commencement of placing the requisition for the service. This must be in line with the provision of the budget allocation and definitely with the compliance of the provisions in the PPA.  The result will benefit from the suggestion from EC (2018 )  that all procurement officers could be asked to sign a declaration for each to confirm they have no interest with any participating tenderer as a way to improve safeguards upon corruption.

One of the good pillars of supply chain sourcing is the ability and the capacities of the user department's  to select the right suppliers with both financial and capability resources to deliver the needs of the customers and meeting the right specifications. Respondents were asked to indicate whether it is necessary to use suppliers with good standing in the records of the hospital books through their working experience with them or by their industry ratings and word-of-mouth recommendation from the industry. The sixty-eight respondents representing 72% were of the view that the hospital must and select suppliers of good standing as this will ensure that the right thing is done since the suppliers have been there before in similar situation and have the capabilities and competencies to deliver the contract on time.  On the other hand, twenty-seven respondents representing 28% indicated that it does not necessarily mean that a supplier must be selected because the supplier is in good standing. The hospital must open their doors to search for multiple sourcing than single sourcing for the purposes of value for money and consequently cost-cutting. The results confirmed (WB, 2016 ) assertion that the Public Procurement Act must make sure that there is the control system, standardized procurement procedures, transparent institutional framework, proficient procurement staffs and provision of measures on anti-corruption.

Source: Field work, 2017

The respondents agreed unanimously that all contracts are published with a 100% representation same with tenders are opened for bidding. This is significant from the awareness, observation and the knowledge level point of view of the respondents concerning the PPA. This is an indication that the procurement processes of the Oda Government Hospital do not take place in secrecy as relevant stakeholders were aware of the processes through the outlets for communication. The result is in line with Georghiou et al. (2014 ) stressing the need for wider engagement on policy measures on public procurement for effective collaboration.  Moreover as indicated by Mahmood (2010 ) that the quality of public administration could be improved through responsible accountability which is an integral part of good governance.

4.4. Excerpt from the Interview with the Procurement Manager on Public Procurement

The interview with the Procurement Manager was face-to-face and took place at his office and the intention was to dig deep to find out the other side of the PPA through it implementers.

The Procurement Manager responded that “the PPA has had a positive effect and has improved the procurement practices of the hospital and further stressed that the hospital since 2004 observe the PPA in their procurements” when asked how the PPA affected the hospital’s procurement activities. It is not much of a surprise as this is what the PPA intends to achieve to avoid wastage of state funds. The response aligns with Onyango (2014 ) advise that stricter compliance with laid down procurement procedure can lead to organizational performance thereby enhancing its profits. The Procurement Manager further took the interviewer through the procurement procedure of the Oda Government Hospital where it was indicated that “The procedure includes the approval of the request, solicitation of offers, evaluation of tenders, awarding of contracts, delivering of good inspection and acceptance of goods and managing the project". The response supports EU (2017 ) pointed out that government procurement is important for both governance and business. It can be said that if the hospital religiously goes through the whole procurement procedure without any compromises there is the possibility that value for money can be attained through enhancing transparency from key stakeholders to the process.

When it comes to policy approval and the supervision of the PPA the Procurement Manager responded that “this is done through the offices of Medical Superintendent and Hospital Administrator of the Oda Government Hospital”. The Procurement Managers indicated "that he does not think that the Oda Government Hospital has sanctioned any contractor or supplier due to non-performance which it implies that the hospital put certain measures in place to achieve this" while on the other hand contractors or suppliers do their best professionally to meet the needs and demands of the hospital requisition of service. Interestingly the Procurement Manager “rated the Oda Government Hospital on compliance with the Act as five over five on a scale of one to five".  The Procurement Manager, when asked of a follow-up question, stated that in terms of documentation on their procurement activities "they send electronic copies of their procurement plan to the Public Procurement Authority”. This result support Arrowsmith (2010 ) stressing that the legal framework through laws and regulations must make sure that its application can bring about accountability, transparency, and integrity to protect the public purse.

It was put to the Procurement Manager if there are any barriers that affect his performance in the use of the PPA. The Procurement Manager responded that "it is worrying as the system cannot take advantage of the competencies and the capabilities of some suppliers to bid low-value contracts as they are not encouraged to do so". The Procurement Manager further stresses “not having the expertise to make use of the Act in terms of knowledge on the Act create problems for implementers which can lead to non-compliance to the provisions of the Act”. There must be the need for the regular update of their knowledge on the Act through seminars and workshops. The response aligned with WB (2016 ) insisted that accountability and transparency in government purchases guided by the adherence of the Public Procurement Act can reduce corruption with stricter enforcement of the Act. Furthermore, the result shares an opinion with Adusei and Awunyo-Vitor (2015 ) suggesting that procurement is as essential as a function that both public and private institutions in their bid to acquire goods and services must be diligent and prudent as it affects the bottom line negatively if not done well. 

The Procurement Manager indicated when asked about any input to make to help the Oda Government Hospital on the implementation of the Act and the response was that “due to the important roles the Nurses played in the hospital administration it will make a big difference of the inclusion of the Nursing administrator in the composition of the entity tender committee for Oda Government Hospital”. It will not be out of order if the inclusion of the Nursing Administrator is not purely on stakeholder’s involvement and participation. Thai (2009 ) suggested that public procurement must meet internal demands of many stakeholders’ expectations. This must be one of the reasons why the hospital administration deemed it wise to include the Nursing Administrator for governance sake.

When the Procurement Manager was asked about any benefits from PPA the response was that” it has helped improve financial levels, added value and helped reduce corruption”. It can be inferred that stricter adherence to the Act and possible sanctions for offenders has put fear in implementers to make sure that the public purse is protected since people will be made to account for their stewardship. The study believes that transparency has helped in this direction. The response aligns with OECD (2017 ) stressed that honesty, professionalism through greater transparency, fair competition and zero corruptions by stakeholders are positive pillars of public procurement.

4.5. Implementation Challenges of the PPA by Oda Government Hospital

The respondents indicated their opinions as a score on a five Likert scale from strongly disagree to strongly agree but the ranking was done using Kendall's Coefficient of Concordance through an output from SPSS. As indicated in Table 2 the theme with its mean rank and ranking. The Kendall's Coefficient of Concordance of (Ws =64.8%) implies that 64.8% agreed to the overall ranking with the firm belief that indeed the challenges cut across among the respondents.

Table-2. Ranking of PPA implementation challenges as identified by the respondents

Theme
Mean rank
Ranking
The Act seems to be more controlling than facilitating the procurement process.
7.34
8th
The Act makes it difficult for innovativeness in the procurement process
9.84
3rd
The procurement process is very bureaucratic
12.34
1st
There are difficulties in applying the Act.
8.37
4th
Ad-hoc memberships of tender board affect the procurement process.
10.29
2nd
Limited logistics slows down the work of tender committee.
6.34
9th
Lack of requisite skills and training by the tender committee in the procurement process.
6.34
9th
Rewarding tender committee members for their services.
6.88
7th
External pressure to subvert the procurement process.
3.50
10th
Suppliers do not search for adverts on procurement
7.32
6th
The Act is making the procurement of goods and services  risky
3.50
10th
Suppliers lack the needed documents for the tendering process
6.42
8th
Coefficient of concordance (Wa) = .648 (64.8%)
Number of respondents = 95

The discussion on Table 2 would be on the first three themes with the highest mean rank and the last three themes with the lowest mean rank. A mean score of 12.34 which was ranked first implied that the entire respondent’s agreed to the fact that the procurement processes are very bureaucratic. This can be inferred that in certain procurement activities this can make it problematic as the process is not flexible. The result shares the concerns of Tadelis (2012 ) public procurement regulations put certain constraints on contracts and awards mechanism that public procurement agencies can use. The frequent changes in the membership of the tender board affect the procurement process with a mean score of 10.29 which was ranked 2nd was a major concern for the respondents. Alluding to the fact that the longer the membership stay the better it becomes in terms of experience in the tendering process in the positive direction but this same strength can be a weakness as it can also corrupt them if members on the board lack integrity and honesty. The result is in line with Arrowsmith (2010 ) insisting that the conflict of interest by key players in the procurement process is a challenge.  In addition, the result supports the assertion of OECD (2017 ) that more can be gained from the honesty and professionalism of procurement staffs in enhancing value for money throughout the procurement processes. 

External pressure to subvert the procurement processes and the Act has made the procurement of goods and services very risky had a mean score of 3.50 representing the very least of the ranking at the 10th position which indicated that the respondents believe that as much as it is a challenge to them it is the least of their worries as the gap between the highest rank and the least mean is 8.84 mean score. This implied that they do not see those themes to affect negatively the potency of the PPA to achieve its intended objectives. This result does not support the assertion of Thai (2009 ) that lack of political will by governments and leaders to stand on their grounds when there is non-compliance by their favourites. However, supports Oyuke and Shale (2014) that firms must employ procurement practices that will contribute most to the attainment of their corporate goals.  The 9th ranked theme was on tender committee members do not have the requisite skills and training in the procurement processes and limited logistics slows down the work of the tender committee had a mean score of 6.34 each. The result aligns with Habonimaa (2014 ) on the need for government to resource its agencies to create value through public procurement.

5. CONCLUSIONS AND RECOMMENDATIONS

Procurement in any business set up has consequences on the financial health of a company as funds are leaving the company in the form of an expense. This is critical as the owners of the financial resource are not only expecting the money back but are also expecting the return. This is why procurement puts the financial burden on a business and must be treated with all seriousness irrespective of the type of the business whether the business is private, public government or not-for-profit. The study concludes that the level of respondent's awareness and the application of the Public Procurement Act (Act 663) are high which can ensure effective implementation of the Act. The study further affirms the need for periodic training of respondents as it reinforces a better application and compliance of the Act. The interview with the Procurement Manager confirms the conscious awareness of the need to comply with the Act to avoid sanctions and possible prosecution this has enhanced transparency and ensures accountability.  The heart of the implementation challenges is the bureaucratic nature of the procurement process which is attributed to the Public Procurement Act (Act 663)

The paper suggests that the hospital must update the knowledge acquisition of its staff on the PPA through meetings, seminars and workshops. It is important for all key stakeholders to understand and appreciate the demands of the Public Procurement Act to be assured of the transparency and fairness of the procurement process. Moreover, there is the need for adequate remuneration to be given to the tender evaluation committee to ward off any temptation of corruption. The study's limitation in this context is that this study is a single case study with a cross-sectional time dimension. A different result will evolve if multiple case studies are considered which will expand the discussions on the PPA in the public hospitals and its service delivery.

Funding: This study received no specific financial support.  
Competing Interests: The author declares that there are no conflicts of interests regarding the publication of this paper.

REFERENCES

Adusei, C. and D. Awunyo-Vitor, 2015. Implementation challenges of the public procurement act by selected metropolitan, Municipal and District Assemblies in the Ashanti Region, Ghana. iBusiness, 7(01): 39-50. View at Google Scholar | View at Publisher

Arney, L. and P. Yadav, 2014. Improving procurement practices in developing country health. Michigan: William Davidson Institute, University of Michigan.

Arney, L., P. Yadav, R. Miller and T. Wilkerson, 2014. Strategic contracting practices to improve procurement of health commodities. Global Health: Science and Practice, 2(3): 295-306. View at Google Scholar | View at Publisher

Arrowsmith, S., 2010. Horizontal policies in public procurement: A taxonomy. Journal of Public Procurement, 10(2): 149-186.View at Google Scholar 

Auditor General Report, 2017. Report of the Auditor-General of the Republic of Ghana on Public Accounts of Ghana Ministries Departments and Other Agencies (MDA’s) For the Year Ended 31 December 2016.

European Commission, 2018. Public procurement guidance for practitioners. Luxembourg: Publications Office of the European Union.

European Union, 2017. Openness of public procurement markets in key third countries. Luxembourg: Publications Office of the European Union.

Georghiou, L., J. Edler, E. Uyarra and J. Yeow, 2014. Policy instruments for public procurement of innovation: Choice, design and assessment. Technological Forecasting and Social Change, 86: 1-12.View at Google Scholar | View at Publisher

Ghana Statistical Services, 2014. 2010 population & housing census. District Analytical Report. Birim Central Municipality. Accra. Ghana Statistical Service.

Habonimaa, J., 2014. The growing importance of public procurement and the need for professionalism. UN Special. Herndon. United Nations Publications.

Hong, P. and H.-B. Kwon, 2012. Emerging issues of procurement management: A review and prospect. International Journal of Procurement Management, 5(4): 452-469.View at Google Scholar | View at Publisher

Mahmood, S.A.I., 2010. Public procurement and corruption in Bangladesh confronting the challenges and opportunities. Journal of Public Administration and Policy Research, 2(6): 103-111.View at Google Scholar 

OECD, 2010. Policy roundtable, collusion and corruption in public procurement integrity in public procurement. Paris: OECD Publishing.

OECD, 2017. Public procurement for innovation: Good practices and strategies. OECD public governance reviews. Paris: OECD Publishing.

Onyango, C.J., 2014. Effects of procurement planning on institutional performance: A case study of Mombasa law court. International Journal of Science and Research, 3(11): 446-455. View at Google Scholar 

Onyinkwa, J., 2013. Factors influencing compliance to procurement regulations in public secondary schools in Kenya: A case of Nyamache District, Kisii County. Interdisciplinary Journal of Contemporary Research in Business, 5(1): 561-592.

Oyuke, O. and N. Shale, 2014. Roles of strategic procurement practices on organizational performance: A case study of Kenya national audit office county. European Journal of Business Management, 2(1): 336-341.View at Google Scholar 

Preuss, L. and H. Walker, 2011. Psychological barriers in the road to sustainable development: Evidence from public sector procurement. Public Administration, 89(2): 493-521. View at Google Scholar | View at Publisher

Shaw, F.N., 2010. The power to procure: A look inside the City of Austin procurement program, applied research Projects. Texas: Texas State University.

Tadelis, S., 2012. Public procurement design: Lessons from the private sector. International Journal of Industrial Organization, 30(3): 297-302.View at Google Scholar | View at Publisher

Thai, K.V., 2009. International handbook of public procurement. London: CRC Press. Taylor & Francis Group.

Uyarra, E. and K. Flanagan, 2010. Understanding the innovation impacts of public procurement. European Planning Studies, 18(1): 123-143. View at Google Scholar | View at Publisher

World Bank, 2016. Benchmarking public procurement: Assessing public procurement systems in 77 economics. Washington, DC: The World Bank.