Acknowledgements

I would like to extend my gratitude to Florence Mawindo for providing invaluable guidance and proofreading this assignment. This assignment would not have been possible had it not been for the ideas and information from Albert Makone, Nongai Macherenga, Joyful Mapuranga, Edson Muchemwa, George Chinomona and Terence Chigwada.

1

Table of Contents

Acknowledgements...................................................1Table of Contents..................................................2

1.0 Introduction...................................................31.1 Assignment...................................................5

1.2 Purpose......................................................51.3 Value........................................................6

2.0 The Logistics Unit as a team...................................62.1 Clear visual goals...........................................7

2.2 Attainable goals.............................................92.3 Recognising achievers.......................................10

2.4 Immediate feedback..........................................112.5 The satisfaction of social needs............................12

2.6 Satisfaction of esteem needs................................132.7 Motivation and influence of group pressure..................13

2.8 Striving to meet higher individual standards................142.9 Planning tactics together...................................15

2.10 Evaluating performance as a team regularly.................152.11 Existence of a high degree of trust among all members......16

2.12 The leader/captain is part of the team.....................173.0 Discussion of findings........................................18

4.0 Conclusion....................................................245.0 Recommendations...............................................24

6.0 Bibliography..................................................26

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1.0 Introduction

The general development of any society encompasses the health

of the individuals in that society. This implies that health

is a dynamic process. In Zimbabwe, the Ministry of Health and

Child Welfare (MOHCW) continuously changes its functions and

structure to better meet the ever-evolving challenges and

demands. The Government of Zimbabwe (GOZ) desires to have the

highest possible level of health and quality of life for all

its citizens. This vision has to be attained through

guaranteeing every Zimbabwean access to comprehensive and

effective health service.

The MOHCW has various departments to ensure that its vision is

achieved. These are the Provincial Medical Directorates,

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Central hospitals, Human Resources, Finance and

Administration, Oral Health Services, Nursing Services,

Traditional Medicines, Laboratory Services, STI, HIV, AIDS and

TB Unit, Policy and Planning, Monitoring and Evaluation,

Quality Assurance, Chief Internal Audit, Epidemiology and

Disease Control, Reproductive Health, Environmental Health;

and Pharmacy Services.

This assignment will be limited to the Pharmacy Services. The

Directorate of Pharmacy Services encompasses the Logistics

Unit (LU) which is responsible for managing essential

medicines and medical supplies including HIV/AIDS commodities

distribution systems and the related Logistics Management

Information Systems (LMIS). In addition, the LU forecasts and

quantifies essential medicines and medical supplies. It

analyses and interprets data in order to report logistics

information, including feedback reports to the various levels

of the MOHCW and its partners such as the Global Fund to fight

AIDS, TB and Malaria (GFATM), United States Agency for

International Development (USAID) and the Clinton Foundation.

The Logistics Unit is made up of The LU Manager, the Deputy LU

4

Manager, Upstream Logistics Coordinator, Prevention of Mother

to Child Transmission (PMTCT) Coordinator, Management

Information Systems (MIS) Officer, three data encoders, an

Administrative Assistant, an Office Orderly and four Logistics

Officers at the Harare office.

Figure 1: Organogram of the LU

Of the fourteen members at the LU Harare office, 2 are

pharmacists, 3 are pharmacy technicians, and the rest have no

pharmacy-related background. This diagram below shows that the

team is composed of members from diverse professional fields.

Each member brings different skills to give a potential fusion

of expertise.

5

LU Manager

Deputy LU

Manager

4 Logistic

s Officers

Upstream Logistic

s Coordinat

or

PMTCT Coordinat

or

Adminstrative

Assistant

Office Orderly

MIS Officer

3 Data

Encoders

Figure 2: LU staff by professional background

Pharmacists; 2

Pharmacy Technicians

; 3

Logistics-related background; 3

Information Technology

background; 4

Office Management;

1

Other; 1

1.1 Assignment

An analysis of the Logistics Unit of the Directorate of

Pharmacy Services(DPS) under the Ministry of Health and Child

6

Services basing on twelve characteristics of a successful

football team.

1.2 Purpose

The Directorate of Pharmacy Services has a mission to ensure

that medicines which are safe, efficacious and of good quality

are available, accessible and affordable (SEQAAA) to all those

in need.

1.3 Value

In pursuit of its mission, the MOHCW is committed to the

following values:-

Equity in health status and healthcare

Comprehensive quality services

Cost effectiveness(value for money) and efficiency

Client and provider satisfaction

Transparency and accountability

Ownership and partnership in health

Furthermore, the MOHCW is committed to monitoring and

evaluating the performance of the health service to ensure

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accountability and adherence to national standards and

policies.

2.0 The Logistics Unit as a team

Katzenbach and Smith (1993) stated that ‘…a team is a small

number of people with complementary skills who are committed

to a common purpose, performance goals, and approach for which

they hold themselves accountable”. This assignment focuses on

the analyses of the LU to compare and contrast its

characteristics to those inherent in successful football

teams. The team utilises resources to maintain internal

processes towards the production of specific products. This

implies inputs and throughput of maintaining teams define the

characteristics of effective teams.

The LU is part of a public health supply chain that ensures

that the right products of the right quality are delivered in

the right quantity to the right place in the right time for

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the right cost. It is the information hub which consolidates

data from SDPs to quantify national needs and inform

procurement.

The LU receives Consumption/Requisition(C/R) forms from

Service Delivery Points (SDPs) which detail the number of

patients receiving antiretroviral medicines by regimen as well

as the consumption of the said medicines. These C/R forms are

then approved by Logistics Officers who generate an order

which will be filled by the National Pharmaceutical Company, a

quasi-government entity responsible for distribution and

storage of pharmaceuticals. The movement of C/R forms,

information and commodities is shown on Figure 3. The twelve

given characteristics of a successful football team are

described in detail below together with the application to the

LU.

2.1 Clear visual goals

Katzenbach and Smith (1994) intimated that goals are ideas. A

goal is a consciously planned and desired result towards which

people are endeavouring. There must be consensus as regards

the goals between the team members for the goals to be the

foundation of the team’s vision. This motivates the members

9

while providing a common purpose and direction. West (1994)

emphasised the need for organisations to have a clear purpose

encompassing the underlying values. The LU is a part of the

DPS and has clearly laid down goals and objectives. The Key

Result Areas (KRAs) are documented and agreed upon as a

directorate. This assignment found out that the clarity of

organisational goals is certainly evident with the exception

perhaps of the lowest levels of personnel. These personnel are

typically those without a pharmacy-based background.

Figure 3: Linkages between the LU as a team and the other

parts of the public health supply chain

10

Facility sends C/R form to theLU

Data encoder enters data into the electronic system for order

MIS Officer compiles and analyses data andsends to

NatPharm packs medicines and medical supplies according to orders

Logistics Officers approve orders and generate Facility feedback Reports electronicallyand send to NatPharm. They

2.2 Attainable goals

Purpose, the responsibility and accountability for achieving

that purpose should be discussed and agreed upon as a team.

The ability to work together to reach a common goal in the

most efficient manner is an important factor of a successful

team. These goals should be meaningful to all members and

should motivate them to stretch themselves and their skills so

that they grow as individuals and as a team. The goals of the

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LU are practical and attainable basing on the results of the

National Medicines Survey (2011).

Survey findings showed that 94.8% (N=77) of facilities

interviewed reported an improvement in medicine availability

between January 2010 to June 2011 and this was mainly

attributed to the supplies received from targeted support to

selected hospitals initiated by MOHCW and Ministry of Finance

and the primary health care packages. West (1994) emphasised

the need to provide teams with adequate financial resources,

administrative, technical support and professional education.

Currently, about 86% of people in need of antiretroviral

services are receiving medicines. Of the 86%, 50% is supported

by The GFATM while the GOZ supports 21% of the 86% according

to the Zimbabwe Full PSM Plan, Round 8, Phase 2 submitted in

December 2012.

As regards essential medicines, United Nations Children’s Fund

(UNICEF) provides Primary HealthCare Packages (PHCP) kits to

primary care facilities. The support from donors has made a

significant impact on programmatic results in the MOHCW.

12

Reports of donor fatigue leading to reductions in grants

extended to countries are worrisome as they may reverse the

gains made so far. It is reported that the USAID which is

supporting personnel at the LU may pull out in the near future

implying that personnel may leave and goals become difficult

to achieve. To maintain the fight against the three epidemics,

governments need to look for alternative funding.

The ministry is decentralising Antiretroviral Treatment (ART)

services and the LU is leading the training of nurses at rural

health centres to manage ART medicines and Voluntary Medical

Male Circumcision commodities. The increase in programs has

strained the staff at the LU. Three trainings may run

concurrently and may compromise the quality of trainings as

well as affect order approvals by the Logistics Officers.

Program managers in the MOHCW and the DPS should improve their

coordination and synchronisation of activities.

2.3 Recognising achievers

13

Successful teams usually have members who excel and drive the

team in times of crisis. In as much these super achievers tend

to have a positive influence on teams; they have a propensity

to require the limelight all the time. If leaders fail to

recognise the talent in others, the efficiency and

effectiveness of other team members will decline as supported

by Skinner’s theory of reinforcement of behaviour. Skinner’s

theory was based on E. L. Thorndike’s earlier work on the law

of effect. Skinner found out that behaviour which was

reinforced tends to be repeated while that which was not

reinforced was extinguished as shown on Figure 4.

Figure 4: An illustration of the law of effect

14

Need

Punishmen

Behaviour

Reward

This means that leaders should praise and offer critical

feedback to members who have successfully met challenges. A

discussion with LU staff showed that this recognition has not

been forthcoming. It would appear that no feedback comes from

the managers regarding task undertaken or reports submitted.

The previous deputy LU manager would complement one Logistics

Officer though for consistently offering quick responses to

issues and reports.

2.4 Immediate feedback

Feedback means letting someone know on a timely and continual

basis how they are performing. This includes both positive and

negative observations. Leaders should use descriptive rather

15

than judgemental language to make particular statements or

give general statements supported by specific examples. Team

members and organisations require accurate and timely feedback

to maintain and/or improve their effectiveness. The managers

should analyse reports submitted and provide feedback on tasks

undertaken by the team.

Hackman (1990) recommended a balance between the more

traditional individual reward systems with team-based

incentives that are contingent upon the whole team’s

performance to emphasise cooperation rather than competition.

The LU manager is reported to provide feedback on rare

occasions to subordinates. LU staff believes that the

management has little or no time to scrutinise reports send to

the managers. This lowers morale and commitment of the team

members and subsequently lowers performance.

2.5 The satisfaction of social needs

Good social relationships maintain effective teams. This is

the third step on Maslow’s hierarchy of needs. In order to

avoid challenges of loneliness, depression and anxiety, people

16

need to feel loved and accepted by other people. Kirkman and

Rosen (1999) wrote that ‘social networks within and beyond

teams facilitate a better understanding of team tasks and an

increased belief in the team’s effectiveness. The LU has no

initiative to have in place group activities.

It is noteworthy though that the employees themselves make

contributions towards birthdays, births and deaths within

families of members as well as end of year parties. These are

efforts by team members to socially interact outside of work

duties. The LU should try to form even sports teams, religious

groups or provide lunch (maybe once a month or a quarter with

various themes). These would provide team members with an

opportunity to interact without the pressures of the work

environment. Maslow’s theory points out that people’s needs

are not just met by hard cash. Well paid people may still have

needs that require satisfaction. Furthermore, Maslow’s

hierarchy offers leaders a whole range of options to use for

building team satisfaction. It is often inexpensive to have

team socials such as a barbecue.

17

2.6 Satisfaction of esteem needs

The fourth level of Maslow’s hierarchy is the need for respect

and appreciation. When the physiological needs are met and

social relationships flourish, esteem needs become more

prominent. The need for feelings of accomplishment, prestige

and personal worth begin to receive more attention in

motivating behaviour. Participation in professional

activities, academic accomplishments and personal hobbies play

a role in fulfilling esteem needs. Pharmacists at the LU are

sponsored to go to a Joint Congress between the Pharmaceutical

Society of Zimbabwe and the College of Primary Care Physicians

of Zimbabwe.

Pharmacy Technicians are sponsored to attend the joint

congress/conference of the Zimbabwe Pharmacy Technicians

Association. Members of the Chartered Institute of Purchasing

and Supply are not sponsored. Some members of the LU believe

that part of their esteem requirements are met as they train

and supervise Service Delivery Point (SDP) staff. Feedback on

18

these activities from the leaders would help motivate the LU

staff more.

2.7 Motivation and influence of group pressure

Members in a team believe that the group has a better

understanding of the situation and special expertise. The team

members may experience extreme discomfort that discourages

them from speaking out against the group even if it is wrong.

The team is made up people with different backgrounds and

areas of expertise. In turn, each motivates others by

excelling in their line of work. The LU should strive to

recruit the best candidates for its positions and resist

pressure to ‘reward’ long service within the MOHCW without due

regard to qualifications.

This in turn should help the inter-influence between members

of the team. These members should undertake continuous

training so that they keep abreast of developments in their

particular fields. Interaction between the professionals would

probably help in improving motivation. Maple (1987) suggested

19

that the professional’s self-image was the most influential in

team members understanding and interacting with each other. As

a result of the diverse backgrounds of the professionals at

the LU, the team members seek to excel so that they do not

bring the name of their profession into disrepute.

2.8 Striving to meet higher individual standards

Individual contributions are a pre-requisite of

characteristics of effective team work. Brill (1976) wrote

that establishing and managing relationships between

individuals who have a variety of personalities and a range of

professional and non-professional experiences is a critical

component of teamwork. The LU has no formal structures in

place to measure individual performance. In as much as the LU

staff may want to excel, feedback from the leaders is rarely

forthcoming therefore motivation is low. The reasons that

necessitate and promote group pressure and influence above

result in individuals who seek to perform to the best of their

abilities and search for continuous improvement of the skills.

20

2.9 Planning tactics together

Strategic leaders work through teams to solve challenges and

develop policy alternatives. The leader is accountable for the

effective functioning of the team and developing a stable

structure as the team engages in its work. Planning tactics as

a group helps leaders get a better understanding of

communication styles and motivating drives which can assist

them to better predict how the team will interact, potential

challenges that may arise and how they may approach shared

goals. The LU develops its work plans as a team. Members share

information on upcoming programs and a consolidated

provisional plan is decided upon. This is then shared with and

input sought from the rest of the DPS. As a result of numerous

programs running concurrently, coordination is of utmost

importance for successful execution of the plans.

2.10 Evaluating performance as a team regularly

21

Peer evaluations give team give team members an opportunity to

assess the performance of their co-workers. Employees have

been observed to be honest about their assessment of a team

member’s performance especially as it relates to interpersonal

relationships with other team members. There are two

fundamental dimensions of team functioning. These are the task

and the social factors that influence how members experience

the team as a social unit. Teams need to review their

performance taking into account their objectives and reflect

on ways in which the team can provide support to each other

and resolve conflicts.

The LU has no formal structures to evaluate the performance of

individuals regularly but rather relies on problems reported

by SDPs of stockouts or expiration of medicines. The

performance of programs is assessed through the analysis of

MIS data. Pharmacy services pertaining to malaria are assessed

through End-User Verifications as well as an analysis of data

gathered through the Zimbabwe Informed Push System (ZIP

System). The ZIP system is a supply chain solution where a

22

moving warehouse (Truck) visits the SDPs and delivers

medicines according to consumption in the previous quarter of

a year while factoring in seasonality and expiry dates of

medicines.

This same system collects data used to assess the availability

of anti-tuberculosis medicines at SDPs. Essential medicines

are supplied as PHCP kits and as bulky items from the central

warehouse. The PHCP kits are delivered during the ZIP System

deliveries. Quarterly review of programmatic progress is good

monitoring practice.

2.11 Existence of a high degree of trust among all members

A key building block of successful teams is a strong sense of

shared trust among team members. An absence of trust impedes

on the ability of individuals to build rapport and trust

thereby diminishing productivity. A lot of what makes teams

successful is embedded in understanding the individual

behaviours and motivating needs of the team members. Logistics

23

Officers have been allocated provinces to service in terms of

order approvals.

These provinces ideally send their reports known as

Consumption/Requisition forms in different reporting to avoid

congestion during order deliveries. Sometimes challenges

require that orders for provinces serviced by different

Logistics Officers are packed at the same time. This situation

creates pseudo-competition for transport. Each Logistics

Officer will push for deliveries to their provinces. Logistics

Officers out in the field become less assured that their

‘provinces of interest’ will receive adequate attention. This

allocation of provinces encourages competition rather than

cooperation and requires rethinking.

2.12 The leader/captain is part of the team

Strong teams have clear leadership. Team leadership is

oriented on satisfying the needs of a team with a view to

enhance team effectiveness. Whatever the form of leadership,

it should be known and supported by all team members for the

24

leadership to add value to the team. A team working together

interdependently on a highly important task results in shared

leadership, this is better than if one person were sitting in

a control centre, issuing orders. The LU team is such that the

leader is the LU manager.

There are concerns that even though he is part of the team, he

usually is not involved in the activities that the team does.

He appears to be mostly active in attending meetings and other

activities without his team. The higher rates supposedly

offered for the activities he attends do little to motivate

the other LU members. Using the analogy of the football team,

it appears the LU management may not be the captain of the

team but rather the coach. This would mean that the one member

of the LU team should step up and lead the team towards its

goals.

3.0 Discussion of findings

25

The characteristics of a successful football team can be used

to analyse and rate the performance of the Lu as a team. The

diagrams below show the results of such an analysis.

Figure 5: Rating of the LU’s performance

Clear goals

Social needs satsifaction

Planning tactics together

01234

Analysis of the LU basing on characteristics of a successful team

Assigned RatingMinimum Acceptable

Characteristics of a successful team

Rati

ng a

ward

ed

26

Figure 6: Illustration of the aggregation of the LU ratings of

the characteristics

4

5

3

Number of characteristics grouped according to the performance of

the LUAbove acceptable rating

At acceptable rating

Below acceptable rating

The diagrams above show that the LU requires strengthening in

many (8 out of 12) of the characteristics of a successful

team. The impact is shown by analysing the data from the LMIS

as well as results reported by the MOHCW to the GFATM through

the Progress Update/Disbursement Request.

264 pharmacists were in-post as of 31 December 2012. 17

pharmacists were appointed against 28 terminations for the

period of July to December 2012. The government's current

freeze on recruitment into the public sector had a negative

27

impact on reaching the target of in-post professionals.

Qualified pharmacists short supply in the public health system

due to high demand in the private sector and outside the

country. The LU is supported by a donor, John Snow

Incorporated. Though this is a welcome development, it is a

supply chain fact that once one bottleneck is addressed

another appears. The LU has managed to retain staff but there

is a high attrition rate of staff at hospitals especially of

pharmacists. This requires continuous training of new

pharmacists in the many distribution systems. The diagram

below shows pharmacist appointments and terminations for the

period between July and December 2012.

Figure 7: Pharmacists attrition between July and December 2012

0

10

20

30

Series1

28

Increase in facilities that are offering ART services is

evidenced by the graph below showing an upwards change in

facilities reporting to the LU. It is should be noted that

Manicaland and Mashonaland East report during the even months(

August, October….) while Mashonaland West, Mashonaland Central

and Harare report during the odd months.

Figure 8: Facilities receiving ART medicines and reporting to

the LU

29

104130

105134

106136

112146

118149

124164

126168

129184

134

212156

222

Total facilities active

Total facilities active

The diagram above shows that there is a stead but sustained

increase in the number of reports and orders expected to be

approved by the Logistics Unit. The numbers above the line

show facilities from provinces which report during odd months

while those below show facilities which report during even

months. It is evident from the diagram that for both groups of

provinces, decentralisation of ART services clearly taking

place. For the same period, the diagram below shows that the

percentage of facilities reporting on time has never been

above the target.

30

Figure 9: Percentage of facilities from Manicaland,

Mashonaland East, Matebeleland North and South and Bulawayo

which reported on time

Months

Oct-11

Feb-12

Jun-12

Oct-12

Feb-13

0102030405060708090100

% Target% Facilities reported on time

Figure 10: Percentage of facilities from Manicaland,

Mashonaland East, Matabeleland North and South and Bulawayo

who did not report

31

0123456789

% Target% Facilities who did not report

The challenges fuelling late on non-submission of C/R forms

include a high workload of nurses at the clinics. Every month,

nurses have to submit a significant number of reports to

different offices for different results and sometimes

duplicating the same data. This adds to the strain of their

clinical work leading to exhaustion and burn-out. Continued

integration of programs and the introduction of electronic

reporting systems should help alleviate these challenges. The

continued decentralisation of ART services means a sustained

increase in the number of facilities reporting to the LU which

maintains the same staff complement. The same LU staff

complement also provides pharmacy services to all the other

departments and programs within the MOHCW. This results in

unmanageable workloads as a result of competing requirements.

32

It was noted that LU staff require clarity on their purpose

and values. Currently, they are seconded to the DPS but

receive salaries from John Snow, Incorporated (JSI) a non-

governmental organisation. Having two ‘masters’ has inherent

challenges. Issues arise as to which entity’s values must the

LU personnel adopt and at what time should they adopt them.

This lack of clarity hinders the performance of the LU team.

Conflicts arise when the MOHCW has identified gaps in the

medicine supply chain and require partners to chip in while

John Snow, Incorporated have funds available for ‘ring-fenced’

for other activities which may not be immediately needed or

may no longer be needed. Should the LU request for these funds

or should JSI report them as ‘savings’?

4.0 Conclusion

It has become the rule rather than the exception that

organisations structure their work around teams. Identifying

33

ways to open up dialogue and discussion about difference and

working towards achieving the characteristics of effective

teams is more productive in reducing negative conflict than

specifically focusing on conflict management. The diversity in

the LU team can lead to conflicts. The leader should not seek

to avoid this conflict but should foster constructive

criticism and harness it for the team. Currently, LU

management is operating basing more on Macgregor’s Theory X

which is causing frustration to the team members. The way it

is distributing tasks among team members is lowering morale

because of the lack of continuity on programs and tasks as

staff is shuffled on the various tasks. This is made worse

because neither feedback nor explanations are offered by the

management.

5.0 Recommendations

5.1 Structured supportive supervision by logistics officers,

provincial and district pharmacy managers of institutions

34

should be done to foster mentorship and harness the benefits

of on-the-job training.

5.2 The LU should have a vision and value statement separate

form that of the DPS which articulate its own purpose rather

than the broad goal of the DPS as a whole.

5.3 The above recommendation should give rise to clear

performance expectations from LU personnel which will be used

to appraise them and provide them with immediate feedback on

their tasks.

5.4 In addition to tracking and analysing programmatic

outcomes and impacts, the LU should monitor and evaluate its

outputs for it to be proactive in providing solutions to

challenges that impede the achievement of its goals. This may

include analysis of the lead times of order processing within

the LU and periodic comparison of electronic records and hard

copies.

5.5 As the team has clarity on shared values, the LU

management should move along the leadership continuum to

delegating tasks as the Lu is made up of knowledgeable people

in their fields,

35

5.6 Social activities and other plans to motivate staff should

be introduced.

6.0 Bibliography

1. Brill NI 1976, Teamwork: Working Together in the Human Services, JB

Lippincott, Philadelphia.

36

2. Hackman, JR (Ed) 1990, Groups that Work (and Those That Don’t),

Jossey-Bass, San Francisco.

3. Katzenbach JR & Smith DK 1993, The Wisdom of Teams: Creating the

High-Performance Organization, Harper Business, New York.

4. Kirkman BL & Rosen B 1999, ‘Beyond Self-management:

Antecedents and Consequences of Team Empowerment’, Academy

of Management Journal, vol 42, no 1, pp 58-74.

5. Maple G 1987, ‘Early Intervention: Some issues in co-

operative team work’, Australian Occupational Therapy

Journal, vol 34, no 4, pp 145-151.

6. West MA 1994, Effective Teamwork, (1st Ed) British

Psychological Society, Leicester.

7. Zimbabwe Full PSM Plan, Round 8, Phase 2 submitted in

December 2012.

8. Zimbabwe National Medicines Survey (2011)

37