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.

Table of Contents
Acknowledgements..................................................................................................... 1
Table of Contents........................................................................................................ 2
1.0 Introduction.......................................................................................................... 3
1.1 Assignment........................................................................................................ 5
1.2 Purpose............................................................................................................ 5
1.3 Value............................................................................................................... 6
2.0 The Logistics Unit as a team...................................................................................... 6
2.1 Clear visual goals................................................................................................ 7
2.2 Attainable goals.................................................................................................. 9
2.3 Recognising achievers........................................................................................ 10
2.4 Immediate feedback........................................................................................... 11
2.5 The satisfaction of social needs............................................................................. 12
2.6 Satisfaction of esteem needs................................................................................. 13
2.7 Motivation and influence of group pressure..............................................................13
2.8 Striving to meet higher individual standards.............................................................14
2.9 Planning tactics together..................................................................................... 15
2.10 Evaluating performance as a team regularly............................................................15
2.11 Existence of a high degree of trust among all members..............................................16
2.12 The leader/captain is part of the team....................................................................17
3.0 Discussion of findings........................................................................................... 18
4.0 Conclusion......................................................................................................... 24
5.0 Recommendations................................................................................................ 24
6.0 Bibliography....................................................................................................... 26

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, 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.
3

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

LU Manager

Deputy LU
Manager

4 Logistics

Officers

Upstream
Logistics

Coordinato
r

PMTCT

Coordinato
r

Adminstrative
Assistant

MIS Officer

Office
Orderly

3
Data
Encoders

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.

Figure 2: LU staff by professional background

Other; 1 Pharmacists; 2
Office Management; 1

Pharmacy Technicians; 3
Information Technology background; 4

Logistics-related background; 3

1.1 Assignment
An analysis of the Logistics Unit of the Directorate of Pharmacy Services(DPS) under the
Ministry of Health and Child 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 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 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 teams
vision. This motivates the members 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
Facility sends C/R
MIS Officer compiles
formand
to the LUapprove orders and
and analyses data
andencoder
Data
LU Management
enters data Logistics
manages
Officers
sends to Logistics
into the electronic
leads thesystem
LU team generate
providingFacility feedback Reports
Officers and reports
to approval
for order
direction,and
motivation
electronically
and guidance.
and send to NatPharm. They
LU manager send to Logistics
compile a report to submit to LU management

NatPharm packs medicines

and medical supplies
according to orders and
distributes to the facilities

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 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 Childrens 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. 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

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 Skinners
theory of reinforcement of behaviour. Skinners theory was based on E. L. Thorndikes 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

Need

Behaviour
10

Reward
Punishment
Switch off

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 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.

11

Hackman (1990) recommended a balance between the more traditional individual reward
systems with team-based incentives that are contingent upon the whole teams 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 Maslows
hierarchy of needs. In order to avoid challenges of loneliness, depression and anxiety, people
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 teams 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. Maslows theory points out that peoples needs are
not just met by hard cash. Well paid people may still have needs that require satisfaction.
Furthermore, Maslows 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.

12

2.6 Satisfaction of esteem needs

The fourth level of Maslows 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 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.
13

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 that the professionals 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.

2.9 Planning tactics together

14

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

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 members 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
15

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 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 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
16

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 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

17

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 LUs performance

Analysis of the LU basing on characteristics of a successful team

Rating awarded

4.5
4
3.5
3
2.5
2
1.5
1
0.5
0

Assigned Rating
Minimum Acceptable

Characteristics of a successful team

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

18

Number of characteristics grouped according to the performance of the LU

Above 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 impact on reaching the target of inpost 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.

19

Figure 7: Pharmacists attrition between July and December 2012

30
25
20
15
10
5
0

Pharmacist appointments

Pharmacist terminations

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

20

Total facilities active

Total facilities active
212

184
164 168
146 149
130 134 136
124 126 129 134
118
112
104 105 106

222

156

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.

21

Figure 9: Percentage of facilities from Manicaland, Mashonaland East, Matebeleland

North and South and Bulawayo which reported on time
100
90
80
70
60
50
40

% Target
% Facilities reported on time

30
20
10
0

Figure 10: Percentage of facilities from Manicaland, Mashonaland East, Matabeleland

North and South and Bulawayo who did not report
9
8
7
6
5
4
3
2

% Target
% Facilities who did not
report

1
0

22

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.

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 nongovernmental organisation. Having two masters has inherent challenges. Issues arise as to
which entitys 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?

23

4.0 Conclusion
It has become the rule rather than the exception that organisations structure their work around
teams. Identifying 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 Macgregors 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 should be done to foster mentorship and harness the benefits of onthe-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.

24

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,
5.6 Social activities and other plans to motivate staff should be introduced.

25

6.0 Bibliography
1. Brill NI 1976, Teamwork: Working Together in the Human Services, JB Lippincott,
Philadelphia.
2. Hackman, JR (Ed) 1990, Groups that Work (and Those That Dont), Jossey-Bass, San
Francisco.
3. Katzenbach JR & Smith DK 1993, The Wisdom of Teams: Creating the HighPerformance 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)

26