Like any government entity, the public health sector has continued to follow procedures for procuring goods, works and services as laid down in the Public Procurement Act (2002) and elaborated in the Public Procurement Regulations of 2004.

During the implementation of the PoW, major challenges in procurement have included: lack of capacity, especially at the central level; poor coordination between the Procurement Unit and other departments, including districts; lack of well documented procurement procedures; unclear role of the central level in procurements undertaken at the district level, and excessive emergency procurements.

Procurement capacity challenges in the public health sector have been exacerbated by the commissioning of multiple audits by different partners and the operation of a parallel system of oversight to provide reassurance to HDPs.

In these areas the development partners have failed to align to country systems in accordance with the 2005 Paris Declaration on Aid Effectiveness and the 2008 Accra Agenda for Action.