The World Health Organization purchased medical supplies and materials worth $866.72 million — 90% of which was emergency procurement — in 2020, including personal protective equipment and COVID-19 testing kits. But an external audit found weaknesses in the organization’s procurement arrangements.
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“We noticed [a] problem in technical evaluation and quality assurance, and issues related to pricing and payment. The role of consultants in these procurements was also a matter of concern,” said Director of External Audit-WHO Krishna Subramaniam during the 74th World Health Assembly.
According to the external auditor’s report, WHO did not have clear technical specifications for PPEs when the COVID-19 crisis hit in early 2020, despite knowing its critical importance in past outbreaks such as Ebola.
WHO said PPE specifications were established in March 2020, although this was not formally adopted in November 2020. It also said that its PPE specifications in response to the Ebola outbreak in 2018-2019 were different for COVID-19, but the auditor said: “technical specifications are based on the level of protection and not the type of disease.”
The U.N. agency also did not have readily available long-term agreements for PPEs that would’ve allowed it to place immediate orders to vendors, according to the report. WHO said it signed three long-term agreements for PPEs in 2019, but that suppliers were not able to honor those agreements because of price increases during the pandemic. However, the U.N. agency later said the agreements were not honored “because of a lack of availability and a lack of access due to State intervention; and not because of an increase in price.”
According to the audit, a 2019 WHO draft report on supply chains also found similar “Unclear product specifications and ad hoc technical validation of requests” as a weakness in the WHO’s procurement system.
Only 8% of the World Health Organization's funding for its global COVID-19 response is flexible, down from 30% last year.
Lack of clarity on technical evaluations also led to delays and quality issues in the procurement of PPEs. For instance, WHO had to cancel orders for isolation gowns worth $4.42 million from a firm after WHO’s main supplier flagged quality and delivery issues. It took WHO more than four months to cancel the orders and place new ones with another firm.
According to the audit, the firm was not able to provide past customer references and did not have an export license — red flags that should’ve served as warning to WHO.
The audit also flagged a conflict of interest in WHO’s use of a consultant for COVID-19-related emergency procurement. The consultant was assisting WHO in technical evaluations while also involved in price negotiations with suppliers.
Weaknesses in procurement were also found in select WHO country offices, where the external auditor found a lack of open competitive biddings and improper bid invitations in select country offices. Procurement delays were also an issue. While the audit acknowledged delays due to supply chain disruption during COVID-19, it underlined the importance of the timely delivery of goods, particularly those needed for emergency purposes.
In Ethiopia, for instance, the government reported flooding and cholera outbreak in early August 2020, but the WHO country office only made a procurement request for interagency emergency health kits in September 2020. The purchase order for the kits was issued only in October 2020 and was delivered between October 2020 and February 2021, “by which time the threat of cholera had completely subsided” according to the report.
WHO said they had medical kits available, aware that “cholera is a recurrent problem in Ethiopia,” and the orders were meant for stock replenishment.
While the medical kits may have been in stock, the report said “the fact remains that the procurement of emergency health kits was made on an emergency basis as a response to the acute cholera outbreak and not as a routine replenishment of stock.”
“We hope our inputs and the lessons learned are used to strengthen the system of emergency procurement so that WHO is better prepared for the next emergency,” Subramaniam said.