The impact of health care programs is not only highly dependent on having the right professionals in place, but also on making sure that they are equipped with appropriate medicines and kit. But the role of procurement and logistics — to ensure medical staff have the right goods and equipment they need to fulfill their roles — is often overlooked.
Professional procurers — when brought in early in the project planning process — are able to develop a clear understanding of the health issues being addressed, and will search marketplaces to find the goods, equipment, or services that will overcome the challenge in a way that represents the best value for money. When this happens in the correct way the benefits can be significant — both for the organizations delivering health care programs and for their end beneficiaries.
Risks riddle the supply chain in South Sudan, with rigorous customs clearances, volatile security on major import routes, and an overall harsh operating environment.
Understanding what is needed
It can sometimes be hard for organizations delivering health care programs to know exactly what they need to purchase in order to fulfill their goals. This is because they aren’t always fully aware of the options available to them, or have conflicting stakeholder views to reconcile. Identifying the most appropriate products and services requires extensive knowledge of local and international marketplaces, which is where professional procurers start to add value — applying their in-depth understanding and helping delivery teams make informed choices.
Unfortunately, all too often, procurers aren’t used to best effect. Program staff will simply ask them to purchase X goods to be delivered to Y country, but if procurers are brought in early and given the opportunity to bring additional strategic thinking to the table, they can shift the conversation from “what” is being procured, to “why” it is being procured. This simple question can result in valuable insights leading to different and improved approaches before the terms of reference have been established.
“Procurement can undoubtedly add value to health care programs but only if there is a shift from traditional approaches of simply buying what is requested, to focusing more on why things are needed.”— Jeremy Rowan, chief medical officer, Delivering Procurement Services for Aid
Making budgets go further
Where hundreds of different products are being bought for numerous health centers, the potential cost savings of taking a strategic approach can be immense. A case in point is a procurement that Delivering Procurement Services for Aid worked on for the maternal, newborn and child health program in Northern Nigeria. When our procurement team examined lists outlining the goods and equipment requirements of six states for 2017-18 and 2018-19, we anticipated that the client was unlikely to be able to purchase everything within the budget.
We recommended that we undertake a technical assistance exercise to see where savings might be found. With our client’s agreement, we scrutinized more than 700 individual line items, and were able to identify 20 areas where cost efficiencies could be made without compromising quality or reducing capability. For example, we recommended opting for clinical-quality microscopes over research-grade ones. These were less expensive but entirely suitable to meet the program’s needs.
In total, we identified cost efficiencies of £10 million ($13 million). This exercise shows what a strategic approach can achieve where a “traditional” approach might be simply to say that only some of the requested items could be bought with the funds available.
Engaging with trusted suppliers
Undertaking due diligence to identify high-caliber suppliers is critical within health care, not least to overcome the risk of counterfeiting. I have also personally encountered considerable variety in the processes used to verify the credentials of clinicians and health care organizations. This means particular care is needed where labels or certificates are applied to goods because numerous standards exist.
The best suppliers have processes for managing the shelf life of perishable items and adhere to international quality standards, such as those by the World Health Organization. DPSA always requests that procured pharmaceuticals have 75 percent of total shelf life remaining, or at least two years, whichever is greater. We also test drugs when necessary, providing a belt-and-braces approach to ensuring pharmaceuticals are fit for purpose.
A smart approach to delivery logistics
Logistics with the end users in mind
Coordination with other organizations, careful labeling, and pre-shipment sorting are critical in crisis situations. Unfortunately, this approach wasn’t taken during the recent Ebola outbreak in Liberia. A humanitarian worker said that “when shipments of supplies arrived it was like Christmas because no one knew what the boxes would contain.”
A better approach, as we used in Sierra Leone, is to package items with their final uses in mind. We designed a logistics plan with our partners that included separating 1,500 tonnes of pharmaceutical and medical supplies into specific consignments for 1,244 health facilities. Providing an end-to-end solution, with items packaged in advance for each end location, meant the supplies were ready for use straight away when they reached their final destination.
Once decisions have been made on the most appropriate goods to procure, the task of getting them to where they are needed begins. An important consideration for pharmaceuticals is cold-chain continuity; because certain medications can be sensitive to heat or cold, it’s critical to keep them at optimal temperatures during the entire journey from manufacture to the final destination.
When I recently visited a hospital in Somaliland to get an insight as to what goods and equipment were needed for the facility, I saw that there were no fridges or secure facilities for storing vital controlled drugs. I therefore recommended that pharmaceuticals requiring these conditions should not be provided until infrastructure and equipment were in place to provide cold-chain continuity. Rather than simply buying what is requested, a strategic approach to procurement can help to prevent wastage, meaning aid goes further.
Being motivated by program outcomes also means procurement professionals can help to ensure health products are deployed quickly and effectively once they reach their destination. For example, when an epidemic is already happening, medical staff who will be working with patients might need protective outfits in the correct sizes. Sorting at the outset according to the sizes needed at each location can help to save time.
Supporting national procurement functions
The responsibility of procurers doesn’t stop once delivery has taken place. Capacity-building is vital to reduce inequalities and strengthen developing nations’ economies going forward.
The 2011 report “What future role for local organizations? A reflection on the need for humanitarian capacity- building,” concluded that “if the humanitarian movement is to maintain its purpose, preserve its value, and respond to criticism about the impact of its action, it must broaden its response through sincere and deeper consideration of local humanitarian capacity-building.”
Building local capacity
We were asked to procure quality-control services for testing drugs in Malawi from facilities outside of the country, as it did not have sufficient capacity to conduct the testing itself.
However, in discussions with the client we discovered that Malawi was planning to build a new drug-testing facility. So we recommended using 70 percent of the available funds to procure the outsourced services, and reallocating 30 percent of the money to buying equipment for the new laboratory.
From the point of view of procurement, this might mean training staff on the ground or providing in-country procurement oversight services to ensure money is spent as intended. Or, it might mean supporting local initiatives rather than outsourcing services internationally.
Helping aid go further
Procurement can undoubtedly add value to health care programs but only if there is a shift from traditional approaches of simply buying what is requested, to focusing more on why things are needed.
When procurement teams are engaged early on, they can be certain that the goods and services they recommend will make the most appropriate contribution to meeting program goals. And when they are motivated by those objectives every step of the way — from approaching the market to delivering the goods — they can help to ensure that donors’ money is used in the most effective and efficient way.
Aid money has been fundamental to turning around entrenched health care issues in the recent past. Taking a strategic approach to procurement provides an opportunity to help aid go further and to contribute to delivering further positive global health outcomes in the years ahead.