UNDP international expert: Patients and NGOs will continue to play a key role once the new health procurement agency is established
14 Feb 2018
Wilbert Bannenberg, UNDP public health expert, is helping with the set-up of a new government health procurement agency in Ukraine. In this interview, he talks about the role of NGOs, the global public spending on medicines per capita compared to Ukraine’s, generic drugs, risks of collusion and whistle-blowing programs.
UNDP has been procuring medicines on behalf of the Ukraine government for over two years now. Starting from April 2019 health procurement is supposed to be transferred to a designated national entity. How is the transition going to happen?
The procurement of medicines after 2019 will require a new government procurement agency to take over public procurement from international agencies. There are several ways for us at UNDP to help the government make the new government procurement agency fully operational.
First of all, we can provide some models of similar agencies that represent global best practices. Even more importantly, based on the experience we gained during these last two years, we can work closely with the staff of the new agency to run a pilot procurement project. This pilot project will offer good opportunities to help develop robust and transparent procedures, and to make sure that the governance model of the new agency is resistant against corruption risks.
The new agency will also mark the switch from an emergency mode to a stable system. How do you see the role of patient organizations and NGOs in the new system?
Patients and NGOs will surely continue to play the role they have played in recent years, in monitoring prices, procedures and performance of the new agency. Prices have significantly decreased from the levels of two-three years ago, however there is still a problem with a low capacity to plan, forecast needs, and prioritize. And we should not forget that a budgetary problem persists: the government’s medicines budget simply does not allow to buy essential medicines for all its 40 million citizens.
The Lancet has published evidence that USD 13 – USD 25 per capita is needed to buy the 200 most essential medicines. Currently the public sector has only USD 10 per capita to spend. And for the reasons that I just mentioned, prices are high in Ukraine: for many items around 3-4 times the global benchmark prices.
This makes it even more important that patient groups and NGOs lobby Parliament and Government for higher budgets, a more strategic National Medicines Policy that prioritizes essential medicines, and a more effective medicines pricing policy.
What do you think is the most important lesson learned for UNDP to pass on to the new health procurement agency?
An important message is that generically produced essential medicines are much more affordable in the international market, and that even rich countries like USA, UK and the Netherlands are importing and using generic drugs (copies of brand-name drugs with same dosage, effects, and safety as the original drug) in big quantities, and with great satisfaction.
The local perception in Ukraine is that generics (especially those produced in India) are bad quality. UNDP knows that one can procure affordable, good quality medicines from foreign suppliers. Ukraine’s government obviously wants to support the local industry, but when prices are 3-4 times higher, maybe the interests of Ukrainian patients should become the priority?
What are the biggest risks, in your view, connected with this hand over? And are there ways to mitigate them?
Even if the new agency is using the world’s best procedures, it could still suffer from ‘old problems’ like collusion between two or more bidders, where they divide the market and agree who will put a winning bid for each lot. This is hard to prevent and also difficult to prove.
The only thing you can do is to monitor prices, and declare a bidding process invalid if the bids are substantially higher than expected. It is then up to the anti-monopoly committee to try and find evidence of collusion. This is made easier if there is a “whistle-blower” protection program, so that more honest pharmaceutical staff can leak such information.
Are there any specific international best practices you think Ukraine should adopt?
There is consensus in the world about good procurement practices. These are widely published and available. The question is more which of these best practice examples will work best in Ukraine. That will require quite a lot of discussion!