For the health system to function properly, it must constantly acquire medical supplies and medicines; thus, purchases are a fundamental axis, which, as well as physicians’ care, must have ethics and transparency in all its stages. Having good procurement processes requires strong leadership, laws, and institutions to contribute in effective processes.
The problem is that, in Latin America until now, ethics and transparency in purchasing processes only have a regulatory focus, and leave aside an essential complement: the inclusion and participation of private companies and citizens, who undoubtedly would improve purchasing processes.
This was the theme that was discussed in the “Integrity and transparency in public procurement processes” forum, organized by the Mexican Association of Pharmaceutical Research Industries (AMIIF for its acronym in Spanish). The forum was held in Mexico, with the participation of experts in transparency, social management and cooperation, as well as public officials from the Mexican government.
How do the purchasing processes work in the health sector?
The first thing to say is that an entire ecosystem is needed to be able to carry out public purchases. First, laws are needed to govern these purchases, enabling a regulatory framework. Each country, and in some cases each state, has its own regulations.
There are also different methods of making purchases, including direct purchasing, agreements, and public bidding. The type of method will depend on the purchase being made and the institution carrying it out. Finally, all these acquisitions can be performed in person, digitally or a combination of the two.
According to Alejandro González, an expert in Social Management and Cooperation, for several reasons agreements are one of the most efficient methods for purchasing processes. They allow, for example, to reduce inventory, infrastructure and administration costs. In addition, they reduce room for corruption without neglecting flexibility in response capacity. These types of agreements are used to purchase vaccines, medical working clothes and patent drugs.
Zoom to Latin America
In the case of Mexico, in order to perform transparent purchasing processes, the Secretary of Public Service created the Business Integrity Register platform. By promoting integrity policies, this seeks to improve the relationship between government, private initiatives and society. As explained by Carlos Villalobos, Liaison Coordinator with the Business Sector for the Secretary of Public Service, it is, in short, an observatory to digitally observe the purchasing processes of all companies and individuals.
Furthermore, this platform allows companies to self-audit and manage risks. Through a questionnaire, the government carries out a validation process and companies receive a certificate for their collaboration. This allows each company to have a diagnosis in order to begin taking actions to minimize risks in public purchases.
However, it is necessary to highlight that there is still room for improvement in Mexico. As Alejandro González, an expert in Social Management and Cooperation, explained, the public procurement regime is fragmented into different institutions and changes, depending on the State. In addition, purchases are still undertaken in a very analogous way and direct purchasing is prioritized, which is problematic in an era where everything works digitally.
In contrast, countries such as Chile have implemented more effective ways of purchasing. An example is through ChileCompra, under the Ministry of Finance, which has achieved efficiency and transparency in its public procurement since 2003. Particularly regarding health sector purchases, Alejandro González explained that ChileCompra have used the agreement modality since 2013; this has allowed the reduction of infrastructure and inventory costs by 40 percent.
Additionally, the Chilean government possesses the Fiscal Observatory tool, which enables to view all purchases, products, suppliers, and purchasing modalities that have been carried out in the health sector since 2010.
Another example that González highlighted was Compra Eficiente in Colombia, which forms part of the National Planning Department and its purpose is to establish public policies that facilitate purchases and efficiency therein. From Colombia Eficiente there are agreements for the purchase of HIV treatments, hemophilia treatments or special products for COVID-19 disinfection and detection, for example. Thanks to this program, González says, the contract purchasing process has increased significantly since 2016.
Regarding the purchasing processes in the region during the COVID-19 emergency, Martín Zapata, Regional Coordinator for Latin America of Fisheries Transparency Initiative (FiTI), explained that the great legacy left by the crisis is that there cannot be “contingency systems without an anti-corruption system”. Likewise, he added that this was an opportunity for all countries to strengthen their purchasing systems and rethink their systems to be integrated with all health stakeholders.
Cooperation to improve results
Regarding the elimination of corruption in public procurement, for Martín Zapata “Latin America has good examples in participatory processes to combat corruption”. However, he explains that in these processes the goal of transparency can be misleading, since it can be rhetoric or written in a manual, but not implemented in actual situations.
This is important because in health sector purchasing processes, “transparency without consequences can be counterproductive, because they are not enough to end corruption”, as explained by moderator María Teresa Cantú, lawyer in charge of ethics and compliance at AMIIF. This means that, in order to carry out an ethical purchasing process, there are still many gaps between health system stakeholders.
For this reason, experts reached a consensus that collaboration between private, public and citizen sectors is needed in order to achieve optimal processes. To be successful, this relationship must have trust and communication. This will work to standardize procedures, involve SMEs, diversify procurement methods, and involve the private sector in transparency co-responsibility.
On the other hand, it is necessary to enact a specific policy for each country based upon cause analysis of bad practices in public procurement processes. This, for the purposes of adapting to local needs in order to achieve greater impact.
In summary, the inclusion and participation of private companies and citizens in public procurement processes will add transparency to this ecosystem because, by making information open to everyone, a trust and co-responsibility culture is created. Likewise, when there is an open communication ecosystem, room for corruption is closed. Finally, the most important matter for achieving a sound procurement process is to consider that the well-being of citizens and patients should always be at the center of any public procurement.