|Joint bulk purchasing of essential drugs - Achats groupés de médicaments essentiels (A.C.A.M.E. - WHO/AFRO, 1999, 28 p.)|
1. Organization of the purchasing trial
For purposes of the joint bulk purchasing, a meeting bringing together CAMEG (Burkina Faso); the essential drugs unit of TOGOPHARMA (TOGO); Pharmacie Nationale d'Approvisionnement (PNA), Senegal; PCG (Guinea); SARL JAMAKA KENEYA (JKK); (GIE Mali); and Pharmacie Populaire du Mali (PPM) was held in Bamako in November 1997. The Office National de Produits Pharmaceutiques, Niger (ONPPC) and CPA (Chad) could not attend the meeting but authorized the participants to represent them.
The one-day meeting helped reach an agreement on the conditions for organizing, managing and awarding contracts. The meeting was aimed at adopting a common position on the following issues: type of invitation to tender, choice of drugs to be purchased and their technical specifications, method of assessing-tenders, award of contracts and the articles and conditions of the contract.
Owing to the multiplicity of suppliers and the difficulties involved in managing such a restricted tendering in which only the best ten suppliers of each central medical store could compete, all central medical stores that attended the Bamako meeting submitted a list of 10 suppliers. After analysis, a shortlist of 25 suppliers was authorized to bid.
To produce the final list, the specifications and the quantity to be purchased, each central medical store was requested to provide information on 10 drugs in high demand. ONPPC, PCG, SARL, JKK and PPM provided the required information which was used as a basis for compiling a list of five suppliers.
The type of contract agreed upon involved the pooling of drug purchases in order to have a single CIF price, with goods delivered to the purchasers. Each purchaser signs a contract with the selected supplier. These arrangements make it possible to adhere to the laws and regulations in force in each country. The supplier is paid 30% upon the delivery of drugs and 70% after quality control is done.
The Niamey laboratory in Niger (Regional quality control laboratory) was selected to conduct drug quality control. For communications and cost reasons, however, the Laboratoire National de la Sante du Mali carried out the tests. A tender assessment commission comprising procurement managers of the central medical stores of participating countries was set up. The ONPPC representative could not participate in the work of the commission.
PPM was requested to prepare a schedule of specifications that took into account the key issues above and to start the tender invitation process.
The draft schedule of specifications was submitted to the central medical stores that approved them in January 1998. The cost of the schedule of specifications was fixed at 100 000 CFA francs.
The invitation to tender was launched in March 1998 and the processing and analysis of bids took place in July 1998.
2. Processing, analysis and results
Out of the 25 suppliers invited to submit tenders, 20 tender files were purchased and 12 bids were received. It should be noted that none of the four local suppliers invited submitted bids, for unknown reasons. It is considered necessary to know the reason(s) for this failure.
On the whole, three countries (Guinea, Mali and Niger) participated in the test on the following five generic essential drugs:
(i) Cotrimoxazole tablets 400 + 80 mg
(ii) Benzylpenicilin 1 MU
(iii) Ampicilin injection 1 g
(iv) Amoxycilin tablets 500 mg
(v) Chloroquine tablets 100 mg Base
At its August 1998 meeting the Committee based examined the bids in stages. The first stage consisted in examining whether the submissions were done in conformity with the administrative rules in force. The second stage involved an assessment of the technical conformity of those bids which had met the set conditions in the previous stage. The tender documents of suppliers who had fulfilled this condition were thus examined for technical conformity. The third stage entailed the examination (macroscopic and packaging) of samples. The last stage involved the classification by price of samples deemed to be of good quality.
The provisional award of tenders was based on the quality of the sample and their price. The final award was made after two conditions are fulfilled: the quality of the services of the supplier (delivery time) and the result of the sample quality control.
The results obtained (annexes 1 and 2) were 7 to 27% lower than the lowest prices each of the participating countries had obtained for over 3 years for any of the five drugs.
Although some suppliers met the conditions in all the stages they were not awarded the contract due to delays in delivery (over 8 months) in one of the purchasing countries. This approach is expected to compel suppliers to be more prompt in executing contracts.
The preparation of tender documents and the tender committee's expenses (accommodation, food and per diem) were fully covered by the costs of tender documents.
For each central medical store, it would be worthwhile making a comparative assessment of the difference between the profit obtained from the joint bulk purchasing and the expenses incurred in organizing it. ACAME was charged to conduct this analysis at the beginning of 1999.
In conclusion one may state that the success of joint bulk purchasing depends on the following:
2.1 a firm commitment will of managers of central medical stores backed by the support of ministers of health;
2.2 the preparation and signing of an agreement defining the applicable rules during the entire tender period; this agreement must cover all matters concerning drug marketing;
2.3 transparency in the implementation of the framework agreement in order to assure suppliers.
3. Other achievements of ACAME
Apart from the study visit to Morocco and Saudi Arabia as well as the implementation of the joint bulk purchasing trial by the ACAME member countries (Guinea, Mali and Niger), the association also undertook the following activities:
3.1 Exchange of information between Burkina Faso, Niger and Chad on suppliers.
3.2 Exchange of stocks of drugs: between Mali and Niger; between Burkina Faso and Niger; and between Benin and Niger.
3.3 Participation in the third meeting of ministers of health of countries of the CFA Franc zone held in Libreville, Gabon from 23 to 26 March 1998.
3.4 Participation in the regional meeting organized by WHO in September 1998 in Praia, Cape Verde on the local production of essential drugs in the WHO African Region.
3.5 The establishment of a data bank for the ACAME member countries.
4. Subsequent ACAME activities
The main activity will be the organization of a third general assembly to be held in Dakar, Senegal from 22-27 November 1999. This assembly will be a milestone. Indeed, apart from the two crucial issues (joint bulk purchasing and the control of illicit drugs), English-speaking and Portuguese-speaking countries will, for the first time, participate in an ACAME meeting. As in the past, WHO will be contacted for its financial and technical support.