P1254413609DrWzh

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Improving Rational Use through Efficient
Procurement Review of the Existing Evidence
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• Libby Levison, Richard Laing, Brenda Waning,
  Warren Kaplan
• Boston University School of Public Health,
  WHO/EDM
• Review paper for RPM-Plus

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Study goals

• Review literature on pharmaceutical procurement
• Summarize evidence on procurement methods
• Identify factors that impact procurement
  performance
• Identify health systems which are best method
  examples
• Identify future research priorities

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Methods

• Medline, EMBASE International Pharmaceutical
  Abstracts
• Articles published 1995 - 2004
• Internet
• Discussion groups E-Drug, IP-Health
• Web-published papers from NGOs
• Comparison with other disciplines
• General procurement supply chain management at
  Business School Library

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Outline

• Participants system structure
• Procurement process
• Planning coordination resources
• Recent developments
• Research priorities
• Quantity of available literature indicated from
  to

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1. Participants structure

• Participants
• Public sector
• Private non-profit
• Private for-profit
• Public-private partnerships
• System structure
• Centralized/decentralized
• Regional/pooled procurement

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Procurement process

• Selection
• Quantification
• Tender format
• Pre-qualification ()
• Tender quantities
• Market intelligence
• Analyzing costs

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Procurement process

• Payment
• Contract specification ()
• Adjudication
• Reception quality control
• Monitoring procurement
• Continued quality monitoring

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Example Van der Veen Fransen

• Studied final cost variations for different
  tendering methods of STD drugs
• Prices of generics 3-6 times higher for
  ministries doing national tendering than for
  international procurement agencies

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Planning and resources

• Procurement planning
• Human resources
• Access to adequate resources

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Lessons learned

• Scarcity of published evidence
• Little evidence for well-established procedures
• Need for easily accessible case studies
• Need metric to assess and compare procurement
  systems

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How to improve rational use

• Decentralization sub-optimal for procurement
• Base selection on EML
• Reduce work and prices with
• pre-qualification and restricted tender
• Implement QC at reception
• 0.39-0.53 of procurement cost
• Access to market data lowers costs
• Strengthen Purchaser terms in contracts
• Improve communication in system
• Provide training, resources to procurement

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Future studies

• Over 60 study outlines listed in paper
• Focus on gathering evidence to inform
  implementation choices
• Each proposed study contains
• Problem description
• Previous studies
• Required knowledge
• Outline of study with suggested variables

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Study Tendering
Type Cross-sectional comparative
Population Proc offices public, private, NGO
Sample size 20-25
Variables Cost differences among tender formats
Variables Impact tender format on efficiency? On cost?
Variables Relationship between tendering method and order delays
Goal Understand how tender process determines price variations
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Study Taxes
Type Cross-sectional comparative
Population All countries
Sample size As many as possible
Variables What taxes are levied?
Variables What form of taxes (VAT, GST)
Variables Exemptions by product, by purchaser
Variables Cost of tax and exemption system?
Variables Tax system history
Goal Gather knowledge of tax systems to inform policy decisions on EMs
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Conclusion goals achieved

• Limited literature on pharmaceutical procurement
• Summarized documented procurement methods in
  practice
• Identified the few factors that impact
  procurement performance
• Found lt10 health systems which are best method
  examples
• Suggested future research priorities