The UN, in charge of public procurement for the health sector, estimates savings of 48 million dollars but is delayed in purchases
The haste with which the Mexican government has wanted to celebrate the great public acquisition of medicines for this year has paid off with some setbacks. UNOPS, the UN agency commissioned to purchase, has managed to close contracts for the moment for 53% of the 379 medicines and healing materials considered “priority” for a health sector that periodically suffers from shortages and that now faces the largest epidemic in decades, according to data shared exclusively with EL PAIS. Among oncologists, this percentage rises to 71%. The rest, however, has yet to be awarded. The delays threaten to delay supply until May when it was scheduled to start in January. Despite the setbacks, the agency estimates savings of $ 48 million on the 509 million spent so far.
UNOPS was hired at the end of July to put an order in the purchase of medicines. For two years, the Executive of Andrés Manuel López Obrador has been battling chronic shortages in the health sector, a challenge that the pandemic has exacerbated with more than 180,000 deaths and two million infections. The lack of chemotherapies has ignited a protest movement of parents of children with cancer, but the bugs have not been fully resolved. In 2020, the civil platform CeroDesabasto received 2,457 complaints from citizens, more than double the number in 2019. The urgency led UNOPS to organize a quick purchase from a list provided by the Institute of Health for Well-being (Insabi) : 244 generics and 135 proprietary or single-manufacturer drugs. The Insabi, who supervises the purchase, has not responded to the questions from this newspaper or to the request to share the content of the list.
The UN body points to savings of 9% on the amount spent until February taking into account the reference prices. The agency has a regional observatory that monitors the market to compare rates before awarding contracts. With this tool and transparent processes, the agency prides itself on achieving fair purchases for the countries that hire it. Beyond the savings, drug deliveries to the Government have accelerated since they began at the end of January and in a month, 601,000 doses corresponding to 93 keys have already been delivered, 43 of them oncological, according to data from the agency until the middle of February. Still, this is just under half of the drugs and supplies already purchased and a fifth of those on the priority list.
Savings and deliveries also coexist with the high percentage of deserted keys. Of the total of 379 priority drugs, 200 have been purchased, and of the 92 cancer patients included in the critical list, 65 have been purchased. Gaps in purchases are not unique to this process. The López Obrador government had already had similar problems. In the purchase for the second semester of 2019, organized by the Secretaries of Health and Finance, 62% of the keys tendered were not awarded. As a reference, in 2018, before the change of Administration and the modification in the purchase scheme, less than 10% had been declared void.
In the acquisition of UNOPS, part of the problems stem from an extremely tight schedule to meet the needs of the Mexican government during the first quarter of the year. For supply starting in January, the agency negotiated the patented drugs in November and, for the rest of those considered critical, it received offers in mid-December. It had planned to award contracts at the end of that month, but it has not been achieved for an important part of the keys.
In some cases, no offers were presented due to the short deadlines and the complicated context of the pandemic; in others the prices were higher than those taken as a reference, point out sources familiar with the process. Added to that is a third cause of delay: Insabi has changed the amounts required for some of the keys and new patent drugs were added to the critical list, forcing the UN agency to turn to sit down with the manufacturers when the negotiation was already concluded. Enrique Martínez, director of Inefam, an analysis center linked to the pharmaceutical industry, attributes the problems to design flaws: “The quantities and maximum reference prices are poorly defined. They don’t create the right incentives for companies, ”says the expert.
UNOPS has sought to re-fish part of the unallocated urgent keys in a second tender that included around 1,800 keys not considered critical. The presentation of offers held this month was positive. 89% of the medicines and 86% of the healing materials received samples of interest from the companies. Insabi celebrated the industry response. “Mexico is shaping up to respect the full right to health for all inhabitants, as stated from the beginning of his government by the president,” said the institute’s director general, Juan Antonio Ferrer.
The strategy of recovering critical drugs through the tender is not without risks. A handful of cancer drugs have not received offers either in this process. This is the case for cyclophosphamide and vincristine, two chemotherapies for leukemia that were in short supply in 2020. Also, bids do not automatically translate into awards; they have to go through a panel of experts first who can rule them out if the price or quality is not up to the mark. There are a significant number of keys with just one offer, which increases that probability. If awarded, deliveries will begin in May, four months after the scheduled date for priority drugs.
The other option is for the government to resort to direct awards, a mechanism that it has used frequently to fill shortages, but which tends to increase the prices paid for drugs. In the case of cancer patients, Mexico has bought from producers from several countries – “here and there”, as the Undersecretary of Health, Hugo López-Gatell, said at the end of last September. Patches that the researcher Fátima Masse, from the IMCO think tank, considers risky: “You open spaces for discretion. If the reason was that there was less corruption, in terms of cost and transparency, direct awards tend to be worse than tenders ”.