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Mexico and Central America: Taking Aim at Corruption in Pharmaceutical Procurement
As Posted on American University's Center for Latin American and Latino Studies Blog, December 21, 2020
Under pressure to reduce the cost of medications and medical supplies, the governments of Mexico, Guatemala, and Honduras have resorted to an international facilitator to combat inefficiencies and a lack of transparency in medical procurement while attempting to build their own capacity to manage purchases and reduce related corruption in the future.
The Mexican government has been trying to obtain lower prices from manufacturers and distributors of patented or single-sourced medications and medical devices since at least 2008, when it created a Coordinating Commission to Negotiate the Prices of Medications and Other Health Inputs. A pooled procurement mechanism overseen by the country’s Social Security Institute (IMSS) was established in 2013 to purchase pharmaceutical products and medical supplies on behalf of various federal and state agencies. When President Andrés Manuel López Obrador (AMLO) took office at the end of 2018, he labelled the Coordinating Commission as ineffectual and IMSS’ pooled procurement process as hopelessly corrupt – and terminated both. He consolidated purchasing authority for Mexico’s public health sector in the Secretariat of Finance and Public Credit, which also proved incapable of handling the task. To address widespread shortages throughout the country that were putting lives at risk, the Secretariat was signing contracts at exorbitant prices.
Last July, the AMLO administration executed an agreement with the United Nations Office for Project Services (UNOPS), a not-for-profit agency based in Copenhagen better known for implementing humanitarian and development projects. For 2021, the Mexican government is expected to spend some $4 billion to procure medications through UNOPS on behalf of federal entities and 26 of Mexico’s 32 states. UNOPS will reportedly net a 1.25 percent commission for what will be its largest single procurement project to date. In 2022, UNOPS will set up an electronic reverse auction system to conduct the bidding process with international suppliers.
Guatemala and Honduras reached out to UNOPS, with good results, years ago.
In 2014, UNOPS began assisting the Honduran Social Security Institute (IHSS) and Ministry of Health to establish a more effective and transparent procurement system for purchasing medications and medical supplies. After a year, UNOPS was able to procure medications at costs at 40 percent or more lower than what had previously been paid. Government funding remains a problem, but allegations of corruption in medical purchases have dropped sharply.
Following major corruption scandals at Guatemala’s Social Security Institute (IGSS), the Guatemalan government signed a contract with UNOPS in 2016 that involved both procurement and technical assistance to the IGSS to enhance transparency and strengthen its procurement processes. As a result, the Guatemalan government estimates the IGSS achieved an estimated 57 percent reduction in the prices of procured medicines and a 34 percent savings in surgical medical supplies and cochlear implants. The IGSS claims it was able to utilize these savings to, among other things, build new hospitals and extend health insurance coverage to more Guatemalans.
These experiences build on Guatemala and Honduras’ participation since 2010 in a mechanism overseen by the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA) to jointly negotiate the prices of medications and medical devices for subsequent purchase by the public health sector in their countries.
Ensuring efficiency and reducing corruption in medical purchases will ultimately depend on the governments’ ability to reform their own systems, not on developing a permanent dependency on UNOPS or other international entities. UNOPS is scheduled to hand the entire procurement system over to the Mexican government in 2024. The recently created Mexican Institute of Health for Well-Being (NSABI) will initially oversee distribution within Mexico, but the AMLO administration has indicated that this function will eventually be taken over by a more specialized agency that will also have warehousing capabilities (including cold storage facilities).
AMLO signed an executive decree at the end of October that recognizes the health safety certificates issued by regulatory authorities in other countries as being equivalent to those issued by the Federal Commission for Protection against Health Risks (COFEPRIS) in Mexico. The decree also simplifies the process for COFEPRIS to issue certifications for the sale and consumption of all imported medications in Mexico. These moves are intended to undermine the ability of unscrupulous pharmaceutical firms to “capture” the regulatory approval process and thereby hinder competition.
The positive experiences in Guatemala and Honduras with UNOPS may encourage reformers in other Latin American countries, as just happened in Mexico, to look to the self- financing UN agency for assistance in clamping down on corruption, ensuring better management of the public health care sector, and implementing modern procurement systems to address the longstanding challenge of getting essential medical supplies to citizens who need them. The COVID 19 pandemic has made health a global priority and exposed serious deficiencies that no longer can be ignored. Without robust and equitable public health care systems, there is no sustainable economy.
* Thomas Andrew O’Keefe is president of Mercosur Consulting Group, Ltd. and lecturer with the International Relations Program at Stanford University.