Moldova. Public Procurement System

The main problem in this area is the COI between the MMDA’s regulatory and procurement functions but there are also various gaps in availability of guidelines, SOPs and monitoring systems. For example, there are no guidelines for staff on tendering processes and although a general law on COI is available, there are no specific guidelines for the procurement process. The regulation on quality control does include requirements for each shipment to be physically checked and samples taken, but there are no SOPs for routine inspection of consignments. There is a computerised management information system to report product problems during the procurement process but it does not include quality assurance information.

Further, there is no centralised system to track the status of each order or to compare quantities purchased with orders. Suppliers’ performance is monitored at least annually but there is no system to track suppliers’ lead-time, shelf-life, packaging of products and pre- and post-qualification of suppliers. It is not straightforward to prevent underperforming suppliers to take part in tenders again. In one instance, a supplier who failed to supply the market at the agreed conditions participated again in the tender process the following year under a different corporate name. While the Republic of Moldova has started using morbidity data and treatment guidelines information for forecasting purposes, procurement is still mainly based on previous consumption data which, as a method, has various limitations.

To be reliable, this method requires a stable supply system with a relatively uninterrupted supply and a full supply pipeline. It also means that is for any reasons some medicines were not procured in one year, they will not be considered in the next forecasting round. National tendering is used to procure hospital medicines but there are often very few bidders and sometimes no bidder at all. In a few instances, when only one bidder was available in both rounds, the price in the second tendering round was higher because the bidder took advantage of their monopoly position, forcing the MMDA to accept the second price offer.

One of the main reasons is certainly the limited advertising of tenders, only using local channels and in local language. A second possible reason goes back to the regulatory gaps identified previously which can act as a disincentive for manufacturers to launch their products due to non-transparent procedures and decision-making criteria. A third possible reason is the underdevelopment of the regulation ground to allow for the use of procurement methods other than centralised tendering. For specific products with limited market share, alternative methods such as price negotiation or single source procurement from international procurement agencies could be better suited.

Finally, the small market size and low income levels are unlikely to make the market particularly attractive. Although it is important from a transparency perspective to have public scrutiny by another body on procurement activities, the need for the Public Procurement Agency under the Ministry of Finance to approve each step in the procurement process and to sign all the contracts has caused delays to the tendering process in the past. This is true also for the very close, and often obstructive, involvement of the Anti-Corruption and AntiMonopoly agencies at all stages of the tendering process. Another issue due to misplaced transparency is the current practice of sharing bids with bidders. This practice was introduced to increase transparency, but could prove deleterious as it may lead to collusion between manufacturers.

Positive developments

Stating in November 2012, new regulations are in place for use of additional public procurement methods including framework agreements, competitive dialogue, negotiation procedure and electronic tender. These were already mentioned in the law but government-approved implementation procedures were missing.

Selection

There is no consistent procedure and criteria for development of the EML, leading to a copy and paste approach of the WHO standard EML without adjusting it to actual needs of the country. Further, there are no efforts in place to promote prescribing based on EML among physicians. There are several gaps regarding selection of committee members including the lack of a declaration of COI, no definition of the role and responsibilities of committee members and the absence of SOPs to guide the selection committee’s decision-making process.

Positive development

The EML is currently being updated to better reflect the epidemiological profile of the country. Further, the medicines reimbursement list is under increased scrutiny from a number of national and international partners. This could help increasing the level of accountability and transparency in the selection process and, hopefully, the extent to which such criteria are evidencebased and following rational selection principles.

Source: Journal of Pharmaceutical Policy and Practice