Caught Off-Guard and Mired in Red-Tape

As governments belatedly ramp up their efforts to mobilize resources to combat the COVID-19 pandemic, they are seeking ways to expedite and leverage the resources of the healthcare sector (both public and private) to augment their pandemic tactical containment and recovery strategies.  Unfortunately, the rapid spread of this global plague caught all governments off-guard. They were unprepared and mired in reactive decision making and procurement bureaucratic red tape that hindered decision making regarding the procurement of healthcare services, works, and supplies.  Too many mistakes have been made and too many opportunities squandered.

Time to be Proactive and Preemptive

Four months into the battle it is time for governments to take proactive and preemptive actions that mobilize the best of both the public and private sectors in incentivized, meaningful and effective partnerships that leverage partnerships to defeat a common enemy.

It is in the interest of both parties to seek common ground.  It is time for both the public and private sectors to think innovatively on ways to procure services, infrastructure, and goods – now  – and during the recovery phase in ways that demolish unnecessary divisions between stakeholders and which streamline procurement processes.  I firmly believe that it will be necessary for government and industry leaders to seek formal partnerships that address the now and the future through future forward looking Public-Private Partnerships (PPP) best practices.

The full spectrum of potential partnerships between the public and private sector should be engaged to combat the pandemic.  This includes short-term partnerships that are dependent on philanthropy and corporate social responsibility (CSP) actions.  Short-term partnerships are “finger in the dyke” arrangements (i.e. for PPE supplies) that need to be supplemented by medium- and long-term partnerships that fall into the realm of formal proactive PPPs.

Formal Healthcare PPPs

Formal Healthcare PPP agreements between the public and private should –

  • Embrace a balanced regulatory environment that enhances incentivized procurement
  • Bring greater efficiency and sustainability to the provision of public services through efficient procurements
  • Allow for the better allocation of risk between public and private partners
  • Be a medium- or long-term contract between a private party and a government entity, for providing a public asset or service
  • Embrace a situation where the private party shares appropriate management responsibility and risk with the public sector
  • Link remuneration to performance of procured goods, services and works
  • Embrace innovative methods that provide goods, services, and works to the public in a way that benefits the broader public and delivers an improvement in the quality of healthcare outcomes

The Need for Innovative Approaches

An important area of implementation will be finding safe techniques to procure what is needed in innovative ways while maintaining competitiveness and transparency.  This will require the public sector to think more like the private sector and visa-versa.  This means that the public sector needs to be receptive to demonstrable ideas. At the same time, the public sector needs to clearly articulate its wants and needs, so that healthcare industry leaders can be laser responsive as well.  It is also fundamentally important that procurement awards are made in a de-politicized environment that awards proven partners and avoids cronyism.  This will only be possible if competition and transparency are fully embraced by all parties.

Recommended Expedited Procurement Best Practices

The following best practices are recommended expedited for medium- (months) and long-term resilient healthcare PPP procurements –

  • Government institutions need to establish a national PPP healthcare procurement platform that lists critical needs that have been coordinated and harmonized with subnational government’s and healthcare stakeholder’s priorities. Platforms should be aligned with government initiatives that mobilize the private sector under legislative acts and executive orders such as the US War Production Act
  • The PPP enabling environment must be revisited for general compliance with emergency procurement guidelines that consider sole source procurements in times of extreme need – if they do not exist, national PPP procurement laws might need to be rewritten
  • Potential private sector partners need to be provided with a digital e-procurement interface where they can register their offerings in areas that include the development of supportive infrastructure, services, and goods (specifically pharmaceutical products and PPEs)
  • Innovative due diligence registration filters need to be created so that PPP procurements can verify partners offerings and prevent nefarious attempts by unscrupulous players to participate
  • Once private sector partners have entered their credentials into the database, they should be vetted, and if accepted, be entered into a preferred supplier’s database
  • Red-tape needs to be streamlined so that decisive and prompt coordinated procurement decisions can be made regarding contract awards
  • The recruitment of public and private sector healthcare technical and procurement experts needs to be expedited so that institutions can support procurement reviews of proposals
  • A procurement fast track needs to be created that allows innovative private sector unsolicited proposals (USPs) to be submitted, reviewed and entertained.  Once proposals have proven to be meritorious they should be considered for competitive and transparent procurement process (e.g. Swiss method) that invited preferred vendors to provide counter offers where possible to maximize value for money
  • Longer-term and larger procurements (i.e. healthcare infrastructure) that are address ongoing long-term goals should undergo a more rigorous review that assesses them for value for money, commercial viability, and bankability. This is particularly important for healthcare infrastructure projects that will require more planning and design
  • Flexible force majeure requirements need to be included in PPP procurement terms and conditions so that healthcare PPPs are not exposed to punitive measures for missed deliverables which are not the fault of the operator
  • Reviews of long-term works, services, and goods must have an added filter that stringently applies sustainability and resilience into the required best practices

Conclusions

Emergency procure response systems that are established to deliver necessary healthcare procurements must not be allowed to lapse as it is highly likely in the globalized world that we live in that “black Swan” pandemics might become the norm. It is essential that innovative procurement strategies that are identified and adopted to mitigate future events, must be supported with public and private sector institutional capacity building exercises so that we do not have to reinvent the wheel every time that pandemic occurs in the future.

What is needed are robust and resilient PPP procurement systems that are flexible enough to respond to any unknown force majeure healthcare emergency.  Whatever strategy is adopted, it must be user-friendly and enhance critically needed partnerships between public and private sector healthcare stakeholders at all levels of society and avoid the current situation where institutions are pitted against each to procure emergency supplies and services, thereby resulting in unforgivable lost opportunities. It is time to avoid finger-pointing and to bump shoulders for amicable agreements. Many of these recommendations should also be applied to international procurements by international organizations such as the WHO, the IRC and major aid agencies.

The ultimate outcome should be a situation where stakeholders can expedite the procurement of needed healthcare services, infrastructure, and goods through PPPs at mammoth scale during pandemic outbreaks. Hopefully, we will be able to sleep better then?

Final Word

We are running out of time and need to evade processes that hinder delivery of sustainable and resilient PPPs, whether they be traditionally procured or procured through USPs.

WAPPP; the ISRC; and PPPHealth4All are collaborating to leverage the skills of the global community of PPP practitioners who are seeking solutions for the COVID-19 pandemic.  If you want to be a collaborator, please reach out to me.

Additional Reading

For additional reading see – proactive-strategic-healthcare-ppps-corona-virus-epoch-david-baxter

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