As of July 27, 2016, 74% of drugs for adult oncology and only 36% for pediatric oncology were supplied to Ukraine.
Two weeks ago, on July 15, the Verkhovna Rada registered bill No. 4008a "On Public Procurement." In the explanatory note to the bill, members of parliament noted the unsatisfactory performance of the British procurement agency Crown Agents, with which Ukraine has been cooperating for almost a year.
On November 6, 2015, the Ministry of Health of Ukraine and the British procurement agency Crown Agents signed an agreement for the procurement of medicines and medical supplies. The agreement provides for the procurement of oncology and oncohematology drugs, as well as chemotherapy drugs, radiological drugs, and oncology patient support medications through Crown Agents. The amount specified in the agreement exceeded UAH 750 million.
According to Bill No. 4008a, the British organization failed to meet its procurement plan for any of the areas, depriving healthcare institutions of significant amounts of anticipated medications for cancer patients. The explanatory note states that medical institutions received only 16% of the funded volume of medications for the "Pediatric Oncology and Oncohematology" area.
Yesterday, during a conversation with journalists, Crown Agents representatives shared their perspective on the situation. Read more about the current state of affairs in the cancer drug procurement system in this article.
Disruption of supplies for cancer patients: was it or wasn't it?
As of early July, Crown Agents had delivered only 16% of the medications ordered for childhood cancer programs. This was stated by Oksana Korchynska, MP and First Deputy Chair of the Verkhovna Rada Committee on Healthcare, at a roundtable discussion titled "Purchasing Medications with State Budget Funds through International Organizations."
She also reported that Crown Agents had purchased numerous medications with expiring expirations and had not received the corresponding discount from the manufacturers. In light of this, the MP emphasized that she would advocate for Crown Agents' right to purchase medications for Ukraine to be revoked.
Olha Bogomolets, head of the Verkhovna Rada Health Committee, agreed with her. According to Bogomolets, international organizations' failures in public procurement have discredited the very idea of procurement through international organizations.
Crown Agents, for their part, claim they are fulfilling all of their obligations to the Ukrainian Ministry of Health and beyond.
According to the company's senior procurement consultant, Christine Jackson, as of July 27, 2016, Crown Agents had supplied 74% of the adult oncology drugs and 36% of the pediatric oncology drugs. Furthermore, the company plans to receive 65% of all components under the contract as early as this week.
Christine Jackson
Jackson attributed the significant delay in drug deliveries specifically for pediatric oncology to the specific nature of the Ministry of Health's technical team's work.
"Unfortunately, the pediatric oncology program is four weeks behind the adult oncology program due to the longer work of the Ministry of Health's technical group, which is determining the list of products and their requirements. In March and February, pediatric oncology received a lot of media attention, which forced the working group to be especially cautious in its product selection. However, we hope that in the coming weeks, supplies of pediatric oncology medications will exceed 50%," the expert says.
Whose products are they buying?
According to Korchinskaya, the lion's share of the drugs purchased by the British company are manufactured by Ukrainian companies. Crown Agents representatives emphasize that their goal is to supply the best. Moreover, the company's tenders are open.
"The tender is open to all companies whose products meet our criteria. This means that all technical and financial documents submitted by bidders must comply with international practices. It's worth noting that, despite systemic challenges, we signed contracts for 45% of medications directly with drug manufacturers, rather than through distributors. All tender procedures are handled by procurement specialists at our head office in London. We have extensive experience procuring pharmaceutical products worldwide," explains Jackson.
The British agency identified 10 drug manufacturers as suppliers for drug procurement in 2015: Accord, Hetero, Roche (Ukraine), Sanofi, Sun Pharm, Teva, Baxter, Pfizer, Lekhim, and Lumiere. Twelve distributors also participated in procurement: BaDM, BCPH, Link Medital, Miller and Miller, Optima-Pharm, Pharmex, Pharm Science, R Pharm, PharmaLife, Bioframa, Lyudmila-Pharm, and Ukroppostach LLC.
She emphasized that, in order to ensure transparency of operations, Crown Agents provides weekly reports, which are published by the Ministry of Health.
"If there are any changes to the supply schedule or if certain goods can be delivered more quickly, this is agreed upon with the Ministry, in accordance with our agreements and legal requirements for the procurement process. This is done on a per-item basis," she adds.
Crown Agents' Head of Procurement, Tom Brown, also stated that 77 companies submitted bids for the tender. Thirty-three companies met the criteria and were invited to participate.
Savings should be economical
"We signed a contract for the supply of pediatric and adult oncology treatments worth UAH 750 million. We spent a great deal of time ensuring these medical supplies were delivered to the country. I emphasize that this is a new process that represents significant and ambitious changes for the Ukrainian government. The savings the Ministry of Health is currently receiving are several times greater than the payment Crown Agents receive for their work," Brown said.
It should be noted that the remuneration of the purchasing agency Crown Agents is 5,5% of the purchase volume.
Christine Jackson says savings of up to 70% in some cases are down from 2014.
"In December 2015, we attempted to launch a procurement process that met not only our requirements but also international best practices. In some cases, savings reached 70% compared to 2014. With the same budget allocated in 2014, we were able to purchase and supply the same quantity of medications for children and adults. And this despite the hryvnia-dollar exchange rate changing by more than 100," she says.
Patient organizations also believe that Crown Agents' overall procurement efforts were significantly more effective than those conducted by the Ministry of Health. However, according to the public organization Medical Control, not all of their purchases were cost-effective or efficient.
Are problems with drug supply the Ministry's fault?
Earlier, this organization published documents according to which the drugs that Crown Agents included in the procurement list for the Children's Oncology program were banned for use in Ukraine due to their non-compliance with quality parameters, following an order issued by Raisa Bogatyreva back in the summer of 2012, when she served as Deputy Prime Minister of Ukraine and oversaw medical and healthcare issues.
The Ministry of Health began investigating the quality of these medications in 2012 after a series of letters from chief physicians at Dnipropetrovsk, Cherkasy, Sumy, and other oncology centers refusing to use them. The chief physician at the Sumy oncology center stated at the time that patients experiencing increased toxicity, complications, and poor efficacy after using oncology drugs manufactured by Venus Remedies Limited (India) were experiencing increased toxicity, increased complications, and poor efficacy.
Following a detailed investigation, in the summer of 2012, the Ukrainian Ministry of Health was forced to ban the use of 115 drugs imported into Ukraine by companies associated with Boris Litovsky (and which the Ministry of Health allegedly intended to import into Ukraine in January 2016 through the organization Crown Agents) due to the fact that some of them had never been officially manufactured anywhere, while the registration of the remaining drugs had been suspended due to significant complaints about the quality of the production sites.
Representatives of Crown Agents deny any accusations against them.
"It so happened that a lot of information appeared in the media regarding our cooperation with the Ukrainian government. Some of the information was false and inaccurate. We would like to present some facts on this matter. We are a commercial organization, founded by a British charity. What distinguishes Crown Agents from others is that we build our work on transparency, ethics, and fair cooperation.
"We've worked in many other areas in Ukraine. One of them was the construction of a spent fuel storage facility. We're currently working with the Ministry of Health to provide cancer patients with medications. We have experience implementing these reforms in other countries. We're not politicians and we don't make policy decisions. We're technical specialists and simply provide services," explains Brian Richmond, Director of Supply Chain Crown Agents.
The company summarizes: they work closely with the Ministry of Health and negotiate with the agency on every item.
Does this mean that the problems with the supply of medicines and medical supplies for cancer patients in Ukraine are solely the fault of the Ministry of Health? In any case, our foreign colleagues at Crown Agents are currently claiming that temporary difficulties are normal during a period of reform. However, in Ukraine, the "era of reform" has been underway for several years now, and there is still no rosy horizon for its end in sight.
Irina Shevchenko, "Facenews"
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