Small Island Developing States (SIDS) of the WHO Africa Region discussed Pooled Procurement Programme to reduce costs and improve access to quality medicines during a First Technical Meeting held in Mauritius from 16 to 18 July 2019.

Directors Pharmaceutical Services, Heads of regulatory and procurements agencies, finance experts and other key stakeholders from SIDS countries of the African Region, namely Cabo Verde, Comoros, Mauritius, Sao Tome and Principe and Seychelles participated in this important meeting. Madagascar also joined the meeting which aimed at building consensus towards the effective implementation of the SIDS Pooled Procurement Program in line with the Seychelles Declaration of September 2017 wherein Health Ministers expressed interest to implement a Pooled Procurement mechanism.   

Dr Jean Baptiste Nikiema, Regional advisor esssential medicines, presented the objectives of the meeting and the progress made since the Seychelles Declaration. The sessions were facilitated by experts from WHO Head Quarters, Geneva, Regional office, Brazzaville including Intercountry Support Teams (IST) and WHO country offices.  The Association of Central Medical Stores (ACAME) which is running a similar initiative was represented. Experts from Organization of Eastern Caribbean States and Pan American Health Organization (PAHO) shared experiences to the delegates in the meeting through online sessions. Over the three days the participants deliberated on reports and documents which have been produced since the Seychelles Declaration and examined the establishment, roles and responsibilities of a SIDS Pooled Procurement Program as well as reviewed the Draft SIDS Pooled Procurement Agreement.

SIDS countries when operating as a single bloc will benefit greatly from Pooled Procurement which has a price reducing effect.  In fact, it strengthens negotiating position. Pooled procurement also allows for greater stability in the supply of medicines and vaccines through pooled resources and purchasing results in lower unit prices generating cost saving. The Strategy and Operational Plan for Pooled Procurement developed by WHO, were discussed on the side-lines of the Sixty-Eighth Session of the WHO Regional Committee for Africa held in Dakar in August 2018.

Dr Nikiema highlighted the importance of coming to a consensus on adoption of the SIDS Pooled Procurement documents and technical content of the SIDS Pooled Procurement Agreement. He stressed on the need to have agreed roles, responsibilities and location of the SIDS Pooled Procurement Secretariat and consensus on the modalities for learning visits to functioning Pooled Procurement Programs.

Dr S. Ramen, the Acting Director General Health Services of the Ministry of Health and Quality of Life, in his keynote address, stated that this meeting comes at an important time where many SIDS countries including Mauritius are facing difficulties with the procurement of essential medicines, particularly for noncommunicable diseases. He highlighted the fact that, Mauritius has always been in favour of pooled procurement due to its small demography and relatively-modest requirements. Pooling the requirement with those of SIDS henceforth present an opportunity for Mauritius to procure medicines at a more competitive price.  

Indeed, NCDs, which account for 80% of premature mortality in low-and-middle income countries, are increasingly responsible for mortality in most SIDS countries in the region ranging from over 40% in Comoros and 89% in Mauritius.  With the increasing burden of NCDs, SIDS countries are facing difficulties to sustain access to quality medicines and vaccines. Concurrently, this epidemic, which is a barrier to development, is devastating families and impacting many economies on a global scale.

Mr Ajoy Nundoochan, Officer-in-Charge at the WHO country office, welcomed all participants on behalf of the WHO Representative, Dr Laurent Musango at the opening of the meeting.  He expressed the gratitude of WHO to the Government of Mauritius for hosting the meeting. The strong engagement of the WHO Regional Office for Africa under the leadership of Dr Matshidiso Moeti, WHO Regional Director, translated into concentre actions to support the establishment and implementation of the SIDS Pooled Procurement Program was underlined. “Access to medicines within the pursuit of Universal Health Coverage (UHC) and financial risk protection should not be source of financial hardship and should not come at the expense of other basic needs – education and adequate nutrition.  The United Nations 2030 Agenda for Sustainable Development, which has a dedicated goal to “ensure healthy lives and promote well-being for all at all ages”, acknowledges access to safe, effective, quality and affordable essential medicines and vaccines for all as one of the thirteen health related targets to be achieved”, highlighted Mr A. Nundoochan.  

“The African region is witnessing growing burden of non-communicable diseases along with rising prevalence of related risk factors in the wake of rapid socio- economic transition. The burden will be exacerbated with the rapid ageing of the population in the SIDS”, said Mr A. Nundoochan, Officer-in-Charge of WHO country office.  The fact that drug discovery breakthrough is offering new hopes to patients with hard-to-treat diseases including cancers was also underlined. “These advances are reducing hospitalization and other healthcare costs by twice as much as the amount spent on prescription drugs. However, paradoxically health system in the developing world is still facing challenges to access the essential medicines. The affordability of medicines is evoked systematically as the main stumbling block”, said Mr A. Nundoochan.

All the participants acknowledged that the information shared was useful to move ahead with the agenda of pooled procurement and technically endorsed the documents with comments to be considered by the secretariat for their finalizing. They also realized much more work has still to be done including Agreement on technical, administrative and financial requirements, List and Specifications of medicines for Pooled Procurement, Signing of Agreement and Location of Secretariat. The fact that SIDS Pooled procurement initiative presents one such immense opportunity that can help address many issues around securing access to quality medicines and vaccines was unanimously recognized by everyone.

At the end of the meeting, the SIDS countries acknowledged that actions need to be initiated for seeking approval on agreements, negotiations and joint operations. The various documents in view of reaching consensus on agreements and other technical, financial and administrative issues as well as the calendar of activities will be finalized soon. They agreed on information sharing mechanism and the information that they should share. The forthcoming Regional Committee meeting scheduled in late August 2019 and SIDS Health Ministers meeting scheduled to take place in Cabo verde will present an opportunity to officially get an approval on various documents including the Agreement.