The United Nations Office for Project Services (UNOPS) is an organization within the United Nations (UN) system, in charge of public procurement, infrastructure, and Project management. It has operations in more than 80 countries and in Latin America we are in 23 countries, including Guatemala.
UNOPS began collaboration in Guatemala since 1997 in support of efforts previous to the peace accords. As of then, it has provided support through the implementation of projects in the areas of public procurement, infrastructure, and project management. Also, through advisory services, implementation, and transactional services. Over the past 24 years, it has contributed in the following areas: culture, sports, justice, governance, health, education, decentralization of services, environment, water and sanitation, institutional strengthening, and public infrastructure.
Relations between UNOPS and Instituto Guatemalteco de Seguridad Social (IGSS) have been strengthened since 2007, initially supporting the actions of the Pirst phase of the IGSS Infrastructure Plan through the building, providing equipment, and the design of 16 hospitals nationwide. This first phase ended in 2018. In 2020, the second phase of Plan de Modernización de la Infraestructura Hospitalaria - Hospitals Infrastructure Modernization Plan through the INFRAIGSS Program, which will be implemented until 2025.
At the same time, in June 2016, the IGSS Board of Directors entered into an agreement with UNOPS for the procurement of drugs and medical supplies, as well as the strengthening of the Institute's capacities, through the AMEDIGSS Project. The main objective of AMEDIGSS is to introduce the required modifications within the entity in order to ensure greater efficiency, transparency, and effectiveness in the expenditure, with the ultimate objective of guaranteeing the quality of the services to IGSS affiliates. AMEDIGSS has planned operations until 2023.
Since 2016, and in an effort to improve the public health system, UNOPS has been working together with IGSS to improve transparency in public procurement, starting with the procurement of medicines and medical supplies and then supporting a broad-reaching institutional reform for IGSS.
The Medicines Procurement and Strengthening of Instituto Guatemalteco de Seguridad Social Project - AMEDIGSS, to be implemented between 2016 and 2023, is based on three strategies: (i) the procurement of medicines and medical supplies; (ii) the hiring of services for the alternative treatment of renal function; (iii) strengthening and modernization the institutional management of IGSS.
During the last four years, the AMEDIGSS project has made 14 tenders, broken down as follows: seven (7) have been for the procurement of medicines; one (1) event for Electronic Reverse Auction; (2) two for the procurement of medical-surgical materials, cochlear implants; and four (4) for the procurement of hemodialysis and dialysis services.
UNOPS has procured 685 types of medicines, on behalf of IGSS, and it executes more than 65 operations on an annual basis. To date, AMEDIGSS has procured 552 million doses of medicines, improving inventory supply levels by up to 90% in 118 IGSS hospitals nationwide.
In addition, in 2018, the AMEDIGSS project incorporated an initiative for the hiring of services for the replacement treatment of renal function, focusing on hemodialysis, dialysis, and the technical assistance associated with these services. As of December 2020, four (4) tenders have been made for a contracted amount of Q. 931 million, equivalent to US$ 119.3 million.
These actions have allowed the expansion and improvement of the supply in renal disease care for patients of the Institute; decentralizing services through 29 National Care Centers and incorporating innovative modalities such as Automated Peritoneal Dialysis for adults and Ongoing Renal Replacement Therapy (CRRT) procedures for critical patients.
There are several benefits. At the administrative level, improve its processes of procurement, consolidation, and better understanding of the needs for each unit of the requirements they have. Leave it up to UNOPS the performance of processes, ensuring in this way transparency and accountability, as well as to achieve significant savings.
In pharmacovigilance, the assessment and verification of the quality and safety of medicines and clinical items procured by IGSS under UNOPS processes, it includes the creation of controls, sampling, methods of analysis and rigorous compliance with the protocols and requirements established by the Ministry of Public Health and Social Welfare (MSPAS), as well as international certifications.
The involvement of companies, suppliers, and the pharmaceutical sector in the procurement tenders processes for medicines and surgical medical equipment, led by IGSS with the support of UNOPS, has been positive. So much so that the interest of the market in participating has increased, from 11 tenderers participating, before the first event, to 62 suppliers. This growth reflects greater confidence in processes and transparency.
Finally, thanks to the tenders made by the AMEDIGSS project in medicines and surgical medical equipment, savings of US$ 270 million have been achieved, representing 58% less versus the prices paid by IGSS in 2016, prior to the agreement with UNOPS. Consolidating IGSS into an influential buyer position in the domestic and international market.
The savings achieved by the AMEDIGSS project are due to, among others:
(i) Consolidation of demand from medical units by generating volumes of medicines procurement. This also evolved into an IGSS Annual Procurement Plan more customized to the Institute's actual needs.
(ii) Conducting price analyses to award medicines at affordable and fair prices with reference to the domestic, regional, and international market.
iii) The transparency in the bidding process and clarity of AMEDIGSS rules generated market trust, increasing the supplier participation in the processes.
The AMEDIGSS project has contributed to improving efficiency and transparency in the management of the supply chain of medicines and medical supplies of the Social Security (IGSS), developing new centralized mechanisms for its logistics, contractual, and financial management and strengthening its quality assurance systems, safety, and efficiency. The quality of the drugs UNOPS procures on behalf of IGSS is supported by:
a) Assessment and verification of quality in the Procurement of Medicines: it is is in two stages ranging from the technical assessment process up to the quality verification carried out during the delivery process. During the supply evaluation pre-contractual stage, UNOPS manages the quality of medicines through a technical assessment that includes the document review of the following documents:
1. Qualitative - Quantitative formula.
2. Current certificate of compliance with the Good Manufacturing Practices or current WHO-type certificate.
3. End Product Quality Control Analysis Certificate with recent completion date (12 months).
4. The methods of analysis or pharmacopoeia used by the manufacturer to perform the analyses that are listed on the related certificate.
But, most of all, the health registration issued by the highest regulatory authority in the country, which is the Ministry of Public Health and Social Welfare (MSPAS) is validated.
(b) Procurement and delivery of medicines: in support of the quality monitoring and pharmacovigilance system established by the Guatemalan regulatory body, UNOPS implements additional complementary measures during the management of drug deliveries, in order to verify the compliance with the specifications required in the bidding process and in the contract entered into with the suppliers. Such measures relate to drug sampling and sample analysis.
Guatemala's Social Security has a historic hospital infrastructure gap. Faced with this, the IGSS Board of Directors has prioritized an Infrastructure Modernization Plan through the building of hospitals, clinics, and health units, by means of two phases. The first phase of the Plan was developed during the years 2007-2018 and was provided with technical assistance from UNOPS for the building, provision of equipment and supervision of hospitals in the city of Guatemala, Quetzaltenango, Sololá, Totonicapán, San Marcos, Huehuetenango, Quiché, Quetzaltenango, and Puerto Barrios.
In this context, the second phase to be developed between 2020 and 2025 involves the building of two (2) hospitals and their related equipment, as well as the design of four (4) additional hospitals, through UNOPS, the design and procurement of equipment for technological modernization, as well as the purchase of ambulances, through the INFRAIGSS Program, in order to increase health care coverage through infrastructure that improves and brings health services closer to the holders of these rights.
INFRAIGSS comes from a comprehensive view towards the needs of the holders of the rights and takes them into account in providing support to IGSS so that it has optimal and well-equipped health care infrastructures, with the most current standards of the health sector, to improve its responsiveness.
The INFRAIGSS Program, throughout its first year, was forced to immediately support the IGSS response to the COVID-19 pandemic emergency. In this context, the procurement and delivery of more than 2,570 state-of-the-art medical equipment, distributed in 17 IGSS medical units and hospitals, was achieved, which allowed better care and coverage to those holders of the rights affected by COVID.
Due to this immediate support, during the first months, different amendments to the agreement had to be worked on, jointly with IGSS, prioritizing major interest and need areas, readjusting the budget for its best use.
It was possible to consolidate the technical teams of the different components that are envisaged for the development of the program, who determined and adjusted the terms of reference to advance in each of its areas.
The participation of companies and suppliers of the pharmaceutical sector and hospital equipment in the procurement tenders processes for medicines, surgical medical equipment and the delivery of equipment, among other services, has been very positive. So much so that the interest of the market in participating has increased, from 11 tenderers participating, in the first event to 62 suppliers in the fourth. This growth reflects greater confidence in the processes and transparency, which allow plurality and competition, as well as an improvement in the cost-quality ratio of medicines procurement for the benefit of the holders of rights of IGSS.
All the processes led by UNOPS are posted on the institutional platforms of the organization, as well as the UN and through the web portals of the participating public institutions of the States, in this case, Guatecompras for information. They are also widely disseminated, by various mechanisms, at the national and international levels. All the documentation of tenders, technical files and contracts (bases, clarifications, evaluation report, proposals, etc.) is shared with national counterparts and it is publicly available.
UNOPS has sound procedures to ensure the proper management of public funds, additionally it has an audit process of more than eight Internal and External Supervision and Audit agencies of the United Nations system that ensure transparency and accountability. As an agency of the United Nations system, it collaborates and coordinates with the control agencies of the State. All the projects and interventions information is posted on the UNOPS website and on the state information systems. In addition, UNOPS has been the first to post all the geolocation data for its projects under the International Aid for Transparency Initiative (IATI).
The governing body of the organization is the Executive Board of UNDP/UNFPA/UNOPS, established in 1993 and its members are elected on an annual basis by the United Nations Economic and Social Council from among the 36 member countries. The Board is in charge of the supervision of the activities of such agencies in accordance with the general policy guidance provided by the General Assembly and the Economic and Social Council in accordance with what is stated in the Charter of the United Nations. In 2015, Guatemala chaired the Executive Board of the three UN agencies.
Both the AMEDIGSS project and the INFRAIGSS program can be audited by the Comptrollership Office and control bodies of the State through Instituto Guatemalteco de Seguridad Social (IGSS), as the owner of the program. On the other hand, UNOPS, as a United Nations agency, is subject to more than nine control and audit mechanisms. Reports issued by the bodies responsible for these controls are regularly reviewed by the Executive Board. All the reports and documents are public and available on the Internet and comply with international transparency policies and commitments.
UNOPS has established clear rules in the processes for the procurement of medicines, providing equipment to hospitals, infrastructure and other services in support of IGSS to ensure transparency, accountability, and savings. To this end, it has defined five strategic areas of technical assistance for the institute: (i) competitive, transparent and open tenders; (ii) strengthening the management of the organization; (iii) improving logistics; (iv) monitoring and evaluation; and (v) improving health services.
Likewise, innovations have been incorporated into the tendering processes. For example, changing the type of contracts to be established with the suppliers through the application of Long Term Agreements (LTA).
And another example, the enforcement of the Electronic Reverse Auction (ERA), which is an online, real-time, dynamic auction entered into between a buying organization, in this case UNOPS, and a number of bidders competing with each other in order for a contract to be awarded to them, for which they submit increasingly low bids over a given period of time.
Such aspect has always been of interest to UNOPS and it is intended to accompany the process of ongoing improvement that IGSS has started in order to strengthen capacities, professionalization of the public state sector; as well as contributing to the fight against corruption and the reduction of the gaps between the public sector, to the benefit of the quality of life of citizens, adding value to public management.
Linked to the above, and in order to incorporate innovations in the management of institutional change within IGSS, we have been working together to implement Excellence-Based Management Models (EFQM) and strategies such as the accompaniment of executive peers, training courses, and institutional strengthening components.
UNOPS leads the initiative to promote an Equitable and Fair Public Management initiative - Fair Public Management. This proposal reflects the commitment to strengthen Public Management in Latin America and the Caribbean through joint actions to build better public services that maximize transparency, efficiency, and effectiveness of the spending of the state.
A good public administration creates impacts on the structural causes of exclusion, inequalities, and poverty, as it generates improvements in the quality of goods and services; it produces significant savings in public funds that can be reinvested to increase the coverage of services, spaces and goods; and it reduces poor practices and corruption.