The clamour around corruption and the procurement of PPE and other products vital to the national COVID-19 response seems to be peaking at a time when the infections also reach an all-time high. The hurried purchasing of huge quantities of supplies over the last few months has exposed systemic weaknesses in procurement systems and their limited ability to deliver quality-assured medical technology products that represent value for money and safe outcomes for health workers and patients.
But it does not have to be this way.
- SAMED condemns in the strongest terms all waste, fraud and corruption in the marketing, procurement and use of medical technologies, and stands committed to rooting out unethical practices across healthcare delivery.
- SAMED is continually advocating that South Africa should adopt value-based healthcare and outcomes-based procurement of medical products and services in order to improve the quality of healthcare, make for more efficient use of health resources, enhance competition and innovation, reduce fraud, waste and corruption and drive socio-economic development.
On behalf of our members and the medtech industry more broadly, SAMED offers its expertise and time to help us achieve these goals collectively.
In the last few years, SAMED has invested much effort into stakeholder and public discourse centred around smart, transparent, value-based procurement. This approach can help us solve a multitude of health system ills while at the same time benefitting the broader national socio-economic development.
However, this is not new for SAMED: many members will remember previous engagements focused on procurement methods that encompass value and intended outcomes of our products and services, and arguments centred around MEAT – the most economically advantageous tender.
The Medical Device Code on Ethical Marketing and Business Practices is also part of the conversations on accountable, effective and efficient procurement. The Code requires that all SAMED members honour ethics and good governance in all their business dealings.
This is a great moment for the medical technology industry to work together with decision-makers and influencers in the public and private health sectors to advocate for urgent adoption and implementation of value-based healthcare and procurement.
The model can help healthcare providers and healthcare systems plan for short/medium/long-term implications of buying medical supplies and take critical decisions on procurement within the context of building a more efficient and sustainable health system. The approach takes into account the wider patient and societal outcomes together with the life-cycle cost of healthcare delivery and services. Doing so can provide more economically advantageous solutions and increase the quality and value of care for patients, healthcare professionals and health systems as a whole.
What is value? And what is innovation? What differences can they make?
Value is defined in terms of patient health outcomes per unit of currency spent. Value goes beyond the initial purchase price to embrace both cost and non-cost factors – basically going beyond the purely technical and cost-per-unit aspects in order to foresee or predetermine the true desired outcomes of the product/service before it is procured or delivered.
Innovation is about value creation. Innovation entails finding new approaches – including new technology, new applications of existing technologies and new models for services and solutions – in order to improve patient outcomes, enhance efficiency and extend the reach of care. An idea that is not transformed into some form of social or economic value is not considered innovation. Within the healthcare system, innovation can improve the quality and efficiency of health services, thus contributing to improved population health (social value).
We derive value from innovation when it decreases patient waiting times, length of hospital stays, morbidity and mortality. Value of medical products and services is also achieved when these:
- Prevent infection or re-infection.
- Afford the patient better quality of life with less pain and suffering.
- Result in a patient’s quicker return to productive, independent life.
- Reduce the need for a repeat of the same procedure and so save health costs in the future.
- Reduce the burden on our over-burdened healthcare workforce.
Requirements for a value, outcomes-based procurement approach
SAMED stands ready to help members and all role-players in the public and private health sectors consult and jointly create the conditions and structures that can support a novel foundation for quality and sustainable healthcare.
- The latest dialogue with the executive managers of SAMED member companies was devoted to introspection and how CEOs and senior executives must drive awareness and buy-in for ethics, quality, transparency and accountability across their own organisations.
- We have also called on the SA Health Products Regulatory Authority (SAHPRA) to increase its inspectorate ability in order to become capable of conducting quality checks and audits among suppliers it grants operating licenses to. This is imperative for rooting out sub-standard, unchecked and unsafe products and a measure which will help the lift the standards of procurement and delivery of products and services.
Further details about best-practices to apply are contained in SAMED’s checklist for implementing value-based procurement, as well as the Medical Device Code.
The following five principles encapsulate the steps to help us lower procurement costs and system risks and enhance the overall quality and performance of medtech:
- Evaluate the total cost of care
Less expensive products purchased to achieve immediate savings may generate greater costs in the long term. High-quality and innovative products that may carry a higher initial procurement price can often generate improvements in patient care and reduced cost over alternative practices.
- Ensure clinical input
Cross-functional involvement of healthcare professionals, administrators, data analysts and other stakeholders in product selection ensures a more holistic range of treatment options and guarantees that clinical needs are met.
- Use flexible contracts
Provisions for new product adoption help assure that contracts are flexible enough to provide rapid access to newly released advanced technologies.
- Encourage supplier diversity
Multiple-supplier contracts allow a larger number of suppliers into the market, which strengthens competition and ensures stability of supply. Less competition also reduces the procurer’s negotiation leverage in future rounds of purchasing, ultimately resulting in higher long-term procurement costs.
- Fair and transparent procurement processes
Adopting procurement processes to internal and external scrutiny minimises excessive bureaucracy and opportunity for corruption.
This last principle no doubt resonates with medtech suppliers, customers in the public and private health sectors and patients as COVID-19 shines the spotlight on contracts and provokes provincial government departments and others that are part of purchasing essential goods and services to open the records to the public. This endeavour is fully supported by SAMED.