The post Flow of Oxygen: How Kyiv Covid Hospitals are Equipped with Oxygen Supply Systems first appeared on Transparency International Ukraine.

The post Oxygen Stations to Be Bought Faster first appeared on Transparency International Ukraine.

The post How Much for a Breath? 2021 Oxygen Concentrators Procurement first appeared on Transparency International Ukraine.

The post More than UAH 1.2 bln Spent on Oxygen in Prozorro since Pandemic Began first appeared on Transparency International Ukraine.

The post How Much for a Breath. 2021 Medical Oxygen Procurement first appeared on Transparency International Ukraine.

The post More than UAH 1 bln Spent This Year on Oxygen first appeared on Transparency International Ukraine.

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The post Corruption Risks in Covid-19 Procurement Persist first appeared on Transparency International Ukraine.

The post Simplified Procurement to Fight Covid-19: Now to Be Used for Everything first appeared on Transparency International Ukraine.

Due to the lack of available places in hospitals, not all patients received sufficient oxygen support, and people were discharged home even with low saturation. At the same time, the state does not provide oxygen concentrators to those who are forced to be treated at home. Therefore, patients look for them on their own.

Once again, volunteers came to the rescue. Over 1000 oxygen concentrators of the Svoi charitable foundation run from patient to patient. Corporation of Monsters charity foundation, Initiative E+, and others help Ukrainians with vital devices.

At the end of April this year the then head of the Ministry of Healthcare Maksym Stepanov stated that the ministry would purchase oxygen concentrators for primary level of healthcare; UAH 693 mln was allocated for them. The devices can be used by patients who have been discharged home after hospitalization, but may need oxygen therapy. So far, the question of how these concentrators will be given out and under what conditions remains unanswered.

Modern Oxygen Concentrator is a device that produces oxygen from the atmospheric air. It is used both in medical institutions and at home. Concentrator models differ significantly in their characteristics and, consequently, cost differently. We have identified the 5 most popular products in Prozorro:

1. Oxygen concentrators of the Ukrainian brand “Biomed.”
   Most often, procuring entities purchased the JAY-10 model, which in the system cost from UAH 30,000 to UAH 42,000. More powerful oxygen concentrators, JAY-10 (4.0), suppliers offered for UAH 110,000 – 150,000.
2. Oxygen concentrators of another Ukrainian brand — “Viola” (their production is located in China).
   In particular, the SZ-5AW model in Prozorro was sold for UAH 19,000–22,500.
3. “Angel” oxygen concentrators (China)

Procuring entities bought the 10S model at the price of UAH 36,600 – 41,700.

1. Oxygen concentrators “Centrox” (USA). These concentrators of the AS074-2 model in Prozorro cost UAH 700,000–888,000.
2. Autonomous oxygen stations (oxygen concentrators complete with a central compressor station). Hospitals purchased them at a price ranging from UAH 2,1 mln to 3,4 mln.

How many oxygen concentrators have been bought through Prozorro since the beginning of the year?

According to our calculations, since January of last year, 40,651 oxygen concentrators worth UAH 1.9 bln have been purchased through Prozorro. Most of the devices were purchased in November 2020 – 7,800 items (19% of the total number) and December 2020 – 12,900 items (32% of the total number).

Demand for oxygen concentrators began to grow rapidly in October 2020, along with the autumn disease wave. Back then three times more concentrators than in September were bought, and the trend continued. But already at the beginning of 2021, the volume of orders decreased rapidly. For example, in January, Ukrainian procuring entities purchased only 186 concentrators. In March 2021, the next wave of procurement began which directly correlates with an increase in the number of patients.

We have collected procurement indicators by region: the total number of the purchased devices and their cost. At the same time, it should be noted that the price of one oxygen concentrator varies significantly depending on its characteristics. Therefore, we cannot state that procuring entities of one region overpay when spending more money on the same number of devices as their colleagues from another region. First of all, this may indicate that they purchased different types of oxygen concentrators.

For almost a year and a half, most oxygen concentrators have been purchased in the following oblasts:

• Kyiv — 4,771 items worth UAH 203.4 mln;
• Odesa — 3,854 items worth UAH 172.6 mln;
• Dnipropetrovsk — 3,489 items worth UAH 174.9 mln.
• Cherkasy — 3,393 items worth UAH 154.5 mln.

Fewer devices have been purchased in the following oblasts:

• Sumy — 574 items worth UAH 30.4 mln;
• Zhytomyr — 720 items worth UAH 36.9 mln;
• Volyn — 835 items worth UAH 40.5 mln.

According to statistics, the demand for concentrators is growing even when hospitals with their oxygen reserves cannot withstand the pressure of morbidity. And the chances of patients recovering with minimal complications depend on the timing of receiving care.

In addition, some MPs raise the question whether it is worth buying namely concentrators for hospitals. There is an alternative — autonomous oxygen stations. Unlike concentrators, each designed for one person, the stations produce larger volumes of air. It is much more difficult to calculate how much money has already been spent on such oxygen stations in Prozorro. The Verkhovna Rada even registered draft law on changes to the state budget which proposes to allocate UAH 800 mln for procurement, design, and installation of oxygen stations.

However, no matter what the MPs decide, we hope that under the new leadership, the approach to equipping hospitals with oxygen and everything necessary to fight the coronavirus in general will become more systematic and proactive.

The post How Much for a Breath? Oxygen Concentrators Procurement first appeared on Transparency International Ukraine.

The DOZORRO project has been monitoring procurement for coronavirus fighting since the beginning of the pandemic. This time, we have investigated how the medical mask market has changed from last spring to today. 

Types of masks

There are several types of masks. The simplest of them — fabric ones — are often homemade, and they protect a person the least. This type is followed by a medical disposable mask (surgical). It reduces the spread of airborne infections. As a rule, this is a three-layer mask that has a filter between the two outer layers of non-woven fabric.

The World Health Organization notes that although protective masks do not completely protect against COVID-19, they reduce the risk of contracting the virus. It is also important that they prevent excessive touching of the face, and this reduces the risk of transmitting the virus to the mucous membranes. Studies show that the effectiveness of the mask is higher the greater the distance between people. The optimal distance is 2 m or more, and not the usual 1-1.5 m.

There are also three types of respiratory masks, depending on the level of protection: FFP 1, FFP 2 and FFP 3. They are usually used by doctors or military personnel who are at the epicenter of events.

At the beginning of the pandemic, less attention was paid to the mask type — the main thing was to cover your nose and mouth with it. However, the approach to this issue is gradually changing. For example, the German government has introduced stricter requirements. Now wearing a simple cloth mask in public spaces is not enough — you must have at least a three-layer surgical or medical mask of the FFP2 protection standard.

How many masks were purchased for budget funds

We have selected all mask procurement from January 1, 2020, to May 5, 2021. During this period, 179 mln medical masks worth UAH 685.6 mln were purchased through Prozorro. Peak months were:

• August 2020 – 16.5 mln items were purchased
• September 2020 – 18.1 mln items
• December 2020 – 58.2 mln items

How prices for medical masks have changed

Before the start of the pandemic, budget institutions could easily buy medical masks through Prozorro for UAH 0.58-1.1. However, as we all remember, in March 2020 there was a sharp jump in prices. Suppliers sold medical masks for UAH 10 and sometimes 25–27 apiece.  The median price during this month was UAH 1.6-15. Let us remind you that the median price is the one that is in the middle of the total distribution. You can use it to find the average value of the indicator, without distortions due to cases of abnormally high or low prices.

In April, compared to the previous month, the median price of a medical mask increased even more and already amounted UAH to 9.7-16.8. At that time, it was possible to observe a frenzied divergence of prices. The cheapest masks cost UAH 3 per item, while the most expensive ones cost 9 times more — UAH 27 per item. Probably, such a significant difference can be explained by the massive demand. At the same time, the risks of overpayments increased massively — there was no time to analyze the market, suppliers did not have enough goods, and procuring entities were ready to pay any money. However, this hype passed quite soon. Already in May, prices for medical masks began to decline. Then the median price was UAH 3.0-11.8.

This reduction in price continued in the following months. In June, the median price of a medical mask was UAH 6-11.1, in July — UAH 5.17-8.16, in August — UAH 4.07-7.53, and in September, it fell to UAH 3.3-6.89. The market came to order, and medical masks were no longer in short supply.

In the future, the median price also only declined. For example, at the end of 2020, it was UAH 2.13-3.79. And in April 2021, it reached the level of UAH 1.23-1.85 per item. Although median prices have not yet become the same as they were before the quarantine, we are confidently moving towards this.

The median price is also affected by the fact that despite the market having come to order, procuring entities continue to buy medical masks without auctions, when the transaction value exceeds UAH 50,000. They have the right to do so because masks are still on the list of the CMU’s resolution on COVID-19 procurement. In general, more than 98% of medical masks were purchased by procuring entities through non-competitive procedures (reporting on the concluded contract, negotiation procedure), in the E-catalog and upon request for price offers. Accordingly, less than 2% of such procurement were competitive.

At the same time, it was competition that allowed the procuring entities using the appropriate procedures to save budget funds. So, for example, in the pre-threshold procurement of the territorial social service center of the Obolonskyi District of Kyiv, 14 suppliers competed for being awarded, and the price of the mask decreased by more than 3 times — from UAH 2.3 to UAH 0.68. Moreover, 14 suppliers took part in the procurement of “MYKOLAIVHAZ.” Then the price of the mask decreased by 72% — from UAH 2 to 0.68 UAH. The Primary Health Care Center No. 1 of the Darnytskyi district of Kyiv saved UAH 70,000 on the procurement of masks because the price for one mask during the auction decreased from UAH 4 to UAH 0.4. Thirteen suppliers took part in the tender.

Of course, the savings indicator that we have just presented (the difference between the expected procurement price and the amount of the concluded contract) is very relative. After all, it does not take into account how well a procuring entity analyzed the market and determined the expected procurement price. However, as we can see, in competitive bidding, the risk of overstating the final price is minimized by competition between suppliers.

This is the second year of the pandemic in Ukraine — and for the second year, procuring entities can buy medical masks and a number of other goods, works and services without competitive procedures for any amount. In the first 12 months, government agencies spent almost UAH 31 bln on COVID-19 procurement. At the same time, the exclusion of such procurement from the Law has risks of inefficient use of funds (overpayments) and violations in procurement.

We must understand that the pandemic will not end in the near future, and the money saved will definitely be needed to fight the virus.

One of the ways to save money can be to amend the Resolution 225 of the Cabinet of Ministers of Ukraine. In particular, it is worth considering the option of procurement according to the rules of competitive additional pre-thresholds. This will be faster than buying at open auctions, and at the same time cheaper than signing agreements directly. In addition, it is necessary to determine which of the procuring entities can apply the special procedure and review the list approved for it in detail. It should be limited to really necessary goods, works and services, the procurement of which cannot be planned. Do masks currently belong to such products? We are more inclined to a “no.”

The post How Are Medical Masks Bought Through Prozorro? first appeared on Transparency International Ukraine.

Such purchases in Prozorro have a special label through which they can be tracked and analyzed. However, it is important to remember that the amounts of COVID-19 purchases are not equal to the total cost of fighting the virus. This procedure is an opportunity, not an obligation. Some procuring entities used regular procedures to buy what they needed, including auctions. Hospitals were also helped by business and volunteers. However, it is the COVID procurement reports that make it possible to track how facilities were provided to operate in a pandemic and to save lives.

General COVID-19 Procurement Dynamics

To control COVID procurement quickly and conveniently, you can use the Prozorro COVID-19 Procurement tool by the DOZORRO team. It collects, visualizes and helps to process data on COVID-related public procurement. According to the module data, between March 18, 2020, and March 18, 2021 (inclusive), 148,500 COVID tenders were held for a total amount of UAH 30.9 billion.

Traditionally, the most active month in procurement was December. At the end of the budget year, procuring entities tried to spend all the funds allocated to them as quickly as possible. In addition, several major coronavirus agreements were concluded in December. For example, the end of the year was marked by a centralized purchase of ambulances for UAH 728 million. On the last but one day of 2020, SE Medical Procurement signed the agreement for supply of 1.9 million doses of the Sinovac Biotech vaccine for UAH 964.3 million. In total, in December, 11 agreements were signed for amounts exceeding UAH 100 million each.

At the same time, in other periods during the year, you can track the link between the increase in the number of coronavirus patients and COVID-related tenders. For example, after a relatively quiet summer, the number of infected and patients in hospitals began to rise sharply in the fall. Accordingly, the needs of medical institutions increased. This trend of coronavirus agreements was also caused by the changes that the Cabinet of Ministers made to the list of goods, works and services that can be purchased under the COVID-19 procedure. In 2020-21, this list was amended 14 times—and almost always expanded.

Coronavirus Procurement: Most Active Procuring Entities

The COVID-19 procurement procedure is used not only by medical institutions, but also by other budgetary institutions and enterprises. For example, schools purchased masks, antiseptics, protective shields, etc. to start the school year offline. And local authorities or regional administrations could centrally purchase, for example, medical equipment, which was then distributed to city / oblast hospitals. In total, almost 9,000 procuring entities have used the coronavirus procedure at least once.

At the same time, three of them account for 35% of the total amount of concluded COVID-19 contracts (UAH 10.8 billion). The top three procuring entities by the value of all coronavirus agreements include the State Enterprise Medical Procurement of Ukraine, the Kyiv City State Administration and the Ministry of Internal Affairs of Ukraine.

Medical Procurement conducts centralized procurement for the Ministry of Healthcare. In 2020, the enterprise spent most on CAT scan machines under the coronavirus procedure—UAH 2.3 billion. The procuring organization also signed agreements for the supply of COVID-19 tests (UAH 988 million), the aforementioned COVID vaccine Sinovac Biotech (UAH 964 million), ventilators (UAH 840 million) and ambulances (UAH 728 million). By the way, there was a plan to buy ambulances in 2020 even before the pandemic started. Initially, the funds were allocated to the regions, but after the start of quarantine, they were transferred back to the Ministry of Healthcare so that the SOE could conduct centralized procurement.

The second buyer by the total amount of COVID-19 agreements is Kyiv City State Administration. Enterprises and institutions controlled by the Kyiv City State Administration spent UAH 1.65 billion on goods and services to combat COVID-19. That includes over UAH 630 million on medical equipment (ventilators, X-ray machines, ultrasound machines), and over UAH 411 million on pharmaceutical products and medication.

The last place in this trio of leaders is occupied by the Ministry of Internal Affairs. Structures subordinate to the MIA spend UAH 1.27 billion on fighting COVID-19. Law enforcement used this money to buy PPE, disinfectants, and medical equipment. Before mid-summer, the MIA led the rating of procuring entities by biggest spending under the COVID-19 procedure. Interestingly, the main supplier of PPE for the Ministry of Internal Affairs is the state enterprise Fort. It is also subordinate to the MIA. Before the pandemic, Fort specialized in the development and manufacture of firearms and special equipment for law enforcement officers. But when the coronavirus started in Ukraine, the SOE started supplying imported PPE to structures subordinate to the Ministry. During this time, more than 12% of all MIA’s coronavirus-related expenses, almost UAH 154 million, ended up on Fort’s accounts.

How Money under COVID Procedure Was Spent

The coronavirus procedure cannot be used for all goods, works and services that the procuring entity wants to buy to fight the virus, but only those on the list approved by the Cabinet of Ministers. For example, it does not include the COVID-19 insurance that hospitals purchase for their staff.

In general, medical equipment was the biggest part of spending under the COVID-19 procedure—the total amount reached UAH 14.7 billion (47.5% of the total spending). Procuring entities purchased ventilators, ultrasound and X-ray equipment, CAT scan machines, and oxygen concentrators. Another UAH 7 billion was spent on medicines, UAH 2.4 billion on ambulances (in addition to the SOE, they were bought by other procuring entities). Tests have cost UAH 1.3 billion total.

Violations and Risks in COVID-19 Procurement

At the beginning of the pandemic, the COVID-19 procedure undoubtedly greatly helped the medical system to respond quickly to new conditions and to meet acute needs in the situation of shortages. At the same time, exempting such procurement from the Law has a number of risks of inefficient use of funds and violations in procurement.

Overpayment

In the spring, the rampant demand for personal protective equipment, antiseptics and other products that had not been so popular before, led to a deficit and a sharp rise in prices. For example, in March and April 2020, masks became 15-20 times as expensive as in January. However, as early as in May, the market started to even out, and some procuring entities even successfully held open bidding for goods that had recently been in deficit. This trend persisted.

However, not all procuring entities analyze market prices before signing COVID-19 agreements. Some of them continued buying goods for prices twice or even three times as high as their colleagues did at the same time.

For example, the city healthcare department in Sumy bought 10 ventilators for prices exceeding market prices. Thanks to the media and activist outcry, the cost of the procurement was eventually reduced by UAH 250,000, and the prosecutor’s office started a criminal proceeding on inefficient spending. In Cherkasy, the oblast laboratory center bought disinfectants and medical masks at inflated prices, and the municipal consultation and diagnostic clinic significantly overpaid on PPE. In Zhytomyr, the prosecution also started a criminal investigation into the procurement of respirators.

These are just some examples, but civic analysts and journalists encounter such situations rather often.

The procurement of goods, works, and services which are not on the list

At the beginning of the pandemic, procuring entities used the COVID-19 procedure to buy everything they needed to fight the virus, in their opinion, from household appliances to food or even toilet paper.  In the first weeks of the quarantine, Odesa hospital of infectious diseases started actively buying furniture, including cabinets and couches, at high prices. At the beginning of April, Kyiv municipal enterprise INFORMATYKA wanted to buy 400 cameras with a thermal screening function for UAH 64.9 million under the specialized procedure.

Today, doctors, scientists, and experts speak about the start of the third wave of COVID-19 in Ukraine. Four oblatss are in the red quarantine zone: Zhytomyr, Zakarpattia, Ivano-Frankivsk and Chernivtsi oblasts, plus the city of Kyiv. On March 19, Lviv imposed strict quarantine. The number of infections is growing, and there’s no single idea what to do with the COVID-19 procurement procedure next. A prudent decision would be to review the approved list in detail and limit it to the most essential goods, works and services whose procurement cannot be planned effectively. In addition, this procedure should be restricted to particular procuring entities. This will support hospitals in these difficult times, as well as protect budget funds from inefficient use. In the meantime, we will continue to monitor COVID-19 procurement.

The material was prepared with the support of the U.K. Government through UK Aid.

The post A Year of Procurement under Covid-19 Procedure first appeared on Transparency International Ukraine.

On May, 7 the Parliament passed the law on insuring medical professionals against COVID-19. However, this law stipulates payments only if medical workers get a disability or die because of the coronavirus. This insurance does not cover the fact of infection itself. Back then, they established the following payments for medical workers:

• UAH 630,000 — disability type III
• UAH 735,000 — disability type II
• UAH 840,000 — disability type I
• UAH 1.5 million — payment to the medical worker’s family in case of death

In turn, at the beginning of summer, the Cabinet approved a resolution regulating insurance payments to healthcare workers who fell ill or died of COVID-19. They must be paid by the Social Insurance Fund of Ukraine. UAH 233 million was allocated from the state budget for this purpose.

In 2020, the Fund paid the families of 36 medical workers who died of COVID for a total amount of UAH 56.8 million. Another UAH 5.99 million was paid to 9 healthcare workers who got a disability as a result of COVID-19 complications (3 workers — type II, 6 workers — type III).

To receive this compensation, you needed the conclusion of an investigation carried out by a commission consisting of the State Department of Labor, the employer and representatives of the local Social Insurance Fund branch. It was the commission that decided whether a health worker could have gotten sick at work or not. Such investigations lasted from 5 to 15 working days, depending on the severity of the case.

So getting insurance payments from the state was not easy. Relatives of the deceased cannot prove that doctors became infected with COVID-19 at work. 

Among the families of deceased doctors who did not get anything is the family of Cherkasy surgeon Oleh Haida. The man worked at a local hospital for 26 years and died this summer from complications caused by the coronavirus. The fact that the doctor became infected at work was confirmed by two commissions of the State Department of Labor. However, the Social Insurance Fund did not agree with them and is now appealing the decision in court.

Another story, probably one of the best-known in this context, is about a doctor from Pochaiv, Ivan Venzhynovych. It was he who looked at us from the PSA about gratitude to doctors. Ivan Venzhynovych died at the end of September in the same hospital where he had previously treated patients. The family did not receive compensation because the PCR test showed a negative result. His colleagues, however, say he had all the symptoms of COVID-19.

At the end of 2020, the government talked about simplifying the procedure for providing assistance to the families of doctors who died from COVID-19. And on January 5, the Cabinet of Ministers approved a resolution amending the investigation procedure. Now they will be conducted by the commissions of medical institutions where the doctor worked, without the involvement of representatives of the State Labor and the Social Insurance Fund. Officials have also reduced deadlines—from now on, investigations must be conducted within 5 working days of the commission’s formation. As the subsistence minimum has increased since January 1, 2021, the amount of payments will now also be higher—by UAH 50-200 thousand, depending on the case.

Time will tell if this will be helpful. So far, as of February 8, the Fund has received almost 40,000 reports of clinically confirmed cases of COVID-19 among medical staff. 467 have been lethal.

Insurance in Prozorro 

To protect their employees, some health care facilities began insuring them independently against COVID-19 infection before the law was passed. Charitable organizations, volunteers and businesses can provide such protection. For example, Lviv Oblast has introduced its own medical insurance program. Funds for the special stabilization fund were collected mainly through charitable contributions from businesses and citizens. This program made it possible to insure more than 5,000 medical workers of Lviv region against COVID-19.

Of course, hospitals also procured such services via Prozorro. In 2020, medical institutions insured 28,828 employees in this way. Most physicians were protected in Mykolayiv (4,042), Sumy (3,927) and Vinnytsia (3,500) oblasts.  The fewest—in Kirovohrad (77) and Khmelnytskyi (98) regions.

In June, November, and December more physicians were insured than in the other months: 4,886, 4,884 and 4,990 respectively. At the end of the year, there were no oblasts left where hospitals had not purchased such services. That is despite the fact that as of October, Khmelnytskyi and Kharkiv oblasts did not have a single doctor insured against COVID-19 via Prozorro.

According to our estimates, it would be possible to insure all physicians working with patients with COVID-19 for less than UAH 30 million. This costs as much as repairing one city road in Kherson oblast. However, in addition to the fact that such a state program has not yet been organized, insurance procurement has not even been included in the list of services that can be purchased under the coronavirus procedure.

The largest number of contracts with medical institutions for insurance against COVID was signed with the company ORANTA. In 2020, the company entered into 91 agreements and insured more than 7,000 physicians.

ORANTA was founded in 1994. The end beneficiary through BTA Bank is indicated as a Kazakhstan businessman and venture investor Kenes Rakishev.

Kenes Rakishev’s father-in-law is Kazakh politician Imangali Tasmagambetov, who from 1993 to 2004 served as assistant to the president, head of the presidential administration and deputy prime minister of Kazakhstan. In 2004-2014, Tasmagambetov was the head of the administration of Almaty and then Astana (now — Nur-Sultan). He returned to government in 2014 (first as defense minister and then as deputy prime minister). In February 2017, he was appointed ambassador to Russia.

The second spot by concluded agreements belongs to insurance company U.S.A. It has insured more than 6,000 workers against coronavirus by signing 70 contracts.

U.S.A. was founded in 2003. The beneficiary of the insurance company via TOV BK-EXPERT is Oleksii Kocherev, who ran for Parliament in 2012 with Natalia Korolevska’s political party Ukraine Forward.

Medical personnel deal with the virus almost daily, so they are at the highest risk of contracting COVID-19. And often they have to sacrifice their own health and sometimes their lives to fight the disease. Although the state has a program of financial assistance to doctors and their families, it does not cover every case of infection. And it was frankly difficult to get insurance payouts in 2020. And while the government introduces new, simplified payment procedures, hospitals are forced to insure their employees themselves or seek help from charities, volunteers or businesses.

The post Why hospitals insure employees in case of COVID-19 first appeared on Transparency International Ukraine.

This year, the Government decided to address the problem of lack of quality specialized cars for EMCC. It is worth noting that ambulance cars were always purchased, gradually. From 2016 to 2020, 1,584 ambulance cars were purchased through Prozorro.

Ukraine’s 2020 national budget included UAH 0.9 in subventions to update the ambulance car fleet in the regions. Initially, they were to be purchased locally. However, in August 2020, within the budget program “Development of the emergency medical care system”, the designated recipient of budget funds was the state enterprise “Medical Procurement of Ukraine”, which belongs to the Ministry of Health.

At the same time, in March, the procurement of a number of goods, works and services required to combat COVID-19 was allowed to be carried out without taking into account the requirements of the Law of Ukraine “On Public Procurement”. To this end, the Government passed the special Resolution No. 225. The goods, works and services listed therein can be purchased under direct agreements without competitive procedures. Back in April, the purchase of ambulance cars was included in this resolution. Thus, 2020 brought two changes at once: vehicles for EMCC were purchased centrally and not through competitive auctions on Prozorro, but directly, only reporting on the purchase. 

What Ambulance Cars Are Purchased

According to the state standards of Ukraine, ambulances are divided into three types:  A, B, C.

Cars of A1 and A2 types are designed to transport patients whose cases are probably not “emergencies.” The difference between the two types is the availability of an additional chair for the medical worker.

The type B car is designed for medical care by a medical (paramedic) team, transportation and monitoring of the patient’s condition at the prehospital stage.

Type C is a resuscitation vehicle that is needed to transport patients in serious or critical conditions.

This year, ambulance cars of types B and C were purchased.

Centralized Procurement

Officially, Minister of Healthcare Maksym Stepanov announced the plans to purchase ambulance cars in the summer. Then, the Ministry decided to purchase 400 cars by the end of 2020. The procurement was entrusted to SE Medical Procurement of Ukraine, which had recently been granted the status of a central procurement organization.

First of all, according to Nashi Hroshi, the enterprise defended non-discriminatory technical requirements, allowing more suppliers to participate in the procurement. Initially, the expert state institution “Polytechmed” tried to include high engine power in the requirements. This condition would effectively narrow down the circle of potential participants to one company, Autospetsprom, which is already the main supplier of ambulance cars to the state. Luckily, Medical Procurement of Ukraine managed to prove that this requirement was not mandatory.

In addition, SE Medical Procurement of Ukraine decided to carry out market analysis first before entering into direct agreements. It did it as openly as possible, with the help of Prozorro.  At the end of October, Medical Procurement of Ukraine announced 4 competitive tenders. They planned to buy two types of ambulance cars (types B and C) with all-wheel and front-wheel drive. Any bidder who could deliver ambulances in accordance with the specified requirements could submit his proposal. However, there were also complaints from the market.

A potential participant in the procurement of TOV BRIORSON MOTORS complained to the procuring entity about the discriminatory requirements of the technical part regarding the front-wheel drive of the car. The company wanted to offer “cars on a cost-effective offer that meet all national standards and are certified, but have a rear axle drive.” However, the complaint was not satisfied. As a result, TOV BRIORSON MOTORS did not participate in the procurement. The procuring entity probably decided to buy specifically ambulance cars with front-wheel drive because this type of cars has better off-road performance, especially in winter, on slippery or snowy roads. And this is important for ambulances, which should be able to drive anywhere in any weather conditions.

Another bidder, TOV VIDI UNICOMMERCE, complained to the procuring entity that “the expected cost of all-wheel drive ambulances is incorrectly formed and abnormally low. And the delivery deadline, November 4, 2020—December 31, 2020, is obviously impossible given the declared quantity of goods.” The procuring entity declined this complaint as well. Despite this, TOV VIDI UNICOMMERCE participated in the procurement, and in one tender, it even proposed the lowest price, reducing its initial proposal by UAH 181,000. However, no agreements were concluded with this company. After analyzing the market, participants continued to reduce prices, and finally another company gave the best offer.

4 to 6 companies participated in the tenders used by Medical Procurement of Ukraine to analyze the market.

At the end of December 2020, the State Enterprise “Medical Procurement” published 5 contracts for the purchase of ambulances on Prozorro.

The two largest contracts went to TOV Autospetsprom, the company which supplied the largest number of ambulance cars to the state throughout the entire existence of Prozorro. We estimate that in the last four years, the enterprise sold 1,152 ambulance cars to the state for a total amount of over UAH 2.3 billion. As part of these tenders, it will also supply 104 type C ambulances with front-wheel drive and 142 type B ambulances with front-wheel drive.

In addition to Avtospetsprom, 2 contracts were awarded to TOV Spets-Kom-Service: 75 all-wheel drive cars type B and 39 all-wheel drive type C. Another 56 type B ambulance cars will be supplied by TOV ADAMANT MOTORS ZAPORIZHZHIA.

With the help of preliminary market analysis in Prozorro, Medical Procurement of Ukraine managed to save over UAH 120 million while buying 416 ambulance cars. The final contract prices were much lower not only than the expected cost of procurement (which is the baseline used to calculate the savings) but also than the final prices proposed by suppliers as part of auctions announced for market analysis.

It is currently unknown how these ambulance cars will be distributed among the regions. Daria Pakhomova, a point of contact at the state enterprise, said on the phone that “the distribution of vehicles is not within the purview of the state enterprise and will be carried out by the Ministry of Healthcare of Ukraine.” We hope the cars will be supplied in time, and the distribution and quality will be satisfactory.

Who Else Purchased Ambulances

Despite large-scale centralized procurement, procuring entities on the ground decided to replenish their fleets of ambulances as well. They were purchased by executive committees of city or rayon councils, and mostly by emergency medical care centers (EMCC). We estimate that in total, 836 ambulances for UAH 1.6 billion were purchased in 2020. This is more than the total number for the past four years—748.

48%, i.e. 398 cars, were purchased under non-competitive procedures. The remaining 52% are still competitive procedures: 22 ambulances were purchased through open bidding and 416 cars were purchased centrally by Medical Procurement of Ukraine with preliminary competitive selection.

As for oblast distribution, the biggest quantities of ambulances in 2020 were purchased in Khmelnytskyi (36), Zakarpattia and Kyiv (35 each), and Lviv (31) oblasts. The fewest—in Vinnytsia (1) and Luhansk (6) oblasts. None were bought in Kirovohrad, Odesa, Poltava and Donetsk oblasts.

For instance, 12 type B ambulances based on Citroen Jumper were purchased by the Healthcare department of Dnipropetrovsk oblast state administration, 7 type C ambulances and 5 type B ambulances based on Citroën Jumper were bought by the Ministry of Defense.

EMCC alone managed to buy 344 type B vehicles (for UAH 688 million) and 41 type C vehicles (for UAH 108 million). Most commonly, ambulances were based on Citroën Jumper — 336 cars (86% of the total number) and Volkswagen Crafter — 30 cars (8%).

EMCC bought ambulances from 3 enterprises in 2020: TOV Autospetsprom, TOV KSENKO AUTO PRODUCTION, TOV ADAMANT MOTORS ZAPORIZHZHIA.

Who Bought Ambulances the Cheapest

Not surprisingly, the cheapest ambulances were purchased by the State Enterprise “Medical Procurement of Ukraine.”  They saved over UAH 300,000 on one type B front-wheel drive ambulance, and over UAH 600 — on a type C ambulance. Of course, the price may be affected by the number of purchased vehicles and equipment installed therein, but the fact remains that competition pays off. The prices achieved by the State Enterprise “Medical Procurement” are pleasantly surprising in comparison with the prices offered by the same participants in separate tenders.

In total, Medical Procurement of Ukraine managed to save over UAH 120 million on the purchase of ambulances.  Non-competitive procedures almost always lead to overpayment. For this reason, we are not sure why it would make sense to allow procuring ambulances without auctions. This practice needs to be done away with, returning to competitive procurement.

The state budget for 2021 includes UAH 1 billion for the purchase of 438 ambulance cars. The experience of the state enterprise shows that these funds can be spent reasonably and under clear, understandable rules. We hope that the Ministry of Healthcare and the participants will draw the right conclusions.

By the way, we believe that the list of goods, works and services that can be purchased under the COVID-19 procedure is long overdue for a review to exclude items the purchase of which can be safely planned. So far, this list has only been expanded.

The material was prepared in collaboration with public procurement specialist Yaroslav Pylypenko and analyst Oksana Dziavornyk with the support of UK Aid and the UK Government.

The post Ambulances to Fight COVID-19 first appeared on Transparency International Ukraine.

Recently, the Ministry of Healthcare changed the standards of medical assistance for COVID-19. In particular, the list of cases where PCR testing is necessary has been reduced. In addition, the Ministry of Healthcare simplified the procedure for leaving self-isolation for contact persons. Nowadays, if a person does not have symptoms of coronavirus in two weeks, they do not need to have a second PCR test. Before planned hospitalization patients also do not have to do PCR tests if there are no signs of respiratory diseases.

“PCR testing should be performed exclusively for people who have symptoms of coronavirus disease and who visit a family doctor. According to the doctor’s decision, a mobile team will be sent to the patient to conduct a PCR analysis,” the Minister explained.

From March till September 22, government agencies purchased almost 3 million tests for detecting COVID-19 through Prozorro. They spent UAH 272 million. It should be noted that this data is about tests that were purchased through the electronic procurement system. In addition, medical institutions can receive them from the Ministry of Healthcare, volunteers, or in the form of humanitarian assistance.

There are three types of tests: express, PCR, and ELISA. The first ones are the most accessible, but the least accurate. In the first days of transmission, they may show a false negative result, because they react to antibodies that do not appear in the blood immediately. PCR testing determines whether a person is currently ill. Whereas ELISA (enzyme-linked immunosorbent assay) tests check if there are antibodies to the virus. This method can determine whether a person has had COVID-19. 

During the pandemic in Ukraine, the majority of the purchased tests were ELISA tests – 1.7 million. This is 55% of the total number. PCR tests were purchased by 974 thousand (33%), but express — 363 thousand (12%). 

PCR tests

Compared to the spring, in the summer the amount of PCR tests procurement increased by a multiple of 16. 58 thousand of them were purchased in the spring. And since the early summer — 916 thousand. This type of test is done for people who have symptoms or who were contact persons. PCR testing allows us to determine how many citizens are sick right now. 

Most of the PCR tests were purchased by regional laboratory centers of the Ministry of Healthcare. Due to their high workload, the Ministry of Healthcare considers engaging private laboratories to conduct PCR tests. The state will pay for these services.

There is no direct correlation between the number of purchased PCR tests and the number of confirmed cases of COVID-19. This is probably because laboratory centers receive a significant number of tests through distribution from the Ministry of Healthcare, humanitarian aid, or volunteers. Nevertheless, a certain connection can be traced.

Kyiv and Lviv oblasts are the leaders in the number of cases of COVID-19. Meanwhile, the most number of PCR tests are being purchased in these oblasts. But, for example, in Kirovohrad and Luhansk oblasts there are few cases of the disease. In those oblasts the number of purchased tests is significantly lower. 

However, it is difficult to understand whether there are few cases of infection detected due to a lack of tests, or whether there are few purchased tests because there is no need. 

ELISA and express tests

The most popular type of tests became enzyme immunoassay tests. 1.6 million ELISA tests have been purchased since the beginning of June. Such a significant demand can probably be explained by mass enzyme immunoassay testing conducted by the Ministry of Healthcare. It was announced by the chief state sanitary doctor Viktor Liashko at the end of April.

In contrast to the increase in the number of purchased ELISA and PCR tests, the demand for express tests decreased. In period of June-September their purchases dropped by 58 thousand less compared to the period of March-May. 

Biggest buyers

The clear leader in the number of purchased ELISA and PCR tests is Kyiv oblast. Government agencies in this region purchased 206,000 ELISA tests (12.4% of the total number in the country) and 198,000 PCR tests (20.4%). 

The second place is taken by Dnipropetrovsk oblast: 205 thousand ELISA tests (12.3%) and 15 thousand PCR tests (1.5%) were purchased here. 

Lviv oblast is also among the top three in terms of the number of purchased tests — customers of the region purchased 130 thousand ELISA tests (7.8%) and 73 thousand PCR tests (8%). 

The smallest number of PCR tests were purchased in Luhansk oblast — only 50. Kirovohrad and Donetsk oblasts are also at the bottom of the list. Their customers bought 2.5 thousand and 2.6 thousand PCR tests, respectively. 

More than 61% of the total number of express tests were purchased by customers of the Kyiv (133 thousand) and Dnipropetrovsk (89 thousand) oblasts. While the least number of  this type tests were purchased in Chernihiv (1.5 thousand), Mykolaiv (1.7 thousand) and Kirovohrad (1.8 thousand) oblasts. 

Who they buy from

From June to September, tests to detect coronavirus were delivered to customers by almost 400 entrepreneurs. The leader among them is ASTRAVIR TECHNOLOGY. The company sold 354 thousand different tests to medical institutions for almost 29 million hryvnias. TOV ASTRAVIR TECHNOLOGY was created at the beginning of the pandemic in March 2020. The owner of this company is a well-known Kharkiv businessman Olexandr Yaroslavskyi. 

 Among the leaders are also TOV Real Diagnostics, TOV Ukrgastech and Labsvit. They sold 297,000, 144,000, and 125,000 tests, respectively. In total, these 4 companies delivered 35% of all tests purchased from Prozorro.

The dynamics of purchases of laboratory tests for detecting COVID-19 increased significantly in the summer. At the same time, the number of confirmed cases of coronavirus has also increased rapidly. The DOZORRO team will continue to monitor COVID-19 purchases to establish the truth.

The post HALF A YEAR WITH CORONAVIRUS: HOW MANY AND WHAT TESTS WERE PURCHASED IN PROZORRO first appeared on Transparency International Ukraine.

From the very beginning the allocation of funds was somewhat strange, since over half of the fund went to the “Big Construction” projects. “I feel like the government and the Ministry faced the problem of lacking budget funds for these projects. So, considering the need for this construction and the fact that it had already been announced, they just decided to use the money from the Fund,” suggests Ivan Lakhtionov, Director of TI Ukraine’s Innovation Projects Program.

As of September 11, the majority of funds went to road construction — over UAH 9 billion. The Ministry of Economy, Ministry of Regional Development, Ministry of Social Policy and Ministry of Internal Affairs, too, have spent more money from the Fund than the actual Ministry of Healthcare.

The Ministry of Healthcare has spent just UAH 499.1 million over this time. This is 3.5% of all the allocated funds. In almost half a year of the pandemic, not a single ventilator was bought using the money from the Fund, nor was it used to pay medical workers. Deputy Minister Svitlana Shatalova said these expenditures are scheduled for October. Ivan Lakhtionov points out that this money needs to be spent, and soon.

We hope that the Ministry will conduct all the necessary purchases in the near future, and the State Audit Service will control the use of money from the Fund overall.

The post How Is Money from COVID-19 Fund Spent first appeared on Transparency International Ukraine.