Healthcare in Ukraine has gained a new lease of life after Crown Agents stepped in to mend ailing procurement systems that had failed to supply hospitals with essential medicines and equipment to meet patients’ needs over decades.
Ukrainian citizens now have access to cardiological devices and cancer drugs due to a radical overhaul of procurement processes, that also secured $50 million in savings for the national health budget.
This intervention – implemented by Crown Agents upon invitation from the Ukrainian Ministry of Health – is a rare good news story in the battle against corruption – and was the focus of the ‘Ending corruption in healthcare’ event organised at the Frontline Club last week.
As guest speakers CEO Fergus Drake and Country Director Tetiana Korotchenko shed light on Crown Agents’ approach to eliminating inefficiencies and corrupt practices in Ukrainian healthcare procurement. They were joined by British Neurosurgeon and best-selling author Henry Marsh who shared his personal experiences of working inside the system for more than 25 years.
Organised by investigative journalist Oliver Bullough, the event was the 11th in the Kleptocracy series where questions of how corruption affects citizens, where the money goes and how to stop the theft are analysed and discussed.
Henry Marsh set the scene by describing how low pay and fierce financial competition has created the conditions for rampant and illegal private practice, including patients and their families being overcharged and medical training opportunities being reserved for those who can pay professors – unwilling to share their knowledge with anyone beyond their own children.
He said: “Doctors are paid a small salary – around $300 a month, which is not a living wage. They have to be paid by their patients and families and this creates unregulated invisible private practice.
“I don’t know if there is an actual market economy for what people charge or not. I’ve been told that brain surgeons charge around £5,000. The consequence of all this is that there are too many unnecessary procedures and poor people lose out.”
Nodding in agreement Tetiana Korotchenko confirmed that this was an everyday fact of life and something she herself had experienced as a Ukrainian citizen.
Shifting the focus to the problem of ‘sophisticated corruption’, Tetiana explained that within procurement processes, corrupt practices had actually been permitted by law. Reflecting back to Crown Agents’ arrival in 2015, when essential drugs and medical devices were in short supply and prices were sky high, she said:
“When we entered Ukraine the MoH was conducting open competitive tenders but the government only had five suppliers on its books. In our first year this rose to 37 and now we have over 93 suppliers.”
In the first year Crown Agents generated 40% in savings for MoH’s cardiological programme, enabling them to supply 25,000 heart stents to hospitals around the country, which could treat every emergency case they faced for the first time.
She continued: “The first year was really striking, even for our team in Kyiv because when we calculated our savings we were shocked. We didn’t do any magic, we just conducted competitive open tenders, very simple things. No inventions, nothing, just a standard tender with competitive qualification criteria, a proper evaluation and the result we received was striking.”
So can Ukraine’s success be replicated around the world? If you want to defeat corruption is this how you do it? Oliver turned his attention to Fergus to respond.
“The anti-corruption narrative is absolutely everywhere. I haven’t seen an African leader or manifesto not talk about corruption because everyone feels it.” Fergus said.
He added: “I think in Ukraine it was this confluence of civil society and top cover and actually the courage to bring in international organisations because obviously there is a counter narrative there that says: ‘well shouldn’t Ukrainians be doing it for themselves?’
“The idea is to build capacity to the point where Ukrainians have their own National Procurement Agency that is set up on internationally accepted procurement procedures and then they can crack on and there’s no turning back. But you don’t get all those pieces in place in the other countries in which we work.”
To hear the full conversation and Q&A with the audience, listen to the podcast (begins @ 00:25 secs).