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4 takeaways to improving health outcomes through open contracting

12 Jun 2019

Por Sebastiana Etzo, Transparency International Health Initiative

Open contracting matters for health and the Open Government Partnership Global Summit is a key platform for us at the TI Health Initiative’s Open Contracting for Health team to learn, discuss and influence the agenda. This year, it was encouraging to see open contracting featuring so prominently in the program, allowing for some deep-dives into specific sectors and intersections with other open government priority areas such as beneficial ownership and gender. This shouldn’t come as a surprise considering that just over half of all OGP members are implementing open contracting commitments. According to the independent reporting mechanism (IRM), these commitments achieve generally better results compared to others and have contributed to increasing transparency in public procurement.

Even more exciting has been witnessing the growing interest in the health sector. This gave us the opportunity to share our work and learn about the many complementary initiatives across different continents. Health is one of the policy areas of the OGP and the second-most common public services-related category after education, with commitments mostly centered around data publication, participation in decision-making, and accountability.

Health is also fourth among the sectors with open contracting commitments following infrastructure, education and extractive industries, with countries like El Salvador and Romania having very specific health targets. Yet lack of transparency, weak health systems and patchy data on health sector governance are hindering results, and ultimately impacting people’s ability to access the high-quality standard services they need.

An estimated 40% of the total spent on health globally doesn’t contribute to better health for the majority of people – an enormous $3 trillion! This figure is actually much more than the amount needed on an annual basis to reach the SDG health targets, $370 billion, as we’ve described here. According to the World Health Organization, five of the ten leading causes of inefficiencies in the health sector are procurement related. This is an even more significant problem in countries where public resources are severely constrained and each dollar, shilling or kwacha saved matters. The Open Contracting for Health initiative directly targets procurement across a number of low and low-middle income countries to address these inefficiencies, thus giving more people access to healthcare.

The OGP summit brought many of these issues to life, with a strong focus on implementation, pathways forward, and what the open contracting community can do to advance transparency and accountability in procurement. These are my top 4 highlights for open contracting in the health sector:

  1. The Open Contracting for Health project has a major focus on the local and regional level – so we really welcomed Hivos’ Local Open Contracting Initiative event and panel. It was a great opportunity to share experiences and learn from governments and civil society organizations across the five continents. Despite the many successes, however, there is an underlying tension between central and sub-national governments. We experience it in the health sector, where procurement is often a shared responsibility and where devolution processes may be underway. Understanding political systems and (vertical and horizontal) power relations remains crucial and should inform our approach. We can build on the strengths of communities, civil society, and the private sector to work together with local authorities to push for policy change and meaningful reform.
  2. ‘Make the overwhelming less overwhelming’ was a message that was heard a lot, including in the session we co-hosted with OCP. This can be achieved through a modular approach, such as the one adopted by Mexico City, or agile procurement management that focuses on users and outcomes. Easier said than done in the public sector, but not impossible. As a team, we found the benefits of more flexible and adaptive project management helpful and we encourage our implementing partners to do the same, particularly to generate quick lessons and close the feedback loop. The challenge: working creatively with governments, procurement officials, vendors, and civil society to engrain agile management in procurement and procurement monitoring.
  3. Data, data, data… and more data! There is a deep hunger for access to good quality data in a sector that is highly technical and where predicting needs is challenging. By working more closely with all stakeholders, we can combine different sources of health data sets to make more sense of the procurement information available. OCP’s new strategy – launched during the OGP Summit week – commits to support better quality and use of data. More importantly, the strategy brings attention to the importance of a data-driven and problem-focused approach to designing reforms, to go beyond data publication or transparency as the ultimate goal, and aim for a more radical transformation based on the needs of the users.
  4. I loved the emphasis on intersections at OGP – mostly gender and indigenous knowledge/businesses – and how these are reflected in procurement and on data. Several sessions highlighted the challenges and the long road ahead. We know that disaggregating data and referring to gender and historically-disadvantaged groups in a policy or a public procurement notice is just a first step. Inclusion requires a more systemic approach to integrating indigenous knowledge and gender perspectives and understandings in decision-making. I look forward to learning more from the Feminist Open Government Initiative on how women and other underrepresented groups can be brought in to inform and shape reforms that are truly inclusive.

I came back from Ottawa with the feeling that despite the challenges, we have achieved a lot in open contracting, in a relatively short time. It’s the time to celebrate, but also to be more ambitious if we want to seize this momentum and – to quote OCP’s strategy – move from making data ‘open by default’, to ‘making the whole system open by design’.