Moldova: A powerful combination therapy

Patients in Moldova have spurred authorities to adopt a transparent system for purchasing medicines that has proved invaluable in tackling the coronavirus pandemic and the country’s long standing epidemic of other infectious diseases. Reforms led by the patient-run organization Positive Initiative and experts in government have driven down the cost of drugs without compromising on quality, freeing up funds for other critical health activities. The government has saved millions by switching medical procurement to the transparent e-procurement system, MTender, while other user-friendly open data platforms allow authorities and civic actors to track the purchase and roll-out of medicines across the country in real time.

Key open contracting strategies

A new central open contracting e-procurement platform	Partnerships for reforms: civil society engagement and capacity building including through OCP’s Lift impact accelerator	A focus on improving critical public services such as medicine procurement	SMEs awareness campaigns

Challenge
With the highest rates of HIV/AIDS in Europe, it was expensive for patients to buy life-saving medicines as a lack of transparency in procurement kept competition out and prices high.

Open contracting approach
In Moldova, the patient-run organization Positive Initiative has been at the forefront of efforts to make medicine procurement more efficient and competitive. Since 2018, they’ve become a trusted partner for authorities, working with open-minded public health experts on a series of procurement reforms that have driven down the cost of drugs and freed up funds for other critical care activities. Positive Initiative has worked with the government medicine procurement agency (CAPCS) to improve the procurement process from planning, to needs assessment, and delivery. When the COVID-19 pandemic hit, this partnership between civil society and government put Moldova in a better position to purchase items efficiently and monitor in real-time how emergency funds were spent. MTender now generates open contracting data that powers a range of user-friendly digital tools for tracking the procurement, roll-out and availability of medical supplies.

Results
As a result of the collaboration, there is now a centralized stock management system, legislation to improve procurement policies and close loopholes, and cheaper, generic replacements for brand-name drugs have reduced costs.  Between January 2021, when CAPCS purchases returned to MTender, and the end of October, the central procurement agency successfully completed over 1,470 procurement lots for almost $31 million via the system, with average savings of 18% compared to the planned value. There were overall savings of 19% on the 2020 procurement budget for HIV treatment, while the share of expensive brand name products dropped from 58% to 3%.