Nigeria: Helping aid go further for thousands of mothers and children

DPSA’s Technical Assistance delivers £10 million in cost efficiencies

Saving the lives of women and children

Pregnancy and childbirth should be joyful times for mothers. However, in northern Nigeria, this happiness is frequently marred by the fear of something going wrong. In Yobe state, for example, 1,549 mothers die for every 100,000 live births [1] – compared to around eight deaths in the UK [2]. Children are also at risk, with almost a fifth of the 5.3 million children born each year dying before the age of five [3].

At DPSA, we strongly believe that procurement can play a critical role in helping aid go further and assisting those most in need. However, achieving this takes more than effective tendering. It also demands a clear understanding of what goods and equipment are needed to meet programme goals, why they are important and how they will be used. Our procurement in northern Nigeria, for the Maternal, Newborn and Child Health Programme (MNCH2), highlights the benefits of taking this approach. By examining the specifications for the requested goods against MNCH2’s goals, we were able to identify cost efficiencies of £10 million.

MNCH2 aims to save the lives of 2,000 pregnant women, 42,000 newborns and 60,000 children during the course of the programme. It provides a ‘continuum of care’ for women, from pre-pregnancy through each child’s first five years of life. This encompasses sanitation, the spacing of pregnancies, immunisation and the management of childhood illnesses. The five-year programme began in 2014 and is supported by the UK Government’s Department for International Development (DFID). UK aid from the British people funds the programme.

Procurement help needed

DFID sought DPSA’s assistance with a large procurement of pharmaceuticals, medical equipment and consumables. MNCH2 needed the goods to stock 954 primary and secondary health facilities that it supported in Yobe, Zamfara, Katsina, Kano, Kaduna and Jigawa states. The goods were divided into ten categories, ranging from vaccine storage to sterilisation instruments and medical consumables.

To help define what was needed, each of the States was asked to outline the goods and equipment required to address its particular mother-and-child health issues for the years 2017–18 and 2018–19. The responses included estimated quantities and preferred specifications. “Armed with this information, we went to the marketplace to get a rough estimate of the total cost,” explains Sibby Smith, one of DPSA’s Regional Managers. “We calculated that the cost of the goods themselves, without any logistics or warehousing, would exceed the budget ceiling for the procurement by several million pounds.”

Clarifying the need

The project team set about identifying how this cost might be reduced, combining the skills and expertise of DPSA’s category specialists and its supply chain and procurement professionals.

As a first step, the team separated all the items into those that would need to be bought in each of the two years (such as drugs and medical consumables) and those that would last for several years (such as laboratory equipment). This made sure the budget allowed for consumable goods to be purchased in both years, but that money was only allocated once in the two-year period for durable items.

“Although this reduced the estimated total cost of the procurement, it was clear that we still needed to find further savings,” says Sibby. “So we recommended that our Technical Assistance – TA – team carry out an in-depth assessment of the specifications.”

Leaving no stone unturned

This assessment involved analysing the programme’s needs based on input from MNCH2 stakeholders, and examining the amounts and specifications of each line item on the lists.

“Often when people define the goods and equipment they need, they refer to what they have bought before,” explains Stephen Ashcroft, DPSA’s Head of Growth & Partnerships. “Or they request items that they believe are the right ones, based on knowledge available to them at the time. But, with our access to the global marketplace, we can look for options which are just as appropriate – and may be cheaper.”

The TA team worked to four key principles, so that it could recommend how costs could be saved without jeopardising either quality or the programme objectives:

  1. quality and adherence to regulation will not be compromised;
  2. tracer drugs [4] are essential to the programme and no cuts will be made;
  3. lead times have a dual impact – on the programme itself and on the client’s overall targets; and
  4. prices must be competitive, but local vendors are preferred if the lead times are shorter.

With these principles in mind, the TA team examined the 700 non-pharmaceutical goods that had been requested. Here, it identified 20 areas where cost savings could be made, primarily by opting for alternative specifications. As Dr. Jeremy Rowan, DPSA’s Head of Delivery Assurance and Chief Medical Advisor, notes: “Clinical-quality microscopes were as good as research-grade ones for the programme’s needs, but were less expensive. It’s our role to help our clients find the best solutions for their needs, without comprising quality.”

Next, we turned our attention to the pharmaceutical items. The team identified where other health programmes were already distributing requested drugs, such as Nigeria’s National Malaria Control Programme, which supplies anti-malarial drugs nationwide. Where drugs could be obtained from sources other than MNCH2-funded facilities, our experts were able to remove them from the procurement list and free up resources.

The MNCH2 programme team were involved throughout our review and welcomed our TA team’s findings. We therefore used the revised specifications in the Terms of Reference for the tendering process to identify the best-value suppliers.

Adding value by cutting costs

To put the £10 million cost saving into perspective, we looked into how cost affects access to maternal healthcare. In Kaduna State for example, only 35% of babies are delivered by health professionals [5], and cost has been cited as a barrier to women using antenatal care and facility-based delivery services. So the programme has a critical aim, to provide 6.3 million high-quality MNCH services to women and children of northern Nigeria [6], including increasing skilled birth and antenatal care attendance.

From the outset of this procurement, we worked with our client and its stakeholders to understand exactly how they intended to use the listed items for the programme. With this approach, we were able to recommend alternatives that would fulfil MNCH2’s goals without going over budget.

As we’ve explained, understanding the what, why and how is all part of our approach to procurement. So we did not simply say at the outset that it was not possible to buy everything that had been asked for with the money available.

MNCH2’s efforts to reduce maternal and child mortality in six states of northern Nigeria will contribute to Sustainable Development Goal 3, to “ensure healthy lives and promote well-being for all at all ages”. At DPSA, we are excited that our strategic approach to procurement is helping aid go further and contributing to making a difference to people’s lives.

[1]   http://www.mnch2.com/kaduna-state/ (deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes)

[2] https://devtracker.dfid.gov.uk/projects/GB-1-202992

[3] Defined by the World Health Organization as essential medicines that should be freely available at public health facilities, tracer drugs can be tracked to ensure this happens.

[4] http://www.mnch2.com/yobe-state/

[5] https://www.theguardian.com/news/datablog/2010/apr/12/maternal-mortality-rates-millennium-development-goals#data

[6] https://www.unicef.org/nigeria/ng_publications_advocacybrochure.pdf

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By |2018-12-04T04:51:40+00:00March 29th, 2018|Case study, Healthcare, Nigeria|0 Comments