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Auditor-General on DoH’s vaccination-spend: Some teething issues but quick footwork

The Auditor-General’s audit of the national Department of Health’s vaccination procurement processes and nationwide rollout found some “teething issues” but paints a generally positive picture of the DoH’s financial management of the vaccination process, writes MedicalBrief.

“While there were areas that really worked well … with regards to the vaccination programme, some areas needed improvement,” Senior Manager at the AG’s office Thabelo Musisinyani told the parliamentary Portfolio Committee on Health, during a briefing on the DoH’s annual performance plan and the AG’s vaccine audit report.

There were some teething issues with the (vaccine roll-out). However, we observed that the department was able to amend or quickly change the plans to align with the changes taking place, like the challenges with the AstraZeneca vaccine,” said Musisinyani.

The department had been allocated sufficient funds, amounting to R12.9bn, from the National Treasury to acquire the vaccines. Among the problem areas were non-compliance with tender procedures, possible overspending, poor IT systems and poor price negotiations.

The audit was initiated in January 2021 by former Health Minister Dr Zweli Mkhize, asking it to conduct a real-time audit similar to the one done on the acquisition of personal protective equipment. The office of the AG then developed a value chain based on its understanding of what processes the department needed to follow, with the main objective being “to monitor wastage or leakage in the process”.

AG’s observations:

  • “As at August 31 2021, 80% of the doses committed by Pfizer were received as opposed to 30% committed by Johnson & Johnson. We then raised a risk to the department that because these contracts were signed with international service providers, with foreign currency, management needed to be aware that there was a possibility of overspending due to the fluctuating currency rate.”
  • “Our findings relating to the logistics is that when they put out the tender, we noticed that they did not include subcontracting criteria as required by the regulation to ensure that bidders have guidance on how the subcontracting will be dealt with. This resulted in bidders using their own judgment on subcontracting.”
  • Initially, the DoH had intended to award the contract to one service provider but it did not include criteria that clearly stated that should the winning bidder not be able to deliver the services, the tender could be awarded to the second-highest bidder. “Unfortunately, due to the different changes, management decided to award the bid to more than one supplier and on our side we requested evidence on the thought process that led them to that decision. The evidence was not provided.”
  • Price negotiations were not performed with the appointed second-highest scoring bidder. “The second bidder had prices significantly higher than the winning bidder, so we raised that they needed to negotiate with the second bidder to reduce the prices.” However,  possible collusive bidding was not identified by the bid evaluation committee.
  • On the administering of the vaccine, the AG observed that the majority of vaccination sites had implemented the rollout processes. However, “there was a shortage of ICT equipment and poor connectivity with systems being offline and there [were] storage conditions or storage practices where the facilities were not adhering to the prescripts issued by the national and provincial departments.”
  • “We noted that the stock management itself — when it was at the facilities — that the movement of the stock was not being tracked effectively in some of the sites. We also highlighted challenges around used vaccine vials that were not defaced and labelled.” This opened the sector to the vials being reused and sold on the black market.
  • On the electronic vaccination data system (EVDS), Musisinyani said even though there were teething problems initially, the department was able to swiftly make changes to it.
  • “The financial situation in the health sector requires immediate action by the sector so it is able to continue to render services and fulfil its mandate,” said Musisinyani.

See more from MedicalBrief archives:

 

Crisp: Private sector is to blame for much of SA’s wasted healthcare spend

 

Dysfunctional provincial health departments make a mockery of the ‘capable state’

 

With 7m doses set to expire, DOH tries to boost sluggish vaccination campaign

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