Special Review of the Procurement of the Cuban Medical Brigade

27th July, 2022

The Office of the Auditor General is pleased to announce that its report entitled Special Review of the Government of Montserrat’s Response to the COVID-19 Pandemic: Procurement of the Cuban Medical Brigade – Lessons-Learned Report was presented to the Legislative Assembly on July 26th, 2022.   It assessed the Ministry of Health and Social Services’ [MOHSS] procurement and deployment of medical professionals from Cuba, including compensation, terms and conditions, services to residents, financial management, and public-health outcomes.

Background: In December, 2019, the World Health Organisation confirmed the emergence of the new Corona Virus (SARS-COV2) in Wuhan, China.   Within two months, the W.H.O. proclaimed a global pandemic of this infectious respiratory illness.   In early March, 2020, the first identified case of COVID-19 was confirmed in Montserrat. A contract was signed on July 14th, 2020, for 13 medical professionals: 5 doctors and 8 nurses.   Their actual date of arrival in Montserrat was July 21st, 2020.

Key Findings:

  • Boost to medical capacity.   The Ministry of Health succeeded in procuring 13 medical professionals to fill some of the chronic nursing gaps along with specialist medical positions in Montserrat.   At the peak of the support, April to June, 2021, the number of Cuban healthcare professionals surged to 20 persons; thereafter, the contingent was reduced to 10 persons.   The initial contract-term of 3 months was extended to nearly two years (to March 31, 2022).
  • Increased revenues.   The Government has earned revenues of approximately $83,000 from patients who benefitted from the work of the Cuban medical specialists (especially in obstetrics and gynaecology): related fees totalled $39,200 in fiscal year 2020/2021 and $43,511 in fiscal year 2021/2022.
  • Reduced costs of recruitment.  The Government achieved large cost-savings through employing Cuban medical doctors versus the GOM’s regular market-rates otherwise applied to recruiting these categories of workers (plus the costs of prolonged vacancies).   At regular market-rates, the cost of recruiting 5 medical doctors alone would have exceeded E.C.$1.5 million per year (salaries only).   For a similar sum, for the period of July, 2020, to March, 2021, the GOM obtained 5 doctors plus 8 nurses from Cuba (including salaries, accommodation, meals, transportation and incidentals).
  • Improper procurement of local transportation.  Transportation was outsourced without following normal procedures for public procurement.  The Procurement Unit confirmed that it was not consulted or engaged in any aspect of this procurement.  Large amounts were spent on local transportation: the cumulative amounts for July to October, 2020, alone exceeded $108,000 which was procured from only two service-providers.   By February, 2021, the cumulative total exceeded E.C.$190,000. 
  • Public officers provided paid or charged for services.   Some public officers provided, and were paid or charged the Government for, goods and services for the Cuban Medical Brigade.   The General Orders for the Public Service and best practices against corruption usually require/recommend that full-time employees of the Government of Montserrat be dedicated to their occupation in the public service.   However, there was good interdepartmental co-operation in the assignment of officers to provide specified services to the Cuban Medical Brigade.
  • Increased local access to medical services.   The people of Montserrat enjoyed access to several medical services on the island (and either at low fees or, in most cases, at no direct charge to patients).   The 5 Cuban specialists handled a total of 774 patient-visits during year #1 (effectively, 9 months: July, 2020, to March, 2021) and 1,690 patient visits during year #2 (April, 2021, to March, 2022).   These figures are for Specialist Clinics alone, and do not include all the patient-visits that the Cuban doctors provided at the Glendon Hospital’s wards or at the District Clinics.
  • Fewer medical evacuations; major cost-savings.   There were major savings to persons who would otherwise have had to travel overseas to obtain these services.    Local interventions by Cuban specialists also served to reduce/prevent some high-risk medical cases from worsening or reaching a critical stage that would require high-cost treatments locally and/or medical evacuation overseas.   The number of medical evacuations from Montserrat declined approximately 50% during the past 2 fiscal years (2020/2021 and 2021/2022), the period that the Cuban specialists were on the island, compared with the number of medical evacuations from Montserrat in the two prior years (2019/2020 and 2018/2019).   This represents cumulative cost-savings in the hundreds of thousands of dollars. 

Key Recommendations:

  • Improve procurement and transparency.   Even in times of emergency, there are opportunities, both in preparation for potential crises, and after crises arrive, to use pre-qualified service-providers at short notice.   However, times of crisis and instances of new or unusual procurement are all the more important times to seek the advice and the inputs of the Procurement Unit.  Where the sums of contracts to be awarded exceed the stipulated thresholds, all desired public procurement should be advertised on multiple established channels.   This is important for transparency and accountability of the Government.    
  • Improve negotiations.   The Government should be vigilant against price-gouging whereas one provider charged 200% of the rate charged by another provider.   The Government should negotiate more favourable rates and prices for specified products, accommodation, and services, given its size as a client in comparison with other clients of the service-providers.   Group-rates and appropriate group/quantity discounts should be pursued in all cases.
  • Benchmark suppliers and competitive pricing.     The Government should establish a schedule of fair and reasonable rates and prices for commonly procured products and services.   Deviations should be flagged immediately for investigation, review, and negotiation.   The sharing of price data and experiences across Ministries/Departments would benefit all participants by ensuring a broader and deeper range of inputs into procurement decisions, a better assessment of suppliers over time, and more accountability for service-providers.

The full audit report highlights several other findings, recommendations and client responses.  The implementation of recommendations will bring significant improvements.

The report in its entirety can be found at the Montserrat Public Library, on the Office of the Auditor General Online Publications and Facebook Pages or by requesting an electronic copy from the Office of the Auditor General, located upstairs Angelo’s Complex, Brades. E-mail: audit@gov.ms; Telephone: (664) 491 – 3460 or 491 – 4569