{"id":606,"date":"2022-07-27T15:32:31","date_gmt":"2022-07-27T15:32:31","guid":{"rendered":"http:\/\/audit.gov.ms\/?p=606"},"modified":"2022-07-27T15:32:31","modified_gmt":"2022-07-27T15:32:31","slug":"special-review-of-the-procurement-of-the-cuban-medical-brigade","status":"publish","type":"post","link":"http:\/\/audit.gov.ms\/?p=606","title":{"rendered":"Special Review of the Procurement of the Cuban Medical Brigade"},"content":{"rendered":"\n<p>The Office of the Auditor General is pleased to announce that its report entitled <strong>Special Review of the Government of Montserrat\u2019s Response to the COVID-19 Pandemic: Pr<\/strong><strong>ocurement of the Cuban Medical Brigade \u2013 Lessons-Learned Report<\/strong> was presented to the Legislative Assembly on July 26<sup>th<\/sup>, 2022.&nbsp; &nbsp;It assessed the Ministry of Health and Social Services\u2019 [MOHSS] procurement and deployment of medical professionals from Cuba, including compensation, terms and conditions, services to residents, financial management, and public-health outcomes.<\/p>\n\n\n\n<p><strong>Background: <\/strong>In December, 2019, the World Health Organisation confirmed the emergence of the new Corona Virus (SARS-COV2) in Wuhan, China.&nbsp;&nbsp; Within two months, the W.H.O. proclaimed a global pandemic of this infectious respiratory illness.&nbsp;&nbsp; In early March, 2020, the first identified case of COVID-19 was confirmed in Montserrat. A contract was signed on July 14<sup>th<\/sup>, 2020, for 13 medical professionals: 5 doctors and 8 nurses.&nbsp;&nbsp; Their actual date of arrival in Montserrat was July 21<sup>st<\/sup>, 2020.<\/p>\n\n\n\n<p><strong>Key Findings:<\/strong><\/p>\n\n\n\n<ul><li><strong>Boost to medical capacity<\/strong>.&nbsp; &nbsp;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.&nbsp;&nbsp; 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.&nbsp;&nbsp; The initial contract-term of 3 months was extended to nearly two years (to March 31, 2022).<\/li><li><strong>Increased revenues<\/strong>.&nbsp;&nbsp; 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.<\/li><li><strong>Reduced costs of recruitment. &nbsp;<\/strong>The Government achieved large cost-savings through employing Cuban medical doctors versus the GOM\u2019s regular market-rates otherwise applied to recruiting these categories of workers (plus the costs of prolonged vacancies).&nbsp;&nbsp; At regular market-rates, the cost of recruiting 5 medical doctors alone would have exceeded E.C.$1.5 million per year (salaries only).&nbsp;&nbsp; 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).<\/li><li><strong>Improper procurement of local transportation.&nbsp; <\/strong>Transportation was outsourced without following normal procedures for public procurement.&nbsp; The Procurement Unit confirmed that it was not consulted or engaged in any aspect of this procurement.&nbsp; 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.&nbsp;&nbsp; By February, 2021, the cumulative total exceeded E.C.$190,000.&nbsp;<\/li><li><strong>Public officers provided paid or charged for services<\/strong>.&nbsp;&nbsp; Some public officers provided, and were paid or charged the Government for, goods and services for the Cuban Medical Brigade.&nbsp;&nbsp; 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.&nbsp;&nbsp; However, there was good interdepartmental co-operation in the assignment of officers to provide specified services to the Cuban Medical Brigade.<\/li><li><strong>Increased local access to medical services.&nbsp;&nbsp; <\/strong>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).&nbsp;&nbsp; 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).&nbsp;&nbsp; These figures are for Specialist Clinics alone, and do not include all the patient-visits that the Cuban doctors provided at the Glendon Hospital\u2019s wards or at the District Clinics.<\/li><li><strong>Fewer medical evacuations; major cost-savings<\/strong>.&nbsp;&nbsp; There were major savings to persons who would otherwise have had to travel overseas to obtain these services.&nbsp;&nbsp;&nbsp; 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.&nbsp;&nbsp; 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).&nbsp;&nbsp; This represents cumulative cost-savings in the hundreds of thousands of dollars.&nbsp;<\/li><\/ul>\n\n\n\n<p><strong>Key Recommendations:<\/strong><strong><\/strong><\/p>\n\n\n\n<ul><li><strong>Improve procurement and transparency<\/strong><strong>.<\/strong>&nbsp;&nbsp; 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.&nbsp;&nbsp; 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.&nbsp; Where the sums of contracts to be awarded exceed the stipulated thresholds, all desired public procurement should be advertised on multiple established channels.&nbsp;&nbsp; This is important for transparency and accountability of the Government.&nbsp;&nbsp; &nbsp;<\/li><\/ul>\n\n\n\n<ul><li><strong>Improve negotiations.<\/strong>&nbsp;&nbsp; The Government should be vigilant against price-gouging whereas one provider charged 200% of the rate charged by another provider.&nbsp;&nbsp; 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.&nbsp;&nbsp; Group-rates and appropriate group\/quantity discounts should be pursued in all cases.<\/li><\/ul>\n\n\n\n<ul><li><strong>Benchmark suppliers and competitive pricing<\/strong><strong>.<\/strong>&nbsp;&nbsp;&nbsp;&nbsp; The Government should establish a schedule of fair and reasonable rates and prices for commonly procured products and services.&nbsp;&nbsp; Deviations should be flagged immediately for investigation, review, and negotiation.&nbsp;&nbsp; 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.<\/li><\/ul>\n\n\n\n<p>The full audit report highlights several other findings, recommendations and client responses.&nbsp; The implementation of recommendations will bring significant improvements.<\/p>\n\n\n\n<p><strong><strong><strong>The report in its entirety can be found at the Montserrat Public Library, on the Office of the Auditor General\u00a0Online\u00a0<a href=\"http:\/\/audit.gov.ms\/publications\/\">Publications<\/a>\u00a0and Facebook Pages or by requesting an electronic copy from the Office of the Auditor General, located upstairs Angelo\u2019s Complex, Brades. E-mail:\u00a0<\/strong><a href=\"mailto:audit@gov.ms\"><strong>audit@gov.ms<\/strong><\/a><strong>; Telephone: (664) 491 \u2013 3460 or 491 \u2013 4569<\/strong><\/strong><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Office of the Auditor General is pleased to announce that its report entitled Special Review of the Government of Montserrat\u2019s Response to the COVID-19 Pandemic: Procurement of the Cuban Medical Brigade \u2013 Lessons-Learned Report was presented to the Legislative Assembly on July 26th, 2022.&nbsp; &nbsp;It assessed the Ministry of Health and Social Services\u2019 [MOHSS] [&hellip;]<\/p>\n","protected":false},"author":1001003,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"_links":{"self":[{"href":"http:\/\/audit.gov.ms\/index.php?rest_route=\/wp\/v2\/posts\/606"}],"collection":[{"href":"http:\/\/audit.gov.ms\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/audit.gov.ms\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/audit.gov.ms\/index.php?rest_route=\/wp\/v2\/users\/1001003"}],"replies":[{"embeddable":true,"href":"http:\/\/audit.gov.ms\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=606"}],"version-history":[{"count":1,"href":"http:\/\/audit.gov.ms\/index.php?rest_route=\/wp\/v2\/posts\/606\/revisions"}],"predecessor-version":[{"id":607,"href":"http:\/\/audit.gov.ms\/index.php?rest_route=\/wp\/v2\/posts\/606\/revisions\/607"}],"wp:attachment":[{"href":"http:\/\/audit.gov.ms\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=606"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/audit.gov.ms\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=606"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/audit.gov.ms\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=606"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}