E-DRUG: Bednets acquisition Suriname - availability and prices
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Dear e-druggers,
Some weeks ago I requested information related to the acquisition of bed nets in an emergency situation in Suriname. Simultaneously, a request for information (availability and costs) was sent to suppliers (IDA, IMRES and MEG all three in The Netherlands; Missionpharma and Vestergaard-Frandsen in Denmark) and one NGO (PSI, PermaNet). All but one reacted. There were substantial differences in the information provided. Lowest FCA price for an extra large bed net (190x180x150cm PermaNet) was USD 4.54 (PSI) and the highest USD 7.99; the average price was USD 5.94 and the median price USD 4.99. This compares favorably compared to the prices on the Roll back Malaria website that range from USD 5.12 to 5.37 for the same extra large PermaNet (depending on colour).
There was no substantial difference in the delivery times; all offered a total delivery time of less than eight weeks (to carrier) with part delivery (10 to 15%) from stock. From the two WHO pre-qualified bed nets only PermaNet was offered (3 out of the 5 offers). Reportedly, for one of the bed nets offered an application for pre-qualification has been submitted (IDA with Dawa).
Separately, PAHO worked on acquisition; the price obtained could not exactly be compared to the prices mentioned above because it included airfreight. However, analysis suggests that the price per PermaNet bednet is substantially higher (a couple of US-dollars) than the median price of USD 4.99 mentioned above. Delivery was not faster. In my experience Value for Money, efficiency and transparency are often not the strongest points in procurement by UN-agencies. My advice to the Ministry of Health in Suriname has been in future to demand access to all details of such transactions before the UN-agency places firm orders.
In my first message on e-drug I quoted from joint WHO/RBM/UNICEF/PSI/MSH Project publication "Sources and Prices of Selected Products for the Prevention, Diagnosis and Treatment of Malaria" of September 2004 that polyethylene bed nets last 5 years against polyester 2-3 years: ".the development of technologies within the textile and the chemical industries permitting the durable impregnation of fiber with insecticide has led to several possibilities for making Long-Lasting Insecticidal Nets (LINN) which can retain efficacy throughout the normal lifespan of the netting material itself (5years for polyethylene, and 2-3 years for polyester nets)."
This triggered a reaction from the manufacturer of PermaNet, Vestergaard-Frandsen, which I present below: "Whilst the polyethylene nets that are currently marketed has a higher bursting strength than the polyester nets (like PermaNet) then this is only because the yarns are thicker - not because the material is actually stronger. This means that PermaNet(R) is also available in a stronger version. It is fair to say that for the commercially available mosquito nets, that are recommended by WHO, PermaNet(R), will likely last around 4 years, whilst Olyset® will last around 5 years."
The first remark to be made is that specifications and quality of bed nets are an issue. Bed nets offered do not always come with enough specifications to establish the quality. The Draft guidelines for quality control of mosquito nets (WHO, 19/02/2003) (http://rbm.who.int/mmss/guidelines.html) contains bed net specifications and proposes a provisional full QC procedure including quality control criteria. Dr Mohammadou Kabir Cham from the Global Malaria Program Vector Control & Prevention kindly informed me about the status of the definition of specifications for bed nets and quality control: "This draft (WHO, 19/02/2003) was meant to be a transition between the experience accrued since the publication of the Specifications for Netting Materials Report of an Informal Consultation. WHO, 8-9.6.2000 and the convening of the Technical Consultation on specifications and quality control of netting materials for mosquito nets (untreated and treated) late last year. The Technical Consultation replaced the 2000 product-specific specifications for polyester, polyethylene and cotton netting, and instead developed generic specifications for all netting materials irrespective of the fibre it is made from. The core characteristics are: prevention of insect/vector entry, dimensional stability after washing, strength of netting materials and seams, and storage stability. Future non-warp-knitted materials also need to be proven comparable to warp-knitted netting in elasticity and in resistance to shifting of the yarn (assuring that netting holes retain their diameter). It should, however, be noted that at the moment only polyester nets with a filament count of above 30 are known to provide the appropriate characteristics for insecticide treatment at field level, and can be recommended for this purpose. These Specifications are to be published within a couple of months. The Guidelines for laboratory and field testing of long-lasting insecticidal mosquito nets (WHO/CDS/WHOPES/GCDPP 2005.11) reflect the specifications of netting materials for mosquito nets as insecticidal products and as such these reflect both the insecticidal as well as the physical characteristics of these products. Whereas the soon to be published Specifications will relate to the physical characteristics of netting materials for mosquito nets (both untreated and treated) and also the quality control aspects of these materials. In this context, these new specifications will replace the 2003 draft guidelines for quality control of mosquito nets. "Please refer to Dr Mohammadou Kabir Cham (chamm@who.int) or Pierre Guillet (GuilletP@who.int), both from the Global Malaria Program Vector Control & Prevention, for more information.
Conclusion: From our little investigation it shows that best Value for Money is to be obtained by procuring WHO pre-qualified bed nets. The acquisition does not need to be necessarily restricted to the original source of these nets. Benefits are to be obtained by sourcing from large scale buyers and distributors who may be able to provide from stock, in cases even from somewhere within the region. In our case in SouthAmerica that was PSI, but there are others also specialized in Africa. The Roll back Malaria Partnership website (http://www.rbm.who.int/) is a must for all who want information about bed nets and other supplies needed for malaria. The Malaria Medicines and Supplies Service (MMSS) is an initiative of the Roll Back Malaria Partnership to facilitate the access to quality affordable antimalarial medicines and other essential supplies: insecticide-treated mosquito nets, rapid diagnostic tests (RDT), and insecticide (http://rbm.who.int/mmss/).
Finally, on a special note which is not related especially to the emergency procurement of bednets the following. Indigenous people living in the forests in Suriname developed a design for a bednet that can be used for both beds as well as hammocks. Vestergaard-Frandsen used this design to produce these special bed-hammocknets for Suriname. In case someone is interested in this design, I am sure it can be obtained from the Ministry of Health in Suriname.
Kind regards,
Rob Verhage
Pharmaceutical Consultant
PO Box 4002
Suriname
597 438966
verhager@cq-link.sr