This page describes the strategies and protocols that we follow for procurement of supplies outside of Nepal.   

Guiding Principles on Procurement  Corporate In-Kind Donations Strategies for Talking on the Phone with Potential Donors Issues in Epidemiological Estimation Sustainability of donated consummable supplies Scalability of donated capital supplies On Corporate Relationships Shipping Volunteer In-Kind Donations On the importance of a sound procurement strategy

 

Guiding Principles on Procurement 

• We strive towards a single standard of care for all patients.
• We believe fundamentally in equity, that all individuals have a right to an excellent, not “basic,” or “minimum” standard of medical care. Hence, we will strive to use the best technology - therapeutics, diagnostics, and informatics - to serve the greatest public health good, given the available resources, and to advocate for an expansion of those resources.
• Equipment procurement will give full and fair opportunity to local suppliers.
• Equipment will be purchased from local vendors, when feasible. In keeping with Nyaya’s overall mission to foster equity and fair opportunity, supplies will be purchased from community vendors will bolster and preserve the local economy.
• We will use the most efficient, cost-effective, and reliable suppliers possible.
• Establishing a reliable supply is essential to our mission in providing high-quality healthcare. This requires purchasing from vendors who can deliver authentic, high-quality medications and supplies at a fair price.
• We will avoid excess expenditures and minimize waste in our operations and be held accountable for the most effective use of our supplies.  However, we will not use “cost-effective” as an excuse for “second-rate services for the poor."
• Our goal is to create effective medical and public health systems and healthy communities.
• To tackle acute health needs, we must first address the emergencies posed by AIDS, TB and maternal and infant mortality, but the long-term vision is to develop a strong health system that can meet the complex, changing needs of these communities. 

Corporate In-Kind Donations

Overall strategy for pursuing corporate in-kind donations is to: 

1. Identify the particular technology, test, or pharmaceutical that Nyaya is looking for.
2. Search on the web for companies that provide the desired item, verify its quality, and make notes of corporate contacts at: http://spreadsheets.google.com/a/nyayahealth.org/ccc?key=p-TJjzE7A-O6Ye3SXh31Udw&hl=en
3. Work with other members of the Nyaya team on the exact amount and timeframe for using the items.  Before sending any estimates and timeline to any corporations, please verify whether the estimates are correct.  It is important that we are realistic so that we can best make use of corporations' generosity and also not burden staff and volunteers with unnecessary equipment.  See note on the subject below.
4. Read carefully through Grants page for the overall approach to pitching our organization.
5. Put together a brief PDF pitching the procurement idea.  See SharedNyaya\Clinic\Grants\equipment for examples of the successful proposals (e.g., ultrasound, i-stat, quidel) that we have taken to companies; typically they are 3-pages with at least 1-3 pictures and in straightforward but compelling language.  **Make sure that your PDF is sent over team list for review prior to contacting the companies so that all can review and comment; this will make it more likely that we will be able to meet the commitments proposed in the PDF.
6. Contact the company by phone and email.  Be agressive.  Key is to find someone within the company who has the power to allocate the item to Nyaya.  You often have to search extensively even within the department of a company. 
7. Once you find the right person, pitch it to them via an emailed PDF.  
8. Once donated, you must follow-up agressively with the person in charge of shipping the item.  ALWAYS demand that they provide you a shipping number.  Keep on them if they do not provide it.  
9. Figure out how to ship to Achham, ideally by on-person transport of a volunteer going there.   Try to convince the company to pay for shipping.
10. Create a protocol for the appropriate use, record keeping (i.e., how to incorporate it into our database), data reporting, and maintenance.  You should discuss this protocol with the Achham team.
11. Follow-up regularly with the Achham team as to the status of the item, and if there are any issues that need to be addressed.
12. Write reports to the company every 3-6 months on the use of the device.  Examples are found in SharedNyaya\Clinic\Updates.  Any person that you have worked with at the company (administrators, executives, technicians) should recieve the report, as well as should be placed on our donors list for receiving our regular general updates and reports.  The sheet for this is: http://spreadsheets.google.com/a/nyayahealth.org/ccc?key=pWMfEM1cjNv18GuSXCoSyNw&hl=en  

Strategies for Talking on the Phone with Potential Donors

Some grantors/donors/companies will want to speak with you by phone.  This is an excellent opportunity to pitch the organization in a compelling and rigorous fashion.  If you are new to the organization, set up a time to talk with a more experienced member for practice.  Some strategies: 

1)  Be clear about your title with the organization

2)  Know the exact costs of each item that you are proposing the donor sell (see Budget page)

3)  Use straightforward and concise language.  Do not overstate the challenges of Achham; rather, highlight how we are addressing those challenges.

4)  Use positive language and tones.

5)  Be clear as to Nyaya's vision both in general and specific to this project.  Be ready to articulate exactly how our vision matches that of the donor.

Issues in Epidemiological Estimation

For many laboratory devices, some estimation is required as to the amount of reagent, supplies, or tests to request.   A balance is required since on the one hand we do not want to over-estimate and then not be able to meet the donors' expectations. At the same time, given uncertainties in transport and supply chains, it is our responsibility to ensure that we do not start a program and then run out of supplies.   Furthermore, we should not await on receiving an essential test just because we do not know exactly how many we would need.  See some notes on the subject on our NewPrograms page.   For the most part, once we get the tech out there and gain some, experience and document what we are doing, our supporters totally accept that the timeline and exact use was not as initially stated.  That said, we do need to go off the best available estimates, and fortunately with our electronic patient database we can make some reasonable throughput calculations.  It is important for any volunteers working on procurement that they realize that the estimates are estimates only, and that they should manage both their own and the corporations' expectations accordingly.  In some cases, a volunteer may work very hard to procure some donated item only to find that the item cannot be implemented immediately.  This can be disheartening for the volunteer unless it was discussed from the outset more accurately what are some of the possible outcomes of the donated items: 1) immediate, widespread, effective use; 2) immediate incorporation into clinic protocols, but much lower volume/throughput than anticipated; 3) donated item that is non-functional, breaks, gets lost, or gets stolen, or is otherwise not useful in our setting.

Sustainability of donated consummable supplies

There are several consummable supplies that are difficult or too expensive to procure in Nepal.   For example, we have obtained generous donations of consummable laboratory supplies from Quidel (point-of-care tests), Abbott (i-Stat cartridges), and QBC Diagnostics (blood testing cuvettes).   These have enabled us to rapidly create a top-notch rural laboratory.  The challenge is that we have to continue to import them, but it is preferable to have in-country suppliers both logistically and philosophically.  Certainly for developing a broader model that is implementable across multiple sites and by the government, in-country suppliers are critical.

In planning for the roll out of these, a few strategies: 1) err on the side of over-estimating so that we do not run out of supplies earlier than anticipated; 2) provide regular updates to the donor to keep them engaged; 3) review monthly utilization stats and adjust our supplies requests accordingly; 4) have in-country back-up plans in the case of malfunction or supplies chain mishaps.

Scalability of donated capital supplies

An important dilemma with donated capital supplies is that for the most part these supplies are donated because our organization is capable of writing compelling grant applications and marketing materials.  The problem is that when we develop an effective model for deployment of these technologies (e.g., our donated portable ultrasound), the model is less likely to be feasibly scaled to other sites.

On Corporate Relationships

It is important to take care not to have valuable corporate relationships taint the quality of care we provide.  This can be difficult to avoid because of both psychological and economic factors that would make the recipient (Nyaya Health) more likely to evaluate a donated item favorably.  It is important to remember that, even in the non-profit world, there is "no free lunch" (to borrow a term used in the movement against free hand-outs from pharmaceutical marketers); that while we do require corporate partnerships to get essential technologies out to Achham, our responsibilities to our patients mandate that we are critical in our application of these donations.  Some strategies that can help avoid the pitfalls of corporate partnerships: :

• Identify our needs and then seek corporate support.  this for the most part is how we operate, since corporations are not soliciting us for donations.  By ourselves first evaluating products and then approaching companies on our terms, we can set the proper mechanisms in place to avoid misuing a product.
• Be willing to turn away a donation and pay for an alternative product.
• Monitor our use and the effectiveness of any technologies, which is an important principle whether the technology is donated or not.

Shipping

Ideally, the corporate donor ships for free to a volunteer in the United States who then brings the items on his/her person.  Additional options:

• Pursue free shipping options
  • see Grants worksheet for fedex, which we can't apply to until July '09

Volunteer In-Kind Donations

If a volunteer donates a technology, you should note their donation on the "In-Kind" tab of the Donations sheet:  http://spreadsheets.google.com/a/nyayahealth.org/ccc?key=pWMfEM1cjNv18GuSXCoSyNw&hl=en

The value should represent the current retail value of the item; if used, the volunteer should estimate the approximate value that could be obtained by selling it on Ebay or other online vendor.

On the importance of a sound procurement strategy

“Lest this sound too general, allow me to consider maternal mortality. Gender inequality and poverty, together not apart, are the cause of almost all deaths during childbirth: half a million women die each year in childbirth, but these deaths are registered exclusively among poor women. They can all be prevented, but to do so requires that women with obstructed labor have access to modern obstetrics…I wish that when I first traveled to Haiti, in 1983, someone had told me that to advocate for human rights there we’d need to consider learning to build operating rooms and procure equipment and supplies; it would have saved us a great deal of time and made us more effective.”

Farmer M.D., Paul. “Challenging Orthodoxies in Health and Human Rights.” American Public Health Association. 134th Annual Meeting and Exposition. Boston. 5 November 2006. p.4.  [thanks to one of the OAN design entrants: http://www.openarchitecturenetwork.org/node/1529 for this quote.