A/HRC/23/42 D. Procurement 47. Efficient and transparent procurement of medicines is central to ensuring the availability of medicines in sufficient quantities in all public health facilities. Procurement of medicines occurs at the international, national, regional and local levels. Inefficiencies of procurement at each level can cause unreliable medicine supplies and higher costs. An efficient procurement system is one that relies on transparent management, a limited drug selection that is based on a restricted list (for example, NEML), accurate and scientific forecasting of need, competitive tendering, bulk purchasing, pre-qualification of proposed suppliers and close monitoring of selected suppliers, and reliable financing.66 The Special Rapporteur is pleased to note that most States that responded to his questionnaire have formulated national medicine procurement policies. 48. With respect to quantification of medicines needs, one developing country experience indicates reliance on historical data gathered from hospitals all over the country and the epidemiological pattern of disease, which are reviewed every six months. A 20 per cent buffer to account for shortages or seasonal increases in disease is then added. Stock shortages are nevertheless commonly reported in this State. Fewer than half of the respondent States had a policy in place to address medicines shortages. States attributed stock shortages to insufficient funding for procurement, inaccurate forecasting of needs, inadequate buffer stock of essential medicines, and inefficient distribution and recordkeeping systems. Stock shortages can force patients to resort to more expensive private health centres, inappropriate medicines or even forego treatment altogether. Overquantification of demand, on the other hand, is equally harmful, as it can lead to the wastage of scarce resources and the expiry of medicines, for which safe disposal systems are lacking in many States.67 States are therefore encouraged to develop more scientific, reliable and evidence-based methods for forecasting and quantification such as the use of computerized methods for quantification and reliance on data about actual consumption where there are reliable records available.68 Participation of civil society and the affected communities must be encouraged as it helps create information networks to monitor and inform competent health authorities on medicine stocks. 49. International shortage of medicines, especially cancer medicines, was also raised as an issue by civil society participants to the survey. Such shortages in medicines are attributed to a limited number of manufacturers, shortages of raw materials, production problems and stockpiling.69 They negatively impact States’ ability to procure medicines for public health facilities and seriously affect their availability to patients. States should therefore identify particular medicines markets that face such shortages and promote the development of local production of these medicines to ensure supply sustainability in the long term. 50. The Special Rapporteur satisfactorily notes that a majority of States surveyed by the Special Rapporteur reported the use of competitive bidding for public procurement of medicines. A transparent competitive bidding process, both at the national and international 66 67 68 69 Essential Drugs and Medicines Policy Interagency Pharmaceutical Group, WHO Operational principles for good pharmaceutical procurement (Geneva, 1999). Roger Bate et al, Antimalarial medicine diversion: stock-outs and other public health problems, Research and Reports in Tropical Medicine , vol. 1 (2010), pp. 19-24, pp. 22-23. Chap. 18, “Managing Procurement”, in Management Sciences for Health (2011), pp. 18.9-18.10, and p. 18.4. Monika L. Metzger et al, “The Impact of Drug Shortages on Children with Cancer - The Example of Mechlorethamine”, New England Journal of Medicine, vol. 367 (2012), pp. 2461- 2463. 15