A/HRC/23/42 level, can bring down prices and save substantial medicine-related expenditure by States.70 The success of competitive bidding largely depends on transparent management, which provides clear and sufficient tender information to all government agencies involved.71 Efficient and transparent management can also protect against bid-rigging practices in public procurement systems.72 51. In decentralized systems, however, poor financial and procurement capacities combined with weak governance present challenges which has even led to different prices in different regions of the same country. Decentralized systems also pose challenges for bulk procurement, which is routinely used in public procurement systems around the world.73 While decentralized procurement has the advantage of increasing local level accountability, it is susceptible to fragmentation, which causes duplication of procurement and negatively impacts coordinated negotiations, resulting in less favourable contract terms for governments.74 To maintain purchase volumes, some States have adopted systems to centrally negotiate prices while requiring lower levels of government to order their requirements through the successful bidder at the price negotiated at the central level.75 The Special Rapporteur recommends streamlining guidelines at the national level to ensure better coordination and efficient decentralized procurement. 52. Good procurement practice requires that suppliers be certified for Good Manufacturing Practices (GMP) to ensure quality assurance. A robust, multi-level tender process would exclude suppliers that do not meet GMP standards. Suppliers’ licensing agreements must also be strictly monitored throughout the supply chain until the time of delivery. States should publish the names of manufacturers who do not meet GMP standards and disqualify them from future bidding. 53. Accountability mechanisms are essential for addressing corrupt practices, especially in the selection, procurement and registration of medicines. The States, civil society and pharmaceutical companies that participated in the Special Rapporteur’s questionnaire raised concerns about corruption within the public procurement system. To prevent corruption in government procurement, different procurement functions of selection, quantification, preselection (eligibility) of suppliers and adjudication of tenders should be independently managed by different offices and trained individuals. Such separation of functions will allow for transparency and avoid potential conflict of interest.76 70 71 72 73 74 75 76 16 Ezekiel Emanuel et al, A Systemic Approach to Containing Health Care Spending, New England Journal of Medicine, No. 367 (2012), pp. 949-954 at p. 950. OECD, “Guidelines for fighting bid rigging in public procurement: Helping governments to obtain best value for money”. Available at http://www.oecd.org/competition/cartelsandanticompetitiveagreements/42851044.pdf Ibid. East African Community, A Situational Analysis and Feasibility Study on Regional Pooled Bulk Procurement of Essential Medicines and Other Health Supplies in the East Africa Community Partner States, Final Report (2007). Available at http://apps.who.int/medicinedocs/documents/s18414en/s18414en.pdf See Prabal Vikram Singh et al, “Replicating Tamil Nadu’s Drug Procurement Model”, Economic and Political Weekly (2012), vol. XLVII, No. 39. Ibid. Australian Government/AusAID and WHO, “Measuring Transparency in Medicines Registration, Selection and Procurement: Four Country Assessment Studies” (2006), p. 19.