Text version of Email Directive Sent from Shoko Arakaki (HO) and Eric Dupont (PSB)

April 6th 2020

 

Title: Humanitarian Office and Procurement Services Branch Operational Update for Humanitarian Country Offices on Supplies and COVID-19

 

There have been requests by a number of UNFPA Country and Regional offices for specific clarity on Supplies for COVID-19 for humanitarian operations. In that light Humanitarian Office (HO) and Procurement Services Branch (PSB) have compiled the following information note and guidance on key supply considerations. Please kindly ensure this email is appropriately communicated to all relevant CO colleagues and that any requests for follow-up support be coordinated by the ROs as required.

 

UNFPA Programmatic Priorities 

As has previously been communicated, the general programmatic priorities for UNFPA throughout the COVID-19 Pandemic include:

  • Ensuring continuity of lifesaving SRH and GBV Services
    • SRH: Ensuring continuity of MISP services 
    • GBV: Ensuring continuity of lifesaving GBV prevention and response services (remote or, where feasible, in person) 
  • Ensuring coordination continuity 
    • For SRH Services and Supplies (SRH Working group or sector, or within Health cluster/sector)
    • For GBV sub-cluster/sector
  • Ensuring supply availability 
    • Ensuring the availability of Personal Protection Equipment (PPE) to health care workers providing lifesaving SRH services throughout the COVID-19 pandemic
    • Mitigating the impact of COVID-19 on the distribution of access to other lifesaving essential SRH supplies, particularly in humanitarian crises

 

These interventions with the aim of contributing to the reduction of person-to-person transmission of COVID-19

 

Personal Protection Equipment (PPE)

UNFPA PPE Objectives

According to the Humanitarian Office directive to PSB, UNFPA country offices should only be procuring PPE supplies, related to the COVID-19 Pandemic, for activities specifically in line with UNFPA's mandate. This means, COs should be permitted to procure PPE for:

  • Ensuring health care workers can continue to deliver the SRH MISP service objectives; and,
  • Ensuring staff implementing minimum GBV prevention and response services, that have direct interaction with affected populations, can have basic protection  

 

Following this logic, the procurement of supplies related to clinical care for COVID-19 patients, not related to UNFPAs direct mandate, should be left to organizations like WHO, UNICEF, ICRC, MSF and other partners who have the expertise and whose mandate covers this area. We know from past epidemics that SRH and GBV interventions can often be deprioritized and UNFPA must hold accountable to ensure that we can prevent the disruption of lifesaving SRH and GBV interventions first and foremost.  

 

Challenges for PPE Provision

  • Globally, Demand is Greater than Supply - difficulties sourcing and/or arranging delivery, many suppliers struggle to quote within the provided deadlines
  • Dramatic Decrease in Freight Options and Increases in Price - Freight Forwarders are having a hard time keeping up with submitting binding quotations.                                                              
    • There are destinations freight forwarders are not capable of quoting                                                             
    • In general, the transportation market is suffering. With numerous containers stranded, empty sailings, and canceled flights, the prices have significantly increased and will continue to be unpredictable.                                                          
  • Border closures and import/export restrictions - Several countries in Europe, Asia and in Africa have started to close borders and apply restrictive measures
  • Larger demand for support with same UNFPA capacity - Demand for support in procurement for PPE items will arise from countries not usually supported by UNFPA international procurement for medical devices. 

 

In the event that PPE is issued to the providers delivering care, offered to vulnerable populations, it  is essential for country offices and partners to consider the potential negative ramifications. Stigma, due to perception that the international community is prioritizing the needs of already vulnerable populations (e.g. refugees and IDPs), can arise. Additionally, as UNFPA and SRH partners are targeting services primarily accessed by women and girls, COs should consider the implications for Gender-based violence. 

 

What is being Done?

International Procurement: PSB and HO have completed a proposal for large volumes of procurement for 9 key PPE items, based on a forecast of potential need for humanitarian and low income countries with UNFPA operations. Funding for this has been integrated into donor proposals at the global level and includes costs for the value of the items and international freight.  

  • As per PSB communication on April 3rd, 9 key PPE items are now covered under the blanket LTA and have been included in the global forecast. These 9 items deemed priority include:
  1. Gloves, examination, long cuff, nitrile, powder free, non-sterile
  2. Gloves, surgical, long cuff, nitrile, powder free, sterile
  3. Gown, Isolation, non woven, disposable
  4. Coverall, disposable
  5. Surgical Respirator FFP2/N95, mask, disposable
  6. Surgical Mask, type IIR, disposable
  7. Surgical Mask, type I, disposable
  8. Goggle, panoramic, regular nose, indirect ventilation
  9. Face Shield, reusable
  • UNFPA and UNICEF are coordinating with other humanitarian actors, including WHO, to pool PPE procurement needs at the global level and working with manufacturers to increase our chances to secure supply as soon as possible.
  • The PPE supplies from international procurement will not arrive tomorrow – If all goes well it is more realistically end of April beginning of May that supplies can begin to be sent to COs
  • Please note PSB will not approve the international procurement of supplies to test or treat COVID-19 positive patients (coordination should be done with other health actors to ensure that any persons of concern to UNFPA can receive adequate care if COVID-19 positive, including referral, while maintaining the quality of their SRH care) 

 

Local Procurement: PSB and HO recommend that countries immediately begin local procurement where feasible.

  • The guidance note that was sent out by the OED on the 1st of April specified 6 items permitted for local procurement, however a decision was made by PSB and HO, in coordination with TD to add key items likely to be disrupted by COVID-19. PSB has issued a notice on the 3rd of April permitting the local procurement of the additional 3 items not originally included in the communication from OED. These 9 items deemed priority include:
  1. Gloves, examination, long cuff, nitrile, powder free, non-sterile
  2. Gloves, surgical, long cuff, nitrile, powder free, sterile
  3. Gown, Isolation, non woven, disposable
  4. Coverall, disposable
  5. Surgical Respirator FFP2/N95, mask, disposable
  6. Surgical Mask, type IIR, disposable
  7. Surgical Mask, type I, disposable
  8. Goggle, panoramic, regular nose, indirect ventilation
  9. Face Shield, reusable
  • Please note PSB will not approve the local procurement of supplies to test or treat COVID-19 positive patients (coordination should be done with other health actors to ensure that any persons of concern to UNFPA can receive adequate care if COVID-19 positive, including referral, while maintaining the quality of their SRH care) 

 

What Can Country Offices Do?

International procurement

Once the order is under production for the 9 key PPE Items - UNFPA COs will be asked to provide a requisition request for PPE, in line with the items that will be procured, in bulk once production is underway (on behalf of UNFPA IPs and NGOs in the SRH working group or other similar coordination mechanism where UNFPA will support these actors). Some COs have already provided this information.

  • HO has provided a brief one-page guide (attached to this email) on how COs could forecast their need in advance of requests 
  • All requests will be sent to HO and PSB (following the same process as the IARH kits – with a transparent process for prioritization)

 

Please note that while the International Procurement of 9 key PPE items will be handled by PSB, with needs coordinated with HO and PSB, a procurement fee will be charged by PSB and should be costed by COs at X% the value of goods, in line with the guidance note on Procurement Services fee (with effect from January 1st, 2017). 

  • Please note: The cost of all direct costs, i.e. the value of the goods, international freight, cargo insurance premium, prepositioning cost, and PSB fee will be covered by the amount of money we receive from international donors and we might therefore have to adjust the final quantity depending on how much money we receive bearing in mind that all these costs will have to covered by the donor funds.

 

The PPE supplies from international procurement will not arrive tomorrow – If all goes well it is more realistically end of April beginning of May that supplies can begin to be sent to COs

 

Local procurement

If local procurement for the 9 priority PPE items is possible in your setting, in line with PSB guidance on ensuring quality, COs should move forward immediately in:

  • Assessing the local market 
  • Coordinating with partners in the SRH working group to get an idea of overall immediate need for local procurement of the 9 PPE items. By pooling orders local manufacturers may be more interested to fulfill orders and UNFPA COs may choose to support local partners who have no resources or capacity to procure these 9 PPE items locally. 
  • Moving forward with local tenders for procurement of the 9 key PPE items, particularly in the immediate future as any international procurement for PPE will not arrive for the next few weeks. 
  • Please note, there have been requests for the exceptions to procure masks made by textile manufacturers for use in healthcare settings. According to UNFPA QA Cloth (e.g. cotton or gauze) masks are not recommended under any circumstances. Therefore all use of self-assembled, DIY and textile versions of medical masks should be strictly avoided in a healthcare setting. 

If local procurement of these items is not possible please consider:

  • Coordination: UNFPA and SRH sector partners should work together to coordinate with other health actors to obtain PPE where they may have orders arriving sooner or donations made. COs can continue to advocate for the importance of protection of healthcare workers providing MISP services throughout the COVID-19 response  
  • Advocacy with government: Many governments are receiving donations of PPE, SRH sector partners should work together to advocate to the governments to reiterate the need to provide PPE to SRH workers providing MISP services

 

IARH Kits, Dignity Kits and Other Essential items 

UNFPA must work to ensuring the continued availability of lifesaving SRH supplies (including the IARH kits, other kits, pharmaceuticals and medical devices) required to implement the MISP; overcoming COVID-19 related bottlenecks in global and local supply manufacturing, procurement, international transit, import, local transportation, local procurement, pharmacy management and waste management which may lead to quality service disruption 

 

Challenges for Provision of other life saving Commodities 

Due to the COVID-19 restrictions in manufacturing, freight and importation, COVID-19 also has the potential to impact urgent availability of other lifesaving SRH supplies, including the IARH kits and other emergency medical kits, needed in humanitarian crises. Without these commodities not only with the impact of COVID-19 lead to morbidity and mortality related to the outbreak, it will also increase overall morbidity and mortality related to other health services like reproductive, maternal and child health. Ensuring continuity of care for priority SRH in emergencies interventions requires continued access to lifesaving SRH supplies, irrespective of an infectious disease outbreak. Bottlenecks include:

  • Significant bottlenecks for international freight, and potential increased costs, along with manufacturing delays for key items in some of the IARH kits will lead to delays in fulfilling requests for IARH kits in the coming weeks
  • Restrictions at national level on import, movement, transportation, and delivery of supplies due to COVID-19 are likely and already being seen in humanitarian countries with COVID-19 cases
    • Delays in customs clearance for supplies that can arrive to ports of entry may arise due to reduced capacity in government ministries due to COVID-19 and overwhelming import of supplies to ports of entry 
    • Domestic restrictions in travel may arise, posing challenges for supplies already in country to be transported from one part of the country to another
    • Increased costs in domestic freight due to limited availability as national restrictions arise
    • Local manufacturers producing supplies may halt or delay production
    • Supplies might be prioritised for COVID-19 prevention and response putting other people at risk, by lowering the capacity to implement IPC measures during other medical and surgical interventions
    • Remote management of IARH Kits and other supplies may arise due to access restraints because of domestic travel restrictions
    • Governments may begin to regulate the provision of supplies to certain parts of the country by the international community throughout the response. This is particularly alarming for vulnerable populations or regions that may not be seen as the priority for the government. This can impact PPE and other lifesaving supply provision to SRH facilities.
    • Staff deemed ‘essential for supply chain and logistics may not be deemed essential under national government restrictions” (e.g. Pharmacists, Medical Waste Management, Transport workers, warehouse managers and staff)
    • Existing warehouse space, and national logistics networks, may be unable to manage the increase in supplies needed throughout the COVID-19 response

 

Country Office Activities 

  • As bottlenecks increase in delivering IARH kits to country offices and partners, UNFPA in coordination with other SRH actors will need to reallocate/re-prioritize the supplies which may be already in the country to plan for delays in receiving new IARH kits and other supplies requested from international procurement, in coordination with other SRH actors 
  • Contingency planning should be prioritized to mitigate, in coordination with other SRH, Health and Logistics sector partners, to ensure supplies can continue to be delivered to health facilities while maintaining quality (Inc. for transport, storage, distribution, waste management and M&E) – e.g. civil-military cooperation in line with Health Cluster Guidance on Civil-military Coordination During Humanitarian Health Action, etc. 
  • COs should implement activities to overcoming COVID-19 related bottlenecks in local supply manufacturing, procurement, international transit, import, local transportation, local procurement, storage capacity, pharmacy management and waste management which may lead to quality MISP service disruption
  • COs should consider hiring local medical logistics experts, where needed, to support the COs ability to overcome logistics bottlenecks posed by COVID-19 
  • UNFPA COs/Partners should work through existing coordination structures to advocate to government and coordination decision makers for the continued allocation of resources to lifesaving SRH services throughout COVID-19 (Inc. delivery of SRH supplies/PPE, and essential need for pharmacists and logistics staff to continue to move around)
  • UNFPA COs should implement systems for remote supplies management to ensure supplies are reaching health facilities while maintaining quality

 

HO/PSB Support Underway

  • PSB and HO are co-organizing a webinar on PPE and COVID-19 on Wednesday April 8th
  • HO has developed a 2-page guidance on dignity kits and COVID-19 (attached)
  • PSB and HO are working to solve international freight bottlenecks in close coordination with Logistics Cluster partners and WFP.
  • UNFPA is working to organizing a webinar on remote supplies management for COs who will have limited access to health facilities and partners throughout the COVID-19 response (more information in the coming days) - UNFPA is willing to organize other webinars at CO request, please submit any needs to Regional Humanitarian Coordinators  
  • UNFPA is working with logistics and supply chain private partners to establish a ‘help-desk’ function for COs who are trying to manage increased challenges with the supply chain due to COVID-19 (more information in the coming days) 
  • HO is reaching out to COs to provide targeted support in specific technical areas. If your CO has specific supply issues they would like the support from HO please reach out to the Regional Humanitarian Coordinator in your region. 

 

Another communication will be coming in the next few days focused on the revision of the UNFPA Global Appeal for COVID-19 with further information on costing the supply related interventions and other activities.