Opening Remarks at the OECS Pharmaceutical Procurement Service Staff Consultation Fortieth Anniversary

Forty years - and what we do with them

Before anything else, be clear about what we are marking this morning. Forty years.

Not forty years of a project - forty years of an institution, operating continuously through hurricanes and volcanic crises, the collapse of the banana trade, a global pandemic, and financial shocks that have swallowed better-resourced bodies than this one. Institutions in this region do not usually reach forty. Let me pay tribute to the person – more than anyone else – responsible for birthing and growing this institution and who after his retirement travelled internationally replicating this model – Mr. Francis Burnett. The man who gave birth to it.

We are good at starting things; we are not always good at sustaining them. Mr. B, you have sustained this one, and there are people in this room who have given it the better part of a working life.

Understand also what kind of achievement it is. This region is more often the importer of other people’s models than the author of its own. In pooled procurement we are the author. We began in 1986; the Strategic Fund at PAHO came thirteen years after us. When small states elsewhere go looking for proof that pooling can actually be done, and sustained, by countries of our size, they find it - and it carries our name.

A fortieth anniversary can be observed in one of two ways. One is a valediction: we applaud what was done, we photograph ourselves applauding, and we quietly signal that the great work lies behind us. That is a retirement dressed as a celebration, and I have no interest in participating in it.

The other way is to treat forty years as an inheritance to be audited: what did these four decades teach us – what worked well? What did not work out as we hoped? and what does that knowledge now oblige us to build? That is the anniversary I would like us to hold. Not applause but critical reflection and instruction for the very different future that is upon us.

And I want it held that way for a hard-headed reason, not a sentimental one. We are already deep into the most uncertain period this region has faced since independence - in our financing, in our trade, in our climate, in the geopolitics that now governs who gets supplied and who waits. Forty years of practice in getting scarce goods into small islands at a fair price is not simply a memory to be honoured. It is a capability we are going to need more than ever, and the only serious way to honour it is to sharpen it.

What the forty years proved

In 1986 this service began with a grant of three million United States dollars and an assumption written on paper: that in five years the thing might pay for itself. It paid for itself in four!

Consider what that means. Anguilla by itself cannot make a pharmaceutical house in Denmark pick up the telephone. Montserrat by itself cannot set terms with a supplier in Mumbai. But nine of us in a single line - one order, one specification, one payment channel - that is a market. That is a customer. Today: eleven hundred and eighty products, thirty million dollars a year, five hundred and twenty purchase orders.

But the figure that is even more significant is smaller, and more eloquent. A vial of human insulin. Four dollars and fifty cents US Dollars. In 2017. Again in 2019. Again in 2021. Three tender cycles - six years - while insulin prices elsewhere in this hemisphere did what they did to patients with no such mechanism standing behind them. US Four dollars and fifty cents held.

Somewhere in Dennery, or Sandy Ground, or Hillsborough, there is a woman who does not know one of your names and will never read a workplan, whose insulin was on the shelf and within her reach because of work done in your building. That is the legacy. It is not a slogan. It is arithmetic that became mercy.

And the surcharge has travelled in one direction for forty years: downward. Fifteen per cent at the outset. Thirteen in 2005. Eleven. Nine in 2016 with seven in our sights. Show me another regional institution that has spent four decades charging its members less.

So let no one confuse the difficulties I am about to name with a verdict on pooled procurement itself. The model is not on trial. The model is proven. You proved it.

Plain talk about what went wrong

Now the harder part of the inheritance.

In 2020 we folded General Procurement into this service and called the result the Pooled Procurement Service. Six years on, I can repeat to you what the forensic review said and what most of you told Mr. B in that review: it did not work. It placed two dissimilar disciplines under a single head, when no head can honestly hold both. And it guaranteed that whichever portfolio held that head’s attention, the other waited.

And it took a toll on the people inside it. The review records that plainly, in your own words, and you know it better than any review can. Many of you have carried heavy portfolios through several years of uncertainty that was not of your making. I will not dress that up, and I will not dwell on it either - except to say that ending it is my responsibility and not yours. This happened on my watch and under my authority, and I have no interest in the kind of leadership that turns up only for the ribbon cutting. The diagnosis now exists, in writing and unvarnished, and we must act on it rather than simply file it.

The distinction that matters most

But here is what I most want you to carry out of this room. Please don’t conclude the wrong lesson from the last six years is – don’t conclude that pooling of procurement has failed and so let’s retreat. The right lesson is narrower, and far more useful.

What failed was not pooling. What failed was a merger. They are not the same act.

Pooling aggregates the demand of nine countries, so that small buyers acquire the standing of a large one. That is what this service has done for forty years, and it works. The merger did something else: it aggregated administration across two functions inside one building. It pooled an organogram, a payroll and a floor plan - it did not pool a market. One of those acts creates power in a market; the other creates a longer reporting line.

So disaggregation is not a retreat from pooling. It removes something that was never pooling - so that the real instrument can be strengthened, given a head with the expertise the work demands, and placed in a manner that streamlines processes, creates efficiencies, while drawing on the right expertise to deliver with least bureaucracy. Access to medicine is not a procurement convenience. It is a human right, and it should sit where the region can see that we treat it as one.

Five lessons the forty years are trying to teach us

If this anniversary is to be instruction rather than applause, let us name what it instructs. There are five lessons that we have earned and learnt, some of them expensively. And these lessons point the way and should provide the specification for everything we build next.

First: pool the transaction, not the sovereignty.

This mechanism never asked a member state to surrender anything except the disadvantage of being small. Countries kept their budgets, their ministries, their clinical judgement; what they gave up was the futility of negotiating alone. And governance stayed with the principals - a Policy Board of Health Ministers, a Tenders Committee, a Technical Advisory Committee. That is why it survived forty years while other regional initiatives, built as technical units with no political owner, quietly died.

Second: an instrument must carry its own weight.

We were seeded by donor money and free of it within four years. Reflect on that this morning, because the agency whose three million US dollars started us no longer exists in the form that created us. The patron is gone; the instrument it seeded still runs, still buys, still pays its own staff. Self-financing by design rather than by aspiration buys you the right to outlive your funders - and in an era when concessional finance is closing to us, that is the entry requirement for anything new we attempt. And it is also a lesson that we must now apply to every structure that we build in these times.

Third: depth before breadth. Expansion is earned by proof, not by ambition.

For three decades this service did one thing and did it excellently. The difficulties began with the proposed expansion - when the portfolio ran ahead of the capacity - dental, dialysis, orthopaedics, equipment servicing, private clients, assistive devices, countries beyond the OECS: a committee for dental supplies, a cost for each, while the core strained. The evidence sits in the laboratory line: we told the market to expect eight hundred and seventy-seven thousand dollars of business and delivered one hundred and fifty. Ambition is not the sin; sequencing is.

Fourth: competence at the helm is not a matter of preference.

These are specialised trades. When the head of a supply chain function lacks the discipline itself, the organisation pays for the gap somewhere - in our case, twenty thousand dollars for external training a competent head would have delivered in-house, and far more than that in confidence forgone. Each of these functions will now be led by someone who has actually done the work.

Fifth: a pooled instrument is a covenant, not merely a contract.

This is the lesson we have learned least well, and it follows us through any organogram we care to draw. Our contracts say sixty days; our average was one hundred and eight. Every late payment becomes a late shipment, and every late shipment an empty shelf in somebody’s pharmacy. If we forecast badly, our suppliers price our uncertainty back to us. Members buy outside the mechanism, then wonder why prices get erratic. Pooling returns only what its members put in: the discipline of the participants to play their part is not a detail of the design - it is the design.

Why the lessons matter now

This is what building on a legacy looks like, as distinct from applauding one. We take what forty years taught us, and we put it to work on the conditions in front of us.

When Beryl came through the Grenadines, what our people needed within days was not a policy paper. It was tarpaulin, lumber, cement, roofing, generators, water - at a fair price, at speed, at scale. In the pandemic we learned the same lesson in a harsher classroom: when the world is short, small states are served last, and those served first arrive as one large order rather than nine small ones. Tariffs and geopolitical alignment have since turned supply chains from a question of logistics into a question of statecraft.

We control none of that. We control only whether we meet it as nine small buyers or as one. And we are not starting from theory or from somebody else’s manual. We start from forty years of proven practice, and from five hard-won lessons about how such an instrument is built and how it fails. Very few institutions anywhere in this hemisphere are that well equipped for what is coming. This one is.

The question we must actually answer

Let me put the essence of it as plainly as I can. The challenge is not whether to pool. It is how to structure procurement so that it answers the vital needs of Member States while meeting and maintaining the highest professional standards of every sector we serve.

Those are two obligations, not one, and a design that satisfies only the first will fail. The second demands something different in each sector.

Health. We have proved it for medicines. The frontier is equipment, supplies and diagnostics - and equipment is not a purchase, it is a lifecycle: specification, installation, calibration, spares, servicing, disposal. A pooled contract that delivers a machine and no maintenance regime has not served the sector; it has burdened it.

Education. Devices, textbooks, school furniture, laboratory and workshop equipment. Here the standard is set by curriculum and pedagogy before it is set by price - devices matched to what we are actually teaching, texts aligned to our own syllabuses rather than somebody else’s, furniture built for the body of a growing child and for our humidity. A desk bought cheaply that fails in three years is not a saving. It is a deferred cost with a child sitting in the middle of it.

Disaster recovery. Here the professional standard is time. You cannot tender after a hurricane, so the work must be done before one: pre-qualified suppliers, pre-negotiated framework contracts and standing offers that a declaration of emergency simply activates. The procurement must already exist on the morning the roof comes off.

Sport. Small enough to dismiss, and instructive for that reason. Equipment carries federation specification and safety certification; gear that does not meet it cannot be used in sanctioned competition. Our young athletes should not be training on equipment that disqualifies them.

The common thread is the whole lesson of these forty years. What made pharmaceutical procurement work was never that we were good at buying. It was that the professional standard of the sector lived inside the mechanism - a formulary, quantification discipline, cold chain, pharmacovigilance, and a Technical Advisory Committee of the region’s own chief pharmacists above it. Extend the model without extending that, and we will simply be buying cheaply and badly in four sectors instead of one. So, each sector we take on must bring its own professionals into the governance of the instrument, on the pharmaceutical pattern - and one at a time, in the order the third lesson requires.

I do not bring you those answers this morning. But I know where the practical knowledge to build them resides. It resides in this room - forty years of it, and it is the most valuable asset the Commission holds in this field.

What I ask of you today

Three things, and then I will sit down.

Candour. When Francis takes you through the workplans, do not perform agreement. If something in that plan will not work, say so today, while it can be fixed - rather than in a corridor in November, when it cannot. I would rather have a difficult morning here than a wasted year afterwards.

Ownership. Nadine has titled her session “Lead where you are: small decisions, big impact.” More bluntly: the difference between a purchase order that moves and one that sits is almost never a Commission-level policy. It is an officer who decides not to let it sit. And do not mistake Vernil’s session on artificial intelligence, or Simonia’s on integrated laboratory services, for items filling a programme. They are the beginnings of the answer I have just told you I do not yet have.

And care for one another. I can restructure a division; I cannot legislate team spirit. The reality in this Commission that I have experienced with some bitterness is that there can be too many clashing egos, too much unprofessional disagreement and ​ too many lost opportunities for teamwork to make the dream work. You can decide, today, in this place, how you intend to treat each other from here forward. No one else can decide that on your behalf.

Closing

Your theme opens with a verb of obligation, not of nostalgia. To honour a legacy is not to stand bes ​ ide it in a photograph. It is to take what it taught and put it to work on the years ahead - which will be harder to navigate than the ones behind us, and which we will navigate with what these forty years have made us.

Forty years built something that works; the only fitting way to mark it is to make it bigger than we found it.

That is the work in front of us.

And the other one, which I use often enough that some of you may be tired of hearing it: one hand can’t clap. Nothing this service achieved in forty years was achieved by one hand - not one country, not one unit, not one officer, not one Director General. It was achieved koudmen: the way it was built, and the only way it will be rebuilt.

Enjoy the day. Argue well. Rest a little. And thank you for continuing the effort of forty years - sincerely, on behalf of our participating member states and the people in them who will never know your names but have received the benefit of your work.