Procurement is defined as a process to purchase goods and services (e.g. medicines) that involves many steps and many stakeholders based on national, or supranational, regulation, policies, structures and procedures. Procurement procedures depend on the product; they comprise two-stage framework agreements, open procedures including tendering, restricted procedures such as competitive dialogue or competitive procedure with dialogue). Public procurement refers to the process by which the public sector (e.g. federal or regional governments, public hospitals) purchase work, goods or services from companies, as this is frequently the case for health technologies, including medicines. Pooled (or joined) procurement is the result of the collaboration of different (individual) procurers, either within a country (e.g. group procurement of hospital, regional procurement and centralised procurement at national level) or across countries. The latter may be managed by a supranational institution such as the European Commission (e.g. Joint Procurement Agreement to procure medical countermeasures or the Pan American Health Organization (e.g. PAHO Revolving Fund, PAHO Strategic Fund) or without involvement of an international organisation (e.g. the Joint Nordic Tenders of the Nordic Pharmaceutical Forum, joint vaccines procurement of the Baltic Procurement Initiative). Public procurement activities may be supplemented by other relevant policies, e.g. pricing, reimbursement or HTA.
Public procurement has gained attention recently (e.g. in the “Pharmaceutical Strategy for Europe”, Opinion on public procurement in healthcare system), with regard to pooling of volumes and in terms of award criteria. First, joining forces has been considered as an approach to gain faster, affordable and more equitable access to medicines and vaccines, e.g. high-priced medicines or medicines with low prices for which local markets may not be sufficiently attractive. This has also been the rationale of cross-country and international collaborations. In addition, collaborative action through pooled procurement can be a beneficial approach in emergencies such as a pandemic. Second, there is increasing interest in award criteria. As also confirmed by the 2014 Procurement Directives of the European Commission which introduced the MEAT (Most Economically Advantages Tender) criteria, price should not (always) be the sole criterion. Further quality award criteria may come into play, with regard to the use of the medicines but also social and labour standard and environmental criteria (“green procurement”).