Open Contracting for Health (OC4H)


Open Contracting for Health is the flagship project of the Transparency International Health Initiative. The project has been operational in Uganda, Zambia, Kenya, Nepal and South Africa since 2018. Implementation is led by Transparency International chapters with technical support from the Transparency International Health Initiative. The project seeks to improve health outcomes in partner countries and increase public trust in health services by achieving the following outcome and outputs by 2021:

Outcome: Public procurement in national health systems is made more transparent

  • Output 1: National health systems have the skills and resources needed to implement open contracting in public procurement
  • Output 2: Supplier diversity in health sector public procurement is facilitated
  • Output 3: Civil society is sustainably engaged in public procurement processes

The initiative aims to improve transparency and accountability in health systems by promoting the use of open contracting principles and practices in public procurement. To date, this has been done through a mixed methods approach of training, capacity building, social accountability, and data analysis and utility. Activities in each country have been tailored and implemented according to the political context, institutional and policy frameworks, and civic operating space.

TIHI have supported Transparency International (TI) chapters to analyse procurement and health expenditure data, through access to interactive online tools and resources such as the oc-hub. This has been utilised in policy engagement, advocacy, procurement planning, budgeting and monitoring purposes across all implementing countries. Chapters and their networks also have access to tailored, country specific data dashboards and visualisations through the oc-dashboard. The utility of data has helped to develop use cases for different stakeholders, as well as highlight red flags, thus indicating potential corruption in health supply chains.

Under the OC4H project, chapters in Uganda, Zambia, Nepal, Kenya and South Africa have conducted awareness raising sessions with government stakeholders on the benefits of adopting open contraction principles and practices in their health procurement systems. Where relevant, this has been followed by tailored technical assessments and clear recommendations on how to reform current procurement practices which are inefficient or vulnerable to corruption. Over the project duration, strong relationships have been forged with health ministries, procurement oversight agencies and other key government stakeholders. This has led to multiple recommendations pertaining to transparency and accountability being incorporated into formal health procurement processes.

Chapters have provided structured training to procurement officers and health administrators on how to utilise e-procurement systems, as well as supported governments with data analysis to improve future decision making in the health sector. Training and sustained capacity support to government has led to an increased uptake of e-procurement usage by government, thus reducing key procurement corruption risks. Post training surveys have highlighted that TI-led trainings have measurably enhanced the knowledge and awareness of government in areas of procurement transparency and e-procurement.

Training led by TIHI and TI chapters on procurement transparency and common corruption risks has been provided to procurement oversight authorities, procurement curriculum decision makers and university students preparing to move into public procurement roles. This has subsequently led to open contracting being adopted into formal public procurement curriculum training in Zambia.

Small and medium enterprises (SMEs) have been supported by TI chapters to enter the public health contracting market. Stakeholder diversification in the market improves competition and drives down the cost of doing business for government, allowing for greater value for money in purchasing health goods and commodities. Private sector engagement has been done primarily through training and capacity building on bid writing, procurement best practices, anti-corruption awareness and ethical business behaviour. Such initiatives have helped to ensure private sector entities operate with integrity. SMEs are now aware of the available channels to report corruption and can hold government to account where protocol is not followed. Chapters have provided private sector stakeholders with a neutral platform to voice their contracting concerns with government through mediating multi-stakeholder dialogues and supporting SMEs to develop formalised associations to amplify their collective voice. These mechanisms are particularly effective at resolving disputes at district level and have successively led to increased business integrity and greater market engagement and participation by SMEs.

Chapters have supported locally elected community monitors to develop monitoring frameworks and built their capacity to advocate for transparency in the health sector. Monitors are equipped with the necessary skills to participate in regular site visits to ensure clinics, hospitals and maternity shelters are built according to specifications outlined in contracts. Irregularities have been flagged to the relevant local government authorities, which has helped to close the feedback loop and ensure corrupt practices are rooted out. This initiative has helped to fill a gap faced by under-resourced governments, with community monitoring directly contributing to improved building materials being used in the construction of health facilities.

Robust mechanisms to report instances of corruption have been developed through the use of a toll free help line, enabling members of the public to play an active role in holding governments and private entities to account. Where possible, efforts have been made to institutionalise and embed monitoring and accountability processes into government structures to guarantee sustainability past the life of the project.

Further cross-cutting activities undertaken thus far have included the dissemination of key advocacy and policy messaging to civil society organisations and communities through stakeholder engagements, radio shows, social media, webinars and other relevant channels. All TI chapters continue to push for key legislative change and policy reform in the health sector, with the overall goal of improving health outcomes in their respective contexts. Approaches range from providing valuable technical input into draft procurement bills, conducting awareness raising activities with citizens to increase momentum on a particular reform, or targeting decision makers with tailored recommendations.

In addition, chapters and their CSO networks have collaborated with journalists, academics and media agencies to build understanding and awareness of the importance of health sector transparency. Training and capacity building support has been provided by TIHI and project partner Open Contracting Partnership, to equip stakeholders with the necessary tools to conduct investigative journalism using procurement data.