What is better for ambulance - UAZ or Porter?

Замир Осоров
On the way of improving the system of
emergency medical care of Kyrgyz Republic

("Achyk Soz" newspaper, 21 March)

For several weeks, the question of the delivery of ambulances bought to a German grant has been discussed on local media and Kyrgyz parliament.   It is said that the technology is already stolen, that it is unsuitable for working with patients, that they are very expensive and so on.
I tried to figure out what is really going on.
As it turned out, all purchased cars - 7 Hyundai Porters, 2 Toyota HiLux and 6 Toyot Hyas are in the garage of the Ministry of Health and we bring their pictures here. No one has given them away or sold them.
Second, the machines are the most modern, beautiful and functional. Some newspapers and even deputies wrote and said that it would be better to buy UAZ (that is, an old Soviet ambulance) that Porter can only carry livestock. This is all - a complete lie. You can compare Porter and UAZ themselves, which stand side by side (on Fig. 3), they can not even be compared, neither in terms of capabilities, nor in comfort for doctors and patients. Porters are several times better than UAZs.
Why does the Ministry of Health do not accept them and do not let them to work? We visited the garage, as when there was a German delegation with representatives of the Ministry of Health and the supplier company, to learn everything from the first mouth.

The grant for the purchase of modern ambulances

Acquisition of medical equipment and ambulances was planned within the framework of the project "Creation of a National Electronic Medicine System", financed by the German Development Bank KfW.
After updating and specifying the list of necessary equipment, tender documents were prepared for the purchase of 7 ambulances (including medical equipment (lot 3) and 8 specialized ambulances (including medical equipment). The documents were approved by KfW Bank
The location of the procedures and evaluation of bids was identified by Germany, the city of Bad, Homburg, where the headquarters of the international consultant of the project, EPOS company is located. All expenses for the relocation and stay of the tender commission in Germany were carried out from the grant, without raising funds from the state budget of the KR, for which the consent of KfW was obtained.
The opening of proposals was held on September 26, 2016. There were 8 offers in total. The winner was the Dutch company Dutch Health BV, the total amount of the contract was almost 1.2 million euros.
According to the contract, the delivery and commissioning of the machines must be completed by July 22, 2017. The contracts provide for penalties for delay.
In addition, given the complexity of the equipment, the Ministry of Health decided to conduct an inspection of ambulances at the refitting plant before shipment for transport to Kyrgyzstan. KfW approved this step, providing for two people to finance the trip from the project consultant (EPOS company).

Contract delay for the 2 reasons

But on May 2, 2016, the Ministry of Health of the Kyrgyz Republic received a letter from the DutchHealth company that only a part of the cars will be delivered to the contractual date (June 30, 2017) by lot 7, and the rest, due to their structural difficulties in re-equipment, will not be delivered. Another reason for the delay in the manufacture of ambulance vehicles was the month of Ramadan, during which, allegedly, labor productivity in the UAE is reduced to 50%.

And a month later, on June 7, 2017, DutchHealth BV sends another letter to the Ministry of Health, which says that the equipment will not be on any lot within the terms stipulated in the contracts. DutchHealth BV, at the request of the Consultant, in a letter dated July 31, 2016, asserts that the machines will be ready for pre-shipment inspection only by September 4, 2017.
This verification was carried out in the UAE, at a refurbishment plant from 4 to 9 September, which identified defects, and the Supplier undertook to eliminate them before shipment.
As a result, the machines were shipped only 20 days after the completion of the inspection (September 29) and arrived at the customs station of the KR in lots - from November 8 to 27. The procedure for customs clearance was completed on December 12, 2017.
In the Ministry of Health of the Kyrgyz Republic, a commission was established to accept cars, which, when inspecting cars, revealed a number of discrepancies between the technical parameters of the delivered vehicles and the contractual ones. Among them there are small shortcomings that can be fixed easily and quickly, and there are serious deviations that will require time, strength and professional approach:
The main thing is the Toyota Hiase salon (lot 7) - cars destined for Bishkek and Osh are made with defects: the cabin height was lower than the one specified in the contract by 25 cm, as a result it will be inconvenient for doctors to work in a semi-bent position. Furniture in the cabin is installed so that the approach to the patient is limited, and this, too, must be changed. Also there were no fog lights, instead of two seats on the side of the stretcher for the medical staff and accompanying there was only one bench with a drawer under the seat. Also there was no part of the consumables, as in Lot 3. The wall mount for the defibrillator is available, but it is not mounted in the interior of the machine, because it does not fit in the height, the ceiling of the cabin is covered with a material that can not be installed in the SMP machine, since it absorbs moisture and do not allow the disinfection of the cabin and this should also be changed
The second problem is that the medical compartment of Hyundai Porters (lot 3) is 80 cm longer than it is written in the contract. The Ministry of Health had a question – How could be affect the car movability such deviation of the length of the cabin?
Also there were no additional stop lamps, external lighting above the doors of the medical salon, some consumables (oxygen masks, test strips for measuring blood sugar, portable blood sugar measuring device.
For Toyota Hilux (lot 7) there is no additional stop lamp, fog lamp, other seats in the cabin, stationary oxygen supply system, and, as in the first two cases, there is no part of consumables and medical equipment. In addition, some cars have mechanical body damage (scratches, dents) that are not properly fixed

Eternal question - who is to blame?

As a result, the machines were not received by the Ministry of Health of the Kyrgyz Republic. If it got them, then all these problems from the shoulder of the supplier's company passed to the Ministry's shoulders.
It should be noted that the ministry's experts compiled official inspection protocols, which were sent to the company with a proposal to give an answer when and how these shortcomings will be rectified. About the beginning of all these problems with the execution of contracts, the Ministry of Health of the KR informed KfW Bank about the letters dated August 9, 2017 and December 15, 2017.
On February 15, 2018 a letter was received from the supplier (DutchHealth) in response to requests from the Ministry of Health of the Kyrgyz Republic that they sincerely regret the situation and are ready to fix everything, asks only to give it at this time, offering additional discounts of 8 percent to the cost contract for delay.
On March 7, 2018, a letter was received from an international consultant (EPOS) about the invitation of independent international experts to determine the possibility of bringing the technical parameters of the delivered vehicles to the technical specifications stipulated in the concluded contracts.
According to Vladimir Titov, the director of the consulting company "Avanko Consulting", all of the above indicates that the supplier (DutchHealth BV, the Netherlands) has performed an unconscionable supply contract. We have been working in this market for 20 years, and this is the first case in our practice of such a serious miscalculation, although there are always some minor defects that are being eliminated as the matter progresses. The machines themselves are very good, but some deviations from the contract figures, such as a decrease in the cabin height by 25 centimeters, make it impossible or very difficult to service the patient in the cabin of the car. The doctor should work in a half-bent state. Therefore, the ministry is striving for the exact fulfillment of contractual obligations.
The envisaged penalties can not yet be applied, as the delivery is not completed and the sanctions continue to accumulate. Penalties will be withheld from the next payment.
On the part of the Ministry of Health of the Kyrgyz Republic, all necessary measures have been taken, the Supplier and the Donor (German bank KfW) have been notified. The Ministry of Health took all steps to solve this problem. At present, after the decision of international experts, it is expected that the discrepancies and inconsistencies of the received machines will be eliminated. The German side offered to specialists -  to find out, can all the problems be rectified in Bishkek or need transport these technics abroad? To this end, this week will arrived international experts who will be able to answer this question. And then try to fix all these defects as soon as possible.
And the company - the supplier will be punished - both with fines, and with additional discounts. The Ministry of Health will continue to think whether it is possible to work with such a company, and what measures need to be taken to prevent this from happening again, it may be necessary to increase fines, carry out inspections at the stages of preparing supplies, etc.