Tender Disputes Stall Dialysis Machine Procurement at Public Hospitals, Disrupting Patient Care

The government has taken an initiative to purchase 1,030 dialysis machines to expand services for kidney patients at public hospitals across the country. However, complications remain even after three rounds of tendering. Eligibility requirements have changed with each tender, and the size of the machines’ monitors has also been revised.

In the latest tender, bidders have been required to demonstrate experience in executing projects worth Tk 160 crore and installing at least 1,000 dialysis machines. Related persons say these conditions have restricted competition. There are also concerns that requirements concerning dialysers, the specialised filters used to clean blood during dialysis, could increase government expenditure in the future.

Meanwhile, delays in the tender process are holding back the implementation of the kidney dialysis service expansion project, directly affecting patients. As services remain concentrated in the capital, many patients from district areas have to travel long distances for treatment. For those whose lives depend on regular dialysis, every delay adds to their medical and transportation burdens.

According to sources concerned, the government initially planned to purchase 472 haemodialysis machines as part of a programme to expand services at 22 medical college hospitals and district-level general hospitals. The first tender was scheduled to be submitted and opened on October 17, 2024. It was cancelled without any specific reason after the fall of the Awami League government. The first tender required bidders to have experience in executing government or private projects worth Tk 70 crore.

When the tender was invited again, the required project experience was reduced from Tk 70 crore to Tk 1.5 crore. The dialysis machines were also required to have 15-inch monitors. However, the second tender was cancelled for reasons that remain unclear.

The requirements were changed again in the latest tender. This time, bidders must demonstrate experience in projects worth Tk 160 crore, along with experience in supplying and installing at least 1,000 dialysis machines. Meanwhile, the required monitor size has been reduced from 15 inches to 10 inches. The deadline for submitting bids is November 30.

The reasons behind such major changes in eligibility requirements for the same project remain unclear. The authorities also need to explain why the first two tenders were cancelled and what technical assessments were conducted before setting the latest conditions. Without reviewing the tender documents, evaluation reports and cancellation decisions, it is not possible to determine whether the changes were intended to favour any particular company.

Those familiar with the process claim that it would be difficult for a Bangladeshi company to meet the latest requirements. They believe a company associated with a Japanese manufacturer through a joint partnership may be in a favourable position. There are also concerns that purchasing machines from that company could increase future government expenditure because of a requirement to use its own dialysers.

A dialyser is an essential component of haemodialysis. If the use of compatible alternatives is restricted, the government could face difficulties in changing suppliers, encouraging price competition and controlling procurement costs over the long term. Experts therefore believe that the government must consider not only the purchase price of the machines but also the lifetime costs of dialysers, filters, tubing and other essential supplies. The technical specifications must also be examined to determine whether alternative consumables can be used.

An official of the Directorate General of Health Services (DGHS), speaking on condition of anonymity, said Germany’s B. Braun manufactures high-quality dialysis machines, but its monitors are 15 inches in size. The official added that distributors were concerned that supplying the machines at the price sought by the government would not generate sufficient profit.

The official also said the company attempting to participate in the tender as a local distributor might face limitations in supplying the necessary accessories and consumables, even if it could provide the machines. Meanwhile, sources said another German company, Fresenius, was interested in participating directly in the tender. However, complications reportedly arose because its local distributor demanded a six per cent commission. Questions have also been raised about whether the local distributor has the capacity to participate in the tender independently.

Those concerned said suppliers had shown considerable interest because the project was being tendered through international competitive bidding (ICB). They claimed that in local tenders, suppliers could face costs of up to 35 per cent when value-added tax, duties, advance income tax and other taxes were included. By contrast, they said these costs were around three per cent under international tenders.

According to the Kidney Awareness Monitoring and Prevention Society (KAMPS), around 38 million people in Bangladesh suffer from some form of kidney disease. Approximately 40,000 patients become dependent on dialysis every year. However, reliable national data on the number of patients whose kidneys have completely failed remain limited. Doctors are concerned that dialysis services remain inadequate compared with the needs of patients.

In February 2020, the Executive Committee of the National Economic Council (ECNEC) approved a project titled “Establishment of 50-Bed Kidney Dialysis Centres at Medical College Hospitals and 10-Bed Centres at District General Hospitals”.

The original plan was to establish 50-bed dialysis centres at 22 medical college hospitals and 10-bed centres at 44 district general hospitals between January 2020 and December 2022. However, the work was not completed within the scheduled period, and the project deadline has been extended several times.

On April 7, the health minister told Parliament that infrastructure development, medical equipment supply and procurement activities were underway at 15 medical college hospitals and 44 district general hospitals under the project. He expressed hope that the project would be completed by December 2027.

Meanwhile, the Sandor-operated dialysis centre in Dhaka is currently unable to accommodate new patients, according to people familiar with its operations. The centre can provide dialysis to 236 patients a day by operating around the clock in four shifts. Under its agreement, the centre was supposed to provide 19,000 subsidised dialysis sessions annually until 2027. However, it conducted 42,000 sessions last year.

Dr KUAM Shamsun Nahar, a consultant at Sandor Dialysis System, said, “During the Covid period, we even conducted 96,000 sessions in a year. Under the agreement, we are supposed to provide 19,000 dialysis sessions annually until 2027. But for humanitarian reasons, we provided 42,000 sessions last year as well. However, it is not possible to accommodate new patients.”

She said new patients might be accommodated if the government expanded the service after the agreement expired. Dr Rashed Anwar, director of the National Institute of Kidney Diseases and Urology, said around 400 dialysis beds were currently operational across the country.

“Dialysis alone cannot provide a comprehensive solution to kidney disease. Greater emphasis must be placed on prevention. When an earning member of a family develops kidney disease, the entire family faces financial and social hardship,” he said.

Kidney specialists estimate that only 12 to 16 per cent of patients receive dialysis through the public healthcare system. Dialysis keeps many kidney patients alive, but repeated tender cancellations and years of delays in expanding services have raised questions about the effectiveness of public health management.

Before proceeding, the authorities need to establish how many patients will benefit from purchasing the 472 machines, how much each dialysis session will cost the government, and how much will be required for consumables over the long term.

For kidney patients, dialysis is not a luxury; it is a condition for survival. Transparency, fair competition and cost efficiency are therefore essential to resolving the tender complications. Otherwise, project deadlines will continue to be extended and plans to expand services will remain on paper, while thousands of patients suffer without access to the treatment they need.

Repeated attempts were made to contact Professor Dr A N M Ehsanul Karim, project director at the Directorate General of Family Planning, by mobile phone, but he did not answer the calls. Health Minister Sardar Md Sakhawat Hossain, however, told Inqilab that the dialysis machines were being procured in accordance with the Public Procurement Rules (PPR).

“The dialysis machines are being purchased in compliance with the Public Procurement Rules (PPR). They will be awarded to those who meet the specified conditions. There is no scope to go beyond the rules,” he said.
The minister said procurement was underway for a total of 1,120 dialysis machines, including 1,030 under the project and another 90 through the Central Medical Stores Depot (CMSD). He added that patients would begin receiving services through these machines within the next two to three months.