Six Years, Three Tenders, Shifting Rules: Who Benefits From Bangladesh’s Dialysis Machine Purchase?

Approved in 2020 to expand care for kidney patients, Bangladesh’s plan to buy 1,030 dialysis machines remains incomplete after nearly six years and three tenders. Important conditions have changed with each round, and those changes now face a pointed question: are they driven by what patients need, or by an effort to favour a particular company?

One project, three sets of conditions

The experience demanded of suppliers offers a clear example. The first tender set the bar at Tk 70 crore. The second lowered it to Tk 1.5 crore. The third has lifted it to Tk 160 crore, and also asks for experience in supplying and installing at least 1,030 machines.

The machine specifications have moved too. The latest tender reduces the monitor from 15 inches to 10 inches while raising the estimated price per machine from Tk 21 lakh to Tk 25 lakh, which amounts to paying more for equipment with comparatively fewer features. Why a project that once sought modern machines with 15-inch monitors dropped to 10 inches, and why the experience requirement has swung so sharply, are questions that now demand answers.

What it could mean for patients

People concerned with the process allege that modern double-pump, dual-chamber technology has given way to a request for comparatively older single-pump, single-chamber machines. Experts say machine capability is extremely important when treating ICU patients, the critically ill and those with complex conditions.

A bill that may outlast the purchase

There are concerns, too, about what happens after the machines are bought. Dependence on specific types of disinfectant and other supplies could push up the government’s long-term spending. And if the choice of alternative suppliers for dialysers and related accessories narrows, the country may end up relying on one company.

An assurance under test

According to the project director, specifications will be changed if necessary after a technical committee review, and efforts will be made to ensure all local and foreign companies have a chance to compete. That assurance is now being tested. If an open and competitive tender is the goal, there should be no objection to explaining the unusual conditions publicly.

The ministry’s role is also in question. How much oversight is the top level of the health ministry exercising over repeated specification changes in such a large purchase? No evidence has come to light that the health minister is directly involved. Even so, does the minister know how, and on whose recommendation, the technical conditions are being altered? If a company has been favoured, the public has a right to know whose influence was at work.

What the government must clarify

Before the 1,030 machines are bought, the government needs to take a clear position on at least five questions:

• What technical reasoning lies behind reducing the monitor from 15 inches to 10 inches?
• Why is the estimated price going up when features are going down?
• On what basis was the experience requirement set at Tk 160 crore?
• Will the country become dependent on a particular company’s dialysers or chemicals?
• Above all, were the tender conditions changed to give a particular company an advantage?

This is more than a routine government purchase. It involves the lives of thousands of kidney patients, public money and treatment costs for many years ahead. If it opens the door to business interests, patients and the state will bear the cost. Technical transparency must therefore go hand in hand with accountability at the ministry level, and the question of who gains from this spending of public money must be answered before the purchase is made.