Prior to the onset of the pandemic, the public health service (PHS) played a rather subordinate role in the German health care system, but that suddenly changed when public and political interest skyrocketed. Public attention quickly focused on the challenges confronting the PHS and triggered political measures to strengthen the sector and make it crisis-proof: the “Pact for the PHS”. Now that applications for funding have been submitted, what are the next steps for the health departments, and what are the envisioned designs of the digital public health department?
The Pact for the PHS sets aside a total of four billion euros from the federal and state governments, earmarked primarily for personnel increases and digitalization. The determination of needs based on the maturity model has been completed, and the funding applications for model projects of specific health departments or cooperation ventures along with planned state measures have also been submitted to the agency in charge of the project.
Step 1: Funding decisions
After receipt of the applications from the health departments, the Federal Ministry of Health (BMG) decides whether to approve the funding requests. When making its decisions, the BMG determines what measures can be implemented as coordinated state measures or as interstate “One State for All” (ELFA) measures. The first approvals and funding notices are expected to be sent to the health departments in the middle of September; the actual implementation can begin at that point.
Additional information: public procurement law for the PHS Pact
Funding from the PHS Pact will be awarded in compliance with public procurement law and observing the requirements of national and European public procurement law. The selection of the type of procedure is based on the estimated value of the contract. Any contracts exceeding the EU threshold value (€214,000 net for services and supplies) must be in conformity with the regulations of the Public Procurement Regulation (Vergabeverordnung; VgV) and chapter 4 of the Act Against Restraints of Competition (Gesetz gegen Wettbewerbsbeschränkungen; GWB). If the EU threshold value is not reached, the regulations of the relevant federal states apply (Sub-threshold Public Procurement Regulation, Unterschwellenvergabeordnung; UVgO).
Generally speaking, the VgV prescribes two standardized procedures:
- In the open procedure, bids from an unlimited number of companies, which must provide proof of their suitability to fulfill the contracts, are obtained pursuant to an announcement issued throughout the EU.
- The contracting authority also has the option of the non-open procedure comprising two stages.
- In the first stage, the suitability of the bidders is determined by means of a tender competition.
- In the second stage, suitable bidders are invited to submit a bid.
When the UVgO applies, the public announcement of the tender is the same as for the open procedure and the restricted announcement to submit tenders is the same as the non-open procedure.
Step 2: Tender and award
Many of the measures falling within the scope of the Pact for the PHS involve technically demanding tenders where related specialist expertise is an advantage. This is especially true of the performance specifications of complex tenders. Ideally, the health departments evaluate the extent to which there is a need for consultation in the preparation and operational conduct of the procedures as well as the follow-up work and evaluation of the incoming bids.
A sensible step for the awarding of contracts under the Pact for the PHS is the request for performance specifications from the bidders. This measure ensures that the contracted vendors have the necessary competencies for successful implementation of the digital solutions in the health department and are able to fulfill expectations during project implementation. The coordination of various project participants and the compilation of specific requirements in performance specifications require a high expenditure of time that often exceeds the personnel and technical knowledge of the contracting offices of the health departments.
The focus of our consulting firm’s Health division is on the content-related implementation of digitalization measures. Before the announcements to tender bids are issued, however, the recommendation is to seek legal counsel for the avoidance of procedural errors and the resulting clawbacks.
When the engagement of third parties is advantageous — an example
The funding guidelines prioritize open source licenses to ensure efficient subsequent use. In addition, the adaptation of interfaces and further development costs as part of the performance specifications are also decisive. One advantage of third parties is their ability to process and respond to specific bidder inquiries during the procedure. Lawmakers have required the contracting authority to make “essential decisions” itself and prohibited the delegation of these decisions to third parties. In other words, external third parties serve merely as “decision-making support”.
Step 3: Evaluation procedure during the project work
Once the contracts have been awarded, the project work itself can begin. At this time, the appointment of a digitalization manager or project manager is a reasonable measure that provides operational support for the entire model project and regular monitoring of target achievement, reducing the risks of possible clawbacks.
The BMG’s funding announcement stipulates that the achievement of targets for the entire project must be tracked on the basis of the increase in the maturity model. Project management should constantly monitor all subprojects and, on the basis of its observations, report the project progress to the agency in charge of the project. This verification requirement specifies that both a self-assessment by the maturity model and a status report must be submitted annually to the agency in charge of the project. Other milestone reports must also be submitted. In general, it is the responsibility of the health departments to collect all relevant documentation on the projects to secure local reviews by the agency in charge of the project.
Since many health departments do not have at their disposal the human resources required to manage such an extensive project, external service providers with experience in project management and public funding can be engaged to take charge of the pertinent tasks.
Detailed planning and preparation of the measures defined in the funding application should be carried out. Professional support can ensure the improvement in quality, the cost efficiency of envisioned projects, and lightening of the burdens otherwise placed on the personnel in the health departments while also contributing to fast success in the digitalization process.