should be a temporary strategy until public financial management systems have been sufficiently strengthened.

_Making prices transparent to reduce procurement fraud_ By regularly monitoring prices of common goods and holding purchasing managers accountable if prices substantially differ from those of other hospitals or benchmark prices, procurement fraud can be discouraged. When the government of Argentina introduced monitoring of prices hospitals paid for medical supplies there was wide dispersion in prices. For goods on the monitored price list, prices fell by an average of 12 percent over the first few months of the program. But benefits were not sustained as hospital managers realized that the program was based purely on moral suasion with no tangible sanctions, and subsequently, they reverted to their previous practices (Savedoff 2008; Schargrodsky, Mera, and Weinschelbaum 2001). In Colombia price variations of medical supplies were statistically significant across purchases of public hospitals, particularly where hospitals ignored the price lists negotiated and endorsed by a local NGO under contract to the government and estimates indicated that 11 percent of costs could have been saved if accepted public tendering rules had been followed (Giedion, Morales, and Acosta 2001).

_Using e-procurement to improve efficiency and discourage corruption_ Electronic government procurement (e-GP) can increase transparency and accountability in health procurement thereby improving resource management and reducing opportunities for fraud, ultimately, leading to lower prices. One example of e- GP in health procurement is Chile, which created an electronic bidding system to oversee pharmaceutical procurement and used the internet for information dissemination at all stages of the procurement process. The system helped reduce collusion by ensuring a competitive bidding process, which reduced the incentives for corruption, and by making drug prices transparent to all bidders and purchasers resulting in cost savings (Cohen and Montoya 2001). In addition, through ChileCompra Express all public hospitals have access to a range of services from private providers, which can be chosen according to price or distance and has helped improve supply and hospital management (GOC 2007). In Brazil the federal health ministry has an online price database (Banco de Pecos em Saude) that records recent prices paid to suppliers for many medical inputs, and a complementary online bidding system (Pregao Eletronico) that permits e-bidding on public contracts, which together make transactions transparent and avoids possible charges of irregularity in purchasing of health inputs La Forgia and Couttolenc 2009).

_Autonomy and organization of central medical stores and drug revolving funds_ The level of autonomy and organization of Central Medical Stores (CMS) and Drug Revolving Funds (DFR) affects the ability to provide a rapid, responsive drug supply to local health facilities. Under the Partnership for Transforming Health Systems (PATHS) six Nigerian states undertook reform of CMS and DRFs combined with measures to strengthen capacity and internal financial management and control systems. The organizational reform also strengthened accountability through stronger community oversight of the CMS and DRFs with community representatives on the Health Facility 26