Procurement management of strategic inputs in coping with COVID-19: scoping review protocol

The health crisis triggered by the COVID-19 pandemic has challenged public management in several countries to ensure the timely and efficient procurement of the various health technologies necessary to cope with it, such as medicines, diagnostic tests, personal protective equipment (PPE) and medical materials/equipment, among others. This article introduces a protocol for a scoping review that aims to map and synthesize studies portraying the management capacity related to public procurement of inputs used in coping with the crisis arising from COVID-19. The protocol is intended to document the processes involved in the methodological planning and execution of a scoping review guided by Joanna Briggs Institute guidelines and developed using the 2015 PRISMA-Protocols (PRISMA-P) checklist. The PCC strategy (population, concept and context) systematized the search for studies published in MEDLINE, LILACS, Scopus, Embase, Web of Science and WHO-COVID-19 (Global literature on coronavirus disease), as well as in the gray literature, by September 2021. The selection of articles will be carried out in two steps (titles and abstracts, followed by the assessment of the full text of the articles), by two independent reviewers, with the resolution of disagreements by a third reviewer. The results will be analyzed qualitatively/quantitatively and will be organized by themes. The checklist present in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) will be used to guide the Research, Society and Development, v. 11, n. 3, e3111326233, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i3.26233 2 final review report. The protocol was registered in the Open Science Framework under the number 10.17605/OSF.IO/W6KHY.


Introduction
Due to the spread of the new Coronavirus in several countries, the World Health Organization (WHO) declared a public health emergency of international importance on January 30 th , 2020; and, subsequently, on March 11 th , 2020, declared a pandemic situation in which refers to infection by the etiologic agent SARS-CoV-2 (Alves et al., 2020). In Brazil, the first case of COVID-19 was identified on February 26 th , 2020, in São Paulo and, less than a month after its confirmation, all Brazilian states had already reported cases of the disease, with deaths recorded in eight of them (Silva et al., 2020). Since then, the number of cases in the country has exceeded 21 million, with more than 610,000 deaths (World Health Organization, 2021).
Given the emergency situation resulting from the global crisis, an adverse, uncertain and complex scenario was established that challenged the public management of several countries to ensure the efficient procurement of health technologies during the fight against the pandemic, which involves medicines, diagnostic tests, personal protective equipment (PPE) and medical materials/equipment, among others. Thus, in addition to the various activities in the health area, which include preventive measures, diagnosis and assistance to patients affected by the disease, other actions are imbricated, such as public procurement management and the supply chain of these strategic inputs.
Public procurement is understood as the process by which governments seek to obtain services, materials and equipment necessary for their functioning in compliance with the laws in force, encompassing the provision of public goods and services freely available to the population such as health, safety, education and infrastructure (Schmidt et al., 2011;Thai, 2001). The development of management actions on public procurement is not a trivial task, because it depends on a succession of chained steps, requiring from the buyer a broad view of the health context, in addition to more specific knowledge, linked to the administrative, legal, economic and technical dimensions. Such aspects provide greater agility in the procurement process, the achievement of competitive prices and the guarantee of the quality of the products to be purchased (Osorio-de-Castro et al., 2014).
Public sector procurement is central to adequately responding to crisis situations, such as the new coronavirus pandemic, and requires governments to have the ability to select and assemble the necessary materials at short notice to trigger effective delivery of government services (Atkinson et al., 2020). In this context, the purchase may run into difficulties, in view of the increase in demand, the low availability of raw materials of manufacturing inputs and finished products, besides the increase in prices (Amaya et al., 2021;Gaudette, 2020).
Despite being a strategic aspect for the success of health actions, the theme related to administrative management is little debated in the scientific literature and has often received more attention when there are reports of shortages (Cohen & Rodgers, 2020), corruption (Teremetskyi et al., 2021), etc. In the current context of the health emergency, it is proposed to investigate the key characteristics and challenges imposed on the public procurement management of health technologies as part of the formulation of responses to COVID-19 through a scoping review. This paper represents the scoping review planning protocol to map and synthesize studies published in the scientific and gray literature portraying management capacity related to public procurement of medicines, diagnostic tests, medical materials/equipment and PPE used in coping with the crisis arising from COVID-19.

Study design
The scoping review allows for a broad exploration of the theme under investigation, in this case, the management of strategic supplies procurement in the context of meeting the demands generated by COVID-19. This type of review makes it possible to identify thematic, bibliometric, conceptual and organizational aspects (Arksey et al., 2005a).
Scoping reviews have great utility and are often used to map the existing literature in a particular field in terms of its nature, characteristics, key concepts and volume (Arksey et al., 2005b). They are commonly used for recognition, that is, to clarify the working definitions and conceptual boundaries of a topic or field (Anderson et al., 2008;Ehrich et al., 2002). It is a method that is considered consistent to show the results in an accessible format, through a rigorous and systematic approach.
The choice for this type of review when compared to other possibilities, such as the systematic review, is justified because the research question is comprehensive, with a more exploratory nature, aiming to apprehend a larger contingent of studies related to the theme, added to the expectation of the existence of studies with diverse methodological designs (Morris, MSc et al., 2017). Scoping reviews can be conducted to determine the value of a full systematic review, and also as independent exercises to summarize and disseminate research findings, to identify research gaps and to make recommendations for future research (Nyanchoka et al., 2019). Research, Society andDevelopment, v. 11, n. 3, e3111326233, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i3.26233 4 In this circumstance, themes related to COVID-19, a new disease and, specifically, the management of purchases related to its combat, are still marked by uncertainty and heterogeneity. Therefore, it is a research theme that is still little studied.
In a survey carried out in August 2021 on the Open Science Framework (OSF) platform and on the international PROSPERO database (International Prospective Register of Systematic Reviews), which allow the registration of scoping review protocols, no scoping or systematic review was identified in progress or published related to the proposed theme.
This scoping review will follow the methodology for this type of review proposed by the Joanna Briggs Institute (Aromataris et al., 2020), using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist (PRISMA-ScR) (Tricco et al., 2018). This review protocol was structured based on the 2015 Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist (PRISMA-P) (Shamseer et al., 2015).

Research guiding questions
The scoping review will involve research on public procurement. A few questions structure the conduct of the research as well as the conduct of the analyses on the key concepts and evidence identified in the proposed scoping review: 1. What are the key characteristics involved in the procurement of medicines, diagnostic tests, PPE and medical materials/equipment for coping with COVID-19 present in the scientific and gray literature? 2. What challenges were identified and what strategies were used to deal with the difficulties faced?
The research question or scoping review question guides and directs the development of the specific inclusion criteria.
In addition, its clarity aids in the development of the protocol, facilitates the conduct of the literature search and provides a clear framework for the development of the scoping review (Aromataris et al., 2020).
The mnemonic PCC, Population, Concept and Context is recommended for constructing the scoping review, and should be incorporated into both the title and the structuring of the question (Table 1).

Search for relevant studies
The search strategy to identify published studies addressing health technology procurement in the fight against COVID-19 took place collaboratively and was supported by an experienced librarian from the Oswaldo Cruz Foundation. The search strategy was broad and adapted according to the syntax to be performed in each base, covering the theme by using descriptors in health sciences (DeCS, MeSH or Emtree), when available, and free words in the title, abstract and text of the manuscripts, involving three major cores: (a) procurement management; (b) strategic inputs (medicines, diagnostic tests, personal and collective protection equipment, medical materials and equipment); and (c) COVID-19. The search was restricted to human studies and adapted according to the syntax for each base (Table 2). Table 2: General structure of the terms and search strategy used according to the cores involved in the scoping review.
By means of cross-search in the articles initially selected, additional references will be searched, seeking to identify other potential articles related to the theme and to increase the coverage of the research carried out.
A search for gray literature was also carried out, in research sources defined by convenience. This option is justified by the fact that the theme of COVID-19 is still emerging, involving a set of investigation specificities and recent coping actions, with the participation of several national and international organizations recognized around the world that contributed to the publication of reports and documents that may be related to the theme under examination.
In The gray literature searches were performed separately and manually on each of the websites of the aforementioned organizations. Words (and combinations) of the terms "COVID-19", "novocoronavírus", "compras", "procurement", "purchasing", "supply chain" were used in this step.

Manuscript selection based on inclusion and exclusion criteria
This step will involve the application of inclusion and exclusion criteria, which are based on the specificities of the research question to select the relevant studies (Arksey et al., 2005b).

Inclusion criteria
Different types of works will be accepted, encompassing research articles, opinion articles, essays, reports, discussion papers and review articles published in academic journals, in English, Spanish and Portuguese, as of January 2019. It will include papers on procurement for public purposes or involving health care in the fight against COVID-19 and showing general characteristics, key concepts, organization of purchasing processes, in addition to approaches to problems and strategies related to procurement. Because of the advent of the pandemic, issues related to the supply chain and its management will be added, as these may involve procurement issues.

Exclusion criteria
Researches addressing specific themes that portray clinical studies of treatments, use and diagnosis, production of strategic inputs, management training, as well as treatment and diagnostic protocols, will be excluded.
Publications classified as letters, conference proceedings, book reviews, clinical trials, as well as academic works from doctoral theses and master's dissertations and conference presentations will also be excluded.

Article selection process
The bibliographic references identified through the search strategies will be exported and managed by the Zotero® software, in order to identify and eliminate duplications.
After removing the duplicates, the selection of articles will be carried out in two steps. The first will involve reading and analyzing titles and abstracts in line with the established inclusion criteria. The second step will involve obtaining and assessing the full text with the purpose of selecting only those that fully meet the eligibility criteria, as well as those whose relevance to the research is not clear only by the title/abstract, marked as doubt. Reasons for excluding studies after full text review will be documented.
Two independent reviewers will select the articles, with disagreements resolved by a third reviewer.
A spreadsheet will be structured in the Excel program, exported from the Zotero® software, in order to organize the extraction phase. The study selection process, which will involve the identification, selection and inclusion of articles, will be synthesized through a flow chart using the PRISMA model, which will contain the total of articles retrieved in the search, excluded duplicates, selected articles and, finally, those included in the scoping review.

Data extraction
Similar to the process to be carried out in the selection of articles, two reviewers independently will perform the data extraction of the articles included in this review. Cases of disagreement will be mediated by a third reviewer.
From the library developed in the Zotero® software, a standardized electronic spreadsheet in the Excel® application will be generated for data extraction, to be previously tested by the reviewers in a set of included studies, with a view to determining if the approach and content is consistent with the question and the purpose of the research.
As in the previous steps, data extraction from the selected articles will be conducted independently by two reviewers, with an opinion issued by a third reviewer in case of disagreements.
The data to be extracted to guide the analysis are displayed in Table 4.

Methodological quality assessment
There is considerable debate in the literature about the obligation to include assessment of the methodological quality of studies in scoping reviews, mainly because these aim to provide a broad spectrum of knowledge and types of evidence available on a topic, clarify important concepts and obtain a comprehensive understanding of new concepts (Khalil et al., 2016;Munn et al., 2018). In the current review, considering the scope and object of the intended purpose, no methodological quality assessment tool will be applied.

Analysis and summarization of results
Given the advent of the pandemic, which is still recent, significant heterogeneity among studies is expected, especially in relation to methodologies. In this sense, many papers can be supported by experience reports, opinion articles, essays and descriptive studies on the reflexes and the fight against COVID-19, purchase of medicines, diagnostic tests, personal protective equipment and medical materials/equipment. Data summarization will involve a quantitative component, which synthesizes the frequency using simple percentage and the main characteristics of the studies, and a qualitative component, to outline the underlying concepts/theories and the elements and structures of the conceptual models identified in the search.
Quantitative data will be displayed in the form of charts, tables and graphic elements. The qualitative analysis will be guided by the expositions and key points identified by the authors classified into categories defined from the reading of the articles, and then a narrative synthesis will be produced. In addition, a summary chart of each study will be made available as supplementary material to the scoping review study.
The final review report will follow that recommended in the checklist according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018).

Ethical aspects
This protocol refers to a scoping review, having as sources of information published scientific studies or public documents with unrestricted access, which involve administrative data. Accordingly, prior ethical approval by ethics committees in research involving human subjects will not be necessary. Nevertheless, the authors of this review declare that they have no links with funding institutions that may characterize potential conflicts of interest and its results will be published in open access journals or presented in relevant scientific events.

Final Considerations
The existence of knowledge gaps as a result of the new disease and the need to implement, in a short period of time and with a high degree of uncertainty, intervention actions with levels of evidence of safety and effectiveness that are still uncertain, has demanded from health managers agility in the decision-making process.
Such issues put a strain on governments to provide urgent measures to purchase health technologies that can support health care.
The COVID-19 pandemic has exposed the existing inadequacy of systems and the underlying processes and vulnerabilities in the supply chain of the globally established health care system, and especially in the procurement systems. Elements such as demand and supply stressed the supply systems, which are very dependent on a few countries, which concentrate the production of the health technologies addressed in the scoping review.
The relevance of the pandemic, associated with the importance of procurement management, has still been little addressed in studies, which is why a scoping review is justified. It was necessary to expand the search beyond the procurement issues, introducing elements of the supply chain, since these themes have a direct correlation with the object under study.
Finally, the protocol for carrying out a scoping review aimed to systematize the succession of methodological paths classically established in the pertinent literature. It is expected that one of the findings compiled from this review will support the preparation of notes and guidelines for the field of management according to the Brazilian reality, which has a complex federative system, in addition to its continental dimension.
In addition, future research that seeks to identify issues related to public procurement of health technologies to address the Covid-19 pandemic may provide input on other public management challenges, given the scenario of uncertainties still present.

Funding
The research is funded under the Fiocruz Innovation Promotion Program (Inova Fiocruz) -Knowledge Generation -Coping with the Covid-19 Pandemic and Post-Pandemic.