Support for using integrity pacts (IPs) in Honduras first emerged in the early 2010s, against a backdrop of systemic corruption in healthcare procurement. Lacking proper procurement planning or budgeting processes, the government typically procured medicines and other healthcare needs on an emergency basis through a dedicated trust fund, without any criteria for purchase. This increased prices and provided fertile ground for extortion of bribes and collusion.

The local Transparency International’s chapter, Asociación por una Sociedad mas Justa (ASJ), led efforts to raise public awareness about the problem. In 2013, ASJ carried out an investigation which found a system of bribe extortion, favouritism and collusion and also gave proof of how millions of dollars worth of medicines were being stolen from the Central Medicine Warehouse and possibly sold in the black market. Subsequent investigations on the case resulted in the involved individuals’ arrest, trial, and conviction.

In 2014, the new Honduran president, Juan Orlando Hernández, vowing to tackle the problem, created a new independent trust fund to oversee purchasing and distributing medicines for state-run hospitals. After that, the Ministry of Health set up a tripartite committee with ASJ and the bank operating the trust fund to design and introduce an integrity pact to monitor the new tendering system for pharmaceutical procurement.

The negotiations on the IP went on until 2017. ASJ involved a consultant with experience in supporting IPs in Colombia to advise on how to tailor an IP for pharmaceutical procurement. They also drafted a concept and strategy paper and approached the industry to secure support for the IP activities. The United Nations Office for Project Services also played an important role in the negotiations and supported reform efforts by setting up a web platform called Medicamentos Abiertos (Open Medicines), which published all medicine purchases online.

In 2017, the Ministry of Health and ASJ signed a two-year Framework Integrity Pact Agreement outlining ASJ’s role, rights, and responsibilities as a monitor. ASJ was granted full and timely access to all documents and information on medicines purchases, as well as the right to inform relevant state authorities about irregularities as deemed necessary. The monitoring mechanism was designed to be publicly accessible and interactive, featuring regular updates on the monitoring work and allowing citizens to comment on the procedures and report suspected irregularities.

The integrity pact featured commitments for both contracting authorities and bidders. On the government’s side, the Ministry of Health’s procurement officials committed to refrain from bribery and collusion, to apply fair competition principles in the procurement procedures, and to disclose relevant procurement information and documents to the bidders and the public. In the initial phase of the initiative, ASJ trained over 200 public officials on their obligations.

Pharmaceutical suppliers committed through the IP not to bribe, collude, or commit other irregular acts and were subject to misconduct and fraudulent representation liabilities. The signature of the IP was mandatory for bidders if they wanted to participate in the tender.

According to ASJ, implementing the IP in pharmaceutical procurement resulted in significant competition and price stability benefits. A study on the initiative showed that while between 2005 and 2010, there were only 19 suppliers, the number increased to over 40 following the introduction of the integrity pact. Another study by ASJ, based on historical data from the Open Medicines platform, demonstrated that increased competition tamed inflation of the medicines’ prices, which was rampant between 2005 and 2010.

Due to the initiative's success, the Framework Integrity Pact Agreement was renewed in 2019 and lasted until 2021, when a new government led by a different political party came to power. Meanwhile, ASJ expanded the Open Medicines platform to cover El Salvador and Guatemala, aiming to increase competition across the Central American “Northern Triangle”.

At present, ASJ is promoting the adoption of the IP in the health sector procurement processes. They’ve strengthened their efforts after the new government dissolved the trust fund and announced that the health authority would directly manage the procurement process. They also continue to advocate for civil society monitoring in other sectors like energy and education.