Report: Elodie Winizuk, Robert Balazs

Medical procurement solutions for NATO Allies and Partners

Resilience and a rapid response are key to counter crises timely and efficiently in any military operation. The COVID-19 pandemic or the current conflict in Ukraine have demonstrated that crises are becoming increasingly complex and they become rapidly global.
Fighting the pandemic was a key priority of each NATO Ally and Partner over the last two years. In this context, the NATO Support and Procurement Agency (NSPA) has played a crucial role supporting NATO, its Allies and Partner nations in their response to tackle the pandemic.
The provision of strategic airlift capabilities; the supply and transport of key relief medical supplies and equipment; the delivery of rapidly accessible infrastructure to augment national medical capabilities; or the establishment of testing laboratories in operational threats to control the outbreak, are some of the examples where NSPA has contributed to mitigate the impact of COVID-19.
A great part of this effort has been coordinated and managed by the NSPA Medical Support team, made by experts in the field of biomedical engineering, medicine and pharmacy, supported by professionals in operational logistics and procurement.
Today, the Medical Support team acts as the focal point for any medical related businesses within the Agency. The team encompasses the full spectrum of capabilities of NATO medical doctrine, including planning, developing, coordinating, procuring, maintaining and deploying medical solutions for the military. This ensures that NSPA follows and maintains the doctrinal guidance of NATO and the Committee of the Chiefs of Military Medical Services in NATO (COMEDS) when undertaking medical procurement. By doing this, NSPA not only supports national procurements but also offers alternate solutions, capabilities and services using the expertise and background of the medical team in collaboration with national experts.
NSPA has carefully selected and grown the medical capability, enlisting the support of a wide range of national personnel over time with proven track records in medical disciplines and crucially, with prior experience of NATO military activity.

How can Nations benefit from NSPA Medical Services?

NSPA brings nations together by providing multinational cooperation solutions and mechanisms that allow nations to combine their efforts, consolidate and share resources and take advantage of economies of scale.
This is also particularly important in the medical domain. A single national requirement, can be shared with other nations via NSPA mechanisms. This generates the advantageous commonality of purpose among NATO members, it increases requirement volumes leading to cost effectiveness from “economies of scale” purchases.
In addition, procurement processes are generally protracted and complex, with multiple steps and stages. This consumes significant amounts of time, which is not optimal for a dynamic military force that may have immediate needs. NSPA has a great deal of prior experience that can speed up activity and can sometimes operate under NATO directions beyond individual national considerations.
The NSPA Medical Support team can help nations planning, developing, coordinating, procuring, maintaining and deploying their individual or common medical solutions. The operational environment is highly specialised and requires familiarity with the situation and military processes, in order to be effective. All NSPA medical personnel hold prior military experience and follow NATO doctrine, which provides the framework for deployable medical activity. 


COVID-19 Support 

There is no argument that the COVID pandemic challenged many aspects of society, including within the procurement chain, the supply, the manufacturing and the transport functions within the industries and economies of every nation. NSPA was one of many options, explored by member nations when the demands for both civil and military support began.
Whilst NSPA had contractual agreements in place that met some of the demands for support, the scale, scope and speed of the requests was overwhelming in March 2020. There was a global rush to secure limited production items for which no nation was fully prepared for. NSPA was not positioned to answer the large and sudden demand, but through its unique partnership with over 100,000 different industry providers, the Agency was able to provide key and rapid assistance to meet the challenge. To provide an idea of the scale of the requirement, it is worth noting that, at the beginning of the pandemic, NSPA alone received over 1 billion EUR of requests for PPE (Personal Protective Equipment) and associated equipment and supplies within a 1-month timeframe.
Neither NSPA nor industry was able to fulfil such requests in the time requested. Nevertheless, the NSPA team worked alongside their member nations, 24/7 to source and secure as much of the requested items as they could. At the same time, they collaborated with national experts to identify the wildly different standards from the customers that eventually emerged for the PPE and matched them to the available manufactured products. The required standardisation was time-consuming, yet there was no time to spare for life-saving procurements.
During the pandemic, the NSPA Medical Support team not only supported Nations with the provision of PPE equipment and other urgent medical supplies. They also worked closely with NATO’s Euro-Atlantic Disaster Response Centre (EARDCC) providing the necessary medical expertise for the donations of critical medical equipment, and helped NATO Allies and Partners with the procurement and transportation of patient monitors, thermometers, oxygen concentrators, resuscitation modules, negative pressure transportation chambers or pulse oximeters, among others. The team also delivered two COVID-19 testing laboratories with staff EMMS  European Military Medical Services 2022 9 Medical procurement solutions for NATO Allies to increase the testing capacity of the NATO-led Resolute Support Mission service members at the time, and the Kosovo Force (KFOR) mission. The laboratories enabled to conduct quick virus detection to monitor the spread of the virus. The KFOR lab is still active and, since its delivery in September 2020, it has performed almost 24,000 tests, contributing to a better protection of the service members deployed in this NATO mission.
In addition, NSPA provided rapidly accessible infrastructure to augment national medical capabilities. In 2020, the Agency, through its Southern Operational Centre (SOC), prepared and coordinated, within a few days, the transport and construction of a field hospital in Luxembourg, with capacity for 100 additional beds. This augmented the capabilities of one of the main hospitals in the country.

The evolution of the NSPA Medical Support

Before there was a true medical capability at NSPA, the Medical Directorate of Allied Command Operations (ACO) engaged with the J4 Logisticians in designing a capability package to support a NATO deployed multinational Headquarters, where no nation would assume the lead nation status.
By 2007, ACO had developed a medical Role 1 shell capability: a medical presence was established at NSPA, and Capability Package 156 was born. Since then, NSPA has maintained this capability package in their storage facility in its Southern Operational Centre (SOC) in Taranto, Italy, and is ready to deploy it in support to operations and exercises.
In 2007, NATO military medical planners were looking for an enduring solution for medical support for the multinational forces in Kabul, Afghanistan. NSPA (NAMSA, at the time) created and built a fixed multinational Role 3 hospital at the airbase, replacing the multiple medical facilities of the combined nations and acting as a focal point for medical care in the region.


The success of this project led to the creation of a replicate Role 3 facility, built by NSPA at the airbase in Kandahar. A remarkable survival rate of over 95% of the battle injured casualties arriving at the facilities was anecdotally reported1. This was due to the combined capabilities offered by these two hardened medical facilities, combined with the military medical experts within that provided their tremendous clinical skills.
In 2010, NSPA began to address a medical shortfall in strategic aeromedical evacuations. The few nations who had this capability were coming under greater pressure due to operational tasking, and were in difficulty to fulfil all requests for support from other nations who lacked the capability. Even the larger nations were making requests for support, as their beleaguered capabilities reached maximum tasking. NSPA created a commercial Strategic Evacuation (STRATEVAC) contract under the scrutiny of its Operational Support Logistics Partnership. This enabled any NATO member nation to request a commercial STRATEVAC support for patient movement and usefully has provided medical planners with an additional option to their existing capabilities. In September 2015, NATO asked NSPA to find a replacement capability for the French military forces who were leaving their role after seven (7) years as the custodians of medical primary care for the Camp Maréchal de Lattre de Tassigny (CMLT) at KFOR base, located just outside Pristina. NSPA rapidly created a contract for a commercial NATO Role 1 medical services, which continues to the present time as part of the base services.
In November 2016, NATO medical planners asked NSPA whether they could provide a replacement Role 2 DCS (damage control surgery) service contract for KFOR nations, to fill the gap left by the outgoing German Role 2 facility at Prizren. This facility would have to incorporate liaison with host nation medical capabilities, coordinate blood supplies, dental emergency services and assist patient repatriations. It needed to be in place by January 2018. The Agency completed the task in the record time of less than 12 months, delivering the infrastructure, the equipment, the supplies and most importantly, the medical specialist staff to run the facility. The facility is still operational at Camp Film City, and remains under the collective ownership of the participating nations with NSPA management oversight until the mission requires such essential capability


By 2017, the Medical Support team had become an independent section within NSPA.
The team has also played an important role in supporting with medical capabilities CSTC-A (Combined Security Transition Command – Afghanistan), and the Afghan National Defence and Security Forces in their mission. Over several years, NSPA has provided a vast range of supplies and services to the mission, through the NATO Trust Fund arrangement. This ranges from oxygen concentrators, x-ray devices, bandages, antibiotics, halal-vaccines, clinical analysers, biomedical servicing capabilities, controlled drugs and a myriad of other support pharmaceuticals. This effort has required coordination with Government officials in multiple countries, transport routes involving convoys, air routes and helicopter lifts, and unimaginable levels of paperwork. Today, further to the end of the Resolute Support Mission in Afghanistan, the team is involved in the provision of medical services at one of the refugee’s camps for Afghans in Kosovo.

Current support in Ukraine

In 2014, the medical team supported Ukraine in developing essential rehabilitation capabilities. NATO Allies established several Trust Funds in response of the conflict in Crimea and then in Ukraine. Thorough the analysis of the health care system and with the support of NATO Nations, the essential rehabilitation principles have been instated and the education of future medical rehabilitation staff has commenced. Through the Trust Fund, several injured veterans have been treatedabroad and have been provided with the state of the art prosthesis.
As the crisis in Ukraine demands new approaches and engagement beside the rehabilitation projects, NSPA is working with NATO Headquarters in Brussels to deliver medical supply for civilians in Ukraine, including first aid kits, bandages, combat simulation and training equipment.

Looking ahead: The creation of a Medical Support Partnership

To prepare for future medical challenges, future crisis or conflicts that NATO and Allies might face over the next years and that are of direct concern for the medical community, NSPA is concentrating its efforts into the creation of the first Medical Support Partnership. This collective group would be the single point of 10 EMMS  European Military Medical Services 2022 contact for all medical requirements, saving crucial time and concentrating resources and instruments to be more responsive in the event of crisis. This would not only be beneficial in a pandemic crisis, but also for NATO’s engagements in Humanitarian Aid and Disaster Relief operations.
The Medical Support Partnership will be launched in the second half of 2022, with the support of several Allied Nations that are already committed to its creation. The Medical Support Team will be directly involved and continue to provide support in identifying, developing and procuring medical solutions to equip NATO Nations and Partners with responsive, effective and optimised medical solutions.

About NSPA

The NATO Support and Procurement Agency (NSPA) brings together, in a single organization, acquisition, logistic, medical and infrastructural capabilities, operational and systems support and services to the NATO nations, NATO Military Authorities and partner nations. As NATO’s primary enabler, the Agency’s mission is to provide effective and cost efficient multinational solutions to its stakeholders.
Since its establishment in 1958, NSPA acquires, operates, and maintains everything through an unbiased link between industry and the nations: from weapon systems to fuel delivery, port services, airfield logistics, medical and catering services or base support services for troops stationed across the world. The Agency enables the consolidation and centralisation of logistics management functions, providing a “cradle to grave” support and allowing its customers to achieve economies of scale.
NSPA is a customer-funded agency, operating on a “no profit - no loss” basis. The business activity has grown nearly fourfold in the last decade, reaching an annual business volume of €4 billion. NSPA is headquartered in the Grand Duchy of Luxembourg, with main operational centres in France, Hungary and Italy and the Agency employs around 1,400 staff. 

For the authors:
NATO Support and Procurement Agency (NSPA)
Technical Officer (Biomedical Eng.)

Date: 01/20/2023

Source: EMMS