Abstract
BackgroundForty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources. Undiscerning procurement processes are at the heart of this issue.We conducted a systematic review of the literature to August 2013 with no time or language restrictions to identify what product selection or prioritization methods are recommended or used for medical device and equipment procurement planning within low- and middle-income countries. We explore the factors/evidence-base proposed for consideration within such methods and identify prioritization criteria.ResultsWe included 217 documents (corresponding to 250 texts) in the narrative synthesis. Of these 111 featured in the meta-summary. We identify experience and needs-based methods used to reach procurement decisions. Equipment costs (including maintenance) and health needs are the dominant issues considered. Extracted data suggest that procurement officials should prioritize devices with low- and middle-income country appropriate technical specifications – i.e. devices and equipment that can be used given available human resources, infrastructure and maintenance capacity.ConclusionSuboptimal device use is directly linked to incomplete costing and inadequate consideration of maintenance services and user training during procurement planning. Accurate estimation of life-cycle costing and careful consideration of device servicing are of crucial importance.
Highlights
Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources
We note that procurement activities frequently involve all stakeholder groups outlined; we identified only one document where donors solely undertook procurement activities on behalf of Low- and middle-income countries (LMICs) [18]
We identify six main prioritization criteria across reviewed documents, which correspond to both normative and feasibility conditions, and list these in Fig. 6 according to relative importance assigned in the literature
Summary
Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources. The absence of safe, effective and well-functioning medical devices and equipment (MDEs) impairs health service provision, leads to poor patient outcomes and poses substantial health system and national security risks [1,2,3] Nowhere has this been more evident than the recent Ebola Virus Disease outbreak in West Africa [4,5,6]. The absence of appropriate technologies impairs more than emergency care, : routine services in maternal, child and reproductive care (e.g. immunizations or reproductive control), interventions for non-communicable (e.g. diabetes management) and communicable diseases (e.g. HIV/AIDS diagnosis) all require suitable infrastructure and functioning technologies From basic products such as weighing scales and condoms, to glucometers and flow-cytometers, health service delivery is predicated upon. Installation, preventive and corrective maintenance services and user training programs are traditionally absent in LMICs, leading to unsafe device handling practices with potentially harmful consequences for patients (e.g. in cases of misdiagnosis due to mis-calibration or infection propagation due to device re-use)
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