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Table 5 Evidence inputs and factors considered in medical device procurement planning

From: Methods for medical device and equipment procurement and prioritization within low- and middle-income countries: findings of a systematic literature review

Factors/ Evidence input

Areas of concern in current procurement planning processes

Selected key references a

Recommended course of action to address areas of concerns / best practices:

Selected key references a

Medical device cost: costs considered for each product purchase

Installation, maintenance and safe disposal costs not captured;

User training costs not included;

SR143: WHO, 2011

SR122, 124–131: WHO, 2010

Include all expenses associated with medical device deployment to health facilities, in particular user training and maintenance;

SR241: Martin, 2005

SR247: Free, 1993

SR122, 124–131: WHO, 2010

Specialist expertise: advice or opinion of biomedical engineers, health economists, clinical or procurement specialists considered when planning

Experts are rarely locally available;

Where experts are available, expertise is likely financing/ pharmaceutical rather than device specific;

SR79: Mullally, 2008

SR26: Mundy, 2012

SR34: Mundy, 2012

If possible, create national training programs/specialized procurement units staffed with biomedical engineers;

Consult international biomedical engineers or health economists on specifications and value for money of products;

SR63–69: Bloom, 1989

SR80: Mytton, 2010

Regulations and standards: Equipment conformity to international regulatory approval (FDA approval, ISO certification, CE mark)

Products complying with international regulatory approvals may be costly and unavailable in local markets;

Absence of national regulatory agencies impedes verification of certifications;

SR163: WHO, 2012

SR133: WHO, 2011

As a minimum standard, ensure high-risk equipment is internationally certified for use so as to ensure patient safety;

SR35: Keller, 2010

Health needs assessment: Identified population health priorities and/or technological needs

National level decision-makers may distrust needs-assessments conducted by health facility personnel due to exaggerations or mis-information;

Needs assessment information may not be up to date;

SR38: Aid-Khalet, 2001

SR56: Mavalankar, 2004

Create regional or national level participatory structures where health facility representatives may directly participate in procurement planning and tendering.

SR122, 124–131: WHO, 2010

SR176: WHO, 2000

Clinical guidelines: Patient management guidelines for interventions/clinical areas

Clinical guidelines may not include information on products needed to carry out specific health interventions;

SR184: Anderson, 2008

Incorporate indications on medical device necessities into clinical guidelines and where possible advise on LMIC friendly product specifications.

SR41: Briggs, 2008

SR44: Dyer, 2010

Health technology assessment: Methods and reports on the procurement economic and health impact, and policy and regulatory approval

HTA difficult to undertake due to data paucity on health impacts, medical device coverage, equipment life span, true costs of equipment.

SR24: PAHO, 2012

SR249: Withanachchi, 2007

Within resource constraint, adopt transparent and evidence-based processes to evaluate different investment options; If possible, secure political support for HTA implementation.

SR106: Panerai, 1989

SR198: Teerawattananon, 2005

  1. a Numbers with a prefix “SR” shown in the Table refer to identification numbers for documents included in the systematic review – please see Additional file 4 to identify the individual references