Sustainable procurement of medical devices in an international context - Part 3. Assessment of local and lifelong use conditions

Background and Objectives This article aims to describe how sustainable procurement of medical devices (MDs) can be implemented in operational projects in the context of developing countries. It also further details how sustainability principles and concepts of value-based procurement can be applied by the biomedical/clinical engineer lead (BCEL) in charge of the technical support during all steps of a procurement process of MDs. Material and Methods Based on the authors’ experience of more than 20 years in procurement projects and implementation of MDs, the role of the BCEL will be developed from a theoretical point of view with the description of the second and third pillars of a sustainable purchase following the needs assessment: the assessment of existing conditions along with local capacities and the evaluation of the use conditions during the lifetime of the medical equipment. The application of these principles in operational projects will be further discussed through the analysis of literature and lessons learned from projects implemented in developing countries. Results/Proposal The BCEL has a key role in the sustainable procurement of MDs to design the technical specifications of the goods, related services and post sales conditions in order to maximize the benefit of the investment. As the specialist able to analyze the local existing conditions and capacities while also ensuring an efficient use of the MDs during their lifespan, he/she can contribute to a sustainable implementation of MDs in developing countries. The BCEL shall also be able to analyze the local and international markets to find all possible technological solutions meeting the needs, local conditions and capacities as well as ensuring a quality use during the lifespan of the purchased MD. The BCEL shall have competences in identifying all the risks related to the use of the MD from the safety risks linked to its installation, use and maintenance to the sustainability risks linked to obtaining the conditions that guarantee the use of the device and maintain them as long as possible. Examples of these conditions include: presence of qualified and trained users, availability of maintenance and consumable budgets, availability and maintenance of infrastructure conditions (access, electrical power, water, drainage, medical gasses, etc.) and last but not least, presence of patients requiring a diagnosis or treatment using the purchased MD who were identified during the evaluation of the first pillar: a sound needs assessment. Conclusion As an evolution of the BCEL’s traditional biomedical and clinical engineering work, he/she shall assume the responsibility to guarantee the sustainability of the MDs purchase. This quality assurance and control role is achieved by a sound theoretical background knowledge based on the three sustainable procurement pillars: the needs, existing and lifetime use conditions assessments together with the analysis of the local and international markets and a broad understanding of sustainability risks.