Enhancing sustainability of medical devices procurement in Low- and Middle-Income Countries

this research originates from the observation that a significant proportion of Medical Devices (MDs) in Low- and Middle-Income Countries (LMICs) remain unused. Unused MDs in the public health sector are the result of an unsustainable procurement that does not consider the existence or creation of the conditions for a safe, effective and sustainable use of the MD. Focusing on the causal factors behind unused MDs, this study aims to explore how procurement processes can be improved to avoid this unsustainable waste of resources. A systems thinking approach was applied to investigate the root causes of the failure of the processes involved in MD procurement. Beginning with the development of a diagram based on a literature analysis and expert panel judgements, this research resulted in the recommendation of three key leverage points to be implemented during the procurement of MDs: conducting robust, evidence-based assessments of local needs, conditions, capabilities and constraints; involving a multidisciplinary team of experts in the procurement process; and strengthening local clinical engineering capabilities. The results show how sustainable procurement shall primarily focus on effective, long-term use of MDs, strengthening procurement governance and resources appropriate use, and assess their environmental, social, and financial impacts as second steps.