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

摘要

Background: Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken,udunused or unfit for purpose; this impairs service delivery to patients and results in lost resources. Undiscerningudprocurement processes are at the heart of this issue.udWe conducted a systematic review of the literature to August 2013 with no time or language restrictions to identifyudwhat product selection or prioritization methods are recommended or used for medical device and equipmentudprocurement planning within low- and middle-income countries. We explore the factors/evidence-base proposedudfor consideration within such methods and identify prioritization criteria.udResults: We included 217 documents (corresponding to 250 texts) in the narrative synthesis. Of these 111 featured inudthe meta-summary. We identify experience and needs-based methods used to reach procurement decisions. Equipmentudcosts (including maintenance) and health needs are the dominant issues considered. Extracted data suggestudthat procurement officials should prioritize devices with low- and middle-income country appropriateudtechnical specifications – i.e. devices and equipment that can be used given available human resources,udinfrastructure and maintenance capacity.udConclusion: Suboptimal device use is directly linked to incomplete costing and inadequate consideration ofudmaintenance services and user training during procurement planning. Accurate estimation of life-cycle costing and carefuludconsideration of device servicing are of crucial importance.