Procurement of medical devices in countries a protocol for a systematic review – Pubrica
                     PROCUREMENT OF MEDICAL  
DEVICES IN LOW- AND MIDDLE-  
INCOME COUNTRIES: A 
PROTOCOL  FOR A SYSTEMATIC 
REVIEW
An Academic presentation by
Dr. Nancy Agnes, Head, Technical Operations, 
Pubrica  Group: www.pubrica.com
Email: [email protected]
Today's 
Discussion
Outlin In-Brief  
e Introduction  
Search strategy 
 Data 
collection  
Analysis
Procurement and relevant stakeholders 
 Limitations
Future scope 
 Conclusion
In-
Brief
Low- and middle-income countries (LMICs) medical device procurement 
processes are  poorly understood and researched. International public health 
organisations and research  agencies publish a wide body of mostly grey 
literature, including guidelines, manuals, and  recommendations, to aid LMIC 
policy formulation in this area. This part of conducting a  systematic analysis 
to classify and investigate the medical device procurement  methodologies 
proposed and other literature (1). The facilitators and obstacles to  
procurement will be established, and methodologies for prioritising medical 
devices under  resource constraints will be discussed.
Introductio
n Medical devices and equipment are important for 
providing  high-quality health care.
In low- and middle-income nations, reports and 
studies point  to a shortage of basic medical devices 
and medical  equipment that has fallen out of use.
It has a significant impact on healthcare delivery and 
also  results in a loss of staff and funds.
There are two potential causes for this issue, 
according to  the WHO's Priority Medical Devices 
project.
Contd...
First, medical device manufacturers seek out economies in high-income 
countries  because of the higher profit margins.
As a result, medical device supply and equipment design are limited to 
products  and requirements appropriate for implementation in 
environments with specialised  facilities and technologically skilled human 
resources.
Second, low- and middle-income countries face judicious medical device  
procurement (LMICs) (2).
Contd.
..
Table: 1 Procurement of medical devices at national level concerning 
country income  classification

Search 
strategy
Early scoping searches on medical device 
procurement  strategies for LMICs turned up 
much grey literature  from foreign public health 
agencies, think tanks, and  other organisations, 
but few journal articles or research  studies.
As a result, it was critical to creating search and  
selection strategies that were as broad and 
inclusive as  possible, with no time or language 
limitations.
Contd...
However, the collection of data documents to be included will be limited 
to publicly  accessible digitised content, partly due to resource limitations 
and partly because  we believe this best reflects the different materials 
that LMICs will have access to.
A filled list of sources to be searched is provided in the Table.
Contd.
..

Data collection
One reviewer (KD or MB) extracted data from all 
included  documents based on a pre-determined list 
of questions.
Normative or descriptive accounts of MDE 
procurement  and technology management 
processes; the relevance of  health technology 
assessment exercises and health  needs 
assessments in procurement; the input of health  
care professionals or specialist staff (e.g. biomedical 
 engineers, economists) in procurement decisions; 
device  installation, maintenance, and 
decommissioning  procedures.
Now looked for clear accounts of MDE prioritisation  
processes in the documentation and extracted 
quotes or  process details for qualitative review
Analysis
To summarise and analyse the data collected, two 
methods  of analysis were used.
For issues related to the research questions raised,  
narrative synthesis provided a summative and 
descriptive  report of all included documents.
For a subset of documents detailing concrete 
prioritisation  methods/processes, a qualitative meta-
summary was used  to investigate MDE prioritisation.

Procurement 
 and Individual health facilities also participatein the direct
relevant  acquisitio
Nn.ot all medical device procurement decisions are 
stakeholders taken at the  regional, country, or supra-national level.
The authors of the documents reviewed caution 
that such  procedures are not uniform across LMICs: 
hospitals also lack  dedicated resources for MDE 
procurement and rely on  donations, reuse, and 
recycling to meet technical needs.
The literature search help is largely vague on how  
stakeholder views are aggregated or divergent 
opinions  treated, with only three documents 
containing examples of  such accounts.
Contd...
The value of multi-criteria decision-making approaches for aggregating 
and  integrating individual decision-makers perspectives.
Decision-makers involved in the procurement of MDEs and clinical or 
financial  administration personnel use this approach to rate 
technologies based on a  specific and well-defined set of parameters, 
such as patient population benefit.
After that, the highest-scoring inventions are purchased. However, 
such  mechanisms can be inherently biased: decision-makers 
experiences may not  represent the best available evidence globally.
Limitations
Distinguish that the current project has several 
limitations.
To begin,recognise the challenge of
conducting a first-line  analysis on a subject 
with methodologically diverse literature.
Second,we do not attempt to find or
include national policy  documents on medical 
devices in this review.
Future scope
Furthermore, the scope of the analysis may be 
restricted,  as it is not intended to define and include 
prioritisation  methodologies for whole intervention 
packages rather than  individual devices or 
equipment.
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Conclusion
It's unclear how LMICs go about procuring and prioritising 
 medical devices.
Internationally proposed guidelines, recommendations, or 
reports  are regularly provided to advise LMICs on this 
subject, whether  produced by public health agencies or 
clinical research  organisations.
They may affect their national policy formulation.
This systematic review aims to describe these 
methodologies,  investigate the factors that have been 
identified to influence  procurement practises in LMICs, 
and develop a preliminary  framework for how medical 
device prioritisation and procurement  can be planned 
and conceived in resource-constrained settings.
Contd...
The results of this systematic review help formulate initial hypotheses 
about what  factors and stakeholders influence these processes and a 
quality assurance  structure capable of providing LMIC decision-makers 
with a well-rounded  understanding of the topic.
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