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 
 
Dr. Nancy Agnes, Head, Technical Operations, Pubrica, [email protected] 
 
 
In brief Country Does procurement of medical 
classification devices occur at the national level? 
Low- and middle-income countries (LMICs) 
medical device procurement processes are poorly 
understood and researched. International public  Yes NO 
health organisations and research agencies 
publish a wide body of mostly grey literature, 
including guidelines, manuals, and Low income 25 8 
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 
 (1)
proposed and other literature . The facilitators 
and obstacles to procurement will be established, 
and methodologies for prioritising medical devices Low-middle 
under resource constraints will be discussed. income 31 7 
 
I. INTRODUCTION 
Medical devices and equipment are important for 
providing high-quality health care. In low- and 
middle-income nations, reports and studies point to 
Upper-middle 
a shortage of basic medical devices and medical 
income 30 17 
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. First, 
medical device manufacturers seek out economies 
in high-income countries because of the higher High income 17 27 
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 Total 103 59 
technologically skilled human resources. Second, 
low- and middle-income countries face judicious 
 (2)
medical device procurement (LMICs) . 
Table: 1 Procurement of medical devices at 
national level concerning country income 
classification 
 
Copyright © 2021 pubrica. All rights reserved 1 
 strategies that were as broad and inclusive as 
possible, with no time or language limitations. 
II. SEARCH STRATEGY However, the collection of data documents to be 
Early scoping searches on medical device included will be limited to publicly accessible 
procurement strategies for LMICs turned up much digitised content, partly due to resource limitations 
grey literature from foreign public health agencies, and partly because we believe this best reflects the 
different materials that LMICs will have access to. 
think tanks, and other organisations, but few 
A filled list of sources to be searched is provided in 
journal articles or research studies. As a result, it 
the Table. 
was critical to creating search and selection 
 III. DATA COLLECTION 
 One reviewer (KD or MB) extracted data from all 
included documents based on a pre-determined list 
 
 
Copyright © 2021 pubrica. All rights reserved 2 
of questions. Normative or descriptive accounts of IV. ANALYSIS 
MDE procurement and technology management 
processes; the relevance of health technology To summarise and analyse the data collected, two 
assessment exercises and health needs assessments methods of analysis were used. For issues related to 
in procurement; the input of health care the research questions raised, narrative synthesis 
professionals or specialist staff (e.g. biomedical provided a summative and descriptive report of all 
engineers, economists) in procurement decisions; included documents. For a subset of documents 
device installation, maintenance, and detailing concrete prioritisation methods/processes, 
decommissioning procedures. Now looked for clear a qualitative meta-summary was used to investigate 
accounts of MDE prioritisation processes in the MDE prioritisation. 
documentation and extracted quotes or process 
 (3)
details for qualitative review . 
 may not represent the best available evidence 
globally. 
V. PROCUREMENT AND RELEVANT 
STAKEHOLDERS VI. LIMITATIONS 
Individual health facilities also participate in the Distinguish that the current project has several 
direct acquisition. Not all medical device limitations. To begin, recognise the challenge of 
procurement decisions are taken at the regional, conducting a first-line analysis on a subject with 
country, or supra-national level. The authors of the methodologically diverse literature. Second, we do 
documents reviewed caution that such procedures not attempt to find or include national policy 
are not uniform across LMICs: hospitals also lack .documents on medical devices in this review  
dedicated resources for MDE procurement and rely 
on donations, reuse, and recycling to meet technical VII. FUTURE SCOPE 
needs. 
Furthermore, the scope of the analysis may be 
The literature search help is largely vague on how restricted, as it is not intended to define and include 
stakeholder views are aggregated or divergent prioritisation methodologies for whole intervention 
opinions treated, with only three documents packages rather than individual devices or 
containing examples of such accounts. The value of equipment. To ensure that relevant methodologies 
multi-criteria decision-making approaches for are not overlooked, reviewers will consult 
aggregating and integrating individual decision- international health experts to recognise any 
makers perspectives. Decision-makers involved in relevant methodologies and discuss the current 
 (5)
the procurement of MDEs and clinical or financial review's results in light of them . 
administration personnel use this approach to rate 
VIII. CONCLUSION 
technologies based on a specific and well-defined 
set of parameters, such as patient population It's unclear how LMICs go about procuring and 
benefit. After that, the highest-scoring inventions prioritising medical devices. Internationally 
 (4)
are purchased . However, such mechanisms can proposed guidelines, recommendations, or reports 
be inherently biased: decision-makers experiences are regularly provided to advise LMICs on this 
 
Copyright © 2021 pubrica. All rights reserved 3 
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. The results of this 
systematic review help will 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 
(6)
topic . 
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