Copyright © 2021 pubrica. All rights reserved 1

Procurement Of Medical Devices In Low-

And Middle-Income Countries: A Protocol

For A Systematic Review

Dr. Nancy Agnes, Head, Technical Operations, Pubrica, sales@pubrica.com

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.

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

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. 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)

.

Table: 1 Procurement of medical devices at

national level concerning country income

classification

Country

classification

Does procurement of medical

devices occur at the national level?

Yes NO

Low income 25 8

Low-middle

income 31 7

Upper-middle

income 30 17

High income 17 27

Total 103 59

Copyright © 2021 pubrica. All rights reserved 2

II. 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.

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.

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 3

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 (3)

.

IV. 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.

V. PROCUREMENT AND RELEVANT

STAKEHOLDERS

Individual health facilities also participate in the

direct acquisition. Not all medical device

procurement decisions are 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. 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 (4)

. However, such mechanisms can

be inherently biased: decision-makers experiences

may not represent the best available evidence

globally.

VI. 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.

VII. 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. To ensure that relevant methodologies

are not overlooked, reviewers will consult

international health experts to recognise any

relevant methodologies and discuss the current

review's results in light of them (5)

.

VIII. 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

Copyright © 2021 pubrica. All rights reserved 4

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

topic(6)

.

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3. Singh, Neha S., et al. "A realist review to

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106322.

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