Procurement of medical devices in countries a protocol for a systematic review – Pubrica

1. PROCUREMENT OF MEDICAL DEVICESINLOW-ANDMIDDLE- INCOMECOUNTRIES:APROTOCOL FORASYSTEMATICREVIEW AnAcademicpresentationby Dr.NancyAgnes,Head,TechnicalOperations,Pubrica Group: www.pubrica.com Email:sales@pubrica.com

2. Today'sDiscussion In-Brief Introduction Searchstrategy Data collection Analysis Procurementandrelevantstakeholders Limitations Futurescope Conclusion Outline

3. In-Brief Low- and middle-income countries (LMICs) medical device procurement processes are poorly understood and researched. International public health organisations and research agenciespublishawidebodyofmostlygreyliterature,includingguidelines,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 resourceconstraints will be discussed.

4. Introduction Medical devices and equipment are important for providing high-qualityhealth care. In low- and middle-income nations, reports and studies point toashortageofbasicmedicaldevicesandmedical equipmentthat hasfallen outof use. It has a significant impact on healthcare delivery and also resultsin aloss ofstaff and funds. There are two potential causes for this issue, according to theWHO'sPriority MedicalDevicesproject. Contd...

5. First, medical device manufacturers seek out economies in high-income countries becauseof the higher profitmargins. As a result, medical device supplyand equipment design are limited to products and requirements appropriate for implementation in environments with specialised facilitiesandtechnologicallyskilled human resources. Second,low-andmiddle-incomecountriesfacejudiciousmedicaldevice procurement(LMICs) (2). Contd...

6. Table:1Procurementofmedicaldevices atnationallevelconcerningcountryincome classification

8. Searchstrategy Early scoping searches on medical device procurement strategiesforLMICsturnedupmuchgreyliterature from foreign public health agencies, think tanks, and other organisations, but few journal articles or research studies. Asaresult,itwascriticaltocreatingsearchand selection strategies that were as broad and inclusive as possible,withnotimeorlanguagelimitations. Contd...

9. 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 webelievethisbestreflectsthedifferentmaterialsthatLMICswillhaveaccessto. AfilledlistofsourcestobesearchedisprovidedintheTable. Contd...

11. Datacollection One reviewer (KD or MB) extracted data from all included documentsbasedonapre-determinedlistofquestions. Normative or descriptive accounts of MDE procurement and technology management processes; the relevance of healthtechnologyassessmentexercisesandhealth needsassessmentsinprocurement;theinputofhealth careprofessionalsorspecialiststaff(e.g.biomedical engineers, economists) in procurement decisions; device installation,maintenance,anddecommissioning procedures. NowlookedforclearaccountsofMDEprioritisation processes in the documentation and extracted quotes or processdetails forqualitative review

12. To summarise and analyse the data collected, two methods ofanalysis were used. Forissuesrelatedtotheresearchquestionsraised, narrative synthesis provided a summative and descriptive reportof allincluded documents. For a subset of documents detailing concrete prioritisation methods/processes, a qualitative meta-summary was used toinvestigate MDEprioritisation. Analysis

14. Individual acquisition. health facilities also participate in the direct Procurement and relevant stakeholders Not all medical device procurement decisions are taken at the regional,country,or supra-nationallevel. Theauthorsofthedocumentsreviewedcautionthatsuch procedures are not uniform across LMICs: hospitals also lack dedicatedresourcesforMDEprocurementandrelyon donations,reuse,andrecyclingtomeettechnicalneeds. Theliteraturesearchhelpislargelyvagueonhow stakeholderviewsareaggregatedordivergentopinions treated, with only three documents containing examples of suchaccounts. Contd...

15. The value of multi-criteria decision-making approaches for aggregating and integratingindividual decision-makersperspectives. Decision-makers involved in the procurement of MDEs and clinical or financial administration personnel use this approach to rate technologies based on a specificandwell-definedsetofparameters,suchaspatientpopulationbenefit. Afterthat,thehighest-scoringinventionsarepurchased.However,such mechanisms can be inherently biased: decision-makers experiences may not representthe bestavailable evidence globally.

16. Limitations Distinguishthatthecurrentprojecthasseverallimitations. To begin, recognise the challenge of conducting a first-line analysisonasubjectwithmethodologicallydiverseliterature. Second, we do not attempt to find or include national policy documentsonmedical devicesinthis review.

17. Futurescope Furthermore, the scope of the analysis may be restricted, asitisnotintendedtodefineandincludeprioritisation methodologies for whole intervention packages rather than individualdevices orequipment. Toensurethatrelevantmethodologiesarenotoverlooked, reviewers recognise will consult international health any relevant methodologies and experts to discuss the currentreview'sresultsinlightofthem

18. It'sunclearhowLMICsgoaboutprocuringandprioritising medicaldevices. Internationallyproposedguidelines,recommendations,orreports are regularly provided to advise LMICs on this subject, whether producedbypublichealthagenciesorclinicalresearch organisations. Theymayaffecttheirnationalpolicyformulation. This systematic review aims to describe these methodologies, investigatethefactorsthathavebeenidentifiedtoinfluence procurementpractisesinLMICs,anddevelopapreliminary framework for how medical device prioritisation and procurement canbeplannedandconceivedinresource-constrainedsettings. Contd... Conclusion

19. The results of this systematic review helpformulate initial hypotheses about what factorsandstakeholdersinfluencetheseprocessesandaqualityassurance structurecapableofprovidingLMICdecision-makerswithawell-rounded understandingof the topic.

20. ContactUs UNITEDKINGDOM +44-7424810299 INDIA +91-9884350006 EMAIL sales@pubrica.com