Sustainable procurement of medical devices in an international context

Abstract

Background and Objectives Sustainability is a working principle included in the United Nations (UN) procurement processes with the adoption of the Sustainable Development Goals (SDGs) in 2015. In the context of internationally funded projects in developing countries for procuring health-related goods during and following the COVID-19 pandemic, this article further investigates what sustainable procurement means when applied to purchasing medical devices (MDs), considering its impact on health services. It also proposes a reflection on the concepts of sustainability and quality assurance as guiding principles for technical teams during the process of MD procurement. Material and Methods This article aims to identify how sustainability can be implemented during the execution of a project based on the analysis of principles that guide procurement actions in the four UN agencies with the highest volume of MD procurement. The concept of sustainability is also explored from a macrosystemic point of view as the ratio between the impact of a procurement project on healthcare services and its investment. Its implications for population health and wealth is also discussed. Based on the experience of the authors in implementing purchasing processes of MDs, a framework for the specific technical activity is then proposed. Results In the UN system, sustainable procurement focuses on the social, economic, and environmental quality of the equipment and on the conditions of its production to guarantee that a sustainable good is procured. Not being enough, the focus should also be on the benefit of a procurement project, not as the possession of a new MD, but as the utility of the device: an instrument to provide healthcare services of the beneficiary country. Procuring sustainable goods should include planning their future use as an essential component for a sustainable positive impact on the health and wealth of the beneficiary population. Thus, the intended use of the procured devices should be defined, planned, and measured. In the proposed framework, sustainability is a ratio between an MD’s social, economic, and environmental costs and the benefits of its use. When neglecting the essential factor of sustainable use of MDs, the risk of purchasing equipment that will not be properly and efficiently used is relevant. To guarantee the sustainable use of a MD, it is essential to assess the needs, the local conditions, and the conditions for its lifelong use. Further evolution of the concept of sustainability is developed towards the possibility of modulating the project’s objective from procuring sustainable MDs to improving the sustainability of the health services by procuring MDs. Conclusion Sustainable procurement of MDs is a key factor in supporting the sustainable development of health services and health systems toward the SDGs. Post-pandemic investments to strengthen the resilience of health services in developing countries shall consider sustainable procurement, including the essential quality assurance process. This process, led by an expert clinical engineer, shall be centered on the future use of the equipment and not be limited to its quality as a material good.