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Received June 20, 2023, accepted July 17, 2023, date of publication August 1, 2023

Sustainable Procurement of Medical Devices in an 
International Context: Part 1 - Background and Definitions

By Valerio Di Virgilio1, Alexia Bouchard Saindon2, Francisco Cesar Gerardo Becerra Posada2

1 Università degli studi La Sapienza - Rome, Italy
2 United Nation Office for Project Services

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 in-
vestigates 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 pro-
curement. 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.

Keywords – Medical device procurement, sustainable procurement, needs assessment, health services in developing coun-
tries, quality assurance, sustainability.

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tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
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Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

J Global Clinical Engineering Vol.5 Issue 3: 2023  30

INTRODUCTION

Sustainability principles have recently been included 
in the UN procurement processes.1 Considering the op-
portunity to follow SDGs2 and reduce health inequities by 
focusing on project implementation, this article investi-
gates further what sustainable procurement means when 
purchasing MDs in a developing country and its impact 
on health services.

Quality in healthcare is a comprehensive and multifac-
eted concept, including technical competencies, effective-
ness, efficiency, continuity, and safety. It is known that in 
developing countries, improving quality is not a luxury, 
and doing so often pays off.3

Therefore, It is essential and possible to place sustain-
ability and quality assurance (QA) at the center of the 
biomedical engineer’s efforts, aiming to improve quality 
healthcare services in developing countries.

Healthcare services save lives and increase the popula-
tion’s well-being, but at the same time, they have a relevant 
impact on the environment, social and economic aspects 
of the communities involved. If not correctly managed, 
this impact can weaken communities and threaten their 
ability to guarantee healthy lives for future generations.4

As the pandemic of COVID-19 progressed and the 
number of patients affected rose, the demand to procure 
materials and medical devices (MD) to deliver healthcare 
increased, especially in developing countries, which were 
more vulnerable to the pandemic due to a historical lack 
of investment in the health sector.5 

In this context, the quality of the procurement process 
to ensure the sustainable purchase of MDs in develop-
ing countries becomes a key factor that goes beyond the 
technical characteristics of the device.

More than ever, the procurement of MDs needs to have 
a durable and positive effect on health services to improve 
patient care while reducing their environmental, social, 
and economic impacts according to the SDGs.6

This article presents the experience of the authors 
during the COVID-19 pandemic when the requests for 
MDs for developing countries exploded. Following this 

increase, in 2021, UNOPS has become the second largest 
health procurement agency within the UN for MDs and 
supply, with USD 500 million in purchases, after UNICEF, 
the number one procuring Agency.

APPLICATION FRAMEWORK AND METHODS

The application framework can be depicted as an in-
ternational procurement process where a funding source 
is donating or loaning money to a beneficiary, typically 
a public institution of a developing country, and the 
procurement is carried out by an implementing agency.

In developing countries, the knowledge asymmetry 
between private suppliers and public purchasers is more 
evident: “Public procurers perceive it hard to know what 
the available market offerings are resulting in the problem 
of finding the best available solution. They also lack enough 
insight into the operations, making it hard to understand 
the need of which the procurement is meant to fulfill. In 
extension this problem makes it hard to mediate the need 
to the market.”7 

The rise of new technologies in the global market in-
creases this knowledge gap, limiting the effort of public 
procurers toward a more sustainable procurement. It is 
essential to have public procurement institutions with 
enough technical capacities to challenge the market to 
reduce the dependence on information from manufacturers 
or suppliers that can be biased to their own advantage. 
To be able to take evidence-based decisions and choose 
only the innovative technologies that represent a real 
advantage, and finally to orient the market development 
toward sustainable innovations that are in the interest 
of developing countries. For these reasons, international 
implementing agencies are also responsible for bringing 
technical knowledge to strengthen local technical capacities.

This article focuses on the procurement of MDs, with 
particular attention on medical equipment that requires 
specific installation and safety measures. It also analyzes 
the main UN procuring agencies perspectives on sustain-
ability and where the focus should be placed.

Consequently, this framework’s target beneficiary of 
the procurement process will be part of secondary and 
tertiary care-level infrastructures. Expert in MDs, the 



31 J Global Clinical Engineering Vol.5 Issue 3: 2023

Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

technical lead of the project should be a biomedical or 
clinical engineer leading the technical part of the procure-
ment process; thus, they are institutionally in charge of 
ensuring the quality of the purchase. 

Within the described framework, the procurement 
of MDs is a project limited in time, with a specific, well-
defined schedule, budget, and expected quality. The Project 
Manager (PM) and their team will pursue these three 
dimensions simultaneously.8 If the PM is not an expert 
in MDs, they will pursue a schedule and a budget while 
relying on the technical lead to ensure the quality/scope.

Firstly, this framework will explore the meaning of ‘sus-
tainable’ and its definition in the context of a procurement 
project of MDs. Secondly, what sustainable procurement 
means from the technical perspective of the project within 
the agency will be investigated. Finally, a discussion on 
quality and sustainability and their similarities and dif-
ferences in the procurement of MDs will be made.

A MACRO APPROACH TO SUSTAINABLE MDS 
PROCUREMENT IN DEVELOPING COUNTRIES

The health of a population is positively correlated with 
economic development.9 A healthier population is more 
active and productive, thus increasing the development 
process of a country. In return, the development of a coun-
try increases its capacity to offer better health services to 
its population. If the third sustainable development goal 
‘Good-health and well-being’10 and universal health cover-
age, are to be achieved, countries must invest at least 5% 
of their GDP.11 Focused investment is needed and fund-
ing agencies can play a key role in their strengthening.12 
Health capital expenditures and assets maintenance and 
management have been historically underfinanced. The 
pandemic pointed out this fragility and lack of resilience 
of health systems. As a result, in 2020, governments’ in-
creased health care expenditure to address the additional 
medical needs was observed.13

A procurement project of MDs represents the injection 
of funds into a developing country’s health services, aiming 
to improve the population’s health and contribute to the 
country’s sustainable economic development. Implement-
ing an investment project in the health sector is part of a 
virtuous circle: direct investments or loans coming from 

present or future taxes are transformed into infrastructure 
and technologies that improve the population’s health. 
The healthier a population is, the better the economy.

However, healthcare financial resources being limited, 
the high-quality (sustainable) or low-quality (unsustain-
able) of an MD procurement project is thus a critical fac-
tor that will impact the health services performance and 
thus, the population’s health. This means that the work 
of the technical leads in MD procurement projects has a 
potential impact on the lives of millions of people.

Therefore it is possible to define sustainability as a 
critical ‘gain factor’ (Figure 1), which depends on how 
the project is implemented. A high-quality project will 
have a highly positive factor so that the investment will 
produce results that will exceed the loan reimbursement, 
thus increasing health services resilience. 

This factor is what makes a project sustainable for the 
convenience of the beneficiary country’s population. In 
light of this top-down definition of ‘sustainability’ it is 
possible to define the sustainability of a project with the 
ratio between the impact of the project on the SDGs and 
the amount of the investment. From this macro perspec-
tive, QA and sustainability assurance are synonymous, 
depending on the project’s impact. 

When the impact of the project is reduced, null, or 
worse, negative (when for example, there are high costs to 
maintain brand-new medical technologies that are seldom 

FIGURE 1. The virtuous circle of investments in health technol-
ogy. The procurement project’s sustainability is a critical factor 
in achieving the intended impact of a healthier population.



Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

J Global Clinical Engineering Vol.5 Issue 3: 2023  32

used), what will remain for the population is a debt that 
will be paid by their own taxes (Figure 2).

The population subsequently receives fewer benefits, 
and the economy doesn’t grow as expected based on social 
determinants of health studies. The lower the income, 
the worse the health.14 Therefore, an MD procurement 
project always impacts the wealth and the health of the 
population it aims to help. This impact depends on its 
sustainability.

Being aware of its impact during the project’s planning, 
design and implementation will improve its sustainability, 
in fact: ‘’...Economic growth and increased health spending 
alone are not enough to scale-up healthcare coverage and 
achieve better health outcomes. These must be combined 
with accountability of results, transparent management 
of public funds, and multisectoral efforts with community 
involvement at implementation level.’’15

PRINCIPLES AND DEFINITIONS OF 
SUSTAINABILITY APPLIED BY THE UNITED 

NATIONS AGENCIES

In 2015, the United Nations (UN) adopted the SDGs 
to end poverty and hunger, ensure prosperity for all and 
protect the environment by 2030.16 These goals and their 
targets, especially the third one ‘Good-health and well-
being’,17 serve as a foundation to the MDs sustainable 
procurement strategies of the UN agencies working in 
the healthcare sector. UN procurement of medical equip-
ment and supplies amount has grown from $640 million 
(average 2013-2019) to $2.26 and $2.35 billion in 2020 
and 2021.18 A group of these agencies, the UN Sustainable 
Procurement in the Health Sector (SPHS), whose objective 
is to contribute to more sustainable health services and 
greener economies through sustainable procurement in 
the health sector, has an estimated annual purchasing vol-
ume of $5 billion in health products which represents the 
largest market share in the health sector.19 Therefore, UN 
agencies are committed to lead by example and may also 
influence manufacturers and suppliers in the healthcare 
market toward more sustainable products concerning 
the SDGs.20 Graph 1 presents the five UN agencies that 
purchased the most medical equipment in the 2020-21 
biennium.

UN Agencies sustainable procurement approach 

The sustainable procurement of MDs approach is 
slightly different depending on the specific mandate of 
each agency. However, the policies of WHO,22 UNICEF,23 
UNDP24 and UNOPS25 all have in common three dimensions 

FIGURE 2. Disruption of the virtuous circle of investments in 
health technology: when quality Assurance/sustainability of 
the procurement project is lacking, sustainable growth of the 
population’s health and wealth associated with the project 
are not guaranteed and often negatively affect the population.

GRAPH 1. Amount of medical equipment purchased by UN 
agencies in 2020 and 2021 in $ million. WFP procures mainly 
food and clinical nutrition supplies that are out of the scope 
of this article.21



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Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

of sustainability: economic, environmental and social 
which are applicable throughout the life cycle of the MD. 
Table 1 summarizes the sustainable procurement prin-
ciples of the four mentioned UN agencies working in the 
healthcare sector, and details the elements considered for 
a sustainable purchase. According to the UN agencies’ poli-
cies, these three dimensions of sustainable procurement 
must be considered in all phases of the implementation 
project (program design, budgeting, implementation, and 
monitoring). The key to a successful project is to plan pro-
curement collaboratively with the relevant stakeholders 
in the early phases of the project.26

The definitions of sustainable procurement of the UN 
agencies include three dimensions: an environmental 

aspect which focuses on the quality of the MD purchased 
- its carbon footprint - a social aspect which focuses on 
the quality of the manufacturing conditions of the MD - 
the condition of the labor force for its production - and 
an economic aspect which focuses on the quality of the 
financial resources allocation - its life cycle cost.

All the UN definitions of sustainability are centered on 
the quality of the device and the quality of its production 
and transportation. However, delivering a quality device 
to a beneficiary is insufficient to ensure sustainability. A 
sustainable device directly becomes unsustainable if not 
used because its environmental, social, and economic 
costs are compared with no benefits as discussed in the 
following paragraphs. 

TABLE 1. Summary of the sustainable procurement principles of WHO,22 UNICEF,23 UNDP,27 and UNOPS.25 



Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

J Global Clinical Engineering Vol.5 Issue 3: 2023  34

UNICEF explicitly includes a “Definition of Need - 
Planning supplies with programme specifications” at the 
beginning of the procurement process and an “End-user 
Utilization - Fit for purpose Impact” at the end to measure 
the impact of the purchase.26 Nonetheless, this does not 
directly link the use of the goods with their sustainability 
and the design of their requirements.

SUSTAINABILITY LEVELS IN THE IMPLEMENTATION 
OF A MD PROCUREMENT PROJECT

As discussed previously, the sustainability principles 
depend on the project results and impact on the health 
services and can be summarized into different levels. The 
technical lead can pursue these levels according to their 
experience, awareness of sustainability principles, and 
role in the dialogue with the PM and the project stake-
holders. It will also be linked to the policy and regulations 
of the purchasing agency. Local regulations have to be 
considered as well.

Basic sustainability level: 
procurement of a sustainable device

This level is the first level of sustainability to achieve 
and as depicted previously, most of the procurement 
policies within the UN system are focused on this level to 
purchase goods produced sustainably. However, owning 
a sustainable MD does not guarantee per-se a benefit for 
the health services and the population. 

Moreover, an environmentally friendly MD purchased 
at a low price and with high ethical standards that are not 
used at all, or not appropriately, or scarcely used during 
all its expected lifetime harms the environment since its 
environmental cost cannot be balanced with an adequate 
health and economic benefit. And therefore, it represents 
a low-quality unsustainable purchase that will damage 
the financial wealth and thus, the health of the population 
it intends to benefit. 

Intermediate sustainability level: procurement 
centered on the sustainable use of an MD

Reflecting on the procurement processes during the 
COVID-19 pandemic, the authors present three pillars 

that guarantee sustainable use of the procured device 
and thus contribute to sustainable procurement.

The lessons learned during the assessment of sev-
eral hospitals in various developing countries show a 
significant percentage of medical equipment (estimated 
by the authors to up to 20%) that is not working or not 
efficiently used. It has been reported that about 40% of 
donated MDs in developing countries are out of service.28 
The main reasons for this situation are: the lack of patients 
and healthcare resources resulting from a weak needs 
assessment; inadequate installation of the equipment; 
absence of funds for consumables, maintenance, and spare 
parts; lack of experience and training of technicians and 
healthcare staff; delays in approvals/permissions as per 
local regulations.

Pictures like the ones shown in Figures 3 and 4 are 
quite common in developing countries where a signifi-
cant amount of MDs is not used with high environmental, 
social, and economic costs.

FIGURE 3. Photos of unused MDs in three different hospitals, 
the first in the Caribbean, the second in Central Asia and the 
third in Central America.

FIGURE 4. Pictures of stored new laboratory equipment. The 
boxes on the pictures were never opened several months after 
their delivery. The third picture shows equipment waiting for 
years to be completely installed.



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Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

Effective procurement is based on getting the correct 
goods to meet the functional needs of the beneficiary. 
That is to say that the planned use of the equipment has 
to provide planned benefits to the population. In fact, the 
entire procurement process is based on a needs assess-
ment as its essential starting point. When a procurement 
process has been carried out transparently, efficiently, and 
coherently with the objectives, the reliability of the needs 
assessment is still to be confirmed to get quality results.29

To guarantee that the purchased MDs will be correctly 
used, the project’s technical lead should investigate its 
intended use by discussing the pretended use of the MD 
with the beneficiary. Thus, the first pillar of sustainability 
should be: the needs assessment where the following 
aspects shall be investigated:
1. The demand - design of the list of MDs to be procured: 

is there an evidence-based health need that justifies 
the proposed MD?

2. The intended use - design of the technological level: 
when the intended use is clarified, it is possible to 
choose the appropriate technological level of the MD 
and its accessories. 

3. The expected quality/durability - design of technical 
specifications: by balancing the available budget with 
the expected quality, the technical characteristics of 
the goods to be purchased can be designed.

Therefore, an adequate MD will result from a pro-
curement process that begins with a needs assessment 
strongly correlated to the population’s health needs 
through a constructive technical dialogue involving the 
beneficiary and the clinical end-user. 

The needs assessment and the preparation of the 
equipment list is usually a process carried out before 
the project starts to estimate the project budget and 
formalize the agreements between the beneficiary, the 
donor, and the implementing agency. Nevertheless, it is 
recommended that this preliminary needs assessment is 
validated and strengthened by a deeper analysis at the 
project’s start, because the conditions may have changed, 
and the preliminary needs analysis is usually too quick 
and does not consider the intended use and the expected 
durability/quality.

The second pillar of sustainability is the assessment 
of existing conditions. 

It is essential to focus on the context where the goods 
will be used. To this extent, the focus shall be on: (1) the 
sustainable and safe delivery of the equipment from the 
fabrication site to the installation site; (2) the infrastructure 
that will receive the MDs and the design of the interface 
of the equipment within the existing environment; (3) 
the interaction of the equipment with other equipment 
or technologies; and (4) the capacities of the human re-
sources that will use and maintain the MDs.

The result of the assessment of existing conditions is 
an adequate delivery and installation plan.

The third pillar of sustainability is the assessment 
of the lifelong use conditions of the MD. As mentioned 
before, it is not enough to purchase an adequate MD and 
install it; a sustainable purchase should also include as-
sessing its useful life conditions. To this extent, the focus 
shall be on: (1) The adjustment of the equipment’s life span 
based on the project’s conditions; (2) The warranty and 
post-warranty services; (3) The existence of organizational 
conditions such as trained resources for sustainable use 
and maintenance of the equipment; (4) The existence of 
funds for maintenance and consumables; and (5) The 
existence of a plan for disposal of the equipment.

The result of the assessment of the conditions during 
the life expectancy of the MDs is an adequate lifelong 
use plan. 

Advanced sustainability level: purchasing an MD 
with a sustainable impact on the health service

When implementing an MD project, it is possible to 
broaden the framework approach to the national health 
service level by considering a targeted population and 
the entire national system of secondary and tertiary 
care infrastructure. In this broader vision, it is possible 
to achieve a wider needs analysis during the planning 
and implementation of a project to adjust the list of the 
equipment and their characteristics.

Some international procurement processes can be 
designed to target the population of an entire country 
so that the needs assessment of the project is focused 



Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

J Global Clinical Engineering Vol.5 Issue 3: 2023  36

on the national healthcare services. In contrast, others 
are limited to infrastructures of specific regions or sites 
such as the equipment of a new health infrastructure. In 
an ideal international procurement project, the technical 
lead can include considerations on the impact of the pur-
chase of MDs on the entire national health service. In this 
case, it is recommended for the technical lead to open a 
dialogue with the National Ministry of Health counterpart 
and request access to consolidated and updated health 
statistical data. This represents a challenge since during 
the implementation of a procurement project, the pres-
sure to comply with the schedule and the budget may 
limit these kinds of actions and considerations. 

Higher sustainability level: Purchasing MDs to 
increase the sustainability of the health service

The final level of sustainability definition includes the 
case when an MDs procurement project’s objective is to 
increase the health service’s sustainability. Since we are 
focusing on secondary and tertiary care, this means a more 
efficient and environmentally friendly way to provide 
care to patients through innovative technology. Targeting 
the improvement of health services quality through ad-
vancing technical competencies, effectiveness, efficiency, 
continuity, and safety can be the primary objective of an 
MDs procurement project.30

New technologies and innovation in the health pro-
cesses following their introduction in the health service 
is a major theoretical subject that includes health tech-
nology assessment (which is not the focus of this paper). 
Nevertheless, at least one specific aspect of introducing 
new technologies is worth underlying: the integration 
of medical equipment with information technology (IT) 
systems.31 This interface is an aspect that deserves to be 
further discussed since it has several well-known clinical 
benefits and improves workflow and efficiency.

IT systems produce a large amount of data that can be 
used for future needs assessment. Therefore, as a valuable 
side effect, the digitization of health services in developing 
countries will bring the decision-makers the data needed 
for evidence-based strategic investment decisions. 

Projects that want to strengthen the sustainability of 
health services through medical technology procurement 

cannot be considered pure MDs procurement since other 
soft components such as “change management” are es-
sential for their successful implementation, which usually 
is spread over several years and requires a joint effort of 
the beneficiaries with the implementing agencies. 

CONCLUSION

There are different definitions of sustainability in MD 
procurement within the UN system. The definitions used 
by the four main agencies in health procurement (UNICEF, 
UNOPS, WHO, and UNDP) are centered on environmental, 
social and economic sustainability, in the sense of the 
environmentally friendly quality of the MD, the socially 
acceptable conditions of its production and its economic 
impact on local communities.

Nevertheless, the attention to the long-term use of a 
MD is essential to its sustainability and will be achieved 
by considering aspects related to environmental, social, 
and economic development in addition to its impact on 
health services. 

Selecting equipment that meets the beneficiary needs, 
the human resources capacities, and the local infrastruc-
ture conditions while considering its lifelong use brings 
to the health services much more benefits and is more 
sustainable than focusing only on the quality of the equip-
ment itself. The technical lead in a procurement project is 
responsible for introducing and strengthening the analy-
sis of the needs, the local conditions, and the conditions 
that can guarantee optimal use of the equipment during 
its lifespan. These analyses are the foundation that will 
guarantee a sustainable and efficient design of the equip-
ment list, the technical specifications, the installation and 
training requirements, and the post-sales services, all in 
line with local conditions and capacities. No solution fits 
all. Each MD procurement project should be tailored to 
the local situation and the project’s framework.

In an internationally funded project, the technical lead 
working for the implementation agency must establish a 
technical dialogue with the beneficiary to understand lo-
cal needs and peculiarities and propose tailored solutions 
based on international sustainable standards adapted to 
the context. This technical dialogue is also a key factor for 



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Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

knowledge transfer and will strengthen the local technical 
capacities to plan new projects.

Once the needs assessment is completed, the project’s 
objective will be defined; therefore, all the effort during 
the implementation phase should be spent on keeping 
coherence with the specified objective. Once the project is 
completed, measuring the impact of the MD purchase on 
health services by determining how much of the project’s 
aim has been achieved will provide lessons learned to 
guide future purchasing projects. Examples of ‘’outcomes 
performance indicators include cost effectiveness, compli-
ance level, and client satisfaction and service leadership.’’32

Considering a project’s critical factor (correlation 
between the invested amount of money and the impact 
on the healthcare system) means investigating the needs, 
planning the objectives, and quantifying the outcome. 
Therefore, evaluating the project’s sustainability as the 
gain produced by its implementation is possible. A critical 
factor with a positive impact can be achieved by ensur-
ing that the project’s objectives are built on the available 
country’s evidence data to reach a planned outcome that 
can be measured at the end of the project. This implies 
a deep technical dialogue with the local beneficiary and 
will enrich the beneficiary’s technical capabilities and 
the knowledge of the implementing agency about the 
local situation.

The SDGs can therefore be achieved by maintaining a 
strict coherence between any project’s objective (or intended 
outcome) and the activities during its implementation. 
Careful planning addressing sustainability issues before 
the execution of the project is a fundamental recommen-
dation. Still, in practice it often conflicts with the schedule 
and pressure to implement the project within a specific 
timeframe linked to the loan and political conditions. 

On the other hand, investments in capacity building, 
health technology management and infrastructure could 
significantly improve existing medical equipment effi-
cacy in a sustainable way, saving the costs of production 
and shipping of new equipment.33 according to UNDP, 
“in order to preserve a healthy environment and human 
well-being, there is a recognized need to move away from 
overconsumption, waste and ecological harm”34 which is 

especially true and applicable in the context of MD sus-
tainable procurement.

CONFLICT OF INTEREST

The authors declare no conflict of interest regarding 
the publication of this paper.

REFERENCES
1. United Nations. The 17 goals | sustainable development. 

United Nations. Retrieved April 8, 2023. Available at: 
https://sdgs.un.org/goals.

2. Rasanathan K, Diaz T. Research on health equity 
in the SDG era: the urgent need for greater focus 
on implementation. Int J Equity Health. 2016 Dec 
9;15(1):202. Available at: https://pubmed.ncbi.nlm.
nih.gov/27938374/.

3. DiPrete Brown L, Miller Franco L, Rafeh N et al. Quality 
Assurance of Health Care In Developing Countries. Quality 
Assurance Methodology Refinement Series.1-33. Avail-
able at: https://pdf.usaid.gov/pdf_docs/pnabq044.pdf.

4. Russell S, Ability to pay for health care: concepts and 
evidence, Health Policy and Planning 1996; 11(3); 
219–237. Available at: https://doi.org/10.1093/
heapol/11.3.219.

5. One Planet Network. Sustainable Health in Procure-
ment Project Annual Report 2020 is here. Kumwenda 
R (Dr), Wilburn S.; 2021 May 18. Available at: https://
www.oneplanetnetwork.org/news-and-events/news/
sustainable-health-procurement-project-annual-
report-2020-here.

6. UNDP. Sustainable procurement: United Nations De-
velopment Programme. UNDP. Retrieved April 8, 2023. 
Available at: https://www.undp.org/procurement/
sustainable-procurement.

7. Peña Hernandez A, L, Rosenström E, Can addressing 
asymmetrical information gaps be an approach towards 
sustainable public procurement. Blekinge Institute 
of Technology. 2017. Available at: https://www.diva-
portal.org/smash/get/diva2:1115465/FULLTEXT02.

8. Project management. The Triple Constraint in Project 
Management: Time, Scope & Cost. Jason Westland; 2022 Jan 

https://sdgs.un.org/goals
https://pubmed.ncbi.nlm.nih.gov/27938374/
https://pubmed.ncbi.nlm.nih.gov/27938374/
https://pdf.usaid.gov/pdf_docs/pnabq044.pdf
https://doi.org/10.1093/heapol/11.3.219
https://doi.org/10.1093/heapol/11.3.219
https://www.oneplanetnetwork.org/news-and-events/news/sustainable-health-procurement-project-annual-report-2020-here
https://www.oneplanetnetwork.org/news-and-events/news/sustainable-health-procurement-project-annual-report-2020-here
https://www.oneplanetnetwork.org/news-and-events/news/sustainable-health-procurement-project-annual-report-2020-here
https://www.oneplanetnetwork.org/news-and-events/news/sustainable-health-procurement-project-annual-report-2020-here
https://www.undp.org/procurement/sustainable-procurement
https://www.undp.org/procurement/sustainable-procurement
https://www.diva-portal.org/smash/get/diva2
https://www.diva-portal.org/smash/get/diva2


Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

J Global Clinical Engineering Vol.5 Issue 3: 2023  38

17. Available at: https://www.projectmanager.com/blog/
triple-constraint-project-management-time-scope-cost.

9. Bloom D E, Canning D, The Health and Wealth of Nations. 
Science 287. 2000. 1207-1209. Available at:https://www.
science.org/doi/abs/10.1126/science.287.5456.1207.

10. United Nations. Goal 3 | Department of Economic and 
Social Affairs. United Nations. Retrieved April 8, 2023, 
Available at: https://sdgs.un.org/goals/goal3.

11. Mcintyre D, Meheus F, Røttingen JA. What level of 
domestic government health expenditure should we 
aspire to for universal health coverage? Health Econ 
Policy Law. 2017 Apr;12(2):125-137. Available at: 
https://doi.org/10.1017/S1744133116000414.

12. OECD. Boosting investment in health systems will be 
essential to deal with future shocks, says OECD. OECD; 
2023 February 23. Available at: https://www.oecd.org/
newsroom/boosting-investment-in-health-systems-
will-be-essential-to-deal-with-future-shocks.htm.

13. OECD. OECD Health Statistics 2022. OECD. Available 
at: https://www.oecd.org/els/health-systems/health-
data.htm.

14. Präg P, Mills M, Wittek R, Income and Income Inequality 
as Social Determinants of Health: Do Social Comparisons 
Play a Role?, European Sociological Review, Volume 
30, Issue 2, April 2014, Pages 218–229, Available at: 
https://doi.org/10.1093/esr/jct035.

15. Sambo L G, Simões J, Do Rosario O. Martins M, Financ-
ing healthcare in low-income developing countries: 
A challenge for equity in health, Oxford Textbook of 
Medicine 2020; 6: 168-C2.16P62. Available at: https://
doi.org/10.1093/med/9780198746690.003.0022.

16. United Nations. The 17 goals | sustainable development. 
United Nations. Retrieved April 8, 2023, Available at: 
https://sdgs.un.org/goals.

17. United Nations. Goal 3 | Department of Economic and 
Social Affairs. United Nations. Retrieved April 8, 2023, 
Available at: https://sdgs.un.org/goals/goal3.

18. United Nations Global Marketplace (UNGM). Procure-
ment data by category. UNGM. Retrieved April 19, 
2023. Available at: https://www.ungm.org/Shared/
KnowledgeCenter/Pages/asr_data_category.

19. SPHS. Sustainable Procurement in the Health Sector. 
Who we are. Retrieved April 8, 2023, Available at: 
https://savinglivesustainably.org/who-we-are.

20. Lindstrom A, Coronado-Garcia L. Sustainable Health 
Procurement Guidance Note. UNDP. March 2020. 1-62. 
Available at: https://www.undp.org/publications/
guidelines-sustainable-procurement-healthcare-
commodities-and-services.

21. United Nations Global Marketplace (UNGM). Procure-
ment data by category. UNGM. Retrieved April 19, 
2023. Available at: https://www.ungm.org/Shared/
KnowledgeCenter/Pages/asr_data_category.

22. WHO. Sustainable Procurement. WHO; April 2022. 
Available at: https://apps.who.int/gb/MSPI/pdf_
files/2022/04/Item5_11-04.pdf.

23. UNICEF. UNICEF Implements Sustainable Procurement. 
UNICEF Supply Division; September 2018. Available 
at: https://www.unicef.org/supply/sites/unicef.org.
supply/files/2019-06/sustainable-procurement-
information-note.pdf.

24. Lindstrom A, Coronado-Garcia L. Sustainable Health 
Procurement Guidance Note. UNDP. March 2020. 1-62. 
Available at: https://www.undp.org/publications/
guidelines-sustainable-procurement-healthcare-
commodities-and-services 

25. United Nations Office for Project Services Procure-
ment Group. Sustainable Procurement Frame-
work - Annex 1 to the Procurement Manual. 
UNOPS. 2021, July 1. Available at: https://content.
unops.org/service-Line-Documents/Procurement/
UNOPS-Procurement-Manual-Annex-1-2021_EN.pdf.

26. UNICEF. UNICEF Implements Sustainable Procurement. 
UNICEF Supply Division; September 2018. Available 
at: https://www.unicef.org/supply/sites/unicef.org.
supply/files/2019-06/sustainable-procurement-
information-note.pdf.

27. UNDP. Practitioner’s Guide to Sustainable Procurement. 
Available at: https://popp.undp.org/UNDP_POPP_DOCU-
MENT_LIBRARY/Public/PSU_Procurement%20Overview_
Sustainable%20Procurement.docx#:~:text=Several%20
of%20factors%20influence%20sustainable,line%20
with%20good%20financial%20management.

https://www.projectmanager.com/blog/triple-constraint-project-management-time-scope-cost
https://www.projectmanager.com/blog/triple-constraint-project-management-time-scope-cost
https://www.science.org/doi/abs/10.1126/science.287.5456.1207
https://www.science.org/doi/abs/10.1126/science.287.5456.1207
https://sdgs.un.org/goals/goal3
https://doi.org/10.1017/S1744133116000414
https://www.oecd.org/newsroom/boosting-investment-in-health-systems-will-be-essential-to-deal-with-future-shocks.htm
https://www.oecd.org/newsroom/boosting-investment-in-health-systems-will-be-essential-to-deal-with-future-shocks.htm
https://www.oecd.org/newsroom/boosting-investment-in-health-systems-will-be-essential-to-deal-with-future-shocks.htm
https://www.oecd.org/els/health-systems/health-data.htm
https://www.oecd.org/els/health-systems/health-data.htm
https://doi.org/10.1093/esr/jct035
https://doi.org/10.1093/med/9780198746690.003.0022
https://doi.org/10.1093/med/9780198746690.003.0022
https://sdgs.un.org/goals
https://sdgs.un.org/goals/goal3
https://www.ungm.org/Shared/KnowledgeCenter/Pages/asr_data_category
https://www.ungm.org/Shared/KnowledgeCenter/Pages/asr_data_category
https://savinglivesustainably.org/who-we-are
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services
https://www.ungm.org/Shared/KnowledgeCenter/Pages/asr_data_category
https://www.ungm.org/Shared/KnowledgeCenter/Pages/asr_data_category
https://apps.who.int/gb/MSPI/pdf_files/2022/04/Item5_11-04.pdf
https://apps.who.int/gb/MSPI/pdf_files/2022/04/Item5_11-04.pdf
https://www.unicef.org/supply/sites/unicef.org.supply/files/2019-06/sustainable-procurement-information-note.pdf
https://www.unicef.org/supply/sites/unicef.org.supply/files/2019-06/sustainable-procurement-information-note.pdf
https://www.unicef.org/supply/sites/unicef.org.supply/files/2019-06/sustainable-procurement-information-note.pdf
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services
https://content.unops.org/service-Line-Documents/Procurement/UNOPS-Procurement-Manual-Annex-1-2021_EN.pdf
https://content.unops.org/service-Line-Documents/Procurement/UNOPS-Procurement-Manual-Annex-1-2021_EN.pdf
https://content.unops.org/service-Line-Documents/Procurement/UNOPS-Procurement-Manual-Annex-1-2021_EN.pdf
https://www.unicef.org/supply/sites/unicef.org.supply/files/2019-06/sustainable-procurement-information-note.pdf
https://www.unicef.org/supply/sites/unicef.org.supply/files/2019-06/sustainable-procurement-information-note.pdf
https://www.unicef.org/supply/sites/unicef.org.supply/files/2019-06/sustainable-procurement-information-note.pdf
https://popp.undp.org/UNDP_POPP_DOCUMENT_LIBRARY/Public/PSU_Procurement%20Overview_Sustainable%20Procurement.docx#
https://popp.undp.org/UNDP_POPP_DOCUMENT_LIBRARY/Public/PSU_Procurement%20Overview_Sustainable%20Procurement.docx#
https://popp.undp.org/UNDP_POPP_DOCUMENT_LIBRARY/Public/PSU_Procurement%20Overview_Sustainable%20Procurement.docx#


39 J Global Clinical Engineering Vol.5 Issue 3: 2023

Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context: Part 1 - 
Background and Definitions

28. Perry L, Malkin R. Effectiveness of medical equipment 
donations to improve health systems: How much medical 
equipment is broken in the developing world? Medi-
cal and Biological Engineering and Computing. 2011. 
49(7):719-722. Available at: https://doi.org/10.1007/
s11517-011-0786-3

29. Kaufman R, Guerra-López I. Needs Assessment for 
Organizational Success. Alexandria(VA): ASTD Press; 
Feb 2013.

30. DiPrete Brown L, Miller Wordo L, Rafeh N et al. Quality 
Assurance of Health Care In Developing Countries. Quality 
Assurance Methodology Refinement Series.1-33. Avail-
able at: https://pdf.usaid.gov/pdf_docs/pnabq044.pdf.

31. Huang, E. (2021). A multi-platform information man-
agement system of total life cycle for medical equip-
ment. Global Clinical Engineering Journal, 4(1), 5–13. 
https://doi.org/10.31354/globalce.v4i1.78.

32. David Y, Jahnke E. G. (2018). Planning Medical Tech-
nology Management in a Hospital. Global Clinical 
Engineering Journal, (1), 23–32. Available at: https://
doi.org/10.31354/globalce.v0i1.23

33. Perry L, Malkin R. Effectiveness of medical equipment 
donations to improve health systems: How much medical 
equipment is broken in the developing world? Medi-
cal and Biological Engineering and Computing. 2011. 
49(7):719-722. Available at: https://doi.org/10.1007/
s11517-011-0786-3

34. Lindstrom A, Coronado-Garcia L. Sustainable Health 
Procurement Guidance Note. UNDP. March 2020. 1-62. 
Available at: https://www.undp.org/publications/
guidelines-sustainable-procurement-healthcare-
commodities-and-services

https://doi.org/10.1007/s11517-011-0786-3
https://doi.org/10.1007/s11517-011-0786-3
https://pdf.usaid.gov/pdf_docs/pnabq044.pdf
https://doi.org/10.31354/globalce.v4i1.78
https://doi.org/10.31354/globalce.v0i1.23
https://doi.org/10.31354/globalce.v0i1.23
https://doi.org/10.1007/s11517-011-0786-3
https://doi.org/10.1007/s11517-011-0786-3
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services
https://www.undp.org/publications/guidelines-sustainable-procurement-healthcare-commodities-and-services

