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Received October 10, 2023, accepted November 21, 2023, date of publication December 1, 2023

Sustainable Procurement of Medical Devices in an 
International Context - Part 2
Needs Assessment
By Valerio Di Virgilio1, Alexia Bouchard Saindon2, Francisco Becerra Posada2

1 Università degli studi La Sapienza, Roma

2 United Nations Office for Project Services (UNOPS)

ABSTRACT

Background and Objectives: This article describes how sustainable procurement of medical devices (MDs) can be implemented 
in operational projects in developing countries. It also further details how sustainability principles and the needs assessment 
can be applied by the biomedical/clinical engineer lead (BCEL) responsible for the technical and quality aspects of the procure-
ment process of MDs. It also emphasizes the importance of the BCEL considering the country’s or region’s specific healthcare 
context when working on MD procurement projects in developing countries.
Material and Methods: Based on the author’s experience of more than 20 years in procurement projects and implementation 
of MDs in developing countries, the role of the BCEL will be analyzed from a theoretical point of view with the description of 
the first pillar of a sustainable purchase, the needs assessment, to how it can be operationally applied through the analysis of 
relevant literature, case studies and lessons learned from past projects.
Results: The BCEL has a key role in the sustainable procurement of MDs as an integrator able to understand clinical needs and 
translate them into requirements while being aware of the sustainability and safety risks linked to technology implemented in 
the fragile environment of a developing country with limited resources. 
This context also creates additional challenges that can be managed if the BCEL is conscious of the country’s health expenditure, 
geopolitical, healthcare, model of care, regulatory, infrastructure, and logistical conditions in which the MDs will be installed. Many 
equipment may remain unused if the technology implementation is not in line with the needs of the beneficiaries. Therefore, a 
thorough needs assessment performed by the BCEL to obtain the detailed list of MDs, their technological level and estimated 
budget is of utmost importance to increase the project’s sustainability and mitigate the risk of unused MDs.
Conclusion: Besides traditional disciplines in biomedical and clinical engineering, the BCEL shall also learn at least basic prin-
ciples in public health, healthcare planning, project management, health infrastructure, and development aid to facilitate the 
dialogue with stakeholders based on knowledge, flexibility, and capacity to anticipate and solve practical issues on the ground. 
To this extent, it is advisable for a BCEL new to the environment of developing countries to have progressive exposure to more 
complex projects and to extensively use the peer review mechanism to assure sustainability and quality during project imple-
mentation. A theoretical background based on sustainable procurement principles, analysis of the local and national health 
context and regulations, and knowledge of lessons learned from past projects should guide the BCEL’s approach to performing 
the needs assessment while implementing a new project.

Keywords – Medical device procurement, sustainable procurement, needs assessment, health services in developing countries, 
quality assurance, sustainability, Biomedical/Clinical Engineer role, international health procurement.

Copyright © 2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
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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19 J Global Clinical Engineering Vol.6 Issue 1: 2023

Di Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context - Part 2 

INTRODUCTION

In a previous article,1 the concept of sustainable 
procurement of MDs has been discussed, and its impor-
tance regarding health services of developing countries 
emphasized. Public investments in MDs aim to improve 
health services and, thus the population’s health. This 
creates a virtuous circle where a healthier population 
improves the economy, which translates into a better 
investment return. In this framework, the sustainability 
aspect in MD procurement projects has been defined as 
the critical factor that transforms financial resources into 
results: improved population health and wealth. This is 
particularly important in low-income countries (LIC) 
where healthcare financial resources are often scarce, 
and deciding where to invest them is paramount. An un-
successful project, where for example, funds are spent to 
purchase equipment that is not needed or not efficiently 
used, can disrupt the virtuous circle by creating a major 
financial debt, which brings more poverty and, thus the 
population to a more fragile status.1 The sustainability 
of MD purchasing projects is therefore intimately linked 
to their resulting impact on the population as well as the 
economy of the country. Therefore, the appropriate and 
efficient use of the purchased devices should be at the 
center of the efforts of the BCEL.

The concept of the three essential pillars to achieve 
sustainable procurement of MDs has been proposed as 
central to preventing the risk of purchasing equipment 
that will not be properly and efficiently used. This concept 
outlines the importance of concentrating the technical 
effort in assessing (1) the needs, (2) the local condi-
tions, and (3) the conditions for the lifelong use of the 
MD. Consequently, technical decisions along the project 
should be strictly coherent with the results of these three 
assessments and the resulting planned project impact 
and objectives to guarantee the sustainable use of the 
purchased devices. 

The objective of this article is to detail further how the 
first pillar for sustainability, the needs assessment, can be 
implemented in procurement projects within the environ-
ment of developing countries. The context of LIC creates 
additional challenges regarding MD procurement such as 
limited clinical, technical, and financial resources which 

need to be considered, especially during the introduction 
of complex MDs. The BCEL has a key role in facing these 
challenges and ensuring the project’s sustainability. The 
responsibility and recommended actions that the BCEL can 
take in these circumstances are discussed and analyzed 
using examples from implemented projects. 

DEFINITION AND CONTEXT OF SUSTAINABLE 
PROCUREMENT OF MDS

The concept of the three pillars to achieve sustainable 
procurement of MDs1 is an addition to the social, eco-
nomic, and environmental considerations that are widely 
included in the policies of the four UN agencies mainly 
responsible for MD purchase: WHO,2 UNICEF,3 UNDP.4 

and UNOPS.5 The sustainability concept of a purchase 
shall be primarily linked to the use of the MD and only 
secondarily to its social, economic, and environmental 
impact. In fact, if the purchased MDs are unfit for purpose 
or wrongly installed and unused, they shall not be con-
sidered sustainable even if they are compliant to certain 
social, economic and/or environmental sustainability 
standards. A low environmental impact is unacceptable 
if the MD is not fit-for-purpose and brings no benefits 
(EG1 and Figure 1).

FIGURE 1. The refrigerator, is too large to be used by a small 
AIDS prevention laboratory in a Central Asian country.



Di Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context - Part 2 

J Global Clinical Engineering Vol.6 Issue 1: 2023  20

EG1 The purchase of a medical refrigerator meeting 
certain sustainability criteria such as durable material 
composition without ozone contaminants, high energy 
efficiency, reduced and recyclable packaging, ISO 13485 
certification, and purchased at the best price available on 
the international market, faces risks to be unsustainable 
if the needs assessment was not correctly carried out. The 
refrigerator is not really needed or is too large for the needs 
of the beneficiary unit creating a problem of space and 
utilization that is solved with its early disposal.

The context in developing countries creates additional 
challenges in the procurement of MDs. According to WHO: 
“in the Sub-Saharan Africa region, a large proportion (up 
to 70%) of equipment lies idle due to mismanagement of 
the technology, acquisition process, lack of user-training 
and lack of effective technical support.’’6 Another study 
reported an average of 38.3% of out-of-service medical 
devices (MD) in developing countries due to a lack of train-
ing, health technology management, and infrastructure.7 

EG2 In an important procurement process managed by 
the Honduras Social Security Institute in 2011 and revised in 
2014, it was found that about 20% of the purchased goods 
had not been used within 3 years from their installation 
while an additional 10% was seldom used. 

Developing countries conditions

The main conditions that a BCEL shall consider during 
the assessment of a new project in a developing country are: 
1. Health expenditure conditions; 
2. Geopolitical conditions; 
3. Pre-existing healthcare conditions;
4. Model of care;
5. Infrastructure and logistical conditions;
6. Regulatory conditions.

Health expenditure conditions: the per-capita health 
expenditure (Figures 2 and 3) linked to the availability 
of human and material resources gives an overview of 
the economic conditions of each developing country. 
Low health expenditure is associated with few or limited 
trained medical and technical resources that might impact 
the technological level of the MDs to be purchased. It can 

also limit the availability of consumables and spare parts 
on the local market and cause a lack of tools and knowl-
edge to repair the MDs. A BCEL shall, therefore, consider 
that even when a budget is available for the purchase of 
MDs, funds for their consumables or maintenance might 
not be available in the long run and might compromise 
their efficient use. 

The huge gaps in per-capita health expenditure between 
the different regions of the world also hide important 
gaps inside a particular region. For example, in the Latin 
America and Caribbean region, the health expenditure 
has a mean value of 594 USD. Still, when countries of 
this region are taken individually, there is a great vari-
ance between the Bahamas which has an expenditure 

FIGURE 2. Worldwide health expenditure per-capita (US$).8

FIGURE 3. Health expenditure per-capita (US$) in Latin America 
and the Caribbean region.8



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Di Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context - Part 2 

similar to Europe & Central Asia, and Haiti, which has an 
expenditure similar to the poorest countries of Africa and 
South Asia, (Figure 2). 

While per-capita and public health expenditure can 
estimate a country’s effort to manage healthcare and 
improve universal health coverage, life expectancy is to 
be considered as a parameter that can roughly summarize 
the results of this effort, not considering other factors 
like lifestyle, socioeconomic, and genetics. It can be ob-
served that the higher the health expenditure per-capita 
the higher the life expectancy of the country (Figure 4) 
with some interesting exceptions like the US where the 
health expenditure is mainly out of pocket, leading to less 
efficient use of the expenditures and the countries where 
per-capita annual expenditures go below $400. Over time, 
as countries invest more money in healthcare, the life 
expectancy of their population increases (Figure 5): “on 
average, a 10% increase in health spending per-capita is 
associated with a gain of 3.5 months of life expectancy.”9

Geopolitical conditions: tense geopolitical conditions 
in countries affected by war zones, territories controlled 
by rebel or criminal groups, and high criminality zones 
might complicate the delivery of equipment or the travel 

of technicians to perform the installation or the repair 
of MDs. In those cases, the delivery of the equipment or 
the maintenance technicians’ access may require a police 
or military escort and pose additional challenges to the 
project.

Pre-existing healthcare conditions: available in-
formation on the local healthcare system, such as mor-
tality/morbidity rates as well as health statistics on the 
population published by WHO11 and data on the present 
workload and activity of the beneficiary center(s) sup-
porting the assessment of the context in which the MDs 
will be implemented. 

Model of care: different countries have different 
organizations and operationalization of health services, 
including different referral systems, processes of care, 
providers’ organization and services management. These 
differences directly impact the distribution of technologies 
in the health infrastructures according to their complexi-
ties. It is recommended that the BCEL adopts the vision 
of a supply chain: a patient with a specific disease can be 
progressively attended to in infrastructures of different 
levels according to the diagnosis of the severity of the 
illness, and thus, the complexity of the technology shall 
be planned accordingly.

Infrastructure and logistical conditions: Delivery 
of MDs in remote areas can be difficult due to poor road 
conditions or accessibility by boat only. Remote areas 
might also have limited or no access to reliable electrical 
or water resources, which might affect the utilization of 
MDs.12

Regulatory conditions: The BCEL working in devel-
oped countries is usually part of a multidisciplinary team 
including medical planners, clinical experts, architects, and 
engineers with an exhaustive background of norms, regula-
tions, and guidelines. In opposition, the BCEL working in 
developing countries has to cope with a multidisciplinary 
team that is significantly reduced or sometimes absent in 
a context of international rules and regulations that may 
not apply to fragile contexts.

The presence of a local National Regulatory Authority 
(NRA) in the country and its level of maturity as defined 
by WHO facilitates the understanding and implementation 

FIGURE 4. Life expectancy versus health expenditure per-
capita in 2019.10



Di Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context - Part 2 

J Global Clinical Engineering Vol.6 Issue 1: 2023  22

of national regulations and the acceptance (or not) of in-
ternational standards in MDs procurement projects. The 
efforts of WHO and the Pan American Health Organization 
(PAHO)13 to improve the capacities of NRAs in develop-
ing countries shall also be considered and monitored as 
part of the BCEL action in MDs procurement projects. The 
BCEL shall also be aware of the WHO Listed Authority,14 
which will assess and classify the maturity level of NRAs 
based on a transparent and objective set of indicators 
established in the WHO Global Benchmarking Tool.15

The role of the BCEL

When a procurement project of MDs for an LIC is assigned 
to the BCEL, he should always consider the beneficiary 
country’s conditions during all project steps. In fact, the 
knowledge and consideration of the local health realities is 
essential to ensure a sustainable result of the procurement 
process and, finally the purchase of sustainable MDs that 
will meet the needs of the local beneficiaries in the long 
term. The role and expertise of the BCEL are crucial in 
addressing the challenges related to the implementation 
of MDs and the promotion of sustainable procurement 
practices in developing countries. BCELs with adequate 
experience should participate right from the start of the 
planning phase of an MD procurement project to ensure 
that sustainability criteria will be considered. 

THE NEEDS ASSESSMENT

The first pillar of sustainability is the needs assessment, 
which involves investigating the demand and the intended 
use of the MD requested by the beneficiary. Considering 
the user’s needs is a central concept in the procurement 
process definitions of the 4 main UN agencies procuring 
MDs. WHO states that the benefits of good procurement 
include: “the most economically advantageous terms for 
the equipment acquired – not necessarily the lowest price 
obtained through tender, but the best deal for the organi-
zation’s needs” and defines the needs assessment as the 
“quantification of gaps between desired health service 
provision and the current situation”.16 UNICEF and UNDP 
also include the importance of meeting the needs of the 
end-user and the “fit-for-purpose” concept17 in their pro-
curement processes: “The selected offers from a competitive 
tender should display the optimum combination of quality, 
whole life cost, effectiveness, and other factors such as so-
cial, environmental and other strategic objectives, to meet 
end-user needs.”18 UNOPS also mentions to “Re-consider 
the needs, i.e. consider specifically whether those goods or 
services need to be purchased.”19 According to the clinical 
engineering handbook,20 the first step in the planning 
phase of MDs acquisition projects is “Demonstrated needs 
and benefits”. Effective and sustainable procurement is 
thus based on getting the right goods to respond to the 
needs. In fact, the whole procurement process is based 
on a needs assessment as its essential starting point.
Public investment in MDs through the implementation 
of an international purchasing process is a long journey, 
and as “most journeys we take are considered successful if 
we arrive at the right place, at the right time, and in good 
condition. The “right place” is vital. Identifying where you 
should head and justifying why you should get there will 
provide you with the critical data upon which to do plan-
ning, design, development, implementation, and monitoring 
and evaluation.”21 

The objective of the needs assessment

The final objective of an MD procurement project is the 
intended impact on population health. Thus, the needs 
assessment’s objective has to align with this intended 
impact on patient care.

FIGURE 5. Life expectancy versus healthcare expenditure per-
capita from 2000 to 2019 in Latin America and the Caribbean 
region.10



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It is important to clarify that the objectives and impact 
of an MD procurement project shall be designed and mea-
sured by clinical variables such as the number of patients 
treated or the reduction of waiting lists, rather than by 
the amount of equipment or money spent during the 
project. Therefore, performing a thorough needs assess-
ment to define the project’s objectives and identify the 
clinical variables upon which the project’s success will be 
measured is essential. The project’s objectives and clini-
cal variables shall also be defined based on the country’s 
health policy and statistics22 as well as on the analysis of 
the context as developed in chapter 2.1. When possible, 
it is recommended to involve, right from this initial step 
of the project, the beneficiary country’s health personnel 
that has, at different levels, a deep knowledge of the local 
technical capacities, conditions, and needs.

The role of the BCEL in the needs assessment

A medical planner usually carries out the analysis of 
the clinical needs along with the establishment of the 
project’s clinical objective. The BCEL has to understand 
the clinical objectives and the process that has been car-
ried out to define them by dialoguing with the medical 
planner. Therefore, the BCEL should deeply understand 
healthcare systems in developing countries and their 
dynamics. Profound knowledge of the healthcare needs 
and the locally and internationally available commercial 
solutions are essential for the BCEL to evaluate and pro-
pose technological solutions for the assessed clinical needs 
and objectives. Starting from this essential dialogue with 
the medical planner, the BCEL can complete the needs as-
sessment by defining the objectives of the procurement 
process in terms of technologies. Based on the planned 
clinical activities and workloads, the BCEL can determine 
the equipment list. In fact, an equipment type that may 
be included in the list corresponds to an equipment class 
that requires a technological-level definition to associate 
the expected clinical throughput with its estimated value 
and technical requirements in terms of space, installation, 
electricity, etc.

EG3 A 20L tabletop autoclave used to sterilize labora-
tory equipment performing a few analyses per day is tech-
nologically much different and less complex than a 500L 
pass-through autoclave of a surgery center, requiring more 

complicated installation steps. Still, often they are simply 
referred to as autoclaves in the purchasing lists provided 
to the BCEL. 

To define the project objectives, the needs assessment 
should be analyzed, validated, and updated in the plan-
ning phase of the procurement process. All stakeholders 
must be involved in the needs analysis, which must be as 
detailed and complete as possible. The scope of this as-
sessment should also include present and future needs in 
a 5 to 10-year projection. By focusing on the specific use 
of the device, the procurement process can be tailored to 
meet the needs of the beneficiaries and select the most 
adequate equipment. The quality of the MD procurement 
process can be maximized when all the actions of the BCEL 
are coherent with the project’s objectives.

In the planning phase of a procurement project, the 
BCEL should also consider the following conditions as 
recommended by the clinical engineering handbook: 

‘’1. Demonstrated needs and benefits of the MDs
2. Available qualified users 
3. Approved and reassured source of recurrent operat-

ing budget 
4. Confirmed maintenance services and support 
5. Adequate environment support 
6. Regulatory compliance’’20

Analyzing these conditions before purchasing the 
equipment allows the BCEL to prevent potential issues 
related to the use of the MD. These conditions are also 
included as part of the three pillars of sustainability. This 
process results in adequate equipment that meets the 
beneficiary’s needs and thus is more likely to be used by 
the clinical personnel (Figure 6). To perform a proper 
needs assessment, the BCEL should always involve the 
clinical end-user as stakeholders and purchase MDs and 
services from local manufacturers whenever possible.

The sustainability risks related to a weak needs 
assessment

A reliable needs assessment conducted under the 
responsibility of the BCEL is, therefore, the central point 
of an effective health procurement process. It also helps 



Di Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context - Part 2 

J Global Clinical Engineering Vol.6 Issue 1: 2023  24

minimize sustainability risks, such as insufficient adequacy 
between the clinical personnel’s needs and the purchased 
MD’s characteristics, compromising its usage. However, 
this analysis can sometimes be difficult to achieve due to 
the following pitfalls:

• Inadequate involvement of the relevant stakehold-
ers in the project is caused either by the difficulty 
of implicating all the necessary stakeholders in the 
needs analysis, deficient identification of the clinical 
beneficiaries, or lack of consideration of the position 
of the beneficiaries in the health system network.

• An outdated needs analysis caused by a significant 
delay between the completion of the analysis and the 
official launch of the project or by a change of the 
actors or some of their characteristics (evolution of 
the private sector, new government, new strategies 
in the distribution of health services, change in the 
clinical team, etc.).

• A short-term needs assessment does not consider 
future needs caused by an analysis that considers only 
the current necessities and lacks to foresee future 
perspectives for at least the next 5-10 years related 
to the new etiologies of diseases and the emergence 
of new diagnostic and therapeutic needs.

Depending on the project’s starting point when the 
BCEL begins to be involved, the needs assessment may 
be included or not in the project scope. The projects 
that start from a list of MDs and technical specifications 
already defined are considered “purely transactional.” 
They can be considered high-risk projects since the pro-
curement project is separated from the needs analysis 
and the evaluation of the impact of the purchase on the 
local healthcare system. Implementing these transactional 
projects represents a high risk to the sustainable impact 
of the procurement project because no one in the proj-
ect team is responsible for ensuring that the MDs to be 
purchased are genuinely needed and that the local condi-
tions allow for their efficient use. The clinical needs are 
unknown to the project team, and the coherence of the 
implementation is jeopardized. Other types of projects, 
such as those where the dialogue between the BCEL and 
the medical planner who defined the clinical objectives 
is impossible, and has moderate risks. These risks shall 
be mitigated by the BCEL, which can revise and validate 
the medical planner’s analysis when possible or at least 
the clinical objectives, focusing on the purchase of MDs.

Case studies

In the following discussion, 2 case studies of projects 
implemented in the Latin America and Caribbean region, 
one in Uruguay and the other in Haiti, representing extremes 
in terms of per-capita health expenditure differences in 
the region, will be presented. Uruguay has a high health 
expenditure and a mature public health system with 
established capacities to understand and properly use 
the funding for capital investment in MDs. On the other 
hand, Haiti has minimal health planning capacities and 
lacks technical experts. 

In 2008, in Uruguay, as part of a project funded by 
a soft loan from Italian corporations, 34 types of MDs 
were purchased and destined for more than 300 health 
centers nationwide.23 The needs assessment process car-
ried out before the beginning of the project has been an 
example of good practice of sustainability (Figure 7). The 
project’s agreement stated the general objective: “Sustain 
the capacity of the Uruguayan Public Health System to 
meet the population’s needs while prioritizing the most 
vulnerable groups.” 

FIGURE 6. Description of the three main activities for each 
needs assessment deliverables that the BCEL shall focus on.



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This process, carried out transparently with an out-
standing maturity by the central office of the Ministry of 
Health in contact with the regional directors, has produced 
the expected results: each center was aware and prepared 
to receive the equipment from the loan investment. The 
BCEL validated the needs assessment carried out by the 
beneficiary and assured coherence of the purchase with 
the needs assessed. 

In 2012, in Haiti, during the design phase of the con-
struction and medical equipment procurement project of 
the Gonaives hospital, no local medical counterpart was 
involved (Baio A. Gonaives Hospital Project - Raising from 
destruction - The challenge of building in Haiti - Interna-
tional Federation of Hospital Engineering. Buenos Aires, 
October 15th, 2014). The only person from the Haitian 
Ministry of Health participating in the technical dialogue 
was the recently appointed, but not yet contracted, direc-
tor of the new hospital. In this case, the BCEL had to plan 
a methodology to define the list of equipment since no 
dialogue with the clinical beneficiary could plan medical 
equipment adequate to the intended level of care and 
size of the hospital (a regional hospital with a 200-bed 
capacity). To mitigate this risk, a workshop was organized 
involving all the stakeholders working on MDs in the 

country. This workshop resulted in a scheme to follow for 
the definition of the equipment list, primarily oriented 
towards implementing simple technologies to facilitate 
local maintenance (Figure 8). For example, manual op-
eration tables rather than electrical ones were chosen to 
allow for ease of use and maintenance.

FIGURE 7. Methodology of the needs assessment of the project “Italian Loan to support Uruguayan Health Services” implemented 
in 2008, starting from the project’s objectives definition and ending with the types of equipment included, the list of equipment 
requested by the beneficiary centers and its adjustment to meet the available budget.

FIGURE 8. Health Technology Management Scheme (Nunziata 
E. Technical workshop on MDs - towards health technology 
management in Haiti. Haiti, June 15th 2012).



Di Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context - Part 2 

J Global Clinical Engineering Vol.6 Issue 1: 2023  26

The demand for local maintenance support was solved 
during the tender process by asking the suppliers to 
establish a maintenance center in the country (at that 
time, no maintenance capacity - private or public - were 
present in the country). To help suppliers comply with 
this challenging requirement, the contracting authority 
included a financial incentive: an important advanced 
payment during the procurement process. Eight local 
technicians were also hired and trained under the guid-
ance of international technical experts to open packages, 
assemble, and install all the hospital furniture purchased. 
At the end of the project, the hospital could recruit trained 
technicians as maintenance employees. This also reduced 
the costs for suppliers since they did not have to travel to 
Haiti to assemble the purchased furniture.

In both case studies, a component of the procurement 
project was focused on strengthening local technical ca-
pacities in terms of equipment maintenance to improve 
the project’s sustainability. In Uruguay, maintenance 
tools were purchased and provided to regional hospitals 
where biomedical engineers trained during the project 
execution could use them to maintain and repair MDs.23 

In Haiti, training and tools for medical furniture repair 
was provided to local technicians, and an incentive for 
international suppliers to establish local maintenance 
centers was added to the procurement project. As a les-
son learned, improving and strengthening local technical 
capacities is strongly recommended as an objective of MD 
procurement projects in developing countries to enhance 
sustainability. 

CONCLUSION

Sustainability is essential in implementing an interna-
tionally funded project in a developing country to procure 
MDs. This factor determines if the project will improve 
the population’s health conditions or the country’s im-
poverishment.1 Sustainable procurement of medical 
devices shall be driven by the BCEL using the framework 
of the three pillars: assessing (1) the needs, (2) the local 
conditions, and (3) the conditions for the lifelong use of 
the MD. The BCEL is responsible for ensuring the quality 
of the project’s results and, thus, its sustainability. This 
article presented the theoretical background of the first 
pillar, the needs assessment, that the BCEL can follow as 

a guideline in the project’s planning phase. In this way, he 
can assume the responsibility for the quality assurance 
processes and the project’s sustainability while raising 
awareness of the possible issues and discussing solu-
tions with the rest of the team, the beneficiary, and the 
stakeholders to minimize the project’s risks.

An international procurement project of MDs requires 
high technical specialties in a multidisciplinary team, in-
cluding project management. The needs assessment step 
requires competencies and knowledge in public health, 
clinical aspects, hospital design, infrastructure, MDs, 
project planning, and market and technology analysis. 
The BCEL has to dialogue with several stakeholders and, 
therefore, understand and use their languages to inte-
grate their points of view, perceived risks, and suggested 
mitigation measures. A good approach for the BCEL is to 
begin the project from a risk analysis perspective. While 
different stakeholders can raise any risk, the BCEL shall 
focus on quality risks, which in the light of the previous 
discussion means sustainability risks: the main risk being 
the investment of money in the purchase of MDs that are 
not or scarcely used because they do not respond to the 
needs of the beneficiary. During the analysis, the BCEL can 
integrate different viewpoints and brainstorm possible 
prevention and mitigation measures.

Considering sustainability as the center of their activ-
ity and responsibility, the BCEL’s role in a project is much 
more important than simply writing technical specifica-
tions or performing technical evaluations. Therefore, 
the BCEL needs thorough professional preparation and 
progressive exposure to the complexity and the issues 
specific to the context of developing countries. In this 
sense, the peer review mechanism is a tool commonly 
used in organizational processes to assure higher quality 
in project implementation and the continuing education 
and professional growth of BCELs interested in leading 
international procurement projects. 

When implementing a specific project, balancing the 
impact of time and budget constraints with quality assur-
ance actions is the main goal that any BCEL has to focus on. 
The needs assessment should be included in the planning 
phase of the procurement project and coordinated by the 
BCEL, which can integrate the different stakeholders’ points 
of view. The assessment of sustainability risks performed 



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Di Virgilio, Bouchard Saindon, Becerra Posada: Sustainable Procurement of Medical Devices in an International Context - Part 2 

during the project’s planning phase allows the BCEL to 
identify the challenges and evaluate the potential risks 
that could impact the project’s outcome. 

CONFLICT OF INTEREST

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

ACKNOWLEDGMENTS

The authors would like to thank Antonio Baio, Enrico 
Nunziata, Cristina Nocetti and Federico Klappenbach for 
contributing to the examples and figures presented in 
this article and for the constructive technical discussions 
during project implementation.

REFERENCES
1. Di Virgilio, V., Bouchard Saindon, A., & Becerra Posada, F. 

C. G. (2023). Sustainable procurement of medical devices 
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