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Received March 12, 2025, accepted May 30 2025, date of publication July 14 2025.

Original Research Article 
Sustainable Procurement of Medical Technologies: Equipping 85 
Modular Healthcare Systems in Argentina

Valerio Di Virgilio1,*, Pedro Enrique Garrigou2, Ignacio Lacasta Casal2, Patricia Mariana Crego2, Miguel Alejandro Bruzzo2

1 Department of Computer, Control, and Management Engineering, University of Rome Sapienza, Rome, Italy.
2 United Nations Office for Project Services, Buenos Aires, Argentina.

* Corresponding Author Email: v.divirgilio@diag.uniroma1.it

ABSTRACT

Context and objectives: This article presents the planning, construction, and equipping of 85 modular healthcare systems 
(MHS) in Argentina as a medium-term response to the pandemic emergency. The objective is to describe the implementation 
and analyze the results of this large-scale national project and its investment component for the acquisition of hospital equip-
ment, highlighting the design, outcomes, and lessons learned in the process with a focus on long-term sustainability. Materials 
and methods: Nine different phases of the implementation process of the project are described and analyzed as components of 
the sustainable procurement methodology. Within the framework of the planning, construction, and commissioning of the NHS, 
data were collected and analyzed to qualitatively and quantitatively assess the experience of planning, designing, and procuring 
equipment for modular health centers. Data analysis was conducted by categorizing the acquired goods into active and pas-
sive medical devices (MD), furniture, support equipment, and installation equipment. Results: The analysis of the equipment 
acquired for the 85 MHS shows that the distribution of assets aligns with specific needs and follows similar patterns across all 
units. Among the 19,600 medical goods purchased, over 60% of the investment was allocated to MD, reaching 87% in centers 
with higher critical care activity. Visits to operating MHS confirmed their general functionality and user satisfaction with the 
infrastructure and equipment. Strengths identified include well-designed facilities and decentralized healthcare delivery, which 
has reduced the burden on central hospitals. At the same time, some lessons have been learned and risks identified, such as 
specific shortages of specialized personnel, minor quality issues with equipment reception, and the storage of some unused or 
little-used devices. The need for active post-delivery management was also observed as lessons learned for future large-scale 
operations. Discussion: It was highlighted that passive MD, mainly medical furniture, while accounting for 64% of the equipment, 
only represents 13% of the investment. However, their appropriate selection and maintenance are crucial for patient percep-
tion and quality of care. Furthermore, the high cost of medical technology was demonstrated by an analysis of investment per 
square meter. Conclusion: The implementation of this project focused on medical technologies, analyzing design, equipment 
investment, outcomes, and lessons for long-term sustainability. The high cost of medical technologies confirms the opportunity 
to evaluate not only the purchase price but also operational, maintenance, and disposal costs. A comprehensive approach to 
equipment planning and management is an essential requirement for sustainability and efficiency in LMICs. Evidence-based 
needs analysis, crucial for sustainable acquisition and to align the equipment with intended use, and post-implementation visits, 
crucial for continuous quality improvement, are recommended for the implementation of future projects. The presented lessons 

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Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

J Global Clinical Engineering Vol.7 Issue 3: 2025 6

learned contribute to establishing a methodological base for 
future MD procurement projects.

Keywords—Sustainable procurement, Medical devices, 
Modular hospitals, Public investment, Argentina, Results 
assessment, Project management, Medical device planning, 
Accessibility.        

Copyright © 2025. This is an open-access article distributed under the terms 
of the Creative Commons Attribution License (CC BY): Creative Commons - At-
tribution 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 permitted which does not comply with these terms.

INTRODUCTION

Since Brunel’s resilient hospital concept, based on 
prefabrication and modular construction—exemplified 
by the Renkioi Civil Hospital built in 1855,1 modular 
hospitals have significantly evolved as an architectural 
solution within healthcare design. They provide new or 
existing health facilities with the flexibility to adapt to 
changing medical care needs and public health emergen-
cies. Depending on the context, modular hospital construc-
tion may serve temporary purposes, such as increasing 
isolation units in densely populated urban areas. In other 
cases, modular expansion in existing hospitals ensures 
uninterrupted facility operations, significantly enhancing 
the efficiency of medical response.2

In Argentina, as in many other countries, modular 
healthcare systems (MHS) were rapidly developed in 
response to the COVID-19 pandemic to provide swift 
solutions and prevent overcrowding at hospitals and 
community healthcare centers. Over time, with positive 
implementation experiences, MHS has become a sus-
tainable solution3 to strengthen healthcare systems in 
the medium and long term, improving medical service 
accessibility in vulnerable areas, including penitentiary 
services, and expanding coverage in strategic locations 
such as tourist areas and border crossings.

This report is based on the experience gained since 
2020, under the “Federal Infrastructure Improvement” 
project. The United Nations Office for Project Services 
(UNOPS) was commissioned by the Secretariat of Public 
Works of Argentina, Ministerio de Obras Públicas (MOP), 
to implement 85 MHS in various locations across the 
country. The project scope followed a “turnkey” model, 
requiring UNOPS to provide infrastructure, installations, 
and material goods such as medical and general furniture, 
accessories, etc. When writing this report, 85 MHS had 
been awarded and constructed. Eighty out of 85 (94%) 
have also been equipped and are functioning. In addition, 
the project has equipped another 19 MHS, where the 
construction of the centers, installed in tourist areas, was 
the responsibility of government authorities in Argentina.

This study focuses on the equipment acquired for the 
execution of UNOPS Project 20313, detailing the procure-
ment process, quantitative and qualitative analysis of the 
equipment, and post-delivery visits to assess usage and 
impact.4

GEOGRAPHIC DISTRIBUTION AND SOCIAL IMPACT

 Argentina is a vast country with a surface area of 
3,761,274 km² and over 46 million inhabitants.5 However, 
its population distribution is unbalanced, with 92% of the 
population residing in urban areas and 70% concentrated 
in the 31 largest urban agglomerations in the country.6

The distribution of MHS under Project 20313 was car-
ried out nationwide, adapting to each area of influence, 
their specific characteristics and needs. The number of 
centers correlates to the country’s most densely populated 
regions: Buenos Aires Province (20.69 million inhabitants, 
including the capital) and Córdoba Province (3.84 million 
inhabitants). These two provinces collectively account for 
53% of the national population, where 45% of the MHS 
were constructed. Figure 1 shows the geographical dis-
tribution of the 85 centers within Argentina highlighting 
the Buenos Aires and Cordova provinces.

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7 J Global Clinical Engineering Vol.7 Issue 3 2025

Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

FIGURE 1. (A) Geographical distribution of the 85 MHS, detailing 
the centers in the provinces of (B) Buenos Aires and (C) Córdoba.

Infrastructure

Because of Argentina’s diverse geographical and 
socioeconomic characteristics, healthcare needs vary 
significantly across the country. To adapt the architectural 
designs, infrastructure, and functional integrations of the 
MHS to each specific context, the MOP technical team con-
ducted an assessment on the use of prefab solutions and 
a consequent needs assessment for each case. Adapting 
responses to particular requirements was a key element 
in ensuring project sustainability.7

Modular centers were conceived as entry points to the 
healthcare system in response to the COVID-19 pandemic. 
The different types of infrastructure provide primary, in-
termediate, or critical care services—either permanently 
or temporarily—until patients can be transferred to more 
complex healthcare facilities. Each modular center addresses 

these needs through its design and infrastructure, despite 
diverse site locations and contextual conditions.

Some MHS were designed to operate independently 
from preexisting healthcare infrastructure while still 
being integrated into the broader healthcare network. 
This was the case for centers located at border crossings 
and tourist areas. At first, these centers have outpatient 
consultation rooms, inpatient rooms, diagnostic imaging 
areas, and clinical laboratories.

An example of this model is the Modular Healthcare 
System Maldonado | HPA San Jorge | Córdoba IV, located 
12 km east of Córdoba city center, as illustrated in Figure 
2. It includes a shock room, observation beds, an inpa-
tient room, an X-ray room, consultation rooms, a clinical 
analysis laboratory, an extraction box, a nursing station, 
and a pharmacy, as illustrated in Figure 3.

FIGURE 2. MHS Maldonado, HPA San Jorge, Córdoba.

Other MHS served as support areas integrated into 
preexisting structures and operational frameworks. These 
include those annexed to existing healthcare centers or 
those that expanded medical areas within penitentiary 
facilities. 



Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

J Global Clinical Engineering Vol.7 Issue 3: 2025 8

 

FIGURE 3. Floor plan of the MHS in Maldonado, HPA San Jorge, Córdoba. 

An example of this model is the MHS at the Federal Complex Rehabilitation Center for Young Adults in Marcos Paz, 
Buenos Aires Province, as illustrated in Figure 4. 

It includes a nursing station, pharmacy, laundry, guardroom, clinical analysis laboratory, and 12 rooms, as illus-
trated in Figure 5.

A third example of an MHS, in this case, complementing a preexisting healthcare center, is MHS No. 9 in Almirante 
Brown, Buenos Aires, which directly collaborates with the adjacent Unidad de Pronta Atención (UPA) No. 5, as illus-
trated in Figure 6. 

It has been designed with a capacity of 76 beds for critical care and hospitalization, as illustrated in Figure 7.



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Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

FIGURE 4. MHS federal complex rehabilitation center for young 
adults, Marcos Paz, Buenos Aires.

FIGURE 5. MHS federal rehabilitation complex for young adults’ 
floor plan, Marcos Paz, Buenos Aires. 

FIGURE 6. MHS No. 9, Almirante Brown, Buenos Aires. A prefab 
module to complement an existing center.

FIGURE 7. MHS No. 9, Almirante Brown, Buenos Aires. A prefab 
module to complement an existing center.



Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
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METHODOLOGY

Planning, designing, and procuring the equipment of the 85 MHS have been accomplished using the PRINCE2 
methodology.8 Before project closure, a phase to analyze the results has been implemented with organization visits 
to a few centers, as samples, several months after their commissioning, to assess the results and the impact of the 
project on the healthcare system.

Several months after their commissioning and before the closure of the project, a sample visit to 10 centers has 
been carried out to analyze the project’s results.

Procurement Process

The project’s implementation considered a multistep procurement methodology:

1)Grouping the procurement process for multiple MHS according to execution timelines and type. A total of nine 
procurement processes were conducted for the 85 MHS between 2020 and 2023, as described in Table1.

# Process Number of 
Sites Year

1. Modular Healthcare Systems 11 2020

2. Modular Healthcare Systems for Penitentiary Services 6 2020

3. Modular Healthcare Systems for Penitentiary Services 12 2020

4. Modular Health Centers for Border 16 2020

5. Health Isolation Centers for Penitentiary Services 10 2021

6. Modular Healthcare Systems Phase 1 12 2021

7 Modular Healthcare Systems Phase 2 and Modular Healthcare Systems for Penitentiary Services 7 2022

8 Modular Healthcare Systems Phase 3 6 2022

9 Modular Healthcare Systems Phase 4 5 2023

TABLE 1. Nine procurement processes carried out to equip the eighty-five health centers.



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Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
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Note: For the 19 MHS where UNOPS was only respon-
sible for supplying material goods, the equipment was 
organized into five further procurement processes during 
2020 and 2021.9,10

2)Determination of requirement lists: Based on 
infrastructure analysis and functional programming, using 
the room-by-room methodology, which designs the optimal 
set of equipment and furniture for each environment, 
considering space size and internal operational workflows.

3)Consolidation of procurement needs: Grouping 
similar or identical goods into packages according to 
complexity and usage characteristics, considering the 
local and international hospital equipment markets.

4)Definition of technological level: Through continuous 
dialogue with end users, the type of technology and 
complexity level of the equipment to be acquired were 
determined.11

5)Specification of equipment requirements: To ensure 
minimum acceptable quality thresholds, procurement 
processes followed the lowest-price principle, requiring 
careful assessment of local and international markets.

6)Procurement process compliance: Adhering to the 
UNOPS Procurement Manual,12 focusing on promoting 
local production. For Class I or A medical devices (MD) (EU 
and US regulations) manufactured locally in Argentina, 
only the local regulatory agency certification: ANMAT 
was required. For higher equipment of higher complexity, 
certifications from stringent regulatory entities such as 
those in the United States, Europe, Japan, Australia, and 
Canada were required.

7)Receipt of goods by medical units and installation 
of complex equipment by suppliers.

8)Certification by the national regulatory authority 
for fixed radiological units.

9)Analysis of procurement and installation outcomes 
in 10 selected centers, as a sample of the 85 centers, with 
different characteristics.

Equipment Requirements

● MD and In Vitro Medical Devices (IVD) defined 
according to IMRDF13 were classified as active or passive.

○ Active devices: Depend on an external energy source 
(other than the human body or gravity) and modify or 
transform that energy.

○ Passive devices: Do not require an external energy 
source beyond that generated by the human body or gravity.

● Support Equipment: Items not classified as MD 
but requiring electrical power (e.g., bedpan washers, 
industrial dryers, compressors, standard refrigerators, 
and computers).

● Support Furniture: Items related to general human 
activities or medical practice support, specifically designed 
for healthcare environments (e.g., dining tables, chairs, 
stairs, and carts).

● Facilities-related equipment: Supply systems 
supporting medical equipment and patient care (e.g., 
power generators and medical gas plants).

MDs, both active and passive, were classified into four 
functional groups:

● Basic Care: Equipment used in low-complexity 
areas, mainly for screening or primary care, such as 
blood pressure monitors, hospital beds, and scales. These 
represent 75.2% of the total medical equipment acquired 
for all CMS, accounting for 24.6% of the total investment.

● Critical Care: This category includes MDs used in 
critical patient care, such as ventilators, defibrillators, 
and infusion pumps. This group constitutes 19.2% of 
the medical equipment acquired and 40.2% of the total 
investment.

● Sterilization: Equipment used to eliminate pathogens 
from medical tools and devices, which includes hydrogen 
peroxide sterilizers and dry heat sterilization ovens. It 
represents 0.36% of MD but accounts for 5.4% of the 
total investment.

● Imaging and Laboratory Diagnostics: Internal 
body images for diagnostic, prognostic, and treatment 
purposes are generated with diagnostic imaging. Because 
of the nature of these healthcare centers, the acquired 



Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

J Global Clinical Engineering Vol.7 Issue 3: 2025 12

equipment in this category includes fixed and mobile 
X-ray machines and ultrasound devices. Clinical laboratory 
equipment includes centrifuges for test tubes, microscopes, 
micropipettes, and medical refrigerators. This group 
accounts for 5.4% of the MD acquired but represents 
29.8% of the total investment, reflecting the high cost of 
imaging technology.

Results and Outcome Measurement Visits

Biomedical Engineers from UNOPS personally conducted 
results-measuring visits to the selected 10 MHS to ensure 
the effectiveness of public procurement in healthcare. 
The results measurement phase evaluated the qualitative 
and quantitative impact of investment on population 
health while identifying lessons learned for continuous 
improvement.14

As part of this framework, site visits were planned to assess 
the condition and usage of delivered medical equipment 
and collect user feedback. A sampling methodology was 
used, resulting in 10 visits. At least one modular unit from 
each of the first eight processes outlined in the Section 
“The Acquired Equipment” was inspected. However, for 
Process 9, mentioned in Table 1, the modular units had 
not been equipped, making it impossible to include them 
in the assessment. The visits were conducted in person 
by one or two biomedical engineers from UNOPS.

Phase 1: Selection of Centers and Pre-Visit Planning

Before each visit, the medical coordinator of each site 
was contacted to ensure that the information collected 
at each center was representative and sufficient. This 
way, the visit would occur at a date and time, when the 
maximum number of users (e.g., X-ray technicians and 
ultrasound physicians) were available, and full access to 
all medical equipment was granted.

Phase 2: Information Gathering

Before conducting each visit, a thorough review of 
procurement and delivery documentation was performed. 
This included the examination of published procurement 
processes, received bids, evaluations, awarded contracts, 
purchase orders, and delivery receipts. All this information 
was organized into specific templates for each center, 

facilitating traceability and serving as a reference during 
the visits.

Phase 3: Structured Interview

A structured interview approach to ensure comparable 
data collection has been used. When addressing satisfaction 
with the proposed subjects, the referents were asked 
to categorize their answer using the following options: 
strongly disagree, disagree, neither disagree nor agree, 
agree, strongly agree. The structured interview comprising 
eight questions was submitted to the director of the visited 
modular unit or the person in charge during the visit, 
resulting in a talk of approximately half an hour.

Section a: Equipment satisfaction and suitability

1. Overall satisfaction: “The received equipment in 
terms of its quality, functionality, and quantity relative to 
your experience and expectation, is satisfactory.”

2. Technology level: “The technology level of the 
received equipment meets the clinical needs of your patient 
population and the capabilities of your staff.”

3. Completeness: “The equipment was delivered with 
all necessary accessories, components, and software 
required for its intended functionality and immediate use.”

Section b: Personnel and training 

4. Presence of personnel: “The center has sufficient and 
adequate staff to use the purchased medical equipment.”

5. User training adequacy: “The training provided to 
clinical users on the operation and application of the new 
equipment was adequate and effective.”

6. Technical training adequacy: “The training 
provided to technical staff (biomedical engineers and 
technicians) on the maintenance, troubleshooting, 
and repair of the new equipment was adequate and 
effective.”

Section c: Supplier support

7. Supplier contact information: “You have clear and 
readily accessible information on how to contact the 



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Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

supplier for warranty claims, technical support, and 
spare parts.”

8. Warranty claim satisfaction: “If you have 
submitted a warranty claim, you are satisfied with the 
supplier’s responsiveness, the speed of resolution, and 
the overall outcome.”

Section d: Impact on healthcare infrastructure

9.Impact on higher-level facilities: “The presence of 
this center and its equipment has reduced the burden 
or demand on higher-level healthcare facilities in the 
province.”

Phase 4: On-Site Assessment

The duration of in-person visits varied depending on the 
center’s size, the quantity of installed medical equipment 
and furniture, the number of interviews conducted, and 
the specific operational conditions at the time of the visit. 
The evaluation process included:

1. Verification of serial numbers for all MDs.

2. Assessment of equipment integrity.

3. Documentation of each item’s location.

4. Capturing photographic records of relevant 
documentation.

5. Identification of any potential issues affecting 
equipment usability.

6. Confirmation of appropriate user training 
provided for equipment operation.

7. Evaluation of supplier responsiveness in cases 
where technical support was requested.

The organization of the assessment tasks according 
to the complexity was as follows:

Type A assessments, applicable to high-complexity 
equipment:

● Verify the presence of the equipment.

● Check installation conditions.

● Verify the validity of the warranty and whether it 
has been used.

● Confirm whether the training required by the 
award contract has been provided.

● Ensure the presence of user manuals.

● Verify the delivery of accessories, if applicable.

● Take at least three photographs of the equipment: 
one showing its placement within the facility, one 
close-up of the equipment, and one of the serial 
number plate.

● Assess the equipment’s functionality and gather 
user experience feedback.

● If possible, determine the number of patients 
examined or treated using the equipment.

Type B assessments, applicable to low-complexity 
equipment:

● At a minimum, verify the presence of the 
equipment, installation conditions, and warranty 
status.

● Take at least one close-up photograph of the 
equipment.

Type C assessments, applicable to medical 
furniture:

● Verify the presence of the furniture.

● Photograph and document any identified issues or 
anomalies related to its delivery.

Phase 5: Reporting and Lessons Learned

After each visit, a detailed report was compiled 
summarizing findings and observations. These findings 
were then consolidated into a final report, listing the 
visits chronologically and highlighting key insights for 
future improvements.



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J Global Clinical Engineering Vol.7 Issue 3: 2025 14

RESULTS

The Acquired Equipment

With the definitions explained in the methodology, the 
analysis of the acquired equipment and furniture allows 
us to demonstrate the distribution of quantity and values, 
as reported in Figures 8–11.

Of the goods and services directly related to medical 
practice and patient care, 78% correspond to MD, repre-
senting 78.9% of the investment in this category.

FIGURE 8. Distribution of facilities-related equipment, medical 
devices, support equipment, and support furniture.

FIGURE 9. Distribution of investment in facilities-related equip-
ment, medical devices, support equipment, and support 
furniture.

FIGURE 10. Distribution of medical devices by application.



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Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

FIGURE 11. Distribution of investment in medical devices by 
application. 

The MHS were constructed in geographical locations 
with dissimilar characteristics and needs; therefore, the 
quantity and characteristics of the assets are not homo-
geneous across all centers but rather respond to the epi-
demiological needs of each case. Nevertheless, analyzing 
examples from each of the MHS typologies, it is observed 
that their distribution follows similar patterns in all cases.

More than 60% of the investment allocated to goods 
directly related to medical practice, in all analyzed cases, 
corresponds to MD, reaching 87% in units with higher 
critical care activity, as higher cost devices.

Regarding MD characteristics, the largest group cor-
responds to basic care equipment, exceeding 62%. This 
is consistent with the conception of health centers as 
gateways to the health system. The percentage reaches 
94% in Penitentiary Services Centers, where immediate 
and low-critical medical care is expected to be provided.

Visit Results

The objectives set for the MHS visits were met, allow-
ing for the assessment of installed equipment conditions, 
its usage, and supplier responses to users. In all cases, it 

was possible to interview coordinators or medical officers 
and obtain information on current situations and future 
projections. The results of the structured interview car-
ried out with the eight questions presented in “Section 
2, Phase 3: Structured Interview” are presented in Table 
2, as percentages of answers for each question.

TABLE 2. Results of the structured interview.

Strongly 
Disagree 

(%)
Strongly 
Disagree 

(%)

Disagree 
(%) 

Neutral 
(%)

Agree 
(%)

Strongly 
Agree 

(%)

N/A 
(%)

Q1 0 40 0 10 40 10

Q2 0 10 0 60 20 10

Q3 0 0 0 30 50 20

Q4 0 25 0 25 0 50

Q5 0 30 10 10 30 20

Q6 0 10 10 0 0 80

Q7 0 30 0 10 30 30

Q8 0 0 0 0 10 90

Q9 0 0 0 10 20 70

The eight questions are presented in “Section 2, Phase 
3: Structured Interview” and the results are categorized 
as Strongly Disagree, Disagree, Neutral or Neither Agree 
or Disagree, Agree, Strongly Agree, N/A: not applicable or 
not answered. The percentage of each answer is shown 
in table 2 and the statistical analysis of the answers is 
reported in Table 3.

Assigning numerical values from 1 to 5 allows for the 
calculation of mean values and standard deviations to gauge 
the level of agreement. Based on these metrics, the MHS 



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Directors’ responses suggest the following:

● Technical and clinical staff training: The directors do 
not generally support the idea that adequate training of 
the technical staff has been carried out. However, they 
show slight support for the notion that the center has 
sufficient and adequately trained staff for equipment use.

● Equipment quality and support: There is some agree-
ment among the directors regarding the quality, function-
ality, and quantity of the received equipment. They also 
agree on the availability of information for contacting the 
supplier when needed.

● Equipment adequacy and impact: The directors 
generally agree that the level of equipment is adequate 
for both clinical needs and staff capabilities. They also 
acknowledge the good condition of the equipment upon 
arrival and recognize that the center and its equipment have 
reduced the burden on higher-level healthcare facilities.

● Warranty satisfaction: In the one instance where the 
warranty was activated, the supplier’s response was rated 
as very satisfactory. 

TABLE 3. Statistical analysis of the results of the structured interview.

Question
Average 
Level of 

Agreement
std dev

Q6: Adequate and effective training provided 
to technical staff 2.5 0.7

Q4: The center has sufficient and adequate 
staff to use the equipment 3.5 1.4

Q5: Adequate and effective training provided 
to clinical users 3.5 1.4

Q1: Received equipment in terms of its quality, 
functionality, and quantity is satisfactory 3.6 1.5

Q7: Clear and readily accessible information 
on how to contact the supplier in case of need 3.6 1.5

Q2: The level of the equipment is adequate to 
the clinical needs and staff capabilities 4.0 0.9

Q3: The equipment was delivered in good 
condition for its intended functionality 
and use

4.3 1.0

Q9: The center has reduced the burden or 
demand on higher-level healthcare facilities 4.5 0.6

Q8: Supplier’s responsiveness to warranty 
claims, satisfactory speed of resolution, and 

overall outcome
5.0 N/A

Note: Results below 3 show a disagreement (pink), results 
between 3 and 4 show a certain agreement (yellow), and 
results between 4 and 5 show high levels of agreement 
(green). N/A: not applicable. Std dev: standard deviation.

Figures 12–17 show some of the hospital areas and 
equipment inspected during the visits.

FIGURE 12. Equipment and facilities-related equipment in-
stalled in a critical care unit, MHS No. 9—Almirante Brown, 
Buenos Aires. 

FIGURE 13. Equipment installed in a clinical analysis laboratory, 
MHS No. 28—Exaltación de la Cruz, Buenos Aires.



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FIGURE 14. Equipment installed in a gynecological room, MHS 
No. 28—Exaltación de la Cruz, Buenos Aires.

FIGURE 15. Equipment and facilities-related equipment installed 
in an observation sector, MHS San Jorge, Córdoba. 

FIGURE 16. Equipment and facilities-related equipment 
installed in a hospitalization room, MHS No. 9—Almirante 
Brown, Buenos Aires. 

FIGURE 17. Equipment installed in an emergency office, MHS 
No. 28—Exaltación de la Cruz, Buenos Aires.



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Although in a few cases, clinical services were found 
to be not operational because of a lack of clinical spe-
cialists, like cardiologists or pediatricians, end users 
expressed satisfaction in quality, quantity terms, and 
supplier responsiveness toward the available technology. 
They also highlight the improvements that equipment 
and facilities-related equipment have brought to their 
daily work. In addition, the new medical specialties and 
practices introduced in some MHS have reduced patient 
waiting lists in central hospitals.

The following four strengths of the implemented project 
were identified:

Strengths:

1. Well-designed facilities with spacious areas and 
adequate lighting.

2. High user satisfaction with received goods and their 
positive impact on daily work.

3. Reduced demand in central hospitals because of 
decentralized healthcare services.*

4. Properly stored and managed equipment, all of them 
are in good working conditions.

*Note: Reduced demand in central hospitals because of 
decentralized healthcare services is a qualitative finding 
from Question 8 of the structured interview: “To what 
extent has the presence of this equipment at your center 
reduced the burden or demand on higher-level healthcare 
facilities in the province?”

Lessons Learned

The following six lessons learned have been identified 
during the visit and an analysis of their results:

1. It is essential to establish a dedicated process ensur-
ing sufficient personnel/specialists for MHS operation. In 
some cases, the absence of clinical personnel has delayed 
implementation and affected the warranty, since the 
equipment has been stored for a long time.

2. It is essential to establish a formal process to inspect 
the quality and integrity of each delivered equipment. In 
a couple of cases, the visit detected missing accessories 

(one wheel of one examination lamp and few shelves) and 
the problem was solved with the suppliers.

3. It is essential to prepare the equipment list based on 
the real existing or projected needs. It was observed that 
few equipment (about 2%), like humidifiers to support 
mechanical ventilation, were not used because of a lack of 
specific needs. The presence of some underutilized equip-
ment may be a consequence of misalignment between 
the specific needs of MHS facilities-related equipment 
and the equipment provided as well as changing needs 
during a project’s implementation.  

4. As a result of the structured interview, it is recom-
mended that the training process is monitored and certi-
fied. It was identified that some end users were unaware 
that they could request training from the equipment 
suppliers. In addition, they did not know how to contact 
the suppliers. Compounding the issue, internal training 
sessions were conducted by other users of similar equip-
ment, with the risk of incorrect concepts leading to an 
improper use of the devices.

5. It is recommended that all the local regulatory re-
quirements are properly managed in advance. Specifically, 
the necessary authorizations from the Radiological Health 
Authority of the Argentine Ministry of Health (Radiología 
Sanitaria), responsible for verifying and approving radiol-
ogy rooms, were not processed from the beginning, with 
the risk of delays in the start-up of radiology services. 
In this specific case, a prompt reaction and a proactive 
management of this specific risk have avoided delays. 

6. It is recommended to streamline the communica-
tion of the contractual conditions with the final users. In 
most cases, the misconception that equipment belongs 
to UNOPS and not to the final users prevented the pos-
sibility of its redistribution according to changing needs.

Finally, the case of MHS No. 9 in Almirante Brown, 
Buenos Aires Province, can be reported as a remarkable 
success. Originally conceived as a SARS-CoV-2 pandemic 
response unit, it has since been integrated into the local 
healthcare network, coordinating with the “Dr. Lucio 
Meléndez” General Acute Hospital and the adjacent 
“Unidad de Pronta Atención” (UPA) No. 5. It currently 
receives patients requiring hospitalization through the 



19 J Global Clinical Engineering Vol.7 Issue 3 2025

Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

UPA and referrals from the main hospital. During the sec-
ond quarter of 2024, it recorded 695 patient admissions, 
with a projection of 2.800 patients/year, becoming key in 
relieving and decentralizing the demand for critical and 
intermediate care hospitalizations.

DISCUSSION

Replicability for Different Contexts

Some key parameters can be identified to help similar 
projects estimate budgets and workloads in the inception 
phase.

Within the MD acquired for all MHS, passive equipment 
accounts for 64% but represents only 13% of the investment 
in medical equipment, as shown in Figures 18 and 19.

FIGURE 18. Distribution of active and passive medical devices.

FIGURE 19. Distribution of active and passive medical devices.

The passive device group primarily consists of inpatient 
beds, stretchers, wheelchairs, blood pressure monitors, 
and stethoscopes, all of which are low-cost and low-
complexity items. This could lead to underestimating 
the time dedicated to their evaluation and acquisition.15 
However, it is important to note that these devices are in 
contact with the patient for a significant portion of their 
stay in healthcare centers. Since the patient’s perception 
of the environment impacts their treatment outcomes,16–18 

it is relevant to dedicate adequate human and economic 
resources to the selection and maintenance of these assets.

An analysis of the investment in MD, medical furniture, 
support equipment, and facilities-related equipment 
per square meter (m2) shows that for the individual 
modular centers analyzed, the highest investment per m2 
corresponds to MD, followed by investment in facilities-
related equipment.

Table 4 presents the MHS data for various centers with 
different surface areas. Four MHS typologies with different 
surface areas were selected to analyze the parametric cost 
of the equipment. These typologies range from the largest 
surface area (MHS #1 of 1,100 m2) to the smallest (MHS 



Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

J Global Clinical Engineering Vol.7 Issue 3: 2025 20

#4 of 285 m2); two intermediate cases (MHS #2 and MHS 
#3) have also been selected.

As shown in Table 4, MHS for penitentiary services, 
MHS# 3 and MHS# 4, have a lower relative investment in 
MD in comparison with the other centers. Smaller centers 
of the same type have a greater relative investment in MD 
compared to larger ones.

TABLE 4. Investment per square meter for the different types of 
facilities and for four MHS, each representing different sizes and 
types of centers. 

MHS type # 1 # 2 # 3 # 4

Area (m2) 1,100 990 660 285

Medical devices* 533.9 259.4 182.8 336.6

Medical furniture* 11.6 11.8 1.9 2.2

Support equipment* 6.1 0.5 22.1 25.5

Facilities-related equipment* 100.4 25.2 96.6 136.0

Total equipment investment* 652 296.9 303.4 500.3

Percentage of medical 
devices in total equipment 
cost

82% 87% 60% 67%

equipment cost   

* Investment [U$S/(m2)]

In table 4 MHS type #1 corresponds to MHS annexed and 
integrated into preexisting healthcare centers, MHS type 
#2 corresponds to MHS designed to operate independently 
from preexisting healthcare infrastructure, and MHS 
types #3 and #4 correspond to MHS for penitentiary 
services of different sizes, which respond to the size of 
the beneficiary population.

This evidence underscores the high cost of medical 
technology that is independent from the specific size and 

type of center and reinforces the importance of conducting 
a needs analysis as a starting point for the acquisition 
process based, among other factors, on the intended use 
of the assets.

Similarly, costs associated with the entire life cycle of 
medical technology within the healthcare center must 
be considered, from the initial purchase expenses to the 
final disposal costs. The purchase price is only the tip of 
the iceberg concerning associated costs. A proper medical 
technology cost analysis requires considering not only the 
purchase price but also installation, operation, financing, 
disposal, and other costs generated during the useful life 
of the device.19

A detailed analysis of medical technology costs throughout 
its life cycle will require further investigation. The Pan 
American Health Organization considers preventive and 
corrective maintenance costs to represent between 3% 
and 7% of the equipment’s purchase cost per year when 
performed by the healthcare center’s staff; and between 
8% and 15% when external services are contracted.20 Costs 
associated with the devices’ operation vary depending on 
the technology, and their origin is very diverse. Clinical 
analysis laboratory equipment may have high costs in 
reagent consumption, while imaging equipment will have 
large consumption in electricity and cooling supplies. 
The analysis and observation of all costs associated with 
medical equipment during its useful life is a fundamental 
part of sustainable acquisition.21

CONCLUSION

In conclusion, as a medium-term response to the 
pandemic, Argentina undertook a national project to plan, 
construct, and equip 85 MHS. This article describes the 
project’s implementation for the medical technologies 
component and analyzes its results, focusing on the design, 
equipment investment, outcomes, and lessons learned 
within the objective of long-term sustainability.

The evidence presented highlights the significant 
impact of MD investment on healthcare facility costs, 
emphasizing that the purchase price is merely the initial 
expense in a device’s lifecycle.



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Virgilio, Garrigou, Casal, Crego, Bruzzo: Sustainable Procurement of Medical Technologies: Equipping 85 Modular 
Healthcare Systems in Argentina  

Considering the significant financial implications of 
medical technology, as highlighted by the consistent costs 
across various facility types, conducting a needs analysis 
is a crucial first step in sustainable acquisition, ensuring 
that the selected equipment aligns with its intended use 
and the facility’s long-term goals.22

The six identified lessons learned can serve as a valuable 
checklist for future healthcare infrastructure planning 
and medical equipment deployment, enabling hospital 
planners, policymakers, and health authorities to deliver 
effective and sustainable healthcare solutions. These 
lessons, when integrated with the three pillars for MD 
procurement—selecting equipment that meets beneficiary 
clinical needs, considering human resource capabilities, 
and assessing local infrastructure conditions, all while 
prioritizing the asset’s lifelong use—collectively form a 
robust methodology for implementing future projects.

As the post-implementation visit was not included in 
the original project’s plan and has been carried out with 
limited resources, to ensure continuous quality improvement 
process for the MD procurement implementation strategy, 
we recommend scheduling such visits in the design 
phase of future projects, including in the agreement a 
provisions for the regulated sharing of anonymized access 
data related to the project’s infrastructure to measure its 
impact rigorously.

AUTHOR CONTRIBUTIONS

Conceptualization, V.D.V., PMC and M.A.B.; Methodology, 
V.D.V., PMC and M.A.B; Software, V.D.V., PMC and M.A.B; 
Validation, V.D.V., PMC and M.A.B; Formal Analysis, 
V.D.V., PMC and M.A.B; Investigation, V.D.V., PMC and 
M.A.B; Resources, V.D.V., P.E.G., I.L.C., PMC and M.A.B; 
Data Curation, V.D.V., P.E.G., I.L.C., PMC and M.A.B; 
Writing–Original Draft Preparation, V.D.V., PMC and 
M.A.B; Writing–Review & Editing, V.D.V., P.E.G., I.L.C., 
PMC and M.A.B; Visualization, V.D.V., PMC and M.A.B; 
Supervision, P.E.G., I.L.C.,; Project Administration, P.E.G., 
I.L.C.,; Funding Acquisition, P.E.G., I.L.C.

ACKNOWLEDGMENTS

Not applicable.

FUNDING

This research received no external funding.

DATA AVAILABILITY STATEMENT

Not applicable.

CONFLICTS OF INTEREST

The authors declare they have no competing interests.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE 

Not applicable.

CONSENT FOR PUBLICATION

Not applicable.

FURTHER DISCLOSURE

Not applicable.

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