Table 8 A synthesis of recommendations expressed in the literature for consideration by international donors, LMIC stakeholders and the international research community ^a

Close the feedback loop

The WHO deplores the mismatch created by low-resource settings procuring high-end technologies. (1)

Authors in the literature recommend LMICs and donor institutions evaluate past procurement efforts and create participatory structures for health facility representatives to engage in planning/procurement consultations. This increases transparency and pre-empts technology adoption/use issues by informing all stakeholders of health facility needs/infrastructure/skill mix.

Fully cost out potential purchases

Authors in the literature note discrepancies in costing practices, we therefore recommend national costing templates are created and disseminated to facilities and procurement agents for MDE purchases.

Costing templates should be context specific and include:

a) Expenses related to equipment installation, servicing (inspection, installation, preventive and corrective maintenance, decommissioning and disposal);

b) Investments into infrastructural refurbishments of deployment health facilities and user training that would aid in keeping MDEs operational.

The WHO Cost-It templates present a good starting point for this at hospital or program level. We remind users to include inspection, installation and decommissioning/disposal costs in templates under the ‘other’ headings. (75)

Make MDE servicing a legal requirement

Authors in the literature recommend LMIC regulatory agents develop minimum, legally binding, standards for national/regional MDE servicing.

Procured equipment should be subject to specialist inspection and installation once in deployment settings; service provisions/funding allowances for preventive and corrective maintenance, decommissioning and disposal should be identified before tendering.

Include explicit MDE availability recommendations in clinical guidelines.

We note that historically clinical guidelines do not include specific recommendations on what medical devices should be available for specific interventions - authors note this as an issue for biomedical engineers or procurement agents engaged in product selection.

Develop a list of generic specifications for LMIC friendly equipment.

Authors in the literature recommend the elaboration and listing of generic medical device and equipment technical specifications to aid LMIC procurers. The list of broad product features we have identified in this review is a start in this endeavor, but international engineering expertise is needed to create technical specifications or target product profiles specific to LMICs (Table 7).