Policy and management of medical devices for the public health care sector in Benin

Developing countries have very limited resources for procurement and management of medical devices. Usually, the resources that they do have, however, are not used in appropriate and optimal ways. Initial results of a study, supported by NUFFIC and conducted in Benin, are reported, identifying factors that adversely affect the healthcare technology management cycle of planning, budgeting, selection, procurement, distribution, installation, training, operation, maintenance and disposal of medical devices. Poor device management results in low overall community health effectiveness. The study included surveys using semi-structured interviews with policy makers from the Ministries of Health and Finance and Economy, health facility managers, equipment users, maintenance technicians, managers of medical device companies and representatives of external support agencies. Key factors identified so far include: high acquisition costs; lack of insight of the government on medical device market prices; lacks of capacity to monitor reasonable prices from suppliers; lack of insight in the cost/performance ratio of various brands of medical devices; an unequal distribution of devices among health care facilities; an unbalanced allocation of resources for acquisition of devices; infrastructure, and maintenance. Other key factors included the insufficiency of human resources with appropriate capacity to manage the equipment, the unavailability of spare parts, and the lack of an annual maintenance budget. In a nutshell, the lack of good medical devices national policy and management practice. Preliminary results will be presented, starting with a list of essential equipment and of reference prices for the most widely used devices. The latter will allow health sector authorities to monitor financial diversion that may occur during procurement activities, while the former will serve as a reference to assess availability of fully operational devices at different health care facilities- The project aims to provide a basis for the development of basic legislation, empowering the Benin government to assure more cost-effective use of its resources for medical devices. For a variety of reasons, the potential benefits associated with the use of medical devices purchased for the public health care sector of Benin are not fully realized. To improve upon the current situation, the magnitude of the problem and its contributory causes should be examined more systematically. Existing tools, such as value-based pricing, development of an essential medical devices list and technology assessment may be used, but should be tailored to the specific context of the country. Participatory approaches are more likely to produce more sustained effects than simple regulations.