Guide 3.pdf

‘HOW TO MANAGE’ SERIES
FOR HEALTHCARE TECHNOLOGY


Guide 3
How to Procure and
Commission Your
Healthcare Technology


Management Procedures for
Health Facilities and Health Authorities


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‘How to Manage’ Series for Healthcare Technology
Guide 1: How to Organize a System of Healthcare Technology Management
Guide 2: How to Plan and Budget for your Healthcare Technology
Guide 3:How to Procure and Commission your Healthcare Technology
Guide 4: How to Operate your Healthcare Technology Effectively and Safely
Guide 5: How to Organize the Maintenance of your Healthcare Technology
Guide 6: How to Manage the Finances of your Healthcare Technology


Management Teams
Keywords: healthcare technology, management procedures,
health service administration, district health services, developing countries,
purchasing, donations, installation, commissioning, logistics, equipment
Any parts of this publication, including the illustrations, may be copied, reproduced, or adapted to
meet local needs, without permission, provided that the parts reproduced are distributed free or at
cost – not for profit. For any reproduction with commercial ends, permission must first be obtained
from the publisher. The publisher would appreciate being sent a copy of materials in which text or
illustrations have been used.
This document is an output from a project funded by the UK government’s Department for
International Development (DFID) for the benefit of developing countries. The views expressed
are not necessarily those of DFID.


ISBN: 0-9549467-2-3
All rights reserved
A catalogue record is available from the British Library
Design and layout by Jules Stock (email: julesstock@macunlimited.net
Illustrations and charts by David Woodroffe (email: davedraw@dircon.co.uk)
Edited by Rebecca Lowe, Swan Media Services (email: swanmedia@ntlworld.com)




‘How to Manage’ Series for Healthcare Technology


Guide 3


How to Procure and Commission
your Healthcare Technology


by:
Manjit Kaur


Development Officer, ECHO International Health Services, Coulsdon, UK
Trond Fagerli


Senior Advisor, Haraldsplass Deaconal Hospital, Bergen, Norway
Caroline Temple-Bird


Healthcare Technology Management Consultant,
Ziken International Consultants Ltd, Lewes, UK


Andreas Lenel
Health Economist Consultant, FAKT, Stuttgart, Germany


Willi Kawohl
Financial Management Consultant, FAKT, Stuttgart, Germany


Series Editor
Caroline Temple-Bird


Healthcare Technology Management Consultant,
Ziken International Consultants Ltd, Lewes, UK




CONTENTS
Section Page
Foreword i
Preface i
Acknowledgements iii
Abbreviations v
List of Boxes and Figures vii
1. Introduction 1
1.1 Introduction to the Series of Guides 1
1.2 Introduction to This Specific Guide 9
2. Framework Requirements 21
2.1 Framework Requirements for Quality Health Services 22
2.2 Background Conditions Specific to This Guide 31
3. How to Decide When and What to Procure 45
3.1 Why You Need to Procure 45
3.2 Issues to Consider When Choosing Equipment 49


3.2.1 Appropriateness to Setting 50
3.2.2 Assured Quality and Safety 52
3.2.3 Affordability and Cost-Effectiveness 53
3.2.4 Ease of Use and Maintenance 59
3.2.5 Conformity to Existing Policies, Plans and Guidelines 60


3.3 A Review of Ways to Get Equipment 64
3.3.1 Equipment Purchases Using Nationally Available Funds 65
3.3.2 Equipment Purchases Using Funds from External


Support Agencies 67
3.3.3 Donations of Equipment 74
3.3.4 Leasing and Leasing Type Arrangements 76
3.3.5 Research and Demonstration Models 77


3.4 Whether to Obtain New or Secondhand Equipment 78
4. How to Decide on the Way to Purchase 83
4.1 Determining Your Model for Procurement 83


Contents




4.2 Choosing Your Purchasing Method 91
4.2.1 An Overview of Purchasing Methods 91
4.2.2 Tenders 99
4.2.3 Quotation-based Methods 103
4.2.4 Direct Ordering 104
4.2.5 Making the Best Use of Your Purchasing Method 105


4.3 Different Types of Supplier Available 107
4.4 Identifying Suitable Suppliers 114
5. How to Prepare for Procurement 119
5.1 Determining the Quantities Needed 119
5.2 Using Lots 129
5.3 Finalizing How to Procure 131
5.4 Timetabling Your Procurement 132
5.5 Preparing Your Procurement Paperwork 134


5.5.1 Invitation for Bids 135
5.5.2 Purchase Document – Summary 136
5.5.3 Purchase Document – Part One: Item Information 138
5.5.4 Purchase Document – Part Two: Order Information 144


6. How to Manage the Purchasing Process 163
6.1 Asking for Bids/Quotes and Issuing Documents 163
6.2 Receiving and Opening Tender Bids/Quotations 164
6.3 Evaluation and Comparison Process 166
6.4 Award of Contract and Placing the Order 182
6.5 Local Direct Purchasing and Ordering 189
7. How to Receive Goods and Distribute Them to Site 195
7.1 Preparing to Receive Equipment and Supplies 195


7.1.1 Monitoring Progress Using a Gantt Chart 195
7.1.2 Pre-installation work 199
7.1.3 Preparing for Customs Clearance 204


7.2 Safe Shipment, Customs Clearance, and Transport to
Distribution Centres 206
7.2.1 Safe Shipment and Customs Clearance 206
7.2.2 Delivering Goods from Customs to Initial Destination 212


7.3 Storage at Distribution Centres and Despatch 212
7.4 Delivery to Final Destination 214


Contents




Contents


8. How to Receive, Commission, and Store Goods On Site 219
8.1 An Overview of the Acceptance Process 220
8.2 Receipt and Checking of Goods 224
8.3 Assembly, Installation, Commissioning, and Initial Training 229


8.3.1 Assembly and Installation 230
8.3.2 Commissioning 232
8.3.3 Initial Training 235


8.4 Registration and Handover 239
8.4.1 Entering New Equipment Orders into Health Facility Records 239
8.4.2 Storing Manuals 241
8.4.3 Storage and Stock Control of Equipment-related Supplies 242
8.4.4 Handover 245


8.5 When and How to Make Payments 247
8.6 Damage to Goods, or Unsatisfactory Supply of Goods or Services 249
9. How to Undertake Action Planning and Monitoring


of Progress 255
9.1 Setting Goals (Annually) for Procurement and Commissioning 257
9.2 Monitoring Progress with Procurement and Commissioning 264
Annexes 271
1. Glossary 271
2. Reference Materials and Contacts 278
3. Policy Issues 305
4. Examples of Important Safety and Performance Standards 309
5. Evaluating Suppliers 311
6. Obtaining Appropriate Donations 316
7. Specification and Technical and Environmental Data 320
8. International Commercial Terms (Incoterms) for Transportation


of Trade Goods 327
9. Sample Acceptance Test Logsheet for Equipment 332
10. Equipment Data to Record 342
11. Stores Forms 343
12. Source Material/Bibliography 349




Foreword


i


Foreword
This Series of Guides is the output from a project funded by the UK government’s
Department for International Development (DFID) for the benefit of developing
countries. The output is the result of an international collaboration that
brought together:
◆ researchers from Ziken International and ECHO International Health Services in


the UK, and FAKT in Germany
◆ an advisory group from WHO, PAHO, GTZ, the Swiss Tropical Institute, and the


Medical Research Council of South Africa
◆ reviewers from many countries in the developing world
in order to identify best practice in the field of healthcare technology management.
The views expressed are not necessarily those of DFID or the other
organizations involved.


Garth Singleton
Manager, Ziken International Consultants Ltd, Lewes, UK


Preface
The provision of equitable, quality and efficient healthcare requires an extraordinary
array of properly balanced and managed resource inputs. Physical resources such as
fixed assets and consumables, often described as healthcare technology, are among
the principal types of those inputs. Technology is the platform on which the delivery
of healthcare rests, and the basis for provision of all health interventions. Technology
generation, acquisition and utilization require massive investment, and related
decisions must be made carefully to ensure the best match between the supply of
technology and health system needs, the appropriate balance between capital and
recurrent costs, and the capacity to manage technology throughout its life.
Healthcare technology has become an increasingly visible policy issue, and healthcare
technology management (HTM) strategies have repeatedly come under the spotlight
in recent years. While the need for improved HTM practice has long been recognized
and addressed at numerous international forums, health facilities in many countries
are still burdened with many problems, including non-functioning medical equipment
as a result of factors such as inadequate planning, inappropriate procurement, poorly
organized and managed healthcare technical services, and a shortage of skilled
personnel. The situation is similar for other health system physical assets such as
buildings, plant and machinery, furniture and fixtures, communication and information
systems, catering and laundry equipment, waste disposal, and vehicles.




Preface (continued)
The (mis-)management of physical assets impacts on the quality, efficiency and
sustainability of health services at all levels, be it in a tertiary hospital setting with
sophisticated life-support equipment, or at the primary healthcare level where simple
equipment is needed for effective diagnosis and safe treatment of patients. What is
vital – at all levels and at all times – is a critical mass of affordable, appropriate, and
properly functioning equipment used and applied correctly by competent personnel,
with minimal risk to their patients and to themselves. Clear policy, technical
guidance, and practical tools are needed for effective and efficient management of
healthcare technology for it to impact on priority health problems and the health
system's capacity to adequately respond to health needs and expectations.
This Series of Guides aims to promote better management of healthcare technology
and to provide practical advice on all aspects of its acquisition and utilization, as well
as on the organization and financing of healthcare technical services that can deliver
effective HTM.
The Guides – individually and collectively – have been written in a way that makes
them generally applicable, at all levels of health service delivery, for all types of
healthcare provider organizations and encompassing the roles of health workers and
all relevant support personnel.
It is hoped that these Guides will be widely used in collaboration with all appropriate
stakeholders and as part of broader HTM capacity-building initiatives being
developed, promoted and implemented by WHO and its partners, and will therefore
contribute to the growing body of evidence-based HTM best practice.
The sponsors, authors and reviewers of this Series of Guides are to be congratulated
for what is a comprehensive and timely addition to the global HTM toolkit.


Andrei Issakov, Coordinator, Health Technology and Facilities Planning and
Management, World Health Organization, Geneva, Switzerland


Mladen Poluta, Director, UCT/WHO HTM Programme, University of Cape
Town, South Africa


Preface


i i




Acknowledgements


i i i


Acknowledgements
This Guide was written:


◆ with specialist support from:
Andy Barraclough, Healthcare Technology Management Consultant, GIC Ltd,
London, UK
Pieter de Ruijter, Consultant, HEART Consultancy, Renkum, The Netherlands


◆ with assistance from an Advisory Group of:
Hans Halbwachs, Healthcare Technology Management, Deutsche Gesellschaft für
Technische Zusammenarbeit (GTZ-GmbH), Eschborn, Germany
Peter Heimann, Director, WHO Collaborating Centre for Essential Health
Technologies, Medical Research Council of South Africa, Tygerberg, South Africa
Antonio Hernandez, Regional Advisor, Health Services Engineering and Maintenance,
PAHO/WHO, Washington DC, USA
Andrei Issakov, Coordinator, Health Technology and Facilities Planning and
Management, Department of Health System Policies and Operations, WHO,
Geneva, Switzerland
Yunkap Kwankam, Scientist, Department of Health Service Provision, WHO,
Geneva, Switzerland
Martin Raab, Biomedical Engineer, Swiss Centre for International Health of the
Swiss Tropical Institute, Basle, Switzerland
Gerald Verollet, WHO Technical Officer, Medical Devices, Blood Safety and Clinical
Technology (BCT) Department, WHO, Geneva, Switzerland
Reinhold Werlein, Biomedical Engineer, Swiss Centre for International Health of the
Swiss Tropical Institute, Basle, Switzerland


◆ and reviewed by:
Dr. P. Asman, Head of the Bio-engineering Unit, Ministry of Health, Accra, Ghana
Yolanda Bayugo, Provincial Health Advisor, GTZ/UNFPA Support Project,
Kampot Province, Cambodia
Tsibu J. Bbuku, Medical Equipment Specialist, Central Board of Health,
Lusaka, Zambia
Dr. Juliette Cook, Biomedical Engineer, Advisor to Ministries of Health of
Mozambique, and Vanuatu
Peter Cook, Biomedical Engineer, ECHO International Health Services, Coulsdon, UK
Freedom Dellosa, Chief of Hospital Equipment Maintenance Service Division,
Region 9 – Mindanao Peninsula, Department of Health, Zambonga City, Philippines




Roland Fritz, HCTS Coordinator, Christian Social Services Commission, Dar es
Salaam, Tanzania
Andrew Gammie, Project Director, International Nepal Fellowship, Pokhara, Nepal
Muditha Jayatilaka, Deputy Director General of Health Services
(Biomedical Engineering Services), Ministry of Health, Nutrition and Welfare,
Colombo, Sri Lanka
Francis Nalumpa, Senior Medical Equipment Technician, Ministry of Health,
Lusaka, Zambia
Mani Nath Paneru, Senior Biomedical Engineer, Biomedical Engineering Nepal Pvt.
Ltd, Kathmandu, Nepal
Sulaiman Shahabuddin, Director, Patient Services, Aga Khan Foundation Private
Hospital, Nairobi, Kenya
Birgit Thiede, Physical Assets Management (PAM) Advisor, Ministry of Health,
Phnom Penh, Cambodia


◆ using source material:
as described in Annex 12: Source Material/Bibliography


◆ with financial assistance from:
the Knowledge and Research Programme on Disability and Healthcare Technology,
DFID, government of the United Kingdom


◆ with administrative support from:
all the staff at Ziken International Consultants Ltd, Lewes, UK, especially
Garth Singleton, Rob Parsons, and Lou Korda, as well as Thomas Rebohle from
FAKT, Germany


Acknowledgements


iv




Abbreviations


v


Abbreviations
ACP African, Caribbean and Pacific countries
BP British pharmacopoeia
CD-Rom compact disc – read only memory
CFR cost and freight (to a named port of destination)
CIF cost, insurance and freight
CIP carriage and insurance paid
CMS central medical stores
CPT carriage paid to (a named place of destination)
CT computed tomography (scanner)
DDP delivered duty paid
DDU delivered duty unpaid
DVD digital versatile disc
ECG electrocardiograph
EDI electronic data interchange
EP European pharmacopoeia
EPI expanded programme for immunization
Euro currency of the European Union countries
EDF European Development Fund
EU European Union
ExW ex-works (ex-factory or off-the-shelf) price
FDA Food and Drug Administration (of the USA)
GMP good manufacturing practices
HMIS health management information system
HTM healthcare technology management
HTMS healthcare technology management service
HTMWG healthcare technology management working group
IEC International Electrotechnical Commission




Incoterms international commercial terms (for transportation of trade goods)
IP international pharmacopoeia (of the WHO)
ISO International Organization for Standardization
K Kwacha
LOC letter of credit
MOH Ministry of Health
MOW Ministry of Works
MRI magnetic resonance imaging (scanner)
NGO non-governmental organization
PPM planned preventive maintenance
PSI pre-shipment inspection
SDR Special Drawing Rights (international currency)
SMART specific, measurable, achievable, relevant, time-bound (targets)
TIN trader identification number (of importer)
UN United Nations
UNICEF United Nations Childrens’ Fund
UMDNS universal medical device nomenclature system
US $ United States dollars
USP United States pharmacopoeia
V Volts
VEN/VED vital, essential, not so essential/desirable (prioritizing categories)
WB World Bank
WCC World Council of Churches
WHO World Health Organization


Abbreviations


vi




List of Boxes and Figures
Page


Box 1: Categories of items described as ‘healthcare technology’ 2
Box 2: Benefits of healthcare technology management (HTM) 4
Box 3: Savings derived from effective procurement and


commissioning of healthcare technology 10
Box 4: The collective responsibility for procurement and


commissioning activities 18
Box 5: Typical contents of a purchasing/supplies manual 34
Box 6: Summary of issues in Section 2 on framework requirements 43
Box 7: Planning tools which help you decide to procure 48
Box 8: Key factors determining the appropriateness of equipment


and supplies 51
Box 9: Key factors determining the quality of equipment and supplies 52
Box 10: Components of the overall cost to purchase equipment 56
Box 11: Different categories of external support 65
Box 12: How purchasing procedures relate to the type of organization


and funding source 66
Box 13: Advantages and disadvantages of leasing/leasing


type arrangements 77
Box 14: Advantages and disadvantages of second-hand equipment 79
Box 15: Summary of issues in Section 3 on how to decide when and


what to purchase 81
Box 16: Advantages and disadvantages of central and


group procurement 87
Box 17: Advantages and disadvantages of decentralized procurement 89
Box 18: Comparison of purchasing methods 92
Box 19: Advantages and disadvantages of tendering 101
Box 20: Advantages and disadvantages of quotation-based methods 104
Box 21: Advantages and disadvantages of direct ordering 105
Box 22: Advantages and disadvantages of local or


international purchasing 112
Box 23: Summary of issues in Section 4 on how to decide on the


way to purchase 118
Box 24: Quantifying the package of inputs for equipment purchases 122
Box 25: Quantifying the purchase requirements for


pre-installation work 123
Box 26: Quantifying the purchase requirements for in-house


support activities 124


List of boxes and figures


vii




Box 27: Quantifying the purchase requirements for major
rehabilitation work 125


Box 28: Quantifying ongoing requirements for recurrent supplies 127
Box 29: Common procurement timetables 133
Box 30: An example of planning time-critical procurement 134
Box 31: Contents of a typical equipment specification 139
Box 32: Standardization and specifications 142
Box 33: Pre-shipment inspection 152
Box 34: Summary of issues in Section 5 on how to prepare


for procurement 161
Box 35: Most commonly used procedures for tender bid and


quotation opening 165
Box 36: Evaluation information sheets 171
Box 37: Summary technical assessment 172
Box 38: Summary financial assessment 174
Box 39: Summary supplier assessment 180
Box 40: Final outcome of the purchasing process 181
Box 41: Documents and details to include with the notification of


award and the contract 185
Box 42: Summary of issues in Section 6 on managing the


purchasing process 193
Box 43: A checklist of customs clearance arrangements 205
Box 44: Range of documents possibly required for clearing customs 210
Box 45: Summary of issues in Section 7 on preparing to receive and


distributing goods 216
Box 46: Example of resources needed for the acceptance process 223
Box 47: Common types of documents needed when receiving goods 225
Box 48: Summary of issues in Section 8 on receipt, commissioning,


and storage on site 252
Box 49: Example of how to measure a goal 261
Box 50: Examples of statistics and feedback to gather and their use 267
Box 51: Summary of issues in Section 9 on action planning and


reviewing progress 269
Box 52: WHO’s definition of the technology management hierarchy


(Annex 1) 277
Box 53: Example of good selection criteria for purchases and


donations of equipment (Annex 3) 305


List of boxes and figures


viii




Box 54: Pre-purchase evaluation questionnaire
for suppliers (Annex 5) 311


Box 55: Suggested criteria for evaluating new suppliers (Annex 5) 312
Box 56: Suggested criteria for evaluating current and past suppliers


(Annex 5) 313
Box 57: Characteristics that make a good supplier (Annex 5) 315
Box 58: Sample form to use when requesting donations of equipment


(Annex 6) 319
Box 59: Sample technical and environmental data sheet for suppliers


(Annex 7) 325
Box 60: Guidance on the responsibilities of the seller/buyer for


Incoterms (Annex 8) 328
Box 61: Guidance on the division of costs between the seller/buyer


for Incoterms (Annex 8) 330


Figure 1: The place of healthcare technology management in the
health system 2


Figure 2: The relationship between the Guides in this Series 6
Figure 3: The structure of Guide 3 13
Figure 4: The healthcare technology management cycle 24
Figure 5: Sample organizational chart for the HTM Service 29
Figure 6: Procurement cycle within the HTM cycle 37
Figure 7: The hippopotamus syndrome of life-cycle costs for


healthcare technology 54
Figure 8: Strategies for sourcing information and knowledge about


equipment models 63
Figure 9: Strategies to reconcile external support agency rules and


your aims for equipment 73
Figure 10: Questions to ask if buying or receiving


second-hand equipment 80
Figure 11: Things to consider when sourcing equipment 113
Figure 12: Steps to take to pre-qualify suppliers 115
Figure 13: Steps to take when preparing lots 130
Figure 14: Sample quotation comparison form 175
Figure 15: Issues to consider which help you to make a decision 176
Figure 16: Suggestions for procedures to follow when awarding contracts 183
Figure 17: Summary of key points for a contract document 186
Figure 18: Tips on ordering supplies 192


List of boxes and figures


ix




Figure 19: Example of a Gantt Chart for monitoring progress with orders 196
Figure 20: How to set up a Gantt Chart 197
Figure 21: Common site preparation steps 201
Figure 22: Delivery and customs issues to be handled 209
Figure 23: Unpacking and inspecting equipment orders 226
Figure 24: Unpacking and inspecting recurrent orders of


equipment-related supplies 228
Figure 25: Common arrangements required for installation


and commissioning 231
Figure 26: Key steps in the commissioning process 233
Figure 27: Common arrangements required for initial training 238
Figure 28: Procedures for entering equipment-related supplies


into the stores system 244
Figure 29: Procedures for entering equipment into the stores system 245
Figure 30: The planning and review cycle 255
Figure 31: Summary guidelines for recipients of donations to ensure


they are appropriate (Annex 6) 317
Figure 32: Summary guidelines for providers of donations to ensure


they are appropriate (Annex 6) 318
Figure 33: Example of a register of new stocks form (Annex 11) 345
Figure 34: Sample goods received note (Annex 11) 346
Figure 35: Sample stock card (bin card) (Annex 11) 343
Figure 36: Sample layouts for the stock control ledger (Annex 11) 344
Figure 37: Sample stores requisition and issue voucher (Annex 11) 347
Figure 38: Sample purchase order form (Annex 11) 348


List of boxes and figures


x




1 Introduction


1


1. INTRODUCTION
Why is This Important?
This introduction explains the importance of healthcare technology
management (HTM) and its place in the health system.
It also describes:
◆ the purpose of the Series of Guides and this Guide in particular
◆ the people the Guides are aimed at
◆ the names and labels commonly used in HTM, in this Series.


The Series of Guides is introduced in Section 1.1, and this particular Guide on
procurement and commissioning is introduced in Section 1.2.


1.1 INTRODUCTION TO THE SERIES OF GUIDES
Healthcare Technology Management’s Place in the Health System


All health service providers want to get the most out of their investments. To enable
them to do so, they need to actively manage health service assets, ensuring that they
are used efficiently and optimally. All management takes place in the context of your
health system’s policies and finances. If these are favourable, the management of
health service assets can be effective and efficient, and this will lead to improvements
in the quality and quantity of healthcare delivered, without an increase in costs.
The health service’s most valuable assets which must be managed are its human
resources, physical assets, and other resources such as supplies. Physical assets such
as facilities and healthcare technology are the greatest capital expenditure in any
health sector. Thus it makes financial sense to manage these valuable resources, and
to ensure that healthcare technology:
◆ is selected appropriately
◆ is used correctly and to maximum capacity
◆ lasts as long as possible.
Such effective and appropriate management of healthcare technology will contribute
to improved efficiency within the health sector. This will result in improved and
increased health outcomes, and a more sustainable health service. This is the goal of
healthcare technology management – the subject of this Series of Guides.




1.1 Introduction to this series of guides


2


What Do we Mean by Healthcare Technology?
The World Health Organization (WHO) uses the broader term ‘health technology’,
which it defines as including:
‘devices, drugs, medical and surgical procedures – and the knowledge associated
with these – used in the prevention, diagnosis and treatment of disease as well as
in rehabilitation, and the organizational and supportive systems within which care
is provided’


(Source: Kwankam, Y, et al, 2001, ‘Health care technology policy framework’, WHO Regional Publications,
Eastern Mediterranean Series 24: Health care technology management, No. 1)


However, the phrase ‘healthcare technology’ used in this Series of Guides only refers
to the physical pieces of hardware in the WHO definition, that need to be
maintained. Drugs and pharmaceuticals are usually covered by separate policy
initiatives, frameworks, and colleagues in another department.
Therefore, we use the term healthcare technology to refer to the various equipment
and technologies found within health facilities, as shown in Box 1.


BOX 1: Categories of Equipment and Technologies Described as ‘Healthcare Technology’


medical equipment walking aids health facility furniture
communications equipment training equipment office equipment
office furniture fixtures built into the building plant for cooling, heating, etc
service supply installations equipment-specific supplies fire-fighting equipment
workshop equipment fabric of the building vehicles
laundry and kitchen equipment waste treatment plant energy sources
For examples of these different categories, see the Glossary in Annex 1.


Figure 1: The Place of Healthcare Technology Management in the Health System


Funds
Human Resources


Facilities
Healthcare Technology
Consumable Supplies


Health Sector Organization
and Management


Health
Service


Provision


Healthy
Population


Health
System


Policies




1.1 Introduction to this series of guides


3


Often, different types of equipment and technologies are the responsibility of
different organizations. For example, in the government sector, different ministries
may be involved, such as Health, Works, and Supplies. In the non-government sector,
different agencies may be involved, such as Health, and Logistics.
The range of healthcare technology which falls under the responsibility of the health
service provider varies from country to country and organization to organization.
Therefore each country’s definition of healthcare technology will vary depending on
the range of equipment and technology types that they actually manage.
For simplicity, we often use the term ‘equipment’ in place of the longer
phrase ‘healthcare technology’ throughout this Series of Guides.


What is Healthcare Technology Management?
First of all, healthcare technology management (HTM) involves the organization and
coordination of all of the following activities, which ensure the successful
management of physical pieces of hardware:
◆ Gathering reliable information about your equipment.
◆ Planning your technology needs and allocating sufficient funds for them.
◆ Purchasing suitable models and installing them effectively.
◆ Providing sufficient resources for their use.
◆ Operating them effectively and safely.
◆ Maintaining and repairing the equipment.
◆ Decommissioning, disposing, and replacing unsafe and obsolete items.
◆ Ensuring staff have the right skills to get the best use out of your equipment.
This will require you to have broad skills in the management of a number of
areas, including:
◆ technical problems
◆ finances
◆ purchasing procedures
◆ stores supply and control
◆ workshops
◆ staff development.




1.1 Introduction to this series of guides


4


However, you also need skills to manage the place of healthcare technology in the
health system. Therefore, HTM means managing how healthcare technology should
interact and balance with your:
◆ medical and surgical procedures
◆ support services
◆ consumable supplies, and
◆ facilities
so that the complex whole enables you to provide the health services required.
Thus HTM is a field that requires the involvement of staff from many disciplines
– technical, clinical, financial, administrative, etc. It is not just the job of managers, it
is the responsibility of all members of staff who deal with healthcare technology.
This Series of Guides provides advice on a wide range of management procedures,
which you can use as tools to help you in your daily work. For further clarification of
the range of activities involved in HTM and common terms used, refer to the
WHO’s definition of the technology management hierarchy in Annex 1.
Box 2 highlights some of the benefits of HTM.


BOX 2: Benefits of Healthcare Technology Management (HTM)
◆ Health facilities can deliver a full service, unimpeded by non-functioning healthcare technology.
◆ Equipment is properly utilized, maintained, and safeguarded.
◆ Staff make maximum use of equipment, by following written procedures and good practice.
◆ Health service providers are given comprehensive, timely, and reliable information on:


- the functional status of the equipment
- the performance of the maintenance services
- the operational skills and practice of equipment-user departments
- the skills and practice of staff responsible for various equipment-related activities in a range of


departments including finance, purchasing, stores, and human resources.
◆ Staff control the huge financial investment in equipment, and this can lead to a more effective and


efficient healthcare service.




1.1 Introduction to this series of guides


5


Purpose of the Series of Guides
The titles in this Series are designed to contribute to improved healthcare
technology management in the health sectors of developing countries, although they
may also be relevant to emerging economies, and other types of country. The Series
is designed for any health sector, whether it is run by:
◆ government (such as the Ministry of Health or Defence)
◆ a non-governmental organization (NGO) (such as a charitable or


not-for-profit agency)
◆ a faith organization (such as a mission)
◆ a corporation (for example, an employer such as a mine, who may subsidize


the healthcare)
◆ a private company (such as a health insurance company or for-profit agency).
This Series aims to improve healthcare technology at a daily operational level, as well
as to provide practical resource materials for equipment users, maintainers, health
service managers, and donor organizations.
To manage your technology effectively, you will need suitable and effective procedures
in place for all activities which impact on the technology. Your health service provider
organization should already have developed a Policy Document setting out the
principles for managing your stock of healthcare technology (Annex 2 provides a
number of resources available to help with this). The next step is to develop written
organizational procedures, in line with the strategies laid out in the policy, which staff
will follow on a daily basis.
The titles in this Series provide a straightforward and practical approach to healthcare
technology management procedures:
Guide 1 covers the framework in which healthcare technology management (HTM)
can take place. It also provides information on how to organize a network of HTM
Teams throughout your health service provider organization.
Guides 2 to 5 are resource materials which will help health staff with the daily
management of healthcare technology. They cover the chain of activities involved in
managing healthcare technology – from planning and budgeting to procurement,
daily operation and safety, and maintenance management.
Guide 6 looks at how to ensure your HTM Teams carry out their work in an
economical way, by giving advice on financial management.
How the Guides are coordinated is set out in Figure 2.




1.1 Introduction to this series of guides


6


Figure 2: The Relationship Between the Guides in This Series


Who are These Guides Aimed at?
These Guides are aimed at people who work for, or assist, health service provider
organizations in developing countries. Though targeted primarily at those working in
health facilities or within the decentralized health authorities, many of the principles
will also apply to staff in other organizations (for example, those managing health
equipment in the Ministry of Works, private maintenance workshops, and head offices).
Depending on the country and organization, some daily tasks will be undertaken by
end users while others may be carried out by higher level personnel, such as central
level managers. For this reason, the Guides cover a range of tasks for different types of
staff, including:
◆ equipment users (all types)
◆ maintenance staff
◆ managers
◆ administrative and support staff
◆ policy-makers
◆ external support agency personnel.


Chain of activities
in the equipment


life cycle


Plann
ing a


nd


budg
eting


(Guid
e 2)


Procurement and
commissioning


(Guide 3)


Daily
oper


ation


and s
afety




(Guid
e 4)


Maintenance
management
(Guide 5)


Framework/structure
Organizing a network of
HTM Teams (Guide 1)


Ensuring efficiency
Financial management of HTM Teams (Guide 6)




1.1 Introduction to this series of guides


7


They also describe activities at different operational levels, including:
◆ the health facility level
◆ the zonal administration level (such as district, region, diocesan)
◆ the central/national level
◆ by external support agencies.
Many activities require a multi-disciplinary approach; therefore it is important to form
mixed teams which include representatives from the planning, financial, clinical,
technical, and logistical areas. Allocation of responsibilities will depend upon a
number of factors, including:
◆ your health service provider
◆ the size of the organization
◆ the number of decentralized levels of authority
◆ the size of your health facility
◆ your level of autonomy.
The names and titles given to the people and teams involved will vary depending on
the type of health service provider you work with.
For the sake of simplicity, we have used a variety of labels to describe
different types of staff and teams involved in HTM.
This Series describes how to introduce healthcare technology management into your
organization. The term Healthcare Technology Management Service (HTMS) is
used to describe the delivery structure required to manage equipment within the
health system. This encompasses all levels of the health service, from the central
level, through the districts/regions, to facility level.
There should be a referral network of workshops where maintenance staff with
technical skills are based. However, equipment management should also take place
where there are no workshops, by involving general health facility staff. We call these
groups of people the HTM Team, and we suggest that you have a team at every level
whether a workshop exists or not. Throughout this Series, we have called the person
who leads that team the HTM Manager.
At every level, there should also be a committee which regularly considers all
equipment-related matters, and ensures decisions are made that are appropriate to
the health system as a whole. We have used the term HTM Working Group
(HTMWG) for this committee, which will advise the Health Management Teams on
all equipment issues.




1.1 Introduction to this series of guides


8


Due to its role, the HTMWG must be multi-disciplinary. Depending on the
operational level of the HTMWG, its members could include the following:
◆ Head of medical/clinical services.
◆ Head of support services.
◆ Purchasing and supplies officer.
◆ Finance officer.
◆ Representatives from both medical equipment and plant maintenance.
◆ Representatives of equipment users from a variety of areas (medical/clinical,


nursing, paramedical, support services, etc).
◆ Co-opted members (if specific equipment areas are discussed or specific interest


or need is shown).
The HTM Working Group prepares the annual plans for equipment purchases,
rehabilitation and funding, and prioritizes expenditure across the facility/district as a
whole (see Guide 2 on planning and budgeting). It may have various sub-groups to
help consider specific aspects of equipment management, such as pricing,
commissioning, safety, etc.


How to Use These Guides
Each Guide has been designed to stand alone, and has been aimed at different types
of readers depending on its content (Section 1.2). However, since some elements
are shared between them, you may need to refer to the other Guides from time to
time. Also, if you own the full Series (a set of six Guides) you will find that some
sections of the text are repeated.
We appreciate that different countries use different terms. For example, a purchasing
officer in one country may be a supplies manager in another; some countries use
working groups, while others call them standing committees; and essential service
packages may be called basic healthcare packages elsewhere. For the purpose of
these Guides it has been necessary to pick one set of terms and define them. You can
then modify them for your own situation.
The terms used throughout the text are outlined, with examples, in the
Glossary in Annex 1.
We appreciate that you may find it hard to pursue the ideas introduced in these
Guides. Depending on your socio-economic circumstances, you may face many
frustrations on the road to achieving effective healthcare technology management.
We recognize that not all of the suggested procedures can be undertaken in all
environments. Therefore we recommend that you take a step-by-step approach,
rather than trying to achieve everything at once (Section 2).




1.2 Introduction to this specific guide


9


These Guides have been developed to offer advice and recommendations only,
therefore you may wish to adapt them to meet the needs of your particular situation.
For example, you can choose to focus on those management procedures which best
suit your position, the size of your organization, and your level of autonomy.
For more information about reference materials and contacts for healthcare
technology management, see Annex 2.


1.2 INTRODUCTION TO THIS SPECIFIC GUIDE
The Importance of Procurement and Commissioning Activities


Healthcare and patient management have changed dramatically in recent years and
continue to do so, mainly as a result of the advances in healthcare technology.
Healthcare technology plays an extremely important role in everyday clinical and
public health work. Used properly, it can:
◆ contribute to increased life expectancy
◆ enable greater precision for diagnosis
◆ reduce the time needed for investigations, treatment, and rehabilitation.
For these reasons, it is important to take great care when planning and acquiring new
equipment. Any new equipment you acquire must be suitable for your purposes and
improve access to quality healthcare. You also need to ensure that you have the
ability and capacity to absorb, support, and use any technologies procured.


Did you know?
The equipment market is extremely diverse. A bewildering range of equipment technology is
already available, and new makes and models of equipment are coming out continually.
Current estimates show that there are around 6,000 distinct device types and entities and
750,000 brands and models on the market, available from over 12,000 manufacturers worldwide.
The spectrum of equipment ranges from simple items (for example, mechanical apparatus such
as a hand-operated table-top centrifuge) to the more sophisticated ones (such as CT scanners).
Health facilities have to cope with this wide range of products. It has become difficult for
developing countries to select and obtain the technologies appropriate to their needs.




Successful procurement and commissioning processes give you several benefits:
◆ The most economically advantageous terms for the equipment you acquire (not


necessarily the cheapest price, but the best deal for your needs).
◆ Delivery and handover on time.
◆ Satisfactory and well-defined terms for delivery, installation, commissioning,


training, payment, and warranty.
◆ Satisfactory aftersales service.
◆ Greater interest from the suppliers and manufacturers in submitting offers in


the future.
Provided you fully describe and discuss the terms for the delivery, installation,
commissioning, and training, and follow them up, there should be no arguments with
the supplier. All being well, the equipment should work properly at handover, your
staff will have obtained the necessary new skills to operate and handle it, and you
will be able to authorize payment without hesitation.
Box 2 (Section 1.1) shows that HTM provides a wide range of benefits. It is
difficult to express this in financial terms, but Box 3 gives an idea of the sort of
savings that can be made if procurement and commissioning of equipment is
effectively carried out.


BOX 3: Savings Derived from Effective Procurement and Commissioning of
Healthcare Technology


Problems that could be avoided Resulting waste you could save
◆ lack of standardization


◆ purchase of sophisticated equipment for which
operating and maintenance staff have no skills


◆ impact on equipment and buildings during
installation, unforeseen at the initial tender stage


◆ inability to correctly specify and foresee total
needs when ordering equipment


◆ improper use of equipment by operating and
maintenance staff who lack the necessary training


◆ excessive equipment down-time due to absence
of preventive maintenance, inability to repair, and
lack of spare parts


Adapted from: Mallouppas A, 1986, ‘WHO: Strategy and proposed action concerning maintenance
of hospital and medical equipment’, WHO, Geneva, unpublished document


1.2 Introduction to this specific guide


10


◆ 30–50% additional cost for extra spare parts
and extra maintenance workload


◆ 20–40% of equipment remains under-utilized
or unused


◆ extra modifications or additions required for
10–30% of equipment


◆ 10–30% additional unplanned costs


◆ loss of 30–80% of the potential lifetime of
equipment


◆ 25–35% of equipment out of service




Who is This Guide Aimed at?
This Guide is primarily aimed at managers involved in procurement and
commissioning activities. It is designed to help staff:
◆ procure the right equipment, of the right quality, in the right quantities, at the


right time, in the right place, and at the right cost
◆ ensure delivery, installation, and commissioning procedures are carried out so that


equipment is ready for use.
This Guide is intended as a practical tool to assist in the procurement of both
equipment and equipment-related supplies (in other words, consumables,
accessories, spare parts and maintenance materials). The activities in this Guide are
aimed at anyone involved in the procurement of healthcare technology. This includes:
◆ staff directly responsible for, or involved with, procuring and commissioning


equipment (whichever agency they belong to – your health service provider, a
government agency, an external support agency, a partner)


◆ health service decision makers
◆ external support agency decision makers
◆ decision makers of partners such as NGOs, faith organizations, and the


private sector.


What Topics are Covered?
This Guide aims to outline the wide variety of procurement and commissioning
activities in a practical way. This will help you to acquire, deploy, and use the right
equipment and equipment-related supplies. The activities involved are equally
relevant whether you buy, hire or loan your equipment, or receive it as a donation.


Tip • Procurement and commissioning activities cover a wide range of subjects – the
objective of this Guide is only to highlight the key issues.


In this Guide, the phrase ‘procurement and commissioning activities’ is often used.
It should be understood to imply the long chain of logistics activities, including
selection, supply, delivery, storage, installation, commissioning, initial training, and
so on.
Procurement and commissioning activities are part of the broader acquisition phase
of healthcare technology management, which also includes technology assessment
and research and development. These later topics are covered in less detail.


1.2 Introduction to this specific guide


11




This Guide aims to explain:
◆ the options open to you for obtaining and sourcing equipment and supplies
◆ the activities you need to carry out before purchasing
◆ the steps you need to take when purchasing goods
◆ how to prepare for and receive, store, and distribute goods in-country
◆ the process of receiving goods on site, and installing, commissioning, and


accepting them
◆ how to monitor your activities so you can improve future procurement and


commissioning exercises.
It is important to understand where Guides 2 and 3 overlap. Procurement should
not take place until planning and budgeting have occurred. Guide 2 covers planning
and budgeting activities, and describes how you can establish the many management
‘tools’ that are needed for procurement (such as the Equipment Development Plan,
Model Equipment Lists, and Purchasing Policy). In Guide 3, we go on to explain
how you can use these tools to procure and commission effectively, in order to get
the equipment you want. For example, in Guide 2 we explained how to write
equipment specifications. Guide 3 goes on to tell you how you can use these
specifications to purchase the equipment you require. Similarly, selection activities
are split between the two Guides. Guide 2 details the policies that ensure you select
equipment suited to your plans and circumstances, whereas Guide 3 uses those
selection criteria to choose the final product to buy.
In this Guide the following terminology is used:
Purchasing refers simply to the acquisition of goods or services


in return for money or equivalent payment.
Procurement is a wider term and refers to the process of obtaining


goods and services in any way, such as through
purchase, donation, loan or hire.


However, the use of the terms ‘procurement’ and ‘purchasing’ interchangeably to
mean ‘procurement’ is a common and accepted practice.
Procurement of equipment is an area where it is common to receive assistance from
external support agencies.
External support agency a body responsible for providing money, equipment,


or technical support to developing countries on
various terms, such as international donors, technical
agencies of foreign governments, non-governmental
organizations, private institutions, financial
institutions, faith organizations.


1.2 Introduction to this specific guide


12




The system introduced in this Guide provides a solid approach to managing
equipment procurement and commissioning activities. However, we recognize that
there are other ways of organizing these issues which may be more appropriate for
your administrative system. The most important thing is to implement a well-
functioning system.
As you read through the recommendations in this Guide, you may find it useful to
refer to advice in other Guides in the Series, as indicated in the text. Additional
useful materials and contacts are given in Annex 2.


How is This Guide Structured?
Procurement and commissioning of equipment is a complex process, involving many
different activities. The structure of Guide 3 is shown in Figure 3 and highlights the
different steps you must take in order to obtain functioning equipment for your
health facility.


Figure 3: The Structure of Guide 3


1.2 Introduction to this specific guide


13


Introducing the Series, and this particular GuideSection 1


Understanding the central framework for HTM, and
background conditions specific to this GuideSection 2


Understanding why you need to procure, which goods
are appropriate for your needs, and how to obtain themSection 3


Understanding the partnerships for procurement, the different
purchasing methods, and how to identify suitable suppliersSection 4


Getting ready by quantifying needs, finalizing your
procurement options, and preparing documentsSection 5


Managing the purchasing processSection 6


Preparing for and receiving goods in-country Section 7


Section 8 Receiving goods on site, commissioning, handover, and payment


Monitoring the progress made on all these fronts, in
order to improve future procurement and commissioningSection 9




Who Does What in Procurement and Commissioning?
Depending on how many staff you have with the necessary skills, procurement and
commissioning may take place at any level. However, it is often more economic to
procure in bulk, and at a level where the necessary skills are concentrated. Thus, it is
often more cost-effective to procure equipment centrally. Guide 2 and Section 2.2
provide further discussion on the appropriateness of decentralizing different
healthcare technology management activities. Such decisions will depend on:
◆ your country
◆ your health service provider
◆ which level of the health service you work at
◆ the degree of autonomy of your health facility
◆ the scale and type of procurement to be carried out.
If you have limited management and technical skills at your level (for example, health
facility or district level), and procurement and commissioning activities represent a
heavy workload, much of the work described in this Guide should be undertaken at a
higher level in your organization (for example, regional or central level).
We suggest that the Procurement Unit and the HTM Working Group (Section 1.1)
have a large role to play in advising the Health Management Team on all equipment
matters. Depending on the size of your facility or what level of the health service you
are operating at, your HTM Working Group may prefer to set up a number of smaller
sub-groups.


Remember that procurement and commissioning activities are extensive multi-
disciplinary tasks, and therefore require staff with different backgrounds, skills and
experience. The suggestions given in this Guide are only intended as examples of
the type of background required for the members of the groups and sub-groups. It is
likely that many staff will sit on more than one sub-group. If you are short of staff,
you could use fewer members, as relevant to the operational level of the sub-group.


1.2 Introduction to this specific guide


14




In this Guide, the following groups and sub-groups are suggested:
The Procurement Unit which is responsible for managing the procurement
activities could have the following types of staff:
◆ Procurement Manager.
◆ Purchasing and Supplies Officers.
◆ Technical staff, for example a biomedical engineer.
◆ Health planner.
◆ Equipment users, for example a medical advisor.
◆ Finance officers and accountants.
A Procurement/Tender Committee which manages the tender and quotation
process and awards contracts. This could include the following types of staff:
◆ Procurement Manager.
◆ HTM Manager.
◆ Finance Manager.
◆ Co-opted users – invited to relevant meetings which discuss the equipment


purchases for their specialities.
A Specification Writing Group which is responsible for developing generic
equipment specifications, and the technical and environmental data sheets. This
could include the following types of staff:
◆ HTM Manager.
◆ Maintenance staff from various disciplines.
◆ Purchasing and Supplies Officer.
◆ Stores Controller.
◆ Managers and representatives from equipment user departments


– clinical, paramedical, and support services (as appropriate to the equipment
being considered).


A Commissioning Team which is responsible for commissioning and acceptance,
and which could include the following types of staff:
◆ Purchasing and Supplies Officer.
◆ HTM Manager.
◆ Maintenance staff from various disciplines.
◆ Stores Controller.
◆ Support Services Manager.
◆ Representatives from equipment user departments (as appropriate to the


equipment being considered).
◆ Where necessary, stores and grounds staff to help move and open crates.


1.2 Introduction to this specific guide


15




A training sub-group which considers equipment-related training issues, and could
include the following types of staff:
◆ Human Resource Manager.
◆ Head of Medical Services.
◆ Head of Support Services.
◆ HTM Manager
◆ In-service Training Coordinator.
◆ Infection Control Officer, senior users, and maintenance staff (as appropriate to


the equipment being considered).
Your Procurement Unit will carry out the regular and annual planning and
procurement work. However, they may face difficulties if they have to take on the
workload of an extra process, such as equipping a whole new facility. In these
instances hired consultants, external support agencies, or other NGOs may run such
development projects, including the healthcare technology procurement component,
taking it outside the control of your staff that usually plan and procure. Such
situations should be avoided and could be overcome by setting up a formal project
committee where key personnel from all contributors and stakeholders are involved.
We suggest a project sub-group, which sets goals and oversee the progress of any
externally assisted projects (whether for routine equipment procurement or for
major development projects), in consultation with the external funding agency. Such
projects are usually cross-sectoral and can occur across several levels of the health
service; therefore the sub-group should include a variety of types of staff from:
◆ management
◆ equipment user departments
◆ the HTM Service
◆ support services (including the Procurement Unit).


Tip • There may seem to be a large number of sub-groups but the aim is to:
- spread the work around different members of staff so that the HTM Working


Group (Section 1.1) does not have to do everything
- ensure that the Procurement Unit is not solely responsible for everything; and
- make the process more ‘open’ and less likely to be biased and manipulated.


• If you have a small health facility with few staff, the groups created to undertake
procurement and commissioning activities could be much smaller or you could allow
these tasks to be undertaken at a higher level in your organization. Try to use
relevant staff with experience and involve those who show an interest in the task.


• This Guide has allocated many tasks to the HTM Manager and HTM Working Group
on the assumption that they possess technical (maintenance) skills. If they don't, you
should seek assistance from maintenance staff higher up the HTM Service.


1.2 Introduction to this specific guide


16




1.2 Introduction to this specific guide


17


Country Experience
In one country the following personnel are involved in procurement:
◆ Technical specifications are drawn up by the central Health Ministry for all common


equipment (for example, suction pumps, basic X-ray machines). For complex
equipment, specifications are formulated when and where necessary.


◆ To develop specifications, technical committees are formed by the central
procurement agency – the Biomedical Engineering Division of the central Health
Ministry. Each committee comprises two clinicians nominated by their academic
body (for example, the College of Radiologists), one biomedical engineer, and one
administrator. The specifications are revised annually.


◆ The Biomedical Engineering Division acts as a procurement agency, and has the
total financial allocation available within it. But it deals directly only with procurement
of complex equipment and foreign funded projects. The requirements of individual
health facilities are handled by the respective facilities. The Biomedical Engineering
Division releases the financial allocations required. It also assists health facilities with
technical expertise during evaluation, commissioning, and handover of equipment.


◆ All health facilities have set up Equipment Sub-Committees to deal with equipment
matters. The Equipment Sub-Committees are composed of:
- the head of the institution
- clinicians representing the various disciplines
- the matron
- theatre/ICU sisters
- representatives of equipment users (for example radiographers)
- the pharmacist in charge of purchasing equipment
- the Biomedical Engineering Division representative (if required)


◆ Equipment Sub-Committees are entrusted with preparing the annual equipment
requirements, prioritizing them and submitting them to the Biomedical Engineering
Division for budgeting. Once the budget is approved, the Biomedical Engineering
Division informs each facility of their share of the allocation and offers assistance
with procurement of complex equipment if required. The Equipment Sub-
Committees then report monthly to the Biomedical Engineering Division on their
progress. They also coordinate the commissioning and handover process.


◆ Once the equipment lists are received from facilities, the Biomedical Engineering
Division prepares two master lists consolidating all requirements – one for new
purchases, one for replacements. It then submits the estimates to the treasury for
funding. There is a ceiling on annual capital expenditure for the social services
sector, involving health, education and labour ministries. The treasury makes the final
decision on budget allocation depending on the requirements of the whole sector.
The treasury also decides the foreign and local component of allocations and
informs the health ministry. The Biomedical Engineering Division allocates local
funds to the respective health facilities.




A wide range of people in the health service will be involved in procurement and
commissioning activities, as can be seen from the membership of these sub-groups.
It is important for everybody involved to take collective responsibility for these
activities, to ensure equipment is well chosen and installed, and therefore lasts a
long time. The key tasks and functions of the different groups and individuals that
are described in this Guide are summarized in Box 4.


Section 1 summary


18


Procurement
Managers and
Procurement Units
(at all levels of the
health service)


Procurement/
Tender
Committees


Health Service
Providers


◆ are key to a successful procurement system
◆ are responsible for overall management of procurement activities
◆ undertake procurement according to health service provider, national, and


external support agency regulations, policies, and plans (Section 2)
◆ liaise with any other organization procuring equipment on behalf of the health


facility/decentralized health authority
◆ collate submissions on equipment needs and draw up the procurement list


(Section 3.1)
◆ prequalify suppliers, as appropriate (Section 4.4)
◆ prepare procurement paperwork with assistance from the Specification Writing


Group (Section 5.5.2)
◆ administer the quotation and tender processes for the Procurement/Tender


Committee (Section 6)
◆ undertake direct ordering, local purchasing of low-value goods, and ordering of


recurrent supplies (Section 6.5)
◆ evaluate low-value quotations and award low-value contracts according to set


criteria (Sections 6.3 and 6.4)
◆ organize and monitor delivery, customs clearance, and transport to site (Section 7)
◆ process procurement paperwork for payment (Section 8)
◆ set annual action plans for procurement and review progress (Section 9)
◆ for each round of procurement, endorse the chosen purchasing method, timetable,


and source of funds (Sections 5.3 and 5.4)
◆ manage the tender and high-value quotation processes
◆ evaluate all tender bids and high-value quotes and award contracts according to set


criteria (Sections 6.3 and 6.4)
◆ ensure there are regulations, policies, and plans for procurement and


commissioning (Section 2)
◆ ensure there is a Purchasing/Supplies Procedure Manual (Section 2.2)
◆ ensure there are suitable evaluation criteria for products and suppliers


(Sections 3.2 and 4.4)
◆ decide on the models of procurement to use (Section 4.1)


W
or


kin
g


To
ge


th
er


BOX 4: The Collective Responsibility for Procurement and Commissioning Activities


Continued opposite




Section 1 summary


19


HTM Working
Groups (at
all levels)


Heads of
Department and
HTM Managers
Specification
Writing Groups


Commissioning
Teams and HTM
Teams


Training
sub-groups


Stores Controllers
(at all levels)


Accountants and
Finance Officers


Project sub-groups


◆ are responsible for all equipment matters
◆ develop long-term Equipment Development Plans and annual plans (see Guide 2)


that procurement is based on
◆ develop long-term and annual income and expenditure plans (see Guide 2) to


cover the procurement and commissioning costs
◆ ensure procurement and commissioning are managed as part of the HTM cycle


(Section 2.2)
◆ quantify needs for equipment, equipment-related supplies, and associated services


(according to procedures in Guide 2) and submit them to the Procurement Unit
(Section 3.1)


◆ develop a library of clear generic equipment specifications
◆ assist in preparing purchase documents by writing the technical and environmental


data sheets
◆ keep the information up to date (Section 5.5.2)
◆ are key to a successful commissioning system
◆ identify who will be responsible for installation and commissioning (Section 5.1)
◆ organize and ensure all pre-installation work and preparatory activities are carried


out as planned, from the time of placing the order through to the arrival of the
goods (Section 7)


◆ undertake the formal acceptance process for newly received equipment (Section 8)
◆ plan and monitor that all services (installation, commissioning, initial training) are


delivered as requested, or undertake them (Section 8)
◆ hand over equipment to the user department and equipment-related supplies to


the Stores department (Section 8)
◆ set annual action plans for commissioning and review progress (Section 9)
◆ identify training needs
◆ identify suitable personnel of the right discipline to be trained
◆ identify suitable trainers (Sections 5.1 and 7.1)
◆ develop training materials (Section 8.3)
◆ receive, hold and distribute all equipment and equipment-related supplies, as


appropriate (Section 7.3)
◆ undertake the formal acceptance process for newly received equipment-related


supplies (Section 8)
◆ organize the general stores inventory and the stores stock control system (Section 8)
◆ keep accurate records and order stock on time
◆ protect stock against loss through theft or misplacement
◆ are responsible for the financial integrity of the procurement and


commissioning process
◆ ensure that payments are made according to agreed payment schedules, after the


official acceptance of the goods (Section 8)
◆ liaise with external support agencies providing assistance for routine procurement


or major development projects (Section 2.2)
◆ set goals and review progress of externally-assisted projects (Section 9)


W
or


kin
g


To
ge


th
er


BOX 4: The Collective Responsibility for Procurement and Commissioning Activities (continued)




20




2 Framework requirements


21


2. FRAMEWORK REQUIREMENTS
Why is This Important?
In order to deliver quality health services, it is essential to undertake effective
healthcare technology management.
There are various framework requirements to help you do this. These include
legislation, regulations, standards, and policies.
These framework requirements create the boundary conditions within which
you undertake healthcare technology management. They include central or
national guiding principles, policy issues, and high-level assumptions that can
impede or assist you in your work.
It is very difficult to function effectively if these framework requirements do not
exist, and you should lobby your organization to develop them.
Depending on how autonomous your health facility is, you may be able to
develop these framework requirements at facility, region/district, or central level.


In most industrialized countries, laws, regulations, policies and guidelines form an
indispensable part of health service management. For many developing countries,
however, these regulatory procedures have yet to be developed.
Guide 1 provides a fuller analysis of how to develop these instruments, and shows that
effective healthcare technology management (HTM) is essential in order to deliver
quality health services. Section 2.1 summarizes these points and offers advice on:
◆ the regulatory role of government
◆ establishing standards for your health system
◆ policy issues for HTM
◆ the importance of introducing an HTM Service
◆ managing change.
Section 2.2 goes on to discuss the background conditions specific to this Guide, and
provides advice on:
◆ management authorities responsible for procurement and commissioning activities
◆ central health service policies and plans for equipment and procurement
◆ availability and best use of skills, and economies of scale
◆ the role of external support agencies.




2.1 Framework requirements for quality health services


22


2.1 FRAMEWORK REQUIREMENTS FOR QUALITY
HEALTH SERVICES


Regulatory Role of Government
The World Health Organization (WHO) identifies four distinct functions for
health systems:
◆ The provision of health services.
◆ The financing of health services.
◆ The creation of health resources (investment in facilities, equipment, and training).
◆ The stewardship of health services (regulation and enforcement).
Health service provision and financing, as well as resource creation may be taken on by
both the government and private sector. Thus, there are various options for organizing
health systems:
◆ Mainly public.
◆ Mainly private for-profit (for example, run by a commercial organization), and


private not-for-profit (for example, run by faith organizations, NGOs).
◆ A mixture of government and private organizations.
However in all these systems, the government is solely responsible for the regulation
of health services. The reason for this is that the government has a duty to ensure
the quality of healthcare delivered in order to protect the safety of the population.
These regulations may then be enforced directly by government bodies or they may
be enforced by publicly funded bodies, such as professional associations, which apply
government-sanctioned regulations.
Most governments would agree that the protection of health and the guarantee of
safety of health services is vital. However, in many countries this regulatory function is
underdeveloped, with weak legal and regulatory frameworks.
To regulate health services, the government should:
◆ adopt suitable quality standards for all aspects of health services, including


acceptable international or national standards for healthcare technology, drugs,
and supplies in order to ensure their efficacy, quality and safety


◆ establish systems to ensure standards are met, so that the bodies enforcing
regulations have legal sanctions they can use if standards are infringed


◆ establish wide-ranging policies covering all aspects of the utilization,
effectiveness, and safety of healthcare technology, drugs, and supplies


◆ establish systems to ensure these policies can be implemented.




2.1 Framework requirements for quality health services


23


For health services, the Ministry of Health is the body most likely to develop these
government regulations. Other health service providers need to be guided by
government laws, and should look to the Ministry of Health for guidance or follow
their direction if required to do so by law or regulation.


Establishing Standards for your Health System
The government should agree on which quality standards have to be met by the
health services in general. These will cover areas such as:


◆ procedures and training
◆ construction of facilities
◆ healthcare technology, drugs, and supplies
◆ safety
◆ the environment
◆ quality management.


Since drawing up these standards can be both time consuming and expensive,
governments may often choose to adopt acceptable international standards (such as
ISO), rather than develop their own. However, they must be suitable and applicable
to your country’s situation and fit in with your country’s vision for health services.
The adoption of suitable international or national standards for healthcare technology
is of particular relevance to this Guide. Such standards would cover areas such as:
◆ manufacturing practices
◆ performance and safety
◆ operation and maintenance procedures
◆ environmental issues (such as disposal).
These are important since countries can suffer if they acquire sub-standard and
unsafe equipment. Again, in the majority of cases ministries of health would save
money and time by adopting internationally recognized standards. For more
information on introducing internationally recognized standards into your
procurement procedures, refer to Sections 3.2 and 5.5.2.
It is not enough simply to establish these standards; they also need to be adhered to.
You should establish a national supervisory body that has the power to ensure that
health service providers comply with the standards in force. To be effective, such an
enforcement agency must be allocated sufficient financial and personnel resources.
It should also be linked or networked with corresponding international bodies.
Much healthcare technology in developing countries is received through foreign aid and
donations, but such products don’t always meet international standards. Therefore, your
country will need to negotiate with external support agencies. The best way to do this is
to draw up a list of donor regulations – see Section 3.3 and Annex 6.


Standard
a required or agreed level


of quality or attainment
set by a recognized authority,


used as a measure,
norm, or model




2.1 Framework requirements for quality health services


24


The legal system plays an important role in enforcing such standards, by ensuring
that any infringements can be effectively prosecuted. It is therefore essential that
the legal system is allocated sufficient financial and human resources to enforce
claims against any institution operating equipment that does not meet the
prescribed standards.


Developing Policies for Health Services
Every country needs to establish wide-ranging policies covering all aspects of health
services. National health policies are usually developed by the Ministry of Health. If
these policies are linked to regulations, then other health service providers must also
follow them. Each health service provider can expand them internally, and must
establish systems to ensure they are implemented.
One key framework requirement for this Series of Guides is that your health service
provider should have started work on a Healthcare Technology Policy (for guidance
on this process, see Annex 2). Such a policy usually addresses all the healthcare
technology management (HTM) activities involved in the life-cycle of equipment,
as shown in Figure 4.


Figure 4: The Healthcare Technology Management Cycle


• Create
awareness
• Monitor
and
evaluate


Technology Assessment
and Selection


Budgeting and
Financing


Planning and
Assessment


Training and Skill
Development


Installation and
Commissioning


Procurement
and Logistics


Decommissioning
and Disposal


Maintenance
and Repair


Operation
and Safety




2.1 Framework requirements for quality health services


25


Here we will consider just four issues that provide key background conditions:
◆ A vision for health services.
◆ Standardization.
◆ The provision of maintenance.
◆ Finances.


A Vision for Health Services
Every health service provider needs a realistic vision of the service it can offer. This
should include a clear understanding of its role in relation to other health service
providers in the national health service. Only when this vision is known can the
health service provider decide what healthcare technology is needed, and prioritize
the actions required to develop its stock of equipment.
It is unhelpful if lots of individual health facilities pull in different directions, with
no coordinated plan for the health service as a whole. The central authority of each
health service provider should be responsible for considering what sort of healthcare
should be offered at each level of their health service. Preferably they will collaborate
with the Ministry of Health, or follow their guidance if regulated to do so.
If there is no health service plan, there is no framework on which to base decisions.
Guide 2 provides further information on developing a vision and planning your
healthcare technology stock.


Standardization of Healthcare Technology
Introducing an element of standardization for healthcare
technology will help you to limit the wide variety of makes and
models of equipment found in your stock. By concentrating
on a smaller range for each equipment type, your technical,
procedural, and training skills will increase and your costs and
logistical requirements will decrease (see Guide 1).
It is easier to achieve standardization if equipment is planned and
ordered on a country-wide, district-wide or health service
provider basis. It is therefore important to combine forces with


other facilities or health service providers, and it may be wise to follow standardization
strategies of the Ministry of Health. It is important that these standardization efforts
do not just apply to products purchased by health facilities, but also to donations.
Standardizing your healthcare technology may be difficult for a number of reasons.
Your country and local businesses may have their own trade practices and interests.
National donors may have tied-aid practices, while the procurement procedures of
international funding agencies, health service institutions, and individuals may act
against your standardization strategies (Sections 3.3.2 and 3.3.3).


Standardization
(also known as rationalization,


normalization and harmonization)
– the process of reducing the


range of makes and models of
equipment available in your stock,


by purchasing particular named
makes and models.




2.1 Framework requirements for quality health services


26


You may need to hold discussions with organizations such as the Ministry of Industry
and/or Trade, the chambers of commerce or specific business associations, as well as
external support agencies. However, it is well worth persevering, as standardization
offers many benefits, both in terms of cost and efficiency.


Provision of Maintenance
Proper maintenance is essential to ensure that the equipment you have purchased
continues to meet the standards required throughout its entire working life.
Undertaking maintenance belongs to the service provision function of health
systems, and could therefore, in principle, be carried out by the government, the
private sector, or by a mixture of the two.
It is useful to organize the maintenance system along similar lines to the health
service provision already existing in your country. For instance, if the health sector is
predominantly run by the government, it is probably simplest to let the government
run the maintenance organization as well. In contrast, if private organizations run the
health services, it makes little sense for the maintenance activities to be carried out
by a government body. In the majority of cases, a mixed system is most likely.
However, the government may wish to take a regulatory role and establish regulations
that guarantee that healthcare technology performs effectively, accurately, and safely.
The rules established are valid for all health service providers, irrespective of their
type of organization.
Specific maintenance requirements would not need to be prescribed by the regulatory
body. Instead, it is up to individual health service providers to decide how these will
be provided. However, the nature and the complexity of some maintenance services
often call for partnerships between the public and private health service providers.
Partnerships may also exist between health service providers and private sector
sources of maintenance support. For more details, refer to Guide 1.
To provide maintenance services, you will normally need to establish good links
between maintenance workshops. This will create a network that supports the needs
of all your health facilities. Maintenance is, of course, only one of many HTM
activities that need to be carried out. However, the fact that maintenance workshops
usually already exist in most countries serves as a useful starting point for establishing
a physical HTM Service across your health service provider organization and across
your country. For more details on how to organize an HTMS, refer to Guide 1.




2.1 Framework requirements for quality health services


27


Finances
To ensure that healthcare technology is utilized effectively and safely throughout its
life, your health service provider will need to plan and allocate adequate capital and
recurrent budgets. See Guide 2 for more advice on this.
In a government-organized system these funds have to be provided by government
budgets, while private systems or mixed systems must generate the required funds
from their customers, or from benefactors and donors.
Depending on your health service provider and country, your HTM Service may be
able to generate income by charging for services provided. Whether this income can be
used to further improve the HTM Service depends on the policies of the responsible
financing authority (such as the treasury or central finance office). Guide 6 provides
advice on this.


The Importance of Introducing a Healthcare Technology
Management Service


We have established the importance of:
◆ adopting standards for healthcare technology
◆ developing healthcare technology policies
◆ establishing systems to ensure these policies are implemented.
All these aims could be achieved if each health service provider practised healthcare
technology management (HTM) as part of the everyday life of their health service.
The best way to do this is to have an HTM Service incorporated into each health service
provider organization.
Box 2 (Section 1.1) shows that HTM provides a wide range of benefits. Guide 1
attempts to express this in terms of the sorts of savings that can be made if HTM is
effectively carried out. Taking maintenance as an example, we can see that it has not
only a positive impact on the safety and effectiveness of healthcare technology, but
that is also has two important economic benefits:
◆ It increases the lifespan of the equipment.
◆ It enhances the demand for health services, since demand for services is crucially


dependent upon the availability of functioning healthcare technology.
Healthcare technology that is out of order quickly leads to a decline in demand, which
will in turn reduce the income and quality of services of the health facilities. You will
lose clients if, for example, it becomes known that malfunctioning of sterilization
equipment may endanger the health of patients. Similarly, patients will avoid visiting
health facilities that do not possess functioning diagnostic equipment.




2.1 Framework requirements for quality health services


28


Thus the justification for introducing an HTM Service is that it will benefit you
economically and clinically, by ensuring that healthcare technology continues to
meet the standards required throughout its working life.
The activities of an HTM Service belong to the service provision function of health
systems. However, the government may wish to take a regulatory role and establish
regulations that guarantee that HTM occurs. To achieve this, it will be necessary
to have:
◆ a government body to provide regulations that will ensure the continued


performance and safety of healthcare technology throughout its life
◆ a control mechanism to check that all health service providers pursue these


healthcare technology management activities effectively
◆ legal or other sanctions that are enforceable if the rules are infringed.
The government body responsible for providing regulations could be the central
level of the national HTM Service. Each health service provider could then develop
its own HTM Service. It should involve a network of teams and committees that
enable HTM to be practised in all facilities. In order to establish an effective HTM
Service, you will need to provide sufficient inputs, such as finance, staff, workshops,
equipment, and materials. Only in this way will you get the outputs and benefits that
you require. For details of how to develop such an HTM Service, see Guide 1.
The organizational chart for the HTM Service will vary depending on the size of your
country and your health service provider organization, and whether you are just
starting out. However, Figure 5 provides an example of the relationship between
HTM Teams and HTM Working Groups (Section 1.1) that we envisage.


How to Manage Change
The regulatory requirements presented in this Section may appear somewhat
idealistic, compared to the reality in many health systems. However, the aim is not
to highlight the deficiencies of existing systems, but to provide a blueprint for a
functioning healthcare technology management system. Hopefully, this will enable
you to get the right framework conditions in place, and thus improve the effectiveness
and the safety of your health services.
We are not recommending that your health service provider:
◆ throws out all its current HTM strategies and starts again
◆ makes sudden and sweeping changes that are likely to fail if they are over ambitious.
Rather it is better to take a step-by-step approach, introducing changes gradually, with
a careful review process. To implement an HTM system with all the complexities
described in this Series of Guides will take several years, and to try to achieve
everything at once could be disastrous. However, for healthcare technology
management to improve, it is important to act.




2.1 Framework requirements for quality health services


29


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Figure 5: Sample Organizational Chart for the HTM Service




2.1 Framework requirements for quality health services


30


It is possible to write down all the correct procedures and yet still fail to improve the
performance of staff. To ensure that your HTM procedures are effective, it is important
for there to be good managers who can find ways to motivate staff (Section 9.2). Simply
ordering staff to implement new procedures doesn’t usually work. It is much better to
discuss and develop the procedures with the staff who will implement them. This could
take the form of discussion, working groups or training workshops. People who are
involved in developing ideas about their own work methods are more likely to:
◆ understand the objectives
◆ understand the reasons why processes are necessary
◆ be encouraged to change their way of working
◆ be more interested in making changes which result in improvement
◆ see that the aim of the HTM procedures is to improve their delivery of healthcare.
We recognize that many readers will face difficulties such as staff shortages, poor
finances, lack of materials, a lack of influence and time, and possibly even corruption.
Introducing new rules and procedures into a system or institution that has no real
work ethic, or which possibly employs dishonest workers, will not have any
significant effect.
Therefore, strategies may be required to bring about cultural and behavioural change.
For example:
◆ When materials are short, instead of focussing upon breakages and loss, place more


emphasis upon the importance of staff working hard and putting in the hours.
◆ Favour good managers who are seen to be present and doing what they preach.
◆ Encourage an atmosphere where staff are praised for good work, rather than a


culture of judgement and criticism.
Introducing rules and administrative procedures alone will not be sufficient to bring
about cultural change. You will also need to find ways of increasing performance and
productivity, and acknowledging/rewarding good behaviour is essential. For example:
◆ It is better to break a tool while actively undertaking maintenance, rather than


breaking nothing but never doing any work.
◆ It is better to break a rule in an emergency (such as withdrawing stocks from


stores), rather than stick to the rules and risk the possible death of a patient.
Annex 2 has some examples of useful reference materials. To bring about such
changes, you will require skills in:
◆ managing change
◆ staff motivation
◆ effective communication
◆ encouragement
◆ supportive training with demonstrations.




2.2 Background conditions specific to this guide


31


All parties involved in the network of HTM Teams and HTM Working Groups need
to participate in developing the HTM Service. This will encourage a sense of
ownership of the service and its responsibilities, and will lead to greater acceptance
and motivation among staff. If you are short of skilled staff (such as technicians,
managers, planners or policy-makers), you may need to obtain specialist support to
assist with some of these tasks.


2.2 BACKGROUND CONDITIONS SPECIFIC TO
THIS GUIDE
Your country and health service provider may have existing regulating principles and
conditions which will affect, or can inform, aspects of your procurement and
commissioning work.
You will need to find out whether the regulations, policies, and procedures discussed
in this Section exist in your country and organization. If they do, it makes sense to
follow them. If such regulations do not exist, you will need to highlight these issues
at the central level of your organization, and continue to follow the advice provided
in this Guide at your level.


Management Authorities Responsible for Procurement
and Commissioning


If you work for a health service provider organization, you must conform to:
◆ any existing regulations and guidelines concerning equipment procurement and


commissioning activities, which are produced by the central management body.
In addition, there may be other higher authorities that provide regulation and
guidance on equipment procurement and commissioning. Some examples of these
are provided here:
◆ The Ministry of Finance usually provides regulations and guidelines for


government procurement, stores management, imports, and customs duties.
◆ Other health service providers may look for guidance from the Ministry of Health.
◆ Any National Regulatory Authority might provide regulation and guidance on


product standards, and monitor the imports of equipment and equipment-related
supplies.


◆ The national Healthcare Technology Management Service, or your own, should
provide guidance on equipment installation, commissioning, and acceptance.




◆ Other agencies may have been given authority to procure and commission certain
types of equipment, and you must either follow their guidelines or not interfere
with the equipment outside your responsibility. For example:
- In the government sector, the Ministry of Works may be responsible for health


buildings, plant, and service supply installations; the Ministry of Supplies for
furniture and office equipment; and the Ministry of Transport for vehicles.


- In the non-government or private sectors, there may be a Maintenance Service
and/or a Logistics Division with authority over different types of equipment.


- The national electricity supply, water supply, and telecommunication authorities
will have varying responsibilities for different types of equipment.


These management authorities should have paid special attention to policies,
procedures and guidelines in their relevant area. These will provide you with a clear
sense of direction and enable you to make informed decisions about procurement
and commissioning activities. Without the existence of such framework conditions,
the task of selecting, procuring, and using suitable health sector goods becomes
much more difficult.
One area of particular importance is the policies and procedures to cover
unauthorized procurement outside the system (for example, doctors with contacts to
donors). Your policies and procedures should make sure any items obtained through
unauthorized procurement are supported with maintenance, and that any recurrent
costs have been accounted for. Policy can either support unauthorized procurement
or discourage it, but either way it should be made plain.
Guide 2 on planning and budgeting provides advice on developing policies for
purchasing, donations, replacement, and disposal of equipment. Such policies should
include information about when to purchase, what to purchase, when equipment
should be replaced, reasons for replacement, and when you should write off
equipment (see Section 3.1 and Annex 3).
As procurement is a quasi-legal process and procurement and stock control involve
large amounts of money and assets, it is usual for them to be strictly regulated. In the
government sector it is often the Ministry of Finance that develops a Purchasing
Regulations and Procedures Manual (also known as a Supplies Regulations and
Procedures Manual). An outline of the form such a document could take is given in
Box 5 on page 34.


2.2 Background conditions specific to this guide


32




2.2 Background conditions specific to this guide


33


Country Experience
One country’s purchasing policy is:
a) priority is given to replacement of obsolete equipment
b) sophisticated and complex equipment for all facilities is procured by the Central


Health Ministry
c) foreign funded procurement is handled by the Central Health Ministry
d) all the purchases are carried out through competitive bidding
e) where sophisticated or complex equipment is concerned, the ‘turnkey’ approach is


always adopted (where the supply of equipment includes installation, commissioning,
initial training for operators, warranty, building modification, safety, service and
maintenance for five years after warranty)


f) other equipment is procured by the respective institutions under national
procurement guidelines


g) an expert committee at national level formulates generic specifications for each item
and circulates them among healthcare institutions in the country. These specifications
are upgraded annually. The technical committee for drafting specifications consists of
two consultant clinicians nominated by the respective academic bodies (such as
the College of Paediatricians), one biomedical engineer who acts as secretary to the
committee, and one administrator.


Another country’s purchasing policy for the government sector lays down general
principles such as:
i) Purchasers should base all procurement of goods and services on value for money,


comparing issues such as quality (or fitness for purpose) and delivery against price.
Value for money should be judged on whole life-cycle costs, not simply initial costs.


ii) Goods and services should be acquired by competition unless there are good
reasons to the contrary.




Separate manuals may be required to cover different circumstances, as the source
of funding for procurement will influence the way in which you arrange and carry
out procurement:
◆ If funding for procurement is provided by an external funding agency such as


xa development bank (for example, the World Bank), it usually has its own
procurement procedures and requirements. These procedures may take
precedence over national law, in which case you would have to follow them.


◆ Other ministries may have responsibility for purchasing some items of equipment.
For example, vehicles may be purchased by the Ministry of Transport, and plant
and service supply installations by the Ministry of Works. Procurement using
national budgets will be governed by national rules and regulations.


The manual should describe who it applies to:
◆ In the government sector, different ministries will be involved in procurement,


such as Health, Works and Supplies. The Ministry of Health, Central Medical
Stores, or Supplies department may share joint responsibility for medical supplies
and equipment. However, some independent programmes (for example, dental
and laboratory services) or health facilities may handle their own procurement.


◆ For other health service providers, different divisions may be involved, such as
those for purchasing, logistics, supplies, or transport.


The manual should provide:
◆ charts showing the place of purchasing and supplies within the organization
◆ job descriptions including roles and responsibilities for all posts within purchasing


and supplies
◆ administrative information for staff – for example, absences, hours of work.
The manual should provide:
◆ policy statements setting out objectives, responsibilities and authority for


purchasing and supplies
◆ terms and conditions for purchasing
◆ relationship with suppliers, especially regarding gifts, entertainment, etc
◆ supplier and product selection
◆ acceptable freighting methods and insurance
◆ customs regulations
◆ reports to management.
The manual should contain:
◆ descriptions, accompanied by flowcharts, of procedures relating to requisitioning,


ordering, transporting, customs clearing, receiving, inspecting, storing, and paying
for goods


◆ procedures relating to the rejection and return of goods
◆ procedures in respect of the disposal of scrap and obsolete or surplus items
◆ descriptions of procurement and stores records, and how they should be kept.


2.2 Background conditions specific to this guide


34


BOX 5: Typical Contents of a Purchasing/Supplies Manual
Authority/coverage
of the manual


Responsible
purchasing bodies


Organizational
issues


Policy issues


Procedures


Continued opposite




2.2 Background conditions specific to this guide


35


Funding for procurement may come from a number of sources, including:
◆ national funds
◆ central funds
◆ own funds, such as cost recovery schemes
◆ loans
◆ donations.
There should be descriptions of any variation in procedures depending on the type
of funding source.
Different people (in different posts) responsible for purchasing are only allowed to
purchase up to a particular monetary value. These authority levels and financial
limits should be described.
The manual should include a statement describing how the policies and procedures
should be implemented, and how progress is monitored.
Complete copies of the manual should be given to the following people:
◆ Directors at health facility and decentralized health authority levels.
◆ Purchasing and supplies staff, both centrally and locally.
◆ Heads of teams involved in purchasing and supplies (such as finance teams, and


HTM Teams).


BOX 5: Typical Contents of a Purchasing/Supplies Manual (continued)
Financial resources
and funding
mechanisms


Financial limits
for procurement


Implementation


Distribution of
the manual


The Purchasing/Supplies Manual:
◆ does not specifically address issues that are crucial to the successful purchase of


equipment. So, alongside the Manual, the Procurement Service and HTM
Service will also need to consult this Guide for further advice


◆ does not normally cover the technical details of the commissioning activities.
Thus, you need guidelines from the HTM Service, Ministry of Works, or any
other relevant body, on issues such as site preparation, installation,
commissioning and acceptance of equipment.


Your health service provider needs to:
◆ develop written procedures and guidelines on all the aspects of procurement and


commissioning that are covered in this Guide. This should take the form of a
simple and easy-to-read guide that staff can refer to, and which can also be used
as a training aid.




Central Plans for the Health Service
Equipment Development Plans and Budgets
Before any procurement and commissioning activities can take place, you must
properly plan and budget for them.
Such planning is essential to limit wastage. Proper planning ensures that scarce
funding is properly allocated, with high priority needs being dealt with first, and avoids
unnecessary purchases. Maintaining an accurate inventory record and stock control
system is invaluable when planning your purchasing requirements. Guide 2 describes
how to plan and budget for your equipment. (Topics covered in Guide 2 include:
establishing the Equipment Development Plan, purchasing policies, appropriateness
criteria, Model Equipment Lists, equipment specifications and equipment inventory.)
Your budgets need to cover all your procurement and commissioning needs. When
drawing up the budget, you need to differentiate clearly between different types of
expenditure. For example, the capital budget is usually spent on equipment, and the
recurrent budget is spent on running costs (such as consumables and spare parts).
When procuring any item of equipment, you must commit funds to keep it in
running order for a number of years or, if possible, over its lifetime.
The Procurement Process and Plan
Procurement and commissioning can be thought of as a cycle that includes various
steps, as shown in Figure 6. This process can be time consuming and expensive, but
is necessary if you want to end up with the correct functioning equipment for your
situation. Figure 6 also shows that procurement is just one part of the healthcare
technology management cycle. Other areas of healthcare technology management
also feed into the process, so that the procurement process can be reviewed and
improved. Not all cycles correspond exactly to the procurement cycle in Figure 6,
but good ones incorporate all the stages.
Product selection is an important stage in the procurement process. Products must
be selected based on a thorough needs analysis and adjudication system, taking into
account the level of the health facility and the skills available. More sophisticated
equipment is generally needed at higher levels, as the range of diagnostic and
treatment services offered broadens (Section 3.2).
While there are several options for buying equipment, the majority of equipment
purchases are carried out as either a tender or quotation process (Sections 4.2 and 6).
Whatever method you use:
◆ you need to prepare a purchasing plan that indicates all the different procurement


activities that must be carried out, with details and a timetable of when they
should take place (Section 5.4)


◆ your purchasing method and plan should be designed to avoid the risk of collusion
and corruption. It should also ensure transparency, accountability, and value for
money, and foster fair competition.


2.2 Background conditions specific to this guide


36




Figure 6: Procurement Cycle Within the HTM Cycle


2.2 Background conditions specific to this guide


37


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HEALTHCARETECHNOLOGYMANAGEM
ENTC


YCLE


PROCUREMENT AN
D COMMISSIONING CYCLE




Availability and Best Use of Skills
This Guide presents a detailed and complete description of the procurement and
commissioning process. To carry out the procedures outlined here, you will require a
reasonable number of well-trained staff. In government sectors, this level of
management and technical skills may be available at national or central level or even
in large hospitals, but may be a problem at district level. In many non-government
health facilities, purchasing is often the responsibility of individuals or groups who
have little or no specialized training in equipment procurement, and who may lack
technical expertise.
The current decentralization efforts in the health sector will bring about significant
changes in the management and procurement of healthcare technology. District
managers may be asked to quantify and specify all future procurement activities.
This task is large and complex, and the present skills of district managers in some
countries will be inadequate.
For these reasons, it may be necessary to:
◆ encourage planning, budgeting, and procurement tasks to be undertaken at


central level for those facilities and service levels which cannot undertake the
whole management process themselves


◆ encourage the planning and implementation of commissioning by a zonal level of
the HTM Service that has sufficient skills


◆ encourage district managers to understand the process and be aware of what they
are able to manage, and where they need help.


Training is therefore essential in order to ensure effective procurement and
commissioning. All staff involved, from all agencies, must be properly skilled,
managed and coordinated, with clear lines of responsibility and authority being given.
This is important, as lack of coordination and decisions made on an ad-hoc basis can be
costly. Poor practices not only lead to waste and delays but can also provoke
allegations of corruption and inefficiency.


Tip • To make the process of coordination easier, you should clearly identify which
different departments (in your organization and others) have a role to play in
procurement and commissioning, detailing their job titles and responsibilities.


Obtaining equipment is a multi-disciplinary team task and you will need to involve
individuals from across the health facility and organization (Section 1.2). As a
minimum, it is likely that you will require specialized procurement expertise and
experience, and will also need to involve personnel from the finance, medical,
nursing, maintenance, and support services. In addition:
◆ HTM Working Groups should take the coordinating and monitoring role to ensure


that procurement takes its rightful place in the healthcare technology
management cycle (see Figure 6).


2.2 Background conditions specific to this guide


38




Experience in Southern Africa
In one southern African country, poor procurement procedures and lack of consultation
between different disciplines led to problems. The Ministry of Works staff were not consulted
by the Ministry of Health on the plumbing fittings to be put in a hospital, although they would
be expected to maintain them.
The hospital experienced many problems with blockages of the toilets and flushing of the
cisterns that were purchased from France. The Ministry of Works maintenance personnel
tried to end these problems by replacing the toilet and cistern fittings with ones generally
used in Africa. But this could not be done, because the European fittings used non-standard
positions for water entry and waste exit, and the pipework installed could not be attached to
the products available in Africa.


Complexity of equipment will determine the number of people involved in the
process and their expertise. Placing several individuals on a number of different
committees will enable better coordination as well as the most informed and
best decisions.


Tip • Generally speaking, the greater the technical nature and complexity of an item, the
greater the involvement should be of technical staff in the buying decision.


Economies of Scale
As your management system improves, decentralization often promotes accurate and
timely decision making. However, certain activities may be better carried out at a
central level, because it will not be economical to develop such knowledge at district
or facility level. These could include defining equipment levels, developing
technical specifications, and undertaking installation and commissioning. This is a
good example of how the ‘economy of scale’ for technical knowledge will challenge
the decentralization process.
Procurement may also be more efficiently carried out at a central level. Procurement
of small quantities increases both the initial and the life-cycle costs of equipment
(Section 3.2), because you cannot benefit from the savings that bulk-buying offers.
When making a needs assessment for one hospital, you are likely to arrive at low
quantities of a broad variety of equipment. So undertaking calculations at facility
level will not enable you to benefit from economies of scale. Instead, by combining
procurement for several facilities at the same time, and gaining the resulting
standardization, you can obtain significant advantages. These include better prices
for bulk orders of equipment, consumables, and spare parts, shared training costs,
and improved aftersales commitment from the supplier.


2.2 Background conditions specific to this guide


39




Thus it is preferable to:
◆ undertake equipment management and needs assessment at district or regional


level, and merge procurement needs for a number of facilities or districts. This
will result in the ideal combination of accurate management and procurement
advantages, proportional to the economy of scale.


You may face problems with this rationalization and savings strategy when external
support agencies target funds at individual facilities or districts. Thus it is preferable to:
◆ ensure external support agencies follow your Model Equipment Lists, Generic


Equipment Specifications, and standardization policy (see Guide 2), in order to
overcome the drawbacks.


The Role of External Support Agencies
The role of external support agencies in procurement is very important. Although
their assistance is invaluable to many developing countries, often the recipients do
not receive good quality products that are appropriate to their situation. These
unfortunate circumstances arise when:
◆ there is a lack of knowledge of how to make appropriate choices of complex


technologies
◆ there are formal procedures and rules (such as the use of open tenders) which do


not lend themselves to selection based on the best overall deal for your situation.
Thus, throughout this Guide we highlight the areas where conflict may arise between
your wishes and external support agency practices, and try to suggest resolutions.


Tip • Ultimately you will have to learn how to identify the right external support agency
for different procurement needs.


Another problem is control of externally assisted projects (whether for routine
equipment procurement or major development projects). Often external support
agencies, hired consultants, or NGOs run such projects, including the healthcare
technology procurement component, and take control away from the staff who are
normally responsible for planning and procurement. Such situations should be
avoided and could be overcome by setting up a formal project committee/
organization where key personnel from all contributors and stakeholders are
involved. This could be a sub-group of the HTM Working Group (Section 1.2).
By setting up a formal project committee, your organization would have access to all
the information and a channel to influence the project, without having to bear the
full workload of the additional process. Further information on establishing project
organizations is not a part of this Guide, but it is recommended that you consider
such solutions when similar situations occur.


2.2 Background conditions specific to this guide


40




One useful initiative includes the following strategies:
◆ A project committee made up of a range of local managers (such as technical,


medical, financial) who have an input and veto into the design, specifications,
procurement package, and purchase sources for the project.


◆ An implementing/procurement agent, contracted to act only as advisor to the
health service provider. The agent would carry out specific actions such as
administration or paperwork, on behalf of the health service provider. However,
they would not act in the health service provider’s place.


◆ A tender process that preferably involves selective bidding. This would ensure
that an element of standardization can be maintained, and preferred sourcing is
adhered to. The tender process can be undertaken by either the agent or the
health service provider.


◆ The agent should display the bids in comparison tables so that the health service
provider can choose the most economically advantageous option (taking into
account a full range of issues and not just the cheapest price).


Such strategies are required to enable developing countries to regain some control.
Where there is a strong local Procurement Unit it is possible to subject gifts to the
same scrutiny as is the purchase of equipment. In some developing countries, for
example, the maintenance service is asked to advise on its capacity to guarantee
maintenance before a donation is accepted. In other countries, unsuitable shipments
of donated equipment are turned away from the port of entry.
The suggestions in this Guide aim to improve the quality of support from
external agencies, not to hinder it.


2.2 Background conditions specific to this guide


41




Experience in Sri Lanka
The Ministry of Health plans procurement and identifies funding sources. If the procurement
is financed through external support, a steering committee and a technical/finance
committee are appointed at central level.
The steering committee is comprised of the Secretary to the Health Ministry, a representative
of the Department of External Resources, a representative of the National Planning
Department, and the Chairman of the Tender Board. Its responsibility is to set up the time
frame for procurement in consultation with the technical/finance committee, to monitor
progress every two months, and to liaise with the external support agency.
The technical/finance committee consists of senior consultant clinicians covering the
respective clinical disciplines, a biomedical engineer, a finance manager, an administrator,
and a member of the Procurement Support Bureau. (The Procurement Support Bureau in the
Treasury Department has a pool of experts on procurement issues, whose expertise on
topics such as contract negotiations and legal matters is valuable.) The technical/finance
committee is responsible for writing specifications, drafting tender documents, evaluating
bids, and making recommendations to the tender board.
The tender process is administered by the Biomedical Engineering Division of the Health
Ministry. Its responsibilities are invitations for bids, coordinating with the committees,
issuing awards, signing and managing the contracts, and acceptance and handover of
the equipment.


Box 6 contains a summary of the issues covered in this Section.


2.2 Background conditions specific to this guide


42




Section 2 summary


43


BOX 6: Summary of Issues in Section 2 on Framework Requirements


Government


Ministry of Health


All Health Service
Providers in general


Qu
al


ity
H


ea
lth


S
er


vic
es


◆ actively regulates health services whether they are provided by public providers,
private providers, or a mixture of the two


◆ develops checking systems and legal sanctions for infringement of health
regulations


◆ adopts suitable standards for quality health services, in general
◆ specifically for healthcare technology, adopts standards for:


- design, development, and manufacturing
- performance and safety
- use and training
- waste disposal


◆ develops donor regulations to ensure all equipment received through foreign aid
and donations also complies with the standards


◆ establishes public or quasi-public supervisory bodies to enforce regulations
and standards


◆ develops national policies for health services
◆ specifically develops a Healthcare Technology Policy to cover all healthcare


technology management activities including:
- a vision
- an element of standardization
- the provision of maintenance
- provision of finances for all HTM activities
- the organizational structure for an HTM Service


◆ regulates on these issues (if required)
◆ develops an HTM Service made up of a network of teams and working groups
◆ uses the central level of the HTMS as the national regulatory body, if necessary,


and to ensure that HTM policies are implemented
◆ provides sufficient inputs to ensure the HTMS is effective
◆ uses strategies to manage the changes involved carefully, so that they can


be successful
◆ conform to regulations and guidelines provided by government
◆ conform to the standards set by government
◆ follow the policies of the Ministry of Health if regulated to do so
◆ develop their own internal Healthcare Technology Policy and expand strategies
◆ develop their own HTM Service made up of a network of teams and working


groups, with sufficient inputs to ensure it is effective, in order to ensure that
HTM policies are implemented


◆ follow MOH regulations on the HTMS if regulated to do so
◆ implement strategies to develop skills in managing change, staff motivation,


effective communication, encouragement, and supportive training with
demonstrations


◆ introduce rules and procedures using discussion, working groups, training
workshops, etc with the staff that will implement them


◆ include all parties involved in the network of HTM Teams and Working Groups
in the development of the HTMS


◆ introduce changes to HTM step-by-step, with a careful review process


Continued overleaf




Section 2 summary


44


BOX 6: Summary of Issues in Section 2 on Framework Requirements (continued)


High-level
Regulatory Bodies


Health Service
Providers


All groups
involved in
procurement and
commissioning
(at each level of
your organization)


Pr
oc


ur
em


en
t a


nd
C


om
m


iss
io


ni
ng


◆ ensure that regulations, policies, guidelines and Procedure Manuals exist for
procurement, standards, logistics, customs, stores management, installation and
commissioning


◆ ensure it is understood which agencies are responsible for procuring and
commissioning which equipment


◆ ensure the regulations, policies, guidelines, and procedures are updated regularly
◆ ensure additional policies and guidelines are developed for their organization on


replacement strategies, appropriate selection criteria, standardization, recurrent
cost provision, and initial training for equipment


◆ ensure adequate planning and budgeting takes place (see Guide 2), and
procurement of equipment occurs according to those plans and budgets


◆ ensure a procurement cycle and plan are developed and understood by staff
◆ develop written procedures for all aspects of procurement and commissioning
◆ ensure that multi-disciplinary teams are established to manage the procurement


and commissioning process for healthcare technology, with sufficient technical
input from the HTM Service


◆ negotiate with external support agencies to ensure that the right procedures are
used that will enable equipment appropriate to your needs to be procured


◆ establish a project sub-group that works jointly with external support agencies for
routine equipment procurement or major development projects, in order to
retain control within the health service


◆ only decentralize procurement and commissioning activities to levels where
skills exist


◆ use economies of scale to your advantage by:
- making use of technical skills and guidance from levels where the knowledge exists
- combining forces with other levels to undertake needs assessment and bulk-buy


equipment and supplies to gain procurement savings and standardization
◆ conform to regulations, policies, guidelines and Procedure Manuals provided by


relevant bodies for procurement and commissioning activities, which dictate who
can procure and commission what, when, and how


◆ only undertake procurement and commissioning activities at suitable
decentralized levels in your organization where sufficient skills are present


◆ carry out their duties as team members according to their role and responsibility
within the procurement and commissioning process




3. HOW TO DECIDE WHEN AND WHAT
TO PROCURE


Why is This Important?
Your aim is to obtain equipment in the right quantities that is both suitable and
appropriate for your needs, and fits your budget.
Obtaining equipment is intensive work, both in terms of time and resources.
You therefore need to consider a number of factors before committing to
buying, accepting donations, or hiring equipment.
You should consider whether acquiring the equipment represents rational and
good practice. Any decision should take account of which supply sources are
available, and also consider whether the funding organization has particular
requirements that could influence your options.


You need to make some important decisions when considering the procurement of
equipment. In this Section, we consider the following:
◆ Why you need to procure (Section 3.1).
◆ Issues to consider when choosing equipment (Section 3.2).
◆ A review of the different ways to get equipment (Section 3.3).
◆ Whether to obtain new or second-hand items (Section 3.4).


3.1 WHY YOU NEED TO PROCURE
Procurement Policies


Before carrying out any equipment procurement (through purchases, donations or
rentals), you should already have carried out all the planning and budgeting activities
which are described in Guide 2.
In other words, you should already have drawn up:
◆ an up-to-date Equipment Inventory
◆ a vision for health service delivery
◆ purchasing, donations, replacement, and disposal policies
◆ Model Equipment Lists.


3 How to decide when and what to procure


45




Planning and budgeting activities should result in an Equipment Development Plan,
covering short- and long-term needs. Thus, ideally, all procurement should be for
those items laid out in the Equipment Development Plan for the current year, plus
occasional additional items required to cover contingencies (emergencies and
unplanned-for events).
In line with the suggested Purchasing and Donations Policy in Guide 2, the five
main reasons for procuring equipment (listed in order of priority), are normally:
1. Equipment requires replacement


Equipment should be replaced when:
◆ it has reached the end of its life
◆ it is no longer economical to repair
◆ it has become technically obsolete. (For example, the manufacturer no longer


produces spare parts or accessories, the technology or technique is no longer
considered appropriate, or a more cost-effective or more clinically effective
model becomes available.)


In order to merit replacement, the equipment should be providing an existing
service (such as a dental chair for a dental clinic). For valid reasons why
equipment requires replacement, see the typical contents of a Replacement
Policy in Annex 3.


Tip • Replacement is not an expansion of services, but merely a way of continuing to offer
existing services.


This may be a good time to review your existing services and consider whether
there is a continued need for the equipment concerned. It is also an opportunity
to consider improving the service.


2. Regular supplies of equipment-related items are required
Examples of equipment-related items which are required on a regular basis
include any of the following:
◆ Consumable items (such as X-ray film, ECG recorder paper).
◆ Replacement accessories (shelves, patient probes).
◆ Spare parts (light bulbs, bearings).
◆ Materials for their maintenance (oil, tubing).


3.1 Why you need to procure


46




It is quite common for health facilities to be unable to function effectively during
much of the year if these items are not planned for and purchased. Many may
need to be imported from abroad.


3. Additional equipment is necessary for providing a basic standard level of care
The basic standard level of care, in equipment terms, is provided by your Model
Equipment List. The items that are currently missing from your stock are
determined by comparing your up-to-date Equipment Inventory with the
standard set in the Model Equipment List (see Guide 2).
You should consider more sophisticated technologies only when these core
equipment needs have been fully met.


4. Additional equipment is required to improve services and go beyond a
basic level of care
Improvements to health services may be brought about by rehabilitating existing
health facilities, upgrading facilities, or building new ones. Any such improvements
and expansion should be carried out in accordance with the strategic plans for the
health facility, such as those laid out in your long-term Strategic Business Plan
(see Guide 2).


5. Additional equipment is required that is outside the health facility’s
own plans
Procuring equipment outside your plans should only occur if the extra items:
◆ have been called for by directives from the central health service provider


organization or a national body
◆ have been identified as a new need, or
◆ cannot be stopped/refused for political reasons, such as out of the ordinary,


high profile, or political projects.
These five reasons for procuring equipment can only be acted upon if the following
key factor is in place:
◆ Funding becomes available.


Once you know your needs and have made plans for equipment procurement
(points 1 to 5 above), you can only ever procure if you have the budget to cover
your plans. When funding does become available, it enables you to pursue the
objectives set out above. Any such allocation of funds should be according to your
Core Equipment Expenditure Plan (see Guide 2), to ensure that the money goes
to the highest priority activity. Thus procurement will be planned and not random.


3.1 Why you need to procure


47




Procurement Planning Tools
Box 7 outlines a number of ‘planning tools’ you can use to help you to decide why you
need to procure. Your Procurement Unit will need to work with many different types of
health staff, in order to identify relevant information on procurement needs (Section
5.1). Further details on how to develop these tools, and how different health service
staff can use them, are provided in other Guides in this Series.


BOX 7: Planning Tools Which Help You Decide to Procure
Planning Tools How They Help
When replacing items:
Replacement Policy
(see Annex 3 and Guide 2)
Equipment Inventory
(see Guide 2), and
maintenance record system
(see Guide 5)


Replacement and
condemnation criteria
(see Annex 3 and Guide 4).
Core Equipment Expenditure
Plan (see Guide 2).


Disposal Policy
(see Annex 3 and Guide 2)
and disposal procedures
(see Guide 4).
Stock control system
(see Section 7.2 and
Guides 4 and 5).


3.1 Why you need to procure


48


Establishing and implementing this tool is much more likely to ensure that
the necessary regular planned replacement of equipment takes place.
These tools enable you to identify the need for replacement equipment at
any time. For easy reference, estimated lifetimes for equipment could be
entered into the inventory and could then prompt you when to purchase.
Remember that the natural life of equipment is shortened by harsh
environment, over-use, unskilled handling, neglect of maintenance and
damage. Equipment malfunction and down-time also increase with the age
of the equipment. Accordingly, cost-effectiveness decreases with age.
These help you to judge when equipment has reached the end of its life,
and therefore help you identify when equipment needs replacing.


Some equipment will have to be replaced every year, so it makes sense to
spread your budgeting for replacement over time. By allocating some
money each year, you can avoid facing a large replacement bill later on. This
tool should spread these costs over the long term.
You can estimate your equipment replacement needs each year by
reckoning that each piece of equipment has an average lifetime of 10 years.
This means that roughly 10 per cent of your equipment stock needs
to be replaced each year.
When you replace equipment, these tools will help you dispose of the old
machine. There may be government regulations regarding disposal that will
help you develop these tools.


Replacement equipment-related supplies should be purchased after an
up-to-date stock take. Accurate stock control systems help with planning
and ordering.


Continued opposite




3.1 Why you need to procure


49


BOX 7: Planning Tools Which Help You Decide to Procure (continued)
Planning Tools How They Help
When buying additional
new items:
Equipment Development
Plan, and Annual Purchase
Plan (see Guide 2)


Package of inputs
(see Sections 5.1 and 5.5.2
and Guide 2)
Core Equipment Financing
Plan, and Annual Budget
(see Guide 2)


3.2 ISSUES TO CONSIDER WHEN
CHOOSING EQUIPMENT
Once you know why you are procuring equipment, you need to know what types of
goods are suitable. In order to make the best use of scarce finances, you must try to
obtain only the equipment that is most appropriate for your needs.
Choosing equipment is not easy, due to the wide range of products available.
External influences also play a part. For instance, external support agencies may
impose their own conditions regarding suppliers, which may result in inappropriate
equipment being supplied or procured (Section 3.3.2). In such cases, it is wise to
renegotiate or, if that fails, consider declining the funds or gifts and trying elsewhere.
It is the responsibility of the Procurement Unit, the HTM Working Group, and the
Procurement/Tender Committee to choose equipment. To help them to obtain only
equipment which is appropriate to your needs, your purchasing and donations policy
(Section 2.2) should clearly specify the ‘good selection criteria’ to employ. All
equipment should:
◆ be appropriate to your setting
◆ be of assured quality and safety
◆ be affordable and cost-effective
◆ be easily used and maintained
◆ conform to your existing policies, plans and guidelines.
Such selection criteria should then be used during the procurement process, when
you evaluate and adjudicate between different offers from suppliers (Section 6.3).


New equipment should be purchased according to your Annual Purchase
Plan (drawn each year from your long-term Equipment Development
Plan). This is based on an up-to-date inventory and Model Equipment
List. Accurate inventory record-keeping helps with planning and ordering.
Planning in advance for what will be needed after the purchase is every bit as
important as the purchase itself. Thus, you must ensure that you procure the
package of inputs required to keep equipment functioning through its life.
Capital expenditure can only take place once you have identified sufficient
funding sources. Your long-term Core Equipment Financing Plan and your
Annual Budget should allocate known and possible sources of funds against
elements of your planned expenditure.




Tip • You must ensure that product selection (screening) criteria are specified in your
purchase documents (Section 5.5.2), so that suppliers are aware of how their
products will be judged.


Country Experience
Often developing countries have been tempted to over-specify their requirements for
sophisticated or complex equipment because funds for the procurement are part of a foreign
aid package and have to be utilized for a specific purpose. Even if they need a basic
technical platform, a sophisticated version and accessories are ordered at once because the
funds will not be available after the budget line is over. Since only the basic functions of the
equipment are commonly used, the funds utilized for advanced features are wasted.
For example, one country in 2001 purchased a Multi Slice CT scanner with 3-D
reconstruction, virtual endoscopy and CT fluoroscopy facilities. However, it is used only for
conventional CT scans. The funds used to procure the additional features were
approximately 40 per cent of the procurement budget. The operators responsible for the
machine were not computer literate, so had to undergo basic computer training before they
could be trained how to use the scanner. The scanner was put into operation almost three
months after installation and it took about eight months to get it going smoothly. Thus eight
months of warranty were wasted.


When you are preparing your purchase documents (Section 5.5.2) it is important
that you state clearly what you want, in order to avoid unsuitable equipment being
procured. The main issues are presented here, and summarized in Annex 3 (see
Box 53).


3.2.1 Appropriateness to Setting
Be sure that you select equipment that conforms to the ideals shown in Box 8.
If you are considering procuring a particular item, it can be useful to talk to someone
in a facility that has experience of using that model. Do not be afraid to ask the seller
about the performance of the equipment in local conditions and ask if they (or a
nominated agent) could provide staff training and maintenance, if required.


3.2 Issues to consider when choosing equipment


50




3.2.1 Appropriateness to setting


51


BOX 8: Key Factors Determining the Appropriateness of Equipment and Supplies
Factors Issues
You have the skills


It suits your climate
and conditions


It is simple to use


It fits into your
health facility


Equipment can be operated and (preferably) maintained by your staff, with or
without additional training.
It has been designed or adapted to cope with the location where it will be used.
For example:
◆ In humid climates:


- mould grows on microscope lenses, unless supplied with a drying agent (such as
silica gel) to store with them.


- if air-conditioning is switched off at night, water condensation builds up on
printed circuit boards causing short-circuits, unless they are covered in a
polymerized film.


◆ In high ambient temperatures:
- condensers and heat exchangers of sterilizers, designed to suit European water


temperatures, do not condense effectively leaving linen wet, unless a long
drying cycle is provided.


◆ With unreliable power supplies:
- some equipment is highly sensitive to power surges and requires suitable


electronic suppressors and filters.
◆ With unreliable water supplies:


- some equipment is sensitive to poor quality or hard water and requires suitable
filters or treatment plant.


◆ In dusty environments:
- some equipment is sensitive to dust levels and requires manual filters.


The equipment should have a limited number of settings and modes of operation
(unless you are buying extremely specialized equipment to suit extremely specialized
personnel). Experience shows that equipment with more than three settings requires
a specialist.
The equipment:
◆ is compatible with existing equipment and knowledge in the organization (if


possible)
◆ is suited to the power source and power quality available
◆ does not require unavailable or unreliable service supply installations (utilities)
◆ does not require more space than you have.


You may find that you have to procure additional pieces of equipment to go with
your original item, if it is to work in your environment. For example:
◆ A voltage stabilizer (surge suppressor plus filter). This offers protection against


power supply fluctuations, but does not protect against power cuts. It monitors
the power supply, removes surges and spikes, and maintains a continuously
regulated alternating current output to the item.


◆ An uninterruptible power supply. This offers protection against blackouts and
power cuts of limited duration.


◆ An air-conditioning unit.
◆ A water filter or treatment plant.




3.2.2 Assured Quality and Safety
All equipment and supplies must be of sufficiently high quality. Some key areas that
determine quality are shown in Box 9.


3.2.2 Assured quality and safety


52


BOX 9: Key Factors Determining the Quality of Equipment and Supplies
Factors Issues
Performance


Sources


Materials
and design


Safety


Standards


Labelling and
packaging


Remember, a highly sophisticated piece of equipment will not necessarily perform
better than a piece of equipment which is more basic, but easier to use. (See
discussion above on ‘appropriateness to setting’.)
Try to always buy from reputable companies, if possible. Unfortunately there are
still many companies that supply poor quality and unsafe products (for example,
infant incubators containing asbestos insulation, hydraulic operating tables that
leak and will not rise, suction pumps that spark, operating theatre lights incorrectly
wired thus producing shadows).
Check the durability and quality of the materials used. Remember, thin metal
bends, cheap material tears, and small castors make it difficult to move items.
Also check whether the equipment design is robust, and whether the equipment is
easy to clean, operate, and maintain.
User and patient care and safety should never be compromized by poor quality
items. Poor quality equipment (as well as bad installation, lack of maintenance, and
improper use) can all lead to potentially dangerous situations, such as exposing
patients and staff to radiation, electric shock and infection. Refer to Guide 4 for
detailed guidance on operation and safety issues.
Equipment should always meet recognized standards. There are a variety of
formal safety standards and guidelines relating to equipment. These include
standards covering:
◆ design, development, construction, and manufacturing practices
◆ performance and safety requirements
◆ operation and maintenance procedures
◆ environmental issues (such as disposal)
For examples of different international and national standards relating to
equipment, see Annex 4.
Packaging should protect equipment and supplies from damage or deterioration
during transit and storage. Goods should be specially packed and crated for shipment
to avoid damage. Although most supplies are quite durable, some (such as rubber
tubing and latex items) will spoil if left unused for too long. Plastic wrapping helps
to protect such items against high humidity, and is more robust than paper wrapping.
Labelling should include information about country of origin, date of manufacture
and, if appropriate, expiry date and storage instructions. Labels and packaging
should avoid long and unusual symbols.
Before purchasing specify the shipment packing requirements (Section 5.5.2) and,
if possible, check the quality of the labelling and the packaging.




3.2.2 Assured quality and safety


53


People involved in choosing equipment should at least be aware of the major
national and international standards and quality certificates that apply to
equipment. Be aware that:
◆ apparently standard quality certificates may be based on varying factors
◆ export certificates and ‘good manufacturing practice’ certificates are both issued


by authorities in the country of origin – thus their value depends on the capacity
and diligence of the issuing regulatory authorities.


Not all countries have the necessary facilities and technical personnel to conduct
complex quality and safety testing of goods. In these circumstances, there may be
facilities that could be used in neighbouring countries, or the wider region.
Another way of ensuring quality and safety is by procuring from reputable and
certified manufacturers and suppliers. The quality of manufacturing standards
differs from country to country. Useful tips include:
◆ Only procure equipment and supplies from licensed, reputable and reliable sources.
◆ Before buying, ask the supplier which safety and performance standards an item


complies with.
◆ Be wary of copies (items made to look like a well-known brand) as these are often


of poor quality and do not conform to international standards.


3.2.3 Affordability and Cost-Effectiveness
There are a number of aspects to affordability and cost-effectiveness:


i. Cost and Quality
Cost and quality often go together. Better quality equipment is more expensive, but
cheaper equipment is often of poor quality. Buying the cheapest item can be a false
economy, because it may need repairing or replacing more frequently. It may be
more cost-effective to spend more on a higher quality item that is more reliable and
lasts longer.


When procuring, you should consider not just the initial cost of
purchasing, but also the life-cycle costs of the equipment. These
are the costs covering the entire lifetime of the equipment, such
as for use and maintenance. They can often amount to more
than the initial purchase price. You may find that an item with a
higher initial price has lower running costs over the long-term
than a cheaper alternative.


Life-cycle costs
are those costs associated with
obtaining, using, caring for and
disposing of equipment, as well


as the support, training and
operating costs incurred over the
period in which the item is used.




Remember also that the cost of transportation and installation of poor quality
equipment is at least as high as for more expensive equipment of possibly better
quality. For most developing countries, with their long delivery routes, limited
finances, and difficult operating conditions, equipment of good quality will in the
end prove the better and more economical choice.


ii. Cost-effectiveness
In order for an item to be considered cost-effective, all the life-cycle costs have
to be planned for and should be balanced against the benefits gained from the
equipment. There are a variety of life-cycle costs related to healthcare technology,
and most of these are hidden. This can be illustrated by using the image of a
hippopotamus as shown in Figure 7. Hippos are known for only having a small
proportion of their bulk showing above the water, while the vast majority is hidden
dangerously below the surface.


Figure 7: The Hippopotamus Syndrome of Life-cycle Costs for Healthcare Technology


For accurate cost estimates you need to categorize your equipment, ranging from
simple health facility furniture to highly sophisticated medical equipment. The cost of
installation, training, maintenance, and spare parts normally increases as the level of
sophistication of the equipment increases (see Guide 2 on planning and budgeting).


3.2.3 Affordability and cost-effectiveness


54


Cost of recording
and evaluating
data


Transport and
installation
costs


Maintenance
costsOperating


costs


Staff
costs


Training
costs


Costs of
removal
from service


Administration
and supply
costs


Purchasing costs




Consider these costs carefully. Choices can then be made in an informed way. For
example, a basic autoclave can sterilize up to the same standard as a sophisticated
electronically controlled autoclave. However, both purchase and maintenance costs
would be significantly lower for the basic unit.


Did you know?
The purchase price of a piece of equipment represents only a small part of the total lifetime costs
of owning that item.
The average estimate is that the purchase price is only 20 per cent of the overall cost of ownership.
Therefore, the cost of operation, maintenance and training through the life of the equipment may
be as much as four times the purchase price.


To limit your costs, you should consider an element of standardization (Section 2.1).
For example, obtaining equipment from a limited range of trusted suppliers is more
economical in terms of service visits, spare parts, consumables, and training.
If you cannot meet these costs, you should reconsider whether it is worth getting
the equipment, and the benefits of doing so. Some criteria for judging cost-
effectiveness are:
◆ If the equipment is not available, will the management/treatment of a significant


number of patients be impossible or unsatisfactory?
◆ Can the equipment significantly reduce other expenses (such as length of


hospital stay, need for referrals to a more expensive higher-level facility, the need
for expensive personnel or drugs)?


◆ Is the equipment too dependent on foreign sources and skills for spare parts and
maintenance?


iii. Cost to Get Equipment Functioning
There are various costs involved with getting equipment onto site and functioning
effectively when it first arrives. Further details on how to estimate such costs are
given in Guide 2 on planning and budgeting.
Before you procure any item of equipment, you need to make a careful comparison of
the local and overseas costs for factors such as import duties, customs tax, freight,
handling and insurance. Box 10 itemizes the factors which influence the cost of
procuring equipment.


3.2.3 Affordability and cost-effectiveness


55




BOX 10: Components of the Overall Cost to Purchase Equipment
If you know the net purchase price of a piece of equipment, then the following additional components are
required, depending on the equipment type, to provide the overall cost of the equipment:
Cost components Percentage of purchase price
Package of inputs (accessories, consumables etc) for one year 2–7%
Installation, commissioning, and initial training 0–15%
Spare parts for two years’ operation 0.5–20%
Freight charges 8–15%
Insurance 1.5%
Contingency 3%
Further additional components may be required, such as:
Charges of a procurement agent 5–10%
Site preparation work 0–10%
Warehousing, unloading/lifting equipment 0–1%
Service support for one year 0.5–7%
Refer to Guide 2 to see how these figures relate to different equipment types.


The cost of the planning, delivery, installation, and training for equipment
often exceeds the cost of the equipment itself.


iv. Cost to Keep Equipment Functioning
There are several costs required to keep equipment functioning throughout its life.
Further details of how to estimate such costs are given in Guide 2 on planning and
budgeting. Cost components could include:
Consumable material costs. For some equipment, the cost of consumables,
replacement accessories, and spare parts represents the main bulk of life-cycle costs.
Ask yourself the following:
◆ What consumables, accessories, and spare parts do you need to operate and maintain


the equipment? Does the equipment use its own specialized consumables?
◆ How much will these items cost?
◆ Are consumables and accessories available as disposable or reusable products?
◆ How many of these items have a short life (for example, those which are fragile


and vulnerable to mechanical damage or repeated sterilization, those with fixed
lifespans, those with shelf lives)?


◆ Can you obtain regular and reliable supplies of consumables, accessories, and
spare parts?


◆ Where will the items come from and how easy is it to get hold of them, in
particular those with a short shelf life?


3.2.3 Affordability and cost-effectiveness


56




◆ Are the items part of an ‘open’ procurement system, in other words anyone can
supply them for your equipment, different manufacturers’ products can fit your
machine, and this competition leads to lower-cost items? Or are the items part of
a ‘closed’ procurement system, in other words they are only made by the
equipment manufacturer, you are limited to one supplier only, and this monopoly
leads to more expensive items?


◆ How long will they continue to be available? (Up to 10 years is a reasonable period
for most equipment, and most manufacturers will agree with this.)


◆ Is the equipment likely to become obsolete due to technical and general advances
in the sector? (Equipment manufacturers normally supply spare parts and
consumables for out-dated equipment for up to only five years after a particular
model has been taken out of production.)


Most suppliers know and can offer advice on which high-usage consumables,
accessories and spare parts should be kept on hand.
Operational costs. To ensure the equipment can be used to provide the service
required, further operational questions should be considered:
◆ What staff are required to manage, maintain, and use the equipment?
◆ Are staff available with the necessary skills and qualifications? What is their


current workload?
◆ Do you need to train your staff? Do you need to hire additional/specialist staff?
◆ What service supply installations does the equipment require (such as electricity,


water, gas, fuel)?
◆ How much will these items cost?
◆ Will you be able to afford any future upgrades and replacements for the equipment?
Maintenance costs. To ensure that equipment is continuously available for use,
further questions must be answered:
◆ Is service support available locally, in the region, or from overseas?
◆ Will you be charged for service visits under warranty terms?
◆ Do you need a maintenance contract?
◆ What will a maintenance contract cover, and how much will it cost?
An easy way of estimating maintenance costs would be to ask suppliers to include and
specify maintenance costs in their bid/quote. However, there is internationally
recognized advice on typical maintenance costs. As shown in Box 10, the annual cost
can range from 0.5 to 7 per cent of the equipment purchase price, depending on the
type of equipment.


3.2.3 Affordability and cost-effectiveness


57




Experience in Sri Lanka
It can be difficult to attain maintenance skills in-house for sophisticated equipment, since
manufacturers often will not provide advanced in-depth maintenance training for third parties
(in other words, the client) preferring to provide it to their own staff or those of their
representatives. Thus, the Ministry of Health in Sri Lanka has adopted the following policy
when purchasing sophisticated equipment:
◆ Require the manufacturer to have a local agent that can undertake the maintenance needed.
◆ Negotiate a five-year post-warranty service contract (including parts and labour) with the


local agent at the time of purchase.
In this way:
◆ the local agent earns a respectable profit to run their business
◆ the Ministry of Health obtains a working machine, while keeping the service costs in the


range of four to five per cent of the equipment value.
All sophisticated equipment on the Ministry of Health’s inventory is on a service contract,
and they know the exact costs involved for maintaining such machines. Once the service
contract prices are known, they find that the budget estimates for the balance of the
equipment can be easily calculated.


Training costs. Training is essential if you want to make effective use of equipment.
Do not compromise on training, but include actual needs in your calculations.
Consider the following for each type of new equipment:
◆ How many equipment operators and maintainers need to be trained? How many


training sessions will you have to run?
◆ How much will the instructor, the facilities, and any equipment-related materials


cost for the training sessions?
◆ How much will it cost to develop training materials, buy manuals, and obtain


training equipment?
◆ How often will you have to repeat these training sessions to allow for staff


turnover, and gradual loss of skills?
Such training requirements are necessary initially, at the commissioning phase (when
equipment first arrives). Training is also required on a regular basis, throughout the
life of the equipment and the careers of your staff. For more details on analysing
training requirements, drawing up an Equipment Training Plan, and estimating
training costs, see Guide 2 and Section 5.1.


3.2.3 Affordability and cost-effectiveness


58




3.2.4 Ease of Use and Maintenance
There is no point in procuring new equipment if your staff do not have the expertise
or information to use and care for it effectively. The following four issues should
be considered:


Skills and Training
Before procuring equipment, consider the following issues:
◆ How easy will it be for your staff to use, clean, and maintain the equipment?
◆ Are additional staff training or support services required? If so, can the supplier


provide these or recommend someone who can? This is particularly important
for complex vital equipment, such as critical care equipment (for life support,
anaesthetics, ventilation, infusion, etc) as well as diagnostic imaging,
radiotherapy, etc.


◆ Is the equipment supplied with detailed, easy to use instructions, together with
operator and service manuals?


Tip • User and service manuals must contain detailed information on the technical
characteristics and specifications of the equipment. They should include circuit
(wiring) diagrams; planned preventive maintenance schedules; application, trouble-
shooting and technical fault-finding routines; spare parts lists; safety procedures;
adjustment procedures and calibration tests.


Maintenance and Support Services
It is important to specify requirements for maintenance and support very clearly
in the purchase document (Section 5.5.2). Before procuring equipment, consider
the following:
◆ If maintenance requires the services of a skilled engineer, is there a local supplier


or agent available to help you in the event of a breakdown?
◆ If not, are maintainers available locally or nationally who can service, maintain and


repair the equipment?
◆ If there is no authorized agent in your country, are there other organizations that


offer this service? For example, the Ministry of Health’s HTM Service or mission
maintenance services (such as the Joint Medical Stores in Uganda, and the
Christian Social Services Commission in Tanzania).


◆ How long is the maintenance contract for?
Typically maintenance contracts are taken out
or renewed every 12 months, but many other
options are possible – negotiate the contract
that best meets your needs.


3.2.4 Ease of use and maintenance


59




Guarantees and Warranties
Before procuring equipment, consider the following:
◆ Does the supplier provide a guarantee or warranty for the equipment and for the


parts? Think of every detail. For instance, in the case of imaging equipment, does
the warranty cover glassware such as X-ray tubes? If so, is it covered on a full
replacement basis or a pro rata basis? (If it is pro rata, you may only receive the full
cost to replace an X-ray tube up to, for example, 30,000 exposures, after which the
amount you receive will depend on how many exposures have been taken.)


◆ If a guarantee or warranty is provided, when does it begin and how long does it
last? Guarantees can last for a year or more. Extended periods – such as three to
five years – are possible, depending on the type of equipment or product.


◆ What conditions does the guarantee or warranty cover? In the case of equipment
breakdown, will the manufacturer replace it, repair it, or provide a refund if the
equipment is found to be defective due to faulty materials or workmanship? Does
it cover both parts and labour costs? Are travel expenses covered, or will the user
be responsible for sending the item back to the manufacturer?


◆ What consumer guarantees exist in your country? What are you covered for (refund,
replacement, repair, compensation, or compensation for consequential loss)?


Tip • Guarantees will not cover defects arising from misuse, neglect, accidents or repairs
carried out by service personnel and agencies not authorized by the manufacturer.


Consumables, Accessories and Spare Parts
Finally, consider the availability of consumables, accessories, spare parts and
maintenance materials (refer to point iv in Section 3.2.3 on the cost to keep
equipment functioning).
Equipment that does not have adequate service support, or for which
consumables and spares are not always readily available, is likely to be out
of action for long periods and may have to be replaced prematurely.


3.2.5 Conformity to Existing Policies, Plans and Guidelines
Compliance With Your Purchasing and Donations Policy


As stated in Section 3.1, all procurement should be carried out in line with the
Equipment Development Plan for your facility, should follow your procurement
priorities, and should not introduce items that you cannot afford to sustain.
Equipment purchases and donations by external support agencies should not divert
you from your plans, or be too complex, and should promote your basic standard of
healthcare delivery before introducing more sophisticated services.


3.2.4 Ease of use and maintenance


60




Compliance With Your Standardization Policy
Using a standardization policy can help you to limit the variety of equipment you
buy, and help limit your purchases to a few trusted suppliers (Section 2.1). This is
helpful, as it:
◆ enables you to make more economical use of consumables and spare parts
◆ simplifies inventory and stock control considerably
◆ enables operators and maintainers to more easily gain and retain knowledge


concerning the equipment they deal with
◆ is better in terms of supplier relationships and services – suppliers will have


greater incentive to provide aftersales support at reasonable cost if they believe
you represent a larger market and there is potential for establishing a long-term
relationship with you.


Experiences in Africa
The problem of not standardizing equipment was evident in one country where eight different
types of obstetric equipment were found in a single hospital.
A good example of standardization occurred in Botswana where the same type of X-ray
machine from a single company is used in all primary hospitals. Surgical instruments are
also standardized so that all surgeons are familiar with the equipment wherever they go in
the country.
In several places the highest benefits in standardization have arisen with laboratory
equipment, because it is so heavily dependent on the use of reagents and other supplies.


Compliance With Model Equipment Lists and Generic Specifications
The equipment planning and procurement process should be based on national
equipment lists. In many countries, the Ministry of Health has developed guidelines
or standard lists of equipment for all levels of the health system. If there are no
standard lists available, HTM Working Groups can work together to develop them
based on a consultation process or adaptation of existing lists (from neighbouring
countries, for example). Guide 2 describes how this can be done, and Annex 2
provides some examples.
A standard list is essentially a model list of equipment, based on the type of health
interventions (diagnosis, treatment, and care) a facility is expected to carry out. It
should reflect a suitable level of technology for those interventions, which can be
supported at that level of facility. Referring to such a list can be particularly useful if,
for example, you are faced with a wide variety of makes and models of the same type
of equipment and do not know which to choose, such as choosing between an
electric or foot-operated suction pump.


3.2.5 Conformity to existing policies, plans and guidelines


61




Experience in Uganda
In Uganda, a ‘minimum healthcare package’ has been developed for each healthcare level,
which describes all the interventions required. From this, the National Advisory Committee on
Medical Equipment has drawn up five model lists of medical equipment. The model lists
provide a comprehensive overview of all the equipment and furniture required in a particular
level of health facility.
The lists serve as a model for (re-)equipping all existing and new health facilities. They can
be adjusted according to workloads, and size of the catchment population.


Literature and Knowledge Available to You
If you are considering purchasing any new equipment, it is essential to weigh up the
costs against the potential benefits, before you buy.
It will not be feasible to be fully up to date in a market that is characterized by
rapidly changing technologies. Technology assessment is part of the procurement
process (Section 1.2) but is a large subject area in its own right. Usually there is
limited technology assessment at national level for many developing and other
countries. They rely on international research, however little of this has been
directed at the needs of developing countries (see Annex 2).
You should carry out some market research, and try to find out as much as possible
about the equipment before you buy it. Doing this not only helps you understand
the specific requirements of the equipment, but also ensures that you are purchasing
the most appropriate equipment for your particular needs.
Figure 8 presents a variety of options available for obtaining literature and knowledge
about particular pieces of equipment, and you should use a combination of these.


3.2.5 Conformity to existing policies, plans and guidelines


62




Figure 8: Strategies for Sourcing Information and Knowledge About Equipment Models


3.2.5 Conformity to existing policies, plans and guidelines


63


Strategy Action


Obtain detailed brochures


Make use of the Internet, if you
have access to it


Visit trade exhibitions


Contact suppliers and their
customers


Establish a library, as described
in Guide 2 on planning and
budgeting


Use feedback


Use external assistance


Source these from the suppliers or manufacturers for any items
identified as potentially suitable. Study these specifications and
ask suppliers to clarify any ambiguities or uncertainties.


Regularly search the world wide web (www) and online
databases for relevant information. Be careful not to input
information about yourself or your organization via the internet
that could be used to compromise you later.


Make face-to-face contact with suppliers and manufacturers.


Contact suppliers’ offices and ask for the names of customers
who have purchased similar equipment to that which you are
thinking of buying. Visit or contact these customers and ask
them if they are satisfied with the equipment and after-sales
service and whether they had any problems. Be cautious of
any supplier who shows reluctance to share this information.


Set up a reasonably up-to-date library of product information,
technical data and specifications, which can be accessed by
decision-makers and general staff. The library should include
items such as:
• operator and service manuals for equipment, and parts manuals
• healthcare standards directories
• comparative pricing information
• supplier information such as catalogues and brochures
• clinical and/or technology assessment journals
• national and international hazard and device bulletins
• trade directories and other publications which provide
information on sources of equipment
• publications concerning equipment performance and suitability.
Many of these items are available from international and national
sources and databases (see Annex 2).


Establish a system of feedback from operators regarding the
equipment in use, and from maintainers regarding its technical
history. Then base your decisions on their opinions, when
considering whether to purchase this model again (Section 9.2).


Develop a catalogue of the
products usually available
within your organization


Compile a catalogue, with illustrations, of the items available
centrally or nationally through bodies such as a Central Medical
Stores and the Supplies Department. This will be useful for
users, maintainers, procurement and stores staff.


When a major reassessment of the health service’s stock of
equipment is carried out, it may be worth paying for the services
of an experienced consultant.


Use pre-purchase
questionnaires


For any intended purchases that you are not familiar with, the
seller should be asked to complete a pre-purchase
questionnaire as a way of evaluating the supplier before you
decide to buy from them (see Section 4.4 and Annex 5).


Obtain manufacturer’s updates


The manufacturers of some products (such as MRI and CT
scanners, clinical chemistry analyzers) provide updates on a
regular basis about the application of their equipment, through
application bulletins or scientific journals. Ask the manufacturers
if they provide any such ongoing application literature. Find out
if it is available on a subscription basis only, or is free of charge.




3.3 A REVIEW OF THE WAYS TO GET EQUIPMENT
Once you know the equipment you need, there are several ways to obtain it:
◆ Purchasing – using funds from government (national budgets that are


made available by the Ministry of Finance)
– using independent funds from your own facility or health


service provider
– using funds from some types of external support agency


(see Box 11). These funds can come in different forms:
- as repayable loans with interest, from international financial


institutions, and private organizations
- as grants that do not have to be repaid, from foreign


government aid agencies, and non-governmental
organizations.


◆ Donations – from some types of external support agency (see Box 11).
Pieces of equipment are chosen and supplied free of
charge by non-governmental organizations, charities,
individuals, and private businesses. This can range from gifts
of small quantities of items to substantial equipment
procurement projects.


◆ Leasing, renting, – may be an alternative to outright purchase of equipment for
or hiring those with limited budgets or cashflow problems.


Box 11 shows the different types of external support agencies and their typical
funding preferences.
Note: the use of the word ‘donor’ can be confusing as it can be used to refer to large
governmental aid agencies providing interest-free grants for the purchase of equipment,
as well as individuals providing free gifts of equipment. In this Guide we try not to use
the word ‘donor’, and instead distinguish between being given money to purchase
equipment and being given the equipment itself. Thus, we talk of ‘purchasing using
external support agency funds’ which covers grants (Section 3.3.2), and ‘receiving
donations of equipment’ which covers gifts of equipment (Section 3.3.3).
The ability of your Procurement Unit to choose between these options will vary
depending on your country, your health service provider, your level within the health
service (central, district, or facility level), and your level of autonomy.


3.3 A review of the ways to get equipment


64




BOX 11: Different Categories of External Support
Implementors Source of funds Type of support Target groups


3.3 A review of the ways to get equipment


65


Multi-lateral
finance


Multi-lateral aid


Bi-lateral aid


Non-
governmental


Private


International financial
institutions, such as
the World Bank, Asian
Development Bank
Groups of
governments through
aid agencies, such as
the EU/EDF, and
international agencies,
such as UNICEF
Governments through
aid agencies, such as
USAID or GTZ


Religious,
humanitarian, and
charity groups and
individuals


Private banks and
businesses


Contributions of
member states


Contributions of
member states


Tax money, to
some extent
donations


Tax money, to
some extent
donations
Donations


Profits


Repayable loans
with interest


Non-repayable
grants, donations
of equipment,
technical assistance


Non-repayable
grants, donations
of equipment,
technical assistance
Non-repayable
grants, donations
of equipment,
technical assistance


Repayable loans
with interest, non-
repayable grants,
donations of
equipment


Predominantly
governmental
organizations


Mixture of
governmental
organizations and
population groups


Mixture of
governmental
organizations and
population groups
Predominantly
population groups
and local non-
governmental
organizations
Mixture of all
organizations and
population groups


3.3.1 Equipment Purchases Using Nationally Available Funds
In many countries and facilities, the way in which
items are purchased is determined by who is financing
the purchase. The process varies depending upon:
◆ the objectives of the funding organization
◆ the amount of funds
◆ the timescale in which the item is to be procured.
Funding can cover the entire purchase cost or just the cost of specific components. Funds
may be provided in the form of a one-off lump sum or as an annual sum, renewable over
several years.
The procedures you have to follow depend upon the source of funds and your
organization, as shown in Box12.




BOX 12: How Purchasing Procedures Relate to the Type of Organization and
Funding Source


Type of facility and funds Purchasing procedures required
A public facility using its own
funds or government funds
A non-government facility (such
as a mission hospital or private
hospital) using its own funds


Any type of facility using external
support agency funds or other
special funds (Section 3.3.2)


Did you know?
International organizations, including UN agencies and the World Bank, have purchasing
procedures for buying equipment. You can obtain guidelines from these agencies which you can
adapt to your needs, if you have no procedures of your own.


Using Government Funds
At national level, responsibility for purchasing equipment is divided up between
various government ministries. Within ministries, specific aspects of purchasing may
also rest with particular departments or programmes. For example, in the public sector:
◆ In the Ministry of Health, both the Central Medical Stores (CMS) and the


Supplies Department usually carry out purchasing.
◆ CMS usually purchases and distributes pharmaceuticals, medical supplies and


basic (small) medical equipment, while Supplies is responsible for equipment and
spare parts.


◆ Some independent programmes, such as the dental and laboratory services may
handle their own purchasing, without referral to the MOH Supplies Department
or CMS.


◆ Other ministries, such as Works, Supplies or Transport, may also be responsible
for purchasing some types of equipment (for example, plant, furniture, and
vehicles respectively).


There is often little coordination between these different units and most purchasing
decisions are made on an ad-hoc basis. Often, there is great confusion about who is
responsible for the different aspects of equipment purchasing. In many cases, heads
of units, health facilities and staff do not know what type of equipment they can
obtain from which source, and through which channel.


3.3.1 Equipment purchases using nationally available funds


66


Equipment must be bought using government purchasing procedures
(these are laid down in national laws and regulations).
Equipment can be bought according to your own organization’s
procedures. If there are no purchasing guidelines, you will need to
develop these, or use national or external support agency purchasing
guidelines instead.
Equipment must be bought using the funder’s purchasing procedures.
If these present a problem for your plans or technical requirements,
you will need to negotiate any necessary changes.




Most purchasing at the national level will be funded through national budgets and
external sources. Also most tenders take place at this level.


Tip • Find out which bodies, such as ministries, and which sections are responsible for
purchasing different types of equipment. Make a chart for future reference.


At decentralized levels (for example, district health authority and health facility
levels) government funds allocated can be used to purchase equipment up to certain
value limits. The financial limits will be specified in the Ministry of Finance’s
Purchasing Manual (Section 2.2). Often there are, as yet, limited purchasing skills
at the decentralized levels.
If other health service providers receive government funds they must also follow
the guidelines in the Ministry of Finance’s Purchasing Manual.


Using Your Own Independent Funds
Government health facilities may be allowed to raise their own funds through
some form of cost-recovery programme, or local business backing. The amounts
raised are usually small. Therefore, the purchasing method used will be a simple one
suited to low value, low volume purchases (Section 4.2).
Other (non-government) health service providers can purchase equipment
according to their own rules when using their own funds. Responsibility for
purchasing equipment is often divided up between various departments or
programmes – for example, Procurement, Logistics, Supplies, or Transport divisions.
As for the public sector, there is often little coordination between these different
units. Most purchasing decisions are made on an ad-hoc basis, and often there is
great confusion about who is responsible for the different aspects of equipment
purchasing. Most tenders take place at the central level.


3.3.2 Equipment Purchases Using Funds From External
Support Agencies
This applies to external support agencies that provide loans (repayable with
interest) for you to do the purchasing, and grants (non-repayable) that they often use
to purchase on your behalf in consultation with you.


The Regulations and Procedures of the External Support Agencies
If funding for the purchase of equipment comes from an external source, you need to
purchase the equipment in accordance with the funder’s procedures and conditions,
or negotiate any necessary changes. Particular care should be taken when funding
comes from external sources because some have their own agenda.


3.3.1 Equipment purchases using nationally available funds


67




Others, although they mean well, may have regulations and procedures which
conflict with your aims. You should be aware of the following conflict areas:
1. Your standardization policy


Procurement conditions may be tied to a particular country. External funders are
often tied to national economic interests, which can result in tied aid (where the
product must come from the donor country or another specified group of
countries). This often results in inappropriate technologies being supplied that
do not conform to your standardization efforts. Lack of coordination between the
various external funders can also lead to duplication of effort, and multiple brands.


Country Experience
One country, in 1994, estimated that approximately 75 per cent of medical equipment in their
hospitals and health centres had been funded from sources other than the regular
government budget.
In many countries, hospitals within the same district or region are equipped with a variety of
makes from different suppliers and countries, even for the same type of equipment. This
places a great burden particularly on maintenance personnel, who often have not been
properly trained on the equipment, and on hospital administrators in terms of providing funds
for adequate stock levels of spare parts and consumables.
One hospital requested toilets from two donors. They received two sets, each of three
toilets. One would have been enough, and neither had a path suitable to reach them in the
rainy season.


2. Your available budgets
Funding may be limited to only certain types of projects or goods, and for a set
time frame. External sources of funding may provide one-off equipment
replacements, or equip new facilities. Alternatively, they may directly donate
equipment (Section 3.3.3). However, they often provide no support to keep the
equipment running. Ideally, external support agencies should be willing to
finance both the equipment and a ‘package of inputs’ that will sustain the goods
(Section 5.5.2), as well as provide support for an HTM Service so that
equipment can receive long-term support.


Experience in Pakistan
The Finnish government aid agency supplied laboratory equipment to the Pakistan health
service. The agreement included supply of consumables, spare parts and manuals, user and
maintenance training, and the establishment of maintenance workshops.


3.3.2 Equipment purchases using funds from external support agencies


68




Although offers of equipment may seem attractive, it is important to weigh up the
benefits of having the equipment over the long term (Section 3.2). For example,
will it prove difficult and expensive to run and maintain? Will the recurrent costs
of consumables, spare parts, and maintenance mean the equipment is discarded
once external funds and interest are withdrawn?


3. Your aims and wishes
Procurement conditions may be tied to a particular procurement method. Care
must be taken not to be put in a position where your ability to make decisions
about your choice of equipment is dictated by the use of competitive tenders
(Section 4.2.2).
The aim of tendering is to have a process that means all suppliers submitting bids
are treated the same and no one has the chance of receiving preferential
treatment or offering incentives (in other words, a transparent process), and all
bids remain confidential (in other words, a competitive process). This is achieved
by using formalized rules and procedures. The very inflexibility of these rules and
procedures, however, can affect your ability to make technical judgements about
the bids.


Most international financial institutions (such as the World Bank, African
Development Bank) and many bi-lateral government aid agencies dictate that some
form of tender process should be used (normally international open tenders). Such
open tenders must be competitive and open to anyone to bid. Therefore, your
attempts to get the equipment that suits you may often be regarded as restrictive
practices (and therefore illegal). For example, with an open tender, there can be:
◆ no standardization of equipment
◆ no consideration of additional factors concerning the equipment and supplier (for


example, the aftersales support available locally), other than what is stated in the
specification (Section 5.5.2)


◆ no screening of the manufacturing capability of the suppliers after the tender bids
are in (unless you are allowed to use qualification criteria to judge suppliers and
specify the criteria in the original purchase (tender) document – Section 5.5.2)


◆ no adjudication of bids on any basis other than the cheapest (unless you are allowed
to use a scoring matrix of various factors that determine the best deal and the
selection criteria is specified in the original purchase document – Section 5.5.2).


Procurement is a quasi-legal process and must be conducted in legalistic ways
regardless of technical needs. Therefore such rules make the open competitive
tender process unsuitable for buying complex technologies. As can be seen from the
list above, your only chance of entering some of your technical needs into the process
is to ensure that all of your requirements and methods of adjudication are explained
in full in the original tender document. This can be very hard to achieve, but it is
something you can aim for in the long-term.


3.3.2 Equipment purchases using funds from external support agencies


69




More realistically, successfully procuring the equipment you want depends upon
gaining knowledge of the different external support agencies’ procurement rules.
For example:
◆ For procurement methods involving quotations (Section 4.2.3), you can usually


meet your technical aims and wishes (standardization, provision of aftersales
support locally, quality manufacturing, the best deal).


◆ For procurement using a restricted tendering process with national funds, non-
governmental funds, and some bilateral aid agency funds, you may be able to meet
your technical aims and wishes as long as you stick to the tendering rules and
specify the screening and adjudication processes in detail in advance.


◆ For procurement using an open tendering process and funds from an international
financial institution (a development bank), you probably will not be able to meet
your technical aims and wishes unless purchasing simple equipment.


Thus, the art of getting the right equipment is choosing the right external
support agency to fund it.
For example:
◆ If you want good quality complex technology – such as an ECG monitor – using an


international financial institution to provide the funds would not be appropriate as
their procedures may require you to source the cheapest unit from any supplier and
country, regardless of the quality.


◆ If you want simpler technology in bulk, such as sphygmomanometers, funds and
procedures of an international financial institution could usefully be employed to
source the items globally and obtain the best price.


3.3.2 Equipment purchases using funds from external support agencies


70




Country Experience
In developing countries, the World Bank (WB) mainly supports the financing of capital goods
as opposed to consumable supplies. The World Bank uses its own guidelines on the type of
standard equipment that should be on site at primary, secondary, and tertiary health facilities.
The World Bank does not carry out direct equipment supply, but provides the money as a
loan for purchasing equipment. The borrower buys all goods, works and services, but the
World Bank oversees the borrowers’ use of funds and procurement method (international
open tenders), and ensures that the purchasing is undertaken according to WB guidelines
and is in line with its purchasing policies.
The World Bank has its own step-by-step guide on how the purchase of WB-financed goods,
works and services should be planned and implemented. These guidelines apply equally
when purchasing is carried out by the borrowers, their procurement agents, or other
intermediaries such as UN agencies working on behalf of the borrower.
The strict rules and procedures for international open tenders mean that it has proven
difficult to buy good quality complex healthcare technologies this way that are appropriate to
developing countries’ needs. WB support has been found to be most suited to bulk
purchases of low technology healthcare equipment items.


Securing External Funding
If you are looking to secure funding from an external support agency, you will need to
put forward a convincing business case to support your procurement plan. This case
needs to be framed according to the agency’s guidelines for applying for support.
A carefully constructed Equipment Development Plan or Strategic Business Plan
(see Guide 2) helps to strengthen your proposal, by presenting clear equipment
needs and goals, as well as expenditure and financing requirements. In this way, you
could encourage external sources to donate equipment and offer funds that support
your plans, and hopefully avoid purchasing inappropriate equipment.
Avoiding inappropriate equipment may be difficult but it is not impossible – some
external support agencies have been known to make exemptions to their usual
procurement rules (Section 4.2) in order for the client to obtain equipment
more suited to their needs. Often, it may help if you can highlight specific examples
of problems with equipment due to poor specifications or inappropriate
procurement procedures.


3.3.2 Equipment purchases using funds from external support agencies


71




Country Experience
Many external support agencies place restrictions on sourcing goods, preferring them to
come from a certain group of supply countries. However, health service providers have
obtained exemptions enabling them to include buying from outside the European Union and
ACP countries (countries in Africa, the Caribbean, and the Pacific).
In Malawi, there was a European Union-financed project procuring spare parts. For this
project Malawi managed to get exemptions (for more than 50 per cent of the parts) from
both the EU usual practice to purchase from a single source, and their practice of procuring
only from EU countries. The process delayed procurement, since parts were bought from
many sources, but proved worthwhile because the parts could be sourced either from the
actual manufacturers or from known alternative suppliers. These reputable alternative
suppliers provided generic spare parts at a significantly reduced price. For example,
operating theatre bulbs were obtained for as little as a quarter of the equipment
manufacturer’s cost. Contactors and battery packs from general suppliers showed similar
price differences.


As the regulations and procedures of external support agencies may result in
inappropriate equipment, you should take the steps shown in Figure 9.
Fortunately, the World Health Organization (WHO) and the World Council of
Churches (WCC) have developed guidelines that aim to help both external support
agencies and their potential recipients to understand one another’s needs (see
Annex 2). The aim of the guidelines is for donations to be appropriate, and they
cover both equipment purchased using aid agency grants, and gifts of equipment.
Annex 6 provides a summary of the strategies to pursue for both recipients and
providers of such support.
It will be useful to develop your own guidelines on relationships with external
support agencies – some form of donor regulations (Section 2.1). To do this, you
could adopt or modify the internationally available guidelines.


3.3.2 Equipment purchases using funds from external support agencies


72




Figure 9: Strategies to Reconcile External Support Agency Rules and Your Aims
for Equipment


3.3.2 Equipment purchases using funds from external support agencies


73


Strategy Considerations


Investigate different external
support agencies


Check if their rules will affect
the type of equipment you can
choose


Try to re-negotiate their support


Link the right product to the right
procurement method and
external support agency


Try to improve the evaluation
of products


• What goods are different agencies willing to fund?
• What procurement method are they likely to prefer?


• Is the funding tied to the purchase of specific brands from
specific countries?
• Will their purchasing regulations and procedures mean that
you are unlikely to be able to select equipment according to
your own ‘good selection criteria’? (Section 3.2)
• Are these restrictions acceptable for the type of equipment
being purchased, or do you need to request a waiver (an
exemption) from one or more of their regulations?
• Will they accept waiver requests for any of their regulations?
• Discover this before you submit your request for funding.


• Is the external support agency willing to respect the health
facility’s or country’s need to standardize?
• Will the external support agency finance a package of inputs
together with the equipment hardware, to help keep it
functioning for a period of time?
• Can the purchase of equipment be coupled with the
commitment of funds to keep the equipment in running order
for the long-term (for example, support for a national
HTM Service)?
• Is the external support agency willing to redirect funding to the
purchase of different products, which won’t be so badly
affected by their regulations?


• Which funding source could be used for which type of
equipment?
• Would it be better to decline the funds rather than accept the
wrong equipment item? Be aware that equipment failure may
be attributed to the fault of the user rather than the supplier.
• What alternative funding solutions are there?
• Which funding solutions use procurement methods other than
international open tenders?


• Have you developed your own product selection criteria
(Section 3.2 and Annex 3)?
• If using a quotation-based method, have you used the criteria
in a scoring matrix when evaluating quotes (Section 6.3)?
• If using a tender process, have you stated the criteria in your
tender document (Section 5.5.2) so that all bidders are aware
of how you will be judging the bids from the start?




3.3.3 Donations of Equipment
Occasionally, external support agencies may choose to provide you with equipment
itself, rather than funds. This equipment may either be purchased by the agency
(with or without any input from you), or existing equipment may be supplied.
Many items of equipment may be chosen and donated (supposedly free of charge) by
external sources, charities, or individuals. Donations can range from a single piece of
equipment to projects that provide substantial packages of equipment. In most
cases, equipment will be supplied as new, though second-hand equipment is
sometimes donated (Section 3.4).
Donations may be made as a result of a genuine desire to help, as a direct response
to a request, or to secure financial gains for the donor (such as tax deductions). While
donated goods are obviously an attractive proposition, you need to think carefully
about all the advantages and disadvantages before accepting them.
The issues you need to consider include:
◆ What will it cost?


Are there any hidden charges, such as paying for customs clearance, storage,
insurance and transport?


◆ Is it appropriate?
Is the equipment suitable for your health facility? Does the proposed equipment
fit in with your health priorities and purchasing policies?


◆ Do you have the skills?
Are the necessary staff in place to install, operate, and maintain the equipment?
Are staff suitably qualified or is additional training required?


◆ Is it sustainable?
Does the proposed equipment require consumable items? Are such items
available for a reasonable cost? Will it be supplied with a ‘support package’ of
aftersales support and maintenance?


◆ Why am I being offered it?
Is the proposed donation regarded as a disposable piece of equipment due to
difficulties in maintenance, obtaining spares, etc? If the donated equipment is
second-hand, is it in danger of becoming obsolete in the foreseeable future, due to
lack of parts, manuals or servicing support?


3.3.3 Donations of equipment


74




Country Experience
One country was donated a new hospital building with operating theatres, intensive care
unit, wards and radiology department. Equipment from the donor country was provided,
much of which was substandard, and did not conform to the receiving country’s standard
specifications.
In 2001, another country received a donation of 70 used dialysis machines. The machines
were five different models from three different manufacturers and were supplied without
water treatment plants, manuals and some accessories. Two years later, none had been
commissioned.
A study in 1994 in Ghana discovered that half of the equipment found to be unusable in the
Western Region was originally donated.
In Zambia, some equipment donated to the Ministry of Health, such as doppler units and
suction pumps, proved to be unreliable and unpopular with users.
Some African countries have found that donated mobile clinics and maintenance units in
practice take more than a year to get into running order.


In Vanuatu, sterilizers were donated but lack of adequate water pressure and hard water
resulted in regular failures. An electric nebulizer was donated to a health centre that had no
electricity. Also, a container-load of bed and wheelchair parts was sent in the hope that some
would be usable – it created a large disposal problem instead.
In one country, a private individual donated an electro-surgical unit to a health facility in
gratitude for good treatment. The unit was built for the US power supply (110V) rather than
the local power supply (220V).
A decommissioned military base supplied six advanced ventilators to Nepal without their
external gas flow sensors. As the hospitals could not afford these accessories, the ventilators
could not be used.


3.3.3 Donations of equipment


75




In certain circumstances, you may feel it more appropriate to refuse donations. While
it may feel awkward to do this, there is little point in accepting donations of
equipment that are inappropriate to your needs. If in any doubt about whether to
accept a donation or not, it will be useful to refer to:
◆ the ‘good selection criteria’ outlined in Section 3.2
◆ the summary guidelines for recipients and providers of donations (see Annex 6)
◆ the WHO and WCC donation guidelines (see Annex 2).
If you decide you would like to accept such support, you can submit a request for
funding to the external support agency. Annex 6 provides an example of an
Equipment Donation Request Form.


Tip • Remember, donated equipment should be treated the same as if it were purchased.
This means it should be registered and authorized for use in-country, and should be
entered onto the equipment inventory and into the stock control system (Section 8.4).


3.3.4 Leasing and Leasing Type Arrangements
If you do not wish to buy equipment using your capital budget, you may choose some
form of leasing arrangement, which uses funds from your recurrent budget instead. If
you choose to do this, you need to weigh up carefully the costs and benefits. You
must also check whether such arrangements are legal and approved by national
authorities or your central management body.
There are two basic forms of leasing:
◆ Leasing: this is the straightforward hiring of equipment. In this case, the leasing


organization retains ownership of the item and is also responsible for the
maintenance, repair, and updating of the equipment. The lessee (in this case, the
health facility) has possession and use of the equipment until such time as the
lease contract runs out.


◆ Leasing type arrangements: this enables equipment to be acquired
immediately but permits the cost to be spread over a period of time. Examples of
leasing type arrangements include deferred payment (deferred purchase), hire
purchase (paying by instalments), lease to buy, and sale and leaseback (when you
sell something to release funds in order to rent something else).


Few of these schemes are likely to represent value for money, and such schemes
should not be entered into simply as a means of avoiding current cash limit restraints
or shortages of capital.
If you are planning to lease, carefully examine the terms and conditions of the contract,
especially with regard to such aspects as limitations on the use of the equipment, and
responsibilities for its insurance and maintenance. Box 13 lists some of the key issues.


3.3.4 Leasing and leasing type arrangements


76




BOX 13: Advantages and Disadvantages of Leasing/Leasing Type Arrangements
Advantages Disadvantages
◆ Provides certainty as costs are known


in advance.
◆ Reduces the need to tie up capital


funds in fixed assets.
◆ Enables the suitability of equipment


to be assessed over a pre-determined
trial period.


◆ Sometimes enables you to obtain
equipment or material that is hard
to purchase.


In practice, the issue of whether to lease or buy is complex, and depends on
operating, legal, and financial considerations.


3.3.5 Research and Demonstration Models
Some manufacturers provide research models to chosen facilities
for the purpose of testing their performance under real
conditions before large-scale production is undertaken. The
product must still comply with international safety standards.
Occasionally manufacturers try to sell equipment that they say is
pending approval from authorities such as the Food and Drugs


Administration (of the USA). For example, in one case a manufacturer attempted to
sell ventilators pending FDA approval. The sale was refused, and the customer later
learned that FDA approval had been withheld.


Demonstration models can be regarded as second-hand
equipment (Section 3.4), but they usually come with full
documentation and warranty.
You should accept research and demonstration models only
under strict conditions and using the following criteria:


◆ The equipment has been officially tested and approved by an
independent authority.


◆ It conforms to international manufacturing safety standards such as IEC 60101 for
medical and electrical equipment, ISO 5358 for anaesthetic equipment, etc, or
national equivalents (see Annex 4).


◆ The equipment remains the property of the supplier.


3.3.5 Research and demonstration models


77


◆ A fixed obligation is created to pay rental from your
recurrent funds.


◆ The flexibility to dispose of obsolete equipment before the
end of the lease may be reduced.


◆ Doesn’t provide ownership.
◆ Agreements are one-sided. When leasing, if something goes


wrong most risks are transferred to the lessee (for example,
loaned items must be replaced if damaged). Under leasing type
arrangements, although most of the risk remains with the owner
of the equipment this has to be paid for in the rental price, and
additional costs will be incurred, depending on the contract
terms, if a leased item is misused or otherwise damaged.


Research models
pieces of equipment still under


development that are not yet
available on the market.


Demonstration models
pieces of equipment that are


used by manufacturers for the
purpose of demonstrating them


to potential buyers.




◆ The supplier bears the running costs incurred (for example,
accessories, consumables).


◆ The supplier will be responsible for any subsequent litigation arising from using
the equipment on patients.


◆ You are not responsible for the loss or damage of the equipment.
◆ You obtain the consent of the patient or patient’s relatives before using the


equipment on the patient.


3.4 WHETHER TO OBTAIN NEW OR SECOND-HAND
EQUIPMENT


Obtaining used equipment from dealers, auctions, specialist
suppliers or by direct purchase from a previous owner may be an
alternative to buying new. However, if you choose to take this
option, you need to check that your financing source allows it.
Many international aid agencies and financial institutions do not
allow the purchase of used equipment. Some countries also have
a policy of not buying used equipment (though they are often


not in a position to refuse donated used equipment). Important indicators for used
equipment are the reliability of the supplier and the offer of a warranty.
Some companies (such as Philips and GE) offer factory refurbished equipment
that can be an excellent option for buyers with limited funds. Refurbished
equipment normally comes with a one-year standard warranty and a commitment
to supply spare parts for several years.
Second-hand equipment is usually bought by small charities and non-government
health facilities. Often, second-hand equipment is also donated to facilities.
Whether bought or donated, you need to check that second-hand equipment is legal
and approved by your national authorities. Box 14 shows some of the key benefits
and dangers.


3.4 Whether to obtain new or second-hand equipment


78


Second-hand equipment
previously used equipment,


some of which may have been
refurbished (reconditioned,
rebuilt) to return it to good


working order




3.4 Whether to obtain new or second-hand equipment


79


BOX 14: Advantages and Disadvantages of Second-Hand Equipment
Advantages Disadvantages
◆ Often reduces the cost substantially


(on average between 40 and 80 per
cent of new equipment costs).


◆ May be more readily available.
◆ When reconditioned or rebuilt, may


have a long life and be protected by
guarantees or warranties.


◆ May be economical to buy when it
would not pay to acquire new.


◆ May be compatible with others
already in use, thus reducing the cost
of holding stocks of spare parts and
consumables.


◆ Can have problems linked to age and lack of spare parts,
consumables, manuals, or servicing support. Although some
organizations repair second-hand goods to improve their
lifespans, many do not.


◆ Risks are bigger and you may have less protection if anything
goes wrong. Used goods are sold as they are, meaning they are
not always perfect. The supplier takes no responsibility if the
faults are obvious when you make your purchase and you
cannot expect a refund or compensation. You can only ask for
your money back if the equipment does not do the job you
bought it to do.


◆ May be less reliable, last for a shorter period of time, and
require more maintenance than new equipment.


Country Experience
Many health service providers have successfully purchased second-hand goods from
organizations that refurbish equipment (such as Dentaid or ECHO). Such reputable
agencies recondition and restore equipment to its original working condition for the purpose
of resale. The equipment is supplied together with the necessary manuals, accessories,
stocks of consumables, stocks of spare parts, and aftersales support.


Second-hand equipment requires particular care. As a buyer you should try to satisfy
yourself as to the condition, type, make, model and year of the item being supplied,
rather than relying on the seller. However, we recognize that this is difficult if you
are a long distance from the supplier. Figure 10 provides you with some questions to
ask which can help.
Remember, in some countries it is against the law for anyone to sell dangerous
electrical goods. If you are buying or receiving second-hand equipment, carry out
your own checks for any faults before you accept it (Section 8).


Tip • It may be more cost-effective to buy new equipment rather than second-hand
equipment which only has a limited life. If in any doubt, compare the costs of new
and second-hand equipment before buying and, if there is not a significant
difference, choose the new.


• Remember that second-hand equipment should be treated as if it were new. This
means it should be registered and authorized for use in-country, and should be entered
onto the equipment inventory and into the stock control system (Section 8.4).




Figure 10: Questions To Ask if Buying or Receiving Second-hand Equipment


3.4 Whether to obtain new or second-hand equipment


80


Factors Questions to ask


Age and condition


Reconditioned or rebuilt


Safety and performance


Technical literature


Equipment-related supplies


Maintenance and repair


Delivery and installation


• Is there any indication of age, such as a serial number?
• How much longer will the equipment last?
• Is a history of the equipment available?
• Does it come with all the essential spare parts and
accessories to function as designed?
• Does it use readily available consumables?
• Is it broken, obsolete or outmoded?
• Has it been exposed to extreme climate or extremely heavy
use?


• What is its new estimated lifetime?


• What safety standards now apply?
• Has it been fully tested and calibrated?


• Will it be supplied with installation and user instructions, service
and repair manuals?


• Are at least two years supply of the consumables, replacement
accessories, and spare parts required for its function included?
• Will the supplier be able to continue to provide accessories,
consumables and spare parts for the future life of the item?
• Will you be able to source them locally or easily?


• What after-sales support will the supplier provide?
• Will the supplier be able to continue to provide technical
support and maintenance for the future life of the item?
• Will service support be available locally?


• How long will it take from placing the order to receiving the
item?
• What will be the cost, where appropriate, of dismantling,
transporting and re-connecting/installing the equipment?


Training • Will staff have to be trained to use the equipment or are they already familiar with it?


Terms and conditions


• How does the price asked for compare with the cost of buying
a new model?
• What special terms and conditions, if any, apply to the
purchase?
• Do any guarantees or warranties supersede the protection
given under the Sale of Goods Act?
• What trials, tests or approval period will the vendor allow?


The vendor • Are they a well-established company? • Have they a sound reputation?




Section 3 summary


81


BOX 15: Summary of Issues in Section 3 on How to Decide When and What to Procure


Health Service
Provider, and
Health Management
Teams (at all levels)


HTM Working
Groups and
Procurement Units
(at all levels)
HTM Working
Groups


Procurement Units
and Procurement/
Tender Committees


Health Service
Provider


Health Management
Teams (at all levels)


Procurement Units
(at all levels)


W
ay


s t
o


Ob
ta


in






C


ho
ic


e
Is


su
es









W


hy
P


ro
cu


re
?


◆ ensure that equipment planning and budgeting takes place, and that the
planning ‘tools’ required to help decide why and when it is necessary to procure
equipment are available, such as:
- an equipment inventory (see Guide 2)
- a maintenance record system (see Guide 5)
- a stock control system (see Guides 4 and 5)
- purchasing, donations, replacement, and disposal policies (see Guide 2)
- an Equipment Development Plan (see Guide 2)


◆ ensure these planning ‘tools’ are used to develop expenditure and financing plans
for all equipment needs, as follows:
- the long-term Core Equipment Expenditure Plan and Core Equipment


Financing Plan (see Guide 2)
- various annual action plans and the annual budget drawn from them (see Guide 2)


◆ use these annual plans to ensure that equipment is purchased for the right
reasons, in the right order of priority, and for which funds are available


◆ detail the ‘good selection criteria’ to employ when selecting equipment and
supplies, according to the Purchasing and Donations Policy, and taking into
account all factors relevant to the location, size, skill-level, and aims of the health
facilities concerned (see Annex 3)


◆ use the ‘good selection criteria’ when evaluating offers and deciding what items
to purchase (Section 6.3)


◆ develops guidelines for negotiating with external support agencies in order to try
and obtain appropriate equipment (see Annex 6)


◆ decides whether the leasing, renting, or hiring of equipment will be allowed
◆ decides whether research and demonstration models will be allowed
◆ consider the different ways of getting equipment when developing the Core


Equipment Financing Plan and income portion of the annual budget
◆ negotiate with external support agencies in order to identify the best type of


funds for each type of equipment purchase (see Figure 9)
◆ procure according to the rules for each of the different ways of obtaining equipment:


- national rules for government funds
- own health service provider’s rules for own funds
- external support agency rules for external funds
- negotiations for donations
- terms for leasing


◆ decide which of the above ways you will use to obtain equipment on the basis of
appropriateness of product, usage rate, costs for purchase, operational costs,
lifespan, life-cycle cost, and availability of alternatives locally and regionally.


Box 15 contains a summary of the issues covered in this Section.


Continued overleaf




Section 3 summary


82


BOX 15: Summary of Issues in Section 3 on How to Decide When and What to Procure
(continued)


Health Service
Provider


HTM Working
Groups and
Procurement Units
(at all levels)N


ew
o


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se


d?


◆ discover whether national regulations allow for the import of either used or
refurbished goods


◆ decide whether the purchase of used items will be allowed for the health service,
and under what circumstances


◆ decide whether the purchase of refurbished items will be allowed for the health
service, and under what circumstances


◆ if allowed to purchase either used or refurbished equipment by central
authorities, always investigate carefully the advantages and disadvantages before
going ahead (see Figure 10)


◆ always carefully commission and safety test this equipment before accepting it
(Section 8)




4. HOW TO DECIDE ON THE WAY
TO PURCHASE


Why is This Important?
Whenever you purchase equipment, you need to decide the best model of
procurement to use (for example, whether to purchase by yourself or collec-
tively). You also need to decide upon the most appropriate purchasing
method, and the types of suppliers to approach. Such planning will enable
you to make efficient use of resources, and ensure that any equipment you
buy is appropriate to your needs and is of the right quality. It will also enable
you to work within the appropriate timescales.
Your purchasing decisions will be interlinked with the activities we have
already described in Section 3 on how to decide when and what to purchase.
Your purchasing decisions will also affect the activities in Section 5 on how to
prepare for procurement.


There are various ways of purchasing equipment. You need to know the different
options available to you, so that each time you buy you can select the most
appropriate option. In this Section, we discuss the options open to you by looking
at the following:
◆ Determining your model for procurement (Section 4.1).
◆ Choosing your purchasing method (Section 4.2).
◆ Different types of supplier available (Section 4.3).
◆ Identifying suitable suppliers (Section 4.4).


4.1 DETERMINING YOUR MODEL FOR
PROCUREMENT
There are various models for procurement open to you, and the one you choose may
affect the subsequent purchasing method you need to use (Section 4.2).
Each time you wish to obtain equipment, you need to determine the appropriate
procurement body. This could be your Procurement Unit, the National Procurement
Unit, or an external support agency. Often, you will use various combinations of these
arrangements. For example, your health facility’s Procurement Unit might place
orders with local suppliers, while the national unit deals with international suppliers
(possibly operating through procurement agents and external support agencies).


4 How to decide on the way to purchase


83




Most equipment procurement (purchasing, leasing, and requesting donations) is
undertaken through one of five arrangements:
i. Centralized procurement – procurement takes place centrally, for example at


the national level.
ii. Group procurement – joint procurement by different health facilities, health


authorities (district, diocesean, regional), or health service provider organizations
(public or private).


iii. Decentralized procurement – health facilities or health authorities to which
authority has been decentralized procure equipment themselves, or health facilities
and health authorities with independent funds undertake their own procurement.


iv. Mixed procurement – a combination of centralization and decentralization,
whereby some parts of the procurement process are undertaken centrally and
others at district or facility level.


v. Using procurement agents – private companies are hired to handle procurement.


Centralized Procurement
Centralized procurement on behalf of many health facilities can be undertaken at
the central level of your health service provider organization, or at national level. The
unit responsible for procurement is often determined by the type of equipment to
be bought. Equipment may be procured, for example, through the Ministry of
Health, Ministry of Works, or Logistics Division (Section 3.3).


4.1 Determining your model for procurement


84


Ministry
of Works


Ministry
of Finance
Supplies


Department


Health Service
Provider
Logistics
DivisionMinistryof Health


government facilities non-government facilities




In general:
◆ To ensure the right equipment and equipment-related supplies are ordered, any


Central Procurement Unit must work with the relevant end-users to draw up a list
of requirements and specifications, and to prepare purchase documents which are
appropriate to their needs. They must also liaise with the service providers about
the evaluation process and final recommendations (Section 6.3).


◆ If using national funds, the procurement must be carried out using national
procurement procedures (see Box 12, Section 3.3).


◆ If procuring on behalf of another organization, the National Procurement Unit
should liaise with the director of the recipient health facility (such as a mission
hospital) or health authority (such as a diocesan authority) to determine whether
the equipment conforms to the organization’s Equipment Development Plan,
capabilities, and finances.


◆ For tenders and high-value quotations, a Central or National Procurement/Tender
Committee (also known as a Tender Board) will evaluate the bids and choose the
winning supplier.


For the advantages and disadvantages of centralized procurement, see Box 16 under
the discussion on group procurement below.


Group Procurement
Non-government facilities (such as faith or mining health facilities), and public facilities
and authorities that have been given a degree of autonomy, can be more flexible in their
procurement practices than the usual government facility. In order to make the best use
of resources, there are instances when forming a procurement group is beneficial. You
could join with other health facilities or authorities in the region, or with other facilities
of the same speciality or type. This is also known as pooled procurement.


4.1 Determining your model for procurement


85


B


A


C


Health service
providers' A, B and C
procurement group




As a pooled team you have greater buying and negotiating power. You can procure
items in higher quantities that make an order more worthwhile to the supplier. This
leads to more favourable warranties and stronger service and training support. For
example, a group of health facilities or small health service providers may decide to
buy together, in order to secure the best deal. They may set up their own
Procurement/Tender Committee for this purpose, or use the committee of one
member of the group.
Normally, in group procurement one member negotiates some form of equipment
‘supply-period contract’ (see ‘Mixed Procurement’ below and Section 6.4) for all
members of the group with similar needs and interests. Generally:
◆ While prices or terms are negotiated centrally (to the group), ordering and


payment are the responsibility of the individual health facilities and/or
decentralized health authorities.


◆ A contract awarded to a single supplier does not mean that the entire volume
must be shipped at once. It can specify, as part of the contract terms, divided
deliveries over the period of the contract to different members of the group, and
multiple delivery points.


Country Experience
The Joint Medical Stores in Uganda procures for a large number of individually financed
health facilities and tries to keep a stock of spare parts for all the equipment.
Aga Khan Health Services covers a number of health facilities in several countries. It has a
well-established group procurement system for them.


Box 16 outlines the benefits and limitations of group procurement.


4.1 Determining your model for procurement


86




BOX 16: Advantages and Disadvantages of Central and Group Procurement
Advantages Disadvantages
Economies of scale
◆ Lower costs or better terms can be obtained


because of bulk (multiple) procurement of goods.
◆ A more competitive procurement process as the


orders are bigger.
◆ Provides possibilities for discounts and rebates.
◆ Allows for consolidation of quantities and deliveries.
◆ Gives you improved and stronger procurement


power as you are a larger customer.
◆ As a more significant and favoured customer,


suppliers are encouraged to offer favourable
contract terms.


◆ Acts as an incentive for suppliers – they find it more
convenient to approach one Procurement Unit than
a number of individual units.


Procedures and skills
◆ Uniform policies and procurement procedures can


be followed.
◆ Promotes standardization by preparation of


standard specifications for the whole package.
◆ Lends itself to the use of a formal tender process.
◆ Centralizes expertise to makes the best use of


scarce technically skilled procurement personnel.
◆ Minimizes the financial and accounting


management requirements of procurement.
Coordination and consultation
◆ Encourages interaction and consultation between


central and lower levels, and between group
members.


◆ Encourages coordination.


Administration
◆ Keeps administration costs low – it is cheaper to


place and process one order for US$ 10,000 than 10
each of US$ 1,000.


◆ Most cost-effective method when ordering a few
high cost, slow-moving spare parts.


4.1 Determining your model for procurement


87


◆ Distances between the centre doing the
procurement and the districts/facilities
receiving the goods.


◆ Problems in making the product available in a
timely and efficient manner.


◆ Procurement is often slow.


◆ Lack of knowledge of local needs may lead to
inappropriate choices.


◆ Variety of specifications for different
geographical circumstances may not be taken
into consideration.


◆ If corruption occurs, it can lead to a disastrous
waste of funds on a large scale.


◆ Coordination between many units can
be difficult.


◆ Coordination of distribution, and good
installation may suffer.


◆ User resistance can arise due to preference
for different brands.


◆ Lack of involvement may make local staff feel
less responsible.


◆ Could result in many activities that involve
expenditure and time without adding value.


◆ Can lead to proliferation of paperwork and
delays.


◆ Is an intensive process and requires a great
deal of work.




Decentralized Procurement
Non-government health facilities, and government facilities and health authorities to
which responsibility has been decentralized, can often procure equipment
themselves. If they wish, they can also request the National Procurement Unit to
procure on their behalf, or enter into group procurement arrangements with others
(see above).
Where full decentralization has not yet occurred, the Ministry of Health may have
devolved some responsibilities for limited procurement to government health
authorities and facilities, or to other facilities that they help to finance, such as faith
facilities. In these cases, only items below a financial value limit set by the Ministry
of Finance’s Purchasing/Supplies Manual can be purchased by the facility or district
without referral to the Ministry of Health (Sections 2.2 and 4.2.1).
Decentralized procurement by health facilities or districts is particularly suitable for:
◆ obtaining single, one-off items of equipment
◆ small orders
◆ low value and low volume
◆ emergency procurement
◆ prompt procurement
◆ supporting local suppliers
◆ obtaining items not supplied by central stores
◆ buyers with limited technical knowledge who can save time by bringing user


departments directly in contact with the supplier, but at the risk of unfavourable
financial terms.


If the orders are of low value, the Procurement Unit of the decentralized health
facility/authority could evaluate quotations. But if responsibility for higher value
purchases has also been decentralized, each health facility/authority may have its
own Procurement/Tender Committee (also known as a Tender Board) for evaluating
bids and selecting the winning supplier.
Box 17 summarizes the benefits and drawbacks.


4.1 Determining your model for procurement


88




BOX 17: Advantages and Disadvantages of Decentralized Procurement
Advantages Disadvantages
◆ Facilities and districts are given greater


control over the procurement process.
◆ They also have the right to make their own


decisions regarding the goods and
suppliers, albeit on a restricted basis.


◆ Staff at decentralized levels are given an
opportunity to develop their procurement
capabilities.


Mixed Procurement
Mixed procurement uses a combination of centralized and decentralized skills in the
procurement process.
In some countries, the Ministry of Health has started to hand over some components
of each round of procurement to decentralized levels (such as quantifying needs,
writing specifications, handling the acceptance process); other areas (such as
tendering, supplier selection, and price negotiation) continue to be dealt with at
the central level.
Another example of mixed procurement is where the Central Procurement Unit
undertakes a centrally managed bid process to contract suppliers of goods, such as spare
parts. In this case, health facilities are allowed to place orders direct from the supplier.
Such contracts are usually supply-period contracts (also known as framing
contracts, draw-down contracts, or time-supply contracts). In these cases, the
supplier winning the tender is given a contract to supply certain goods over a fixed
period; for example, one or two years. During that period any member of the health
service provider organization (facility, district, etc) wanting those goods simply
orders them direct from the supplier. After the supply period, the tender is run again
at central level (Section 6.4).


Country Experience
In the Philippines there is a combination of centralized and decentralized purchasing.
Regional offices handle tenders or quotations for the needs of all different health facilities,
and a price schedule is distributed to the facilities so that they can buy the goods from their
regional office.
In one country, supply-period contracts were agreed for five years (for items such as surgical
instruments, infusion pumps). There was an initial large central delivery covering the needs
of all the different facilities. After this, supplements were bought on the same contract by the
different facilities individually.


4.1 Determining your model for procurement


89


◆ Administrative costs are often higher, making this a less
cost-effective way of procuring.


◆ Discounts are unlikely.
◆ In some circumstances, the products obtained may


conflict with standardization attempts.
◆ Staff at decentralized levels may have less experience


and expertise at procurement than the centre.




Using Procurement Agents
In special circumstances, procurement agents may be hired to carry out procurement.
This normally happens when the order is large or complicated to import, or the skills
required are beyond in-house capacity and resources. Typically this happens when
there is procurement for a development project, such as equipping a new hospital. In
addition, it can be a cost-effective option when a group of districts lack procurement
expertise or sufficient knowledge of the equipment market.
Procurement agents are usually private companies who have experience in dealing
with procurement of a wide range of goods, in bulk, from multiple sources. Many
procurement agents, but not all, have experience of health sector goods. Some
United Nations agencies, such as UNICEF, can also be hired to act as procurement
agents. Procurement agents can be costly. They will work on a variety of bases, either
a fixed fee or a small retainer plus a percentage of the order.
As stated in Section 2.2, ideally:
◆ The procurement agent should strictly follow the procurement procedures


of the organization hiring them. However, if such procedures are not available,
they will use their own procurement procedures or other agreed procedures.


◆ The procurement should always be based on the client’s equipment
specifications and requirements. However, if these are not available, they may
have specifications of their own and advise you on requirements. In this case, it is
essential you ensure they have knowledge of health sector goods.


◆ The procurement agent should involve your organization in the evaluation
process and final recommendations. However, some may assume you do not
have the skills and, believing they know best, may try to make the decisions for
you. This does not always provide you with appropriate equipment for your needs.


Tip • The procurement agent should be working on your behalf and presenting the outcome
of each step of the procurement activities to you, so that you can make the decisions.
They should not be following their own agenda and keeping you in the dark.


• Always ensure you use a procurement agent that has a good reputation of prior
knowledge and experience for procuring healthcare technology.


4.1 Determining your model for procurement


90




4.2 CHOOSING YOUR PURCHASING METHOD
4.2.1 An Overview of Purchasing Methods


Various purchasing methods exist for different circumstances. You will need to select the
right method for your situation, in order to ensure the appropriate items are purchased
at the right time, in the correct quantities, and on the most favourable terms.
Purchasing equipment may involve either:
◆ placing a direct order with a company
◆ going to tender (national, regional, or international); or
◆ obtaining a number of quotations (through various methods).
Direct order contacting the supplier directly for a price, and placing an order.
Tendering a purchasing procedure whereby potential suppliers are invited


to make a firm and unambiguous offer of the price and terms
which, on acceptance, should be the basis of the subsequent
contract. As the process is confidential, suppliers can provide an
offer knowing that no other bidder can knowingly undercut
them. As the bidding format is formal and ‘transparent’, no
supplier can offer an extra incentive.
The process can be either ‘open’ to anyone to respond to, or can
be ‘restricted’ to a smaller group (Section 4.2.2).


Quotation the stated price and terms provided by a supplier, when asked to
do so, with a validity period for acceptance by the purchaser.
Usually several quotations are obtained for comparison.
You can obtain the quotation via a number of methods – request
for quotes, national competitive bids, or competitive negotiation.
The method you select will depend upon whether you are
buying locally, nationally or internationally, and what rules apply
(Section 4.2.3).


The objective of the tendering/quotation process is to ensure the ‘best fit’ supplier is
selected to supply goods and/or services that offer best value for money. Each
purchasing method involves different steps and different time requirements, and is
suitable for different models of procurement (Section 4.1). Box 18 provides a
summary of the main purchasing methods, each of which are discussed in more detail
in the rest of this Section.


4.2 Choosing your purchasing method


91




BO
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4.2.1 An overview of purchasing methods


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4.2.1 An overview of purchasing methods


93


BO
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ids


, an
d


sup
pli


er
qu


alif
ica


tio
n


Di
rec


t O
rd


eri
ng


Di
rec


t in
vit


ati
on




2 w
eek


s–1
m


on
th


Us
ual


ly h
igh


est


Lo
we


r le
vel


pro
cu


rem
en


t
exp


ert
ise


fo
r


pre
par


ati
on


of
req


uir
em


en
ts,


an
d


eva
lua


tin
g o


ffe
r


Co
mp


eti
tiv


e
Ne


go
tia


tio
n


Di
rec


t in
vit


ati
on




1–
2 m


on
ths


Fav
ou


rab
le,


an
d v


ery
low


if
har


d
com


pe
tit


ion


Ex
pe


rie
nc


ed
Pro


cur
em


en
t U


nit
wit


h g
ood


ac
ces


s to
ma


rke
t in


tel
lig


en
ce,


kn
ow


led
ge


of
sou


rce
s,


cur
ren


t w
orl


d p
ric


es,
and


ne
got


iat
ing


sk
ills


Na
tio


na
l


Co
mp


eti
tiv


e B
id


Ad
ver


tiz
ing


lim
ite


d
to


the
of


fic
ial


gaz
ett


e
or


nat
ion


al p
res


s


5–
6 m


on
ths


In
loc


al c
urr


en
cy,


fav
ou


rab
le


wh
en


pri
ces


ar
e b


elo
w t


he
int


ern
ati


on
al m


ark
et


Hi
gh


le
vel


pro
cu


rem
en


t
exp


ert
ise


fo
r


pre
par


ati
on


an
d


eva
lua


tio
n o


f
ma


ny
bi


ds


Re
qu


est
fo


r Q
uo


tes


Di
rec


t in
vit


ati
on


2 w
eek


s–1
m


on
th


Ac
cep


tab
le


Lo
we


r le
vel


pro
cu


rem
en


t
exp


ert
ise


fo
r


pre
par


ati
on


of
req


uir
em


en
ts,


an
d


com
par


iso
n o


f q
uo


tes


Co
nti


nu
ed


ov
erl


ea
f


Me
th


od




4.2.1 An overview of purchasing methods


94


BO
X 1


8:
Co


mp
ari


so
n o


f P
urc


ha
sin


g M
eth


od
s (


co
nti


nu
ed


)
Te


nd
ers


Qu
ota


tio
n-b


ase
d M


eth
od


s


Fe
atu


res
Su


ita
bil


ity


Op
en


Te
nd


er



ann


ual
pu


rch
asi


ng



wh


en
m


any
rep


uta
ble


su
pp


lie
rs


are
av


aila
ble


an
d


lik
ely


to
be


int
ere


ste
d





lar
ge


con
tra


cts



lar


ge
val


ue
an


d b
ulk


eq
uip


me
nt


pu
rch


ase
s





if p
re-


qu
alif


ica
tio


n
is n


ot
fea


sib
le o


r n
ot


allo
we


d b
y


reg
ula


tio
n o


r th
e


ext
ern


al f
un


din
g


ins
tit


uti
on





Wo
rld


Ba
nk


rec
om


me
nd


ed
me


tho
d





for
es


tab
lish


ing
sup


ply
-pe


rio
d


con
tra


cts


Re
str


ict
ed


Te
nd


er





ann
ual


an
d b


ian
nu


al
pu


rch
asi


ng



lar


ge
vol


um
e o


f
goo


ds



spe


cia
liz


ed
eq


uip
me


nt



com


ple
x e


qu
ipm


en
t





hig
h v


alu
e


eq
uip


me
nt





wh
en


a l
im


ite
d r


an
ge


of
rep


uta
ble


ma
nu


fac
tur


ers
an


d
po


ten
tia


l su
pp


lie
rs


are
av


aila
ble






wh


en
a s


ub
sta


nti
al


list
of


re
gis


ter
ed


sup
pli


ers
ha


s b
een


de
vel


op
ed





lar
ge


em
erg


en
cy


pro
cu


rem
en


t, s
uc


h a
s


in
a n


atu
ral


di
sas


ter



for


es
tab


lish
ing


sup
ply


-pe
rio


d
con


tra
cts





for
es


tab
lish


ing
a


pro
du


ct
to


wh
ich


oth
ers


m
ay


be
sta


nd
ard


ize
d


Di
rec


t O
rd


eri
ng





bra
nd


pr
od


uc
ts





sin
gle


-so
urc


e
ite


ms



spe


cia
liz


ed
pro


du
cts


or
de


red
on


re
qu


est



for


pu
rch


asi
ng


goo
ds


sta
nd


ard
ize


d t
o


exi
sti


ng
m


ake
s


and
m


od
els





low
va


lue
go


od
s





sm
all


vol
um


e
ord


ers



ext


en
sio


n o
f a


n
exi


sti
ng


co
ntr


act



reo


rde
rin


g a
s p


art
of


a s
up


ply
-pe


rio
d


con
tra


ct


Co
mp


eti
tiv


e
Ne


go
tia


tio
n





loc
ally


av
aila


ble
eq


uip
me


nt
and


ser
vic


es
(bo


th
nat


ion
al a


nd
im


po
rte


d)



sm


all
vol


um
e o


rde
rs





eq
uip


me
nt


no
t


wid
ely


av
aila


ble



spe


cia
l te


rm
s o


r
spe


cif
ica


tio
ns


are
req


uir
ed





em
erg


en
cy


pu
rch


ase
s





wh
en


yo
u k


no
w t


he
lim


ite
d a


mo
un


t y
ou


can
sp


en
d





lim
ite


d s
ou


rce
s o


f
sup


ply


Na
tio


na
l


Co
mp


eti
tiv


e B
id





wh
en


go
od


s o
r


ser
vic


es
are


ava
ilab


le
loc


ally
at


pri
ces


be
low


th
ose


in
the


in
ter


nat
ion


al
ma


rke
t





wh
en


co
ntr


act
val


ue
do


es
no


t
jus


tify
pr


oce
du


ral
cos


ts
of


ten
de


rs



wh


en
na


tio
nal


reg
ula


tio
ns


req
uir


e
sup


po
rt f


or
loc


al
bu


sin
ess


es


Re
qu


est
fo


r Q
uo


tes





reo
rde


r le
vel


pu
rch


asi
ng





em
erg


en
cy


sup
ply





sm
all


vol
um


e o
rde


rs



low


va
lue


go
od


s



lim


ite
d s


ou
rce


s o
f


sup
ply


Co
nti


nu
ed


op
po


sit
e


Me
th


od




4.2.1 An overview of purchasing methods


95


BO
X 1


8:
Co


mp
ari


so
n o


f P
urc


ha
sin


g M
eth


od
s (


co
nti


nu
ed


)
Te


nd
ers


Qu
ota


tio
n-b


ase
d M


eth
od


s


Fe
atu


res
Co


mm
en


ts


Op
en


Te
nd


er





hig
he


st
adm


ini
str


ati
ve


wo
rkl


oad
an


d c
ost





ne
ed


s c
are


ful
pre


par
ati


on



tec


hn
ica


l
jud


gem
en


t o
f b


ids
ma


y n
ot


be
po


ssi
ble


, so
do


es
no


t n
ece


ssa
rily


pro
vid


e t
he


be
st


de
al f


or
you


r
sit


uat
ion





do
es


no
t c


om
mi


t
you


to
ac


cep
t


low
est


pr
ice


on
ly i


f
eva


lua
tio


n c
rit


eri
a


are
sp


eci
fie


d i
n t


he
ten


de
r d


ocu
me


nt


Re
str


ict
ed


Te
nd


er





com
mo


nly
us


ed
me


tho
d





hig
h a


dm
ini


str
ati


ve
wo


rkl
oad


an
d c


ost



tec


hn
ica


l
jud


gem
en


t o
f b


ids
ma


y n
ot


be
po


ssi
ble


, so
do


es
no


t n
ece


ssa
rily


pro
vid


e t
he


be
st


de
al f


or
you


r
sit


uat
ion





do
es


no
t c


om
mi


t
you


to
ac


cep
t


low
est


pr
ice


on
ly i


f
eva


lua
tio


n c
rit


eri
a


are
sp


eci
fie


d i
n t


he
ten


de
r d


ocu
me


nt


Di
rec


t O
rd


eri
ng





no
t tr


ans
par


en
t a


nd
the


ref
ore


lia
ble


to
qu


est
ion


s o
f e


thi
cal


ch
ara


cte
r





use
ful


if
the


pr
ice


is
rea


son
abl


e a
nd


the
re


is n
o b


en
efi


t
fro


m
com


pe
tit


ion



in


the
ab


sen
ce


of
com


pe
tit


ion
, it


is
mo


re
dif


fic
ult


to
de


ter
mi


ne
wh


eth
er


the
qu


ote
d p


ric
e i


s
eco


no
mi


cal
or


rea
son


abl
e





the
qu


ick
est


me
tho


d


Co
mp


eti
tiv


e
Ne


go
tia


tio
n





no
t tr


ans
par


en
t a


nd
the


ref
ore


lia
ble


to
qu


est
ion


s o
f e


thi
cal


ch
ara


cte
r





sho
uld


be
app


roa
ch


ed
wi


th
cau


tio
n.


Ho
we


ver
it


is o
fte


n t
he


m
ost


eco
no


mi
cal


an
d


eff
ici


en
t w


ay
of


pro
cu


rin
g p


rod
uc


ts


Na
tio


na
l


Co
mp


eti
tiv


e B
id





no
rm


ally
us


ed
fo


r
pu


bli
c p


roc
ure


me
nt


wit
hin


th
e b


uy
er’


s
cou


ntr
y





un
lik


ely
to


at
tra


ct
for


eig
n s


up
pli


ers
,


tho
ug


h l
oca


lly
rep


res
en


ted
int


ern
ati


on
al


sup
pli


ers
ca


n
par


tic
ipa


te



loc


al c
urr


en
cy


is
gen


era
lly


us
ed


fo
r


bid
din


g a
nd


pay
me


nt
pu


rpo
ses


Re
qu


est
fo


r Q
uo


tes





oft
en


us
ed


fo
r


pu
rch


ase
s fr


om
sup


pli
ers


in
th


e
im


me
dia


te
loc


ati
on


of
the


bu
yer






low


ad
mi


nis
tra


tiv
e


wo
rkl


oad
(re


qu
est


s
for


qu
ote


s c
an


be
fax


ed
an


d e
ma


ile
d


to
sup


pli
ers


)



en


sur
e s


uff
ici


en
t


spe
cif


ica
tio


ns
are


pro
vid


ed
wi


th
you


r
req


ue
st


to
en


cou
rag


e
app


rop
ria


te
qu


ote
s


Me
th


od




4.2.1 An overview of purchasing methods


96


Experience in Sri Lanka
In Sri Lanka, the Ministry of Health uses a competitive tender process that follows national
guidelines for all equipment procurement. These national guidelines include the requirement
for each supplier to have an established local agent/distributor in the country with a minimum
of two-year authorization, and evident financial and technical capability.
Quotations are used for common and standard accessories, and are obtained only from
manufacturers who have already supplied equipment. The quotations must specify the
quantity, unit price, total price, validity and delivery period.
However, for foreign-funded projects the Ministry of Health may be obliged to use other
procurement methods laid down by the external support agency.


The purchasing method you choose will vary, and depends on the following:
a. What you are purchasing


The type and quantities of equipment, supplies, and services being purchased.
b. The model of procurement used


Whether centralized, decentralized, group, or mixed procurement, or using a
procurement agent (Section 4.1)


c. Who is paying
Purchasing methods vary depending on whether the money comes from your own
funds, national funds, or external support agency funds (Section 3.3). The funding
organization (whether national or external) usually recommends the purchasing
method and the forms of contract to be awarded (Section 6.4).


d. The transparency required of the process
For tenders, the process must be formal and conducted so that suppliers cannot offer
health service staff any incentive. In certain instances, such as some quotation-based
methods and direct ordering, an element of personal communication is allowed
during negotiations, which opens the process to possibilities of influence.


e. Procurement guidelines
Procurement procedures vary between the different funding bodies and these
requirements must be taken into account.


f. The market place
Purchasing methods vary depending on whether there is the likelihood of interest
by foreign bidders, and whether there is a locally available range of quality
products (locally produced, or imported for resale).


g. The size and value of the purchase
Your Purchasing/Supplies Manual (Section 2.2) should state the financial limits
that determine the purchasing method to use. For example:




4.2.1 An overview of purchasing methods


97


◆ Items below a certain value (individually) and a package of items costing less
than a certain value are usually purchased using the quotation-based methods.


◆ Items above a certain value (individually) and a package of items costing more
than a certain value are usually purchased using tenders.


If an external support agency is funding the purchases, they may set the financial
limits that will determine the purchasing method used.


Country Experience
Financial brackets may be set by international bodies that determine which purchasing
method to use. For example, the EU/EDF in 2003 had the following financial brackets:
◆ 0–5,000 Euro: direct procurement
◆ 5,000–25,000 Euro: three quotations
◆ 25,000–100,000 Euro: limited or restricted tender
◆ 100,000 Euro and above: international tender.
In Zambia in 2000, government regulations provided the following financial brackets:
◆ for items up to Kwacha (K) 150,000: buyers purchase directly from the supplier (direct


procurement)
◆ for items from K150,000 up to K5,000,000: buyers purchase upon presentation of a


minimum of three quotations obtained from reputable suppliers (request for quotes)
◆ for items from K5,000,000 up to K25,000,000: permission must be sought from the Executive


Director of the facility or health authority to purchase via the Tender Committee using either
an open tender or selective tender, as long as a minimum of three bids is obtained


◆ for items from K25,000,000 and above: the Tender Committee still goes out to tender, but
must refer the papers to the National Tender Board for ratification


◆ non-government facilities and private hospitals do not have to use these financial brackets,
as long as they are using their own funds.


For a UK-based international NGO, the financial brackets are:
◆ For items below £2,500, there is no need for three quotations. However, the reasons for


choosing the particular supplier should be documented in writing on the copy of the
Purchase Order.


◆ For items between £2,500 and £18,000, a minimum of three quotations are requested.
Completed quotation forms are compared, and the reasons for selecting a particular
supplier are documented in full, including any specific donor requirements.


◆ For items greater than £18,000, tenders are issued, taking into account the individual
external support agency’s requirements.


Note: some international bodies may express financial brackets in the international SDR
(Special Drawing Rights) currency. This is a stable theoretical currency that is based on a
number of real currencies such as the US dollar, the British pound sterling, the Euro, and the
Japanese yen. Any country can find out the exchange rate for its currency against the SDR.




h. The level of authorization required
Your Purchasing/Supplies Manual (Section 2.2) should also state the
authorization levels required for each purchasing method. For example:
◆ items that are individually below a certain value, or a package of items costing


less than a certain value, are usually purchased by personnel at health facility
and decentralized authority levels, using a quotation-based method


◆ items that are individually above a certain value, or a a package of items costing
more than a certain value, are usually purchased by personnel at regional or
central authority levels, often using tender methods.


Country Experience
The approval levels for purchasing for a UK-based international NGO are as follows:
◆ Less than £1,000 – an Operations Assistant in the field.
◆ More than £1,000 but less than £10,000 – the Operations Manager in the field.
◆ More than £10,000 but less than £150,000 – must be referred to the Operations Manager


at head office.
◆ Greater than £150,000 – any two of the Chief Executive Officer, Director of Finance, or


Director of Operations at head office, and a tender format is used.


i. How soon the equipment is needed
There may be critical dates for delivery and different purchasing methods involve
different timescales. Direct ordering is obviously the quickest method, followed
by quotation-based methods, while tendering methods take a considerable time
to organize and process.
Using tenders, the absolute minimum time from the start of the
purchasing process until the contract is awarded is four months. This
allows for one month for preparing the tender documents, two months tender
response time, plus one month evaluating the tenders and negotiating the
contract. However, depending on the organization undertaking the tender,
the time can be considerably longer than this. Experts suggest it can take
anything up to 12 months and sometimes longer, depending on the equipment.
The key is to set deadlines and stick to them.


4.2.1 An overview of purchasing methods


98




Experience in Sri Lanka
The Ministry of Health in Sri Lanka finds that tenders can take as long as 16 to 24 months to
process, as follows:
◆ Preparation and approval of the tender document – two months.
◆ From tender issuing to closing – six weeks to two months.
◆ Evaluating the bids and awarding the contract – three to six months.
◆ Obtaining guarantees and signing the contract – one to two months.
◆ Obtaining letters of credit – one month.
◆ Freighting, customs clearance, and in-country delivery – five to eight months.
◆ Installation, commissioning, and handover – two to three months.


4.2.2 Tenders
At the national and central levels most purchasing above a certain value is
undertaken using a tender process. This is also the chosen method for the majority
of the purchasing activities of external support agencies.
The reason a tender process is preferred is due to its nature, which:
◆ is formal and regulated. Above certain order values, it must be undertaken


according to international rules.
◆ allows any supplier to place an offer. In other words, it is open to ‘free market’ forces.
◆ uses a standard written bidding format which ensures all suppliers provide


information and prices for the same specified elements of the bid, and there is no
space for anyone to offer added incentives. In other words, it is transparent.


◆ ensures that each supplier’s bid is confidential and that no supplier can know
what their competitors are offering. A tender process also encourages each
supplier to provide a good offer if they hope to win. In other words, it makes the
bidding competitive.


◆ does not allow negotiation between the supplier and health service staff, which
de-personalizes the process. In other words, it avoids corruption.


◆ has formal written procedures and rules which are quasi-legal. In other words,
breaking the rules amounts to fraud/criminal deception.


Types of Tender
A tender can be either open or restricted. Be careful to check if there are regulations
concerning each specific type of tender, such as restrictions or requirements from the
funding organization.


4.2.2 Tenders


99




Open tenders are open for any interested supplier to bid. They can be national,
regional, or international, and you can receive many responses. Normally,
international open tenders attract the most competitive offer and potentially the
lowest price. But they take a long time, and are fairly complex and expensive to
administer. The most complex process is an international open tender under World
Bank guidelines, which is open to all member countries from the World Bank. (Note:
although the World Bank calls it international competitive bidding, it is in fact an
open tendering process.)
The timescale from the start of the tender process (writing tender invitations
including the specifications) until the goods are commissioned and ready for use is
seldom less than six months. It may take at least one year, or even longer, for open
international tenders.
Restricted tenders are restricted to a smaller number of pre-qualified suppliers
(Section 4.4), which means you eliminate bids from suppliers who may be wasting your
time or are unsuitable. Restricted tenders can also be national, regional, or international.
There are several formal ways to pre-qualify suppliers, depending on the regulations
of your country and the organizations involved. Often, using an open tender process
initially to assess and pre-qualify suppliers is the best method. You need to carefully
specify your requirements for such pre-qualification – for example, financial viability,
past supplies, local representation, documented company skills, quality control
programmes, reputation, references, etc. You also gain leverage against poorly
performing companies by threatening to take them off your list of pre-qualified
suppliers (Section 4.4).
Restricted tenders are usually quicker, since the pre-qualification process is carried
out in advance. Also, once you have a limited number of competitive suppliers, it is
easier to produce your tender documents and it takes less time to evaluate the
tenders. The timescale could therefore be as short as four to six months if everything
works out smoothly.


Adjudication of Tenders
In the past, many tenders have been accepted on the basis of the lowest purchase
price, rather than the best deal for your situation. This practice can be misleading
and should be avoided. However, you can only enter into technical judgements about
the bids if you have produced an extremely detailed tender document covering all
aspects of the product, and specified how the bids will be judged.


Tip • Aim to make your tender document as detailed as possible. What is the point of
receiving as many offers as possible, if none of them provides you with the
equipment you want?


4.2.2 Tenders


100




Thus, your tender document should specify the whole ‘package of inputs’, your
product evaluation criteria, supplier qualification criteria (if applicable), and any
scoring system, so that you are free to select the ‘best fit’ product and not just select
on the basis of price alone (Section 3.3.2).
As Section 3.2 shows, the product evaluation factors that you should specify
explicitly on your tender document include:
◆ equipment quality
◆ documentation
◆ aftersales support
◆ installation/commissioning requirements
◆ maintenance
◆ training provision
◆ delivery requirements
◆ need for consumable products
◆ quality control
◆ warranties.
These allow you to consider bids on the basis of the ‘most economically advantageous’
offer – in other words the best value for money – rather than just price alone.
Box 19 describes the benefits and drawbacks of using tenders.


BOX 19: Advantages and Disadvantages of Tendering
Advantages ◆ suitable when many reputable suppliers are available and likely to be interested


(open tender)
◆ suitable when you know that a limited number of reputable suppliers can be


identified to compete (restricted tender)
◆ suitable for large contracts, large equipment value, and high volume/bulk


equipment purchase
◆ suitable when transparency is required to avoid allegations of fraud, and formal


procedures are required to avoid allegations of corruption
◆ suitable if funding organizations require a process open to the free market


competition (open to anyone)
◆ normally ensures a very low price (although not necessarily the best deal – see below)


with restricted tenders giving a favourable price, but not as low as open tenders.


4.2.2 Tenders


101


Continued overleaf




BOX 19: Advantages and Disadvantages of Tendering (continued)
Disadvantages ◆ suppliers may quote a price that is too low in order to win, leading to subsequent


disputes if goods or services supplied are unsatisfactory
◆ once the bid is closed, you cannot change any of the tender conditions
◆ unsuitable for some contracts (for example, if technical specifications cannot be


detailed in the tender documents and consultation is essential to clear up technical
points)


◆ bids mostly accepted on the principle of the lowest price – this can be misleading as
the best buy is not necessarily the lowest price


◆ unsuitable for technically complex equipment (for example, a complex order may
require extensive technical evaluation and subsequent amendments, which may not
be allowed in a tender process as they could affect the validity of competition)


◆ a slow process and therefore not suited for emergencies
◆ an expensive process in terms of administration (clerical staff, stationery, postage


costs, etc)
◆ requires a high level of purchasing expertise, including knowledge of sources and


supplier qualifications, preparation and evaluation of bids, etc
Some of the points above can, however, be prevented by thorough tender preparation.


Skills and Time Available
Although a tendering process is meant to achieve the best price, equipment
suppliers also face problems with the tender process, mainly due to the shortage of
the buyer’s skills and the time constraints imposed by the funding institution’s
procurement procedures. Equipment suppliers report that existing tender
procedures present the following problems that ultimately affect the bid value:
◆ The buyer’s lack of experience in writing specifications and purchase (tender)


documents means the supplier receives inadequate information on which to bid.
◆ The tender document format, designed to provide no preferential bias, does not


allow bidders to explain pertinent features of their product/offer (for example, any
important detail that the buyer forgot to specify), biasing the process in favour of
the lowest cost bid.


◆ The buyer’s poor understanding of equipment means tender documents
frequently omit the ‘package of inputs’ required to keep the equipment working.
If a bidder includes them his price will not be competitive, but if he quotes for
them separately such an addition to the bid is unacceptable.


◆ Inadequately skilled adjudicators cannot compare the relative merits of bids, so
tenders are usually decided on the basis of cost.


◆ The bid preparation time allowed is short, leaving no time for clarification.
However, the process of adjudication, clarifying contracts, making financial
arrangements, etc, can take up to a year. This delay has to be reflected in the price
or they will make a loss on the product.


4.2.2 Tenders


102




◆ Significant effort is invested in preparing each bid. The chance of success is small,
so this cost is reflected in the price. For tenders where delays are common and
significant amounts of paperwork are required (for instance the multi-lateral
funding institutions such as the World Bank and other development banks), the
mark-up can be as much as 20 per cent. To save money, clerical staff may draw up
the bid, and are less likely to detect problems in the tender request.


4.2.3 Quotation-based Methods
It is often preferable to use some form of quotation-based method, as these are less
formal and rigid than tenders. Also, they do not have to conform to international
regulations, and you can apply your own technical judgements when evaluating the
offers. This leads to faster processing and cheaper administration, and you are more
likely to get the equipment you need. However, the key disadvantage of using
quotation-based methods is that they can introduce the possibility of corruption,
due to:
◆ the lack of transparency in the process (the possibility of the buyer being


influenced by the seller)
◆ the possibility for direct negotiation after the first round of bidding.
For these reasons, quotation-based methods are generally less well suited for large
contracts, where the implications of corruption have greatest importance. However,
the more strictly the quotation process is regulated (for example, by national law or
by your organization’s policy), the easier it is to use quotation-based methods instead
of tenders.
For most of these methods you approach a minimum of three suppliers that are
selected (either pre-qualified suppliers or those who have expressed an interest –
Section 4.4). For some of these methods, negotiations can take place directly after
receiving the first quote.
The main quotation-based methods are:
◆ Request for quotes where the buyer simply approaches a minimum of three


suppliers and asks them to quote for specified goods and services. The buyer
then evaluates and compares the quotations and selects the best one for their
situation.


◆ National competitive bids where the need for quotes is advertized nationally so
that as many quotations as possible are received from anywhere in the country,
which are then evaluated and compared.


103


4.2.3 Quotation-based methods




◆ Competitive negotiation, where the buyer approaches several suppliers telling
them the sort of goods/services that are required (and even the money available)
and asks what sort of deal they can put together. After the suppliers make their
first offer, the buyer does a round or more of negotiating to get better deals. The
buyer can tell each supplier about the offers from other suppliers, and ask if they
can do better than that (and may even say who the competing suppliers are and
give details of the offers made). This round of undercutting goes on until the
buyer is happy they’ve got a deal they like.


Box 20 describes the benefits and drawbacks of using quotation-based methods.


BOX 20: Advantages and Disadvantages of Quotation-based Methods
Advantages ◆ much quicker and less formal than tenders


◆ can (sometimes) negotiate the terms of the offer directly with suppliers
◆ more likely to get the type of equipment you want than with tenders, as you can use


technical judgements in the evaluation process
◆ for small or uncomplicated orders, the same written format – a Purchase Order – can


be used for both requesting a quotation and for placing an order. You will need to
state clearly whether it is a quotation request or an order


Disadvantages ◆ less transparent than tenders (more open to corruption)
◆ greater risk of dispute about contract terms (delivery times, etc) as the purchase


document may be less detailed
◆ greater risk of accusations about unfair treatment from suppliers who are not successful


4.2.4 Direct Ordering
Direct ordering is used when buyers:
◆ know what they want, even down to the exact make and model
◆ know which supplier to approach
◆ can contact the supplier directly, communicate personally with them, and


negotiate terms.
Direct ordering is the most informal and the fastest method. It is best suited to small
contracts, emergencies, purchasing from local suppliers, and purchasing direct from a
specific manufacturer (for example, for a standardized product).
The supplier you approach is either a specific manufacturer, a reliable company you
may have dealt with before, or someone on your lists of pre-qualified suppliers or
suppliers who have expressed an interest in the past.
Box 21 describes the benefits and drawbacks of direct ordering.


4.2.4 Direct ordering


104




BOX 21: Advantages and Disadvantages of Direct Ordering
Advantages ◆ you can purchase exactly what you want, from the supplier you want, and negotiate


any terms you want
◆ you can talk all the issues over in person
◆ the fastest and most informal method
◆ the same written format (a Purchase Order) can be used for both requesting a price


estimate and for placing an order. You will need to state clearly whether it is an
estimate request or an order.


Disadvantages ◆ there is no competition in prices
◆ you do not give yourself the chance to see what other beneficial products and deals


were available
◆ most open to corruption


4.2.5 Making the Best Use of Your Purchasing Method
With effective tenders and quotation processes you can achieve substantial savings,
if the market provides sufficient competition. However, the process is fairly
complicated and experienced purchasing personnel with knowledge of sources and
negotiating skills are required for tasks such as:
◆ supplier qualification (Section 4.4)
◆ preparing purchasing documents and contracts (Sections 5.5.2 and 6.4), and
◆ adjudication (evaluation) of bids/quotes (Section 6.3).
In order to attract the best suppliers and achieve the best prices, you need to use
purchasing procedures that are as clear and transparent as possible, and base your
decisions upon formal criteria that have been stated in detail. Anything less could be
perceived as being secretive or, worse, could lead to accusations of favouritism among
suppliers. Unsuccessful suppliers may feel that they have no chance of winning and
consequently withdraw from future tenders or quotations.
Any of the purchasing methods described can be used whatever your procurement
timetable is, no matter whether you procure on an annual, scheduled, perpetual or
single project basis – see Section 5.4.
Choosing the right purchasing method is vital for fulfilling other aspects of HTM
such as, standardization, maintenance and quality control. For example,
standardization is not achieved by frequent use of international open tenders based
on price, but may be accomplished by using an international open tender process to
establish a supply-period contract lasting several years (Sections 4.1 and 6.4).


4.2.5 Making the best use of your purchasing method


105




Many countries have been successful in using tenders to obtain supply-period
contracts for either:
◆ products they buy in large volumes such as


small handheld medical equipment
(stethoscopes, laryngoscopes); or


◆ specialized equipment such as laboratory
equipment or X-ray machines.


In this way, it has been possible to equip many facilities
with the same type of equipment over several years.


Tip • International open tenders usually attract the most competitive offers and
potentially the lowest price, but quality issues are often of secondary importance to
the price. It is also difficult to ensure the project is delivered on time, as you may be
dealing with unknown suppliers and longer lead-times.


The purchasing methods most commonly used are as follows:
Some form of restricted
tender, which requests
bids from pre-qualified
suppliers
Some form of
quotation-based method


Tip • If external support agencies or procurement agents are involved in the supply of
goods, they may undertake the quotation/tendering process themselves, or you may
need to use their quotation/tendering format. Encourage them to use your
Equipment Specifications, Purchase Document and Contract details.


• To be ready to purchase, you should already have a list either of pre-qualified
suppliers or those that have expressed an interest.


4.2.5 Making the best use of your purchasing method


106


◆ countries with well-established purchasing
systems


◆ international external support agencies
◆ central Procurement Units
◆ international NGOs
◆ civil societies
◆ private sectors
◆ decentralized Procurement Units




4.3 DIFFERENT TYPES OF SUPPLIER AVAILABLE
Before choosing any equipment, your Procurement Unit needs to draw up a
prospective list of credible and reliable suppliers. Suppliers come in a number of forms:
International and national manufacturers. These are primary sources of
equipment, as they carry out the manufacturing themselves. Most equipment is
manufactured outside developing countries, but increasing amounts come from
developing countries. For example, Pakistan is one of the largest producers of surgical
instruments that are marketed by large European companies.
International and national suppliers. These are secondary sources of equipment,
which means they sell items made by others. They include manufacturers’
representatives and agents, distributors, wholesalers, foreign exporters, local
importers, and retailers (small sales outlets).
International supply organizations. These are bodies that procure items on your
behalf, and may also stock supplies in bulk (similar to a wholesaler). They include
procurement agents and non-profit supply organizations. They are also known as
packaging agents since they can procure and freight a ‘package’ of compatible
equipment for their clients, supplying all the items needed to equip a new
department or an entire hospital. (Note: this package is not the same as the package
of inputs required to keep equipment functioning throughout its life.)
International turnkey organizations. These are companies that, in addition to
providing the services of a packaging agent (as described above), oversee the arrival
of the equipment on site and organize its installation, commissioning, and handover
in a working condition to the client. They may also offer consultancy support on
issues such as specifications, equipment selection, appropriate room use and service
supply installations.
To establish the available suppliers of each type, the Procurement Unit will need to use:
◆ equipment brochures
◆ staff experience
◆ equipment records, such as the equipment inventory (see Guide 2) and the


maintenance record system (see Guide 5)
◆ internationally available equipment source directories and databases, usually


accessed by subscription (see Annex 2)
◆ information gathered from incoming tender documents, which should contain


facts about suppliers, such as references, financial situation (last available
accounts), authorizations (which manufacturers they represent), knowledge and
skills, service locations, and more.


4.3 Different types of supplier available


107




The different types of supplier are most commonly used as follows:
Buying direct from manufacturers
(manufacturers rarely supply direct
to smaller-scale or low value
customers) or procurement agents
Buying through a wholesaler or
retail outlet (for example,
local distributors, specialist stores,
showrooms, department stores)
or a non-profit supply organization


International Manufacturers and Their Representatives
Some multinational manufacturers have their own supply and distribution network,
but many use local representatives or agents to distribute and market their products.
The advantages of such an approach are:
◆ There is someone local to you – in your country or a neighbouring one – to whom


you can address your concerns and needs, who can deal with issues such as currency,
customs clearance, and tax duties, and hopefully can supply aftersales support.


◆ If the agent represents multiple suppliers, they may also be able to provide you
with valuable product comparison information on various products, such as cost
comparisons, alternatives, literature and brochures.


You should be aware that equipment purchased through representatives may appear
more costly than buying from the manufacturer direct, since the cost will include a
commission for the representative. However, such commissions are important since
they are used by the representative to ensure that they can provide aftersales support.


Local Manufacturers and Suppliers
The equipment sector in developing countries can broadly be divided into
two categories:
◆ Suppliers of (predominately imported) equipment.
◆ A handful of companies involved in equipment services, such as installation,


maintenance, and repair.
Few companies combine supply and servicing. Even fewer actually manufacture the
products they sell. Where it exists, local manufacturing of healthcare products is
normally limited to a small number of common products such as basic consumables,
simple furniture, prosthetics, occupational therapy and physiotherapy aids. For
example, simple furniture such as beds and cabinets may be manufactured locally, but
specialized furniture such as adjustable beds, is likely to be purchased from abroad.


4.3 Different types of supplier available


108


larger customers, such as
◆ government Central Stores
◆ procurement agents
◆ external support agencies
smaller-scale or low value customers, such as
◆ facility level
◆ district level




When equipment is made locally, it is generally designed to suit local conditions,
such as climate and available power supply. It will also take into account local needs,
such as a requirement to be robust and made of hard-wearing material, so it may last
and perform well in your environment. However, it will generally be designed to local
standards for safety and performance, so make sure these products are of good
quality and are safe. Try to apply the same quality judgements as if you were buying
internationally (Section 3.2).


Wholesalers and Retailers (International and Local)
Wholesalers and retailers buy a range of products from a variety of manufacturers for
re-sale. Only occasionally do they also act as representatives for the manufacturer,
offering some level of aftersales support in addition to selling. Some are distributors
for more than one manufacturer, and the same products may be sold by many
companies. Others have exclusive rights to act as a manufacturer’s sole distributor in
a country or region, and they then answer invitations to tender or quote only for that
manufacturer’s products. The advantages of using a wholesaler or retailer are:
◆ Cost effectiveness – their close relationship with manufacturers, a good network


of contacts, and purchasing in bulk, means that such suppliers can often offer a
favourable price and obtain discounts.


◆ Flexibility – such suppliers can fulfil orders of variable sizes (single units or
multiples) when the manufacturer cannot always do so. Retailers may also be
involved in leasing equipment.


Tip • You should be aware that wholesalers and retailers can be a barrier between you and
the manufacturer. Sometimes they place their own name plates on equipment so you
don’t even know who the manufacturer is, or how to contact them when facing a
problem with the equipment.


International Supply Organizations
These can be commercial procurement agents, as well as non-profit supply
organizations.
Procurement agents are commercial companies, such as the Crown Agents, that
will purchase goods on your behalf, and add a percentage for doing so in order for the
company to make a profit.
Non-profit supply organizations can be national organizations such as Joint
Medical Stores in Uganda and Mission for Essential Drugs And Supplies in Kenya, or
international bodies such as Technologie Transfer Marburg in Germany and
International Dispensary Association in the Netherlands. They work on the not-for-
profit principle, so any charges passed on to you are to cover their costs only.


4.3 Different types of supplier available


109




The international supply organizations offer an alternative to purchasing directly
from manufacturers. Buying in this way is particularly attractive for Purchasing and
Supplies Officers, who may have limited experience, for the following reasons:
◆ Expertise – international supply organizations can provide procurement expertise


together with illustrated catalogues and price lists.
◆ Cost-effectiveness – as they are not tied to particular manufacturers, and act as


wholesalers buying products in bulk from many sources, these organizations are in
a unique position to be able to provide internationally competitive prices. Non-
profit supply organizations have the added advantage of being able to offer you
even better prices as they are not trying to make a profit from the transaction.


◆ Wider range of contract size – international supply organizations can also supply a
range of contracts since they both hold bulk stocks and can make small volume
equipment sales that may not interest the manufacturers.


Non-profit supply organizations can play a valuable role in some tenders and quotes,
depending on whether the external funder has any restrictions on their use.


Tip • You should be aware that many international supply organizations deal in all types of
products and do not necessarily have any experience of health sector goods. It is
important to identify those that have knowledge and experience of healthcare
technology products.


• International supply organizations do not usually provide you with aftersales
support. They may be able to negotiate for aftersales support from the manufacturer
on your behalf, if you request it.


Country Experience
When the World Bank finances projects, they have rules about buying from international
non-profit supply organizations, as follows:
◆ In emergencies and disasters, or where the number of items is large but the overall value is


small, procurement directly from established UN agencies such as UNICEF, and non-profit
supply organizations such as the International Dispensary Association is acceptable.


◆ However, the total amount of procurement directly from these organizations on any given
project should remain small, and should be used only when an international open tender
is not possible. In other words, no more than US$ 5 million should be procured from UN
agencies, and US$ 250,000 from NGOs experienced in procurement.


4.3 Different types of supplier available


110




International Turnkey Organizations
You can contract these commercial firms to undertake part, or all, of the procurement
and commissioning activities described in this Guide on your behalf. To achieve this,
they utilize a combination of their own engineers, those recruited for the duration of
the contract, and manufacturers’ representatives. They can provide advice on the
design of rooms, and the schedule of equipment and service supplies required. In
many cases, however, they operate to a brief provided by the client’s architects.
As for all other types of secondary suppliers listed above, it is important to remember
that turnkey organizations:
◆ do not all have knowledge and experience of the health sector
◆ can be a barrier between you and the equipment manufacturers
◆ do not usually provide you with aftersales support for the goods supplied.
In addition, the interests of the turnkey organization are not the same as those of the
client. It is in the turnkey organization’s interest to supply as much expensive
equipment as possible, which may come from particular manufacturers that they
have close ties to. Care must be taken with the selection of such firms, their
contract, and the goods they offer to supply.


Whether to Buy Locally (Local or Imported Products) or Internationally
For equipment, an international bid almost always results in lower prices than a
tender or quotation limited to the local market. Therefore, in both the public and
private sectors, developing countries most frequently purchase their equipment
from foreign sources.
If purchasing from abroad, it is worth noting that suppliers of equipment are unlikely
to provide a full range of aftersales services to buyers in developing countries. This is
because it is often difficult for suppliers to identify local companies with the
facilities and staff required to provide aftersales support. In addition, setting up such
a support network is expensive, and suppliers are unlikely to do this until they are
confident that a stable market for their goods will be established.


Tip • At every opportunity when talking and negotiating with international suppliers,
provide feedback on the performance of their local representative if they have one.
If they don’t have a local representative, provide local knowledge of firms with
suitable facilities and skills to act as representatives.


4.3 Different types of supplier available


111




There may be some instances when it is cheaper to purchase locally – for example,
where the shipping cost is high and the product cost is low. You may also prefer to
purchase items which are manufactured locally to encourage the development of
sustainable local markets, particularly for simple items.


Tip • If available, quality, low value and small volume items should be purchased locally.
A summary of the benefits and drawbacks of buying locally or internationally is given
in Box 22.


BOX 22: Advantages and Disadvantages of Local or International Purchasing
Source Advantages Disadvantages
Local ◆ speed and efficiency of communication


◆ makes payment easier – local agents
can sometimes accept local currency
and allow deferred payments


◆ helps the delivery process – local
agents often handle port clearance


◆ introduces new products which may
be cost-effective alternatives to
existing products


◆ more appropriate products, if
made locally


◆ commissions paid on sales help local
aftersales support capabilities


◆ knowledge about actual product and
support available locally


◆ quick availability in emergencies
◆ prompt delivery
◆ lower transport costs
◆ provides support to the local economy


International ◆ more competitive products at lower
prices (depending on delivery costs)


◆ products of better quality (possibly)
◆ can order a wider range of goods of


different complexities
◆ more likely to fulfil your specifications


(if appropriate)
◆ better capacity, financial position,


reputation, and reliability (if good
sources found)


4.3 Different types of supplier available


112


◆ may slow communication, if untrained,
unmotivated, or a part-timer


◆ may increase costs through addition of
commission and other charges – could
be as much as 15 to 30 per cent of
export price


◆ higher unit prices paid for low volumes
◆ not always available in the quantity and


quality needed
◆ local capacity and services may be


insufficient or unavailable
◆ shortages may occur in the local


supply market


◆ communication may be more difficult
◆ longer delivery time
◆ higher transportation costs
◆ foreign currency difficulties
◆ complex payment structures (letters of


credit, bank drafts, etc)
◆ import duties and insurance
◆ delays in delivery due to weather,


transport, strikes, and customs action
◆ complexity of buying abroad
◆ legal and commercial considerations and


procedures involved in buying abroad
◆ unavailability of local support services
◆ does not support the local economy
◆ products may be inappropriate to local


needs and conditions




Figure 11 provides you with some factors to consider when deciding where to
source equipment.


Figure 11: Things to Consider when Sourcing Equipment


4.3 Different types of supplier available


113


Issues Considerations


Do you need both equipment
and services?


Are you buying complex or
expensive equipment?


Are you buying only a few items
of one type?


What can local distributors offer?


Is the supplier authorized to
supply?


What is the local impact of your
decision?


Unless the equipment is simple, your contracts with suppliers
should specify both the equipment (hardware) and services.
This can be difficult when the contract is for only one health
facility or a few items. This is one reason why it is important to
standardize equipment, and to join with others to buy in bulk.


It is prudent to stick to well-known and reputable manufacturers
or suppliers. Ideally, choose those that are able to offer a full
range of support services, including: accessories, spare parts,
advice, training, technical back-up and support, trouble-
shooting, maintenance, servicing and repair. Consider pre-
qualifying these suppliers – see Section 4.4).


It may not be economical to request the suppliers to visit to
commission and train staff. They should have a suitable agent in
the region that could undertake these activities.


Find out who distributes equipment in your area. If the seller is
an independent distributor, what is his/her relationship with the
manufacturer? Remember, if they sell exclusively for a particular
manufacturer, they can only offer you one make of products.
Alternatively, they may represent several manufacturers, and
offer you competing lines.


Request a ‘letter of authorization to supply’ from the supplier.
This ensures that the supplier is legitimately offering products
that he/she has the authority to sell. It is customary for suppliers
to show that they have authority to sell in particular countries and
regions. Letters of authorization can, but need not, apply to both
equipment and equipment-related supplies.


Decision-makers should be aware of their influence on the
shape and competitiveness of the local equipment industry,
and bear in mind any policy to purchase locally.




4.4 IDENTIFYING SUITABLE SUPPLIERS
To get the best suppliers, your Procurement Unit needs a credible and reliable
screening, assessment and selection process.
Screening of prospective suppliers can take place:
◆ before the bidding/quoting process (known as pre-qualification); or
◆ after the bidding/quoting process (known as post-qualification).
It is used to narrow the field to suitably capable companies from which to accept offers.
If your purchasing method is open (open tender, national competitive bid), you can
receive responses from any potential supplier, whether you know of them or not. In
this instance you should post-qualify them during the bid/quote evaluation process
(Section 6.3).
If your purchasing method is restricted (restricted tender, competitive negotiation,
request for quotes, direct ordering), you need a list of suppliers to approach. Ideally
this should be a list of suppliers that you have pre-qualified (see below), but it can
also be a list of suppliers who have expressed an interest in the past, which you then
post-qualify during the bid/quote evaluation process.
Selection of the final supplier and product occurs once all bids/quotes have been
evaluated and compared (Section 6.3). However, you can prepare for this by
identifying suitable qualification criteria for the suppliers.
The screening process should be ongoing, and should consider:
◆ supplier and product quality
◆ service reliability
◆ delivery time
◆ capability and technical capacity – the ability to offer technical advice, back-up


and support, troubleshooting, servicing, repair, and supply of consumables,
accessories, and spare parts


◆ experience and reputation – have they given good service in the past? Is the
experience of their products good? Are they well represented in your country or
region? What are their references?


◆ formal certification – do they have ISO 9000 certification or other independent
assessment results (see Annex 4)?


◆ formal authorization – have they the authority from the manufacturer to supply
the goods?


◆ financial viability – can they produce copies of their audited accounts?
If properly managed, screening of prospective suppliers and ongoing monitoring,
helps to eliminate substandard suppliers and ensure that only the most reliable
supplier is contracted.


4.4 Identifying suitable suppliers


114




Tip • You should use the same criteria for pre- and post-qualification
• You may have a National Regulatory Authority (Section 2.2) that already screens


suppliers. If not, you should buy only from those suppliers that are known to provide
quality products, because their products have been approved by their own national
regulatory authority (see Annex 4).


• You should keep an up-to-date list of suppliers that express an interest in providing
goods and services.


Pre-Qualification
Pre-qualification means that potential suppliers are formally screened before bids


or quotes are requested from them. This is used for restricted
purchasing processes where suppliers receive direct invitations,
such as restricted tenders and competitive negotiation.


Pre-qualification is not a device intended to reduce competition, instead it is a
process to ensure invitations to bid/quote are extended only to those who have
adequate capabilities and resources.
A sample questionnaire for pre-qualifying suppliers, together with a list of the
characteristics of a good supplier, is provided in Annex 5. Figure 12 provides the
steps to take when pre-qualifying suppliers.


Figure 12: Steps to Take to Pre-Qualify Suppliers


4.4 Identifying suitable suppliers


115


Step Action


Decide when to use
pre-qualification


Invite suppliers to
pre-qualify for bidding


Evaluate suppliers


Carry out reference checks


Preview the goods, if possible


Make a list of the suppliers that
meet your requirements


Decide for which goods or services you want to pre-qualify
suppliers, and how long they will be qualified before revision.


This can be done by advertising, directly contacting interested
companies, or by using an open tender procedure. The notices
to pre-qualify for tenders should be advertised as Specific
Procurement Notices in national newspapers and in the official
gazette (if any), through embassies and trade representatives,
and should also be sent to interested suppliers.


Take into account the specified parameters (see Annex 5).


Speak to past customers and international agencies that have
used them, and gather information locally.


If applicable, request samples or testing of products.


Consider formal registration and/or formal inspection of these
suppliers. (If purchasing using external support agency funds,
you may need to have this list of suppliers approved by the
external funding body).




Once you have drawn up a list of pre-qualified suppliers, you can then issue purchase
documents and ask them to bid/quote.
Establishing such a list can be time consuming. However, in the long run, it speeds
up the time taken to adjudicate bids and award contracts. It also reduces the
workload of the purchaser who would otherwise have to evaluate bids from
unqualified suppliers.
When asking for new quotations and bids, you should always consider new bidders
alongside your list of pre-qualified suppliers, in order to ensure continued
competition. Ideally, you should review your list of pre-qualified suppliers at least
every two years. This enables suppliers who did not pre-qualify the first time to
apply again for pre-qualification at a later stage.
Also, you can threaten poor performing suppliers with being removed from the list of
pre-qualified suppliers unless they improve.


Country Experience
Developing countries can contact agencies such as UNICEF and WHO/EPI who have a list of
qualified suppliers that may be accessed (for example, suppliers of cold chain equipment
such as refrigerators).


Post-Qualification
Post-qualification means that potential suppliers are screened after bids or quotes


have been evaluated. This is used for all open purchasing
processes where invitations have been advertized (such as
open tenders and national competitive bids), and any process
where you have not been able to pre-qualify the suppliers.


In this case, the screening of suppliers does not take place until after bids/quotes
have been received and evaluated (Section 6.3). Then the Procurement/Tender
Committee uses the ‘supplier qualification criteria’ to assess the supplier’s
capabilities, based on forms you have asked the supplier to complete and samples
they have provided. Sample criteria for evaluating past, current, and new suppliers,
and the characteristics of a good supplier are provided in Annex 5.


Tip • You must ensure that the supplier qualification (screening) criteria are specified in
your purchase document (Section 5.5.2), so that suppliers are aware of how they will
be judged.


4.4 Identifying suitable suppliers


116




If there are numerous offers from suppliers there may be long delays in awarding
contracts, as it is necessary to ensure your chosen suppliers can provide quality
products and services. Should long delays occur, it may be necessary to reconfirm
prices, or ask suppliers to re-bid, before finalizing the contract (Section 6.3).


Monitoring
Once selected, the Procurement Unit should also monitor suppliers throughout the
procurement process and throughout their contract term. To do this, you need a
monitoring system in place (Section 9.2). This will be based on the supplier
qualification criteria which was originally used to select suppliers.
The Procurement Unit should maintain a cumulative file for each supplier with
copies of registration documents, references, special correspondence, complaints and
other anecdotal supplier information. This database may also be useful to select
suppliers for coming tenders/quotations.


Disqualification
You should also have a system and criteria in place for disqualifying or barring
suppliers who perform poorly, supply sub-standard products, or do not adhere to
contract terms. Suppliers should not be disqualified permanently. Instead, a register
of barred suppliers should be maintained for an agreed time limit. Re-admittance
will depend on re-inspection.
Note: disqualification or being put on a barred list is not the same as refusal for
pre-qualification. Only the most reputable and reliable suppliers will be pre-qualified.
The other suppliers assessed are not pre-qualified. However, they are not
automatically barred.


4.4 Identifying suitable suppliers


117




Section 4 summary


118


BOX 23: Summary of Issues in Section 4 on How to Decide on the Way to Purchase


Health Service
Providers


Procurement Units


Health Service
Providers or a
higher authority
(such as the
Ministry of Finance)
Procurement Units
(at all levels)
Procurement Units
(at all levels)


Health Service
Providers


Procurement Units
(at all levels)Sc


re
en


in
g





Su
pp


lie
rs



M


et
ho


ds






M


od
el


s


◆ decide what should be procured centrally and what procurement can be
decentralized


◆ decide if group procurement will be used, and who with
◆ decide whether and how to undertake mixed procurement
◆ decide whether to use supply-period contracts
◆ decide whether and when to use procurement agents
◆ procure using the model appropriate to each situation as per the health service


provider organization’s central guidelines
◆ decide the value limits and authority levels for each purchasing method, so that


it is clear when they should be used and by whom
◆ decide where tenders should be undertaken (at central, regional, district, or


facility level), and establish the appropriate Procurement/Tender Committees


◆ follow the health service provider’s rules for each type of purchasing method
(usually found in the Purchasing/Supplies Manual – Section 2.2)


◆ gather information from multiple sources on the different types of suppliers
available, and their characteristics


◆ use the types of supplier required by the external support agency
◆ approach the types of suppliers appropriate to your level


◆ develop ‘supplier qualification criteria’ (see Annex 5)
◆ use both pre- and post-qualification of suppliers (see Annex 5), as appropriate to


the purchasing method (see Box 18)
◆ develop a process for monitoring supplier performance
◆ ensure there is a system for disqualifying poor suppliers
◆ compile a list of suppliers that have expressed an interest
◆ screen the suppliers that you use at your level
◆ feed back information on the performance of suppliers and their products to


groups and authorities that need to know (Section 9.2)


Box 23 contains a summary of the issues covered in this Section.




5 How to prepare for procurement


119


5. HOW TO PREPARE FOR PROCUREMENT
Why is This Important?
There are certain pre-purchase activities that must take place every time you
purchase equipment. These ensure you buy only the equipment you need,
enable you to make efficient use of your skills and time, and ensure you are
prepared, so that all activities go smoothly.
The pre-purchase activities already discussed (Sections 3 and 4) will help you
determine which options to choose for each round of procurement. These
options will then have a knock-on effect on other preparatory activities. For
example, your method of purchasing will determine what purchase
documents you must prepare. Likewise, your chosen model for procurement
will have implications in terms of the personnel involved. Also, the source of
funding will determine the time required


In this Section we look at the pre-purchase activities that must take place each time
you decide to obtain equipment:
◆ Determining the quantities required (Section 5.1).
◆ Deciding whether to use lots (Section 5.2).
◆ Finalizing how to procure (Section 5.3).
◆ Timetabling your procurement (Section 5.4).
◆ Preparing your procurement paperwork (Section 5.5).


5.1 DETERMINING THE QUANTITIES NEEDED
Available Plans


The planning and budgeting activities of your HTM Working
Group (see Guide 2) should have produced the following short-
and long-term plans (ideally covering five or more years):
◆ The Equipment Development Plan showing healthcare


technology needs.
◆ The Equipment Training Plan showing ongoing skill development requirements.
◆ The Core Equipment Expenditure Plan showing expenditure requirements.
◆ The Core Equipment Financing Plan showing the planned funding allocated for


these needs.


Estimate
an approximate judgement
of number, amount, quality,


and character




The annual planning and budgeting process should identify, cost, and prioritize
which activities from these plans, can be afforded and achieved in the coming year
(see Guide 2). Thus, by the date set by your health service provider for finalizing
annual budget estimates, you should have developed the:
◆ Annual Purchase Activities for replacement and new equipment, including the


package of material inputs (stocks of accessories, consumables, spare parts) and
support activities (such as pre-installation, installation, commissioning, and
initial training)


◆ Annual Rehabilitation Activities for major large-scale renovation projects
◆ Annual Corrective Activities for undertaking repairs and PPM, and covering


consumable and administrative inputs
◆ Annual Training Activities for ongoing training and skill development in all


aspects of healthcare technology management
◆ Annual Equipment Budget showing income and expenditure.
However, if you have not yet undertaken these steps, Guide 2 provides a short-cut
planning and budgeting process. As a bare minimum, the HTM Working Group
needs to:
◆ review the equipment inventory and maintenance records to see what equipment


needs replacing
◆ gather requests for urgent needs for replacement and new equipment from Heads


of Department
◆ apply the priorities outlined in your purchasing and replacement policies to


decide what to buy
◆ agree the likely package of inputs and support activities for the equipment to


be purchased
◆ undertake an exercise (see Guide 2) to calculate the realistic usage rates of


consumables, replacement accessories, spare parts, and maintenance materials.
The HTM Working Group submits the requirements to the Health Management
Team, which:
◆ checks available budgets to make sure there are sufficient capital funds to buy the


equipment with its package of inputs and support activities. There must also be
sufficient recurrent funds to buy the existing needs for ongoing recurrent supplies


◆ increases future recurrent budgets, if equipment is bought, to cover the additional
running costs.


5.1 Determining the quantities needed


120




Quantification
During the annual planning and budgeting process (see Guide 2),
different members of staff will finalize the lists of requirements
for the different needs, with cost estimates. These requirements
must be submitted to the Procurement Manager. The members
of staff responsible for quantifying and submitting the actual
requirements are detailed in the rest of this Section.


For procurement purposes, the Procurement Unit needs to list the items they have
to purchase according to the following categories:
a. orders from capital budgets
b. orders from recurrent budgets.
a. Orders from Capital Budgets
Spending financed by capital budgets is different from spending financed by
recurrent or operational budgets, because:
◆ the cost per item (equipment, contract, or project) is usually much greater –


items tend to be high value, one-off purchases, which make up a sizeable portion
of most budgets


◆ other associated needs (supplies, materials, labour) should be purchased at the
same time as the item while the capital funds are available, to ensure the new
item can function


◆ the purchasing procedure is usually more complex.
Thus capital budgets are used for:
◆ equipment
◆ the package of inputs (accessories, stocks of consumables and spare parts, freight


and insurance, and possibly other inputs from the supplier – see below)
◆ pre-installation work
◆ support activities which ensure that you can use the equipment (installation,


commissioning, and initial training – these may be part of the package above if
the supplier is providing them)


◆ major equipment rehabilitation work that is too expensive to be covered by your
usual annual recurrent maintenance allocation.


These requirements are quantified as follows:
Equipment
New and replacement equipment needs will form part of the Annual Purchase
Activities drawn up by the HTM Working Group, who will also determine indicative
prices for the annual cost estimates (see Guide 2).


5.1 Determining the quantities needed


121


Quantify
express as exact measurable


numbers, amounts, sizes,
and types




The sorts of equipment you buy are likely to depend upon the level of health
services you provide. Health facilities are most likely to purchase single items of
equipment (for example, an ultrasound machine, an X-ray machine). Districts and
national health authority levels, on the other hand, purchase multiple items of
equipment to equip or re-equip a number of health facilities.
The package of inputs and support activities required from the supplier
The HTM Working Group decides which elements of the package are to be provided
by the supplier for each type of equipment. This will be determined when annual
cost estimates are prepared, which include indicative prices. However, different
members of staff will need to determine what items you actually need to buy, and
how many. They will then submit these requirements to the Procurement Unit. Box
24 highlights some of the issues you need to consider.


BOX 24: Quantifying the Package of Inputs for Equipment Purchases
Package element Considerations
An initial stock of accessories
to cover your initial stock period
(possibly one or two years)


Heads of User Departments
should calculate the needs


An initial stock of consumables
to cover your initial stock period
(possibly one or two years)


Heads of User Departments
should calculate the needs


5.1 Determining the quantities needed


122


Depending on your knowledge of the equipment, you have two choices:
Either you ask in your specification (Section 5.5.2) for the supplier
to submit an offer and price for the types and quantities of
accessories that he thinks you need for your initial stock period.
Or, you consider how you want to use the equipment, and use the
procedures in Guide 4 to decide:
◆ the different types of accessories to get (for different modes of


operation of the equipment, different applications, different size
patients or samples, whether re-usable or disposable, and all
associated connecting parts)


◆ the quantities required to make up a ‘basic set’ for each piece of
equipment (for example, although you only use one monopolar
diathermy electrode at a time, you may need to own a basic set of
three monopolar electrodes – one in use, one being cleaned, one
as a spare)


◆ the multiples of the basic set required for the initial stock period
(depending on the lifetime of the accessory, and the numbers of
the same piece of equipment being purchased).


Depending on your knowledge of the equipment, you have two choices:
Either you ask in your specification (Section 5.5.2) for the supplier
to submit an offer and price for the types and quantities of
consumables that he thinks you need for your initial stock period.
Or, you consider how you want to use the equipment, and use the
procedures in Guide 4 to decide:
◆ the likely consumption rate of each consumable at your health facility
◆ available pack sizes
◆ typical shelf lives
◆ the quantities required to cover your initial stock period
◆ multiples to cover the numbers of the same piece of equipment


being purchased
Continued opposite




BOX 24: Quantifying the Package of Inputs for Equipment Purchases (continued)
Package element Considerations
An initial stock of spare parts
to cover your initial stock period
(possibly one or two years)
The HTM Manager should
calculate the needs


Freighting and insurance
The HTM Working Group
should identify the needs
Installation, commissioning,
and initial training
The HTM Working Group should
determine who does this


Pre-installation work
The requirements will be determined when specific annual cost estimates are
prepared, and amended if necessary once the final equipment choice is known
(Section 6.4), as shown in Box 25.


BOX 25: Quantifying the Purchase Requirements for Pre-Installation Work
Requirements Activity
Site preparation tasks
The HTM Manager should
calculate the needs


Lifting equipment
The HTM Working Group
(or Commissioning Team)
should calculate the needs


5.1 Determining the quantities needed


123


Depending on your experience with maintaining the equipment, you
have two choices:
Either you ask in your specification (Section 5.5.2) for the supplier
to submit an offer and price for the types and quantities of spare parts
that he thinks you need for your initial stock period, for both planned
preventive maintenance and likely breakdowns.
Or, you use your experience and the procedures in Guide 5 to decide:
◆ the different parts to get for unpredictable work, such as repairs,


by considering the life of the part, how many machines you need
that part for, and at what service level the parts will be stored


◆ the different parts to get for planned preventive maintenance, by
considering the rate of use of the part, how many machines the part
is required for, and at which service level the parts will be stored


You list your particular requirements in your purchase document
(Section 5.5.2) so that the supplier can offer a price.


If you are asking the supplier to provide these support activities, you
list them in the specification (Section 5.5.2) so that the supplier can
offer a price.


Continued overleaf


Use the procedures in Guide 2 to:
◆ plan the work
◆ draw up bills of quantities for the materials required
◆ identify needs for contracts
◆ determine indicative prices
Use the procedures in from Guide 2 to:
◆ identify the need for hiring of lifting equipment
◆ identify available sources and costs
◆ determine indicative prices




BOX 25: Quantifying the Purchase Requirements for Pre-Installation Work (continued)
Requirements Activity
Warehousing
The HTM Working Group
(or Commissioning Team)
should calculate the needs


Support activities, if undertaken in-house
The HTM Working Group will identify whether there are elements of the package
you can provide yourselves. The requirements will be determined when specific
annual cost estimates are prepared, and amended if necessary once the final
equipment choice is known (Section 6.4), as shown in Box 26.


BOX 26: Quantifying the Purchase Requirements for In-House Support Activities
Requirements Activity
Installation and commissioning
undertaken in-house
The HTM Manager should
calculate the needs


Initial training undertaken
in-house
The HTM Working Group
(or its training sub-group)
should calculate the needs


Major equipment rehabilitation work
The annual planning and budgeting process will identify the major equipment
rehabilitation tasks which cannot be funded using recurrent budgets. The
requirements will be determined when specific annual cost estimates are prepared,
as shown in Box 27.


5.1 Determining the quantities needed


124


Use the procedures in Guide 2 to:
◆ identify the need for warehousing of equipment
◆ identify available sources and costs
◆ determine indicative prices


Use the procedures in Guide 2 to:
◆ plan the work
◆ draw up bills of quantities for the materials required (cables,


piping, connectors) and the supplies required (consumables
needed during commissioning)


◆ identify needs for contracts (extra labour, or the whole job)
◆ determine indicative prices
Use the procedures in Guide 2 to:
◆ plan the work
◆ identify training materials required (photocopying of handouts,


paper) and the supplies required (consumables needed
during training)


◆ identify needs for contracts (trainers, room hire, accommodation)
◆ identify needs for equipment hire (overhead projectors, for example)
◆ determine indicative prices




BOX 27: Quantifying the Purchase Requirements for Major Equipment Rehabilitation Work
Requirements Activity
Major equipment
rehabilitation work
The HTM Manager should
calculate the needs


Tip • The Procurement Unit is responsible for compiling the list for procurement. This is
carried out by combining the lists and requests submitted by different departments
and/or facilities, and linking them to the annual action plans.


• Manufacturers’ manuals, their local agents, and suppliers can often provide useful
information about the items required and the likely consumption rates. This can
help you to calculate the quantities required and associated costs.
b. Orders from Recurrent Budgets
Spending financed by recurrent or operational budgets is different from spending
financed by capital budgets, because:
◆ the cost per item (supplies, utilities, contracts) is usually less – items tend to be


low value individually, and are bought in small volumes
◆ but the items are constantly being replaced at regular intervals, so cumulatively


make up an important portion of most budgets
◆ the purchasing procedure is usually better understood, as it is undertaken routinely.


5.1 Determining the quantities needed


125


Use the procedures in Guide 2 to:
◆ plan the work
◆ draw up bills of quantities for the materials required
◆ identify needs for contracts
◆ determine indicative prices




Thus recurrent budgets are used for:
◆ replacement accessories
◆ regular supplies of consumables
◆ regular supplies of spare parts
◆ regular supplies of maintenance materials
◆ contracts
◆ administrative inputs for equipment and maintenance management
◆ inputs for ongoing training.
Unfortunately these needs usually get lost among all the general and medical supply
requirements (food, stationery, bandages, drugs, etc). To keep your existing
equipment in working order, you need to quantify accurately throughout each year
the various equipment-related supplies you need to purchase. This can be difficult,
and facilities often run out of stocks, unless:
◆ you have undertaken a special exercise to determine realistic needs, rather than


simply ordering what you bought last time which may not have been enough.
Guide 2 provides advice on how to do this.


◆ you have made equipment-related supplies ‘stockable’ items in your stores system
(Section 8.4 and Guides 4 and 5)


◆ you have a good stock control system (Section 8.4 and Guides 4 and 5).
Recurrent supplies estimates will form part of the Annual Corrective Activities and
the Annual Training Activities drawn up by the HTM Working Group, who will also
determine indicative prices for the annual cost estimates (see Guide 2).
However, to quantify the actual needs, different members of staff should consider
the issues presented in Box 28.


5.1 Determining the quantities needed


126




BOX 28: Quantifying Ongoing Requirements for Recurrent Supplies
Package element Considerations
Stocks of consumables
and replacement
accessories
The Stores Controller and
Heads of User Departments
should calculate the needs


Stocks of spare parts and
maintenance materials
The Stores Controller and the
HTM Manager should calculate
the needs


Maintenance contracts
The HTM Manager should
calculate the needs


5.1 Determining the quantities needed


127


Depending on your stores system, you have two choices:
If these items are ‘stockable’ in the stores system and you have a good
stock control system, the Stores Controller:
◆ uses stock control cards to calculate the order quantity (by


multiplying the average monthly consumption by the time
between orders), using the procedures in Guide 4


◆ consults Heads of Department for new additional needs
(see Box 24).


If these items are ‘non-stockable’ in the stores system, Heads of
Department use their knowledge of the equipment and the
procedures in Guide 2 to calculate the needs, using as guides:
◆ experience of typical requirements for expected workloads
◆ new requirements for items being brought back into working


condition (see major rehabilitation work and maintenance plans)
◆ additional requirements for planned new purchases
◆ user PPM schedules and timetables
◆ an allowance for emergencies.
Depending on your stores system, you have two choices:
If these items are ‘stockable’ in the stores system and you have a good
stock control system, the Stores Controller:
◆ uses stock control cards to calculate the order quantity (by


multiplying the average monthly consumption by the time
between orders), using the procedures in Guide 5


◆ consults the HTM Manager for new additional needs (see Box 24).
If these items are ‘non-stockable’ in the stores system, the HTM
Manager uses their knowledge of the equipment and the procedures
in Guide 2 to calculate the needs, using as guides:
◆ experience of typical requirements for likely breakdowns, planned


remedial work, and PPM schedules and timetables
◆ additional requirements for planned new purchases
◆ replacement of tools
◆ an allowance for emergencies.
Use the procedures in Guide 2 to calculate the needs, using as guides:
◆ a review of the previous year’s contracts
◆ experience of typical requirements for likely breakdowns, planned


remedial work, and PPM schedules and timetables
◆ additional requirements for planned new purchases
◆ calibration of tools.


Continued overleaf




5.1 Determining the quantities needed


128


BOX 28: Quantifying Ongoing Requirements for Recurrent Supplies (continued)
Package element Considerations
Administrative inputs
Heads of Department and
the HTM Manager should
calculate the needs


Training inputs
The HTM Working Group
(or training sub-group)
should calculate the needs


Use the procedures in Guide 2 to calculate the needs for:
◆ stationery, forms, records
◆ literature, written resources, subscriptions
◆ utilities
◆ fuel allocations
◆ protective clothing
◆ any leasing (rental) charges (Section 5.3).
Use the procedures in Guide 2 to:
◆ review the Equipment Training Plan
◆ identify training materials required (photocopying of handouts,


paper) and the supplies required (consumables needed
during training)


◆ identify needs for contracts (trainers, room hire, accommodation)
◆ identify needs for equipment hire (overhead projectors,


for example)
◆ determine indicative prices


Tip • Maintaining accurate and up-to-date stock records will help you to determine how
many recurrent items to stock.


• The Procurement Unit is responsible for comparing the list of requests with past
consumption, and clarifying any ‘out of the ordinary’ trends directly with the various
departments and Stores Controller.


• The procedures for drawing up maintenance contracts are provided in Guide 5 on
maintenance management.


Prioritization
With so many purchase requirements it is often necessary to prioritize needs to suit
the funds available. Guide 2 provides advice on prioritizing needs during the annual
planning and budgeting process, and Guide 5 provides advice on prioritizing
maintenance work. The method suggested is the VEN (VED) system in which
items are categorized as:
◆ Vital – items that are crucial for providing basic health services and should be


kept functioning at all times.
◆ Essential – items that are important but are not absolutely crucial for providing


basic health services. In other words, a period when they are out of operation can
be tolerated.


◆ Not so essential/desirable – items that are not absolutely crucial for providing
basic health services. In other words, it is possible to adapt and plan around their
absence if they are out of operation.




If funds are limited, actions involving vital items should be given first priority,
followed by those involving essential items. Items that are not so essential/desirable
are given the lowest priority.
The task of prioritizing the requirement belongs to the relevant departments and
the Health Management Team. It is not the job of the Procurement Unit.


Contingencies
Procurement should be carried out at all times according to your established plans.
However, occasionally departments may require additional equipment and
equipment-related supplies which were not in the original plans. This could be due
to any of the following:
◆ Emergency unforeseen needs (requiring additional equipment, or training).
◆ Crisis breakdowns of serviceable equipment (requiring additional spare parts,


maintenance materials, and contracts).
◆ Unexpected surges in workload, outbreaks and epidemics (requiring additional


consumables and replacement accessories, and administrative inputs).
In these cases the relevant Head of Department/HTM Manager submits their needs
to the HTM Working Group for consideration (see Guide 2). If approved, and the
Health Management Team can allocate a budget, then the Procurement Unit can
purchase the necessary items.


5.2 USING LOTS
Having identified what you need to procure, you can consider whether it is worth
combining any of the requirements into lots (sets) to ease the procurement
administration process.
Combining similar or related equipment items into lots for the purpose of purchasing
them can provide you with substantial savings, by:
◆ reducing the timescale of the procurement and delivery processes
◆ achieving economies of scale
◆ attracting a larger number of bidders – ranging from suppliers bidding for a single


lot or a small number of lots, to those able to supply all the lots.


5.1 Determining the quantities needed


129




Some items are easy to group since they are well defined. Examples include office
furnishings (furniture and fixtures), medical furnishings, surgical instruments,
electrical supply equipment, plumbing fixtures, kitchen equipment and laundry
equipment. Medical equipment is harder to group, as the term covers a much wider
variety of items. Some examples of possible groupings that can be used are:


critical care equipment ward equipment
imaging equipment dental equipment
laboratory equipment eye equipment


The steps you should take to group equipment into lots are provided in Figure 13.


Figure 13: Steps to Take When Preparing Lots


5.2 Using lots


130


Step Activity


Discover any constraints


Prepare lists of equipment


Group the equipment


Choose a suitable purchasing
method


Choose a suitable funding
organization


Choose a suitable purchasing
timetable


Before grouping, check whether the items are needed at more or
less the same time, or whether there are long gaps between the
desired delivery times.


Compile the list of equipment to be purchased (Section 5.1),
and use it as the basis for deciding how items should be
combined or divided into packages (see below).


Carry out the following steps:
i. Make a technological assessment
ii. Group the equipment according to its level of technical
sophistication.
By doing this, you will be able to form multiple lots of items
requiring similar levels of technical support (such as installation
and maintenance).


Depending on the content of each lot, you can decide which
purchasing method is the most suitable (Section 4.2).


Some funding organizations have restrictions on the kinds of
contracts that can be financed.


Work out a timetable for procurement (Section 5.4) that suits
the majority of the recipients of the goods in the lots.


Prepare appropriate bid/tender
documents


In the bid/tender documents, each lot must have a special
conditions page where specific requirements are detailed
(Section 5.5.2) so that they can be weighed in the evaluation,
for example:
• the quality of stainless steel for surgical instruments must be
higher than the quality required for office furniture
• each lot may need to be split and packed ready for delivery to
several different sites
• some items in a lot may require installation while others don’t.




Experience in Uganda
In Uganda, the Ministry of Health observed that the grouping of similar equipment into
specific lots has generated a wider response of eligible tender bids, thus increasing
competition and the chance of better prices.


5.3 FINALIZING HOW TO PROCURE
At this stage in the pre-purchase activities, you are able to make decisions that will
finalize how you are going to procure. Such decisions must be taken each time you
procure equipment. We have already discussed all the different options, in Sections
3 and 4, so here we will simply describe the steps that are usually taken. (Please note
that many of these steps are inter-linked, so they may occur in a different order.)
First of all, you will have determined:
◆ the type and quantities of equipment and equipment-related supplies required


(Section 5.1)
◆ the lots to use (Section 5.2).
This will provide you with information that can help you make your next choices:
◆ The type of items to be procured and the size of the order will determine the


most appropriate procurement model to employ (central, group, decentralized,
mixed, using a procurement agent – Section 4.1).


◆ The financial limits and authority levels for such orders will determine the
purchasing method (open tender, restricted tender, a quotation-based method,
direct ordering – Section 4.2).


◆ The purchasing method will determine whether you must identify potential
suppliers, and possibly pre-qualify them if you have not already done so
(Section 4.4).


You can refer to the Core Equipment Financing Plan to identify the funds available
and likely funding sources (government, self, external support agency – Section 3.3),
and make decisions on:
◆ how to use government funds and your own funds
◆ the external support agencies to approach for funds that would be most


appropriate for the type of goods/lots, value of order, and likely purchasing method
◆ which items cannot be financed and which external support agencies to ask for


donations of equipment
◆ whether recurrent funds can be used to lease the equipment rather than


purchasing it from the capital budget (Section 3.3).


5.3 Finalizing how to procure


131




You will then need to procure the goods according to the rules for each of the
different ways of obtaining equipment:
◆ National rules for government funds.
◆ Own health service provider’s rules for own funds.
◆ External support agency rules for external funds.
◆ Negotiations for donations.
◆ Commercial terms for leasing.
The next step is to decide when the procurement of these goods can occur
(Section 5.4).


5.4 TIMETABLING YOUR PROCUREMENT
In previous sections, we have considered how to determine what items you require,
and looked at various methods for procuring them. You will now need to go on to
consider your procurement timetable. There are various options open to you.
Equipment and supplies may be procured on an irregular basis, or according to a
planned and fixed timetable (schedule). For instance, you may decide to make a one-
off purchase of an ultrasound machine because funds have become available.
Alternatively, you could add it to your planned and scheduled orders and buy it at the
same time as your other purchases.
Box 29 provides a brief description of common procurement timetables, and
procurement is often achieved through a combination of these.


Tip • Most procurement takes place through a combination of procurement timetables for
different categories of products.


The frequency with which items are ordered often depends upon:
◆ what you are purchasing
◆ whether this is a one-off or routine and recurrent purchase
◆ whether you are purchasing a low or high volume of items
◆ the supply system
◆ procurement procedures (this is dictated by who is financing the purchase)
◆ value of goods (this often dictates how often you buy and from whom)
◆ whether the supply source is local or international
◆ geography
◆ storage capacity
◆ administrative costs
◆ health situation (such as seasonal variations, epidemics).


5.4 Timetabling your procurement


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BOX 29: Common Procurement Timetables
Timing Description
Annual procurement This consists of one time per year when orders should be placed for all items.


Once the annual quantification exercise has been carried out, the entire annual
amount (or as much as can be afforded) is procured using the appropriate
purchasing method (Section 4.4), leasing, or requesting donations. There
should also be mechanisms for making small supplementary procurements if
needed, during the year. Ideally tenders/quotations should be advertized at the
beginning of each financial year to minimize the chance of running out of stocks
of equipment and supplies.


Scheduled procurement This consists of periodic orders at set times during the year, such as monthly,
quarterly, biannually. Orders are placed at the scheduled order dates for
quantities large enough to cover average needs until the next order is scheduled
(this includes stock needed during the lead time for that order, plus
replenishment of stock).


Perpetual procurement This consists of orders being placed as and when you need them, for example,
whenever stock falls below a certain set level.


Single project procurement This is often used when the procurement of healthcare technology is part of a
larger project which is separately funded – for example, the construction of a
new health facility.


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133


For example:
◆ A central store might purchase most items on a yearly basis.
◆ Zonal stores (regional, diocesan, district) might order from the central store on


a fixed re-supply interval, such as quarterly.
◆ Health facilities might order most items monthly from the regional or district


stores, or less frequently, depending on their situation. For instance, an isolated
rural hospital which is hard to reach may decide to order less frequently than an
urban hospital which is closer to the store.


Tip • Ordering the correct quantities on time avoids difficulties such as shortages, the
need for emergency supplies, and being forced to accept inappropriate equipment at
short notice. Overstocking is costly, and you should regularly review the quantities
you require. (See Guides 4 and 5 for advice on stock control).


• In order to retain stock levels and receive items on time, you will need to plan for
the long-term, particularly when procuring items from abroad.


For time-critical procurement, you should timetable your procurement process
carefully. It is often a good idea to start with the date that you want the equipment
to be ready for use. From there you can work backwards, and deduct the time for
ordering and all other parts of the procurement process (Sections 6, 7 and 8). An
example is shown in Box 30.




BOX 30: An Example of Planning Time-Critical Procurement
A new specialist gynaecologist is expected to arrive for a new health facility,
and it has been agreed that she should be equipped with an ultrasound
machine. The machine needs to be commissioned and ready for use when
she arrives. However, working backwards through the tasks we can see that:
◆ acceptance testing and commissioning 1 week
◆ local transport 1 week
◆ overseas shipping and customs clearance 3 weeks
◆ finalizing the contract and supplier filling the order 6 weeks
◆ evaluation of bids 2 weeks
◆ bidding process 5 weeks
◆ preparation of the bidding documents 3 weeks
◆ approval of funds for the ultrasound machine 3 weeks


Total 24
As a result, you have to be prepared to start the procurement work six months before the gynaecologist takes
up her new post.


Whenever you procure, you should prepare a procurement plan that indicates the
different procurement activities that you must carry out, with a timetable of when
they should take place. This should include activities such as:
◆ when procurement paperwork should be prepared (Section 5.5)
◆ when pre-qualification documents should be issued (Section 4.4)
◆ when procurement notices will be advertized (Section 6.1)
◆ when purchase documents will be issued to suppliers (Section 6.1)
◆ when and where the public opening and evaluation of bids will take place


(Section 6.2).


5.5 PREPARING YOUR PROCUREMENT PAPERWORK
The paperwork you need to prepare will vary, depending on your choice of
procurement method. For example:
◆ If you have decided to lease equipment – you will need to complete the


commercial leasing forms, contract, and other paperwork of the company concerned.
◆ If you have decided to request donations of equipment – you will need to


complete your donation request form (see Annex 6) and any subsequent
paperwork from the external support agency, such as a donation agreement. To
assist the donation of appropriate goods, it will be advantageous to also prepare an
equipment specification, technical and environmental data sheet, and any
delivery requirements you have (Section 5.5.2).


◆ If you have decided to purchase equipment – you will need to follow the
instructions in the remainder of this Section.


5.4 Timetabling your procurement


134




Whatever purchase method you choose, it is important that you prepare and use
appropriate paperwork for the purchase process. This is usually in two parts:
◆ the invitation to bid/quote (also known as the invitation to tender/quote, or


tender/quote notice), and
◆ the purchase document (also known as the purchase request document, tender


document, bidding document, request for tenders/quotations, Purchase Order).
Depending on the purchase method you choose (Section 4.2), this paperwork can
be comprehensive in design and detail (for tenders) or simpler (for quotations).
Preparing the purchase paperwork requires a significant investment of time and
resources. You will need to consult with a wide range of staff from different
disciplines, including: health workers, technical personnel, administrators and
financial officers. Depending on the equipment being purchased, you may also need
to consult builders and architects.
Standardizing the layout and common information to be contained in your purchase
paperwork helps ensure a uniform approach and, in the long run, makes the purchase
process much easier.


Tip • If you need assistance with preparing purchase paperwork, you should seek advice
from the appropriate national authorities and other institutions that frequently
purchase equipment.


• Make sure all purchase paperwork uses clear and unambiguous descriptions and
instructions. The quality and evaluation of bids/quotes depends to a large extent on
the quality of your paperwork. Be aware that ambiguous terms or poor specifications
can lead to problems later on.


5.5.1 The Invitation to Bid
The invitation to bid should outline the tender/quotation
requirements. This should be kept brief – remember it may
have to appear as an advertizement in a newspaper. The
Procurement Unit should include information that describes:
◆ the nature of the purchase (what goods or services are


required, for what purpose, etc)
◆ the purchasing group that is asking for offers


◆ the procedures to be used for the purchase (whether a tender or one of the
quotation-based methods, possibly the timetable for the purchase process and the
evaluation method, etc)


5.5 Preparing your procurement paperwork


135


Invitation to bid
a notice to prospective


suppliers that the buyer wants
to purchase goods, used


to advertize the tender/request
for quotations.




◆ conditions under which bids/quotes will be accepted (received on time, including
all necessary information, all formalities are met, etc)


◆ how the purchase document (bidding document) can be obtained
◆ the charge for the purchase document, if applicable. Note: a charge is sometimes


applied, in order to discourage time-wasters and to cover costs
◆ address for submission
◆ closing date for bids/quotes
◆ details of other dates covered by the purchase process (date of opening of


bids/quotes, validity period of prices/offer, etc).
Depending on the purchase method used (see Box 18 in Section 4.2), such
purchase notices are:
◆ either advertized in:


- official gazettes
- technical magazines
- national and international newspapers
- trade publications
- embassies


◆ or they are sent directly to the prospective suppliers.


Tip • If a fee is to be charged for the purchase document (bidding document), it must be
reasonable and reflect only the cost of printing and delivery to prospective bidders. It
should not be so high as to discourage qualified bidders.


The invitation for a quotation should always be in writing. It should be submitted to
at least three suppliers. These should be either pre-qualified or be suppliers who
have already expressed an interest.


5.5.2 The Purchase Document – Summary
For the simplest purchasing methods (direct orders, obtaining
quotes from three suppliers in your local town), you could use a
standard pre-printed Purchase Order form (see Annex 11 for an
example). However, you would have to:
◆ state clearly that it was a request for a quote rather than an


actual order
◆ attach sufficient additional information to encourage appropriate offers, such as the


specification, details of the supply requirements, relevant drawings, etc. Details of
what information to include are outlined in the remainder of this Section.


5.5.1 The invitation to bid


136


Purchase document
where the buyer clearly states


everything that they wish to
purchase, and the terms of


the purchase.




Tip • The information you provide must be sufficient to ensure you receive quotes from a
number of suppliers, which are comparable in quality and cost.
However, for more complex purchasing methods, including tenders and most
quotation-based methods:
◆ the Purchase Order is only used once the bidding and negotiating is over and you


are placing your order (Section 6.4), and
◆ the actual purchase document usually consists of a whole series of forms and


guidelines collected together.
The detail and content of purchase documents may vary, depending on the size and
nature of the order. However, they generally include similar contents. The documents
for quotations are likely to be less detailed and rigid than those for tenders.
Purchase documents need to provide:
◆ item information that describes all the things you want to purchase, set out in


some form of schedule of requirements, and
◆ order information that provides instructions to bidders on the terms and


conditions for supplying the goods.
As long as all pertinent details appear somewhere, there is no set rule for what you
provide under the item information and what you provide under the order
information. In this Guide, the phrase ‘item information’ is used to refer to all
paperwork that requires a technical input from the end-users and maintenance staff.
The phrase ‘order information’ is used to cover data that staff regularly involved in
procurement will know.


Tip • Ensure all likely requirements for the goods or services are identified and included in
this preparatory process.


Some information may apply to all items in the order (for example, language
requirement or technology requirement may be generic for the whole country).
Some information may apply to different parts of an order (for example, delivery to
different health facility sites). More specific details may be relevant to one item only
(for example, packaging and transport for refrigerated supplies).
The Procurement Unit must gather together the information from various sources
and responsible bodies, and these are noted through the rest of this Section.


5.5.2 The purchase document – summary


137




5.5.3 The Purchase Document – Part One: Item Information
The item information includes:
a. the equipment specification and quantities required
b. technical and environmental data
c. special conditions page
d. summary price schedule for the offer.
The Procurement Unit should obtain this information from the HTM Working
Group (or its smaller Specification Writing Group).


a. Equipment Specification and Quantities
In your purchase document, you need to provide a clear generic specification, including:
◆ a detailed description of the equipment
◆ the ‘package of inputs’ needed to keep the equipment going through its


lifetime (including delivery, installation, initial training, consumables, and
aftersales support)


◆ the quantities required.
The specification is the most important document, both for the purchaser and for
the potential supplier, since it sets out precisely what characteristics are required of
the products or services sought.


5.5.3 The purchase document – part one: item information


138


Did you know?
Many countries suffer from using poor equipment specifications. Common mistakes include:
◆ the product description is too short, providing insufficient details of what is required. For


example, a specification which says: ‘Please supply one autoclave’ is useless. It gives no
details at all about the type of unit, what needs to be autoclaved, its size, or how it will be
powered (by electricity or kerosene). Many different sorts of autoclaves could be supplied,
most of which would be unsuitable.


◆ the product description is too rigid. If the description provided is not general enough, this can
be very limiting. For example, a specification which states: ‘Please supply one X-ray machine
such as a Siemens model Unistat 11’ is so specific that most suppliers (other than Siemens)
cannot help. The only exception to this rule would be if you actually wanted to buy a particular
make and model of machine (for example, if you have standardized to it – see Box 32).


◆ the product description reduces your options, by providing a description of a type of
equipment rather than the function you require. For example, a specification which states:
‘Please supply one peristaltic pump for diffusion’ means that all you will be offered is
peristaltic pumps. If instead you say you want to undertake infusion with the best available
pump, you widen the choice of different available pumps that suppliers can offer.




The HTM Working Group (or a smaller Specification Writing Group) is responsible
for developing a library of generic specifications. Such specifications are based on the
functions you want the equipment to perform, not brand names. Guide 2 on
planning and budgeting describes how to develop such a library, using a consultation
process with relevant equipment users and maintainers.
Box 31 describes the sorts of information that you should include in your specification.


5.5.3 The purchase document – part one: item information


139


◆ Describe what the equipment should be used for.
◆ Describe what the equipment should do – its purpose, scope, function and


capabilities (that is, the output required).
◆ Describe the design and features you want, taking into account factors such as


performance to be achieved, and technical characteristics as follows:
- operational requirements
- versatility of the equipment
- safety requirements (in other words, the manufacturing standards equipment should


comply with). Where you cannot provide a standard, specify that the equipment
should match the authoritative standards appropriate to the country of origin (for
example, DIN – German Industrial Norms, BS – British Standard, or others – see
Annex 4)


- quality expected
- durability
- energy saving features
- physical characteristics (for example, construction/material requirements, colour


and finish, unit or pack size, power-type, whether or not it is portable).
◆ Describe what preferences you have when there are alternatives (for example,


whether you want wheels, handles, a drying cycle, extra facilities, whether it must
be made of plastic).


◆ Include any restrictions on country of origin.
◆ Include the expected performance or output, but do not necessarily define how


this should be achieved.
◆ Try to use common titles for equipment types that are widely understood by


various countries. For example, the United States uses a United Medical Devices
Nomenclature System (UMDNS). Other manufacturing countries have developed
their own systems, and the European Commission is trying to combine these as a
Global Medical Devices Nomenclature (see Annex 2).


◆ If the goods you are purchasing are not whole pieces of equipment, but are simply
accessories, consumables, and spare parts for existing equipment, you must provide
technical details of each item. You must also specify the make, model and year of
manufacturer of the equipment that they are used with (see Guides 4 and 5).


BOX 31: Contents of a Typical Equipment Specification
Element Examples
Description of
the equipment,
and quantities


Continued overleaf




5.5.3 The purchase document – part one: item information


140


The package of inputs may include any or all of the following:
◆ Accessories (for example, shelves, mains lead, patient cables, hand-pieces). Outline


all the accessories you need to last a specified length of time (at least two years),
together with sizes, types and quantities. Usually, it will be necessary to purchase at
least three sets of accessories – one in use, one being cleaned, one as spare.


◆ Consumables (for example, electrodes, breathing circuits, gel). You will require a
stock to last a specified period of time (at least two years), although you should also
take into account expiry dates and short-life items. You must detail the exact type
and number of consumables. (It may be advisable to make them conform to the
types and sources of existing supplies, so that existing stocks can be rationalized.)
Remember that, while some equipment uses standard supplies, other equipment
requires specific supplies and you will need to order accordingly.


◆ Spare parts (for example, bottles, switches, o-rings, gaskets). You will require a
stock to last a specified period of time (at least two years). You must detail your
requirements for both planned preventive maintenance and typical repairs. This
should be based on your experience, knowledge of the technology, and the
manufacturer’s recommended list.


◆ Manuals – you will require both Operator and Service Manuals including circuit
diagrams. It is advisable to obtain two copies of each.


◆ Warranty – you must specify that the guarantee should last for at least 12 months
from delivery or the end of commissioning, not 12 months from the shipping date
(since if the goods spend six months getting to you, you will have lost half the
guarantee period). If the equipment is not going to be used for some time after
delivery, special arrangements must be made with the supplier to re-define the
warranty period (Section 5.5.4).


◆ Delivery – you must specify the freighting arrangements, by air, sea, or road. Also
include details for the packing and crating for freight, the destination, and the
delivery date or delivery period (number of weeks). Try to use common Incoterms
(for trade transportations). These can be found on the internet (world wide web)
with good explanations, and should be checked before use as they are occasionally
updated (Section 5.5.4).


◆ Insurance – you must specify whether you want the goods to be insured during the
delivery period. Some countries require all imports to be insured locally. Make sure
you specify any rules that apply (Section 5.5.4).


◆ After-sales support (the supplier’s general capacity to deliver technical and
commercial know-how after delivery) – specify whether you require this to be
available locally, and outline the sort of support required. In addition, ask for a price
for a maintenance contract (for reference, in case it is needed).


BOX 31: Contents of a Typical Equipment Specification (continued)
Element Examples
Package of inputs
required. This
must cover
everything else
you need to use
the equipment
over its entire
lifetime.


Continued opposite




5.5.3 The purchase document – part one: item information


141


◆ Site preparation details – you must ask for the technical instructions and details
from the suppliers so that you can plan for this work, either in-house or by
contracting out.


◆ Installation – you must ask for help with this if it is required.
◆ Commissioning – you must ask for help with this if it is required.
◆ Acceptance – you must clearly detail the responsibility of both the purchaser and


supplier with respect to testing and/or acceptance of the goods.
◆ Training of both users and technicians – you must ask for help with this if it is


required, and for written training resources.
◆ Maintenance contract (an important part of aftersales support) – you must ask


for one of these if it is required (see Guide 5). It will be necessary to agree and
stipulate the duration and whether it should extend beyond the warranty period,
the cost and whether it includes the price of labour and spare parts, and the
responsibilities of the owner and supplier.


BOX 31: Contents of a Typical Equipment Specification (continued)
Element Examples
For some
equipment, such
as sophisticated
or imported items,
or equipment
which is new to
you, you may also
need to specify
the following
item lines:


The layout of the equipment specification is important, since details must be clear
for the bidding suppliers. The easiest method is to lay it out like a form, with details
of your requirements on one side of the page and the response from the supplier on
the other. On one side, you write down your schedule of requirements. This
includes a concise description of each element of the order, with the quantities
required and the technical specification unique to that element. On the other side,
sufficient space should be provided so that the supplier can enter all relevant
information (such as model type, unit size, and price) against each element. This
layout makes it easy to compare the supplier’s reply (their offer) with your
requirements (your specification), and is useful when you are evaluating bids
(Section 6.3).


Tip • When listing the package of inputs, it is important that you do not simply ask the
supplier to state whether or not they can supply the various services listed. If so, you
may just receive a ‘yes’ or ‘no’ answer. Instead, you must specify that they should
provide a quote for each of the services listed. This way, when it comes to awarding
the contract, you can decide whether to omit certain services if they are too costly.


The length of the specification will vary, depending on the item being purchased.
For a simple item the specification may be a brief description. For a more complex
item it may run to several pages. An example of a layout for a long specification is
shown in Annex 7. Another is provided in Guide 2 on planning and budgeting.




Your technical specifications need to be revised and updated periodically (Section 9.2),
in response to:
◆ feedback from users and maintainers
◆ changes in technology
◆ arrival of new products and applications on the market.
Properly written generic equipment specifications enable you to conform to the
standards set by government, and to continue to meet the standardization policy of
your health service provider (Section 2.1). Box 32 describes how you can use
generic specifications and still introduce an element of standardization into your
stock of healthcare technology.


BOX 32: Standardization and Specifications
If standardization is in place, you need to procure particular or named makes and models of equipment.
However, this can present difficulties with international funding institutions (such as the World Bank) and
other government aid agencies, since their guidelines dictate that purchase by tenders must use generic
descriptions of equipment.
The following methods will help you to achieve a better balance between international and national
procurement rules and your standardization policy:
◆ Standardization to a level of technology. This type of standardization can be achieved by writing clear


generic specifications which safeguard the standardization of equipment at a certain level of technology.
These specifications should describe the suitability of equipment, and reflect the skill levels of user and
maintenance personnel.


◆ Standardization on makes, and economical viable quantities. Procuring and stocking recurrent
supplies for single items of equipment is often prohibitively expensive. Therefore, it makes sense, where
possible, to try to obtain significant quantities of the same make and model for certain equipment. This is
more economical when it comes to buying and stocking spare parts and consumables. It also enables you
to share things such as maintenance and training. This, in turn, leads to a greater retention of relevant
technical knowledge among your staff, which can result in considerable savings. This type of
standardization can be achieved in the following ways:
- by quantifying and ordering equipment using a model for procurement on either a country- or district-


wide basis (Section 4.1)
- by using supply-period contracts that allow the winning bidder to supply goods over a set number of


years (Sections 4.1 and 6.4)
- alternatively, using a tender process to select the competitive make and model to purchase. For


subsequent purchases, sticking to that brand by using direct ordering or quotations (if there is more than
one supplier of the goods), until such time as you wish to review the marketplace.


5.5.3 The purchase document – part one: item information


142




b. Technical and Environmental Information
As well as providing details of the types of equipment and support services required,
your purchase document also needs to include technical and environmental data that
describe your domestic preferences. Such data describes the types of environment and
surroundings in which the equipment will be used. This enables the supplier to offer
the most suitable product for your needs, and suggest technical solutions if required.
For example, a supplier might offer:
◆ a voltage stabilizer or uninterruptible power supply, if you have an unstable


power supply
◆ to adjust motors and pressure vessels to operate correctly, if you are at a great


height above sea-level
◆ an air-conditioning unit, if your health facility reaches very high temperatures
◆ silica gel to store with supplies and polymerized coatings for printed circuit


boards, if you suffer from high humidity
◆ extra filters, if your environment is dusty .
You may include this information within the generic equipment specification.
However, since much of the information is common to many pieces of equipment,
some health service providers have found it simpler to develop a separate summary
‘Technical and Environmental Data Sheet’, which can be referred to in the purchase
documents. This data sheet can be distributed to all suppliers, interested parties,
trade delegations and other relevant bodies. Such a data sheet can be provided
regardless of the length of specification or the procurement method used, ensuring
that all parties are kept informed of prevailing national conditions that could affect
the operation of equipment.
The HTM Working Group (or a smaller Specification Writing Group) is responsible
for developing a Technical and Environmental Data Sheet. Guide 2 on planning and
budgeting describes how this is done. It should include details of:
◆ electricity supply – mains or other supply, voltage and


frequency values and fluctuations
◆ water supply – mains or other supply, quality and pressure
◆ environment – height above sea-level, mean temperature and


fluctuations, humidity, dust level, vermin problems
◆ manufacturing quality – international or local standards required
◆ language required – main and secondary
◆ technology level required – manual, electro-mechanical or


micro-processor controlled.


5.5.3 The purchase document – part one: item information


143




You can develop a general data sheet for your country, or create more specific data
sheets for your region, or your health facility. A sample of a Technical and
Environmental Data Sheet is given in Annex 7.


c. Special Conditions Page
A separate page should describe any special conditions attached to different parts of
the order (for example, conditions which apply when using lots – Section 5.2). For
example, there may be:
◆ different delivery destinations and crate labelling required for different parts of


the order
◆ different quality of stainless steel required for surgical instruments than for


office furniture
◆ elements of the order that require installation and elements that do not.


d. Summary Price Schedule for the Offer
The supplier needs to provide a concise summary of the offer in terms of prices. The
aim is to get a quick overview of the offer, which can be used in the evaluation
process when offers are compared (Section 6.3).
You should lay out this summary in the same format as the schedule of requirements
(so that the supplier does not have to duplicate their efforts), and list each element
from your specification that needs a price. In this schedule the supplier should provide:
◆ the unit and total prices for the quantities in each element (product, accessories,


training, etc)
◆ prices for alternative ways of providing your requirements
◆ any pricing options that you must choose from (for example, delivery with


insurance, delivery without insurance).
At the end of the sample full (long) equipment specification in Annex 7, there is a
summary table of all prices arising within the offer. This can be used as the summary
price schedule for the offer, otherwise an alternative price schedule must be drawn
up for the supplier to complete.


5.5.4 Purchase Document – Part Two: Order Information
In addition to outlining your purchase requirements, your purchase document needs
to include a section on supply conditions including:
a. instructions to bidders
b. evaluation and award criteria
c. warranty requirements
d. delivery requirements and conditions
e. payment arrangements and conditions
f. standards and quality requirements.


5.5.3 The purchase document – part one: item information


144




The Procurement Unit should obtain this information from the relevant people and
authorities listed through the rest of this Section.
Once the Procurement Unit has compiled such data, they can develop a general version
of the requirements. This will then only need modifying for each round of purchasing.


a. Instructions to Bidders
These instructions should cover everything a potential supplier needs to know when
preparing and submitting a bid, and includes:
◆ project description
◆ language documents must be submitted in (for example, English)
◆ how the cost of the offer should be presented, and in what currency
◆ how the relevant forms (described in Section 5.5.3 on item information above)


must be completed
◆ details of the closing date and procedures for submitting offers
◆ bid/quote opening details
◆ regulations covering the tender/quotation, such as eligibility requirements


(evidence of arrival on time, all parts completed and signed, samples enclosed, etc)
◆ other documents required, such as bid forms, bid and performance securities


(see point e on payment arrangements below), brochures, manufacturer’s
specifications and certificates


◆ any special clauses, such as procedures for:
- requests for modifications and clarifications to the offer
- bid withdrawals
- bid amendments and variations in quantity.


◆ monitoring criteria for goods and services (usually delivery and quality
of performance).


Tip • Specify all bids/quotes to be submitted in triplicate, clearly marked as ‘original’ and
‘copies’ and ‘not to be opened before’.


b. Evaluation and Award Criteria
These details should cover the criteria and procedures for bid evaluation/
adjudication, award, and notification. Here you should specify:
◆ general compliance criteria (for example, the offer conforms to all terms and


conditions, the bidder is qualified to supply, the bidder has a local representative
in your country able to provide aftersales service support – Section 6.3)


◆ the product selection criteria (Section 3.2)


5.5.4 The purchase document – part two: order information


145




◆ the importance of the technical specifications, and the fact that financial criteria
will only be considered after the technical criteria have been met (Section 6.3)


◆ any scoring system and weighting system, if used for adjudication (Section 6.3)
◆ the supplier qualification criteria (Section 4.4)
◆ criteria for disqualification (Section 6.3)
◆ any legal reasons why offers may be rejected.


c. Warranty Requirements
This section should describe your preferred warranty period and start date. However,
the final arrangements will need to agreed at the contract stage (Section 6.4) along
with the details of what is covered by the warranty (Section 3.2).
A common warranty period is 12 months. Ideally, the warranty period on new
equipment should not begin until installation and acceptance testing are complete.
Often, however, there is little choice. For instance:
◆ For European Union/European Development Fund purchased equipment, the


warranty begins from the time of receipt.
◆ For World Bank purchased equipment, the warranty begins from the time


of shipment.
It is common for a health facility to lose several months of free parts and service from
the manufacturer because new equipment is not immediately installed (Section 8.3).
Some suppliers will agree to different conditions, such as the warranty lasting:
◆ 15 months from shipment
◆ 12 months from installation
◆ 12 months from the date of handover, if the time elapsed is not 12 months


from shipment.


d. Delivery Requirements and Conditions
These details describe the delivery terms that suppliers must conform to, so that
they can prepare suitable quotes or bids. In this part of your purchase document, you
need to state your requirements for:
i. destination of the goods
ii. delivery schedule and date
iii. packing requirements
iv. freighting method, terms and charges
v. carrier and clearing method
vi. import regulations and requirements


5.5.4 The purchase document – part two: order information


146




Tip • If external support agencies and/or procurement agents are involved in the supply of
goods, they may dictate some of the delivery requirements and conditions. Check
whether this is the case or not.


• The Ministry of Finance’s Purchasing/Supplies Manual should give guidance on
freighting, customs and transport (Section 2.2). It will specify the use of specific
trade terms depending on the type and size of supplies and degree of urgency.
Alternatively, seek advice of other groups (such as other facilities, ministries, NGOs,
external supply agencies).


i. Destination of the Goods
You must specify whether goods have to be delivered directly to the health facility
site, a central store/distribution centre, or to the nearest custom clearance point (for
example, an airport, or a sea port).
Transporting goods directly to the health facility site is more desirable (especially for
large or complex goods) but can be costly. If you want this to happen you must
specify a suitable freighting method and terms (see point iv below and Annex 8),
and whether you want the goods to be pre-cleared through customs in order to avoid
routing them through your capital city (see point v below). It is not usually
economical for the supplier to organize the onward delivery from your port to the
health facility, as there is unlikely to be a scheduled service or normal transportation
route (in some cases it can add up to 15 per cent or more on the cost of goods). Thus,
you will need to inform the supplier of the carrier/freight forwarder you want them to
use (see point v below).
To save on delivery charges, you could ask for various products from different
suppliers to be delivered to a central collection point abroad, where they can be
combined together for freighting in bulk. In these cases, the destination will be
specified as the ‘consolidation location’.
ii. Delivery Schedule and Date
The delivery lead time (the number of weeks from placing the order to receiving the
goods) is not given to you by the supplier automatically – you will only receive such
information if you ask for it. Delivery times vary, depending on factors such as:
◆ your budget
◆ availability of goods ordered
◆ means of transport (road, sea, air)
◆ whether goods are to be consolidated
◆ import/export formalities, and
◆ pre-installation preparations.
You may want to state your own delivery date by which the goods must be delivered.


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iii. Packing Requirements
You may need to give instructions on packing arrangements to make sure that goods
are not damaged or do not deteriorate during transport. If you are insuring the
delivery (see point iv on freighting below), the insurer may have stricter
instructions. You should:
◆ specify how the goods should be packaged and protected (for example, crated or


boxed, export packed, marked for special storage or handling)
◆ ask for an indication of carton sizes and weight (required when transporting the


goods yourself, and when unloading and moving the packages).
For most developing countries, the packing should be sufficient to withstand rough
handling, exposure to extreme temperatures, salt and precipitation, and open storage.
Normally it is sufficient to state that the supplier must ensure air or seaworthy
packaging. If any special markings are required on the boxes, the supplier must
be informed.
iv. Freighting Method, Terms, and Charges
There are various freighting methods and terms, which describe the
arrangements for transportation and insurance.
The following criteria should be considered when selecting the mode of transport
and freighting terms for international shipments:
◆ urgency of shipment
◆ size of the shipment – weight and volume
◆ origin of the goods – supplier’s location
◆ normal transportation routes and scheduled services between the source


and destination
◆ ports of entry, receiving facilities, and transportation infrastructure at the destination
◆ relative costs and budgetary limitations.
If you want the supplier to quote for freighting the goods to you, you should specify:
◆ the delivery route (whether by road, sea or air)
◆ the method of delivery (carrier, courier, post, etc)
◆ the type of insurance.


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To keep things simple, it is sensible to request that freight and insurance charges are
quoted separately from the cost of the goods. Make sure this is reflected in the
layout of your equipment specification and summary price schedule (Section 5.5.3).
If you are unsure of the best way to freight and insure goods, ask the supplier for
advice.
To help you select the freighting services best suited to your needs, suppliers use a
range of different international commercial terms (Incoterms) for the transportation
of trade goods, which cover freight and insurance. The most commonly used terms are
summarized in Annex 8. Use these terms in your communications with suppliers.
For example:
For goods from abroad ◆ ideally offers should be invited on the basis of Cost,


Insurance and Freight (CIF) or Carriage and
Insurance Paid (CIP)


◆ under CIF and CIP, the supplier arranges insurance
◆ in all other cases, insurance cover is not automatic


but can be arranged if you require it (either by the
buyer or supplier)


◆ note that only under CIP are deliveries made direct
to a destination of your choice (such as the health
facility site) rather than to a port.


For locally available, locally
manufactured, or locally
assembled goods
(including those
previously imported)
Freighting charges vary enormously. The cost depends on:
◆ the volume and weight of the goods ordered, rather than on the value of the goods
◆ the type of goods. For example, hazardous or heat-sensitive goods can cost


considerably more to transport and may be restricted to particular modes of
transport (for instance, laboratory reagents, which are flammable, require special
packing and documentation). Note that packing dangerous goods with other
items affects the whole shipment


◆ mode of transport (road, sea or air) and distance.
Insurance charges vary depending on what parts of the journey and what activities
are covered. Insurance from dispatch until the end of commissioning is best, but your
choice will depend on cost.


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◆ offers should be invited on the basis of ExW (ex
works, ex factory, or off-the-shelf)


◆ the ExW price, in these cases, should include all
duties, sales and other taxes already paid.




Did you know?
Equipment manufacturers and suppliers report that as much as eight per cent of goods exported
are damaged during delivery.


When buying insurance, you need to check the validity, terms and restrictions. The
standard CIF and CIP terms offer basic cover only and, as a buyer, you may need to
consider additional insurance cover. CIF terms, for instance, only offer cover from
port to port, and are valid for a limited period of time.
Freight contracts that include insurance are usually more expensive. However, it is
worth paying a little more to insure your goods against loss or damage during
freighting. If the supplier is responsible for freighting, it may also be convenient to
let the supplier organize the insurance for the goods.
The amount you have to pay for insurance depends on the value of the goods. So:
◆ list a variety of alternatives in the purchase document and pick the best fit
◆ ask your supplier or carrier (see point v below) for details of insurance costs and


terms, before placing the order/signing the contract (Section 6.4)
◆ ask for details on the type of cover the insurer provides – will it be a refund, a


credit, or replacements of goods.
While insurance is extremely valuable, some external funders, such as government aid
agencies, do not always pay for insurance. In such cases, you will have to balance the
risks and weigh up the cost of insurance against the consequences if you do not insure.


Country Experience
Some countries, such as Pakistan, require that all incoming consignments are insured locally.
International NGO, MSF (Doctors Without Borders) insures all goods bought internationally
up to 90 days after arrival in the port of destination.


v. Carrier and Clearing Method
As well as specifying how you want items to be delivered (point iv above), you also
need to specify in the purchase document who you want to transport them.
The company that transports your goods is known as the Carrier or Freight
Forwarder. This may be:
◆ a carrier that your health service provider or government already has an


arrangement with, who they regularly use to transport goods
◆ a carrier recommended by the external support agency funding the procurement
◆ a carrier recommended by the supplier, or
◆ if no such arrangements exist, a carrier you contract yourself.


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When choosing a carrier, you should consider their reputation and range of services.
The questions to ask include:
◆ Will they comply with the instructions – from yourself and the supplier?
◆ Can they produce documentation accurately and on time?
◆ Are there satisfied customers you can speak to?
◆ Will they transport goods from the port to your stores within city boundaries, and


if necessary outside city boundaries? (Often this is done by the clearing agent –
see below, who may seek the services of another transport company, depending on
the size of the shipment.)


◆ Can they conform to your specified carrier conditions (for example, no changes of
carrier en route, no deck cargo)?


The range of tasks carried out by the carrier depends upon whom you choose:
◆ Some can make all the delivery arrangements, including freighting, paperwork,


crating, consolidation services and transportation of the goods. If contracted, they
may even handle customs clearance and cargo handling services.


◆ Others may only offer limited services, such as just sea or air freight, or delivery to
selected sites but not door-to-door, and may not include ‘extras’ such as packing.


Tip • Freight forwarders (forwarding agents) usually provide the most comprehensive
service, including shipment, customs clearance and onward transportation of the
goods from the port to the final destination.


• Ask your supplier, external funder, or procurement agent for advice and
recommendations for the best carrier for your purposes. If you work for government,
also liaise with other government bodies for advice.


Clearing customs is a complex and specialist task, whether clearing through a major
port of entry (such as the capital) or pre-clearing the goods so they can be delivered
to a small customs post (Section 7.2). Unless you have an experienced team with
clearing and forwarding skills, it is better that you hire some form of specialist agent
to clear goods and provide onward transportation for you.
Your carrier, if contracted to do so, can normally deal with importation, customs
clearance, and onward transportation. However, in some cases this may not be
possible or desirable. For example:
◆ The carrier has no local branch in your country.
◆ You prefer a firm other than the carrier to be your customs agent.
◆ You require help to clear customs and receive the goods on arrival.


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In this case, you need to contract a separate Clearing Agent (handling agent)
instead of the carrier to deal with importation, customs clearance, and onward
transportation. State in the purchase document who this agent will be. You can use
either the government-appointed agent or, if the price seems reasonable, another
experienced agent.


Tip • Remember that a clearing agent may need inputs from you to help them describe the
healthcare technology correctly in the paperwork for customs.


• Liaise with central or local supplies departments or other procurers to find a reliable
and knowledgeable clearing agent.


vi. Import Regulations and Requirements
Each country has specific import regulations and requirements. As part of your order
information, you need to detail whether Pre-Shipment Inspection (PSI) is required
or not. Box 33 describes this activity. You need to check current procedures regarding
inspections with your national customs department, as well as with your supplier. Be
aware that you, as the buyer, must request PSI – it will not happen automatically.


BOX 33: Pre-Shipment Inspection
Pre-Shipment Inspection (PSI) involves inspection of goods
before they are shipped. Goods are inspected at the supplier’s
own premises. Inspectors:
◆ check the quantity and quality of goods to be exported
◆ ensure that they are fit for their intended purpose and


are adequately packed for shipment
◆ offer an independent assessment of the net worth of items, and
◆ certify that the value of the goods matches the commercial invoice.
PSI is a legal requirement for some countries for customs clearance or import. It may be required for
shipments of all goods, or only for shipments over a certain value. Thus, the buyer must check current
procedures with their national customs department, as well as with the supplier.
Failure to comply with PSI requirements can cause delays in customs clearance and extra expense, or can
result in goods being confiscated or returned. Thus, the buyer must be responsible for requesting PSI, if it is
a legal requirement.


Country Experience
Some developing countries, such as Tanzania, require Pre-Shipment Inspection on all
imports over US$ 5,000.
PSI is a common condition for procurement for many international external support agencies,
for example EDF/EU-funded goods.


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As part of your order information, you also need to make sure that responsibilities
for customs formalities are clear. Customs formalities include:
◆ the import/export license
◆ duty payments, and
◆ other administrative matters.
Whether responsibility for these matters will be yours or the suppliers depends on
the freighting terms agreed between the two of you. For example:
◆ If the freighting arrangements entered into are Delivered Duty Paid (DDP) – the


supplier clears the goods for import and carries out, where applicable, all customs
formalities including paying duty.


◆ If the freighting arrangements entered into are Delivered Duty Unpaid (DDU) –
the supplier carries out the customs formalities for exporting the goods from their
country, and the buyer carries out all customs formalities necessary for importing
the goods.


For further details of how customs responsibilities differ according to freighting
arrangements, see the box of Incoterms in Annex 8.


Tip • Often medical equipment and supplies are exempt from customs duties and tax. If
this is the case, you need to:
- obtain the certificate that proves the goods are exempt (usually provided by the


Ministry of Finance)
- either give it to the supplier if he is responsible for having the goods cleared


without paying duty and tax, or
- give it to your own clearing agent for customs clearance.


Some types of goods require special documentation for their transportation (for
example, to allow them to be exported, to warn of the presence and special handling
for hazardous materials). Ask the supplier to state what special documentation
applies to the products they are providing.


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e. Payment Arrangements and Conditions
Having determined your delivery requirements, you will now need to draw up
payment arrangements and conditions. These details describe for the suppliers the
payment terms they must conform to, so that they can prepare suitable quotes or
bids. In this part of your purchase document, you need to state the following:
i. Specific requirements for payment
ii. Validity period of quotes/bids
iii. Validity period of contract prices
iv. Details of payment schedules
v. Payment methods and terms
vi. Details of bid security and performance security arrangements
vii. Penalties for default.


Tip • If external funding agencies or procurement agents are involved in the supply of
goods, they may dictate some of the payment arrangements and conditions. Check
whether this is the case or not.


• Best practice is to finalize all payment negotiations when drawing up the contract
(Section 6.4), and to avoid extra expense and paperwork on both sides.


i. Specific Requirements for Payment
In your purchase document, you need to specify the currencies in which bidders are
to state their prices, as well as the currency for payment.
This is an important distinction, as often the currency quoted in the offer may be
different to the currency used to pay the supplier. For example, for some EU-funded
projects the quote/bid must be in local currency, but payment can be made in Euros.
If you expect to receive offers from several countries, you need to outline the
procedure that you will use to convert prices from different currencies into a single
currency for the purpose of comparing and evaluating bids/quotes.
You must provide information concerning what you will do in the case of currency
fluctuations. Changes in exchange rates should be based on bulletins issued by an
international bank or independent money bureau. The date used to apply the
exchange rate could be the date of payment or the date of import declaration.
ii. Details of the Validity Period for Quotes/Bids
You should provide suppliers with details of the validity period you require for their
initial offer. This is the date up to which the supplier confirms that their terms and
conditions, and price are valid. The period covered should be sufficient to enable you
to compare and evaluate the offers and award the contract.


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The period required will vary depending on the external support agency and the
length of time taken in their procurement process. For example:
◆ For procurement by the EU/EDF, the validity period is 150 days.
◆ For procurement under many World Bank contracts, the validity is 180 days.
Find out if there are national regulations or external support agency restrictions, and
choose an appropriate time window depending on the volume and complexity of the
tender/quotation.
iii. Details of the Validity Period for Contract Prices
You also need to include details of the validity period for the prices in the final
contract. This is the date up to which the supplier confirms that their terms,
conditions, and prices are valid once the contract has been signed. The length of this
period will vary, depending on the type of tender/quote and contract. For example:
◆ For more complicated purchasing methods (such as tenders) and complex orders


(such as multiple deliveries over time), contract prices need to remain fixed
for longer.


◆ For contracts that include services (such as installation, and training) that may
take place some time after the goods are shipped, the contract prices also need to
remain fixed for longer.


In some exceptional circumstances, such as highly inflationary environments and
very complicated procurement processes, you may need to include a ‘price escalation
clause’ that adjusts prices for inflation at specific intervals. It is highly recommended
that such a clause is based on or linked to an objective measure, for example a rate
quoted by an international bank or independent money bureau. If you do use a price
escalation clause you need to:
◆ specify in what circumstances an adjustment to prices will be made (one example


could be exchange rate fluctuations)
◆ specify clearly what adjustments will be made in these circumstances
◆ specify that all subsequent price rises will only be accepted if the suppliers can


provide details of proven escalation in costs. (This is to deter a monopoly supplier
from using the clause as an excuse to increase prices beyond inflation.)


For supply-period contracts over several years (Sections 4.1 and 6.4), you may
combine fixed and escalating prices. For example, you could set fixed prices for the
first year, while prices for subsequent years would be linked to inflation rates. Also
remember to include a clause about exchange rate fluctuations.
iv. Payment Schedules
Your purchase document should outline the payment schedules. You should include
arrangements for dealing with suppliers who fail to deliver any or all of the goods, or
who fail to perform the services within the specified period.


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You should state whether the contract provides full payment either in advance (this
should occur rarely), at the time of delivery (when you receive the goods), or at a
deferred date. A deferred payment is when payment is deferred for a set period that
can be 30, 60, 90, 120, or 180 days.
Alternatively you may wish to use a phased payment schedule (also called staggered,
staged, retention, or split payment). Under this arrangement, payment is made in
defined amounts at defined stages. For example:
◆ 40 per cent of the total may be paid on shipment, and the balance paid following


satisfactory receipt of the goods.
◆ For added protection for some orders of equipment, you may separate out the


payment for goods (the equipment) from the payment for services (commissioning,
installation, and initial training). In this way, it is easier to ensure that goods and
services are only paid for once they have been satisfactorily received.


Both deferred and phased payments allow you to withhold payments if the supplier
provides sub-standard or incomplete deliveries.


Tip • For deferred and phased payments, remember to include clauses about exchange
rate regulations.


Country Experience
Many international external support agencies use phased payments, for example:
◆ For EU/EDF, 60 per cent of payment is made on shipment, 30 per cent on provisional


acceptance, and 10 per cent after the warranty period.
◆ World Bank projects vary, with no standard payment schedule.
◆ For the African Development Bank, 40 per cent of payment is made on shipment, 40 per


cent on receipt, 10 per cent after installation, and 10 per cent after the warranty period.
One developing country uses the following payment schedule:
◆ 50 per cent of payment is made on despatch of goods, triggered by the supplier’s proof of


despatch (Bills of Lading showing shipment by a stipulated date)
◆ 20 per cent is made on arrival, triggered by proof of arrival at the delivery site (the clearing


agent’s papers)
◆ 25 per cent is made on acceptance at the health facility site, triggered by proof of


acceptance by the Commissioning Team
◆ 5 per cent is only paid if the goods arrived and the services were completed on time (as


stated in the contract).
An example of a payment schedule for an NGO is:
◆ 80 per cent of payment is made on shipment, and 20 per cent on final acceptance


supported by the acceptance certificate.


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v. Payment Methods and Terms
In order to obtain the best prices from your suppliers, you need to guarantee that
payment is secure and will take place on time. Your purchase document must
therefore clearly state your payment method and outline the terms and procedures
for payment. Two important factors determine payment methods:
◆ the value of the order (for high value orders, all parties feel more secure with


confirmed letters of credit), and
◆ the relationship between the supplier and purchaser (if there is a satisfactory


track record on both sides the supplier may agree to different methods, such as
payment on receipt rather than in advance).


Various payment methods exist. These can include cash, cheque, bank draft,
‘authority to pay’ letter, and letter of credit. The method of payment you select will
depend on a variety of issues, including the amount to be paid, availability of foreign
currency and geographical location. The characteristics and security levels of the
different methods of payment are listed below:


◆ Cash is only used for small amounts of low value items that you purchase locally to
your health facility out of ‘petty cash’ (usually used for payments in advance and
on receipt).


◆ Cheques are normally used to pay local suppliers (usually used for payments in
advance, on receipt, and phased payments).


◆ A bank draft is a bank guaranteed cheque and therefore works almost like cash
(usually used for payments on receipt, and phased payments).


◆ An ‘authority to pay’ letter is issued by the buyer to his or her bank. Funds are
then transferred to the supplier’s bank once goods have been received, resulting
in payment (usually used for payments on receipt, and phased payments).


◆ The most secure way to pay is to use a Letter of Credit (LOC). This is an inter-
bank document stating that money is available in the buyer’s bank for the
contracted supplier to claim once the job has been completed. To do this, the
supplier must present evidence (within a given time period) that the goods have
been supplied (shipping documents, etc) and that all the terms and conditions
stipulated in the contract have been met (the buyer’s handover certificate, etc).
Then the bank can credit the supplier’s account.


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It is best to state the method of payment you are offering in the purchase document.
However, some suppliers may query the chosen way to pay: this may be an indication
that they have limited financial credibility. For example:
◆ A LOC is generally required by the supplier if they are unsure of the buyer’s


financial status. For instance, they may know that the buyer is periodically short of
funds or has a slow payment process, and the LOC will assure prompt payments.


◆ A LOC is generally used by the buyer when asked to provide part or all payment
in advance of receiving the goods (in other words, when placing the order).
Sometimes there might be reasons to believe that the supplier will not be able to
supply the goods as agreed. Experience shows that some supposed ‘suppliers’ do
not even exist or cannot be traced after they have received some money. Ideally
you should avoid doing business with suppliers if you are uncertain of their
credentials; however, it is often difficult to check all companies, particularly from
developing countries. Thus, using a LOC is a way to secure your funds from being
spent on companies that fail to deliver.


There are different varieties of LOC, and the cost to set them up increases with the
number of guarantees which are built in:
◆ A ‘revocable LOC’ can be cancelled or altered by the buyer after it has been issued.
◆ An ‘irrevocable LOC’ is a legally binding obligation for the issuing bank to pay (as


long as the buyer meets all the terms and conditions), and cannot be amended or
cancelled without the consent of all parties to the transaction.


◆ A ‘confirmed LOC’ is one that is issued by a national (relatively unknown) bank
in a developing country and validated by a recognized international bank which
guarantees payment to the supplier in the case of the national bank or
buyer defaulting.


When developing countries buy from foreign suppliers, a confirmed LOC is most
commonly used. The cost is high, but the payment is assured.
Using a LOC entails the following terms and conditions:
◆ a LOC must be above US$ 100,000 in order to be economical
◆ a LOC generally involves a surcharge of between 1 and 2.5 per cent for the buyer
◆ phased drawings can be arranged on LOCs against stipulated conditions.
These terms must be negotiated with the supplier at the contract stage (Section 6.4).
You should seek professional advice from either procurement agents or the banking
sector to establish suitable conditions and procedures.


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vi. Bid Securities and Performance Securities
In your purchase document, you need to specify any ‘securities’ required from the
supplier. There are two common types – bid securities, and performance securities.
A bid security (also known as a bid bond) is a financial guarantee given by the
potential supplier at the time a bid is submitted. It is normally only used for larger
tenders. Its purpose is to provide the buyer with some protection against
irresponsible bids and encourage suppliers to live up to their obligations. It may
take the form of:
◆ cash
◆ a certified cheque
◆ a bank draft
◆ a state bond or other negotiable bank document
◆ a bank guarantee from a reputable bank.
This security (normally one per cent of the value of the offer) is forfeited if the
successful bidder withdraws the offer or refuses to agree to contract requirements.
The bid security usually remains valid for four weeks beyond the validity period for
the bid.
The bid security must be returned when the Notice of Award is announced and
contract accepted (Section 6.4). Even if the validity of the security has expired, you
are still legally required to return it. If you fail to do so, your Procurement Unit may
be charged costs.
A performance security (also known as a performance bond) is a deposit given by
the supplier at the time the contract is awarded. It gives the buyer some protection
against failure to deliver/perform and encourages the supplier to fulfil their contract
obligations. However you may decide that phased payments provide enough security
instead (see point iv on payment schedules above).
Performance securities are mainly used for contracts for services that are not linked
to the purchase of goods, where the buyer feels that security is necessary (for
example, with foreign, unknown companies) but cannot obtain any security from
payment for goods that will ensure the supplier’s compliance. For example, they
might be used for a service contract after the warranty has expired, since all the
goods will have been paid for by the time the service contract starts.
A performance security may take the form of:
◆ a bank guarantee from a reputable bank
◆ an irrevocable letter of credit.


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The form and amount of the performance security should be specified in your
purchase document. This will vary, depending on the type of security and the nature
and size of the work contracted. An amount of between 2.5 and 10 per cent of the
contract price is often used. The performance security is returned only after goods
and services have been received, and are found to meet all contractual standards and
be of acceptable quality.
The decision when to use bid and performance securities generally depends on the
relationship between the buyer and supplier, and the type of payment used.
For example:
◆ If payment is made after full delivery, then a performance security is only needed


for the warranty.
◆ If payment is in advance then a bank guarantee or LOC should be requested for a


large proportion of the contract value.
vii. Penalties for Default
Your purchase document should contain remedies if the supplier fails to comply with
the signed contract, or if you as a customer do not comply. Your order information
needs to specify:
◆ the remedies available to each party in case of default by the other party
◆ the body of law under which defaults will be resolved
◆ the penalties to the supplier for defaulting on contract details (for example,


withholding payments in progress and/or cancelling any outstanding transactions).


Tip • It is very important that the penalties specified must be practical – in other words
they must be possible to impose.


f. Standards and Quality Requirements
The item information in your purchase document should have detailed the technical
standards and quality requirements (see Box 31). But in the order information, you
need to provide details of how the supplier shows that they conform to these
standards. You need to detail your requirements for:
◆ quality and safety standards or certificates for each product, to be provided with


the bid/quote
◆ registration with any national or health service provider authority that controls


and oversees quality and compliance of imported healthcare technology (if
applicable in your country), and


◆ any other relevant evidence of quality assurance, to be submitted with the
bid/quote and each shipment.


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160




Section 5 summary


161


BOX 34: Summary of Issues in Section 5 on How to Prepare for Procurement


HTM Working
Groups (and
sub-groups),
Heads of
Department,
HTM Managers,
at all levels
Procurement
Managers
Procurement
Managers


Procurement
Manager/Health
Management Team


Procurement/
Tender Committee
Procurement
Managers


Procurement/
Tender Committee
Specification
Writing Group


Procurement Unit


Do
cu


m
en


ts





Ti
m


et
ab


le





C
ho


ic
es






Lo


ts





Qu
an


tif
y


◆ estimate and quantify all procurement requirements once annual funding has
been finalized (see Guide 2)


◆ submit the quantified needs to the Procurement Unit
◆ prioritize the needs, if funds are short


◆ compile those procurement needs that will come out of capital funds, and those
needs that will come out of recurrent funds


◆ decide if use of lots is applicable
◆ group the goods into lots


◆ for each type of item, quantity, and lot to be procured, choose:
- the correct procurement model (Section 4.1)
- the right purchasing method (Section 4.2)
- whether you must pre-qualify suppliers (Section 4.4)
- the funding source (Section 3.3 and Guide 2)
- whether to purchase, lease or obtain a donation of equipment (Section 3.3)


◆ ensure each round of procurement is carried out according to the rules that apply
to the choices made


◆ review and approve the quantification preceding each procurement exercise
◆ review and approve recommendations for tenders, quotations, or direct orders
◆ decide when each item/lot should be procured (by annual, scheduled, perpetual,


or single project procurement)
◆ plan time-critical procurement carefully
◆ make a procurement plan of the activities to be carried out
◆ approve the procurement timetable and the procurement plan


◆ prepare the generic equipment specifications for items to be purchased (see
Guide 2)


◆ prepare the Technical and Environmental Data Sheet(s) (see Guide 2)
◆ prepare the special conditions page
◆ prepare the summary price schedule for the offer
◆ prepare the invitations to bid
◆ prepare all the order information for the purchase documents, consulting with


relevant bodies as necessary
◆ check the item information against quantification (Section 5.1)
◆ compile the complete purchase documents


Box 34 contains a summary of the issues covered in this Section.




162




6. HOW TO MANAGE THE
PURCHASING PROCESS


Why is This Important?
To be efficient and effective, purchasing needs to be carried out according to
clearly documented policies and procedures. This applies equally to complex
tender/quotation processes or simple orders from stores.
Purchasing must also conform to the requirements of the funder – whether
national or external. It is important that staff who buy equipment understand
all aspects of the purchasing procedures and comply with them.


In this Section we discuss the four main stages of the buying process, when using
tenders/quotations:
◆ Asking for bids/quotes and issuing documents (Section 6.1).
◆ Receiving and opening the bids/quotes (Section 6.2).
◆ Evaluation and comparison process (Section 6.3).
◆ Award of contract and placing the order (Section 6.4).
In addition, this Section covers:
◆ Local direct purchasing and ordering (Section 6.5).


6.1 ASKING FOR BIDS/QUOTES AND ISSUING
DOCUMENTS
For each round of purchasing, the Procurement/Tender Committee approves the
appropriate purchasing method (Section 5.3), according to national procurement
procedures or those of the health service provider organization. The Procurement Unit
and the HTM Working Group prepare a detailed purchase document (Section 5.5.2).
The next step is to request tender bids or at least three quotations. This should
always be done in writing. Usually the Procurement/Tender Committee manages the
tender and high-value quotation processes, while the Procurement Unit manages the
low-value quotation processes. However, this will depend on your country and health
service provider.


6 How to manage the purchasing process


163




The process of requesting bids/quotes varies with the different purchasing methods,
as follows:
Open tenders/
national competitive bids


Restricted tenders/
competitive negotiation/
request for quotes


Direct ordering


Before any purchase document is sent out, the Procurement Unit must check it for
accuracy, check the details are correct and complete, and ensure all essential papers
are attached (Section 5.5.2).
There are some circumstances when you will not use the standard requesting process:
◆ If you simply want to reorder an item that has previously been purchased from a


satisfactory supplier at an acceptable price, it may be possible to issue a repeat order.
◆ In exceptional situations, when a certain item is likely to be out of stock


imminently, you might consider negotiating with the supplier from the previous
tender or contract to provide you with replacement items.


Tip • In your invitation to bid/quote, it is usual to state the day, time, and place for both
the receipt and the opening of the bids/quotes.


6.2 RECEIVING AND OPENING TENDER BIDS/
QUOTATIONS
For the simpler or less formal purchasing methods, the procedures tend not to be so
rigid. However, a more regulated process leads to clearer transparency (lack of
corruption) and greater confidence among suppliers. The process you choose
depends on your method of procurement, as outlined below:
◆ For direct ordering – the Procurement Unit will simply receive the quote from


your chosen supplier, by a date agreed, and open and study its contents.


6.1 Asking for bid/quotes and issuing documents


164


◆ the invitation to bid (Section 5.5.1) is
advertized in a number of locations (see
Box 18) and the purchase document is
issued to interested suppliers.


◆ the purchase document is issued directly to
a number of pre-qualified or selected
suppliers (Section 4.4), together with the
invitation to bid.


◆ the purchase document is issued directly to
a single pre-qualified or selected supplier so
they can provide a quote (Section 6.5).




◆ For competitive negotiation – since the offers are not confidential with this
method, the process can be formal or informal. Depending on your regulations and
the value of the order, the Procurement Unit could simply provide a date for
receipt of quotes (without a special opening date), and open and study the
contents on receipt.


◆ For a request for quotes for low-value goods from suppliers in your local
town – the process is usually much less formal. Relevant user and maintenance
staff may collect the quotes from the suppliers. Alternatively, the Procurement
Unit may provide a date for receipt of quotes (without a special opening date),
and open and study the contents on receipt.


◆ For all other methods – you will need to follow the instructions in the remainder
of this Section.


The Procurement Unit must receive the bids/quotes by the specified closing date
and time. These may be submitted by hand or by mail. The Procurement Unit
should keep a written record of all bids/quotes received, noting down when they
were received and who received them. Received bids/quotes should then be stored
unopened in a secure location (such as a safe) until the opening date. Box 35
outlines the common procedures for opening tender bids and quotations. In general,
the quotation processes are less formal than tender bids.


BOX 35: Most Commonly Used Procedures for Tender Bid and Quotation Opening
Opening Tender Bids Opening Quotes
Opening
◆ On the opening date, the Procurement Manager


(or an appointed officer from the Procurement
Unit) should formally open the sealed bids at the
stipulated time and place and in public.


◆ The box/envelope should be opened in the
presence of at least three official representatives.
One should be a representative from an outside
department (such as the Treasury) and at least
one should be a member of the
Procurement/Tender Committee.


Registering
◆ Bidders and/or their representatives who are present


should sign a register showing that they were present.


6.2 Receiving and opening tender bids/quotations


165


◆ For high-value orders:
- on the opening date, the Procurement Manager


(or an appointed officer from the Procurement
Unit) should formally open the quotes at the
stated time and place and in public.


- the box containing the quotes should be opened
in the presence of at least three official
representatives. At least one should be a member
of the Procurement/Tender committee.


◆ For low-value orders, the quotations may be
received and opened by the Procurement
Manager, in the presence of one or two members
of staff from the Procurement Unit.


◆ The opening of the quotes is recorded.


Continued overleaf




BOX 35: Most Commonly Used Procedures for Tender Bid and Quotation Opening
(continued)


Opening Tender Bids Opening Quotes
Processing
◆ On opening, the following should take place:


- Bids opened in order of receipt.
- Bidder’s name, total amount of each bid, any


discount, list of samples, bid modifications,
and other such details should be announced
and recorded.


- Confirmation that the bid is properly signed
and accompanied by the required securities,
if applicable.


- Confirmation that the documents meet the
eligibility and tender requirements (evidence
of arrival on time, necessary documents and
samples enclosed, etc).


◆ If satisfactory, the bid is admitted for further
comparison (evaluation). If not satisfactory, the
bid is excluded. The excluded bidder should be
informed in writing.


◆ Bid opening is recorded, and a copy of the record
is sent to the funder/external support agency
if requested.


Late arrivals
◆ Late bids should not be opened but should


instead be stamped with the date and time and
returned to the bidder with a letter of explanation.


Note: there may be variations to this approach for some purchasing methods. For example:
◆ Restricted tender bids are not opened in public.
◆ In some cases, bid/quote opening may only involve the opening and recording of the offers. The checks for


documentation (such as the bid bond, bid forms, audited financial reports, etc) are carried out during the
evaluation/adjudication process (Section 6.3). You must check national regulations and the funder’s
requirements to see if this is the method to follow.


◆ In some cases, all tender bids are opened, including those that were late. However, the late bids are
recorded as such, and are kept separate from valid bids submitted within the timescale stipulated. Again,
check the national regulations and funder’s requirements.


6.3 EVALUATION AND COMPARISON PROCESS
For the simpler or less formal purchasing methods the procedures tend not to be so
rigid or complex. However, using the evaluation and comparison strategies provided
in this Section can do no harm. Depending on your purchasing method, the
Procurement Unit and relevant user and maintenance staff should carry out the
following activities:


6.2 Receiving and opening tender bids/quotations


166


◆ On opening, the following should take place, as
relevant to the quotation-based method:
- Bidder’s name, total amount of each bid, any


discount, list of samples, bid modifications, and
other such details should be recorded.


- Confirmation that the bid is properly signed
and accompanied by the required securities,
if applicable.


- Confirmation that the documents meet the
eligibility and purchase requirements (evidence
of arrival on time, necessary documents and
samples enclosed, etc).


◆ If satisfactory, the bid is admitted for further
comparison (evaluation). If not satisfactory, the
bid is excluded. The excluded bidder should be
informed in writing.


◆ Bid opening is recorded, and a copy is sent to the
funder/external support agency if requested.


◆ Late quotations should not be considered and
should instead be returned unopened to the
supplier.




◆ For direct ordering – simply study the quote and ensure the supplier has
met all requirements, at a price that you can afford.


◆ For competitive negotiation – ensure each supplier has provided all your
requirements, compare the offers, note the differences and parts that could be
improved, and use these as a starting point for your rounds of negotiation.


◆ For a request for quotes for low-value goods from suppliers in your local
town – ensure each supplier has met all your requirements, compare the
offers, noting the differences, and choose the best deal.


◆ For all other methods – you will need to follow the instructions in the remainder
of this Section.


Once orders rise above a certain value, it is usual for the Procurement Unit and the
Procurement/Tender Committee to both play a role in the evaluation and
comparison process. The Procurement Unit usually administers the process, and
collates information for the Procurement/Tender Committee to pass judgement on.
The Procurement Unit can make recommendations but the task of deciding the
winning bid should be left to the Procurement/Tender Committee. This separation
of responsibilities helps to avoid conflicts of interest. It also reduces the pressure on
general members of staff in the Procurement Unit who may interact with suppliers
on a daily basis.
It is usual for bids/quotes to be assessed:
◆ first, to ensure that the offer complies with the requirements in your purchase


document, and that all parts have been completed and are enclosed
◆ second, to compare and assess all parts of the offer, in order to identify the one


which is the best fit and best value for money.
For assessment to be carried out properly, it is important to ensure that the
Procurement/Tender Committee has the necessary skills to act as an effective
evaluation team. This should include technical, financial, purchasing expertise and,
if necessary, legal expertise (Sections 1.2 and 2.2). Sometimes the Procurement/
Tender Committee may require additional assistance. This may be provided by
relevant end-users and members of the HTM Service, the project sub-group
(Section 1.2), or a hired procurement agent.


6.3 Evaluation and comparison process


167




Experience in Botswana
The Government Computer Bureau of Botswana purchases all computers centrally for all
government ministries, using a Ministry of Finance central budget. For obvious reasons,
the Bureau recognized the need to standardize computer purchases. The Bureau needed
to provide the National Tender Board with the background information necessary
concerning their purchasing plans in order to convince the Board to allow standardization.
They were successful by developing the following close working relationship with the
National Tender Board:
The Government Computer Bureau:
◆ telephones the secretary of the National Tender Board about their purchasing projects,


explains the details, offers assistance if required, prepares the way for an understanding
of pending tender adjudications, and describes what they are trying to achieve


◆ follows tender procedures and obtains as least three quotations/bids from
different companies


◆ sends a member of staff to accompany their tenders to the National Tender Board
meetings to argue their case


◆ presents the Board with the reasons why the ‘package of inputs’ and quality are necessary
◆ provides the Board with tangible reasons why stocks of spare parts and consumables


should be purchased at the same time as the equipment, such as the unproductive
downtime which would result from the lack of consumables or spares, the essential
nature of the service provided by the equipment, and the consequences to services due
to equipment downtime.


The National Tender Board:
◆ accepts technical reasons as valid in the adjudication process, and accepts technical


advice concerning computers from the Government Computer Bureau since the Board
does not have that knowledge itself


◆ does not choose the cheapest option, but looks for quality and a ‘package of inputs’
◆ buys stocks of spare parts and consumables at the same time as buying the equipment.
Unresolved issues are:
◆ The purchase of a blanket maintenance contract for all the computers acquired. Since


the Ministry of Finance has not set up a central budget for computer maintenance, all
ministries owning computers obtain maintenance independently.


◆ The purchase of training with the equipment as part of the ‘package of inputs’. Since all
government training is purchased from a central budget it is not linked to the equipment
procurement process.


6.3 Evaluation and comparison process


168




The process of evaluation and comparison can often be time consuming. However, it
is important to ensure that decisions for awarding contracts are not made simply on
the basis of which items are the cheapest. During evaluation the items should be
assessed against the requirements specified in the purchase document (Section
5.5.2). The most common way to evaluate offers is to use an elimination process,
where some offers are rejected at each stage. Offers should be judged against the
following criteria:
◆ Compliance with requirements in the purchase document.
◆ Technical nature of the offer (part of the product selection criteria – Section 3.2).
◆ Financial nature of the offer (part of the product selection criteria – Section 3.2).
◆ Supplier qualification criteria – Section 4.4.
By doing this, you ensure that decisions are based on best value for money for the
whole life-cycle cost, rather than simply being based on the item’s purchase price.
The process of evaluation and comparison must be fair and thorough. To achieve this,
the process must follow a defined pattern to ensure all bids/quotes are dealt with in
exactly the same way.
The evaluation process for tenders is similar to that for quotes, although the tender
process is normally a far more comprehensive task and is also regulated by law. The
tools for evaluation can be the same, but the amount of information required is
usually much less with quotation methods. Obviously, if you only request three
quotes for a simple small order, the evaluation process should not take much time.
The following evaluation steps are used, and some bids/quotes are rejected at the
end of each step.


Step 1: Checking for Compliance
The first step when evaluating offers is to determine which, if any, are not compliant
with the technical, commercial, and other specifications in the purchase document
(Section 5.5.2). The Procurement Unit should be able to do this. It involves a more
detailed examination of the offer to determine the compliance by the bidder with
the requirements specified in the purchase document. This is known in tender
processes as the substantial responsiveness of the bid. This process is more formal
and comprehensive for tenders than for quotations.
A substantially responsive bid is one which:
◆ conforms to all the terms and conditions. This means that the supplier has


responded to all parts of your schedule of requirements, has filled in all the boxes,
and is able to supply all the parts required; and,


6.3 Evaluation and comparison process


169




◆ also establishes the bidder’s qualifications to supply and deliver the products
within the delivery schedule. For example, the supplier:
- has enclosed signed audited accounts, signed company declarations on health,


safety, and environmental activities, certificates of quality manufacturing, and a
letter of authorization from the manufacturer


- has nominated a representative in your country (if this was one of your
compliance criteria).


All non-substantial bids will be rejected as non-responsive and should be excluded
from further in-depth evaluation.
In practice you will find that most bids contain reservations from one or more of the
detailed requirements given in your document. If these are just minor adjustments
and do not represent a substantial deviation from your expressed interests, you can
still conclude that the bid is substantially responsive and therefore should be
included. However, list the reservations for closer clarification.
To assist in this examination you may ask for other clarifications from the bidder. You
may also wish to inspect the quality methods and production methods stated in their
documents. This request and response should be in writing. The bidders, however,
are not allowed to make any changes to the substance or price of their offers.
After evaluating the offers for compliance, some offers are discarded as the suppliers
fail. The remaining offers can go forward to be compared in terms of technical
performance (in Step 3).


Step 2: Preparing the Evaluation Information
The Procurement Unit should collate and compile the information from all the
responsive bids into Evaluation Information Sheets. Box 36 gives an example of the
sort of data that needs to be included. Ideally the Evaluation Information Sheets
should allow side-by-side comparison of the offers. Figure 14 in Step 4 shows an
example for a simple purchasing method (a quotation-based method). For tenders
there are more responses and the orders tend to be more complex, so more
paperwork is required to obtain a true comparison. Usually there is too much
information to be compiled in a single sheet, so you may like to use:
◆ one sheet for collating purely technical information about the product
◆ one for information on accessories, consumables, and spare parts
◆ one for aftersales service, and
◆ one for price information.


6.3 Evaluation and comparison process


170




You can use large hand-drawn charts to enable comparison between suppliers.
Alternatively, this is an area where the use of computers is useful, especially if
procurement (or tendering) is managed centrally. General spreadsheet programs or
specialized computerized procurement programmes are useful tools to simplify the
collation of data and preparation of the Evaluation Information Sheets (see Annex 2).


BOX 36: Evaluation Information Sheets
Evaluation Information Sheets present an easy way to compare different bids/quotes. For ease of comparison,
it is best to allocate one page per subject matter (technical product details, price, etc) and compare the
offers side-by-side. You should also highlight where each offer deviates from the equipment specification.
Typical Evaluation Information Sheets would include the following evaluation criteria:
Technical product data:
◆ the international/regional standards that the equipment adheres to
◆ whether the operational method used is new, well tried, or old
◆ the level of sophistication of the technology and the operating technique
◆ which functions and measurements do not meet the specifications in the purchase document
◆ whether any quality assurance certificates apply to the equipment
Accessories, consumables, spare parts:
◆ a list and the cost of accessories included in the offer
◆ a list and the cost of consumables included in the offer
◆ a list and the cost of spare parts included in the offer
◆ the length of time spare parts will be available and their location
After-sales service:
◆ cost of aftersales support
◆ guarantee/warranty periods
◆ the details of the aftersales support that can be provided
Price information:
◆ the price
◆ delivery arrangements
◆ costs to install, commission, and train
◆ the life-cycle costs
Note: this is an example and not a comprehensive list. The information you choose to include will depend
upon the complexity of the equipment purchased – you may not need to go into such technical detail for
simple equipment or recurrent supplies.


The Procurement Unit should present the Evaluation Information Sheets to the
Procurement/Tender Committee (for tenders and high-value quotes) or the
Procurement Manager (for low-value quotes). They should be accompanied by an
explanation of the requirements, main objectives, and any binding constraints. Then
the evaluation process can commence (Step 3).


6.3 Evaluation and comparison process


171




Step 3: Carrying out the Technical Evaluation
The Procurement/Tender Committee should base their decision on advice from
members of the group with professional knowledge relevant to the offer. If
appropriate, they should also seek advice from representatives from the relevant user
department and HTM Team. (For low-value quotes, the Procurement Manager
should also seek advice from these end-users.)
The Committee should consider the product selection criteria, as set out in the
purchase document (Section 5.5.2). It is essential that the information provided by
the supplier is only related to the equipment specification and the selection criteria
listed in the purchase document – any additional information intended to sway the
evaluation can be seen as corruption. Hence the importance of detailing your
requirements adequately in the purchase document. The better the purchase
document is, the easier the evaluation process will be.
Details of the selection criteria for evaluating the equipment are provided in
Sections 3.2 and 5.5.2. Box 37 lists a few points to remember, relating to the
technical aspects of the offer.


BOX 37: Summary Technical Assessment
◆ If a detailed specification was issued, then every detail of the offer must be closely checked to make sure


it conforms with the original specification.
◆ If only a brief specification was issued, then the checks should be limited to ensuring the equipment or


service offered meets the requirements.
◆ Any modifications or alternatives offered must be assessed individually, and decisions made whether any


one is more cost effective than another.
◆ Remember that the technical assessment includes suitability, safety, ability to commission and train,


aftersales support, warranty arrangements and more – do not simply assess technical data concerning
the equipment.


For both quotations and tenders it may be necessary to ask the supplier to clarify any
ambiguities or uncertainties. Alternatively, you can draw up a shortlist of suppliers
and ask those included to demonstrate their equipment, as part of your technical
evaluation. (This is unlikely to be necessary for very simple equipment, and may be
impossible for many overseas suppliers.)
After the technical evaluation, some offers are discarded if they fail to meet the
requirements. The remaining offers can go forward to be compared in terms of
financial performance (Step 4).


6.3 Evaluation and comparison process


172




Step 4: Carrying out the Financial Evaluation
The offers that have survived the technical evaluation (Step 3) can now be
compared in terms of financial performance. Remember that financial evaluation
must include all costs. You need to consider:
◆ The lowest purchase price (the cheapest to buy).
Recurrent supplies and basic or simple equipment items could be bought on the
basis of purchase price alone, as long as the quality is sufficient.
◆ The most economically advantageous offer.
For more complex equipment, you need to consider:


- all the other life-cycle factors, alongside purchase price, which could have a
bearing on the cost of ownership – for example, delivery, installation, training,
consumables, spare parts, fuel efficiency, maintenance contract.


- other features that determine the likely life of the equipment and hence its
cost-effectiveness – for example, quality, local availability of aftersales support,
technical complexity.


To make sure you are getting the most for your money consider:
◆ What are the freight costs? Note: it is easier to compare and evaluate freight costs


from competing suppliers when transportation costs are expressed as Cost Insurance
and Freight (CIF) or Carriage and Insurance Paid (CIP) (Section 5.5.2).


◆ Can the equipment be installed and commissioned, and staff trained in-house? Or
will special agreements with the supplier or an outside technical unit be needed?
What will be the costs of these?


◆ What will be the cost of equipment and its operation for the next year/two
years/five years? (Is the equipment expensive to run? Does it require expensive
consumables to run? Does it require costly spare parts?)


◆ What is the expected useful life of the equipment?
◆ What will be the maintenance and repair costs? Are they included or excluded?
◆ Will it be more economical to maintain the equipment in-house or with a service


contract over its useful life?
Paying a higher initial purchase price may be justified if:
◆ the equipment will be more economical over its lifetime
◆ the equipment does not require new investment in training and spare parts’ stock


holdings, because it is similar to equipment already in use
◆ the equipment quality means it will perform better and last longer.


6.3 Evaluation and comparison process


173




BOX 38: Summary Financial Assessment
In summary, the financial assessment should ensure that:
◆ all costs are properly covered in the prices offered (for example, product price, manuals, delivery and


shipping costs, insurance, customs duties)
◆ bids are comparable (in other words, currency conversions are correct at the time)
◆ alternative costings for alternative methods of meeting the specifications are identified and logged


separately
◆ the costs compare with, or are lower than, the estimated costs when the purchase document was prepared
◆ details of any extra costs we did not expect which appear in the offer are noted (for example, testing and


inspection charges, special installation tools, specialized consumables)
◆ discounts are noted
◆ terms of payments are included.
Note: this list is not necessarily complete, but gives an indication of the type of cost make-up that should
be considered.


As for the technical assessment, you should aim to compare offers side by side. With
open tenders and national competitive bids you may receive many responses –
perhaps as many as 30 or more – requiring careful comparison over several pages. But
for other restricted purchasing methods, you should be able to use a fairly simple
form for financial assessment, as shown in Figure 14.
After the financial evaluation, some offers may be discarded if they fail to meet your
requirements. The remaining offers can go forward to be placed in order of priority
(in Step 5).


6.3 Evaluation and comparison process


174


Box 38 provides a summary of financial assessment criteria.




6.3 Evaluation and comparison process


175


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Step 5: Making Recommendations
Having completed these steps in the evaluation process, the Procurement/ Tender
Committee (or Procurement Unit for low-value orders) needs to make
recommendations about the possible winning order of the shortlist of suppliers.
Figure 15 shows the sort of criteria that can help you to make such decisions.


Figure 15: Issues to Consider Which Help You to Make a Decision


6.3 Evaluation and comparison process


176


Issue Considerations


Different currencies


Best offer versus cheapest price


Equipment complexity


Be wary of things that are too
good to be true


Take advice on past experience


• For the purpose of comparing prices, each supplier should
have converted all prices in the offer to a single currency
selected by the buyer, as stated in the purchase document
(Section 5.5.2).


• Ideally, select the equipment that is most ‘economically
advantageous’ rather than the one with the cheapest purchase
price.
• To do this, when comparing bids/quotes, you need to consider
the whole life-cycle cost of the equipment. For example: Is it
of good enough quality to last a long time? Will it require
frequent maintenance or costly software upgrades? Are
consumables affordable?
• You can use this approach only if you stated in your purchase
documents that these factors would be taken into
consideration.


• The more complex the equipment, the more significant and
important the technical criteria are compared to the price.
• For simple robust devices the price is a much more important
factor.


• Treat offers that are more than 10 to 15 per cent lower than the
majority of others with great caution.
• Study the conditions given in the small print carefully as low
prices often indicate that unacceptable economies have been
made in the specifications.


• Members of the Procurement/Tender Committee may have
specific experience of the supplier, and know of particular
problems with the supplier, equipment, or contractual
arrangements. (If so, they should inform the Procurement Unit
so this information can go on record for future rounds of
purchasing).
• The HTM Working Group (or a relevant sub-group) may have
relevant feedback (Section 9.2) on equipment, equipment-
related supplies, and suppliers, arising from their monitoring
of existing equipment usage (see Step 6).




At the end of this process, the Procurement/Tender Committee (or Procurement
Unit for low-value orders) should be able to produce a summary of the bid/quote
information per shortlisted supplier, with their priority ranking (first, second, and so
on). Consultations can then be sought regarding the recommendations (in Step 6).
Possible Scoring and Weighting Systems
To help with making recommendations, some people use a scoring system for each
element of the bid/quote (for example, all the technical and financial selection
criteria used in Steps 3 and 4). The Procurement/Tender Committee (or
Procurement Manager for low-value orders) chooses the scoring system. For example,
an element in the offer scores 0 if it is absent, 1 if it is poor, 2 if fair, and 3 if good.
Each element of a supplier’s offer is given a mark according to this scoring system. By
adding up all the marks, it is possible to see which bid/quote has the highest score.
(If such a system is used, a score line can be inserted into the comparison forms –
such as Figure 14).
However, many people find scoring systems difficult to implement. For example,
everyone has to understand why an element of an offer would be marked ‘poor’
instead of ‘fair’. A points system can become too much of a compromise unless it is
done carefully. Also, some elements of an offer may be seen to have more importance
than others (for example, the presence of a particular safety feature may be more
important than a two-week delay to the delivery date).
Thus, some people also assign a weighting system to different aspects of the
bid/quote. The scores obtained under the points system (described above) are
multiplied by a percentage (a weight) according to their perceived importance. The
actual percentages should be assigned by the Procurement/Tender Committee, be
flexible, and vary depending on the equipment type and in-house skills available.
For example, for medium- and high-complexity equipment, technical criteria are
usually assigned greater importance than the costs of the product. Thus, the
weighting system could be:
◆ 10 per cent for contents of offer fulfilling your requirements
◆ 20 per cent for technical features of the product
◆ 30 per cent for technical support provided
◆ 10 per cent for warranty terms
◆ 5 per cent for delivery time
◆ 25 per cent for life-cycle costs.
This gives a 75 per cent weighting for supplier support and technical features, and a
25 per cent weighting for financial criteria, providing a ratio between the two of 3:1
that is typical for medium- to high-complexity equipment.


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However, many people find that to assess each element of an offer with a points
system, and also place a value on the amount one element represents in the whole
offer is complex (for example, would a good battery life be more important than poor
aftersales support?). Also, if scoring and weighting systems are complex, they
become too difficult to describe in the tender document as required (Section 5.5.2).
Thus, many people find it more straightforward to simply use the phased evaluation
and elimination process described in Steps 1 to 4 above.


Step 6: Consultations
Before the Procurement/Tender Committee (or Procurement Unit) finalizes its
recommendations, it is useful to consult or liaise with the staff that will use and
maintain the equipment. There are two options for doing this:
◆ If such staff are co-opted members of the evaluation committee then their views


will already have been heard, and you can go on to Step 7.
◆ Often relevant staff are not present at the Procurement/Tender Committee


meetings, so they need the opportunity to review the summarized tender
information before the final decision on the winning bidder is made.


It is beneficial to take the time to consult on the recommendations, since:
◆ the evaluation team can gain from the experience of staff that regularly work with


the equipment
◆ the end-users have an opportunity to appeal a decision that they can see will


create problems for them.
To avoid information leaks you should only involve personnel who you think can
contribute actively. All other staff should be informed, but they need not be given
detailed information.
The heads of the relevant user and maintenance
departments should study the summarized
information and recommendations, comment on the
suppliers that appear to be winning the
tender/quotation, and lodge an appeal (with reasons)
where necessary. For example, when there is a tender
for the supply and installation of kitchen equipment,
the relevant kitchen and HTM managers have a
chance to see the priority rankings of the bidders
before a decision is finalized. They can put forward
objections to the winning bidders if they know the
product to be poor or that the supplier’s performance
has been poor in the past.


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The Procurement/Tender Committee (or Procurement Unit) can then take note of
this information in order to shortlist the offers in winning order. This prioritized
shortlist can then go forward so that the suppliers can be evaluated (Step 7).


Step 7: Evaluating the Suppliers
For some purchasing methods, suppliers are pre-qualified (Section 4.4). This may
include restricted tenders or certain quotation-based methods. In such instances, you
do not need to worry about this part of the evaluation process, since suppliers have
already been screened as part of the pre-purchase activities (Section 5.3). Therefore,
the Procurement/Tender Committee (or Procurement Unit) can simply make their
final decision (Step 8).
Other purchasing methods, such as open tenders or national competitive bids, do not
use pre-qualified suppliers. In such cases, you will need to post-qualify them
(Section 4.4).
You could evaluate all the suppliers at the beginning of the evaluation process.
However, since investigating each supplier according to the criteria shown in
Annex 5 takes considerable time, we suggest you only investigate the winning
bidder. If they fail, you can move on to assess bidder number two, and so on. Your
decision on when to evaluate the suppliers will depend on whether you have a great
deal of offers to compare.
The nominated supplier from whom you intend to buy should be evaluated
according to factors such as:
◆ capabilities and capacity to supply the required equipment
◆ financial position
◆ reputation and reliability
◆ ability to effectively carry out the contract
◆ previous history of supplying similar products and services.
This supplier qualification criteria should have been set out in the purchase
document (Section 5.5.2). If the bidder does not meet your criteria, their bid is
rejected. You should then go on to consider and evaluate your second choice bidder.


Tip • You should spend less time on small, low-value, and one-off contracts, but much
more effort if the contract is large, complex, high-value, or if you may want to buy
more from the same supplier later.


The qualification criteria used to screen the suppliers is thoroughly dealt with in
Section 4.4 and Annex 5. Box 39 lists a few points to remember when evaluating
the supplier.


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BOX 39: Summary Supplier Assessment
In summary, the supplier assessment should use the criteria in Section 4.4 and Annex 5 to check:
◆ all aspects of the bidder’s capability to perform according to the contract
◆ all aspects of the bidder’s ability to meet all the qualification criteria.


At the end of this process, the Procurement/Tender Committee (or Procurement
Unit) will be able to make their final decision (Step 8).


Step 8: The Final Decision
At the end of the evaluation and elimination process, the Procurement/Tender
Committee (or Procurement Unit) should be in a position to select their first choice
bidder, based on a summary comparison of the benefits and costs of all the bids received.
However, it is possible to go through this whole evaluation and comparison process
and find that you are not ready to award the contract within the validity period of the
bid/quote (Section 5.5.2). If this is the case, you need to ask the suppliers to extend
this period to enable you to finish the process according to best practice (and maybe
alter the delivery date).
Before awarding the contract, you should check that the overall cost of the winning
bid/quote is within your budget (see Guide 2). If the bid/quote exceeds your
estimated costs, you need to decide on the following:
◆ Whether to reduce the size of the order, or the quality of the goods. There


is a general rule (but not any legal regulation) that an alteration of quantities up or
down by 15 per cent should not normally influence the quoted unit price. So,
often, the supplier is willing to accept a smaller quantity than he calculated for. It
might be more difficult for him to accept a request for a lower quality product,
although he may sell you a simpler model.


◆ Whether to continue, and reappraise your estimate or terms. If you decide
to go ahead with the winning bidder and cannot increase your budget, you may
need to consider other ways of making savings. For instance, you might look at
whether you could carry out the installation, commissioning and initial training
yourself. Alternatively, you may choose a cheaper transportation method, and alter
the delivery date accordingly.


◆ Whether to negotiate with the bidders to reduce their costs to meet your
estimate. This is not normally allowed for tenders, but for other purchasing
methods it can be very effective. For example, you might decide to inform
suppliers that there can only be a sale if the prices are reduced by, say, 10 per cent.


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◆ Whether to abandon and restart the whole exercise. Re-tendering or
requoting is an option. However, it may be quicker and more effective to ask the
bidders to recalculate their prices (through one of the three methods listed
above) while keeping all other parts of the tender identical.


You must be careful that the new requirements (your modifications) are not radically
different to the original requirements. Otherwise, you could be accused by
unsuccessful suppliers of changing the terms so much that they could have put in an
offer on an entirely different basis. You should check national regulations carefully for
assistance on this matter.
The Procurement/Tender Committee needs to agree on these revised terms before
the final contract is agreed (Section 6.4).


Tip • Some buyers award contracts to a single supplier. Others routinely split contract
awards between two or three suppliers, in order to avoid dependence on one supplier
(depending on your standardization strategy).


• The background information used for the selection process should be documented
and held on file for future reference.


At the end of this process you should have obtained equipment with the qualities
detailed in Box 40.


BOX 40: Final Outcome of the Purchasing Process
At the end of the purchasing process, the equipment chosen should:
◆ be of high quality, and manufactured to the relevant international standards
◆ be robust, able to withstand the local climate and conditions, and made with these


conditions in mind
◆ be suitable for use by your existing staff. (The equipment chosen should have a level of


technology that your staff are already accustomed to and are confident to use. Also, staff
should easily be able to attain the relevant skills in operation and maintenance.)


◆ conform to your standardization initiatives
◆ be manufactured by companies with good representation in the region, who can offer competitive prices


for freighting, installation and training visits by local agents, and who can provide accessible aftersales
support and locally available spare parts


◆ avoid the introduction of a wide range of different consumables, accessories and spare parts requirements,
thereby assisting initiatives for rationalization of supplies and bulk ordering


◆ be energy conserving and have been purchased with energy efficiency in mind.


Once the Procurement/Tender Committee (or Procurement Unit) has chosen the
supplier(s), the Procurement Unit needs to negotiate with them and agree the final
terms of the contract, before placing an order (Section 6.4).


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6.4 AWARD OF CONTRACT AND PLACING
THE ORDER


Overview of the Formal Process for Awarding Contracts
Purchase Order a sequentially numbered printed form (from a quadruplicate


book) used by the buyer to place an order with a supplier,
listing the details of all that is required. It is an official and
binding document issued to the supplier, which authorizes the
expenditure of funds for goods and services, and acknowledges
that payment will follow. Once created, the necessary funds
are dedicated from the relevant budget account (expenditure
line) against the Purchase Order number.


For the simplest purchasing methods and small orders, your purchase document
(Section 5.5.2) may simply be a completed Purchase Order form (see Annex 11).
Proforma Invoice a legal document between the supplier and the buyer


providing a complete breakdown of the supplier’s quote and
terms for the order, against which payment is made by the
buyer. Most commonly used by buyers to allocate and arrange
the transfer of funds via bank money transfer to international
suppliers. Used by customs in the country of destination to
determine the customs value of imported goods.


Contract a legally binding document between the buyer and a supplier
for a specified period of time, which describes the goods and
services being supplied.


Once you have chosen a supplier (Section 6.3), there are several documents that the
Procurement Unit issues to them:
◆ a Notification of Award
◆ a finalized Purchase Order
◆ a finalized Contract.
For tenders and high-value quotations, the Procurement/Tender Committee needs
to agree the content of these documents before the Procurement Unit drafts them.
Figure 16 shows the key procedures and activities involved in awarding contracts.


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Figure 16: Suggestions for Procedures to Follow When Awarding Contracts


6.4 Award of contract and placing the order


183


Step Activity


Prepare the Notification of Award


Inform the supplier


Discuss the contract terms with
the supplier


Issue the final purchase order


Supplier’s response


Cross check:
• the price and schedule of requirements submitted by the
supplier against your draft notification of award
• the quantities of different products in the supplier’s offer
against the quantities detailed in your purchase document
• the notification of award value and quantity against the
supplier’s offer
• that the correct documents are attached for reference
(see Box 41).


• Issue the chosen supplier with the finalized Notification of
Award.
• If practical difficulties or other obstacles may delay the signing
of the contract, issue a letter of intent to assure the supplier
that he will be awarded the contract on the basis of the
purchasing process undertaken. This legally binding
document means that the contract cannot be issued to
another company.


• Highlight any alterations to the bid/quote.
• Negotiate the final terms (such as payment arrangements –
see Section 5.5.2).
• Agree the contract.


• Prepare the final purchase order, and get it approved and
signed by the health facility director or administrator.
• Submit the final purchase order to the supplier:
– by fax, email, or mail for quotations
– by mail only for tenders.
• When the supplier confirms receipt of the order (by fax/email) –
register their reference number.


• Ask international suppliers to issue you with a proforma invoice.


Issue the contract


Inform all other bidders


• Prepare the contract document (see main text below).
• Attach the correct documents for reference (see Box 41).
• Issue the draft to the supplier to review.
• Ensure both parties sign the final agreed contract.


• Advise all other bidders that they were unsuccessful.


Organize the funds


Make a record of the purchase


• Make financial arrangements for the release of funds.


• Open a purchase order file.
• Give it a serial number.
• Record in it the total amounts awarded and the procurement
reference number.




For the simpler or less formal purchasing methods the procedures tend not to
be so rigid or complex. Thus, for direct ordering, competitive negotiation, and a
request for quotes you would normally carry out the following procedures:
◆ for local suppliers, discuss and finalize any changes to the initial quote with the


winning supplier. You can then ask them to submit a final quotation, issue a final
Purchase Order based on this final quotation, and prepare the contract (see below).


◆ for international suppliers, discuss and finalize any changes to the initial quote
with the winning supplier. You can then issue a final Purchase Order based on this
final quotation, request a proforma invoice from the supplier, and prepare the
contract (see below).


Tip • There are four copies of the Purchase Order. One is sent to the supplier, one is filed in
stores waiting for receipt of the goods and services, one goes to the finance office for
payment to be arranged, and one remains in the order book in the Procurement Unit.


• The Procurement Unit should file their copy to create a database of all orders. In this
way you will have a record of information (such as the supplier’s contact details, unit
quantities, and code and catalogue numbers) to help you make subsequent orders.


Preparing the Contract
Preparing contracts is a highly specialized task and requires a great deal of care.
Problems can arise from misunderstandings between the buyer and supplier over
factors such as price, delivery, installation, and warranty terms.
To avoid confusion, make sure that your contract is in writing and that it gives clear,
full details of all of the following:
◆ A detailed description of the goods and services to be provided.
◆ Agreed prices.
◆ Any discounts offered.
◆ Payment terms.
◆ Documentation required.
◆ Cancellation rights, if you have any.
◆ Warranty or guarantees, with details of how long they will last.
◆ A date for delivery of the goods.
◆ Delivery terms.
◆ Penalties if either party fails to comply.
◆ The priority of the documents supplied, in case of disagreement over specific


paragraphs in specific documents.


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The contract needs to be comprehensive, but need not be repetitive. It can contain (or
refer to) previous documents for the details, provided those documents are clearly
identifiable. In that way only agreed changes need to be described separately in the
contract. However, the terms and conditions of a contract should not greatly differ from
those on which the bid/quote was requested (as outlined in the purchase document).
Box 41 summarizes the details and documents required for notifications of award
and contracts.


BOX 41: Documents and Details to Include with the Notification of Award and the Contract
Notification of award Contract
◆ Notification of award form signed by authorized


signatories, including:
- unit and total price awarded
- total quantity awarded


◆ Reference to the purchase document and offer


For a comprehensive discussion about what to include in the contract, refer to
Section 5.5.2 on preparing your purchase document. Figure 17 highlights the key
points that need to be clarified with the supplier and included.
When preparing the contract, the Procurement Unit is responsible for:
◆ checking contracts for accuracy and ensuring that specifications, and contractual


terms and conditions are clear and unambiguous
◆ checking what restrictions, if any, may apply to the import of items on the


procurement list
◆ checking whether any items of equipment require special documentation for their


transportation. (For instance, does the supplier require documents from you to
enable the goods to be exported? Do the goods require documents stating the
presence and special handling requirements for hazardous materials?)


◆ specifying the number of copies of invoices and shipping documents that you
require (often too few copies are sent, resulting in customs clearance delay and
expense)


◆ including any other special instructions (for example, no delivery at weekends or
during holidays)


◆ verifying the supplier’s bank account number and details for payment.


6.4 Award of contract and placing the order


185


◆ Contract document, including:
- general conditions of contract
- specific conditions of contract
- agreed schedule of requirements


◆ Summary price schedule for the offer submitted
by the supplier


◆ Notification of award
◆ Reference to the purchase document and offer


(although for tenders and high-value quotations
it is useful to attach these documents so that you
know where they are)




Figure 17: Summary of Key Points for a Contract Document


6.4 Award of contract and placing the order


186


Issue Key Points


Specifications


Warranty terms


Freighting terms


Delivery


• Equipment, services, and suppliers should conform to the
specifications indicated. No alterations or alternatives will be
acceptable unless confirmed in writing.
• Describe installation, commissioning and training
requirements, and ask for any site preparation needs.
• Detail the after-sales maintenance or other similar support
services expected.
• Provide details of the local nominated representative (if this
was an eligibility requirement).


Detail:
• when the warranty starts and how long it lasts
• what is covered by the warranty.


Detail:
• the transport method required (e.g. air, sea, road)
• international freighting terms
• insurance cover.


Detail:
• appointed carrier/freight forwarder, if applicable
• consolidation point, if required
• freight port of exit and arrival point of entry
• destination point
• date of delivery
• shipping and customs documents required.


Payment currency


Payment terms


• Agree on the currency in which payment will be made (this is
not always the same as the currency used for providing the
bid/quote). Payment is usually in a currency widely used in
international trade, or the currency of the supplier or buyer.
(Many international suppliers do not accept payment in local
currency, or include a contingency factor for conversions that
increases the price).
• Determine the exchange rates that will be used.


Detail:
• method of payment (e.g. letter of credit, bank draft, cheque)
• terms of payment (e.g. pre-payment, payment on-delivery,
deferred payments, phased payments)
• validity period for contract prices
• any settlement terms and discount arrangements.


Penalties for default
Detail:
• the remedies available to each party in case of default by the
other party
• the body of law under which defaults will be resolved
• penalties to the supplier for defaulting on the contract details.




If there is anything that you do not understand, ask for it to be explained. If you have
any doubts, get advice before you commit yourself.


Tip • Your contract document is a complete statement of your requirements for goods and
services.


• Problems encountered with suppliers often occur due to ambiguous standards and
poor specifications.


• Check with other health facilities, ministries, NGOs, UN agencies and clearing
agents about national import bans or special requirements. The exact stipulations
may be found in the official government gazette.


• If commercial and legal aspects of setting up the contract are ignored, then the risk
of failure or unplanned expenses is increased.


The supplier should be sent a draft copy of the purchase contract to review. Once
everything has been agreed, the contract is signed by both parties.
Copies of the final purchase contract should be kept in several places:
◆ If buying using external support agency funds or loans, copies of the confirmed


contract and all evaluation reports should be given to the external support agency.
◆ Keep a record of all purchase contracts in a database. Update these records to


show action taken, progress, outstanding issues, and the completion of the
contract (Section 8.5).


Other Contract Formats
Contracts can be drawn up to cover long-term arrangements, such as a supply-period
contract which awards a supplier with the contract to supply certain goods over a set
number of years (Section 4.1).
Establishing a longer-term contract with a supplier (for example, for two to three
years or longer) can:
◆ cut contract transaction costs
◆ reduce the cost of holding stock, and
◆ help towards your standardization policy (Section 5.5.2).
Under long-term arrangements, buyers and suppliers agree commercial terms
(for example, prices, delivery schedules, and packing requirements) for the term
of the contract. Then, when an order is placed against the contract, it can be
delivered rapidly.


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187




Note: you may enter into other types of contract if you procured your equipment by
some means other than purchasing, or you procured services without purchasing
equipment. If you:
◆ lease equipment (Section 5.3) – you need to complete the leasing contract of


the commercial firm you have chosen
◆ request donations of equipment (Section 5.3) – you need to complete the


donation agreement
◆ require maintenance and repair support – you need to enter some form of


contractual arrangement (see Guide 5 on maintenance management for the
options available).


Debriefing Unsuccessful Bidders
Until the successful bidder has been notified, no other bidder should be informed
about decisions relating to the award of the contract.
Once successful bidders have been informed, you should make the summarized
results public and carry out debriefing, if requested by the unsuccessful bidders.
This can be carried out verbally or in writing. Debriefing should cover:
◆ a list of all contracts awarded and names of successful bidders (if necessary the


names can be omitted)
◆ details of the total value of each contract. Details of the actual item price or rates


in individual offers are confidential and should not be disclosed. However, you
may disclose a prospective supplier’s ranking. If the bidder was the lowest in cost
terms but not selected on value for money, it is better to tell the bidder that,
although their price was competitive, other factors were more significant in the
award decision.


You should also give the unsuccessful bidders feedback on issues such as:
◆ offer terms and technical details – where these differed fundamentally from those


of the buyer
◆ aftersales service – inadequate arrangements for servicing or supply of spare parts.
While there may be no obligation to debrief suppliers, it is good practice to do so.
There are many benefits, including:
◆ establishing a reputation as a fair, honest, ‘open’ buyer
◆ offering unsuccessful bidders valuable information that will help them to be more


competitive in the future. This is likely to be of most value to smaller and newer
suppliers.


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6.5 LOCAL DIRECT PURCHASING AND ORDERING
Besides tenders and quotations, there are two ways to obtain goods locally – local
direct purchasing, and ordering from stores.


Making a Local Direct Purchase
Usually, health service providers have established a financial limit, below which
items can be bought by health facilities from suppliers in their local vicinity without
central permission (Section 2.2).
Low value items occasionally need to be bought direct from the local market,
without the need for three quotes (although experience and regular purchasing may
have provided you with knowledge of the best sources). For example:
◆ basic office items, such as stationery, which are in constant demand
◆ items required to directly meet a specific demand that could not be met from


stock (non-stockable items)
◆ items required in an emergency, or for prompt purchase of goods
◆ where the quantity needed is small
◆ where the item is not supplied by the official stores.
When making such local purchases, you should use a Purchase Order (Section 6.4).
This one document performs various functions:
◆ It authorizes you to buy and serves as a guarantee for the supplier that goods will


be paid for (Section 6.4).
◆ It is a record that the goods have been delivered/collected. For the procedures


required for this, see Section 8.2.
◆ It is a trigger to ensure payment is made. For the procedures required for this,


see Section 8.5.
For local direct purchases, the supplier is usually paid at the time of collection or
delivery, and often in cash (or occasionally by a cheque prepared by the finance office).
Accurate records should be kept of these payments, as described in Section 8.5.
Health service stores should review their stock levels regularly to ensure that they
are sufficient to meet demands. New orders should be based on the turnover of the
store (plus, for central/zonal stores acting as distribution centres, the expected
consumption of the health facilities they supply).
When a Purchase Order is drawn up, the unique reference number of the originating
order from the requesting department (user, maintainers, or stores) is recorded on it.
This makes it possible to trace any purchase back to the person who ordered it,
check progress with the order, and match the Purchase Order with its originating
order (see Annex 11).


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189




Ordering From Health Service Stores
In many countries, health service stores hold stocks of small items of equipment
(such as instruments, bed pans), as well as equipment-related supplies (consumables,
accessories and spare parts). Sometimes these items are kept in the Medical Stores
system and sometimes in the Supplies Stores system (Section 7.3). They may be
held in the health facility store, and restocked from central or zonal (district,
diocesan, regional) stores that act as distribution centres. Therefore you should:
◆ find out the correct point of supply for the equipment you require (from the


health facility’s pharmacy or stores departments, from Central Medical Stores,
from the district Supplies Store, and so on)


◆ note down the name of the Procurement Officer through whom your requests
should be channelled.


Internal orders from departments to the health facility store usually occur on a weekly
basis. However, external orders are normally placed with the central/zonal stores at
greater intervals – usually monthly or quarterly – and delivered according to a fixed
schedule. These external orders are either paid for in the usual way, such as by
cheque, or a budget allocation is set up at the central/zonal store that the health
facility can spend. Each Procurement Unit should ensure they:
◆ are familiar with the different sources of supply, and the different sources’


procedures for acquiring goods (such as defined supply periods)
◆ use the stock cards to determine the order quantities required before the next


supply period, and to ensure rational stock levels (see Guides 4 and 5)
◆ only order items your health facility needs and is authorized to keep
◆ only order items if sufficient funds/budget allocations are available.
Equipment and equipment-related supplies can be ordered from stores using various
standard requisition and issue forms (see Annex 11). These forms are printed in
books (in triplicate at least) with sequential order numbers for each form. They can
also be pre-printed with a list of available items, together with their specifications
and stores code numbers. The requisition forms need to be authorized by various
people at health facility level, as follows:
◆ for internal requisitions for goods from health facility stores – the requisition


forms should be authorized by the head of the requesting department
(equipment user, maintenance, or administration). They should also be cleared by
a Finance Officer, who checks that funds are available in the relevant budget.


◆ for external requisitions for goods from central/zonal stores – the requisition forms
should be authorized by the Stores Controller and the Procurement Manager. A
Finance Officer should check that funds are available in the budget expenditure
line set up with the central/zonal store. If not, alternative methods of payment
will be need to be arranged.


6.5 Local direct purchasing and ordering


190




Guides 4 and 5 provide details of how to use these forms to order stocks. You should:
◆ fill in requisition forms clearly, giving as much detail as possible about your


requirements and specifications. This helps to avoid incorrect items being
supplied and prevents delays in filling your order.


◆ process and file the copies of the requisition form in the following areas,
as appropriate:
- the requesting department
- the stores that you are placing an order with
- the Finance Office
- the Procurement Unit.


Getting the Order Right
Figure 18 provides tips on ordering supplies. The recommendations apply to all
recurring supplies ordered at health facility level (both locally and internationally).


6.5 Local direct purchasing and ordering


191




Figure 18: Tips on Ordering Supplies


6.5 Local direct purchasing and ordering


192


Step Activity


Check your stocks


Make a list of your needs


Describe fully what you want


Indicate the quantities required


Check your order


• Carry out a stock-take or check the stock records to find out
the stock balance.
• Decide which items to order and determine the quantities
required (see advice in Guides 4 and 5).


• If you are not using a pre-printed requisition form, list the
supplies to be ordered alphabetically and divide them up into
categories, such as consumables, accessories and spare parts.
• Only include one item and one item size on each line.
• If you are ordering from a catalogue, write down the catalogue
code number for each item.


• Provide a full and clear description of each item.
• When ordering things that need to be used together, (e.g.
battery-operated items and types of batteries), pay particular
attention to specifications to ensure that you order compatible
items.
• When ordering electrical items, include information about the
voltage, frequency and wattage requirements for your health
facility.
• When ordering equipment consumables, accessories, and
spare parts, provide as much information as possible,
including details such as: manufacturer, model or type of
equipment the part is for, the part’s serial or order code
number, a description of the part and, if possible, a diagram
including accurate measurements.
• When ordering chemicals, reagents and stains, provide the
correct name and, if possible, the chemical formulae. Indicate
whether you require powder, liquid concentrate, or ready-made
preparations.


• Specify the quantity of each item.
• Place orders for complete packs. For example, if you need
34 packs of disposable ECG electrodes and a box contains
12 packs, order three boxes.


• Check that all copies of the order are easy to read and are
signed by an authorized person.
• Check that the purchase order form/requisition form includes
your full contact details.


Consider carefully any feedback
from the supplier


• If the supplier/store is unable to provide the specified item,
see if they are offering an alternative.
• Check that the alternative is appropriate for your needs and
affordable within your budget.




Section 6 summary


193


BOX 42: Summary of Issues in Section 6 on Managing the Purchasing Process


Procurement/
Tender Committee
and/or Procurement
Unit


Procurement
Manager


Procurement Unit


Procurement/
Tender Committee
(or Procurement
Manager for
low-value orders)


Procurement Unit


Procurement/
Tender Committee
Procurement Unit


Lo
ca


l O
rd


er
s



Co


nt
ra


ct
in


g






E


va
lu


at
in


g






O


pe
ni


ng


R
eq


ue
st


in
g ◆ once the decision is made on how to procure (Section 5.3), prepares requests


either for tender bids or for quotations
◆ checks the invitations to bid for completeness and accuracy
◆ depending on the purchasing method (Section 4.2), advertizes for suppliers or


directly contacts pre-qualified suppliers


◆ receives offers and stores them safely until the opening date
◆ accepts only those offers received by the specified date
◆ opens the offers on the specified date in the presence of the correct team


(see Box 35)
◆ registers the offers and processes them to see if they meet certain criteria


(see Box 35)
◆ checks the bids/quotes for compliance and discards those that are not


‘substantially responsive’
◆ prepares Evaluation Information Sheets (see Box 36) for the


Procurement/Tender Committee to compare the offers
◆ compares each offer against the technical aspects of the product selection


criteria, and discards those that fail
◆ compares each offer against the financial aspects of the product selection criteria,


and discards those that fail
◆ makes a provisional recommendation and consults the potential users and


maintainers
◆ evaluates the winning supplier according to the supplier qualification criteria,


and if the first choice fails, evaluates the second choice, and so on
◆ makes the final decision
◆ prepares the Notification of Award and final Purchase Order
◆ notifies the winning supplier and discusses terms
◆ prepares the contract document, with specialist assistance as necessary
◆ provides feedback to unsuccessful suppliers
◆ draws up any other types of contract necessary, such as long-term, leasing,


donation, or service contracts
◆ for tenders and high-value quotations, approves the formal documents prepared


by the Procurement Unit
◆ uses Purchase Orders when buying direct from suppliers in the local vicinity (see


Annex 11)
◆ uses stores requisition and issue vouchers (see Annex 11) when ordering from


health service stores (whether the health facility store or central/zonal
distribution centre)


◆ ensures supplies are ordered correctly (see Figure 18)


Box 42 contains a summary of the issues covered in this Section.




194




7. HOW TO RECEIVE GOODS AND
DISTRIBUTE THEM TO SITE


Why is This important?
It is necessary to prepare to receive shipments, in order to avoid delays. It is
also important to ensure safe delivery, safe storage at your distribution
centres, and safe onward despatch.
These activities are key to improving both your performance and the delivery,
and also enable you to control costs.


In this Section, we consider how to receive goods and distribute them to site by
studying the following activities:
◆ Preparing to receive equipment and supplies (Section 7.1).
◆ Safe shipment, customs clearance, and transport to distribution centres


(Section 7.2).
◆ Storage at distribution centres and despatch (Section 7.3).
◆ Delivery to final destination site (Section 7.4).


7.1 PREPARING TO RECEIVE EQUIPMENT
AND SUPPLIES
Once a contract has been awarded (Section 6.4), several tasks must be carried out
while you are waiting for the equipment to arrive.


7.1.1 Monitoring Progress Using a Gantt Chart
You can monitor the progress of your order using a Gantt Chart, as shown in Figure 19.
In a Gantt Chart you display all the activities, from placing the order to using the
equipment. To do this you use lines or bars that extend over calendar months to
show when each activity starts and how long it should take. As each activity occurs,
you mark how long it is actually taking. This shows at a glance what activities are
behind schedule, on time, and ahead of schedule.
Using the Gantt Chart, you can coordinate all your activities across the agreed time
period. For instance:
◆ activities represented by overlapping bars can be performed at the same time
◆ activities shown by non-overlapping bars must be carried out in the


sequence indicated.


7 How to receive goods and distribute them to site


195




Calendar
Activities Timing April May June July August September October


Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual
Planned
Actual


Filling the order
Pre-shipment
inspection


Initial despatch


Site preparation


Consolidation


Shipment


Estimated arrival
Customs
clearance
Onward
transportation
Receipt of
equipment
Inspection and
verification
Preparing training
materials
Installation


Commissioning


Acceptance


Initial training


Handover


Payment
Note: This Gantt Chart shows the planned timing of activities. The Procurement Unit/Commissioning Team need to monitor progress and then mark in the actual timing of activities.


Multiple suppliers


PSI Team


Suppliers


HTM Team


Freight forwarder


Freight forwarder


Freight forwarder


14/7


Clearing agent


31/7 Stores Controller


Commissioning Team


Training sub-group


HTM Team and external team


HTM Team and external team


Commissioning Team


In-house and external trainers


10/9 Commissioning Team/Stores Controller


Procurement Unit/Finance Office


If external support agencies or procurement agents are purchasing the goods on your
behalf they should monitor the progress of orders and keep you updated and
informed of progress. However if you are purchasing your own goods, then your
Procurement Unit and HTM Working Group (or its smaller Commissioning Team)
is responsible for monitoring the procurement programme and detecting when
delays may occur.
The Procurement Unit/Commissioning Team should prepare the Gantt Chart, either
drawing it by hand or using a computer spreadsheet program. They need to take the
steps shown in Figure 20.


Figure 19: Example of a Gantt Chart Monitoring Progress With Orders


7.1.1 Monitoring progress using a Gantt chart


196




7.1.1 Monitoring progress using a Gantt chart


197


Step Activity


Note down all the activities that
must take place


Estimate the time required


Draw up a visual schedule


Use the chart to monitor
progress


Respond to changing
circumstances


From the time the order is placed to the eventual use of the
equipment, the activities may include:
• filling the order
• pre-shipment inspection
• initial despatch
• site preparation
• consolidation
• shipment
• estimated arrival
• customs clearance
• onward distribution
• receipt of equipment
• inspection and verification
• installation
• commissioning
• preparing for training
• acceptance
• training
• handover
• payment.
Note: you can use a Gantt Chart that starts at the beginning of
the purchasing progress, and include activities such as writing
specifications (see time-critical procurement in Box 30)


For each task, decide when it should start, how long it will take,
and who is responsible for carrying it out.


Show all the activities and timings that have to take place, by
representing them as lines/bars extending over calendar months.


As each activity occurs, mark on the chart how long each one is
actually taking.


If activities are delayed, either take corrective actions to get back
on schedule or notify all relevant parties that you are
rescheduling subsequent activities.


Figure 20: How to Set Up a Gantt Chart


There will always be critical and non-critical tasks in a Gantt Chart:
◆ For critical tasks, the estimated time required is equal to the time available in


the programme, and any delay will result in a lengthening of the whole
programme. For example, if it takes the supplier longer to fill the order than
expected, the initial despatch of the goods must be delayed.




◆ For non-critical tasks, the time required is less than that available in the
programme. However if a non-critical task is delayed, there will come a time when
other activities dependent on that task also become delayed and the task then
becomes critical to the programme. For example, shipping, clearing, and delivery
of goods might take several months. During this time, you must prepare the site,
which may only take a fortnight. However, if you delay the site preparation, you
may not be ready when the goods arrive.


The Procurement Unit and Commissioning Team are responsible for monitoring the
chart, making any revisions necessary, and detecting delays. In case of delay, they
need to take appropriate corrective action. For example:
◆ It may be possible to put an activity back on schedule by using additional


resources to complete it. (For example, if the rate of construction of a pump
housing is behind schedule, you could ask the builder to employ more tradesmen
and labourers.)


◆ It may be possible to remove the activity from the critical category by finding an
alternative way of meeting the conditions required for subsequent activities. (For
example, if the electricity supply cannot be connected in time for installation of
the equipment, you could consider using a temporary supply from a generator so
that installation can go ahead).


If the delay cannot be made up, it is necessary to revise the programme to accept the
delays. This means the Procurement Unit/Commissioning Team must:
◆ reschedule the subsequent activities which are affected
◆ inform the HTM Team responsible for preparing the site of the new schedule
◆ inform the manufacturer/supplier or their representative (or any other contractor)


responsible for installation and commissioning
◆ liaise with visiting engineers and other experts before they have left their


countries/towns or booked into local hotels, to avoid unnecessary expense
◆ notify the Health Management Team at the facility
◆ keep any external support agency involved updated of progress.
For quick reference, it is useful to display the Gantt Chart on the wall of the
coordinating office. This is usually the office of the Procurement Unit and/or the
Commissioning Team.


7.1.1 Monitoring progress using a Gantt chart


198




7.1.2 Pre-Installation Work
Pre-installation work involves:
◆ preparing the site ready for equipment when it arrives
◆ organizing any lifting equipment
◆ organizing any warehouse (storage) space
◆ confirming installation and commissioning details
◆ confirming training details.
In some cases, the pre-installation work required is minimal; in others it requires
considerable labour and finance.


Experience in Africa
Lack of pre-installation work can lead to equipment which is unusable.
For example:
On an East African island, a huge steam-driven washing machine was
left to rust for several years on the site of a 50-bed clinic. This was due to
the fact that the clinic had no electricity apart from a small generator.
Finally the washing machine had to be dumped.
The cost to transport the machine to the clinic swallowed up about the same amount
of money as the clinic needed to run for a year.


Site Preparation
As a general guide, site preparation is the work required to ensure that the room or
space where the equipment will be installed is suitable. It often requires the
provision of new service supply connections (for electricity, water, drainage, gas,
waste) and may require some construction work. Site preparation tasks can include:
◆ disposing of the existing obsolete item (disconnection, removal, cannibalizing for


parts, transport, decontamination and disposal)
◆ extending pipelines and supply connections to the site, from the existing


service installations
◆ upgrading the type of supply, such as increasing the voltage, or the


pipeline diameter
◆ providing new surfaces, such as laying concrete,


or providing new worktops
◆ creating the correct installation site, for example,


digging trenches, building a transformer house
or a compressor housing.


7.1.2 Pre-installation work


199




When considering where to position equipment, you should ask yourself the
following types of questions:
◆ Is there sufficient access to the room/space? (Door sizes and elevator capacity are


very important for X-ray and other large machines.)
◆ Is the room/space large enough?
◆ Is the position and layout of the room/space suitable?
◆ Are the required work surfaces and service supply points available?
◆ Is the environment adequate for the purpose? (For example, is it air-conditioned?


Dust-free? Away from running water?)
If you are constructing new buildings or extensions, different relevant departments
and groups need to work closely together to design the rooms and plan the service
supplies. Planners, users, architects, service engineers, and equipment engineers
need to be consulted (see Guide 2 on planning and budgeting).
Site preparation can be carried out by:
◆ in-house staff (for example, the facility HTM Team or a central/regional


HTM Team)
◆ maintenance staff from other national agencies (for example, electricians from the


Ministry of Works)
◆ a contractor you have hired (for example, a private company or an NGO partner)
◆ the supplier or their representative.
While planning and budgeting for your equipment (see Guide 2), you should have
estimated site preparation costs for inclusion in your budget. However, as soon as the
order is placed, the HTM Working Group/Procurement Unit should provide the
supplier with details of the proposed equipment site and services, and officially
request the necessary site preparation instructions.
Once these are received the HTM Manager can plan the work, quantify the needs
and costs for materials and contractors (Section 5.1), and apply for a budget
allocation. He or she should then oversee the work, and ensure it is undertaken
before the equipment arrives.
Figure 21 shows the common site preparation steps that may be required,
depending on the type of equipment purchased.


Tip • By the time the goods start to arrive, the site should be ready to receive them.


7.1.2 Pre-installation work


200




Figure 21: Common Site Preparation Steps


7.1.2 Pre-installation work


201


Step Activity


Review technical needs


Remove existing equipment


Construct or alter building


Provide electrical requirements


Ensure the electricity installation
is safe


• Study the manufacturers site preparation instructions
• Use experience and common sense.


• Cut supply connections and remove the existing item.
• Cannibalize the existing item for parts.


• Build any special construction required, such as a transformer
housing, lead screening, room extension.
• Make any special modifications necessary, such as enlarging
the doorway, or building a worktop.
• Remove any scrap or other items from the room.


Undertake the work required to provide (as necessary):
• a new transformer
• a new or upgraded generator
• a single phase or three-phase supply at the site of installation
• a special circuit breaker
• a special socket outlet
• an electrical circuit with sufficient capacity.


Undertake:
• an exercise to ensure that all relevant electrical installations
are properly grounded and tested
• any remedial works as required.


Provide water and drainage
requirements


Undertake the work required to provide (as necessary):
• adequate water pressure
• water treatment
• increased pipeline diameter
• proper drainage
• appropriate connection points.


Provide steam supply
requirements


Undertake the work required to provide (as necessary):
• a steam supply at the proposed site
• increased pipeline diameter
• a boiler which can accommodate the increased load
• appropriate connection points.


Provide gas supply requirements
Undertake the work required to provide (as necessary):
• relevant gas supplies at the proposed site
• appropriate connection points.


Provide extra specific
requirements for installing the
equipment


Depending on specific guidelines for certain types of equipment
(as detailed by the equipment supplier), provide:
• bolts in the ceiling for attaching operating lights in theatres
• trenches for supply lines to dental suites
• trenches for waste water for washing machines
etc.


Provide any additional
equipment needs


Provide any associated items as necessary for the equipment
or installation, such as:
• an air-conditioning unit
• an uninterruptible power supply (UPS)
• a water pump.




Country Experience
Many countries have examples of poor site preparation:
◆ A special care baby unit so small that the phototherapy lamp treated all the babies


whether they needed it or not.
◆ Piped gas not extended to all labour rooms in the maternity department.
◆ No lead lining in rooms intended for clinical radiography.
◆ Centrifuges without proper interference filters, affecting the performance of other


electronic machines.
◆ A haematology analyser, very sensitive to environmental conditions, unable to be


commissioned because of interference from the room’s overhead light.
◆ A gas-driven ventilator installed in an operating theatre with no gas line.


Organizing Lifting Equipment
When equipment arrives it needs to be unloaded, carried to the correct location, and
positioned ready for installation. Depending on the size of the equipment, these
tasks could be undertaken by stores, grounds, or maintenance staff, with the help of
stores trolleys and hand carts. However, if the goods are large and/or heavy, you may
need to hire lifting equipment such as cranes or fork lift trucks.


You should have made estimates of these hire costs for inclusion in your budget (see
Guide 2), and quantified the needs in Section 5.1. However, as soon as the order is
placed the HTM Working Group/Procurement Unit should:
◆ consult the supplier about the size and weight of crated goods
◆ identify specific lifting requirements
◆ locate local hire sources and identify their costs
◆ enter into hire agreements in advance of the equipment’s arrival.


7.1.2 Pre-installation work


202




Organizing Warehouse Space
You need to consider any storage requirements, and make arrangements for goods
which have to be stored before they can be unpacked and installed. It is common to
make use of your health service provider’s stores as distribution centres, and to find
suitable rooms in the health facility for unpacking (Section 8.2). However there are
some instances when you will have to pay for warehouse space:
◆ If goods are stored by customs because you have delayed clearance or have not paid


duty, then customs will impose charges on you (known as demurrage charges).
◆ If equipment has to be stored when it arrives (perhaps by your freight forwarder,


clearing agent, or a local warehouse) until you are ready to receive it on site, or
install it.


Obviously, it is preferable to avoid these expenses. Thus it is important that the
Procurement Unit and Commissioning Team try to monitor and avoid delays in the
procurement process (Section 7.1.1). However, if these costs cannot be avoided the
Procurement Unit must:
◆ consult with customs and identify costs
◆ consult with the freight forwarder, clearing agent, or local storage warehouses


and identify costs
◆ make choices between the options, and make the arrangements and


payments promptly.


Installation and Commissioning Details
You should already have decided who will undertake installation and commissioning
when drawing up the purchase contract (Sections 5.5.2 and 6.4). The Procurement
Unit/Commissioning Team should liaise with the installation team about the details
that need to be confirmed. You will need to ask the installation team for their
requirements for working/storage space, test instruments, and materials (such as
consumables that will be used during the commissioning process) – Sections 8.3.1
and 8.3.2.
If the supplier (or other relevant agent) is doing the installation and commissioning,
a good time to ask these questions is when you contact them about site preparation
and lifting needs (see above). If you are using some other external agent, now is the
time to contract them and agree all necessary arrangements for their visit (see
Figure 25 in Section 8.3.1).


7.1.2 Pre-installation work


203




Training Details
You should already have decided who would undertake initial training when drawing
up the purchase contract (Sections 5.5.2 and 6.4). The Procurement
Unit/Commissioning Team should liaise with the training sub-group (Section 1.2)
about the training details that need to be confirmed with the chosen trainers. You
will need to:
◆ remind the trainers of the full range of training and training materials required


from them
◆ ask the trainers for their requirements for training space, training equipment (for


example, an overhead projector), and training materials (for example,
consumables that will be used during the training sessions) – Section 8.3.3.


If the supplier (or other relevant agent) is doing the initial training, a good time to
ask these questions is when you contact them about site preparation and lifting
needs (see above). If you are using some other external agent, now is the time to
contract them and agree all necessary arrangements for their visit (see Figure 27 in
Section 8.3.3). If you are undertaking the training in-house, appoint suitable
trainers so that they can prepare for the task (Section 8.3.3).


7.1.3 Preparing for Customs Clearance
International shipments enter a country through a seaport, an international airport,
or land customs depot. Countries control the flow of their imports and generate
revenue through customs inspections, duties, and taxes. Customs agents will not
release imported goods until all duties are paid or a customs exemption certificate is
provided, and goods are inspected. Customs have to investigate all invoices because
in some cases the true value of shipments is understated to reduce the amount of
import duty to be paid. If Pre-Shipment Inspection has been requested (Section
5.5.2) this will speed up the customs process.
Before the goods arrive in the country, it is sensible to deal with clearance issues in
advance. This will help to speed up the clearance process and the transport of goods
from the port to the delivery site. Box 43 outlines the main points to consider.


7.1.2 Pre-installation work


204




BOX 43: A Checklist of Customs Clearance Arrangements
Acting on the following considerations will help speed up customs clearance:
◆ Are any special documents required?
◆ Do you know the procedures and time required for obtaining import licences?
◆ Are you aware of import duties? Have you allowed for this in your budget and timetable?
◆ Are you aware of any exemptions to import duties?
◆ Is documentation necessary for importation clearance?
◆ Are you aware of the rate and cause of demurrage charges (storage charges imposed by customs because


you have delayed clearance or not paid duty)?
◆ Are there any special handling requirements for products (for example, refrigerated storage for heat-


sensitive products)?
◆ Are you arranging clearing in-house or employing a clearing agent?
◆ How will the goods be collected and delivered to their destination?
◆ Do you or your clearing agent have a good working relationship with customs officials?


You may require special documentation for importing some types of goods – see
Box 44 in Section 7.2.1. You should have checked for this when placing the order
(Section 6.4). Prior to customs clearance, the Procurement Unit will need to
organize the paperwork required. Often problems arise because customs officials
have difficulties in assessing the essential nature or intended use of some health
service goods being imported. Therefore it is important to fill in the forms and
communicate with customs effectively.
You should have already chosen your specialized clearing agent or forwarding agent to
clear and deliver the goods, if you do not have an experienced team with clearing and
forwarding skills (Section 5.5.2). Now is the time to contract them and
communicate with them on their requirements.
A duty is charged on all types of goods exported and imported. An external support
agency or organization exporting goods to its projects overseas has to pay duty at the
time of export, and duty in the country of import. In some cases, health service
provider organizations offering charitable or free-of-charge health services may be
exempt from paying these duties. However, this is the exception rather than the rule.
As a buyer you need to:
◆ know what the customs requirements are for sea, air, or land shipments
◆ be familiar with the duties to be paid
◆ know whether you are exempt from paying customs duties in the recipient country


(this is the case for many goods purchased by NGOs, missions and government)
◆ know who has the authority to grant duty-free entry
◆ establish standard document lists, and procedures for submitting them to the


correct people, to help get customs exemption quickly.


7.1.3 Preparing for customs clearance


205




Tip • To help you plan the customs clearance procedure, it is useful to draw up the
information in a table, listing:
- all the different steps required (with a description and the officials involved), and
- the resources (time and costs) needed for each step.


7.2 SAFE SHIPMENT, CUSTOMS CLEARANCE AND
TRANSPORT TO DISTRIBUTION CENTRES


7.2.1 Safe Shipment and Customs Clearance
Once an order has been placed, the Procurement Unit should monitor its arrival
using the Gantt Chart (Section 7.1.1). The Procurement Manager has overall
responsibility for safe delivery and handling of customs clearance. However, contract
terms and agreements will determine who has responsibility for the insurance and
transport management of goods. Depending on the delivery conditions you specified
(Section 5.5.2), the responsibilities and duties of the buyer, seller, and freight
forwarder may vary (see the Incoterms in Annex 8).


Tip • In most cases, the supplier clears the goods for export, while the buyer (or their
representative such as a freight forwarder, clearing agent, or procurement agent)
clears the goods for import.


Safe Shipment
Shipment of goods can be by a variety of methods – sea, air, road, rail, river. Shipment
can take place in stages with different bodies responsible for different stages, as follows:
◆ A foreign supplier’s contract may require them to deliver to a port in your country,


then you organize onward transportation after customs clearance at the port.
◆ The supplier’s contract may require them to deliver to one of your central/zonal


distribution stores (including customs clearance if from abroad), then you
organize onward transportation to the health facility.


◆ The supplier’s contract may require them to deliver direct to the final destination
health facility (including customs clearance if from abroad).


Deliveries direct to the health facility site should be considered for large and
complex goods. In this case, your purchase contract would have to specify direct
delivery (DDU, DDP, CPT or CIP – see Annex 8). For goods from abroad, there
would need to be a halt mid-journey for the goods to clear customs. It is not usually
economical for the supplier’s freighting company to then carry out the last part of the
journey in your country. In some cases it can add up to 15 per cent or more on to the
cost of the goods).


7.2.1 Safe shipment and customs clearance


206




Thus, you should have either:
◆ appointed a freight forwarding agent for the supplier to use, as specified in the


contract document (Section 6.4)
◆ contracted the clearing agent, if you are using one, to arrange for transportation


and delivery to your facility
◆ contracted a freight forwarding agent or local delivery company yourself – however


this is only possible if you are clearing the goods through customs yourself, which
is difficult in many countries.


Alternatively, if your health facility is a great distance from the major port of entry
(such as the capital), but is near to a smaller port of entry (another airfield with
customs officials, for example), you can specify that the supplier’s freighting
company goes through a process known as ‘pre-clearance’ of customs (Section
5.5.2). This means that the goods can go straight to the local customs site without
being processed in the capital.
The Procurement Unit can monitor the progress of shipments by liaising with the
shipping agent, or by using the internet to track goods that have been registered
for shipment.


To ensure your goods arrive safely, you should have arranged for freighting methods
and terms that include insurance (Section 5.5.2). Goods bought internationally
should be insured against damage and loss. As a bare minimum, the insurance should
cover shipment. Ideally, it should extend to cover areas such as all transportation
and installation.
The Procurement Unit must ensure that all shipments are routinely inspected when
they are accepted at the port, central distribution store, and/or final destination, in
order to identify damaged goods or short shipments (shipments with parts missing) –
see Section 8.2 for procedures on checking deliveries, and Section 8.6 for
procedures if goods are damaged or lost.


7.2.1 Safe shipment and customs clearance


207


NO




Procedures for Clearing Customs
Customs clearance can be both inefficient and time consuming, leading to losses and
extra costs. This is partly due to slow customs procedures but, most often, it is
because import regulations have not been followed, documentation is missing, or
buyers and sellers have failed to communicate properly.
Consignments have been known to remain at
ports of entry for months, facing possible damage
and theft and accumulating storage charges
(demurrage charges), due to late submission of
shipping documents or delays in clearing.
Demurrage charges are often difficult to meet,
due to their unexpected nature, and can build up
quickly when deliveries are stalled in customs.
The Procurement Unit can avoid customs delays by:
◆ making sure they have prepared for customs clearance (Section 7.1.3)
◆ ensuring they liaise with the carrier, clearing agent, and customs to negotiate and


handle all delivery and customs matters. These include the issues detailed in
Figure 22.


Documentation Used in Clearance
You can plan your needs for customs clearance documentation by using Box 44,
which lists the range of possible documents required – you will need to discover
which are relevant for each shipment. The documents required will vary depending
on your country, whether the goods are transported by land, air or sea, and the type
of goods being shipped.


Tip • If in doubt about the documents required for clearance ask for advice from the carrier
and clearing agent.


7.2.1 Safe shipment and customs clearance


208




Figure 22: Delivery and Customs Issues to be Handled


7.2.1 Safe shipment and customs clearance


209


Step Activity


Identify the arrival of shipments,
and the details required for
customs clearance


Obtain documentation for
customs clearance


Monitor the shipment’s progress


Supply the correct documents to
customs


Make any necessary payments


• As soon as the goods are freighted, ensure the supplier
informs you (by fax or email) of details of the shipment
including:
– contract number
– description of goods
– quantity
– the name of the carrying vessel, aircraft or vehicle
– the bill of lading number and date (see Box 44 in section
below)
– port of loading
– date of shipment
– port of discharge
– estimated time of arrival
etc.


• Ensure the supplier provides you with the original copies of the
documents used in port clearance (see Box 44) such as:
– supplier’s invoice showing goods description, quantity, unit
price and total amount
– original and additional copies of bills of lading
– packing list for each package/box
– insurance certificates (if insured)
– manufacturer’s or supplier’s warranty certificate
– certificate of origin.
• Ensure the supplier mails these to you (with a copy to the
insurance company, if required).
• Port authorities usually require the original copies of the
documents for clearance. This can be difficult to organize, but
an experienced handling/clearing agent should be able to
handle these requirements for you.


• Check progress on a regular basis, either with the carrier’s
local agent or by looking at the computerized tracking service
on the internet (provided by large freight companies and some
customs departments).
• Contact the carrier’s local agent to obtain the exact arrival date,
and details of the place/port at which the shipment will arrive.


• Ensure that the necessary documentation is correct and
provided to customs on time (see Box 44)
• Ensure that the description of the goods in any duty/tax
exemption certificates (if required) accurately defines the
goods in the consignments.
• Try to obtain documents in advance of the shipment’s arrival –
this helps to avoid storage charges.


• Arrange payment on time for duty plus any administrative
charges, such as charges for permits – this helps to avoid
storage charges.




BOX 44: Range of Documents Possibly Required for Clearing Customs
Typical Requirements Description
To be arranged by the supplier/carrier:
Bill of lading or waybill


Certified invoice(s)


Manifest or packing list


Various export/verification
certificates (as applicable)


7.2.1 Safe shipment and customs clearance


210


This is the freighting contract and proof that the goods are on board
the transport vessel. It describes the load in terms of the number of
packages, volume, weight and any other useful information. The bill
of lading applies to sea (maritime) transport. Waybills refer to land
and air transport (such as an airway bill).
A proforma invoice from the supplier showing the order details and
order value is used by customs to determine the customs value of the
goods. Often it has to be certified by the bank through which the
payment has been arranged.
The manifest is the document that indicates the type of products
sent, their point of origin (where their journey started) and their
destination. It is used by customs officials in the country receiving
the goods.
The packing list is the document that identifies the load package by
package (in other words, lists the exact content of the consignment).
You might find one overall packing list or one packing list per
package/crate. Packing lists often include a reference to order
numbers. It also resembles an invoice or delivery note.
Note: you may find a combination of a waybill and a packing list.
Usually the paper looks like a packing list, and includes the total
number of boxes plus volume/weight details.
A certificate of origin specifies the country where the goods were
manufactured, certified by that country’s Ministry of Trade and
Industry or Chamber of Commerce.
A certificate of manufacture from the exporting country confirms that
the product is manufactured by a licensed manufacturer, or is
authorized for sale in the country of export. It may include additional
details, such as confirmation that the manufacturer is licensed to
produce specific types of items (sterile/non-sterile, liquid/semi-solid,
products for internal/external use, etc). It will also provide assurance
that manufacture is carried out in accordance with Good Manufacturing
Practice, and is regularly inspected by a Medicines Inspectorate.
A certificate of analysis is provided for solutions (reagents, supplies,
etc) and describes the contents of the particular lot/batch of product
being shipped.
Verification certificates can be issued by third parties to verify specific
factors relevant to the shipment. Such factors could include
verification of the product’s value, confirmation that there is a contract
for the import of the goods, assurance that the contents are safe, or
confirmation that the Pre-Shipment Inspection has taken place.


Continued opposite




BOX 44: Range of Documents Possibly Required for Clearing Customs (continued)
Typical Requirements Description
To be arranged by the supplier/carrier (continued):
Various export/verification
certificates (as applicable)


Trader identification number
(TIN) of the importer


Insurance certificate
(if applicable)
To be arranged by the buyer/clearing agent:
Import declaration form


Duty exemption certificate
(if applicable)


Import license/permit
(where applicable)


Customs Bill of Entry


Normally, the shipper sends the documents they are responsible for once the goods
have been handed to the carrier. If this has not happened, you should request that
these documents be sent as soon as possible so you can proceed with the necessary
customs clearance arrangements.


7.2.1 Safe shipment and customs clearance


211


A donation certificate states that the shipment is a donation. This is
important to ensure equipment supplies are not subject to import
tariffs in the destination country
A declaration of hazardous materials is a document that should be
included when the shipment carries one or more chemical products
that require special care, handling or testing. Such products could
include laboratory reagents, water purification products or radio-
active components.
This is the trader identification number linked to the ‘New
Computerized Transit System’ that requires shippers to register their
shipments on the internet or by email. The buyer can then track the
progress of their goods on the internet.
This shows details of the insurance policy and premium taken out on
the shipment/transportation


All importers need to complete this form and attach all other
documents to it for submission to customs.
The Ministry of Finance or the Revenue Department issues
exemption certificates for certain goods that do not require tax or
import duty to be paid (this sometimes applies to donations).
Most goods require an import license, and some restricted items
require special import permits. These are usually issued by the
Ministry of Finance or Ministry of Trade and Industry.
This is a written account of the goods entering the country, which is
used by customs for verifying and approving the release of the goods
to you.




7.2.2 Delivering Goods from Customs to Initial Destination
Some goods may be delivered directly to the purchasing health facility. (Normally,
this can only happen if the entire order is for one health facility – Section 7.4.)
Otherwise, you may deliver goods to a distribution centre where they are unpacked,
marked for distribution to various health facilities, stored temporarily, and later
despatched (Section 7.2.1). The distribution centre can be a central or zonal store
(either a supplies or medical store).
Transport arrangements will have been specified in the purchase contract
(Sections 5.5.2 and 6.4). If your central/zonal store is in the port city, most clearing
agents deliver goods from customs to their warehouse, or to your premises as long as
they are within the boundaries of the city. Delivering goods outside the city’s
boundaries costs extra. Thus, you have a number of options. You can:
◆ contract the clearing agent to do this – this is often the simplest and


cheapest approach
◆ arrange to use your own transport, or
◆ hire a local transport company.
If you ever use your own transport to deliver equipment, it must be a vehicle
belonging to your health service provider and be specified as safe for both the driver
and equipment. Otherwise you can consider hiring a suitable vehicle and driver from
a professional company. The first option is cheaper, but your vehicle may not always
be appropriate.


Tip • Often only certain vehicles with license plates registered with the port/customs
authorities can enter the port. There is no guarantee that your transport or even a
Ministry of Health truck will be allowed into the port.


7.3 STORAGE AT DISTRIBUTION CENTRES
AND DESPATCH
For most consignments, you will not need to consider interim storage at one of your
stores. The only time storage should be required is if it is unavoidable – for instance,
when goods have been bought in bulk and require splitting, if items are intended for
later use, or if the site is not ready for the goods to be installed. Normally your aim
should be to get equipment into place and working as soon as possible. If storage is
appropriate the Procurement Manager should inform the relevant Stores Controller
about the expected delivery and date as soon as the order is placed.


7.2.2 Delivering goods from customs to initial destination


212




Your health service provider organization needs to decide how to store equipment
and equipment-related supplies. Section 8.4.3 discusses the issues about whether
to keep these items together, and who should be responsible for them (see also
Guides 4 and 5). The Supplies Stores and Central Medical Stores systems are
normally responsible for storing, ordering and issuing equipment and supplies. Often
larger equipment items and spare parts are kept in the Supplies Store, while smaller
items of equipment, plus consumables, accessories and a small number of spare parts
for user planned preventive maintenance (such as bulbs) are kept in the Central
Medical Stores.
Generally there are two types of storage processes within a store:
◆ transit storage for onward distribution (undertaken at central/zonal level – see below)
◆ local storage for issue (undertaken at all levels – see Section 8.2).


Central or Zonal Stores
A store acting as a distribution centre (such as a central or zonal store) has two main
functions:
◆ It operates as a supplier of goods held ‘in stock’. Smaller stores such as district and


health facility stores order items from the central/zonal store, which are released
by means of a requisition form (Section 6.5).


◆ It acts as a temporary storage facility for goods ‘in transit’. Goods from customs are
often stored at the central store while delivery arrangements to their final
destination are made, or until the facility is ready to receive them.


Goods arriving at the such central/zonal stores should be accepted into the receiving
area, and dealt with in the following manner:
◆ Items ‘in stock’ are quarantined until physically checked. Receiving clerks must


check the crates/cases and contents against the supplier’s invoice/delivery note.
They should check for damaged and missing goods, and for compliance with the
contract conditions (such as labelling). Any discrepancies, variations, and damage
should be noted and reported to the Stores Controller.


◆ Items ‘in transit’ are not opened, nor are their contents checked. This is to
maintain security and to ensure that no damage or loss takes place between
storage and onward transportation to the final destination and installation. The
clerks, therefore, are only responsible for checking the total number of boxes and
their condition, but not the contents against the invoice/delivery note. If ‘transit’
crates have been opened or are visibly damaged, a member of the Central HTM
Team should be asked to carry out an inspection and a contents check.


Tip • In addition to the delivery note, the carrier/clearing agent must hand over the
shipping documents to the stores clerks.


7.3 Storage at distribution centres and despatch


213




Following these physical checks, the Stores Controller should:
◆ for stock items, sign the invoice/delivery note to indicate that all the goods have


been delivered in the quantities stated on the invoice/delivery note, or for transit
goods sign stating that the total number of unopened cases have been received
and confirming the condition of the cases is correct


◆ note any problems with the goods on the invoice/delivery note (called ‘signing
with reservation’)


◆ not accept any goods or quantities not stated on the invoice/delivery note
◆ report problems to the supplier and the carrier immediately, with an explanation


of the nature of the problem (for example, under-supply or damaged goods)
◆ provide a separate report of any discrepancies to the Procurement Manager for action
◆ acknowledge receipt of the goods by notifying the supplier as soon as possible,


regardless of whether the shipment was international or national.


Tip • Prompt inspection is essential to ensure that suppliers have fulfilled their contracts,
and to make insurance claims if required.


Once checked and approved, the goods should be formally released from the
receiving area and moved to the warehouse to be stored as transit items, or held in
stock. Separate locations in the warehouse should be assigned to deal with transit
goods, stock goods, incoming storage and outgoing storage. Any goods with special
storage instructions should be stored accordingly (such as those requiring refrigeration).
All stores should have a stock control system, either manual or computerized, which
checks items in and out against orders made. (See Guides 4 and 5 for details on a
safe storage system). The distribution centres (central/zonal stores) should keep an
inventory detailing all transit items received and issued, together with details of the
accompanying documents. Methods of transport, delivery times, and confirmation of
receipt from user units should also be recorded. Items to be held in stock should be
entered on to stock control records (Section 8.2).


7.4 DELIVERY TO FINAL DESTINATION SITE
For the goods to reach their final destination:
◆ they may be delivered directly to the purchasing health facility by the freight


forwarder (Section 7.2.1)
◆ you may have arranged collection from the port of entry and onward delivery using


your own vehicle, a hired one, or a clearing agent (Sections 7.2.1 and 7.2.2)
◆ you may organize onward delivery from the central/zonal distribution centres


yourself (Section 7.3).


7.3 Storage at distribution centres and despatch


214




If you are arranging the transport, the Stores Controller and Transport Manager
are responsible for making sure that goods are not damaged during the journey.
This includes:
◆ ensuring that goods are properly packed – placed in pallets, cartons, or crates and


carefully and systematically loaded into vehicles on a first-in/last-out basis
◆ ensuring that the load is held secure by straps, nets or other means (to protect


against the vibrations caused by travel over rough roads)
◆ protecting against water damage during rain, by avoiding transport on open


vehicles, and ensuring goods are loaded and unloaded directly into a building and
not left standing outside.


If the purchase contract states that goods should be delivered direct to the health
facility by the supplier, clearing agent, or freight forwarder, they are responsible for
arranging similar procedures so that goods are not damaged (Section 6.4).
On arrival at the destination health facility, the delivery note needs to be signed-off
by the Stores Controller. The Stores Controller and driver should sign for the total
number of cases and their condition. However, the cases should not be opened and
their contents should not be checked before the Commissioning Team arrives
(Section 8.1). In addition to the delivery note, the shipping documents must be
handed over to the health facility staff.


Tip • When you receive freight at facility level, you may find two signatures already on the
delivery note – one from the Stores Controller of the central/zonal store and one
from the driver that delivered the goods there.


• The signature of the health facility’s Stores Controller on the delivery note transfers
responsibility for the goods from the carrier to the health facility.


7.4 Delivery to final destination site


215




Section 7 Summary


216


BOX 45: Summary of Issues in Section 7 on Preparing to Receive and Distributing Goods


Procurement Unit/
Commissioning
Team


HTM Manager


HTM Working
Group or its
training sub-group
Procurement Unit


Procurement Unit
or Clearing Agent


Procurement Unit


Store Controller
at distribution
centre level


St
or


ag
e/


De
sp


at
ch



S


hi
p/


Cl
ea


r/T
ra


ns
it









P


re
pa


re
to


R
ec


ei
ve


◆ draws up their own Gantt Chart (see Figures 19 and 20), or liaises with any
external support agency or procurement agent, in order to monitor progress of
the procurement process


◆ takes appropriate action when delays occur, and informs all people involved with
subsequent activities to try to avoid incurring unnecessary expenses


◆ organizes the hiring of any lifting equipment, as required
◆ tries to reduce the likelihood of needing to hire warehouse space, but organizes it


as required
◆ after talking to the training sub-group, liaises with the supplier or any other


trainer regarding their requirements for running training sessions, and organizes
the arrangements


◆ contracts a suitable clearing agent
◆ investigates customs clearance requirements and duties to be paid, and obtains


any special import licences and duty/tax exemption certificates (see Box 43)
◆ oversees and ensures the site is prepared before the equipment arrives (see


Figure 21)
◆ liaises with the Procurement Unit/Commissioning Team to identify the


questions and requirements to put to the trainers (whether the supplier, other
agent or in-house) regarding training needs (Section 8.3.3)


◆ monitors the progress of shipments using the Gantt Chart and any tracking
system employed by the shipper


◆ depending on the freight terms (which dictate how far the goods are shipped by
the supplier), arranges transportation for the remainder of the journey


◆ depending on the freight terms (which dictate how much of the journey is
covered by insurance taken out by the supplier), arranges additional insurance for
the remainder of the journey


◆ organizes suitable transport and delivery to a distribution centre for transit,
if required


◆ liaises with the supplier and shipper and prepares the documentation for customs
clearance (see Box 44)


◆ clears customs and pays any duty or demurrage charges required (see Figure 22)
◆ tries to get equipment on site and working as soon as possible
◆ considers storage only if absolutely necessary, and arranges this with the Stores


Controller of the relevant distribution centre
◆ ensures goods arriving ‘in transit’ are not opened and the delivery note is signed


to say this
◆ ensures all shipping documents are received for goods ‘in transit’
◆ stores ‘in transit’ goods separately from stock items
◆ enters into the stores record system: the receipt of ‘in transit’ goods, their


onward despatch, and confirmation of receipt from the final destination


Box 45 contains a summary of the issues covered in this Section.


Continued opposite




BOX 45: Summary of Issues in Section 7 on Preparing to Receive and Distributing Goods
(continued)


Stores Controller
and Transport
Manager at
distribution centre
level
Stores Controller
at the health
facility level


Section 7 Summary


217


◆ ensures goods are transported to their final destination in suitable vehicles and in
such a way that they will not be damaged


◆ ensures the shipping documents accompany the goods


◆ receives the goods and stores them unopened until the Commissioning Team
arrives (Section 8.2)


◆ signs the delivery note to say that the goods remained unopened
◆ takes receipt of the shipping documents


De
liv


er
y




218




8. HOW TO RECEIVE, COMMISSION,
AND STORE GOODS ON SITE


Why is This Important?
When a new item of equipment is introduced into the health service, it is
necessary to make sure that it is:
◆ complete
◆ safe
◆ reliable, and
◆ functioning properly, before it is used.
Equipment that is not reliable or is not functioning properly can be dangerous.
All equipment, on arrival at a health facility, must be commissioned – officially
accepted as safe and correct – and placed onto the facility’s records, thereby
registering ownership.
Similarly all orders for equipment-related supplies must be checked on arrival
to ensure they are complete and correct, and be officially registered by being
entered into the stores stock control system.


This Section covers the various activities that you need to manage once your
equipment has arrived and before you can make use of it, by looking at:
◆ An overview of the Acceptance Process (Section 8.1).
◆ Receipt and checking of goods (Section 8.2).
◆ Assembly, installation, commissioning, and initial training (Section 8.3).
◆ Registration and handover (Section 8.4).
◆ When and how to make payments (Section 8.5).
◆ Damage or unsatisfactory supply (Section 8.6).


Tip • You should develop clear and written procedures for all the activities described in
this Section.


8 How to receive, commission and store goods on site


219




8.1 AN OVERVIEW OF THE ACCEPTANCE PROCESS
Procedures


Each health facility should have an official Acceptance Process for equipment that
arrives on site (a simpler process is used when equipment-related supplies arrive on
their own – see Section 8.2). During the acceptance process, the HTM Working
Group or its smaller Commissioning Team (Section 1.2):
◆ checks that the complete order has arrived
◆ ensures installation, commissioning, and initial training takes place
◆ ensures that the equipment is mechanically and electrically safe for users and


patients and is functioning properly
◆ enters the equipment and equipment-related supplies into various health


facility records.
A simple way to carry out these activities is to fill in a standard Acceptance Test
Logsheet. This form is specially designed to make checking easier and to help to
avoid mistakes. It is an important document since it is the first record to be placed in
the Equipment File (see Guide 5 on maintenance management), provides all
relevant details of the start of the equipment’s life at the health facility, and
commences the service history of the equipment (Section 8.4.1). A sample
Acceptance Test Logsheet is provided in Annex 9.
The Acceptance Test Logsheet has sections that cover all the components of the
acceptance process, including:
◆ delivery/receipt of the equipment on site
◆ unpacking and checking for damage and for the complete order
◆ assembly
◆ installation
◆ commissioning and safety testing
◆ official acceptance
◆ initial training
◆ registration – entering stocks into stores and onto records
◆ handover.
Each of these sections in the logsheet needs to be completed and signed off to
indicate that the activity has been successfully completed. Once the logsheet has
been fully completed, it is signed off by the Commissioning Team to certify that the
equipment and services are satisfactory. Only then can payment be made.


8.1 An overview of the acceptance process


220




If there are problems with goods or services, the Commissioning Team should
not sign off the logsheet, but should instead write a Fault Report on the equipment’s
shortcomings (see the last page of the sample logsheet). This would outline the
problems encountered and advise that payment be withheld until the problems have
been addressed.
The equipment is not normally put into routine use until the complaints have been
resolved, the logsheet finally signed off, and the payments made.
To explain the difference between all the activities in the acceptance process, each
one is discussed separately in the rest of this Section.
We recognize, however, that the acceptance process is straightforward for common
low-technology items of equipment that are simple to use. Installation,
commissioning, and initial training are not major activities and can happen all at
once. For example, for a mobile examination lamp:
◆ Installation involves using a test meter to check the electricity supply of the


socket outlet, and then simply plugging in the lamp.
◆ Commissioning involves using a test meter to check the electrical safety of the


lamp so that it will not give the operator an electric shock.
◆ Initial training involves ensuring the operator knows where the on/off switch is,


how to handle the light bulb, and how to alter the angle of the head without
pulling the lamp over.


Personnel Responsible
The HTM Working Group (through its Commissioning Team) has overall
responsibility for ensuring that the acceptance process is carried out, while the HTM
Manager is in charge of all ‘technical’ components.
From the list of activities involved in the acceptance process, health service staff
must be responsible for:
◆ receiving goods on site
◆ official acceptance
◆ entering stocks and information into existing record systems
◆ payment and complaints.
The people involved should be:
◆ the Commissioning Team at facility level, whose members include stores,


maintenance and user department staff (Section 1.2)
◆ labourers/grounds staff to help lift and move equipment
◆ the Finance Office.


8.1 An overview of the acceptance process


221




However, unpacking, assembly, installation, commissioning and initial training can be
undertaken by either health service staff or external personnel. The Commissioning
Team at the health facility must be involved and, if they are not undertaking the
work themselves, should be assisted by either an in-house or visiting installation
team and training team. The people involved could be any of the following:
◆ Senior maintenance staff within your HTM Team, workshop, or health facility


who have experience of installing and commissioning the equipment or have the
necessary skills.


◆ Specialist maintenance staff from higher level HTM Teams and workshops, or
from other health facilities or health service providers who are knowledgeable
about the equipment.


◆ Technical personnel, such as electricians or mechanics, from other maintenance
organizations responsible for the equipment being installed (such as the Ministry
of Works).


◆ Senior equipment users within your health facility, or specialists from other
facilities or health service providers who have experience of the equipment and of
training staff.


◆ The manufacturer or their representative’s installation/commissioning team and
training team.


◆ Contractors.
◆ Partners in technical cooperation projects, or staff from non-governmental


organizations and charities.


Tip • It is common for a manufacturer to send technical personnel (such as engineers) to
do the installation/commissioning, and a different member of staff (such as a sales
person) to carry out the user training.


To determine what personnel should be involved, ask yourself the following questions:
◆ How complex is the equipment?


The more complex an item is, the more likely it is that you will need the help of
the manufacturer or their representative.


◆ Do you have the necessary skills?
If your HTM Teams cannot undertake the job it is useful to ask for assistance
from a contractor.


◆ Are you buying one item or buying in bulk?
If you are only buying one item it may not be worth the expense of getting the
manufacturer’s help, and your HTM Team might be able to manage with
sufficient written guidance from the manufacturer. However, if you are buying
large quantities of the same product it is often worthwhile contracting the
manufacturer or their representative to undertake the installation,
commissioning, and initial training at as many locations as necessary.


8.1 An overview of the acceptance process


222




Decisions about who will undertake the work must be taken at the purchase contract
stage (Section 6.4).


Resources Required


Box 46 provides an idea of the types of resources required for the acceptance process.


BOX 46: Example of Resources Needed for the Acceptance Process
Documents


Materials


Space


8.1 An overview of the acceptance process


223


◆ copies of the purchase order/contract documents
◆ shipping documents and delivery notes
◆ packing list (contents list) for each crate
◆ a stock of blank copies of the Acceptance Test Logsheet (see Annex 9)
◆ a stock of new Equipment Files (see Section 8.4 and Guide 5)
◆ a stock of Register of New Stocks Forms (see Annex 11)
◆ a stock of blank Goods Received Notes (see Annex 11)
◆ a stock of blank or relevant stores stock cards (see Annex 11)
◆ a hand trolley, fork-lift truck, or other means to lift and move crates and equipment
◆ crowbars and other tools to open crates and boxes
◆ tools for assembly and installation
◆ stock of mains plugs to attach to new electrical equipment
◆ insulation testing instruments for use on all electrical equipment to test adequate


insulation and earth connections (see Guide 5)
◆ a safety analyzer for use on all electro-medical equipment to test that the


equipment conforms to IEC 60101 electrical and medical safety standards (see
Guide 5). If one is not available at the health facility, arrange to hire one


◆ any other relevant test equipment (see Section 8.3.2 and Guide 5)
◆ a suitable room for unpacking (Section 8.2)
◆ a suitable room for assembly and testing if the goods are not installed in situ


(Section 8.3.1)
◆ a suitable room for running training sessions (Section 8.3.3)




8.2 RECEIPT AND CHECKING OF GOODS
Receiving and Unpacking Equipment


The Procurement Manager must ensure that the equipment is delivered to a
specially designated area, in which the crates can be kept safely and securely until
the equipment is officially accepted and signed for. The equipment should not be
delivered directly to a clinical department, where users may assume that it is ready
and safe for use. The only exception to this rule would be very large equipment
items, which must be delivered to the place where they will be installed.
The designated delivery area must:
◆ be clean and properly secured
◆ have easy access for the crates from the loading bay
◆ have easy access to departments once the equipment items are unpacked.
Possible delivery areas could include the health facility’s main store, the
maintenance workshop, or any appropriately sized room with adequate security.
Lifting equipment (such as cranes, forklift trucks, stores trolley, etc) may be needed to
help unload heavy or large equipment or to move and position equipment ready for
installation. This should be planned for and hired in advance (Section 7.1.2). If the
equipment is small and light, it can be unloaded by hand and moved using extra helpers.
Once the goods are unloaded, the driver will need a copy of the signed delivery note
before they can leave. The Stores Controller should sign off the delivery note, stating
that they are simply signing for the total number of cases and their condition, and
not verifying the correctness or condition of the contents (Section 7.4), as you are
unlikely to be able to do this while the driver waits.


Tip • If the packing case (crate) shows signs of damage, and you suspect the equipment
may be damaged, notify the supplier before unpacking. Documenting any damage
with a photo is often useful.


As soon as possible after the goods have arrived, they should be inspected, whether
insured or not, to make sure that the suppliers/issuing stores have fulfilled their
contracts. There are two options:
◆ If the supplier is responsible for the unpacking and installation of the equipment,


health facility staff should leave the packages unopened until the supplier’s
representative arrives. Then the Commissioning Team should join them for the
unpacking.


◆ If your own staff are going to install the equipment, the Commissioning Team
should do the unpacking.


8.2 Receipt and checking of goods


224




Rather than involve all team members, this inspection should be carried out by at
least the HTM Manager, an installation team member (whether in-house or
external), a storekeeper, and possibly an equipment user.
Box 47 shows the different types of forms that are required to receive goods.


BOX 47: Common Types of Documents Needed When Receiving Goods
For goods delivered directly by the carrier/supplier to
the health facility


For goods held ‘in transit’ by central/zonal distribution
centres then delivered to the health facility


For stock items issued by central/zonal stores to the
health facility against a requisition


For confirming the orders
For recording the receiving procedure


For recording discrepancies


The unpacking and inspection process for equipment orders should follow the steps
shown in Figure 23.


8.2 Receipt and checking of goods


225


◆ Shipping documents (including packing lists)
and invoice


◆ Delivery note
◆ Goods Receipt and Issue Note from the


distribution centre
◆ Delivery note
◆ Shipping documents and invoice
◆ Stores Requisition/Issue Voucher (see Annex 11)
◆ Delivery note
◆ Your purchase documents or Purchase Order
◆ An Acceptance Test Logsheet for equipment


orders (see Annex 9)
◆ Stock (bin) cards and stock control ledger for


recurrent orders of supplies (see Annex 11)
◆ Goods Received Note (see Annex 11) for all


types of orders
◆ Goods Inward Book for all types of orders
◆ The Fault Report Form at the back of the


Acceptance Test Logsheet for equipment orders
◆ A Discrepancy Report Form for recurrent orders


of supplies


NOYES




Figure 23: Unpacking and Inspecting Equipment Orders


…insert ‘G3


8.2 Receipt and checking of goods


226


Checks Activity


For damage


Against documentation


Technical requirements


The ‘package’


Administrative requirements


• systematically open one crate at a time
• check the boxes/packages inside each crate for possible
damage
• systematically open one package at a time and note what you
find on the relevant documents (see below)
• keep all packaging, supports, labels and booklets, as you may
have to re-pack the equipment to return it for repairs.
• unpack the equipment carefully
• ensure that the equipment and its associated supplies do not
appear to be damaged
• if anything appears damaged, take a photograph if possible,
and notify the supplier


• check that the delivery matches the packing list(s)
• check that the contents comply with the specifications in the
purchase order – in other words, check the type and model of
all equipment and supplies
• check that the quantities are according to the purchase order


• ensure that the voltage shown on the packing list (or on the
packing case) for electrical equipment is compatible with your
power supply
• check that the equipment data plate matches your order and
the packing case/list and, for electrical equipment, that the
voltage stated is correct
• for electrical equipment, ensure the mains lead and battery
charger, where applicable, is included


• check that all the necessary consumables, accessories and
spare parts have arrived as per the purchase contract
• keep these equipment-related supplies together in a dry, cool
and safe place until you can issue some and register the rest
into the Stores system (Section 8.4.3)
• check that the operating manual, service manual (including a
wiring/circuit diagram), and any assembly and installation
instructions have arrived as per the purchase contract
• keep the manuals together in a dry, cool and safe place until
you can make copies and issue/store them (Section 8.4.2)
• notify the supplier if any documentation is missing or seems
unacceptable (e.g. in another language than requested)


• sign and date all relevant documents (such as the packing list
and your order – see Box 47) to show that the contents of the
delivery was correct
• retain these documents for use in the rest of the Acceptance
Process, and for later submission to the supplier/issuing store
at the end of handover (Section 8.4.4) and submission to the
Finance Officer for payment (Section 8.5)
• record any discrepancies between the documents and the
delivery contents on the documents themselves and on the
Fault Report form
• use the complaints procedures (Section 8.6) to investigate any
discrepancies
• complete the relevant sections of the Acceptance Test
Logsheet.




As the Commissioning Team and any visiting installation team is present, installation
and commissioning of the equipment and supplies can take place as soon as possible
(Section 8.3).


Receiving, Unpacking, and Checking Recurrent Orders of
Equipment-Related Supplies


You will regularly receive accessories, consumables, spare parts, and maintenance
materials that you have purchased from stores or suppliers. At least two people
should receive and check these recurrent orders when they arrive – the Stores
Controller and one other person. The staff involved depends on the type of item
being unpacked. For example, if you are checking spare parts, it would make sense to
have maintenance staff present.
It is important to check supplies that have been received, before you put them away
in the store. Otherwise you may only discover that an item is incorrect, damaged, or
of poor quality when it needs to be used, at which time it will be too late to ask the
supplier for a replacement.
When receiving recurrent orders of equipment-related supplies, you should follow
the unpacking and inspection process shown in Figure 24.


8.2 Receipt and checking of goods


227


YES


NO




Figure 24: Unpacking and Inspecting Recurrent Orders of Equipment-Related Supplies


8.2 Receipt and checking of goods


228


Checks Activity


For damage


Against documentation


Technical requirements


Administrative requirements


• systematically open one box at a time and note what you find
on the relevant documents (see below)
• check the outer and inner packaging to make sure it is intact
and inspect for signs of damage (e.g. spots, breakages, leaks,
missing labels, tape or lids)
• unpack the goods carefully
• ensure that the goods do not appear to be damaged
• if anything appears damaged, notify the issuing store
• do not use damaged goods.


• check that the number of boxes and their contents match the
packing lists (contents list)
• check the delivery note, packing list and contents against the
copy of the requisition or order form
• check the items against the specifications of the
requisition/order document.
• check that the quantities are according to the requisition/order
document.


• check labels are legible and include complete information
(e.g. approved name, strengths, storage instructions,
manufacturer’s details, expiry date)
• check the shelf life and expiry date (if applicable). Do not
accept items if the expiry date has passed. Only accept items
nearing the end of their shelf life if you are sure you can use
them before the expiry date. The expiry date is the time up to
which the manufacturer guarantees the quality of the product,
and many products, such as laboratory reagents, are only fit
for use for a limited time.
• check that consumable items, such as batteries, are enclosed
and have sufficient shelf life
• check that all necessary and requested documentation (such
as care, cleaning, and decontamination instructions) is
enclosed or available.


• sign and date all relevant documents (such as the packing
list and your order – see Box 47) to show that the contents of
the delivery was correct
• return one copy to the issuing store, and retain the others for
reference and submission to the Finance Officer for payment
(Section 8.5)
• record any discrepancies between the documents and the
delivery contents on the documents themselves and on the
Discrepancy/Fault Report form
• use the complaints procedures (Section 8.6) to investigate
any discrepancies
• complete the Goods Received Note (Annex 11) and any
Goods Inward Book
• submit the Goods Received Note to the Finance Office to
trigger payment if there are no problems (Section 8.5).




Recurrent supplies do not require assembly, installation, commissioning, or initial
training (Section 8.3). Thus, once you have unpacked the supplies, you can directly
enter them into the stores stock control system as described in Section 8.4.3.


8.3 ASSEMBLY, INSTALLATION, COMMISSIONING
AND INITIAL TRAINING
The Procurement Manager and the Commissioning Team should be using the Gantt
Chart to monitor the progress of the equipment’s delivery (Section 7.1.1). Thus,
they should have been able to coordinate the arrival of any installation and training
teams (for example, a Regional HTM Team, supplier’s representatives, or
contractor) and ensure that everything runs to schedule.


Did you know?
Many poor installation and commissioning practices are due to poor communication and
coordination between the various responsible departments and the different types of staff.
Common problems include:
◆ equipment arriving on site unannounced
◆ contractors arriving to work in the health facility without giving prior warning
◆ contractors carrying out work in the health facility without consulting the users and in-house


technical staff
◆ health service staff left wondering what is happening and unable to plan their work.


Details of which personnel can carry out assembly, installation, commissioning, and
initial training are outlined in Section 8.1. The final allocation of roles and
responsibilities will depend on:
◆ the type and complexity of the equipment
◆ which organization is responsible for the equipment (for example, your health


service provider or the Ministry of Works)
◆ the skills available locally
◆ the purchase contract terms.


Tip • Initial training may take place at the same time as commissioning or some time later,
and be carried out by different people.


When external staff do the work, members of your Commissioning Team (such as the
HTM Manager or senior maintainers) need to be present during these activities to
supervise, observe and confirm test results. They need to monitor the contract, see
the machines working, and ensure adequate training is given. It is also helpful for
maintenance staff, and possibly user staff, to be present to learn ‘on the job’.


8.3 Assembly, installation, commissioning and initial training


229




8.3.1 Assembly and Installation


Preparation
While planning and budgeting for your equipment (see Guide 2) you should have
estimated installation costs for inclusion in your budget. Also, when preparing the
purchase contract or the donation agreement, you will already have decided who
should undertake the work (Section 6.4).
However, as soon as the order is placed, the technical members of the
Commissioning Team (such as the HTM Manager) should liaise with the chosen
installation team so that they can:
◆ finalize the requirements, materials, need for contractors, and costs (Section 5.1)
◆ ensure all arrangements are in place for the in-house or visiting installation team


(see Figure 25)
◆ oversee the work
◆ complete the relevant section of the Acceptance Test Logsheet, when the work


has been completed satisfactorily.


Country Experience
Many countries have examples of poor installation practices, such as:
◆ X-ray machines with the tube directed at the operator’s position.
◆ Large floor-standing horizontal autoclaves without any partitioning to block off the dirty and


dusty machine access area to the rear of the machine from the sterile Central Sterile
Supplies Department (CSSD) at the front.


◆ Centrifuges wired to insufficient mains capacity.
◆ Operating theatre lights mounted too low.


Tip • Manufacturers/suppliers or their representatives will expect you to have prepared
the site up to the connection points for their equipment (Section 7.1.2), then they
will come and install it.


Usually (but not always) installation and commissioning occur at the same time, and
are carried out by the same people. Figure 25 shows the common arrangements to
make in order for installation and commissioning to take place effectively.


8.3.1 Assembly and installation


230




Figure 25: Common Arrangements Required for Installation and Commissioning


8.3.1 Assembly and installation


231


Step Arrangements


Ensure the work site is ready


Identify staff to learn from and
monitor the work


Liaise with the in-house/visiting
installation team


Provide the necessary inputs


• Ensure all site preparation work is complete (Section 7.1.2).
• Ensure lifting equipment is available if necessary
(Section 7.1.2).


• Draw up lists of:
– the user staff to observe and learn from the installation and
commissioning work
– suitable maintenance staff to learn from and monitor the
installation and commissioning work.
• Ensure they attend at the correct time and place.


Discover:
• how the installation and commissioning will be provided
• any needs they have
• whether initial training will take place at the same time or at a
later date (see Figure 27).


Organize (as necessary):
• overnight accommodation for the installation team
• travel and subsistence for the installation team (for local staff
and those from abroad)
• any materials for installation that you are responsible for
providing (such as cable, plugs, piping)
• any materials for checking operation that you are responsible
for providing (such as consumables used whilst ensuring
equipment is performing correctly)
• any safety testing instruments that you are responsible for
providing.


Ensure you know what you are
doing


• Gather together the necessary assembly, installation,
commissioning, and safety testing instructions.
• If these are not in the manuals/videos that came with the
equipment, liaise with the equipment manufacturer/supplier.


Provide the necessary working
space


Organize:
• a secure room which can act as a store for the installation
team’s materials and instruments
• suitable access for the installation team to the user
department when large/heavy equipment is being installed
and commissioned in situ
• a suitable work room for the installation team when portable
equipment is being assembled and commissioned, which:
– is secure, but has adequate fire exits and fire extinguishers
– has sufficient workbenches
– has access to proper power and water supplies, and gas
cylinders
– is clean and dust-free.




There are some questions and issues that you need to clarify with the installers:
◆ How long will the installation and commissioning take?


What will be the impact on the department, floor or entire facility during the
installation? Will it be necessary to move patients and for how long? What other
activities may be interrupted?


◆ When are the installation team likely to work?
What hours of the day will the installation team work? Will they be able to work
continuously over the weekend, if necessary, to complete the job as soon as possible?


Interruption of basic health services can be minimized if planned well in advance. It
is important to liaise carefully with the user department. The shut-down of water,
electricity and other utilities should be carried out during periods of least use, and
back-up facilities should be considered.


Tip • You should define the types of in-house staff who should attend assembly and
installation in order to learn ‘on the job’, and ensure they attend.


Procedures
Assembly the steps required to put equipment back together again if it


was dismantled for shipment.
Installation the process of fixing equipment into place. Depending on the


complexity of the equipment, this can range from simply
plugging the equipment into an electrical socket, to building
it into the fabric of the room.


Before the installation team (in-house or visiting) can install equipment, they may
have to assemble it. The installation team will install the equipment by connecting
it to the connection points (such as taps, circuit breakers, pipe junctions, connectors,
socket outlets) left by the site preparation team (Section 7.1.2). Assembly and
installation should be carried out by following the manufacturer’s instructions in the
operator or service manual, or by watching any video provided by the manufacturer.


8.3.2 Commissioning
Commissioning a series of tests and adjustments performed to check whether


new equipment is functioning correctly and safely, and ensure
that any necessary adjustments are made, before the
equipment is used.


Commissioning usually, but not always, takes place straight after installation.


8.3.1 Assembly and installation


232




The technical and safety aspects of the equipment should already have been
specified and considered during your selection process (Section 6.3). However, it is
also essential to carry out performance and safety tests on each piece of equipment.
Such tests validate that each piece of equipment is safe and is capable of performing
its intended function. Performance and safety tests should be carried out regardless
of whether equipment is purchased, donated, leased, or borrowed by the health
facility. The Commissioning Team and any visiting installers are responsible for
ensuring these tests take place.
The arrangements for commissioning are the same as those for installation, and are
shown in Figure 25. Key procedures for commissioning are described in Figure 26.


Figure 26: Key Steps in the Commissioning Process


8.3.2 Commissioning


233


Step Activity


Check the documentation


Prepare the equipment for use


• make sure all the relevant documentation is available (for
example, manuals, instructions)
• place it where staff can easily gain access to it during
commissioning
• during commissioning check that everything that is mentioned
in the documentation is available and functioning on the
machine


• fit the correct mains plug to the mains lead
• attach any accessories
• carry out any relevant warm-up processes (for example, with
a boiler, ensure electrodes are activated, and carry out
pre-burn runs, burn runs, blow throughs, etc.)
• where applicable, allow the equipment to go through any
built-in self-check or test programmes on start up (such as
infant resuscitation tables, bench-top autoclaves, diathermy
units)
• where applicable, place the equipment ‘on-charge’ (such as
defibrillators)


Continued overleaf




Function tests


Record the results


• for larger or complex equipment like autoclaves, laboratory
analysers or X-ray machines, run the manufacturer’s
recommended methods/protocols on phantoms or known
samples to ensure the method is adequate and the results are
acceptable and stable over time.
• process a few control samples, or samples of known value, to
make sure the equipment is functioning properly
• both maintenance staff and operators should cooperate in
performing such tests.


• keep records of all test results in the Equipment File (see
Section 8.4.1 and Guide 5.)
• note and record any technical issues in the Equipment File
• fill in the relevant sections of the Acceptance Test Logsheet,
when the work has been completed satisfactorily and all tests
have been passed.


Figure 26: Key Steps in the Commissioning Process (continued)


8.3.2 Commissioning


234


Undertake safety tests


Initial calibration


• ensure all electrical equipment is tested for adequate
insulation and earth connections (see Guide 4)
• ensure all electro-medical equipment is tested for compliance
with IEC 60101 electrical and medical safety standards to
guarantee patient and operator safety (see Guide 4). This is
particularly important if there has been a significant time lapse
since installation (Section 8.3.1).
• consider mechanical safety aspects, visually inspect the
equipment, and study drawings
• if harmful radiation is produced ( , or X-rays), carry out tests
to ensure correct calibration and safe use


• adjust the equipment to prevailing conditions (climate,
electricity supply, altitude, etc.) so the readings are true.
For example:
– adjust laboratory counters to give reliable readings
– adjust air conditioners to the right setting for cooling rooms
– provide X-ray units with sufficient power output to provide
the required dosage to patients.


Calibration


• ensure that the equipment provides dependable and accurate
results. If calibration is not done, the equipment may not
function properly. For instance, an autoclave could go through
its operational cycle without reaching the correct temperature
to sterilize.
• ongoing re-calibration is required throughout the life of the
equipment to ensure that it is in a proper, accurate working
condition. These tasks could eventually be carried out by
users and maintenance technicians, depending on the
equipment model type and its sophistication (see Guides 4
and 5 for more on planned preventive maintenance).




Once the equipment has passed its safety, calibration, and function tests, the
Commissioning Team is in a position to:
◆ officially accept that the equipment has been received in a satisfactory


condition, and
◆ officially accept the equipment as your property.
This could trigger the payment for the goods only (Section 8.5). Payment for
services can only occur when the training is finished (Section 8.3.3), if it was part of
the purchase contract.
If the equipment has not passed the tests, you would start negotiations with the
supplier and complaints procedures (Section 8.6). You do not accept or use the
equipment until these issues have been resolved.
If a visiting team were involved, they may have their own handover certificate, which
needs to be signed off by the Commissioning Team.
Once the equipment is accepted, you are in a position to provide your staff with
training in its operation and maintenance.


Tip • You should define the types of in-house staff who should attend commissioning in
order to learn ‘on the job’, and ensure they attend.


• Representatives from both the Commissioning Team and visiting team should sign
the Acceptance Test Logsheet and test results, to avoid later disputes.


• Do not train staff on equipment which has not been accepted.


8.3.3 Initial Training
Initial training a key training stage in a member of staff ’s career that provides


training in the range of skills required to make the best use of
newly arrived equipment. Initial training takes place at the
time of commissioning.


After successful installation and commissioning, the users and maintainers need
training on the type of equipment and the model purchased. This training can take
place straight after commissioning, with the installation team acting as the trainers.
However, the training team often involves different people, such as those with
clinical or training skills. In this case, the training may take place some time later
when the training team has assembled.
Ideally, the initial training occurs straight after commissioning. After the training, the
equipment can be handed over to the user department for regular use (Section 8.4.4).
However, if there is a delay before training can take place, you may have to consider
whether to hand over the equipment before training staff. We recognize that there will
be pressure to do this as all staff want to start using new equipment as soon as possible.


8.3.2 Commissioning


235




However, this should only be done if:
◆ the equipment is a type that has been used before
◆ the staff are familiar with the equipment
◆ you have experienced staff members in charge of its use, until the remaining staff


can be trained.


Tip • Anyone using or working on equipment without proper training or authority whose
actions result in an accident is likely to be found negligent.


Depending on the complexity of the equipment and your staff ’s previous experience
of it, initial training can include (see Guides 4 and 5):
◆ good practice when handling the equipment
◆ basic ‘dos and don’ts’
◆ how to operate the equipment (along with familiarization with the symbols and


markings on the machine)
◆ the correct application of the equipment
◆ care, cleaning, and decontamination
◆ safety procedures
◆ planned preventive maintenance (PPM) for users
◆ PPM and repair for maintainers.


Did you know?
Evidence suggests that many incidents occur as a result of inadequate training of equipment
users and maintainers. For example, as much as two-thirds of equipment malfunction is due to
incorrect use by the operator. Faults with equipment are often due to the user re-assembling the
unit or attaching accessories and consumables incorrectly.
A knowledgeable user will look after equipment better. Attaching a safety warning label to
equipment will remind users of their responsibility to perform functional and safety checks before
the machine is used.


8.3.3 Initial training


236




While planning and budgeting for your equipment (see Guide 2), you should have
estimated initial training costs for inclusion in your budget. Also, when preparing the
purchase contract, or the donation agreement, you will already have decided who
should undertake the work (Section 6.4). You have many options for in-house or
external trainers, as described in Section 8.1.
However, as soon as the order is placed, the HTM Working Group or its smaller training
sub-group (Section 1.2) should liaise with the chosen trainers so that they can:
◆ finalize the requirements, materials and other resources, and determine the need


for contractors and the likely costs (Section 5.1)
◆ ensure all arrangements are in place for in-house or visiting training teams
◆ oversee the training
◆ complete the relevant section of the Acceptance Test Logsheet, when the work


has been completed successfully.
Figure 27 shows the common arrangements to make in order for initial training to
take place effectively.
The level and nature of training provided depends on whether the equipment is:
◆ A standard make and model. If staff are familiar with the equipment, in-house


staff could train new users and provide refresher training for other staff. The
training sub-group (Section 1.2) should produce suitable and necessary training
resources and handouts for the trainees, using the operator and service manuals,
and any videos available (see Guides 4 and 5).


◆ A new make or model. If the equipment is unfamiliar, training should be carried
out by the supplier or their representative, or by a central training team with
knowledge of the equipment. The training sub-group should observe the training
session, obtain copies of any overheads or handouts used, and compile their own
training pack for future training (see Guides 4 and 5).


Sometimes in-depth training is given only to very few staff members who, at a later
stage, will train the rest of the users. In this case, you need a training timetable to
ensure the ongoing training occurs (see Equipment Training Plan in Guide 2).


8.3.3 Initial training


237




Figure 27: Common Arrangements Required for Initial Training


8.3.3 Initial training


238


Step Arrangements


Identify the trainees to be present
at the initial training sessions


Liaise with the in-house/visiting
training team


• Draw up lists of:
– the user staff to obtain skills in handling, operation,
application, cleaning, safety, user PPM, etc.
– the maintenance staff to obtain skills in operation, cleaning,
safety, PPM, repair, etc.
– any staff that can be trained as trainers.
• Ensure they attend at the correct time and place, and record
that they do so.
• Decide whether to run several training sessions to cover staff
on different shifts, or make use of follow-up training (see
below).


Discuss:
• the types of training required, and how it should be pitched to
suit the skills base of your staff
• how the training will be provided
• whether initial training will take place at the same time as
commissioning (see Figure 25) or at a later date
• how long the different types of training sessions will take.


Confirm your booking at the
training site


This might be:
• at the manufacturer’s factory or their local representative’s
workplace
• at your health facility or a central location for training
• in a special training room and/or around the equipment in situ.


Identify the numbers to be
trained


Decide:
• how many staff need training at each site
• how many times the training sessions should be run.


Provide the necessary inputs


Organize (as necessary):
• room hire
• overnight accommodation for the trainees or trainers
• travel and subsistence for the trainees or trainers (for local
staff and those from abroad)
• trainers’ fees (if not in the purchase contract)
• visual aids and teaching equipment
• training materials (hand-outs) for the trainees
• consumable inputs for equipment demonstrations.


Organize follow-up training
sessions


Decide:
• how many additional staff, who did not attend the initial
training sessions, require training
• which trainer or previously trained staff can train them
• how many times the training sessions should be run
• when they should take place.




Country Experience
After training was given on a new maternity unit at a health facility in Nepal, equipment
breakdowns were significantly fewer and equipment life significantly longer.
For equipment in the mid-price range (for example, ultrasound machines), it is probably cost-
effective to train a number of operators on the health facility site. For equipment in the high price
range (for example, intensive care equipment, steam laundry equipment) it may be more cost-
effective to send an appropriate individual to a busy clinical site for training and experience.
Proper training on X-ray machines will ensure that the operator allows sufficient time for the
tube to warm up before stressing the tube with heavy exposure. This can still happen on
much equipment despite the use of microprocessors to limit the possibility.
Training by the manufacturer can provide too much advanced theory and not enough
practical experience, so it is essential to discuss your needs beforehand.


Tip • You should ensure the chosen trainees turn up for the training sessions, and maintain
records of the training that individual staff members have received.


• You should establish a library of the training resources developed (see Guides 4 and 5).
• The representatives of both the Commissioning Team and visiting training team


should sign the Acceptance Test Logsheet, to avoid later disputes.


8.4 REGISTRATION AND HANDOVER
Once equipment and supplies have been officially accepted, you can register them in
various health facility records and systems, process them, and store or use them as
appropriate. The Commissioning Team is responsible for ensuring that all these
activities take place.


8.4.1 Entering New Equipment Orders into Health
Facility Records
All equipment and equipment-related supplies need to be entered into your health
facility’s records and systems. The most common records and systems are the:
◆ Equipment Inventory (manual or computerized). The HTM Manager should


enter new major pieces of equipment onto your Equipment Inventory. The type
of information recorded should identify the particular piece of equipment, its
manufacturer and location (for an example, see Annex 10). The HTM Manager
can gather this information from the Acceptance Test Logsheet (see Annex 9)
and the Register of New Stocks form (see Annex 11).


8.4 Registration and handover


239




In addition, the HTM Manager should allocate a unique inventory code
number to each piece of equipment and ensure the equipment is
labelled/marked with this code number. (See Guide 2 on planning and budgeting
for details of establishing and updating an equipment inventory and developing
an inventory code numbering system.)


◆ Equipment File (manual or computerized). This acts as a service history for a
particular piece of equipment. The HTM Manager should open a new Equipment
File for each piece of equipment, and label the file with the equipment’s inventory
code number. The type of information recorded in this file at the acceptance stage
should include details of the manufacturer/supplier and purchase contract terms
(see Annex 10). Much of this information will be contained in the completed
Acceptance Test Logsheet (Section 8.1), which should be the first document
placed in this file with supplementary data as required.
Subsequent records placed in the Equipment File are of any maintenance work
carried out so that the file becomes the equipment’s service history. (See Guide 5 for
details of recording maintenance work undertaken and keeping service history files.)


◆ Planned preventive maintenance (PPM) programme. The HTM Manager
should register equipment for any PPM carried out by maintenance staff (if it is
taking place), and enter it onto their PPM timetable so that it gets attention at
regular intervals. (See Guide 5 for details of establishing PPM programmes and
records for maintenance staff.)
On handover of the equipment to the user (Section 8.4.4), the HTM Manager
should liaise with the Head of the User Department about registering the
equipment for any user PPM taking place, and entering it onto their user PPM
timetable. (See Guide 4 on operation and safety for details of establishing user
PPM programmes and records.)


◆ Equipment card. This is a piece of card or laminated sheet that is permanently
kept with the equipment, or tied to it. It can provide users with a summary of the
equipment care instructions (see Guide 4), and a summary service history, such as
dates when routine inspections, testing, and servicing took place (see Guide 5).


Tip • Once the equipment has been checked and is confirmed as safe and ready for use, it
is sensible to highlight this fact. Use a simple strip of tape placed across the main
controls of the apparatus to clearly show that it has been tested. It is preferable to
use printed warning notice tape, but other types could be used.


8.4.1 Entering new equipment orders into health facility records


240




◆ Register of New Stocks form. This provides the Stores Controller with all the
information required for entering each new piece of equipment and its supplies
into the Stores stock control system (Sections 8.4.3 and 8.4.4). The
Commissioning Team should (partially) complete this form by gathering
information from the available contract, packing lists, or invoice, according to a
standard format (see example in Annex 11). The type of information should
identify the manufacturer/supplier’s order codes, description, and batch sizes of
the equipment, consumables, accessories, and spare parts.
The Stores Controller finishes completing the form by allocating and recording
each item’s unique stores code (Section 8.4.3). The Stores Controller provides
copies of the finalized forms to the user departments and HTM Team so they can
order the correct replacement items in future. The HTM Manager keeps this
form in the relevant Equipment File.


◆ Registering warranties. You need to register the guarantee or warranty of the
equipment (if applicable). The date of commencement and the period of the
warranty which have been agreed with the supplier must be entered into all
relevant procurement, finance, and maintenance records.


Tip • Be certain about when the warranty period starts.


8.4.2 Storing Manuals
Operator and service manuals should be supplied with the equipment, according to
your purchase document (Section 5.5.2). It is important to make sure that manuals
are kept in a safe place, and are not lost by staff. It is also important to make them
widely available for use among users and maintenance staff. This can be done by:
◆ Storing the original copies in a safe place, such as the health facility’s library, the


director’s office, the workshop library, the Main Stores office, or the HTM
Service library.


◆ Making two photocopies of all operator manuals received, and giving one set to
the head of the relevant user department, and the other to the HTM Team or
workshop responsible for the equipment’s maintenance.


◆ Making one photocopy of the service manuals received, and giving it to the HTM
Team or workshop responsible for the equipment’s maintenance.


◆ Asking for manuals or their content in other formats, such as CD-Rom, video, DVD.
◆ Scanning the printed documents into a computer to convert them into electronic


copies, and making them easily available to maintenance staff at many locations.
◆ Recording in the Equipment File how the manuals were distributed. This helps


with monitoring and updating the manuals in future.


8.4.2 Storing manuals


241




8.4.3 Storage and Stock Control of Recurrent Orders of
Equipment-Related Supplies


The Stores System
Your health service provider needs to decide where to store equipment, its
consumables, accessories, and spare parts, as well as maintenance materials. In many
countries the system is complex:
◆ Supplies stores, run by supplies staff, keep large equipment items, spare parts


(such as replacement motors, replacement suction bottles, plumbing fittings),
and maintenance materials (such as oil, tubing, pipes).


◆ Medical stores, run by pharmacists, keep equipment consumables (such as ECG
recorder paper, ultrasound gel), accessories (such as diathermy probes, breathing
circuits), small items of equipment (such as oxygen gauges, stethoscopes), and
some spare parts for user PPM (such as ophthalmoscope bulbs, batteries).


◆ Workshop stores, run by maintenance staff, keep tools, test instruments, small
spare parts and materials (such as nuts, bolts, o-rings, electronic components).


◆ Stores belonging to other programmes, such as the laboratory service or dental
service, may keep consumables and user spare parts for their equipment, and be
run by their own staff (such aslaboratory technicians, dental technicians).


The drawbacks of such systems are that:
◆ many different types of people are responsible for different things
◆ it is easy and common for some items to be left out, with no one accepting


responsibility for them
◆ staff without knowledge of healthcare technology (stores and pharmacy staff)


have difficulty recognizing and ordering the equipment-related supplies
◆ general health service staff placed in charge of a store without knowledge of the


stores system have difficulty keeping track of stocks
◆ staff requiring the supplies find it difficult to know how to access what they want.
There is a need to rationalize such situations. Ideally, bulk stocks of all equipment
and their supplies would be stored together in one Main Store, whether at facility
level or at the other levels in the distribution network (district, regional, central). If
this store also stocks other health service supplies, there should be a separate section
for the equipment and its supplies. In this way, the small quantities of varied
technical items should not go missing and can be easily identified among the bulk of
general items in the stores.


8.4.3 Storage and stock control of recurrent orders


242




This Main Store then issues relevant stocks regularly to sub-stores in the user
departments and maintenance workshops. All stores staff (whether in the Main
Store or in the sub-stores) receive training in proper stock control and have
illustrated catalogues to assist with identification. They will seek advice from the
HTM Manager/Head of User Department if there is any doubt about the part to
issue/order.


Tip • The main decision is whether to keep equipment and its supplies with all other
general and medical supplies in the health storage system, or in a separate HTMS
storage system.


Most stores systems have what are known as ‘stockable’ items. These are items
which are automatically replenished when stocks run low, and are therefore always in
stock. This is a common system for medical and general items, but is rarely in place
for equipment-related supplies, making it very difficult to keep equipment
functioning. You should therefore aim to make equipment-related items stockable
too, including:
◆ equipment consumables
◆ commonly-used accessories
◆ the spare parts and maintenance materials required for PPM
◆ those parts and materials which experience tells you will be required for common


repairs.
Less commonly used equipment-related items may remain as non-stockable items.
To make items stockable, you must have sufficient data to enter onto their stock
cards such as their usage rates, stock levels, order dates, delivery times, required
reorder levels and reserve stock levels.
All these issues are discussed in detail in Guides 4 and 5.


Entering Supplies into the Stock Control System
When handing over equipment to the user department (Section 8.4.4), the
Commissioning Team issues them with an initial stock of accessories and consumables.


8.4.3 Storage and stock control of recurrent orders


243




However, you should have a remaining bulk of supplies to cover a stock period (of
one to two years) according to your purchase document (Section 5.5.2). These
stocks must be officially entered into the stores stock control system. The
Commissioning Team hands over these stocks to the Stores Controller with the
completed Register of New Stocks form (Section 8.4.1). Figure 28 shows the
procedures required for storing them.


Figure 28: Procedures for Entering Equipment-Related Supplies into the Stores System


8.4.3 Storage and stock control of recurrent orders


244


Step Activity


Log the bulk of stocks into the
Main Store


Make as many equipment-related
supplies as possible ‘stockable’
items


Stores staff:
• accept bulk stocks of equipment accessories, consumables,
and spare parts (and un-issued equipment) into the Main
Stores for storage until issue
• identify the appropriate stores’ identification code (e.g.
national catalogue code) for each item, to make ordering
easier and help avoid mistakes. If no codes are available for
equipment items, assign new code numbers
(see Guides 4 and 5).
• allocate each equipment item with its unique identity code.
This will enable you to find individual items within the store,
and avoid duplication.
• enter the details onto the Register of New Stocks form
(Annex 11).


The Stores Controller:
• makes equipment consumables, commonly-used accessories,
the spare parts and maintenance materials required for PPM,
and those parts and materials which the HTM Manager
specifies for common repairs, ‘stockable’ items in the Stores
system
• implements stock control procedures to ensure that this stock
is available at all times and is regularly re-purchased
• keeps less commonly used equipment-related items as
‘non-stockable’ items.


Enter goods into the stock
control system


Stores staff:
• enter pertinent ordering information onto Stock Cards (bin
cards) for each type of item in stock (see Annex 11)
• consult with the user department and/or HTM Team for
guidance on the stock levels and re-order levels required
• store the equipment and supplies on labelled shelves with
their stock cards.


Provide the users and
maintainers with relevant
information


Stores staff:
• provide the user departments and HTM Team with copies of
the relevant Register of New Stocks forms listing all items
received and their stores codes so they can order them easily.


Issue goods to sub-stores


Stores staff:
• issue short-term requirements (weekly or monthly needs)
requested by the sub-stores in user departments and the
workshop
• monitor usage rates for any uncommon requests
• submit purchase order requests to the Purchasing and
Supplies Officer to replenish the stock.




Note: the equipment itself is entered into the stores system at handover
(Section 8.4.4).


8.4.4 Handover
Handover the formal presentation of new equipment, after its formal


acceptance, to the user department or the health service
provider’s representative who assumes responsibility for it.


When the Commissioning Team signs off the fully completed Acceptance Test
Logsheet, they are certifying that:
◆ the equipment and services provided are completed and satisfactory
◆ the equipment and services have been formerly accepted by the health facility
◆ payment can be made.
They must provide the Stores Controller with copies of the Register of New Stocks
form and the first page of the Acceptance Test Logsheet so that he or she can carry
out the official stores receiving procedure for equipment.
Figure 29 shows the procedures required to officially receive equipment into the
stores system.


Figure 29: Procedures for Entering Equipment into the Stores System


8.4.4 Handover


245


Step Activity


Obtain the information required


Register arrival of new equipment


The Stores Controller receives from the Commissioning Team:
• a copy of the Register of New Stocks form for each piece of
equipment
• a copy of the first page of the Acceptance Test Logsheet
• the signed shipping documents (Section 8.2).


Once goods have been commissioned and accepted, the Stores
Controller uses the details from the documents provided to:
• fill in the Goods Inward Book
• update the Store’s inventory (computer) files.


Issue new equipment to the user
department


Together with the Commissioning Team, the Stores Controller:
• issues to the user department the new equipment and a stock
of consumables and accessories for immediate use
• completes and signs a Goods Received Note with the user
department
• submits the Goods Received Note to the Finance Officer to
trigger payment.


Take responsibility for all
remaining supplies


The Stores Controller receives from the Commissioning Team:
• all remaining equipment-related supplies and any un-issued
equipment for entry into the Stores storage and stock control
systems (see Figure 28).




Once initial training is over, the Commissioning Team and Stores Controller issue the
new equipment and a stock of accessories and consumables for immediate use to the
relevant user department. The amount allowed (for example, a week’s or a month’s
supply) depends on many factors including cash flow, shelf life, climate and security.
The Stores Controller must also get the user department to sign a Goods Received
Note (see Annex 11). It is useful if the Security Manager also attends so that he is
aware of new property belonging to the health facility, and where it is located.


Tip • At the time of official handover, the users and maintainers should start a programme
of periodic inspection, testing, maintenance, and calibration to ensure equipment is
maintained in a safe and effective operating condition. This process is known as
Planned Preventive Maintenance (see Guides 4 and 5).


The Commissioning Team compiles a handover document, comprising:
◆ the signed delivery document, which transferred responsibility for the equipment


to the health facility (Section 8.2)
◆ the completed and signed Acceptance Test Logsheet (including test results),


which confirms:
- the equipment is complete, safe, and working satisfactorily
- the services were performed satisfactorily and are finished
- both equipment and services can be paid for


◆ any additional handover certificate provided by a visiting installation team
(Section 8.3.2).


They submit this to the Procurement Unit which makes various copies of these
documents for different purposes, as follows:
◆ All signed delivery documents are filed for reference by the Stores Controller.


They should usually be kept for a minimum of two years (or the time specified in
the regulations of your organization).


◆ A copy of the Acceptance Test Logsheet (including test results), and any visiting
teams’ handover certificate are kept by the HTM Team in the relevant
Equipment File (Section 8.4.1).


◆ A copy of the whole handover document is submitted to the Finance Officer to
trigger payment.


◆ A second copy of the whole handover document goes to the supplier documenting
the status and date of handover of the equipment.


The date of signing the Acceptance Test Logsheet may be an important reference
point later on. For example, it may be used as the warranty commencing date, or the
date when payment procedures can begin (Section 8.5).


8.4.4 Handover


246




If there are problems with goods or services, the Commissioning Team does not sign
off the logsheet, but writes a Fault Report (see the last page of the Acceptance Test
Logsheet for an example) explaining the problems and advising that payment be
withheld until the problems have been corrected (Section 8.5). The Procurement
Unit should notify the supplier or issuing store immediately – see Section 8.6 for
further information on complaints procedures.
Any equipment that fails the Acceptance Process must not be handed over to the
user department, but should be left with the Commissioning Team (as long as the
team is active). Alternatively such equipment can be handed over to the HTM
Manager or to the supplier (if he was a member of the Commissioning Team and has
an office locally), until it has passed the Acceptance Process.


8.5 WHEN AND HOW TO MAKE PAYMENTS
A well-organized payment system is important to ensure payments are made on time
and according to purchase contracts. Managing money is a complex and responsible
task, which is mainly carried out by finance officers or accountants. The Procurement
Manager and HTM Working Group have little responsibility for handling money
apart from petty cash. However, they are responsible for reporting to the finance
department that equipment and services are acceptable and payment can be made.


Making Payments
Before instigating any payment, the Procurement Unit must ensure that the goods
have been inspected and accepted, and that the order complies with contract terms
and conditions (Section 6.4). In all payment cases, the Procurement Unit needs to:
◆ cross-check and compare the diverse delivery documents (such as the delivery


note and packing lists) with the Purchase Order
◆ match and link the delivery documents and Purchase Order with the invoice.
After all these checks have been carried out, the Procurement Unit should avoid
‘double payment’ by:
◆ signing and stamping the invoice, and filling in all the relevant data for the


Finance Office including: signature (all checks done), cost centre code and
accounts code


◆ attaching the invoice to the delivery documents and Purchase Order
◆ submitting all the necessary documentation to the Finance Office for payment.
The Finance Office must make payments in accordance with the payment schedule
described in the purchase contract (Section 6.4). For equipment and services, final
payment should only be made by the Finance Office when they have received a
completed and signed Acceptance Test Logsheet (from the Commissioning Team)
and a Goods Received Note (from the Stores Controller).


8.5 When and how to make payments


247




If the Finance Office receives a Fault Report from the Commissioning Team because
there are problems or discrepancies with the goods or service (Section 8.4.4),
payments should be withheld until the problems have been rectified. Only when the
problems with the goods and services have been satisfactorily rectified, can the
Commissioning Team finally complete and sign off the Acceptance Test Logsheet
and submit it, to trigger payment.


Exceptions
Some suppliers may have asked to be paid in advance or on delivery. You should only
agree to this for local suppliers, or as part payment for foreign suppliers. In these
cases, payment may be made in a number of ways. Either the Finance Office:
◆ uses petty cash
◆ raises the necessary cheque or cash on the basis of the Purchase Order (Section 6.4)


and the invoice/delivery note
◆ uses a letter of credit which only pays when the supplier presents proof of


shipping (Section 5.5.2).
In these cases, it is worth negotiating some form of phased payment so that you can
retain a proportion of the money owed until you are sure you are satisfied with the
goods or services provided (Section 5.5.2).


Payments by Others
If another organization (for example, an external support agency) purchases the
goods or services on behalf of the health facility, then that organization is responsible
for making the payments. The Commissioning Team needs to keep such
organizations informed of any issues (such as delays or damage – see Section 8.6),
and the Finance Officer submits all documents to the external purchasing
organization for payment. The Finance Office uses the same documents as required
by your health service provider, with supplementary paperwork if the external
support agency requires it.


Closing Procurement Files
The Procurement Unit can close the file on each round of purchasing when:
◆ the contents of the Purchase Order is fully delivered and accepted
◆ all payments have been made
◆ the Finance Office agrees that there are no outstanding issues (such as a bond for


the warranty period).
The closed files should be sent to the health facility’s (or any other relevant) archives.


8.5 When and how to make payments


248




Tip • Whatever payment method is used, the Procurement Unit should file all documents
for reference, and keep them for at least two years (or the time specified in the
regulations of your organization).


• The HTM Manager should keep a record of warranty periods, and inform the
Finance Office when future call-outs, parts, or labour are still free-of-charge under
warranty terms.


8.6 DAMAGE TO GOODS, OR UNSATISFACTORY
SUPPLY OF GOODS OR SERVICES
Occasionally, there may be problems with the goods or services supplied.
For instance:
◆ goods are damaged
◆ the order is received incomplete (for example, spare parts, accessories, or


documentation are missing)
◆ the wrong product is received (for example, the wrong type or model of equipment)
◆ the equipment does not fulfil its function, as described in the specification
◆ the quality is inferior to the specification
◆ safety standards given in the purchase document are not met
◆ the supplier fails to provide agreed services (such as training)
◆ the supplier provides poor services (for example, there was a problem with


the installation).
Your original purchase contract (Section 6.4) needs to include details of what to do
if events of this kind occur. This should include conditions specified by both the
buyer and supplier. In case of disagreement over specific paragraphs in specific
documents, the priority of the documents must be stated in the contract.
If there are problems with the goods and services supplied, you should first try to
establish exactly how the situation occurred and how it can most easily be remedied.
Always contact the supplier immediately, and give him only objective facts about the
problems. First use the telephone or e-mail and be friendly and polite, then follow up
with written information. The person who should contact the supplier should:
◆ be senior enough to make decisions
◆ have enough clinical and technical knowledge to be able to give and understand


relevant and detailed information about the product received and the
damage/complaint.


8.6 Damage to goods, or unsatisfactory supply of goods or services


249




If an external support agency purchased the goods or services, you should keep them
informed while you make polite enquiries of the supplier. If it becomes clear that the
issues can only be resolved through a legal contractual route, the external support
agency should take responsibility for this.
If a health service store issued the goods, they should be notified of any
discrepancies.


Damaged or Missing Goods
Once it is confirmed that the shipment received was incomplete or damaged, you
should contact your insurance company who sends a surveyor and files an insurance
claim. The supplier should also be notified immediately.
If the insurance company determines that:
◆ the damage was due to negligence on the part of the supplier (unsatisfactory


packing, etc) – then the supplier should re-supply the item or provide money in
kind (although this may have to be negotiated on a case by case basis)


◆ some items from the shipment are missing due to negligence on the part of the
supplier – then the supplier provides the missing items


◆ some items were stolen – then the insurance company compensates.


Country Experience
A computer with an expensive screen had to be stored in a warehouse due to a one-week
delay in installation. It was stolen from the warehouse.
The hospital’s buying conditions stated clearly that the supplier was responsible for all items
procured until the handover certificate was signed, and that the supplier was responsible for
insuring the equipment up until installation was complete.
Since all routines at the warehouse had been followed, the supplier provided a new
computer and screen.


The following remedial action is the normal procedure:
◆ The Commissioning Team does not sign off the Acceptance Test Logsheet, but


writes a Fault Report to the Procurement Manager describing the problems
(photographs of the damage help with insurance claims).


◆ The Procurement Unit:
- notifies the relevant bodies (the manufacturer, supplier, carrier, or issuing store –


depending on the contract), and any external support agency involved
- checks whether the damage is covered by your insurance policy and, if you are


covered, who is responsible (the buyer or supplier)
- completes any insurance claim quickly (delays can lead to a claim becoming void).


8.6 Damage to goods, or unsatisfactory supply of goods or services


250




◆ If responsibility lies with the supplier, you should send the goods back to
the supplier.


◆ Depending on the terms and conditions, you may receive a refund, a credit, or
goods may be replaced.


◆ If the responsibility lies with the buyer, then you will need to obtain replacements
by placing another order.


◆ When any goods are rejected, the supplier/issuing store will not be paid (in full)
until the complaint has been resolved (Section 8.5).


Inferior or Superior Equipment
If you discover that you have been supplied with an inferior product to the one
offered, you have the right to reject the equipment.


Tip • Be aware that sometimes a model is discontinued and replaced during the purchase
process, and that a new model is received. This is normally no reason for rejection.


If the equipment is similar in quality and function, you can request a discount –
especially if the received goods introduce non-standard equipment when you
ordered a standardized model.
If the equipment is of better quality, check that it is appropriate to your health
facility (looking at factors such as level of technology, available skills and local
climate). If the equipment is not suitable, reject it. If it is acceptable, do not pay
more than the amount agreed for the original model.
When incorrect equipment is received, inform the supplier or issuing store
immediately (and any external support agency involved). Take the remedial action
detailed below for unsatisfactory services.


Unsatisfactory Services
If installation, commissioning or training provided by the supplier, their
representative, or a contractor is unsatisfactory, the health facility has the right to
reject any of these activities if they do not conform to the agreed contract.
Alternatively, a discount could be acceptable to both parties.
If the supply of goods or services is unsatisfactory, the following remedial action
should be taken:
◆ The Commissioning Team does not sign off the Acceptance Test Logsheet, but


writes a Fault Report to the Procurement Manager describing the problems.
◆ The Procurement Unit notifies the relevant bodies (such as the manufacturer,


supplier, their representative, or a contractor – depending on the contract).


8.6 Damage to goods, or unsatisfactory supply of goods or services


251




◆ The Procurement Manager:
- either makes personal contact with the supplier so that the necessary parties


(supplier, representative, contractor, health facility) can decide what appropriate
action should be taken


- or, if the purchasing was carried out by an external support agency, reports the
problems to them so that they can negotiate the contractual obligations with the
supplier/contractor.


◆ When any services are rejected, the supplier/contractor providing them must redo
the work, and will not be paid in full until they have done so (Section 8.5).


Box 48 contains a summary of the issues covered in this Section.


BOX 48: Summary of Procedures in Section 8 on Receipt, Commissioning, and Storage
On Site


Section 8 summary


252


HTM Working
Groups


Procurement
Manager
Stores Controller
and team


Commissioning
Team (and any
external contractor)
Commissioning
Team


Commissioning
Team and/or any
external contractor
(if applicable)


As
se


m
bl


y
to


Tr
ai


ni
ng





R
ec


ei
pt






P


ro
ce


ss
◆ develop an Acceptance Test Logsheet covering all elements of the Acceptance


Process (see Annex 9)
◆ establish a Commissioning Team of suitable health service staff (Section 1.2),


joined by any external installation and/or training team when applicable
◆ ensure all resources required for the Acceptance Process are available


(see Box 46)
◆ designates a suitable delivery/unpacking area
◆ arranges any lifting equipment required
◆ sign delivery notes (acknowledging the number of packages and their


condition only)
◆ unpack and inspect recurrent orders of equipment-related supplies (see Figure 24)
◆ unpacks and inspects new equipment orders (see Figure 23)


◆ designates a suitable space and office for commissioning, and space for
training sessions


◆ ensures all the arrangements are in place for assembly, installation,
commissioning, and initial training (see Figures 25 and 27)


◆ oversees all parts of the Acceptance Process
◆ carry out the work (see Section 8.3.1 and Figures 26 and 28)
◆ complete the relevant section of the Acceptance Test Logsheet if the equipment


passes and the work is satisfactory
◆ officially accept new equipment
◆ complete a Fault Report if there are problems with the goods or services


Continued opposite




Section 8 summary


253


BOX 48: Summary of Procedures in Section 8 on Receipt, Commissioning, and Storage
On Site (continued)


Commissioning
Team/HTM
Manager


Health Management
Teams and HTMS
Stores Controller
and team


Procurement
Unit
Finance Officer


HTM Manager


Commissioning
Team
Procurement Unit


Finance OfficeC
om


pl
ai


nt
s








P
ay


m
en


t











Re
gi


st
ra


tio
n/


Ha
nd


ov
er




◆ enters the equipment onto the Equipment Inventory with its own inventory
code number, and labels the equipment with it


◆ sets up an Equipment File for each piece of equipment
◆ enters the equipment into the PPM programme
◆ attaches an equipment card to the equipment
◆ completes a Register of New Stocks form
◆ registers the warranty
◆ copies and stores operator and service manuals appropriately
◆ hands over new equipment and its initial stock of supplies to the user department
◆ hands over the remaining bulk stocks of equipment-related supplies to the


Stores Controller
◆ compiles the necessary documents to create a handover document and submits it


to the Procurement Unit for appropriate distribution
◆ choose the most appropriate storage system for equipment and equipment-


related supplies (see Guides 4 and 5)
◆ enter new equipment into the stores system (see Figure 29)
◆ get a Goods Received Note signed by the user department for new equipment
◆ liaise with the Security Manager about the location of new property
◆ enter equipment-related supplies into the stock control system (see Figure 28)
◆ file all delivery documents for at least two years
◆ compiles all necessary signed documents and submits them to the Finance Office
◆ closes the Procurement Files and stores them for at least two years
◆ pays the supplier/issuing stores according to the schedule in the purchase


contract, only on receipt of a signed completed Acceptance Test Logsheet
◆ only uses payment in advance or on delivery where necessary, and arranges the


payments as appropriate
◆ if another organization is purchasing the goods, processes the paperwork


according to the rules of the external funding organization
◆ keeps warranty records, and informs the Finance Office when work or parts are


free under warranty terms
◆ submits a Fault Report if there are problems with the equipment or services


◆ identifies a suitable person to contact and negotiate with the supplier/issuing
store, or passes the case to the external support agency that financed the
purchase


◆ contacts the insurance company and claims the appropriate compensation
(money, re-supply of goods, corrected work), or re-purchases


◆ only pays the supplier/contractor/issuing store when the complaints have
been resolved.




254




9. HOW TO UNDERTAKE ACTION
PLANNING AND MONITORING OF
PROGRESS


Why is This Important?
Managing the activities described in this Guide will involve a cycle of actions.
You need to monitor your performance, and set yourself goals so that you can
improve. Then you monitor your progress, revise your goals, and review your
progress again – thus undertaking a continuous cycle of planning and review.
Such evaluation helps you to ensure the quality of your work. This is one
element of quality management – an important goal for managers.


The planning and review activities are interlinked in a cycle as shown in Figure 30, but
it is necessary to start the discussion at some point in the cycle. This Section discusses
the following:
◆ The planning process (setting goals) in Section 9.1.
◆ The review process (monitoring progress) in Section 9.2.


Figure 30: The Planning and Review Cycle


9 How to undertake action planning and monitoring of progress


255


Set/Revise
Goals Monitor Performance/Progress


action


feedback




As can be seen from the procurement cycle in Figure 6 (Section 2.2), your skills at
procurement and commissioning can only improve if you obtain feedback regarding
the performance of equipment, suppliers, contractors, and external support agencies.
This helps you to find ways of undertaking procurement and commissioning in
future that enable you to choose better equipment, suppliers, contractors, and
external support agencies.


This Guide covers the wide range of activities known as
‘logistics’. There are many different types of staff who should be
involved in planning and reviewing their progress with this work,
such as members of:
◆ Procurement Units
◆ HTM Teams


◆ HTM Working Groups and/or their various sub-groups (such as the
Commissioning Team, the training sub-group, the project sub-group)


◆ Stores departments
◆ Transport departments.
The main outcome of the planning and review process is that you are able to evaluate
your performance. This is important for ensuring the quality of your work (quality
assurance), which is an essential component of quality management.


Aims of Quality Management
◆ client satisfaction
◆ cost efficiency
◆ compliance with laws


We recommend that quality management is introduced into the health management
systems of all decentralized levels of the health service. It can help to improve staff
attitudes, and this, in turn, can help staff handle the challenges connected with the
many reforms and new management tasks they face (such as those described in this
Guide). Important elements of quality management are:
◆ a management team approach
◆ supervision and evaluation
◆ participative leadership
◆ methods for encouraging staff
◆ individual responsibility and initiative
◆ control measures such as performance measurements and impact analysis
◆ community participation.


9 How to undertake action planning and monitoring of progress


256


Logistics
the detailed coordination of


a large and complex operation
to move and supply equipment


and materials.




9.1 SETTING GOALS (ANNUALLY) FOR
PROCUREMENT AND COMMISSIONING


Purpose
It is necessary for all groups involved in procurement and commissioning to have
goals and plans which set out their priority activities. The goals and plans must be
clearly defined so that they guide the work of:
◆ all departments and groups involved in procurement and commissioning
◆ the health facility or decentralized health authority level that these teams are


based at
◆ higher levels of the same profession (for example, the HTMS, Central Stores, the


Central Procurement Division)
◆ the health service as a whole.
The goals and plans will also enable staff and managers to monitor their own
performance and progress with regard to procurement and commissioning activities.
Every team or department can benefit from an Annual Action Plan which contains
clear, specific goals relating to its key activities. An action planning process should
take place once a year, as standard practice. This is an opportunity for the members
of the team to agree the range of activities (initiatives and changes) they want to
implement, because they believe the activities will improve:
◆ their working environment
◆ their performance
◆ the service they provide.
There are boundaries and limitations to this planning process. The need for major
investments in equipment should be discussed outside the annual action planning
process, through activities such as the Equipment Development Planning exercise
(see Guide 2 on planning and budgeting). Similarly, ongoing shortages of staff or
money are usually excluded from the annual action planning process, and should be
addressed instead by higher authorities that can influence such issues.
Instead, we suggest that annual action planning should focus on improvements and
changes that staff can undertake themselves, and that can be achieved with existing
staff, equipment, facilities, and other resources.


9.1 Setting goals (annually) for procurement and commissioning


257




Staff involved in procurement and commissioning activities should devise a wide
range of initiatives and goals for all aspects of their work, such as:
◆ obtaining information about new products
◆ improving procurement skills
◆ implementing effective equipment acceptance procedures
◆ improving stock control of equipment-related supplies
◆ shorter bidding and delivery periods
◆ more successful installation and commissioning outcomes.


The planning process, and the plans themselves, should be clear and straightforward.
This assists participation and produces goals that can be understood and used by all
staff. Staff who are involved in setting goals and preparing plans are more likely to be
committed to carrying them out. Thus, the planning process should incorporate
representatives of all different types of staff, from all relevant disciplines.
We suggest that you hold an action planning seminar once a year. Such seminars can
be held in various ways:
◆ Either across a ‘horizontal’ level of the health service, in other words,


planning for the health service as a whole with participation from
all disciplines (including those involved in procurement and
commissioning), undertaken by your health facility or by your
district health authority.


◆ Or across a ‘vertical’ professional programme within the health service
(such as the procurement service, or maintenance service). In this
case, representatives would meet from all the Procurement Units,
for example, in your district, or region, or throughout the health
service as a whole.


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The main purpose is to establish an annual planning cycle which:
◆ reviews past performance, problems, and needs
◆ identifies solutions and sets specific goals for the year
◆ prepares an annual action plan for delivering improvements in the coming year
◆ monitors implementation
◆ starts back at the beginning again with another review the following year.
A full description of the process of running an action planning seminar is provided in
Guides 4 and 5. At the meeting or seminar, each priority problem area identified is
discussed, and solutions developed. For each solution or improvement, the meeting
writes new targets, recommendations, and longer-term objectives, as well as
indicators for the coming year (as described below).
The Annual Action Plan developed states the goals, the people, resources, and time
required to achieve them, and how they will be measured (see below). Once ready, it
needs to be communicated back to all staff.


Setting Goals
Three types of goals are required: targets, recommendations, and longer-term objectives.


i. Targets
Targets guide the work of all groups involved in procurement and commissioning
activities, during the following year. They help to improve services and make sure
the most important work gets done. Targets are one of the best tools for judging
progress and work performance. We suggest that each unit/group should have
between five and ten targets, following the ‘SMART’ target-setting process:
Specific state what should be done and who will do it
Measurable easy to measure, or easy to decide that the target has been achieved


or if progress is being made
Achievable possible to carry out with existing staff, equipment and money
Relevant cover a priority problem or improvement
Time-bound state when the activity should be completed by.
It will be clearer if targets are written down using the following headings, which can
be used when the final plans are produced:


Target By whom How to measure How to achieve Timetable
Actions agreed,
listed in order
of priority


9.1 Setting goals (annually) for procurement and commissioning


259


Names of
persons who will
be responsible


How progress will
be determined
(see indicators
below)


Resources
required


Time-frame for
start and
completion




ii. Recommendations
You will discover that some important problems cannot be overcome or
improvements achieved unless extra supplies, staff, or funds are provided, or unless
assistance is obtained from outside. In such cases, recommendations are required.
These should be:
Specifically addressed to the person, official, department, organization, etc that is


able to carry out the recommendation.
Reasonable there is no point in asking for the impossible, such as 10


times more staff
Essential there should be no easy way for the Procurement


Unit/Commissioning Team to achieve the same results on
their own.


iii. Longer-term Objectives
You will also discover some problems which cannot be solved in one year. Maybe they
need large amounts of money, longer preparation, or plenty of time to achieve. Or
maybe it is simply not possible to do everything at once. In such cases, longer-term
objectives are required which will be carried forward to the next year, or for
implementation later on.


How to Measure the Goals
Each goal must be easily measured, so that you can see if it has been achieved or if
progress is being made:
◆ You need a way of determining if you are moving towards your goal – this is called


an indicator. There will always be several possible indicators for each goal, and
more than one way of measuring them.


◆ You need to know where you are starting from, in other words, what the situation
is now – this is called the baseline data. The data chosen must be relevant to
the indicator.


Box 49 provides an example of different ways of measuring a goal using indicators
and baseline data.


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BOX 49: Example of How to Measure a Goal
Goal: Cut the time from tender invitation to equipment delivery to a minimum.
Improving performance on three indicators at the same time would help you achieve this goal.
1st indicator: Reducing the time from the tender closing date to the award of contract (if valued


at more than US$ 100,000) to less than 90 days
Calculation required: Percentage of such contracts awarded within the 90 days


= Number of such contracts awarded within the 90 days, in a given period x 100%
Total number of such contracts awarded in that period


Baseline data: In a study of the current situation you find that in the previous year, only one out
of three contracts were awarded in less than 90 days.
Therefore your baseline data is 33%.


Your aim is to improve this situation by increasing this percentage.
2nd indicator: Reducing the time from awarding the contract to submitting a detailed order to


less than 30 days
Calculation required: Percentage of such orders submitted within the 30 days


= Number of such orders submitted within the 30 days, in a given period x 100%
Total number of such orders submitted in that period


Baseline data: In a study of the current situation you find that of the three contracts awarded in
the previous year, only two of them had orders submitted in less than 30 days.
Therefore your baseline data is 66%.


This performance is good, but you would like to increase this percentage.
3rd indicator: Reduction in warehouse storage of pieces of large equipment which will be


installed by in-house staff
Calculation required: Percentage of such equipment stored in the warehouse


= Number of such pieces of equipment stored in the warehouse, in a given period x 100%
Total number of such pieces of equipment installed in that period


Baseline data: In a study of the current situation you find that in the previous year, seven out
of the ten large equipment items installed by in-house staff had to be stored in
the warehouse.


Therefore your baseline data is 70%.
Your aim is to improve this situation by decreasing this percentage.


9.1 Setting goals (annually) for procurement and commissioning


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It is necessary to choose suitable indicators that are specific to all your annual goals.
There are many possible indicators for all groups involved in procurement and
commissioning, and the health service as a whole, so staff and managers should
decide upon the most important activities (or statistics and results) to measure.




Examples of the types of indicators that can be used for equipment procurement and
commissioning activities are those describing:
◆ Procurement Unit’s - records kept


performance - different procurement methods used
- average time for awarding contracts
- average time for making payments
- number of bids/quotes per purchase


◆ Suppliers’ performance - average lead time (time from receiving the order to
delivering the goods)


- compliance with contract pricing and other terms
- decrease in partial shipments
- compliance with packaging and labelling instructions


◆ Stores’ performance - delivery time
- number of requests for orders met
- decrease of storage time in transit
- decrease in instances when out of stock
- equipment-related items made stockable


◆ Commissioning Team’s - sites prepared on time
performance - decrease in delays before installers arrive


- acceptance process made standard practice
- goods registered into all relevant records


◆ HTM Team/contractor’s - installation cost (or price per square metre)
performance - safety testing undertaken as a standard part


of commissioning
- correct training carried out for correct trainees.


The Procurement and Supplies teams, HTM Team and HTM Working Group
should meet to agree on a few suitable indicators that can be measured easily and
quickly (if possible). Positive indicators are preferable as they motivate staff.
Sometimes it is useful to use common indicators for different teams, groups, and
staff, so that their progress can be compared.
Once the indicators have been agreed, they need regular measuring and charting.
The relevant Health Management Team will need to decide:
◆ how records of these indicators will be kept, for example, in a register, with a form,


or on a chart (Section 9.2)
◆ who will be responsible for keeping them
◆ how regularly the results will be summarized (each month, for example)
◆ what form of charts and displays you will use to show the monthly summarized


results (so that it is easy for people to see how they are progressing).


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Projects with External Support Agency Assistance
Assistance can be received from external support agencies for both routine
equipment procurement, and for major development projects involving equipment,
as follows:
◆ Equipment for any health facility, decentralized health authority, or HTM Service


may be procured using funds from external support agencies (ranging from small
donors, to large multi-national organizations).


◆ Any health facility, decentralized health authority, or HTM Service may be
involved in a large development project, which can be externally funded. Such a
project may be set up across many sectors in the health service. If it involves a
healthcare technology component, the HTM Service must be involved. The
healthcare technology component could address a number of equipment-related
issues, such as:
- the purchase of equipment
- improvements to health facilities
- improvements to the HTM Service
- support for healthcare technology management (including skills in procurement,


stores management, etc).
The healthcare technology component could apply across the health facility, the
district, or the health service as a whole, and over a longer time span than one year.


It is important to remember that the external support agencies financing both the
routine procurement and the development projects will usually have drawn up goals
of their own. These may be different to the departmental goals set annually, and will
often have their own time frame. The HTM Working Group, or a smaller project sub-
group (Section 1.2), should set goals and oversee the progress of externally-assisted
projects. The HTM Working Group/project sub-group should use the principles
already outlined concerning setting targets, recommendations and longer-term
objectives, in consultation with the external support agency. For each element of any
externally-assisted project it is necessary to:
◆ set goals and measurement indicators
◆ agree the time frame for reaching the goals set
◆ monitor progress
◆ report to the external support agency as required by them.


Tip • If you have many external support agencies funding procurement, you may find that
they each have different monitoring and reporting requirements. This can be very
time-consuming. Your health service provider organization should try to negotiate a
common style of monitoring and reporting if at all possible.


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9.2 MONITORING PROGRESS WITH PROCUREMENT
AND COMMISSIONING
The identification of problems and needs is an important part of the management of
equipment-related activities. All equipment-related activities should be monitored
and evaluated, and the performance of equipment, staff, and departments should be
supervized (this applies to all clinical, technical, and support departments). The
results of such monitoring are useful for providing feedback to staff, Health
Management Teams, and the Healthcare Technology Management Service.
Monitoring progress involves a number of different activities. The following
monitoring activities are described in this Section:
◆ Monitoring progress against annual goals (as set in Section 9.1).
◆ Monitoring progress in general, using statistics and feedback.
◆ The audit process for development projects.


Monitoring Progress Against Annual Goals
Monitoring progress against goals is one of the best ways that staff, managers, and
the health service provider can judge their work performance. Thus, it is necessary to
follow up the plans and goals set, in order to ensure that they are put into practice. If
this is not done and goals sit on a shelf gathering dust, then all the time spent
planning will have been wasted.
Regular monitoring of progress against goals is essential throughout the year. This
should be done using the measuring and charting methods introduced in Section 9.1.
Displaying annual goals and progress towards them can be helpful to staff.


At the end of each year, it is essential to review and carefully analyze the results
achieved on all the team/group’s goals, before starting to develop the Annual Action
Plan for the following year. This step is the most important – to review results on a
regular basis with the people who are doing the work.
This is the time to give praise for good progress, or to find out what might be causing
shortcomings or problems, and then seek a solution. If solutions are quite impossible
it may be necessary to change the plans. If common indicators were used for different
departments, groups, teams, and staff, it will be possible to compare their progress.


9.2 Monitoring progress with procurement and commissioning


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Monitoring Progress in General
Monitoring equipment-related activities can help to identify problems and needs.
Thus the results of monitoring are useful for providing feedback to staff and senior
management. By receiving feedback on their activities and answers to their queries,
staff will benefit from experience, and feel a part of the system as a whole. In this
way staff:
◆ will be informed
◆ can obtain support
◆ will feel involved and empowered
◆ can be encouraged to take responsibility.
Regular monitoring of activities and services is also essential for improving the quality
of healthcare. Management need facts so that they can plan effectively, and need to
know how equipment-related activities are being carried out. Thus, it is important to
have some method of collecting information, such as compiling statistics.
The groups involved in procurement and commissioning activities need to gather
and compile statistics. These will provide information on each group’s progress and
work performance in relation to equipment. They need to gather information in
order to:
◆ be better managers
◆ improve the running of their group
◆ provide information to other people and bodies who need to know how the group


is performing.
Feedback is essential to the procurement cycle (see Figure 6 in Section 2.2). The
Procurement Manager needs to obtain feedback from all relevant groups in the
health facility who can provide information on the:
◆ operational performance and safety of equipment, accessories, and consumables
◆ reliability of equipment, spare parts, and maintenance materials
◆ performance of the installation, commissioning, and training teams (whether


in-house or external)
◆ performance of the suppliers (whether companies or health service stores)
◆ performance of the stock control system
◆ performance of any carrier, freight forwarder, clearing agent, or hired


transport company
◆ performance of the external support agency.


9.2 Monitoring progress with procurement and commissioning


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The information gathered should be provided to relevant bodies (at any level of the
health service) so that they can use it to improve the next round of procurement,
such as:
◆ the Specification Writing Group
◆ the Procurement/Tender Committee (adjudicating offers)
◆ the Commissioning Team
◆ staff who write purchase documents and contracts
◆ staff who approach external agencies for support
◆ staff who pre-qualify suppliers
◆ staff who install and commission equipment
◆ staff who train others.
It may be possible to incorporate this data gathering into some form of Procurement
Information System as part of the existing Health Management Information System
(see Guide 1 on organizing HTM). This will enable ‘evidence-based’ planning to
take place.
Statistics and feedback should be gathered regularly, for example on a monthly or
quarterly basis. Box 50 shows the sort of statistics that can be gathered and how to use
them. You will need to decide which are the most useful ones for your health service.
The Procurement Manager and Chair of the HTM Working Group should start the
monitoring by:
◆ selecting statistics relevant for the functioning of the unit/team
◆ deciding how the information should be collected, for example on well-designed


Statistics Forms placed in Statistics Folders
◆ deciding who will carry out the data collection for the different statistics (this may


require staff with particular skills and will also take time)
◆ analyzing and presenting the results in regular Logistics Activity Reports for


senior management, and at meetings.
After monitoring has taken place for one or two months, the monitoring system could
be expanded to include further statistics. Once Logistics Activity Reports are available
for several periods, they can be presented as graphs or tables. Remarkable data or
significant changes, as compared to previous/past months, should briefly be explained.


Tip • Monitoring is not just a one-off activity but something that has to be carried out on
a regular and systematic basis, to help improve the way you work and the service
you provide.


• Monitoring requires the involvement of all staff. Before starting, you should discuss
the reasons for monitoring with the people involved and make sure everyone knows
what they are trying to achieve.


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9.2 Monitoring progress with procurement and commissioning


267


BOX 50: Examples of Statistics and Feedback to Gather and Their Use
Type of statistics Examples
Workload and performance (statistics
obtained by counting numbers)


Quality control of equipment
and suppliers (information obtained
by analysis)


Quality control of the procurement
process chosen (information obtained
by analysis)


For the Procurement Unit, statistics such as:
◆ the number of purchase requests received
◆ the numbers of purchases completed
◆ percentage of the budget spent.
For the Commissioning Team, statistics such as:
◆ the number of commissioning jobs delayed due to


different causes:
- sites not prepared on time
- lack of funds for materials or contractors
- delivery delays
- lack of equipment lifting machinery.


Similar statistics could be found for the stores department, the
training sub-group, etc.
The Procurement Unit can:
◆ track the number and value of contracts awarded in date order
◆ track the value of total purchases from each supplier by year
◆ track the performance of the supplier (and their


representatives) for each contract
◆ monitor the performance of the equipment and equipment-


related supplies over time, and
◆ feed this information back to relevant bodies, such as the


Procurement/Tender Committee or the Specification
Writing Group.


Such a monitoring system for the performance of equipment
and suppliers should eliminate unreliable suppliers, and
improve the quality of the equipment selected in the future.
The Procurement Unit and senior management can review the
choices made in the procurement process, by recording any
problems that occurred and the final outcomes. For example,
was the correct:
◆ model used for procurement?
◆ lot system used?
◆ purchasing method used?
◆ external support agency used?
◆ carrier/freight forwarder used?
◆ clearing agent used?
◆ freighting method and terms used?




Monitoring Progress With Externally Assisted Projects
The HTM Working Group (or its project sub-group) will have prepared the goals for
any externally funded projects, whether routine procurement or large development
projects (Section 9.1). Depending on what is being funded, different elements will
be under scrutiny. Here are some examples:
If equipment is being purchased, you may need to monitor progress with:
◆ equipment procurement procedures
◆ site preparation work
◆ installation, commissioning, and acceptance procedures
◆ the stores system for equipment-related supplies
◆ training of maintainers and users
◆ utilization of new equipment.
If the procurement service is being improved, you may need to monitor progress with:
◆ procurement staffing levels
◆ procurement facilities – space, technical literature, computerization
◆ procurement systems – record-keeping, the tender process, the adjudication process
◆ writing and implementation of purchase documents and purchase contracts
◆ budgetary management and payment procedures.
If equipment management is being improved, you may need to monitor progress with:
◆ the formulation of equipment development plans
◆ development of management ‘tools’ such as an equipment inventory,


specifications, contracts
◆ training plans.
Indicators will have been chosen to measure progress with the goals for such
elements. For large projects, a standard Audit Form can be developed based on this
monitoring structure, containing:
◆ a list of the elements involved in the project
◆ the aspects being developed for each element
◆ a record of the progress made (possible entered against a record of the goal set)
◆ a record of the date the audit was taken.
Such an Audit Form ensures continuity and consistency with subsequent audits of
large projects. An Audit Process can be developed and agreed, and an Audit Team
established to monitor progress regularly.


9.2 Monitoring progress with procurement and commissioning


268




Section 9 summary


269


Mo
ni


to
rin


g
Pr


og
re


ss








S
et


tin
g


Go
al


s


◆ ensures there is an annual action planning process whether across ‘horizontal’
levels (within a health facility or district), or within a ‘vertical’ programme (for
the procurement/supplies division as a whole)


◆ set their targets, recommendations, and longer-term objectives each year, in
order to improve their performance (after reviewing the previous year’s
performance)


◆ develop suitable measurement indicators for these goals and gather baseline data
(see Box 49)


◆ participate in the annual action planning seminar
◆ set the targets, recommendations, and longer-term objectives for any routine or


large development projects for equipment, in consultation with the external
support agency


◆ develop suitable measurement indicators for these goals
◆ ensures the Health Management Information System is developed to include


factors that measure progress with procurement and commissioning of equipment
◆ ensure progress against annual goals is monitored, displayed, and used to


provide feedback to team members, as well as to develop improved goals for the
following year


◆ design suitable statistics that are informative and easy to gather (see Box 50)
◆ use procurement and commissioning records and feedback from staff, for


gathering and compiling statistics, enter them on Statistics Forms, and file then
in Statistics Folders


◆ use the statistics and feedback to write Logistics Activity Reports for management
◆ ensure that progress against any goals (annual, regular, or project) is used to prompt


the correct response, such as training, better budgets, different suppliers, etc
◆ ensure that progress against project goals is monitored and reported as required


by the external support agency.


BOX 51: Summary of Issues in Section 9 on Action Planning and Reviewing Progress


Health Service
Provider


All groups involved
in procurement
and commissioning


Health Management
Teams (or their
Project Sub-Group)


Health Service
Provider
All groups involved
in procurement
and commissioning


Health Management
Teams (or their
Project Sub-Group)


Box 51 contains a summary of the issues covered in this Section.




270




ANNEX 1: GLOSSARY
Acceptance process: Activities undertaken when equipment arrives at an health facility, at


the end of which the equipment will be operational and officially belong
to the facility, such as receipt, unpacking, installing, commissioning,
initial training, entering into Stores and onto records, payment.


Accessories: For equipment, those items which connect the machine to the patient
(e.g. leads, probes), assist with the use of the machine (e.g. trays, foot-
switches), or adapt its performance (e.g. adaptors, lenses).


Administrative level: See decentralized authorities.
Assembly: The steps required to put equipment back together again if it was


dismantled for shipment.
Autonomous: Self-governing or independent.
Carrier: A company which transports your goods (also see freight forwarder).
Central level: Highest authority of your health service provider, such as Ministry of


Health or Board.
Clearing agent: A company that undertakes the importation of goods on your behalf.


They deal with customs clearance for you and often arrange onward
transportation of the goods, hence also known as a handling agent.


Commissioning: A series of tests and adjustments performed to check whether, and
ensure that, new equipment is functioning correctly and safely before
being used.


Communication Any equipment that is used for sending or receiving information, such
equipment: as telephones, two-way radios, nurse-call systems, paging systems.
Consumables: For equipment, those items which are used up during the operation of


equipment (e.g. film, reagents, gel).
Contract: A legally binding document between the buyer and a supplier for a


specified period of time, which describes the goods and services
being supplied.


Decentralized authorities: Local units of an organization which have had authority transferred to
them from the central level of the organization. For example, district,
regional, provincial or diocesan health authority.


Demurrage charges: The charges imposed on the buyer by Customs if they have to store
your goods because you have delayed clearance or have not paid duty.


Direct order: Contacting the supplier directly for a price, and placing
an order.


Distribution centre: A large health service store (such as one at central or zonal level) that
receives orders of goods destined for many health facilities, holds them
‘in transit’, splits the contents and despatches the correct items to
their final destinations.


Donation: A (supposedly) free gift which can take the form of a donation of
equipment, or a non-repayable grant with which to purchase the
equipment. (Unforeseen expenses may be incurred when accepting a
donation).


Donor: See external support agency.


Annex 1: Glossary


271




Electrical safety: The guidelines, practices and procedures to ensure that people are
protected from the fatal electrical risks posed by electrical supplies,
installations, and equipment.


Energy sources: A source of energy or power, such as generating sets, solar panels or
transformers.


Equipment-related Items which are essential for equipment use, such as consumables,
supplies: accessories, spare parts and maintenance materials used with equipment.
Equipment users: All staff involved in use of equipment, such as clinical staff (e.g.


doctors and nurses), paramedical staff (such as radiographers and
physiotherapists) and support services’ staff (such as laundry and
kitchen workers).


External support agency: A body responsible for providing money, equipment, or technical
support to developing countries on various terms, such as
international donors, technical agencies of foreign governments, non-
governmental organizations, private institutions, financial
institutions, faith organizations.


External support People working for external support agencies that health agency
workers come into contact with, such as a country representative, desk
officer, consultant, coordinating agency, director.


Fabric of the building: Items which are part of the integral structure or framework of a
building, such as doors, windows or roofs.


Facility: See health facility.
Fire fighting equipment: Equipment used to put out fires, such as fire blankets, buckets,


extinguishers, hose and sprinkler systems.
Fixtures built into Items which are not part of the integral structure of a the building but
building: are installed into the fabric of the building, such as ceiling-mounted


operating theatre lights, scrub-up sinks and fume cupboards.
Freight Transport of goods in bulk.
Freight forwarder: A carrier which provides the most comprehensive service, including


shipment, customs clearance and onward transportation of the goods
from the port to the final destination, hence also known as a
forwarding agent.


Gantt chart: A display of all activities that occur from placing an order until the
goods arrive showing how long and when each activity should occur
and used to monitor actual progress with each activity.


Handover: The formal presentation of new equipment, after its formal
acceptance, to the user department or the health service provider’s
representative who assumes responsibility for it.


Head of section: Departmental managers, such as head of department, group leader,
officer in-charge, senior operator.


Health facility: Buildings where healthcare is delivered, ranging from small units
(clinics, health centres), and small hospitals (rural, district, diocesan),
to large hospitals (regional, referral).


Health facility furniture: Furniture with a specific clinical use in health facilities, such as beds,
cots, trolleys, infusion stands.


Annex 1: Glossary


272




Health management Health management body, such as facility management committee,
team: district/regional/diocesan/central health management team, Board.
Health service provider: A provider of health services, such as Ministry of Health or Defence,


non-governmental organization, private institution, employer
organization or corporation (for example, mine), faith organization.


Health system: Comprises all organizations, institutions, and resources devoted to
health actions (defined as any effort, in personal or public health
services or through inter-sectoral action), whose primary purpose is to
improve people’s health. (Source: WHO).


HTM Manager: Head of the HTM Team; ranging from a general member of health
staff with some management skills in the smallest HTM Teams, to an
engineering manager in the highest level HTM Teams.


HTMS: Healthcare technology management service made up of a network of
HTM Teams and HTM Working Groups.


HTM Team: A body responsible for management of equipment, such as, equipment
management team, maintenance management team, physical assets
management team; part of the HTM Service.


HTM Working Group: A working group, or standing committee responsible for making
decisions on healthcare technology management issues; part of the
HTM Service.


Indicator: Something that will provide information which shows whether
progress is being made towards achieving a goal.


In-house: Activities undertaken by staff already employed by the health service
provider organization (rather than using temporary hired labour or
external contractors).


Initial training: A key training stage in a member of staff ’s career which provides
training in the range of skills required to make the best use of newly
arrived equipment, and takes place at the time of commissioning


Installation: The process of fixing equipment into place; can range from building
equipment into the fabric of a room, to simply plugging it into an
electric socket.


Inventory: A systematic listing of stock (or assets) held. An annual inventory is
prepared at the end of each year following a physical inspection and
count of all items owned by an organization. The list gives details,
such as location, reference number, description, condition, cost and
the date the inventory was taken.


Laundry and kitchen Equipment required for kitchen or laundry activities, such as cookers,
equipment: cold rooms, washing machines, hydro-extractors, roller-ironers.
Lead time Time interval between placing an order for equipment and receiving it.
Leasing: Renting or hiring of equipment, or some arrangement that allows for


deferred payment for equipment such as paying by instalments and
leasing to buy.


Letter of credit: The most secure way to pay for goods, this inter-bank document states
that money is available in the buyer’s bank for the contracted supplier
to claim once the job has been completed and evidence is presented to
show all contract terms have been met.


Annex 1: Glossary


273




Life-cycle cost: The recurrent cost required to keep equipment going throughout its
life (e.g. fuel, consumables, maintenance, training, disposal).


Lifetime: Lifespan, life expectancy. For equipment, the likely length of time
that an item will work effectively, dependant on the type of
technology and parts used in its manufacture.


Logistics: The detailed coordination of a large and complex operation to move
and supply equipment and materials.


Maintainers: See maintenance staff.
Maintenance staff: Staff responsible for maintenance of equipment, such as craftspeople,


artisans, technicians, technologists, engineers.
Manager: Any staff involved in the management of equipment-related activities.


This could include administrator, nurse-in-charge, medical
superintendent, chief executive, director, health secretary, medical
practitioner, maintenance manager, policy-maker.


Medical electrical safety: The guidelines, practices and procedures to ensure that people are
protected from the fatal electrical risks posed by medical equipment.
There are stricter requirements than for electrical safety as medical
equipment comes into direct contact with patients’ bodies.


Medical equipment: Equipment used for medical purposes, including X-ray units,
diathermy units, suction pumps, foetal doppler, scales, autoclaves,
infant incubators, centrifuges.


Office equipment: Equipment used in an office, such as computers, photocopiers,
calculators, record systems.


Office furniture: Furniture used in an office, such as desks, chairs or
filing cabinets.


Plant, general: Machinery such as boilers, lifts, air-conditioners, water pumps or
compressors.


Pre-installation work: Activities required in preparation for the arrival and commissioning of
equipment, such as preparing the site at the health facility so the
equipment can be installed, hiring lifting equipment, organizing or
hiring warehousing space.


Procurement: The process of obtaining goods and services in any way, such as
through purchase, donation, loan or hire.


Procurement manager: The official that is head of the Procurement Unit and in charge of
managing the procurement process. Another term for a Purchasing and
Supplies Manager.


Procurement officer: The member of staff in the Procurement Unit whose job is to
undertake the daily tasks involved in the procurement process.
Another term for a Purchasing and Supplies Officer.


Procurement unit: The group responsible for managing the procurement process for all
goods that an organization requires. Another term for a purchasing unit
or a procurement office.


Annex 1: Glossary


274




Proforma invoice: A legal document between the supplier and the buyer providing a
complete breakdown of the supplier’s quote and terms for the order,
against which payment is made by the buyer. Most commonly used by
buyers to allocate and arrange the transfer of funds via bank money
transfer to international suppliers. Used by Customs in the country of
destination to determine the customs value of imported goods.


Purchase document: A set of papers where the buyer clearly states everything that they
wish to purchase and the terms of the purchase, used by the buyer to
obtain bids/quotes from potential suppliers.


Purchase order: A sequentially numbered printed form (from a quadruplicate book)
used by the buyer to place an order with a supplier, listing the details
of all that is required. It is an official and binding document issued to
the supplier authorizing the expenditure of funds for goods and
services, and acknowledging that payment will follow. Once created,
the necessary funds are dedicated from the relevant budget account
(expenditure line) against the purchase order number.


Purchasing: The acquisition of goods or services in return for money or equivalent
payment.


Quality control: A system of maintaining standards; testing a sample against
specifications.


Quotation: The stated price and terms provided by a supplier, when asked to do
so, with a validity period for acceptance by the buyer. Usually several
quotations are obtained for comparison. Obtaining the quotation can
be done in a number of ways – request for quotes, national competitive
bids, and competitive negotiation.


Registration: The procedures for entering equipment and supplies, once officially
accepted, into health facility records and systems, and processing
them ready for storage or use.


Service supply Supply installations such as electrical installations, water and sewage
installations: pipelines, gas supplies.
Spare parts: For equipment, those items which make up the machine, need


replacing as they wear out, and may be specific to a particular model
(e.g. bearings, bulbs, printed circuit boards).


Specification: A detailed description of the design and materials used to make
something; a standard (of workmanship, materials, etc.) required to be
met in a piece of work. Generic specifications refer to a class or type
of thing and do not specifically mention a brand name.


Standard: A required or agreed level of quality or attainment set by a recognized
authority, used as a measure, norm, or model for all aspects of health
services and healthcare technology.


Standardization: Rationalization, normalization, and harmonization. In other words,
reducing the range of makes and models of equipment available in
stock, by purchasing particular or named makes and models.


Stock: In stores, this is the goods held by an organization for its own use. The
‘equipment stock’ is all the equipment assets owned by an organization.


Annex 1: Glossary


275




Supply-period contract: A contract drawn up to cover long-term arrangements, which awards a
supplier with the contract to supply certain goods over a set number
of years.


Support staff: Additional types of staff in the health service besides medical
personnel, such as planner, finance officer, procurement officer, stores
controller, human resource officer.


Tendering: A purchasing procedure whereby potential suppliers are invited to
make a firm and unambiguous offer of the price and terms which, on
acceptance, should be the basis of the subsequent contract. As the
process is confidential, suppliers can provide an offer knowing that no
other bidder can knowingly undercut them. As the bidding format is
formal and ‘transparent’, no supplier can offer an extra incentive. The
process can be either ‘open’ to anyone to respond to, or can be
‘restricted’ to a smaller group.


Training equipment: Equipment required when running a training course, such as overhead
and slide projectors, video and tape recorders.


Trigger: Cause to happen.
Turnkey: Approach where the supply of a package of equipment includes


delivery, installation, commissioning, initial training, and handover to
the client. It may also include design advice and building modification.


Users: See equipment users.
Vehicles: Any conveyance used for transporting people, goods, or supplies in the


health service, such as ambulances, cold-chain motorbikes, mobile
workshops, lorries, buses.


Walking aids: Items used to aid mobility, such as wheelchairs, zimmer frames,
crutches.


Waste treatment plant: Any plant used to treat waste, including incinerators, septic tanks or
biogas units.


Working group A group of people set up to be responsible for a particular subject area,
such as a standing committee, select committee, sub-committee.


Workshop equipment: Equipment used in a workshop, such as hand tools, bench tools or test
instruments.


Your organization: See health service provider.


Annex 1: Glossary


276




BOX 52: WHO’s Definition of the Technology Management Hierarchy
Equipment support: undertaking maintenance and repair.
Equipment management: using the equipment database (inventory and maintenance history)


to help you make decisions for improving equipment support.
Asset management: including cost and utilization information (life-cycle cost analysis) in


the equipment database to help you make decisions on replacement
and acquisition.


Technology assessment: reviewing past, current, and future technologies to determine their
efficacy and effectiveness, and to help you make decisions for capital
planning and acquisition.


Technology management: using: equipment
equipment support
equipment management
asset management
technology assessment


to manage technology in health care from conception to retirement.
Source: Department of Health Service Provision, World Health Organization, 2000


Annex 1: Glossary


277




ANNEX 2: REFERENCE MATERIAL AND CONTACTS
This Annex is in two parts, and provides information about:
Part i. Books, guidelines, databases, and websites
Part ii. Organizations, sources of publications in part i, resource and information centres.


i. Books, Guidelines, Databases, and Websites
The following books, guidelines, videos, databases, and websites are listed in subject categories
according to the topics found in Sections of this Guide. For each publication, a brief description of the
content and the main source(s) are included. Contact details for the source organizations are included
in Part ii. Readers should note that many of the publications are available at low cost. In some
countries it may also be possible to obtain these publications from local bookstores, as publishers and
distributors increase efforts to ensure wider availability. Published prices may be flexible depending
on the order size, discounts available and distribution method.


Tip • Many books and documents cover a variety of topics that appear in several Sections of this Guide. The
first time they appear in this list they are described in full. For each subsequent entry only the basic
details are provided.


Healthcare Technology Management Framework Issues
This material covers issues in Sections 1 and 2, such as healthcare technology management
definitions, policy, regulations, guidance, and services. It is listed alphabetically by title. Further
detailed information on this topic is provided in Guide 1.


Developing healthcare technology policy
Health care technology management No.1: Health care technology policy framework
Kwankam Y, Heimann P, El-Nageh M, and M Belhocine (2001). WHO Regional Publications, Eastern
Mediterranean Series 24. ISBN: 92 9021 280 2
This booklet is the first in a series of four titles. It introduces the ideas of and behind health care
technology management, defines terms relating to and sets objectives for health care technology
management policy. It examines what should go in to such a policy, and the national policy framework
and organization. Capacity-building and human resources issues are considered, as well as economic
and financial implications. Attention is also given to legislation, safety issues, cooperation nationally
and between countries, implementation, monitoring, and evaluation. See Guide 1 for information on
the three further titles in this Series:
No.2: Eastern mediterranean regional strategy for appropriate health care technology
No.3: Health care technology policy formulation and implementation
No.4: Country situation analysis.
Available from: WHO
Interregional meeting on the maintenance and repair of health care equipment: Nicosia,
Cyprus, 24-28 November 1986
WHO (1987). WHO document WHO/SHS/NHP/87.5
This document provides a comprehensive discussion of the problem of non-functioning equipment
and of proposed solutions. The major policies, recommendations, and strategies proposed by the
conference on the issue of maintenance and repair of health care equipment are presented. It
includes four Working Papers which cover in detail: maintenance and management of equipment, the
proposed health care technical service, manpower development, and training.
Available from: WHO


Annex 2: Reference materials and contacts


278




Management of equipment
DHSS, UK (1982). Health Equipment Information No. 98
The aim of this booklet is to recommend a system of equipment management that, if fully
implemented, would ensure that all equipment used in the British National Health Service was
suitable for its purpose, was maintained in a safe and reliable condition, and was understood by its
users. Its recommendations and procedures are structured into sections on equipment selection,
acceptance procedures, training, servicing (maintenance, repair, and modification), and replacement
policy. It also covers the management of inventories, equipment on loan, servicing, long-term
commercial contracts, infection hazards.
Available from: Her Majesty’s Stationery Office (HMSO).
Medical equipment in sub-saharan Africa: A framework for policy formulation
Bloom, G and C Temple-Bird. (1988). IDS Research Report Rr19, and WHO publication
WHO/SHS/NHP/90.7. ISBN: 0 903354 79 9
This book provides a good overview of the situation of medical equipment in Africa. Its approach to
the analysis is to unpackage medical equipment technology into its component activities, such as
planning, allocating resources, procurement, commissioning, operation, maintenance, training, etc. It
provides good general policy formulation strategies to address the problems discussed.
Available from: WHO
Practical steps for developing health care technology policy: A manual for policy-makers
and health service managers in developing countries
Temple-Bird, C (2000). Institute of Development Studies, University of Sussex, UK. ISBN: 1 85864 291 4
This book is a practical step-by-step guide for developing health care technology policy. It can be used
by health service providers, regional and district health authorities, health facility managers, and
external support agencies. It describes a process for developing health care technology policy which is
collaborative, participatory, iterative, and involves community stakeholders. Guidance is provided on
underlying management concepts, undertaking a situation analysis, running a ideas workshop,
formulating policy, developing an implementation plan and procedures manual, as well as the
resources required to complete these tasks.
Available from: Ziken International Consultants Ltd
Strategic medical technology planning and policy development
Raab M (1999). Swiss Centre for International Health. August 1999.
This paper discusses the challenge of the fast expansion in technologies, and the choices that have to
be made to manage them. It looks at healthcare technology assessment, the elements and formulation
of a healthcare technology policy, and the strategic planning process required.
Available from: SCIH
See Guide 1 for further resources on, and examples of, developing healthcare technology policy.


Understanding healthcare technology management
International seminar for hospital technicians/engineers: February 1998, Moshi, Tanzania
Clauss J (ed) (1998). FAKT
This document reports the results of intensive work by 38 national and international experts brought
together from faith, public, and private agencies to strengthen equipment management measures in
the health sector. It includes papers, with country examples, on healthcare technology management,
using cost-sharing to finance maintenance, networking, structures of health care technical services,
cash control for workshops, training, communication technologies, modification of medical and
hospital equipment, energy supply and photovoltaics. There are also lists of standardized equipment
for the Evangelical Lutheran Church of Tanzania and the Joint Medical Stores of Uganda, and a
description of how they were developed.
Available from: FAKT


Annex 2: Reference materials and contacts


279




International workshop on healthcare technology management: 2-6 October 2000,
Catholic Pastoral Centre, Bamenda, Cameroon
Clauss, J (compiler) (2000). FAKT
This document reports the results of intensive work by 35 national and international experts involved
in setting up and operating systems for the sustainable management of healthcare technology. It
includes papers, with country examples, on healthcare technology management, the role of
stakeholders, public/private partnerships for providing HTM, financial management of maintenance
organizations, and donations of healthcare technology.
Available from: FAKT
Medical equipment in Botswana: A framework for management development
Temple-Bird C L, Mhiti R, and G H Bloom (1995), WHO publication WHO/SHS/NHP/95.1
This book reports on the results of a study of the healthcare technology sector in Botswana, and the
lessons learnt are of relevance to many other countries. The study was undertaken by unpackaging the
sector into its component activities, such as planning, allocating resources, procurement,
commissioning, operation, maintenance, training, etc. In this way the book provides good general
healthcare technology management strategies to address the problems discussed. This book also
describes how technical staff obtain their basic technical qualifications either as artisans at local Trade
Testing Centres, or as technicians at the local Polytechnic, and provides an understanding of how such
systems and qualifications work.
Available from: WHO
Medical technology management
David Y, and T Judd. (1993) BioPhysical Measurement Series, SpaceLabs Medical Inc.
ISBN: 0 9627449 6 4
This book looks at the appropriate management tools needed to make technology’s role more
clinically effective and cost–effective (based on the healthcare delivery system in the USA). It focuses
on strategic technology planning principles, and how they contribute to improved patient outcomes.
It also looks at a process for technology assessment and life-cycle cost analysis. It defines many
common terms, and the role of useful committees, procedures, and forms.
Available from: SpaceLabs Medical Inc.
Physical assets management and maintenance in district health management
Halbwachs H (2000). GTZ document
This paper provides practical guidance to health workers involved in district health systems
concerning health technology - one of the critical areas in managing health service delivery at district
level. It presents the physical assets management approach, and elaborates on key strategies for
maintenance, financing, quality control, monitoring indicators, cost-benefit analysis calculations, and
a basic paper-based maintenance information system.
Available from: GTZ
The effective management of medical equipment in developing countries:
A series of five papers
Remmelzwaal B (1997). FAKT, Project Number 390
This document is aimed at the health workers, administrators, maintainers, and overseas aid workers
who are involved in medical equipment management in developing countries. It examines the
variation in performance with management of medical equipment in different countries, with the
objective of identifying successful approaches. It addresses some of the managerial issues related to
the conservation of equipment; allocation of human, financial and material resources; and acquisition
and use. It looks at the structure for the HTM Service, and the HTM cycle. It includes an example
spreadsheet layout to use as an inventory form, with various data collection codes.
Available from: FAKT
See Guide 1 for more information on further relevant issues, such as health service definitions, the
place of HTM in health systems, regulations, and standards.


Annex 2: Reference materials and contacts


280




Procurement/Logistics Management
This material covers issues in Sections 2 to 9 on all aspects of managing the procurement and
logistics process. It is listed alphabetically by title.


Tip • The sources in this section cover many topics in the procurement cycle. Sources that cover a single
topic are listed in the sections that follow, each of which is dedicated to an individual topic. When
looking for a specific topic, always check this first general section to see if any sources cover the
subject matter you are interested in.
Equipping hospitals and other health care facilities in developing countries.
Cooper-Poole, J. (1979) in Approaches to planning and design of health care facilities in
developing areas, Vol 3., Kleczkowski, B.M. et al. (eds), WHO Offset Publication No 45.
ISBN: 92 4 1700459
This paper discusses selection of equipment and describes the steps necessary to ensure that the
equipping of a hospital proceeds smoothly. The importance of design briefs, operational policies and
procedures, local conditions, equipment schedules, the purchasing programme, choice of suppliers,
maintenance, spares, tender procedures, commissioning, and the defects liability period are discussed.
Available from: WHO
How to assess health services logistics with particular reference to peripheral health facilities
Battersby A (1985). WHO, Geneva, Switzerland. WHO SHS/85.9
This handbook sets out to help mid-level managers (such as District Medical Officers) who wish to
improve logistics, particularly for their primary health care programme. The first step towards such
improvement is to assess the various elements of logistics. This handbook has two halves: i) checklists
for each part of the logistics system, and ii) supporting material for each checklist. Mid-level managers
can use the checklists to enable them to define the strengths and weaknesses of their logistics
system, and formulate strategies for improvement.
Available from: http://whqlibdoc.who.int/hq/1985-86/SHS_85.9.pdf
Humanitarian supply management and logistics in the health sector
Emergency Preparedness and Disaster Relief Program, PAHO and Department of Emergency and
Humanitarian Action, WHO (2001). PAHO/WHO, Washington DC, USA. ISBN 92 75 12375 6
The acquisition, storage, mobilization and distribution of supplies to the victims of a disaster require a
minimum framework of logistical organization that permits efficient handling and better use of
resources. This book provides guidelines to manage this process. It points out that countries and
organizations should incorporate the topic of logistics into their planning and preparedness for
disasters, and stresses that each step in the supply chain should be seen as a critical and interrelated
link. This book is the result of many years of practical experience (especially thanks to the use of the
SUMA methodology). Despite the fact that it places emphasis on drugs and pharmaceutical supplies,
the techniques and procedures that it proposes are multi-sectoral in nature and can be used in any
type of emergency operation.
Available from: PAHO, WHO
Managing drug supply: the selection, procurement, distribution, and use of
pharmaceuticals, 2nd edition
Management Sciences for Health /WHO (1997). Kumarian Press, Connecticut, USA
MSH and the WHO collaborated to produce the second edition of this book, providing a
comprehensive revision of the well-known textbook that was first published in 1981. Its 48 chapters
provide a complete overview as well as step-by-step approaches on how to manage pharmaceutical
systems effectively. Although aimed at drug supply, many of the principles, policies, procedures, and
methods can be adapted for equipment and other supplies.
Available from: http://www.msh.org


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281




Medical supplies and equipment for primary health care: A practical resource for
procurement and management.
Kaur M, and S Hall (2001). ECHO International Health Services Ltd. ISBN: 0 9541799 0 0
This book is intended for health workers and those responsible for the procurement and management
of medical supplies and equipment at primary healthcare level. It covers guiding principles for
selecting supplies and equipment, provides guidelines for ordering and procurement, storage and
stock control, care and maintenance, and considers decontamination and safe disposal of medical
waste. The manual also discusses the use of standard lists as a tool for encouraging good procurement
practice and includes model lists of medical supplies and equipment required for primary health care
activities in both health facilities in the community, and basic laboratory facilities.
Available from: TALC
Official dictionary of purchasing and supply
Compton HK, and DA Jessop (2001). Liverpool Academic Press, Wirral, UK. ISBN: 190350001X
This dictionary contains all the most up-to-date and relevant terminology for the modern business
practitioner. It includes coverage of correct procedures for purchase, supply, selling and general
trading and is recommended to students and practitioners of the Chartered Institute of Purchasing
and Supply (CIPS).
Available from: major internet bookshops
Operational principles for good pharmaceutical procurement
WHO (1999). WHO, Geneva, Switzerland. WHO/EDM/PAR/99.5
The document is composed of four chapters: i) a brief problem statement illustrating the need for
improvements in procurement practices; ii) four strategic objectives for pharmaceutical procurement
that apply to any health system, whether public or private; iii) twelve operational principles for good
pharmaceutical procurement, grouped into four categories (management; selection and
quantification; financing and competition; supplier selection and quality assurance); iv) practical
implementation of the twelve principles, and mechanisms to improve the performance of the
procurement system. Although aimed at drug supply, many of the objectives, principles, procedures,
and mechanisms can be adapted for equipment and other supplies.
Available from: http://whqlibdoc.who.int/hq/1999/WHO_EDM_PAR_99.5.pdf
Purchasing and supply chain management, 6th edition
Lysons K, and M Gillingham (eds) (2002). Prentice Hall. ISBN: 027365764X
This book takes an integrated approach by drawing on the many disciplines from ethics and human
resources to suppliers, sourcing and strategy that all contribute to a full knowledge of purchasing
practice and techniques. The sixth edition has been substantially revised, with 3 new chapters, to
take account of recent developments. The book covers the syllabus of the CIPS in respect of the
Foundation Stage subjects: ‘Introduction to supply and materials management’ and ‘Legal and
procurement processes’, and the Graduate Diploma, Professional Stage core and option subjects:
‘Purchasing and supply chain management 1 – Strategy’, and ‘Purchasing and supply chain
management 2 – Tactics and operations’. It also largely covers the specialist options of ‘Stores and
inventory management’, ‘Commercial relationships’, and ‘International purchasing’.
Available from: major internet bookshops
The handbook of logistics and distribution management, 2nd edition
Rushton A, Oxley J and Croucher P (2001). Kogan Page, London, UK. ISBN: 0749433655
Logistics and distribution management is a major industrial and economic function – a subject of great
scope and importance. Thus this second edition of a popular and practical handbook looks at the
logistics function as a whole and explores all stages of the supply chain, from raw materials through to
the final distribution of the finished product. The major topics covered are: concepts of logistics and
distribution, planning for logistics, procurement and inventory decisions, warehousing and storage,
freight transport, information and supply-chain management. Richly illustrated throughout with
diagrams and photographs, this new edition is an invaluable guide for distribution, logistics and supply-
chain managers, as well as students taking logistics-related degrees and professional qualifications.
Available from: major internet bookshops


Annex 2: Reference materials and contacts


282




The role of the logistics manager in contraceptive procurement: A checklist of essential
actions, guidelines for logistics managers
United Nations Population Fund (1999). UNFPA, New York
The purpose of this guidebook is to provide a brief checklist of essential actions to help logistics
managers worldwide ensure that service programmes always have adequate supplies of contraceptives
and other products that they need for clients. The guidebook begins with an overview of the re-supply
systems that logistics managers must direct; it elaborates the actions that would ensure that each
stage of the re-supply process is completed before initiating actions that depend upon the completion
of previous tasks; and it includes a list of the principal sources of technical information with which the
logistics manager should be familiar. Although aimed at contraceptive supply, many of the principles,
policies, procedures, and methods can be adapted for equipment and other supplies.
Available from: http://www.unfpa.org/
Strengthening logistic support to primary health care: A programme for action
WHO (1992). WHO document WHO/SHS/NHP/92.1
This booklet discusses logistics requirements (procurement, storage, transport, and maintenance of
equipment and supplies) for primary health care. It provides strategies and country experiences for
policy and planning, procurement, logistics operations management, maintenance and repair,
transport, communications, management information systems, training and supervision of logistics
staff, as well as monitoring, evaluation and operations research.
Available from: WHO


Regulations and standards
This material covers issues in Sections 3.3.2, 5.5.2 and Annex 4 on assured quality and safety. It is
listed alphabetically by title.
A guide for the development of medical device regulations
Cheng M (2002). Essential Drugs and Technology Programme, Division of Health Systems and
Services Development, PAHO. ISBN: 92 75 12372 1
This publication has been prepared to guide regulatory authorities in all countries of the Region of the
Americas in ensuring the safety, efficacy and quality of medical devices. It aims to provide guidelines
for countries seeking to develop a regulation program for medical devices, at all stages in their life. It
is based on, and provides an overview of, the regulatory methods in Canada, the USA, and the
European Union.
Available from: PAHO, WHO
ANSI website: www.ansi.org
American National Standards Institute, which administers and coordinates US voluntary consensus
standards and conformity assessment systems. The site contains catalogues of American Standards, as
well as IEC and ISO standards.
CEN website: www.cenorm.be
European Committee for Standardization, which prepares European Standards in specific sectors of
activity and promotes technical harmonisation in Europe. The site contains a catalogue of European
Standards, many of which cover a wide range of healthcare technology.
CENELEC website: www.cenelec.org
European Committee for Electrotechnical Standardization, which develops European
electrotechnical standards adopted from the international bodies such as the IEC and ISO. The site
includes an online catalogue of European and international standards, many of which cover a wide
range of healthcare technology.


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283




Emergency Care Research Institute (ECRI, USA) products
This organization produces a variety of products on healthcare technology. They are available as hard
copy and as software regularly renewed by subscription, with special rates for developing countries.
The data is comprehensive and primarily written for the US audience, and the software is
sophisticated. The products cover various issues, such as:
◆ Healthcare standards directory
◆ SELECTplus (equipment procurement advisory service)
◆ HECS 4 for Windows (includes inventory management software)
◆ Health devices source book (a directory of manufacturers and distributors for the US market,


their contact details, products, and typical price ranges)
◆ Healthcare product comparison system (a reference guide for selecting equipment)
◆ ECRI spec (a database of specifications, instructions to bidders, and terms and conditions, etc)
◆ Health technology assessment information service
◆ Health devices alerts database
◆ Health technology trends newsletter
Available from: ECRI
European Union’s Directorate General 3 (Enterprise) website: http://dg3.eudra.org
The EU website providing information on pharmaceuticals, biotechnology, and medicines.
IEC website: www.iec.ch
International Electrotechnical Committee, which sets standards for the safe manufacture of electrical
healthcare technology. There is a wide range of specific standards for medical electrical equipment
falling under the standard numbers IEC 60101–1,2, and 3.
ISO website: www.iso.ch
International Organization for Standardization, which is a worldwide federation of national standard
bodies responsible for the development of international standards and related activities. The
standards most frequently referred to are those in the ISO 9000 range covering quality management
for businesses.
Medicines and Healthcare Regulatory Agency (MHRA, UK) products
This agency of the UK government (formerly the Medical Device Agency) ensures medical devices
and equipment meet appropriate standards of safety, quality, performance, and effectiveness, are used
safely, and that they comply with relevant Directives of the European Union. The MHRA produces a
variety of publications, such as:
◆ Medical device alerts (replacing former hazard notices, safety notices, device alerts, advice


notices, etc.)
◆ Device bulletins (replacing former evaluation reports)
◆ Device evaluations
◆ Advice on a wide variety of safety topics (visit the website, click on contacts, then medical


devices, then search under a subject area such as decontamination, or laundry for example).
Available from: MHRA
NICE website: www.nice.org.uk
National Institute of Clinical Excellence, which provides guidance to the UK National Health Service
(NHS) on current best practice covering both health technologies (from medicines to diagnostic
techniques) and the clinical management of specific conditions.


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284




Ways to Obtain, and Sources of, Equipment
This material covers issues in Section 3.3 on purchasing, donations, and leasing of equipment, as well
as the role of external support agencies in providing equipment, Section 3.4 on second-hand
equipment, and Section 4.3 on different types of supplier. It is listed alphabetically by title.
Cost-effective aid for developing economies
Halbwachs H (1999). GTZ, Eschborn, Germany
This paper explains that as funds for aid are dwindling, there needs to be a more effective utilization
of resources. It presents strategies and criteria which would help aid used to supply equipment to be
more cost effective.
Available from: GTZ
Emergency Care Research Institute (ECRI, USA) products
ECRI
Guidelines for health care equipment donations
WHO (1997). WHO document WHO/ARA/97.3
This document presents guidelines that aim to improve the quality of equipment donations, not to
hinder them. They are not an international regulation, but intended to serve as a basis for national or
institutional guidelines, to be reviewed, adapted and implemented by governments and organizations
dealing with health care equipment donations. They provide detailed guidance and checklists for
both the potential donor and recipient. The guidelines are based on extensive field experience and
consultations with many experts internationally. They also merge together several earlier documents,
including the two listed below.
Available from: WHO
Guidelines for medical equipment donations
American College of Clinical Engineering (1995). ACCE, Plymouth Meeting, USA
This document summarizes the recommendations of an ACCE committee that was formed to discuss
ways to improve the effectiveness of donations of equipment. It is divided into five sections: i) helps
the donor screen out equipment that should not be considered for donation, ii) assists the donor to
find the right recipient, through a careful evaluation of their clinical needs and resources for operating
and maintaining equipment, iii) helps the donor and recipient to plan and prepare for the donation,
iv) provides a discussion on successful transfer of goods, including assembly, packaging, shipping,
documentation, customs clearance, unpacking, and installation, v) evaluates each donation so both
parties can learn how to avoid past mistakes and improve future transactions.
Available from: http://www.accenet.org/secure/donationguidelines.html
Guidelines on medical equipment donations
Churches’ Action for Health (1994). World Council of Churches’ publication
This paper is a guide for those accepting and making donations, and is also useful for those planning
to buy equipment. It clearly lays out in point form the responsibilities of the recipient and the
responsibilities of the donor.
Available from: WCC
Health care equipment for developing countries: The conflict between needs and interests
Halbwachs H (1992). GTZ, Eschborn, Germany
This paper discusses the supply of equipment by technical cooperation agencies and charitable
organizations to developing countries, and the problem of much of the equipment failing to work
shortly after receipt. It looks at the roles of the donor and the recipient, the issue of gifts and second-
hand goods, the life-cycle cost of equipment, and equipment requirements and standardization.
Available from: GTZ


Annex 2: Reference materials and contacts


285




Making health care equipment: Ideas for local design and production
Platt A, and N Carter (1990). ITDG Publishing
In this book, healthcare practitioners, planners and artisans will find ideas and designs for equipment
that can be made locally in relatively small workshops. Alternative materials and fabrication methods
are described to meet differing local circumstances.
Available from: ITDG Publishing
Management of equipment
DHSS, UK (1982). Health Equipment Information No. 98
Policy position: Donating and selling used medical equipment
International Medical Device Group (1992). pp 295-296 in Health Devices, Vol 21(9)
This paper discusses the pitfalls in the donation or sale of used medical equipment, ending with three
recommendations for donors and recipients.
Available from: ECRI
The right equipment ..... in working order
Bloom GH et al (1989). Reprinted from World Health Forum, Vol 10, No. 1, pp 3 – 27. WHO, Geneva,
Switzerland
This document contains a series of papers that discuss planning and budgeting issues for healthcare
technology in developing countries. They contain cost estimates (as a percentage of the capital stock
value), financial planning implications, constraints and strategies. They also discuss the different roles
of the users, donors, manufacturers, and their local representatives if procurement of equipment is to
be successful.
Available from: WHO


Equipment Specifications and Placing Orders
This material covers issues in Section 5.5.2 on generic equipment specifications and technical data,
and Section 6.5 on placing orders. It is listed alphabetically by title.
District health facilities: Guidelines for development and operation
WHO Regional Publications: Western Pacific Series No 22 (1998). ISBN: 92 9061 121 9
This revised and expanded book presents detailed, richly illustrated guidelines for the planning and
design of district hospitals including the efficient utilization of space and easy movement of people,
equipment, and supplies, as well as project planning. It also provides extensive information on the
selection and maintenance of medical and laboratory equipment, including specifications for a basic
radiological system and a general-purpose ultrasound scanner. Additional material covers sanitation and
waste management, emergencies and disasters, the procurement of essential drugs, and test instruments.
Available from: WHO
District laboratory practice in tropical countries (part 1)
Cheesbrough M (1998). Tropical Health Technology. ISBN:0 9507434 4 5
A valuable resource aimed at those responsible for the organization and management of district
laboratory services but can also be adapted for use by health centres. Covers selection and
procurement of laboratory equipment and supplies, including lists of requirements with brief
specifications and indicative (1997) prices. It covers parasitological tests, clinical tests and training of
personnel, as well as covering all types of safety issues for laboratories.
Available from: TALC, THT
District laboratory practice in tropical countries (part 2)
Cheesbrough M (2000) Tropical Health Technology. ISBN:0 9507434 5 3
Covers microbiological, haematological and blood transfusion techniques required at district level.
Available from: TALC, THT
Emergency Care Research Institute (ECRI, USA) products
ECRI


Annex 2: Reference materials and contacts


286




Examples of equipment specifications and technical data
A number of health service providers have developed their own equipment specifications, package of
inputs to purchase, national technical data, and supply contracts. For example, more information can
be obtained from:
◆ Dr P Asman, Biomedical Engineering Unit, Ministry of Health (Room 33, MOH Building),


PO Box M-44, Accra, Ghana. Email: nchtm@africaonline.com.gh
◆ Ministry of Health, PO Box 7272, Kampala, Uganda. Email: info@health.go.ug,


website: www.health.go.ug/support_system.htm
◆ Dr N Forster, Under Secretary: Health and Social Welfare Policy, Ministry of Health and Social


Services, Private Bag 13198, Windhoek, Namibia. Email: nforster@mhss.gov.na
◆ Ziken International, contact: info@ziken.co.uk
Future use of new imaging technologies in developing countries.
Report of WHO Scientific Group (1985). WHO Technical Report Series No.723. WHO,
Geneva, Switzerland
This document discusses the use of ultrasound and computed tomography and the specifications for
the required equipment.
Available from: WHO
Medical supplies and equipment for primary health care: A practical resource for
procurement and management.
Kaur M, and S Hall (2001). ECHO International Health Services Ltd. ISBN: 0 9541799 0 0
Physical asset planning and management software (PLAMAHS)
This software package holds information, and supports analysis, on: the equipment inventory,
equipment models and standards, existing and planned facilities, procurement support, and
maintenance support. The software holds various digital images, model equipment lists,
specifications, price and other financial data, and templates for forms, etc., and has a security system.
It has been designed especially with developing countries in mind, is available at special rates for
developing countries, and HEART can assist with the set up and initial training requirements.
Available from: HEART Consultancy
Practical laboratory manual for health centres in East Africa,
Carter J and Olema O (1998). AMREF.
Practical laboratory manual providing information necessary to establish, select and use laboratory
tests for patient management. Also includes material on implementation of safe working practices,
reporting and recording test results, keeping an inventory of supplies and equipment, ordering
supplies and maintaining equipment.
Available from: AMREF
Selection of basic laboratory equipment for laboratories with limited resources
Johns ML and ME El-Nageh (2000). ISBN: 9290212454
This book provides a framework to help laboratory workers, supply officers and decision makers to
choose and buy laboratory equipment and consumables. Includes information on maintenance and
energy requirements for laboratory equipment, quick reference buyer’s guides and equipment data
specification sheets provide easy reference for equipment buyers. The framework can be adapted to
guide general equipment purchasing.
Available from: WHO


Annex 2: Reference materials and contacts


287




Surgical instruments: A pocket guide (2nd edition)
Papanier Wells M, and M Bradley (1998). ISBN: 00721678017
A pocket guide listing and describing surgical instruments: sharps/dissectors, forceps, clamps,
retractors, suction tips, dilators, endoscopic instruments, internal stapling devices, and most
commonly used instrument sets for a variety of surgical procedures. Includes a picture of the
instrument with a brief description explaining the uses, varieties, and alternative names.
Available from: major internet bookshops
UNICEF supply catalogue (formerly the UNIPAC catalogue)
UNICEF
This catalogue lists products with their specifications under categories such as: immunization and
cold chain; medical devices and kits; water, environment, sanitation and engineering; education,
communication; etc. View it online at www.supply.unicef.dk/Catalogue.
Available from: UNICEF Denmark
See Guide 2 on planning and budgeting for more information on material that includes model
equipment lists.


Evaluation and Choice of Equipment
This material covers issues in Section 3.2 on issues to consider when choosing equipment including
healthcare technology assessment, and Section 6.3 on evaluating equipment. It is listed
alphabetically by title.
A pocket book for safer IV therapy (drugs, giving sets and infusion pumps)
M Pickstone (ed.) (1999). ISBN: 094 867232 3
This pocket book has been written to help clinical staff deliver safe IV therapy. It covers the
calculation of drug dose, the make-up of drug solutions and the selection of infusion devices and
associated equipment.
Available from: major internet bookshops
Appropriate medical technology for developing countries: Report of IEE 1st seminar in
February 2000
IEE Medical Focus Group. Report 00/014
This document contains papers on appropriate products that have been designed for use in
developing countries, such as an anaesthetic machine, diagnostic instruments for primary health care,
laboratory equipment, and an incinerator. It also contains discussions on issues such as solar power,
repair and maintenance of equipment, selection and procurement options, and sustainability.
Available from: IEE
Appropriate medical technology for developing countries: Report of IEE 2nd seminar in
February 2002
IEE Healthcare Technologies Professional Network. Report 02/057
This document contains papers on appropriate products that have been designed for use in
developing countries, such as a healthcare technology management information system, laboratory
equipment, a growth monitor, observation of respiratory dysfunction, a virtual doctor system, solar
energy, ophthalmic examination and surgical equipment. It also contains discussions on issues such as
a global medical devices nomenclature, management systems, the use of Cobalt 60 teletherapy for
cancer, a call for a biomedical instrument development centre, and an update of the anaesthetic
machine, diagnostic tools for medical surveillance, and an incinerator.
Available from: IEE


Annex 2: Reference materials and contacts


288




Appropriate medical technology for developing countries: Report of IEE 3rd seminar in
February 2004
IEE Healthcare Technologies Professional Network. UK ISSN: 0963 3308, reference no.: 03/10408
This document contains mainly scientific papers on research and design work being undertaken on
appropriate products and techniques for developing countries.
Available from: IEE
Consumer guide for the purchase of x-ray equipment
Holm T (2000). WHO Collaborating Centre for General and Continuing Radiological Education,
University of Lund, Sweden. WHO/DIL/00.1
This guide includes discussions on: choice of equipment for diagnostic imaging at large primary health
care centres and small hospitals; the World Health Imaging System for Radiography (WHIS-RAD) –
infrastructure, staffing and components; a summary of the technical specifications for the WHIS-RAD
unit; and a variety of sample forms.
Available from: http://whqlibdoc.who.int/hq/2000/WHO_DIL_00.1.pdf
Developing health technology assessment in Latin America and the Caribbean
PAHO (1998). PAHO. ISBN: 92 75 073777
This publication is aimed at policy-makers and health care professionals. The first part provides an
introduction to health technology assessment: why it is important, who does the evaluations, when
and how the evaluations are done. The second part looks at health technology in Latin America and
the Caribbean, and PAHO’s recommendations for promoting health technology assessment.
Available from: PAHO
District health facilities: Guidelines for development and operation
WHO Regional Publications: Western Pacific Series No 22 (1998). ISBN: 92 9061 121 9
District laboratory practice in tropical countries (part 1)
Cheesbrough M (1998). Tropical Health Technology. ISBN:0 9507434 4 5
District laboratory practice in tropical countries (part 2)
Cheesbrough M (2000) Tropical Health Technology. ISBN:0 9507434 5 3
Health technology assessment: Methodologies for developing countries
PAHO (1989). PAHO. ISBN: 92 75 12023 4
This publication reviews the main concepts and methodologies involved in assessing the effectiveness,
safety, cost, and social impact of health technologies, and discusses the potential contributions of such
assessments to improving health care delivery in developing countries. It discusses how the
methodologies must be adapted for developing countries, using results from actual examples.
Available from: PAHO
Infusion systems
Medicines and Healthcare Regulatory Authority (1995). MDA Device Bulletin, No. DB 9503 (May 1995)
This publication addresses many aspects of the use and selection of infusion systems. Its purpose is to
raise awareness of the nature of infusion systems, their advantages and their potential risks, with a
view to reducing the number of adverse incidents that arise from their use. It describes the different
types of infusion devices, risks and applications, training programmes, safety recommendations,
purchasing, and management responsibilities.
Available from: MHRA
Medicines and Healthcare Regulatory Agency (MHRA, UK) products
MHRA


Annex 2: Reference materials and contacts


289




Selection of basic laboratory equipment for laboratories with limited resources
Johns ML and ME El-Nageh (2000). ISBN: 9290212454
Technology assessment in healthcare
Raab M (2000). Swiss Centre for International Health
This paper discusses and calls for the need to undertake health care technology assessment in
developing countries, in order to make the best use of new technologies. It presents some strategies
for starting this process.
Available from: SCIH
See Guide 2 on planning and budgeting and Guide 4 on operation and safety for more information on
material that covers equipment needs. See Guide 1 or 5 for training institues that offer courses on
healthcare technology assessment.


The Receipt and Acceptance Process
This material covers issues in Section 7 on receipt and distribution, and Section 8 on installation,
commissioning, registration, and storage. It is listed alphabetically by title.
A guide to power conditioning and power back-up
Huys J (1996). FAKT, Basler Mission, and HEART Consultancy
This document is an introduction to guide you through the terminology and information regarding
power conditioning and power back-up. It is aimed at health workers facing problems with ensuring
power quality for any electrical equipment, and ensuring power is available when you need it. It deals
with the problems which can occur in the mains supply, and an explanation about the main measures
which can be taken for power conditioning and power back-up (including advice on suppressing
electro-magnetic interferences and radio frequency interference, and advice on different types of
uninterruptible power supplies). It is meant for anybody involved in the decision-making process for
the procurement and installation of such equipment.
Available from: FAKT
Care and safe use of hospital equipment
Skeet M and Fear M. (1995). VSO. ISBN: 0 9509050 5 4
This book provides practical advice for health service staff about proper management of the type of
equipment found in district hospitals or health centres. It includes guidelines on preventive
maintenance and servicing, simple user instructions, checklists for correct and safe use of equipment,
and basic technical information for training of first-line maintenance staff. The information is easily
accessible to those without a technical background. It includes advice on many topics relating to
safety and testing such as checking power supplies, gas cylinders, disinfection and sterilization.
Available from: TALC, VSO
Clinical engineering service departments: Establishment, scope of work and organization
Raab M (1999). Swiss Centre for International Health, Basle, Switzerland
This paper discusses the issues that prompted the evolution of clinical equipment support services,
the resources and staff required when establishing clinical engineering service departments, and their
scope of work, including details of necessary documentation and reporting using inventories and other
recorded data, as well as acceptance testing of equipment.
Available from: SCIH


Annex 2: Reference materials and contacts


290




Commissioning health care facilities
Steele PA, Little FA, and Littlewood, P (1983) in Approaches to planning and design of health care
facilities in developing areas, Vol 4. Kleczkowski, B.M. et al. (eds). WHO Offset Publication No 72.
ISBN: 924 1 70072 6
This paper covers commissioning of health care facilities as a whole, and discusses the component
parts involved in that process. It discusses the commissioning programme, operational policies,
organisational development, training, phasing of occupancy, and evaluation. The commissioning
programme is broken down into a number of tasks which include: scheduling and specifying, the
tender procedure, processing and issue of orders, manufacture and delivery, receipt/installation,
calibration and demonstration. In addition, monitoring of suppliers, coordination of mechanical and
electrical services, and equipment maintenance are discussed in the section on equipment.
Available from: WHO
District health facilities: Guidelines for development and operation
WHO Regional Publications: Western Pacific Series No 22 (1998). ISBN: 92 9061 121 9
How to manage a health centre store
Battersby A (1994). Healthlink Worldwide (formerly AHRTAG).
Describes in detail the structure and organization of a store or dispensary, methods of arranging
stocks, stock control, and basic dispensing.
Available from: Healthlink Worldwide
Maintenance and repair of laboratory, diagnostic imaging, and hospital equipment
WHO (1994). ISBN: 92 4 154463 5
A practical manual for maintenance and repair of basic laboratory and diagnostic equipment, as well as
anaesthetic machines, operation room equipment, and ultrasound and X-ray generators. Intended for
use in settings that do not have technicians or engineers with specialist expertise. The manual uses
line drawings and numerous checklists for inspection and cleaning, good working practices, routine
operation and maintenance. It is also useful as a training aid. It includes advice on many topics
relating to safety and testing such as disinfection, gas cylinders, laboratory hazards, radiation hazards,
and hazards from other types of equipment.
Available from: WHO
Management of equipment
DHSS, UK (1982). Health Equipment Information No. 98
Medical supplies and equipment for primary health care: A practical resource for
procurement and management.
Kaur M, and S Hall (2001). ECHO International Health Services Ltd. ISBN: 0 9541799 0 0
Spare parts and working materials for the maintenance and repair of health care
equipment: Report of workshop held in Lübeck, August 1991
Halbwachs H, and C Temple-Bird (eds) (1991). GTZ, Eschborn, Germany
This book, mainly aimed at maintenance technicians, covers the maintenance requirements for
common items used at district level (anaesthesia equipment, infant incubators, X-ray equipment,
suction pumps, autoclaves and laundry equipment) including some advice on safety testing and test
instruments. It also includes information on workshops, procurement and stock control of parts, and
an equipment inventory code numbering system.
Available from: GTZ
Technician’s handbook for compression refrigerators – Part D: How to keep stocks of
spare parts
WHO Expanded Programme on Immunization (1984). EPI/TECH.HB/D, Document
EPI/LOG/84/20 in Refrigerators use, maintenance and repair series, WHO, Geneva.
This booklet contains a series of case studies to help the reader learn about spare parts management.
Although designed for vaccine refrigerators, it can be applied to any spare parts. It has sections
covering how to choose and order spare parts, how to keep track of stocks of spare parts, how to decide
who should keep the stocks, and how many parts should be kept at each level of the health service. It
contains exercises and case studies for each topic.
Available from: WHO


Annex 2: Reference materials and contacts


291




The division for the supply of medical spare parts in the health system of Kenya
Paton J, Green B, and J Nyamu (1996). Ministry of Health, Nairobi/GTZ, Eschborn, Germany
This paper describes how a Division for the Supply of Medical Spare Parts was set up and is run in the
health system of Kenya, financed through the use of a revolving fund.
Available from: GTZ


Developing Skills, Managing Change, and Monitoring Progress
This material covers issues in Section 2.1 on managing change, Section 2.2 on developing skills,
Section 8.3 on initial training, and Section 9 on target-setting and monitoring progress. It is listed
alphabetically by title.
A book for midwives
Klein, S (1996). Hesperian Foundation. ISBN: 0 942364 23 6
This book provides practical information on antenatal care, labour, birth and post-partum care. It also
includes a section on making teaching materials and low-cost equipment.
Available from: TALC
District health care: Challenges for planning, organization and evaluation in developing
countries (2nd edition)
Amonoo-Larston R, Ebrahim G, Lovel H, and J Rankeen (1996). MacMillan. ISBN: 0 333 57349 8
This book contains practical support and advice intended for those in the planning, management and
evaluation of health services at district level. It covers a wide range of topics based on country
experience, including: staff motivation, teamwork, developing management skills, managing change,
managing conflicts, and staff development; managing finances; monitoring and evaluation; as well as
district health needs, plans, organization and management.
Available from: TALC
Healthcare technology: Training skills for hospital technicians and engineers
FAKT (1999). FAKT Technical Library Data Sheet
This paper discusses the major objectives of training both on- and off-the-job. It then provides
practical guidance on how to undertake on-the-job training effectively by using the PESOS
procedures (prepare, explain, show, observe, supervise). It explains each step in detail. Although
written for maintenance staff, its advice is just as useful for any other types of staff.
Available from: FAKT
Hospital technology: Communication – a vital skill for successful healthcare technical
service management
FAKT (1999). FAKT Technical Library Data Sheet
This paper discusses the importance of communication for both working in a team and working in an
organization/network. It provides advice on how to communicate effectively, its importance, the
barriers that exist, how to promote effective communication, the role of the head of department,
methods to use, and related reading. Although written for maintenance staff, its advice is just as
useful for any other types of staff.
Available from: FAKT
How to make and use visual aids
Harford, N and N Baird (1997). VSO. ISBN: 043592317X
This booklet describes a number of useful and practical methods for making visual aids quickly and
easily, using low cost materials.
Available from: TALC, VSO


Annex 2: Reference materials and contacts


292




Management support for primary health care: A practical guide to management for health
centres and local projects
Johnstone P, and J Ranken, (1994). FSG Communications Ltd, Cambridge, UK. ISBN: 1 87118 02 4
This practical user-friendly book gives support and guidance to leaders in health centres and other
local projects to help stimulate and maintain primary health care (PHC) in their surrounding
communities. Aid workers, and others unfamiliar with PHC and basic management techniques may
also benefit. Includes sections which will assist with staff motivation, such as teamwork and team
effectiveness; managing oneself, others and tasks; and managing change, as well as sections on
planning and monitoring progress.
Available from: TALC
Medical administration for frontline doctors: A practical guide to the management of
district-level hospitals in the public service or in the private sector (2nd edition)
Pearson C (1990). FSG Communications Ltd, Cambridge, UK. ISBN: 1 871188 03 2
This book provides information for doctors who combine wide clinical responsibilities with
administration and support for primary health care services. It covers a wide range of topics, with
country examples, including: management structures; infrastructure and maintenance; buildings,
support services, and equipment; hospital supplies; training; outreach programmes; and wider
responsibilities in the district and above. It includes advice on many safety topics such as cleaning
procedures, linen handling, earthing, lightning protection, and fire prevention.
Available from: TALC
On being in charge: A guide to management in primary health care (2nd edition)
McMahon R, Barton E, and M Piot (1992). ISBN: 9241544260
This practical guide aims to improve the managerial skills of middle level health workers. The text is
reinforced with practical examples, questionnaires and illustrations that help relate the information to
health workers’ own experiences. Topics include identifying health problems, assigning priorities to
their solution, planning and implementing programmes, and evaluating results. Also serves both as a
training and reference guide, covering all aspects of primary health care management including
equipment and drugs.
Available from: WHO
Physical assets management and maintenance in district health management
Halbwachs H (2000). GTZ document
Training health personnel to operate health-care equipment: How to plan, prepare and
conduct user training – A guide for planners and implementors
Halbwachs H, and R Werlein, (1993). GTZ, Eschborn
The aim of this book is to ensure that users are in a position to operate equipment and plant without
causing failure or malfunction. Part one addresses the planner/administrator developing user courses
and gives information about methods, course organization, finances, etc. Part two discusses
interesting issues for the implementers i.e. how to design a course, teaching methods and teaching
aids, conducting a course, etc. This practical guide provides sample checklists, questionnaires,
worksheets, tests, certificates, etc.
Available from: GTZ
Transfer of learning: A guide for strengthening the performance of health care workers
Intrah/PRIME II/JHPIEGO (March 2002)
This book is for health care workers involved in training and learning interventions and enables them
to transfer their newly acquired knowledge and skills to their jobs, resulting in a higher level of
performance and sustained improvement in the quality of services at their facilities.
Available from: free online at http://www.prime2.org/prime2/section/70.html
See Guide 1 for literature that discusses health management information systems, since such systems
should gather data that is useful for managing the procurement process and monitoring progress, such
as information on equipment needs and use of supplies.


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293




Software for Procurement and Logistics
This material covers the areas in procurement and logistics where computer software programs may be
of assistance. For information on deciding when and how to computerize your records, see the GTZ book
by Halbwachs and Miethe that appears first in the list. The material is listed alphabetically by title.
Computerizing maintenance for health care facilities in developing countries
Halbwachs H, and B Miethe (1994). GTZ, Eschborn, Germany
This book describes the documentation and analysis required if healthcare technology management is
to be undertaken effectively (such as inventory management, planned preventive maintenance
timetabling, costs analysis). It illustrates that for large stocks of equipment such work is made easier
with the aid of computers. The book goes on to describe when and how to computerize equipment and
maintenance records, including details of hardware and software requirements and products available.
It includes details of the sort of data to be collected for effective healthcare technology management.
Available from: GTZ


Software for managing the procurement process
Software for managing the procurement process is available that can assist with tasks such as needs
assessments, bills of quantities, preparation of and monitoring progress with purchase orders. It is
useful once you have mastered a manual paper system, procure large enough or sufficiently
complicated quantities of goods, and can obtain sufficient training of staff. There are a variety of
products available with different advantages, for example:
◆ The PLAMAHS software produced by HEART Consultancy, listed in the sections above. This


package provides needs assessment for an unlimited range (in number and levels) of health
facilities at once. (Confidential) costs estimates can be generated, and bills of quantities with
detailed specifications can be produced. The advantage of this software is that HEART has
designed it especially with developing countries in mind, offers is at special rates for developing
countries, and can assist with the set up and initial training requirements.


◆ Tailor-made commercial procurement management software products have many features,
however they are often complex and expensive. These products can be found by searching for
procurement management software on the internet.


◆ The ECRI products, listed in the sections above. Although none of these products actually assist
you to manage the procurement process as described above, certain products can assist with
specific aspects of the process such as identifying equipment standards, writing specifications and
purchase documents, providing procurement advice, and comparing different equipment makes
and models.


Project planning software
Software is available that can help you to timetable projects, and make Gantt charts to monitor
progress. It is useful once you have mastered a manual paper system, have a large enough or
sufficiently complicated project, and can obtain sufficient training of staff. None of these programs
have been tested by the authors of this Series of Guides, and therefore cannot be vouched for. The
freeware and shareware programs are listed at websites: www.tucows.com, and www.download.com,
where user opinions and reviews can be assessed.
◆ Freeware


- Project Engine website: www.projectengine.nu/
- PM Plan website: www.pmplan.com/


◆ Shareware
- Planbee website: www.guysoftware.com/planbee.htm
- ConceptDraw website: www.conceptdraw.com/en/products/project/main.php
- Minuteman website: www.minuteman-systems.com/
- Project Planner by Smartworks website: www.smartworks.us/htm/project.htm


Annex 2: Reference materials and contacts


294




◆ Commercial
- Microsoft Project website: http://office.microsoft.com/en-us/FX010857951033.aspx
- Project Kickstart website: www.projectkickstart.com/
- Twiddlebit website: www.twiddlebit.com/purchase.htm


Stock control software
Stock control of items in stores is an area where simple computer software programs can be of
assistance once you have mastered a manual paper system, have a large enough store (for example, at
central level), and can obtain sufficient training of staff. The following products can be viewed on the
internet and should provide either a full demonstration CD of the software to study, or use of a
shareware program free of charge for a set period of time:
◆ Website: www.easy4you.net/EN/stock.htm


Low cost stock control and invoicing package for small to medium size businesses, provided as
shareware software.


◆ Website: www.microsoft.com/BusinessSolutions/Navision/supplychain.aspx
Navision sales and stock management software is suitable for medium to large scale businesses,
and is available in various building blocks. Navision is used by several central/national medical
stores in Africa, but requires a lot of training


◆ Website: www.requisoft.com/stock/stock.html
Requisoft Stock software controls and manages an organization’s stock, and allows you to browse
through your stock records. It can be used on its own or as a module of the Requisoft
Procurement system.


◆ Website: www.artisan.co.uk/products/index.php?p=Stock
Artisan stock management and control software is comprehensive, and includes complex assembly
component and works order systems.


See Guide 2 for information about inventory software and planning and budgeting software.


Accessing Information
These websites are sources of information concerning many aspects of health service delivery. They
are locations where there is, or may be, information about healthcare technology management and
equipment procurement and commissioning.
Africa online: Health website: http://bamako.africaonline.com/afol/index.php
Provides links to health information sites related to Africa. The links are organized into the following
categories: health information, health news, events, African organizations, international organizations,
schools and hospitals in Africa, projects, publications and health services
AFRO-NETS (African networks for health research and development)
website: www.afronets.org
Forum for exchanging health research information in and between East and Southern Africa.
AJOL (African journals online) website: www.inasp.org.uk/ajol
Offers free online access to tables of contents and abstracts of over 70 journals published in Africa.
Charities (of the USA) website: www.duke.edu/web/gleaning/Charity.html
This site contains a listing of contact details for charities throughout the USA, many of which work in
the health field.
Deliver website: www.deliver.jsi.com
USAID funded project focusing on supply chain logistics for health products in developing countries from
estimating demand for supplies, and maintaining optimal supply levels, to proper storage guidelines.
Eurasia health knowledge network (EHKN) website: www.eurasiahealth.org
Specialises in the health information needs of the Former Soviet Union (FSU) and Central and
Eastern Europe (CEE). Site links to clinical practical guidelines, medical textbooks, and other
educational materials, many in Russian and other regional languages


Annex 2: Reference materials and contacts


295




EU public procurement website:
http://europa.eu.int/comm/internal_market/publicprocurement/index_en.htm
This site contains information about the rules and procedures for public sector procurement under
European Union-funded projects.
FIN: Free international newsletters: www.healthlink.org.uk
Healthlink produces this publication that lists over 130 print and electronic health-related
newsletters and magazines which are available free to readers in developing countries.
Free medical journals website: www.freemedicaljournals.com
This site is a comprehensive, up to date list of medical journals available free on the internet.
GATE (German Appropriate Technology Exchange): www5.gtz.de/gate/
The GATE Information Service seeks to improve the technological knowledge of organizations and
individuals involved in poverty alleviation projects and to develop information and knowledge
management systems of organizations.
Global Medical Devices Nomenclature (GMDN) website: www.gmdn.org/index.xalter
The GMDN is a collection of internationally recognized terms used to accurately describe and
catalogue medical devices. It is a classification system developed to allow for the classification of all
medical devices put onto the market as defined by the European Standards body (CEN). It is intended
to replace the older national device nomenclatures such as UMDNS (USA), CNMD (Canada), NKKN
(Norway), JFMDA (Japan), in order to promote consistency in terminology around the world. The
system has been accepted by the International Organization for Standardization (ISO).
Health exchange website: www.healthcomms.org
Explores issues, ideas and practical approaches to health improvement in developing countries and
provides a forum for health workers and others to share viewpoints and experiences in this area.
HealthNet news website: www.healthnet.org/medpub
Weekly newsletter distributed to health professionals in Africa, Asia and Latin America. Features
current, practical, clinical and public health information.
HIF-net at WHO discussion group
Discussion list dedicated to issues of improving access to reliable health information in resource-poor
settings. To join, email your name, affiliation and professional interests to: health@inasp.info
HINARI (Health inter-network access to research initiative) website: www.healthinternetwork.net
WHO initiative offering free/discounted access to journals from six leading publishers.
HNP flash website: www.worldbank.org/hnpflash
A free monthly electronic newsletter dedicated to sharing knowledge regarding the latest technical
developments in the fields of health, nutrition, population, and reproductive health.
IATA (International Air Transport Association) website: www.iata.org
This organization defines the standards for dangerous goods regulations and provides advice on safe
procedures for carrying certain goods by air.
ID21 health website: www.id21.org/health
An internet based development research reporting service for health policy makers and development
practitioners on global health issues. Latest research summaries are provided on a searchable website,
by email and in a quarterly publication.
IEE healthcare technologies professional network website: www.iee.org/pn/healthtech
The Institution of Electrical Engineers of the UK provides internet sites for a wide variety of
engineering professions, with the aim of enabling people to communicate with their peers around the
world and access the latest global industry news and key information sources. One of their professional
networks focuses on healthcare technologies. It has also hosted a series of seminars on Appropriate
medical technology for developing countries, and their reports can be obtained from the IEE.
INCOTERMS 2000 website: www.iccwbo.org/index_incoterms.asp
This site explains the current definitions and regulations on International Commercial Trade Terms
for transporting goods. It also provides a wallchart describing the Incoterms that can be downloaded.


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INFRATECH discussion group
WHO forum for global exchange of information on infrastructure and health care technology issues
To subscribe send an email to LISTSERV@LISTSERV.PAHO.ORG enter in text: subscribe infratech
‘your full name’.
International health exchange website: www.ihe.org.uk
Provides training, information and advice to health workers in emergency aid and development
situations. This site also provides information about jobs and health development issues.
International journal of technology assessment in health care website:
www.cambridge.org/uk/journals/journal_catalogue.asp?historylinks=ALPHA&mnemonic=THC
This journal serves as a forum for professionals interested in the assessment of medical technology, its
consequences for patients, and its impact on society. It covers the generation, evaluation, diffusion,
and use of health care technology through essays, research notes, regular columns on technology
assessment reports, and sections devoted to particular topics. Sometimes there are articles with
particular relevance to developing countries. In 1994, the Cambridge University Press produced a
book of reprints called Technology assessment in health care for developing countries.
Email: journals-subscription@cambridge.org.
International Monetary Fund (IMF) website: www.imf.org/external/fin.htm
This site provides current data on exchange rates for selected currencies, and the exchange rates
between currencies and the SDR, as well as information about IMF loans.
KAR (Knowledge and research programme on disability and healthcare technology) website:
www.kar-dht.org, and for the latest projects being funded use website: www.disabilitykar.net/
This is the Knowledge and Research Programme on disability and healthcare technology of the UK
governments’s Department for International Development (DFID). It supports a range of projects on
development and use of appropriate disability and healthcare technologies in developing countries.
The website also provides links to:
◆ Disability and healthcare technology newsletter produced every six months describing the


progress and findings of the projects funded;
◆ KaR global database on healthcare technology publications, organizations, manufacturers,


training institutions, etc.
New computerized transit system website:
www.hmce.gov.uk/channelsPortalWebApp/channelsPortalWebApp.portal?_nfpb=true&_pageLabel=
pageVAT_ShowContent&id=HMCE_PROD_010319&propertyType=document
This site describes the New Computerized Transit System (NCTS) for registering regular shipments
on the internet or by email, tracking their progress on the internet, and the shipper’s Trader
Identification Number (TIN) which is linked to the NCTS.
Programme for appropriate technology in health (PATH) website: www.path.org
PATH identifies, develops and applies appropriate technologies to public health problems in
developing countries.
Safe injection global network (SIGN) alliance website: www.who.int/injection_safety/sign/en
This is a network/discussion group for safe injection issues from technical, managerial, and operational
issues to policy development, consensus formation and advocacy. It covers a wide range of topics, such
as whether to use reusable or disposable items. The alliance produces the electronic newsletter
SIGNpost. The site is hosted by WHO.
Special Drawing Rights (SDR) fact sheet website: http://fx.sauder.ubc.ca/SDR.html
This site provides a good explanation of the SDR (Special Drawing Rights) international currency.
The information is provided by the Sauder School of Business, University of British Columbia, Canada.
Sphere project www.sphereproject.org
Seeks to develop a set of universal minimum standards in core areas (water supply and sanitation,
nutrition, food aid, shelter and site planning and health services) of humanitarian assistance in
disaster response.


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TechNet (Technical network for strengthening immunisation services) website:
www.technet21.org
Forum focusing on improving management and operational logistics for health service delivery in
developing countries, in particular, immunisation services.
The manager’s electronic resource center website: http://erc.msh.org
The ERC website is an electronic information resource and communication service for health
managers, containing more than 150 ready-to-use management tools in various languages. A key
feature is:
◆ The health manager’s toolkit, includes spreadsheet templates, forms for gathering and analyzing


data, checklists, guidelines for improving organizational performance, and self-assessment tools that
allow managers to evaluate their organizations. Tools cover areas such as strategic planning, developing
information systems, cost and revenue analysis, sustainability, drug and supply management.


World Bank procurement website: www.worldbank.org (then click on Projects and Operations,
followed by Procurement/Tender)
This site provides access to guidelines for using World Bank funds for purchasing, up-to-date rules for
bank procurement, their procurement manual, technical notes on procuring health sector goods, and
standard bidding documents for health sector goods.
WHO: Health technology and pharmaceuticals website: www. who.int/technology
This WHO site provides information on pharmaceutical and health technology developments with a
particular focus on developing countries. It includes links to blood transfusion safety and clinical
technology, essential drugs, medicines, vaccines and biologicals.
WHO: Management of health services (MAKER) website: www. who.int/management
This WHO site provides information, publications, and country experiences on all types of
management issues for health services, such as facility management, resource management, and
district management.


ii. Organizations, Sources of Publications in Part i, Resource and
Information Centres


For the following institutions we have included the name, address, contact details, a brief description
of the various services they offer, and additional contact details for further relevant activities.
AfriAfya
AMREF Building, PO Box 30125, Nairobi, Kenya
Tel: 254 2 609520, fax: 254 2 609518, email: info@afriafya.org, website: www.afriafya.org
Established by Kenya-based health agencies, AfriAfya provides community access to relevant and
appropriate health knowledge and information in an interactive manner. As well as a section on
HIV/AIDS there is a news centre, message board and discussion forum on their website.
Amazon Bookshop
PO Box 81226, Seattle, Washington 98108-1226, USA
Website: www.amazon.com or www.amazon.co.uk
Internet bookshop
American College of Clinical Engineering (ACCE)
5200 Butler Pike, Plymouth Meeting, Pennsylvania PA 19462, USA
Tel: 1 610 825 6067, website: www.accenet.org
The ACCE is an organization of clinical engineers experienced in the management and support of
medical devices and technology. The purpose of the ACCE is to establish a standard of competence
and to promote excellence in the practice of clinical engineering in the United States and around the
world. Many ACCE members are based in overseas facilities or have broad international experience.
Their International Committee is able to offer training and consultation worldwide (write to the
Chairperson of the International Committee at ACCE or email: icchair@accenet.org).


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AMREF International (African Medical and Research Foundation)
Resource Centre, AMREF Headquarters, Langata Road, PO Box 00506 – 27691, Nairobi, Kenya
Tel: 254 2 501301/2/3, fax: 254 2 609518, e-mail: amref.info@amref.org, website: www.amref.org
Publishes practical books, journals and other literature for health workers, and provides advice on
primary health care. Runs training courses and seminars.
BOND (British Overseas NGO’s for Development)
Website: www.bond.org.uk
A network of more than 260 UK based voluntary organisations working in international development
and development education. BOND works to promote the exchange of experience, ideas and
information by acting as a broker for a variety of relationships and by collating and distributing
information.
Chartered Institute of Purchasing and Supply (CIPS)
Easton House, Easton on the Hill, Stamford, Lincolnshire, PE9 3NZ, UK
Tel: 44 1780 756777, fax: 44 1780 751610, email: info@cips.org, website: www.cips.org
British professional body concerned with all aspects of purchasing and supply. It offers qualifications
in this field, and provides many specialist and technical services for its members. Excellent source of
purchasing books for both practitioners and students.
Dentaid
Giles Lane, Landford, Salisbury, Wiltshire, SP5 2BG, UK
Tel: 44 1794 324249, fax: 44 1794 323871, email: info@dentaid.org,
website: www.dentaid.org/cm/general/whatwedo
This charitable organization tests and refurbish donated dental equipment, package them into
complete surgeries, and sends them to charitable projects all over the developing world. It also
includes an installation and maintenance manual, and a kit of dental instruments.
DFID (Department for international development)
Website: www.dfid.gov.uk
UK government’s department for international development assistance.
ECHO International Health Services Ltd
ECHO International Health Services is no longer trading as it used to. Its services can be accessed
as follows:
i. the charitable foundation can be contacted at:


ECHO, Ullswater Crescent, Coulsdon, Surrey, CR5 2HR, UK
Tel: 44 208 6602220, fax: 44 208 6680751, website: www.echohealth.org.uk/intro2.html


ii. the trading branch of the business (wholesale providers of medical supplies and equipment) is now:
Durbin PLC, 180 Northholt Road, South Harrow, Middlesex, HA2 0LT, UK
Tel: 44 208 8696500, fax: 44 208 8696565, email: cataloguesales@durbin.co.uk,
website: www.durbin.co.uk


iii. ECHO publications are still available from TALC (see below).
ECRI (Emergency Care Research Institute)
5200 Butler Pike, Plymouth Meeting, Pennslyvania 19462-1298, USA
Tel: 1 610 825 6000 ext 5368, fax: 1 610 834 1275, website: www.ecri.org
Offers guidance and advice on health care technology, planning, procurement and management; and
health technology assessment and assistance.
Elsevier Health Science
Elsevier Books Customer Services, Linacre House, Jordan Hill, Oxford, OX2 8DP, UK
Tel: 44 1865 474110, fax: 44 1865 474111, email: eurobkinfo@elsevier.com,
website: www.us.elsevierhealth.com
Books published by WB Saunders, Mosby, Churchill Livingstone, and Butterworth-Heinemann are
now all members of the Elsevier Science, Health Sciences Division.
European Union (EU)
http://europa.eu.int/comm/development/index_en.htm
EU site for international development and aid.


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299




FAKT (Consultancy for Management, Training, and Technologies)
Gansheidestrasse 43, D-70184 Stuttgart, Germany
Tel: 49 711 21095/0, fax: 49 711 21095/55, email: fakt@fakt-consult.de, website: www.fakt-consult.de
Non-profit consultancy firm, that provides information on appropriate hospital and medical
equipment and training in healthcare technologies. FAKT is not a supply organisation.
FIATA (International Federation of Freight Forwarders Associations)
Website: www.fiata.com
The largest non-governmental organization in the field of transportation, representing approximately
40,000 forwarding and logistics firms. Its objectives are to act as advisors to international bodies
dealing with transportation, disseminate information, improve freighting services by promoting
standard documents and trading conditions, assist with insurance, electronic data exchange (EDI),
and vocational training. They have developed a uniform format for freight forwarding forms.
Global Directory of Health Information Resource Centres
Health Information for Development (HID) Project, PO Box 40, Petersfield, Hants, GU32 2YH, UK
Tel: 44 1730 301297, fax: 44 1730 265398, email: iwsp@payson.tulane.edu,
website: www.iwsp.org/directory.htm
This is a directory of health information resource centres that is arranged alphabetically by country.
Between January 2000 and May 2001, Health Information for Development (HID) compiled a Global
Directory of Health Information Resource Centres (HIRCs). This is available from their website. The
Directory is updated on an ongoing basis.
GTZ (Deutsche Gesellschaft für Technische Zusammenarbeit – German government
technical aid agency)
Division of Health and Education, PO Box 5180, D-6236, Eschborn, Germany
Tel: 49 6196 791265, fax: 49 6196 797104, email: Friedeger.Stierle@gtz.de
Website: http://www.gtz.de/de/4030.htm
Friedeger Stierle is the contact for the GTZ’s healthcare technology management programme, and
any articles or documents on HTM.
HAMLO (Hulp aan Medische Laboratoria in Ontwikkelingslanden)
Wilhelminapark 52, 3581 NM Utrecht, The Netherlands
Website: www.nvml.nl/html/hamlo.asp
This committee of the Dutch Association of Medical Laboratory Technologists gives assistance to
laboratories in developing countries. This includes technical advice and supplying literature,
acquiring new equipment and materials, also surplus equipment from Dutch laboratories and
adapting this to the needs of the country requiring the equipment. HAMLO also assists laboratory
technologists who want to work in developing countries to get in touch with development agencies
and gain appropriate knowledge and experience.
Hands to Clinical Labs of Third World Countries Inc.
Public Health Labs, 176 Broadway, Paterson, New Jersey 07505, USA
Tel: 1 201 881 3972
This organization offers several types of technical assistance to laboratories in developing countries
including training for laboratory personnel, short-term assignment of volunteer US laboratory workers
as consultants, and supplying of surplus equipment from US laboratories.
Healthlink Worldwide
Cityside, 40 Adler Street, London, E1 1EE, UK
Tel: 44 20 7539 1570, fax: 44 20 7539 1580, email: info@healthlink.org.uk, website:
www.healthlink.org.uk
Publishes a range of free and low-cost newsletters, resource lists, briefing papers and manuals about
health and disability. Publications include HIV testing: a practical approach which is a briefing paper
on HIV counselling and laboratory testing.


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HEART Consultancy
Quadenoord 2, 6871 NG Renkum, The Netherlands
Tel: 31 317 450468, fax: 31 317 450469, email: jh@heartware.nl, website: www.heartware.nl
Consultancy firm working in all aspects of healthcare technology management in developing
countries. It also produces and supplies the PLAMAHS software package for managing the inventory,
model lists, maintenance, and procurement needs for your healthcare technology stock. HEART also
undertakes research and training, and produces publications on many aspects of sterilization for
developing countries. It has developed a basic testkit for performance testing of sterilizers, and can
identify suppliers that still manufacture basic sterilizers (manually operated/fuel heated).
HMSO (Her Majesty’s Stationery Office)
Website: www.hmso.gov.uk
Publishers of material produced by departments of the UK government.
Humanitarian Information for All
c/o Human Info NGO vzw and Humanity CD Ltd, Oosterveldlaan 196, B-2610 Antwerp, Belgium
Fax: 32 3 449 75 74, email: humanity@humaninfo.org, website: www.humaninfo.org
The goal of this organization is to disseminate health care information free-of-charge in developing
countries. Thus, their Medical and Health Library makes publications available on the internet. Refer
to their homepage to find the large list of publications available.
Intermediate Technology Development Group (ITDG) and ITDG Publishing
The Schumacher Centre for Technology and Development, Bourton Hall, Bourton-on-Dunsmore,
Rugby, CV23 9QZ, UK
Tel: 44 1926 634400, fax: 44 1926 634401, email: enquiries@itdg.org.uk, website: www.itdg.org
The Development Group is a charity concerned with the research and development of ‘appropriate’
technologies for application in developing countries. It has worked on topics such as, alternative
electrical supplies, access to water, disability aids, medical supplies. It also undertake consultancies.
The Publication Division produces and disseminates books and journals covering aspects of health,
development, and appropriate technology. It can be contacted at:
Tel: 44 1926 634501, fax: 44 1926 634502, email: itpubs@itpubs.org.uk,
website: www.itdgpublishing.org.uk.
International Dispensary Association (IDA)
PO Box 37098, 1030 AB Amsterdam, The Netherlands
Tel: 31 20 4033051, fax: 31 20 4031854, email: info@ida.nl, website: www.ida.nl/en-US
This international non-profit supply organization is very well known in the pharmaceutical sector for
essential drug supply to developing countries. It also supplies basic medical equipment, medical
supplies and laboratory equipment to developing countries.
International Electrotechnical Commission (IEC)
IEC Central Office, 3 rue de Varembé, P.O. Box 131, CH - 1211 GENEVA 20, Switzerland
Tel: 41 22 919 02 11, fax: 41 22 919 03 00, email: info@iec.ch, website: www.iec.ch/
Sets the standards for the safe manufacture of medical equipment.
International Society for Technology Assessment in Health Care (ISTAHC)
c/o Institute of Health Economics, 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada T5J 3N4
Tel: 780 448 4881, fax: 780 448 0018, email: info@HTAi.org, website: http://www.htai.org/
International non-profit body with regional branches, it researches and disseminates information
concerning health technology assessment. It produces the International journal of technology
assessment in health care, and has a Special Interest Group on developing countries' issues:
International Society for Technology Assessment in Health Care – Special Interest Group
(ISTAHC-SPIG)
Health Technology Research Group, Medical Research Council (MRC)
PO Box 19070, Tygerberg 7505, Cape Town, South Africa. Tel: 27 21 938 04 13, fax: 27 21 938 03 85.


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Joint Medical Store (JMS)
PO Box 4501, Kampala, Uganda
Tel: 256 41 269699 or 268482, fax: 256 41 267298, email: sales.jms@imul.com
Not-for-profit mission medical store supplying pharmaceuticals, medical supplies and equipment,
with a technical department to deal with maintenance issues and capital equipment. Supplies the
public and non-profit health sector in Uganda, East Africa and Great Lakes region.
Medical Research Council South Africa (MRC-SA)
PO Box 19070, 7505 Tygerberg, South Africa
Tel: 27 21 9380911, fax: 27 21 9380200, email:info@mrc.ac.za, website: www.mrc.ac.za
The MRC-SA’s mission is to improve the nation’s health status and quality of life through relevant
and excellent health research aimed at promoting equity and development. They have a WHO
Collaborating Centre for Essential Technologies in Health, at website:
www.mrc.ac.za/innovation/whocollaborating.htm
Medicines and Healthcare Regulatory Agency (MHRA)
Hannibal House, Elephant and Castle, London, SE1 6TQ, UK
Tel: 44 0207 972 8000, email: devices@mhra.gsi.gov.uk, website: www.mhra.gov.uk
Offers guidance, advice, and regulations on medical device quality, safety, performance, use, and
standards.
Mission for Essential Drugs and Supplies (MEDS)
PO Box 14059, Nairobi, Kenya
Tel: (+254 2) 544244/5, fax: (+254 2) 545062 or 540993, email: sahibu@africaonline.co.ke
Not-for-profit mission medical store supplying pharmaceuticals, medical supplies and equipment to
mission organisations and not-for-profit organisations in East Africa and Great Lakes region.
PAHO (Pan American Health Organization)
Pan American Sanitary Bureau, Regional Office of the World Health Organization, 525 Twenty-third
Street, N.W. Washington, D.C. 20037, USA
Tel: 1 202 974-3000, fax: 1 202 974-3663, website: www.paho.org/
The Pan American Health Organization (PAHO) is an international public health agency working to
improve health and living standards of the countries of the Americas. It also serves as the Regional
Office for the Americas of the World Health Organization.Antonio Hernandez is the contact for
healthcare technology issues, email: 1hernana@paho.org
Quality Assurance Research and Policy Development Group (QARPDG)
Philippine Health Insurance Corporation (PhilHealth), CityState Center, 709 Shaw Blvd., Brgy.
Oranbo, 1600 Pasig City, Philippines
Fax: 632 637 9693, emailmadz_valera@yahoo.com, contact: Dr. Madeleine Valera (Vice President)
PhilHealth is a government owned and controlled corporation that was the main organizer of the 3rd
Asian Regional Health Technology Assessment Conference in 2004, and is the source for the
conference proceedings.
Replacement Parts Industries Inc. (rpi – “The Alternate Source”)
20338 Corisco Street, Chatsworth, California 91311, USA
Tel: 1 800 221 9723, or 1 88 882 8611, fax: 1 818 882 7028, email: moreinfo@rpiparts.com, website:
www.rpiparts.com
This supplier acts as an alternate source of quality and competitively priced replacement parts for well-
known makes of healthcare equipment. The catalogue is divided into sections according to equipment
types (such as sterilizers, dental equipment, centrifuges, infant incubators, lamps/bulbs) and provides
information on which parts will fit which make of machine. There are descriptions and illustrations to
simplify identification. It not only covers current models, but also parts for older models of equipment
that you may still own. The company also offers technical assistance on repair solutions.


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RS Components Ltd.
Birchington Road, Corby, Northants, NN17 9RS, UK
Tel: 44 1536 201234, fax: 44 1536 405678, email: general@rs-components.com, website: rswww.com
Supplier of equipment, supplies, parts, and components for a wide range of engineering professions
such as electrical, electronic, mechanical, heating, ventilation, air-conditioning, plumbing, welding,
pneumatics, computing, automotive. Also a source of textbooks, technical data books, technical
literature, and training videos for all these engineering fields.
Source (International Information Support Centre)
The Wellcome Trust Building, Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
Tel: 44 20 7242 9789 ext 8698, fax: 44 20 7404 2062, email: source@ich.ucl.ac.uk, website:
www.asksource.info
The Source Centre has a unique collection of over 20,000 health and disability related information
resources. These include books, manuals, reports, posters, videos, and CD-Roms. Many materials are
from developing countries and include both published and unpublished literature.
Swiss Centre for Development Cooperation in Technology and Management (SKAT).
Website: www.skat.ch/dc/publ/publ.htm
SKAT works internationally in the areas of water and sanitation, architecture and building, transport
infrastructure, and urban development. They also publish the SKAT newsletter
Swiss Centre for International Health (SCIH)
Swiss Tropical Institute, Socinstrasse 57, PO Box, CH-4002 Basle, Switzerland
Tel: 41 61 284 82 79, fax: 41 61 271 86 54, email: martin.raab@unibas.ch,
website: www.sti.ch/francais/scih/scih.htm
Undertakes consultancies in healthcare technology management in developing countries and
countries in transition.
TALC (Teaching Aids at Low Cost)
PO Box 49, St. Albans, Herts, AL1 5TX, UK
Tel: 44 1727 853869, fax: 44 1727 846852, email: talc@talcuk.org website: www.talcuk.org/
UK registered non-profit charity specialising in supplying affordable books, slides and teaching aids on
health and community issues in developing countries, with a particular focus on materials for PHC
and district levels.
Technologie Transfer Marburg (TTM)
Auf der Kupferschmiede 1, D-35091 Colbe, Germany
Tel: 49 6421 87373 0, fax: 49 6421 87373 73, email: ttm@ttm-germany.de, website: ttm-germany.de
This international non-profit supply organization offers a range of products and services such as
procurement and installation of appropriate equipment for medical projects, to advisory and planning
services, and product development and training.
Third World Network
Email: twnet@po.jaring.my, website: www.twnside.org.sg
The Third World Network is an independent non-profit international network of organizations and
individuals involved in development issues. Its website offers articles and position papers on a variety
of subjects related to developing countries, including trade, health, biotechnology and bio-safety.
Transaid (Transport for Life)
137 Euston Road, London, NW1 2AA, UK
Tel: 44 20 7387 8136, fax: 44 20 7287 2669, email: info@transaid.org website: www.transaid.org
A charity working in the field of international transport management. Thus unique organization works
with many sectors, including health, to ensure that transport resources are efficiently and effectively
used. Their aim is to develop local capacity in transport and logistics management. They produce a
newsletter Hub and spoke, and have developed the Transaid transport management handbook.


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Tropical Health Technology (THT)
14 Bevills Close, Doddington, March, Cambridgeshire PE15 OTT, UK
Tel: 44 1354 740825, fax: 44 1354 740013, email: thtbooks@tht.ndirect.co.uk,
website: www.tht.ndirect.co.uk
Charity concerned with supporting and improving laboratory services in the developing world. Primary
focus is laboratory services, information and technology. Specializes in supply of laboratory equipment,
books, bench aids, slide sets and microscopes.
UNICEF (United Nations Children’s Fund)
UNICEF House, 3 UN Plaza, New York 10017, USA
Tel: 1 212 326 7000, fax: 1 212 887 7454, email: jando@unicef.org, website: www.unicef.org
It provides a wide range or resource materials, journals, books, videos, games and posters for children’s
programmes. Your regional or field office will offer advice on all aspects of child health care and
UNICEF materials – contact details are on the website. The goods contained in UNICEF’s Supply
Catalogue are supplied by the UNICEF Supply Division, UNICEF Plads, Freeport, 2100
Copenhagen OE, Denmark. Tel: 45 3527 3527, fax: 45 3526 9421, email:supply@unicef.org.
World Bank (WB)
www.worldbank.org
One of the world’s largest sources of development assistance including health, nutrition and
population projects
World Council of Churches (WCC)
PO Box 2100, 1211 Geneva, Switzerland
Tel: 41 22 791 6111, fax: 41 22 791 0361, email: info@wcc-coe.org, website: www.wcc-coe.org
International fellowship of churches that produces publications and newsletters. Recent publications
include Guidelines on medical equipment donations.
World Health Organization (WHO)
20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Tel: 41 22 791 2476 or 2477, fax: 41 22 791 4857, website: www.who.int/en/
WHO offers advice, and undertakes programmes, on all aspects of health care. Contact your regional
or field office for advice on all aspects of health care and WHO materials – the addresses of the
regional offices worldwide are available on the website.
◆ WHO has programmes and literature on many aspects of healthcare technology management.


Andrei Issakov, Coordinator of Health Technology and Facilities Planning and Management, is the
contact, and source of WHO literature on healthcare technology management that is not available
as published documents, email: issakova@who.int.


◆ WHO produces and distributes books, manuals, journals, practical guidelines and technical
documents, several include aspects of healthcare technology management. The Distribution and
Sales Office is the contact point for information on WHO publications, email:
publications@who.ch, website: www.who.int/publications/en/. To order WHO publications use
email: bookorders@who.int.


◆ WHO has a comprehensive library and information service on international public health
literature. Contact email: library@who.int. The WHO library catalogue has electronic access to
more than 4000 technical documents, use website: www.who.int/library.


◆ WHO produces many newsletters, for a list contact website:
www.who.int/library/reference/information/newsletters/index.en.shtml


Ziken International Consultants Ltd
Causeway House, 46 Malling Street, Lewes, East Sussex, BN7 2RH, UK
Tel: 44 1273 477474, fax: 44 1273 478466, email: info@ziken.co.uk, website: www.ziken.co.uk
A consultancy organization working worldwide in many aspects of health care development, including
healthcare technology management.


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ANNEX 3: POLICY ISSUES
Additional information on developing policies is provided in Guide 2 on planning and budgeting.


Deciding When to Procure
This aspect of the purchasing and donations policies is described in Section 3.1, where the reasons
for procuring equipment and their order of priority are detailed.


Deciding What to Procure
To help you obtain only equipment which is appropriate to your needs, your purchasing and donations
policies should clearly specify the ‘good selection criteria’ to employ. These issues are discussed in
Section 3.2 and summarized in Box 53.


Annex 3: Policy issues


305


BOX 53: Example of Good Selection Criteria for Purchasing and Donations of Equipment


Indicators of appropriateness Criteria
Appropriate to setting


Assured quality and safety


Equipment should be:
◆ suitable for the level of facility and service provided
◆ acceptable to staff and patients
◆ suitable for operator skills available
◆ suitable for the local maintenance support capabilities
◆ compatible with existing equipment and consumable supplies
◆ compatible with existing utilities and energy supplies
◆ suited to the local climate, geography and conditions
◆ able to be run economically with local resources.
Equipment should be:
◆ of sufficient quality to meet your requirements and last a


reasonable length of time
◆ made of materials that are durable and hard-wearing (for example,


aluminium bends easily compared to iron or stainless steel)
◆ made from material that can be easily cleaned, disinfected, or


sterilized without rusting (for example, a polymerized finish or an
epoxy coating)


◆ made of materials that do not easily break (for example,
polycarbonate rather than glass)


◆ manufactured to meet internationally recognized safety and
performance standards (see Annex 4)


◆ suitably packaged and labelled so that it is not damaged in transit
or during storage


◆ provided by reputable, reliable, licensed manufacturers, or
registered suppliers.


Continued overleaf




Annex 3: Policy issues


306


BOX 53: Example of Good Selection Criteria for Purchasing and Donations of Equipment (continued)


Indicators of appropriateness Criteria
Affordable and cost-effective


Ease of use and maintenance


Conforms to existing policies, plans
and guidelines


Equipment should be:
◆ available at a price that is cost-effective. Quality and cost often go


together (for example, the cheaper option may be of poor quality
and ultimately prove to be a false economy)


◆ affordable in terms of costs for freight, insurance, import tax, etc.
◆ affordable in terms of installation, commissioning, and training of


staff to use and maintain them
◆ affordable to run (for example, cover the costs of consumables,


accessories, spare parts and fuel over its life-time)
◆ affordable to maintain and service
◆ affordable to dispose of safely
◆ affordable in terms of the procurement process (for example the


cost of a procurement agent or foreign exchange)
◆ affordable in terms of staffing costs (for example, costs of any


additional staff or specialization training required).
You should choose equipment:
◆ for which you have the necessary skills in terms of operating,


cleaning, and maintenance
◆ for which instructions and manuals are available to you in a


suitable language
◆ for which staff training is offered by the supplier
◆ for which local after-sales support is available with real


technical skills
◆ which offers the possibility of additional technical assistance


through service contracts
◆ which comes with a warranty/guarantee, covering a reasonable


length of time, for which you understand the terms. (For example,
does it cover parts, labour, travel, refunds or replacements?)


◆ which offers a supply route for equipment-related supplies (for
example, consumables, accessories, spare parts)


◆ which offers assured availability of these supplies for a reasonable
period (up to 10 years).


You should choose equipment:
◆ according to your purchasing and donations policy
◆ according to your standardization policy
◆ according to the technology level described in the Model


Equipment Lists and Generic Equipment Specifications (see
Guide 2 on planning and budgeting)


◆ which is deemed to be suitable, having studied available literature
and compared products (see Figure 8 in Section 3.2)


◆ which is deemed to be suitable, having received feedback
regarding previous purchases (Section 9.2).




Deciding When to Replace Equipment and How to Dispose of It
Every health service provider should have replacement and disposal policies for equipment
containing, as a minimum, the following elements:


Overview
In summary, to replace and dispose of equipment it is necessary to have the following:
◆ technical skills to identify those items ready for replacement
◆ good procurement practices which enable you to finance and purchase replacement items in


good time
◆ courage and determination to take equipment out of service when necessary, even if the users


want to keep using it
◆ a formal method for condemning equipment
◆ a formal method for disposing of the equipment, safely and in an environmentally sound way
◆ a formal method so that the disposal of equipment triggers the purchase of a replacement item.
All these formal methods are described in Guide 4 of this Series.


Valid replacement criteria
Each health facility should replace equipment for valid reasons only, which should be defined.
Suggested valid reasons and criteria for condemning equipment are provided here:
i. Equipment will only be replaced when one of the following valid reasons has been fulfilled:


a. it is worn out beyond repair (has reached the end of its natural life)
b. it is damaged beyond repair
c. it is unreliable – faulty, old, unsafe
d. it is clinically or technically obsolete
e. spare parts are no longer available
f. it is no longer economical to repair.


and one of the following valid reasons has also been fulfilled:
g. utilization statistics are available to show that it is still required
h. a demonstrated clinical or operational need still exists.


ii. Equipment will not be replaced simply because:
◆ it is old
◆ staff do not like it
◆ a newer model has arrived on the market.


Judging when it is time to condemn equipment
Senior maintenance staff need to study the equipment, and judge:
◆ whether the equipment fulfils any of the valid replacement criteria (see above)
◆ whether the equipment has outlived its (internationally/locally) advised typical ‘lifetime’ (see


Guides 2 and 4)
◆ the equipment’s track record and state of health, as documented in its service history records (see


Guide 5)
◆ whether it will be necessary to override the average expected lifespan and condemn the


equipment early, or even to extend the lifespan of the equipment.
For expensive equipment, it may be helpful to obtain an evaluation from the supplier.


Annex 3: Policy issues


307




Deciding how to dispose of equipment
Once equipment has been condemned, you need a formal policy to oversee its disposal. This
should cover:
◆ how it should be disposed of safely
◆ how it can be disposed of as promptly as possible
◆ how it can be disposed of in an environmentally sound way according to your ‘Waste Management


and Hygiene Plan’
◆ how you can strip off the useful spare parts before the equipment is disposed of.
These issues are discussed in Guide 4 on operation and safety.
The condemning and disposal of equipment should trigger the purchase of a replacement piece of
equipment. It is preferable to plan for replacements before they are needed and, where possible, you
should identify likely replacement needs within your annual Equipment Inventory update and annual
plans (see Guide 2). These activities should be timed to take place ahead of the next procurement
cycle, which usually takes place annually.


Annex 3: Policy issues


308




ANNEX 4: EXAMPLES OF IMPORTANT SAFETY AND
PERFORMANCE STANDARDS


All equipment should meet international, regional, or national safety and performance standards (see
Annex 2). The most important standards include:
◆ IEC (International Electrotechnical Commission) – these are international standards for


the electrical safety of any electrical and electromechanical equipment (such as refrigerators).
IEC 60101 is the international standard specifically addressing medical electrical safety that
manufacturers must conform to if medical equipment is to be electrically and mechanically safe
for use by staff with patients. As part of their responsibilities, maintenance staff should also
safety test equipment to ensure it meets these standards (see Guide 4 on operation and safety).


◆ ISO (International Organization for Standardization) – these are international standards
for industry, technology and business, with special standard series for quality management
and systems in any field. ISO 9000-9004 is a series of standards covering the quality of
manufacturing processes, design and development, construction, installation, and servicing.
ISO standards do not currently exist for all equipment, but do apply to a range of medical
devices (for example, ISO 13485 and ISO 13488). ISO standards, however, do not have a status
of official standards unless they are adopted by a competent national authority. ISO is made up
of its members. A member body of ISO is the national body ‘most representative of
standardization in its country’. Examples are BSI (British Standards Institution, UK), ANSI
(American National Standards Institute, US), DIN (Germany), SAI (Australia).


◆ EU standards are developed through the organs of EU, EFTA, and the three European
standardization organizations CEN, CENELEC and ETSI. Directives are issued by the EU
authorities and the standardization organization prepares the technical standards according to
the directives. These become standards to be adopted nationally. There are three main medical
devices directives for Europe. These are: i) 90/385/EEC for active implantable medical devices;
ii) 93/42/EEC covers vigilance and compliance in general for medical devices; iii) 98/79/EC for
in-vitro diagnostic medical devices. CE markings indicate that a product meets European
Union directive standards of performance and safety and, for example, apply to all sterile
medical supplies.


◆ American Standards are adopted from the international work of organizations like the IEC
and ISO, or are developed nationally. ANSI is the national organization that facilitates national
standards development by accrediting procedures of standardization organizations. All new
medical equipment has to be approved by the Food and Drug Administration (FDA-approval)
before it can be commercialized.


◆ Pharmacopoeia specifications – quality specifications for the most commonly used drugs and
some medical supplies, such as bandages, tape, and swabs. Important pharmacopoeias include
the British (BP), European (EP), United States (USP), and the WHO’s International
Pharmacopoeia (IP).


◆ Manufacturer’s Certificates – these are validated by the government of the exporting country
confirming that the exported device is approved for domestic use in the exporting country.
In this way, the importing country can be assured of the same risk exposure as the citizens of the
exporting country


◆ Export Certificates – allow manufacturers to export equipment that is not manufactured
for the exporting country’s domestic sale or use. At present, there is no uniform certificate
for different countries, so it is wise to be cautious in interpreting such ‘export certificates’.
(Note: the WHO export certificate at present only applies to pharmaceutical products).


Annex 4: Examples of important safety and performance standards


309




◆ Good Manufacturing Practices (GMP) – where this has been introduced, a manufacturer’s
Quality System is audited and monitored to ensure standards of production and safety are
maintained and are consistent. GMP has recently been established for manufacturers of
equipment. (For example, quality system standard for medical devices: 1128 in Japan, and 21
CFR part 820 in USA)


◆ Registration or Licensing – of manufacturers, wholesalers, importers, and retail outlets by a
local regulatory authority.


Note: be aware that: ◆ apparently standard quality certificates may indeed be based on
varying parameters


◆ export certificates and GMP are both issued by authorities in the
country of origin, and their value depends upon the capacity and
diligence of the issuing Regulatory Authority.


Annex 4: Examples of important safety and performance standards


310




ANNEX 5: EVALUATING SUPPLIERS
This annex helps you to assess your suppliers by providing:
◆ a pre-purchase evaluation questionnaire for suppliers in Box 54
◆ suggested criteria for evaluating new suppliers in Box 55
◆ suggested criteria for evaluating current and past suppliers in Box 56
◆ the characteristics that make a good supplier in Box 57.


BOX 54: Pre-Purchase Evaluation Questionnaire for Suppliers


Supplier
◆ Full trading name and address of supplier
◆ Full trading name and address of manufacturer (if the manufacturer is not the supplier)
◆ Certificate from the manufacturer authorising to sell the specified product to the intended market
◆ Product group and range
◆ Specific products by type
◆ Is there a local representative/agent/distributor in country? (Provide name and address of same)
◆ Type of agency agreement – exclusive, non exclusive, other (specify)
◆ Equipment already sold to the country (indicating quantities, places available)
◆ Equipment available in the region (references)
◆ Turnover and past performance if available
◆ Copy of the company profile
◆ Literature of the product offered
◆ Any specialist knowledge or expertise
◆ References
Their local agent/representative/distributor
◆ Name and address of the local agent/representative/distributor
◆ Type of agency agreement (exclusive, non exclusive, other)
◆ Date of expiry of the agency agreement
◆ References of equipment already sold in the country
◆ Details of service contract if available
◆ Details of available workshop facilities, transport, technical personnel etc.
◆ Company profile
◆ Any other qualification agent/representative/distributor wish to state.


Annex 5: Evaluating suppliers


311




BOX 55: Suggested Criteria for Evaluating New Suppliers


Issue Criteria
Status


Quality Control


Inspection


Personnel and
facilities


Trade references


Financial status


Local reputation


Quality of
products and
services


Annex 5: Evaluating suppliers


312


◆ Is the supplier a primary manufacturer or a distributor?
◆ If a manufacturer, does the supplier manufacture all products in-house?
◆ If a distributor, who is the primary manufacturer?
◆ Is the distributor selling exclusively for a particular manufacturer or representing


several companies?
◆ Is it a known high quality manufacturer?
◆ Does the manufacturer use GMP, ISO standards, or equivalent (see Annex 4)?
◆ Does the supplier have an on-site quality control laboratory?
◆ What tests are routinely performed during and after the manufacturing process?
◆ Are special tests performed for suitability in tropical environments?
◆ What official government agencies or international organizations have inspected


the manufacturing facilities?
◆ What are the results of the most recent inspection?
◆ What certification documents are available from the national regulatory authority


concerning the supplier’s status and compliance with their regulations?
◆ What are the qualifications of key production and quality control personnel?
◆ What is the capacity of the supplier’s plant(s)?
◆ Does the supplier have a local representative near your?
◆ What is the capacity of the supplier’s representative (for example, does it have a


workshop, skilled personnel, spare parts stocks)?
◆ What other local or foreign public procurement offices and health facilities buy


from the supplier?
◆ How long has the supplier served the above groups?
◆ What is the experience of these customers with regard to the supplier’s quality


and service?
◆ Is the supplier financially stable?
◆ Will the supplier remain in existence for the entire contract period?
◆ How is the supplier regarded by knowledgeable professionals on issues of:


participation, delivery times, adherence to delivery instructions, provision of
documents, packing and labelling, product shelf life, compliance to contract
financial terms, after sales service?


◆ Is the supplier well established and well respected?
◆ Is any information available from public sources (such as newspapers or trade


journals) concerning the supplier’s performance locally or in other countries?
◆ Have any complaints been received concerning product quality for this supplier?
◆ Have any complaints been received concerning the quality of services provided by


this supplier (such as installation, commissioning, and initial training)?
◆ Have any complaints been received concerning the quality of after-sales support


from this supplier?


Continued opposite




BOX 55: Suggested Criteria for Evaluating New Suppliers (continued)


Issue Criteria
Environmental/
Ethical/
Encouragement
of economy in
developing
countries


Adapted from: Management Sciences for Health, 2002, ‘Managing drug supply’, MSH, Boston, USA


BOX 56: Suggested Criteria for Evaluating Current and Past Suppliers


Issue Criteria
Participation
record


Response to
enquiry


Delivery time


Adherence to
delivery
instructions


Provisions of
documents


Packing and
labelling


Annex 5: Evaluating suppliers


313


◆ Does the supplier adhere to your ethical/environmental policies?
◆ Does the supplier adhere to the ethical/environmental policies of the external


support agency funding the procurement?
◆ Does the supplier’s goods, manufacturing, services, or representatives provide


benefits to your national economy (for example, increase the capacity of your
industrial sector)?


◆ Has the supplier accepted an award of bid/quotation and subsequently failed
to deliver?


◆ Has the supplier attempted to alter or withdraw bids after submission?
◆ Has the supplier promised after-sales support, then failed to provide it?
◆ Has the supplier adequately responded to all enquiries and within a reasonable


period of time?
◆ Did the supplier provide regular updates on the status of outstanding orders?
◆ What was the supplier’s average promised lead time?
◆ What was the actual lead time for the last round of procurement?
◆ What percentage of shipments were late? How many days (weeks, months) late?
◆ What additional costs were incurred due to late shipments?
◆ Did the shipments arrive under proper shipping conditions (for example, cool/cold


store for heat sensitive goods)?
◆ Did the shipment arrive at the correct port?
◆ Did the supplier send full shipments as requested, or were there partial shipments


and how many?
◆ Were advance copies of documents provided according to contract terms?
◆ Did shipments arrive with all required documents correctly filled out and signed?
◆ Were adequate site preparation instructions provided?
◆ Were adequate training materials provided?
◆ If required documents were omitted, how did the supplier correct the problem?
◆ Was labelling complete and adequate for proper use? Was it in the correct language?
◆ Did the supplier ship the correct package size? Were the correct contents and


quantities in each package?
◆ Were there specific examples of loss due to damage to packaging during shipments?
◆ Did external packaging protect the product from damage during transport in country?


Continued overleaf




BOX 56: Suggested Criteria for Evaluating Current and Past Suppliers (continued)


Issue Criteria
Product shelf life


Compliance to
contract financial
terms


Quality of
products
and services


Information
available from
supplier


Adapted from: Management Sciences for Health, 2002, ‘Managing drug supply’, MSH, Boston, USA


Annex 5: Evaluating suppliers


314


◆ Did the products comply with contractual terms for remaining shelf life? If not,
how many were shipped with shelf life less than specified?


◆ Did the supplier replace items that did not have acceptable remaining shelf life or
allow the return for credit or exchange of goods nearing their expiration date?


◆ Did all invoices comply with contract pricing terms?
◆ Were all shipments correctly insured and shipped, according to financial terms in


the contract?
◆ Were there any problems obtaining compensation or reimbursement for lost or


damaged goods?
◆ Were there any problems obtaining compensation or reimbursement for poor


services (such as commissioning and training)?
◆ Have complaints been received concerning product quality for this supplier?
◆ Did the supplier cooperate in making samples available and paying for any quality


control tests performed by quality assurance agencies?
◆ Have any complaints been received concerning the quality of services provided by


this supplier (such as installation, commissioning, and initial training)?
◆ Have any complaints been received concerning the quality of after-sales support


from this supplier?
◆ Did the supplier make suggestions concerning ways in which the buyer could reduce


costs (for example, combining or splitting orders or altering delivery schedules)?




BOX 57: Characteristics that Make a Good Supplier


Characteristic Features
Is interested and
thorough


Offers a good deal


Has a good
reputation


Has the resources
required


Is a recognized firm


Annex 5: Evaluating suppliers


315


◆ is friendly and professional and shows an interest in your enquiry
◆ takes an interest in small things as well as big things
◆ asks questions before giving a quotation
◆ genuinely understands your needs and talks to you in details about your


requirements
◆ is able to meet your needs
◆ is willing to suggest to you ways in which you can save costs
◆ chooses the best and most cost effective solution, and settles on a firm price
◆ offers equipment which is affordable and of acceptable quality and safety
◆ provides a package of inputs including guarantees and warranties
◆ has done a good job for others, and is reliable
◆ inspires confidence in their level of aptitude and service
◆ lets you know if your expectations are unrealistic and is willing to


discuss alternatives
◆ is willing to provide installation and commissioning, if applicable
◆ provides training linked to the purchase; if unable to provide this makes


recommendations on the best source of training
◆ has demonstrable capacity to service and maintain the equipment, preferably


based locally to you
◆ can offer after-sales services as a standard or available on request
◆ can offer repair and service contracts as standard practice
◆ is registered or licensed as a supplier by their national authorities
◆ is known by your national regulatory body
◆ has a capacity to supply that you can verify
◆ has set complaints procedures.


Choosing a good supplier will save you time and money. A good supplier is someone who has the
characteristics shown in Box 57.




ANNEX 6: OBTAINING APPROPRIATE DONATIONS
This annex helps you to obtain appropriate donations (both gifts of equipment and those purchased
using grants from aid agencies), by providing:
◆ summary guidelines for recipients of donations
◆ summary guidelines for providers of donations
◆ a sample equipment donation request form.


i. Summary Guidelines for Recipients of Donations
If no national donation regulations are available, you can develop your own by referring to the
guidelines outlined in Figure 31.


Annex 6: Obtaining appropriate donations


316




Figure 31: Summary Guidelines for Recipients of Donations to Ensure they are Appropriate


Annex 6: Obtaining appropriate donations


317


Issues Considerations


Check your policies and plans


Investigate the donor and the
goods on offer


• Do you have a donations policy? You will be in a much
stronger position to negotiate the contents of a donation if
you have a policy.
• What equipment and supplies are needed and in what
quantities? Prioritize the list of items you plan to request.
• Can you provide potential donors with clear and
comprehensive information about the items needed and how
they will be used? The items requested should comply with
your specifications, standardization practices, Model
Equipment List, etc.
• Do national regulations allow these goods to be imported?


• Does the donor have the capacity to fulfil the request?
• Before agreeing to accept a donation, check whether the
goods being offered:
– conform to national policy, or the WHO or WCC equipment
donation guidelines (see Annex 2)?
– are suitable for your facility and staff?
– only require spare parts and consumables that can be
afforded using available recurrent budgets?
• Before agreeing to accept a donation, check whether the
equipment will come with its relevant accessories,
consumables, manuals and some spare parts, so that it can
function and be used?
• Before agreeing to accept a donation, confirm whether the
donor will be responsible for covering the costs of transport,
freight, insurance, import duties, customs clearance, and
installation and commissioning costs, if applicable? If not, do
you have money set aside for this?
• If the goods include reagents or sterile supplies, check whether
these will have an adequate expiry date (at least a year, or half
the shelf life if the expiry date is less than a year)?
• Do the goods on offer conform to your ‘good selection criteria’
(Section 3.2)?
• Who will be responsible for the package of inputs required
throughout the remaining useful life of the equipment?


Use your normal Acceptance
Process (Section 8) as with all
other goods


• If pre-installation work is required, the recipient should
prepare the site and personnel for receiving equipment and
notify the donor when all preparations are complete.
• When donations are received, the recipient must check
packaging for damage. You must make sure that equipment
is fully functioning and is supplied with the relevant and agreed
manuals, spare parts, consumables, and accessories. You
must also check expiry dates and labelling of the recurrent
supplies.
• The recipient must confirm receipt of donated goods with the
donor, including information about the condition and
appropriateness of the goods.
• The recipient should keep a record of all donations received.


Refuse donations if necessary
• Refuse inappropriate donations and provide an explanation
of the reasons for refusal.
• Keep a record of all donations received that you have not
requested, and inform donors of unsolicited donations.




ii. Summary Guidelines for Providers of Donations
If no national donation regulations are available, you can develop your own by referring to the
guidelines outlined in Figure 32. The guidelines can also be used by potential external support
agencies to help them decide whether or not to make a particular donation.


Figure 32: Summary Guidelines for Providers of Donations to Ensure they are Appropriate


Annex 6: Obtaining appropriate donations


318


Issues Considerations


Ensure there is a need/request
for a donation


Involve the recipient


• Only provide donations in response to requests and
expressed needs.
• Know or find out about the recipient.
• Confirm the need for the donation, and check the recipient’s
capacity and financial resources to handle donations.
• Consider whether a donation of goods is the most appropriate
form of support. (In some cases, a cash donation may be
more effective. For example, it may be cheaper to procure a
hospital bed locally than to transport a donated bed from
overseas).
• Coordinate your donations with other donors, to ensure there
is no duplication.


• Ensure the equipment conforms to the national/facility
Equipment Development Plan, and consult recipients on
equipment requirements, and preparation of specifications
and purchase documents.
• Check donations conform to national requirements regarding
selection of equipment.
• Check that the recipient provides clear specifications of the
items required.
• Involve the recipients in the evaluation process and final
recommendations on equipment to be purchased for donation.
• Before sending donations, obtain consent from the recipient.
• Donors should confirm what items are being sent and when
these will arrive so that the recipient can plan to receive them.


Only offer good quality products


• Donors should make sure that they donate appropriate
healthcare technology and supplies.
• Equipment should be in full working order and be supplied
with all technical documents and enough consumables and
spare parts for at least two years.
• Check the quality and safety specifications of donated
equipment. Donors should avoid supplying equipment that
does not meet up-to-date technical and safety specifications.
Although, this does not mean the equipment has to be a
sophisticated model.
• Check with recipients whether the donation is acceptable.
If you are offering alternatives, check that these alternatives
are acceptable.


Do not forget the additional
costs involved in the donation


• Clarify and agree who will cover the costs of international and
local transport, freight and insurance, warehousing, customs
clearance, storage and handling, installation and on-going
support costs.
• Provide the recipient with detailed information regarding the
installation, operation and maintenance of equipment.




iii. Sample Equipment Donation Request Form
If you want an external support agency to donate equipment, you need to fill in some form of request.
Box 58 provides a sample of such a form.


BOX 58: Sample Form to Use When Requesting Donations of Equipment


EQUIPMENT DONATION REQUEST
Note: Fill in a form for each type of equipment requested even when several units are needed. Attach sheets
with more additional information if there is not enough space on this form
1. Requester Identification:


- Name of institution
- Name of department
- Street address
- City, state/region
- Country, Postal code
- Phone, Fax and Email
- Contact person and title
- Date and signature


2. Equipment Identification:
- Equipment name
- Universal code for the equipment type, if known (such as the UMDNS code)
- Clinical applications
- Quantity requested
- Sample brands and models
- Accessories needed


3. Request Justification:
3.1 Procedure(s) that will be performed using the requested equipment, with estimated number


per month
3.2 Explain why the resources (equipment, methods, procedures etc) presently available are


not satisfactory
3.3 When equipment is being requested to complement or replace existing equipment or services,


please describe the resources presently available
3.4 Compare the expected demand and the production capacity of the equipment being requested


4. Readiness to Absorb the Technology:
4.1 Human resources available (indicate additional training if necessary)
4.2 Material resources (additional equipment and devices needed)
4.3 Space and special installation available or planned
4.4 Maintenance requirements (in-house services, external contracts, etc)
4.5 Financial considerations (for installation, operation and maintenance)


Adapted from: American College of Clinical Engineers, 1995, ‘Medical equipment donation request form’,
ACCE, Chicago, USA


Annex 6: Obtaining appropriate donations


319




ANNEX 7: SPECIFICATION AND TECHNICAL AND
ENVIRONMENTAL DATA


This annex provides:
◆ an example of a long generic equipment specification. In Guide 2 there is an example of a more


complex one, for an infant incubator.
◆ a sample Technical and Environmental Data Sheet.


i. Generic Equipment Specification
OPERATING TABLE, HYDRAULIC, 4-SECTION


1. APPLICABLE DOCUMENTS
This specification should be read in conjunction with the ‘Technical and Environmental Data Sheet’,
and all goods offered must conform to the details specified in it and be able to function in the
prevailing conditions described.


2. REQUIREMENTS
2.1 GENERAL DESCRIPTION


To supply: ONE x general purpose hydraulic operating table, manually operated, to be used in theatre.
2.2 OPERATIONAL REQUIREMENTS


Note: supplier to complete ‘Reply’ and ‘Remarks’ sections.


Reply Remarks
2.2.1 Four section table top with 360 degree rotation.


2.2.2 Full length radio-translucent top and X-ray cassette
tunnel with cassette tray.


2.2.3 A mattress divided in sections with an antistatic
conductive rubber coating, of at least 5cm thickness.


2.2.4 Movements available must be the following at
a minimum:
Trendelenburg forward +15 degrees
Trendelenburg reverse - 30 degrees
Lateral tilt left and right 15 degrees
Head section adjustment + to -45 degrees
Leg section adjustment 95 degrees
Height adjustment (hydraulic) 71cm-101cm


2.2.5 All movements to be easily controlled manually by
hand or foot.


2.2.6 The table must have antistatic castors for mobility
and brakes for stability during use.


Annex 7: Specification and technical and environmental data


320
Continued opposite




Annex 7: Specification and technical and environmental data


321


Continued overleaf


Reply Remarks
2.2.7 The leg section must be removable or collapsible for


gynaecological and urological procedures while the top
part should be able to transverse (top to bottom) for
correct patient positioning.


2.2.8 Table size to be approximately 55cm x 190 cm.


2.2.9 The movement and control must be by hydraulic
systems, and gas struts.


2.2.10 The table to have side bars along the full length of
both sides for the attachment of accessories.


2.3 PHYSICAL CHARACTERISTICS
Reply Remarks


2.3.1 The table shall have a stainless steel frame and rails.


2.3.2 The pedestal must also be clad in stainless steel
plates for easy cleaning and to prevent water and
cleaning fluid from entering the unit.


2.4 SAFETY FEATURES
Reply Remarks


2.4.1 The apparatus must comply with international
safety standards.


2.4.2 The hydraulic and gas strut system must be of
sufficient quality to positively maintain any selected
position throughout the operation.


3. ACCESSORIES
Reply Remarks


3.1 4 x Accessory clamps, circular socket, Direct-On


3.2 2 x Accessory clamps, circular socket, End-On


3.3 2 x Arm Supports, perspex


3.4 1 x ‘D’ – shaped ankle pillow


3.5 1 x Patient restraint strap


3.6 1 x Narrow arm table


2.2 OPERATIONAL REQUIREMENTS (continued)




3. ACCESSORIES (continued)
Reply Remarks


3.7 1 x Anaesthetic screen with sleeve


3.8 1 x Pair of shoulder rests, with pads and
accessory clamps


3.9 1 x Pair of spare pads for shoulder rests


3.10 1 x Pair of lithotomy supports, with sleeves and straps,
and accessory clamps


3.11 1 x Pair of spare sleeves for lithotomy supports


3.12 1 x Pair of spare straps for lithotomy supports


3.13 1 x Head stabilizer, doughnut pattern, adult, diameter
20cm x 5cm high and 10cm hole


3.14 1 x Head stabilizer, doughnut pattern, child, diameter
15cm x 5cm high and 8cm hole


3.15 1 x X-ray cassette tray suitable for table, end loading
with flexible handle, for size of cassette up to
43cm x 34cm, trigger straightens 1.2m handle
for loading


3.16 Container of suitable hydraulic oil if required for
initial table assembly.


4. DOCUMENTATION
Reply Remarks


4.1 Supply an operating manual in English for the unit.


4.2 Supply a service manual in English for the unit.


4.3 Supply a list of recommended spare parts required
for maintenance for the unit, in English.


5. SPARE PARTS
Reply Remarks


5.1 Supply a set of only the recommended essential spare
parts for 24 months for maintenance and repair.


5.2 A list of each of each part and its price must be
attached to this offer.


Annex 7: Specification and technical and environmental data


322


Continued opposite




Annex 7: Specification and technical and environmental data


323


6. DELIVERY
Reply Remarks


6.1 Package the table, accessories, manuals, and spare
parts together in one load.


6.2 Crate the goods for transport and label it as follows:
1 x machine for health facility X.


6.3 The cost of freighting the goods by sea and road
DDP to health facility X, in country Y must be stated.


6.4 The cost of insuring the shipment must be stated.


7. INSTALLATION/COMMISSIONING/TRAINING
Reply Remarks


7.1 Full technical guidelines must be provided for table
assembly and commissioning by the client.


7.2 The cost of demonstration of the units and training
of health facility staff in the use and maintenance
of the machine, by your local representative, must
be stated.


8. WARRANTY
Reply Remarks


8.1 A guarantee period must be stated (a minimum of
18 months from the date of shipment).


9. AFTER SALES SUPPORT
Reply Remarks


9.1 After sales support must be available in country Y
or in the region, with maintenance capabilities and
facilities, and spare parts stock holdings.


9.2 Details of the availability and location of spare parts
must be stated.


9.3 Details of the availability and location of maintenance
facilities must be stated.


9.4 Details of the cost and terms for maintenance support
must be stated.


Continued overleaf




10. SUMMARY OF PRICES (detailed as follows:)
Reply Remarks


(total prices) (showing options
and alternatives)


1. Basic unit


2. Accessories as detailed


3. Documentation


4. Spare parts for maintenance and repair for 24 months


5.1 Crating


5.2 Delivery


5.3 Insurance


6.1 Assembly and commissioning instructions


6.2 Training by local representative


7 Maintenance support by local representative
Note: supplier to attach to this summary:
◆ the lists of all accessories, consumables, spare parts, and manuals in the offer, showing their unit


and total prices.
◆ the lists showing the breakdown of travel, accommodation, labour, subsistence, materials, and


any other costs for the installation/commissioning/training offered.
◆ the list showing the breakdown of the rates and costs of travel, accommodation, labour,


subsistence, parts, and any other items that apply to the maintenance contract during the
warranty period, and post-warranty.


◆ the details describing after-sales support availability.


Annex 7: Specification and technical and environmental data


324




Annex 7: Specification and technical and environmental data


325


BOX 59: Sample Technical and Environmental Data Sheet for Suppliers
Example Entries for Health Facility X


Electricity Supply
Source: Mains / generating set / solar panels / none
Type: three-phase 550V, 50Hz / 380V, 50Hz


single phase 220V, 50Hz
etc


Fluctuation: There is some problem with:
a) mains fluctuation, approximately + 10 per cent in both the voltage and


frequency supplied
b) mains cut-off (black out)
c) spikes, not necessarily on the mains supply but when large plant items cut in such


as lift motors
d) power only available for 2 hours a day
etc.
Suppliers should check/modify their power supply units if necessary, or state if voltage
stabilisers or a UPS is required alongside their products.


Water Supply
Quality: Hard water (high mineral or salt content) / soft water / sediment in water/ etc


Suppliers should check/modify their equipment with filters, softeners, or descalers if
necessary, or state if such units will be required alongside their products.


Pressure: 48psi, mains supply close at hand / pressure unknown – borehole supply / pressure
unknown – mains supply to subterranean tank


Problems: ◆ water supplies are frequently cut-off, or the electricity supply to the water pumps
is cut off


◆ very low pressure, or machines suddenly being without any water at all.
Suppliers should state if a back-up water storage tank or water pump is required with
their products




Continued overleaf


ii. Sample Technical and Environmental Data Sheet for Suppliers
You can provide all tenderers, bidders, or suppliers with Technical and Environmental Information in
order to ensure that the equipment they are offering to supply conforms to the prevailing national or
local climate and conditions. The sample sheet in Box 59 contains examples of the sort of entries you
could include, which you can modify according to your own situation. Such a data sheet can be
developed for a country, a district, or a facility.




Annex 7: Specification and technical and environmental data


326


BOX 59: Sample Technical and Environmental Data Sheet for Suppliers (continued)
Example Entries for Health Facility X


Environment
Height above 4,500 – 5,000 feet where the health facility is located.
sea-level: Suppliers should check whether this will affect motors, pressure vessels, etc.
Temperature: ◆ Average temperature in winter inside health facility 16oC


◆ Average temperature in summer inside health facility 32oC
◆ There is no air-conditioning, even in the operating theatres.
Suppliers should state if air-conditioning is essential for the correct operation of
their products.


Humidity: High at 80 per cent. / very low and arid
Suppliers should check their products and, if necessary, carry out the following actions:
◆ tropicalize their printed circuit boards (provide them with a polymerized coating)
◆ replace rubber components which will perish with metal ones
◆ enclose silica gel or use other drying strategies
◆ use cotton not plastic
◆ use stainless steel or epoxy-coated metals which will not rust
etc.


Dust: There are problems with:
◆ dust getting into equipment and clogging up filters.
Suppliers should consider checking/modifying their equipment with additional course
filter protection.


Vermin: There are problems with:
◆ rats chewing through wiring
Suppliers should consider checking/modifying their equipment with metal vermin guards.


Manufacturing Quality
Standards: Equipment to conform to the relevant International Standards (IEC, ISO), or


otherwise to the relevant National Standards, which relate to the safe manufacture of
quality medical and hospital equipment.


Language
Language: All documents and manuals to be in English / French / Spanish or appropriate language


All labels and markings on machines to be in English / French / Spanish or appropriate
language.


Level of Technology of Equipment
Preferences ◆ more manual, less automatic


◆ more electro-mechanical, and less micro-processor controlled
◆ easily used and maintained
◆ robust
◆ to withstand the climate and conditions described above
◆ with technically-skilled after sales support available locally
etc.




ANNEX 8: INTERNATIONAL COMMERCIAL TERMS
(INCOTERMS) FOR TRANSPORTATION OF
TRADE GOODS


Incoterms define the rights and obligations of both the buyer and seller, with respect to:
◆ the party responsible for packing, transport, transport insurance, transport/customs clearances


and documentation (Box 60)
◆ the party which pays for these activities (Box 61)
◆ at which point the responsibility passes from seller to buyer (end of Box 60).
This eliminates any possibility of misunderstanding and subsequent disputes.
The purchase contract should specify the specific responsibilities of both the supplier and buyer. The
division of costs between the supplier and buyer, shown in Box 61, is in accordance with Incoterms.
But the rights and obligations under Incoterms can be overridden or expanded by the purchase
contract which, when accepted by both parties, will take precedence. For example, under CIF and
CIP arrangements, the buyers can request additional insurance to cover the rest of the journey.


Annex 8: International commercial terms (incoterms) for transportation


327




BOX 60: Guidance on the Responsibilities of the Seller/Buyer for Incoterms


Annex 8: International commercial terms (incoterms) for transportation


328


Continued opposite


Responsibility


Incoterms
Ex Works
(at a named
place)


Free Carrier
(to a named place)


Free Alongside Ship
(at a named port of
shipment)


Free On Board
(at a named port of
shipment)


Cost and Freight
(to a named port of
destination)


Carriage Paid To
(a named place of
destination)
Carriage and
Insurance Paid
(to a named place of
destination)


Delivered At Frontier
(a named place)


Delivered Ex Ship
(at a named port of
destination)


Delivered Ex Quay
(at a named port of
destination)


Delivered Duty
Unpaid (to a named
place of destination)


Delivered Duty Paid
(to a named place of
destination)


Cost Insurance and
Freight
(to a named port of
destination)


Incoterms
abbreviation


EXW


FCA


FAS


FOB


CFR


CIF


CPT


CIP


DAF


DES


DEQ


DDU


DDP


Suitable for:


All transport
modes


All transport
modes


Sea / inland
waterway only


Sea / inland
waterway only


Sea / inland
waterway only


Sea / inland
waterway only


Sea / inland
waterway only


Sea / inland
waterway only


All transport
modes


All transport
modes


All transport
modes


All transport
modes


All transport
modes


Seller delivers to:


Buyer collects at
seller premises


Goods export cleared
and delivered to buyer’s
carrier or another person
nominated by the buyer


Named port of shipment


Named port of shipment


Named destination
port


Goods insured and
delivered to named
destination port


Named destination point


Goods insured &
delivered to named
destination point


Named frontier


Named destination port


Duty paid and delivered
to named destination
port


Named destination point


Duty paid and delivered
to named destination
point


Export Issues:
license,
authorizations,
customs


Buyer


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier




BOX 60: Guidance on the Responsibilities of the Seller/Buyer for Incoterms (continued)


Annex 8: International commercial terms (incoterms) for transportation


329


i. Where shown as ‘either’ (supplier or buyer), the purchase contract should specify who will take out insurance.


Import Issues:
license, authorization,
customs


Contract of
carriage


Buyer


Buyer


Buyer


Buyer


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Either


Either


Either


Either


Either


Supplier


Either


Supplier


Either


Either


Either


Either


Either


Contract of
insurance i.


Transfer of Risks
(loss/ damage)
when goods are (notified as):


Placed at disposal of buyer at
named place – supplier’s premises


Delivered into the custody of the
carrier at named place


Delivered alongside vessel at
named port of shipment


Passed across ship’s rail – named
port of shipment


Passed across ship’s rail at port
of shipment


Passed across ship’s rail at port
of shipment


Delivered to first carrier’s custody


Delivered to first carrier’s custody


Delivered to named place of delivery
at the frontier


On board vessel at usual unloading
point in named destination port


Placed at disposal of buyer on quay
at destination port


Placed at disposal of buyer at
named destination point


Placed at disposal of buyer at
named destination point


Buyer


Buyer
(including transit
through any country)


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Supplier




BOX 61: Guidance on the Division of Costs Between the Seller/Buyer for Incoterms


Annex 8: International commercial terms (incoterms) for transportation


330


Continued opposite


Division of
Costs


Ex Works
(at a named
place)


Free Carrier
(to a named place)


Free Alongside
Ship (at a named
port of shipment)


Free On Board
(at a named port
of shipment)


Cost and Freight
(to a named port
of destination)


Carriage Paid To
(a named place of
destination)
Carriage and
Insurance Paid
(to a named place of
destination)
Delivered At
Frontier (a named
place)


Delivered Ex Ship
(at a named port of
destination)


Delivered Ex Quay
(at a named port of
destination)


Delivered Duty
Unpaid (to a named
place of destination)


Delivered Duty Paid
(to a named place
of destination)


Cost Insurance and
Freight (to a named
port of destination)


Inco-
terms
abbrevi-
ation


EXW


FCA


FAS


FOB


CFR


CIF


CPT


CIP


DAF


DES


DEQ


DDU


DDP


Checking,
packaging,
marking of
goods


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Buyer


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Export
Issues:
license,
authoriz-
ations,
customs


Pre-
shipment
Inspection
(PSI ii.) – if
applicable


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Buyer


Subject to
named
place of
delivery


Buyer


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


i. Where shown as ‘either’ (supplier or buyer), the purchase contract should specify who will take out insurance.


Pre-
carriage –
delivery to
main
carrier (inc.
forwarder)


Loading
charges
(export)


Incoterms




BOX 61: Guidance on the Division of Costs Between the Seller/Buyer for Incoterms (continued)


Annex 8: International commercial terms (incoterms) for transportation


331


Provision of
transport
document
(or EDI iii.)


Freight
charge(s)
– main
contract
of carriage


Buyer


Buyer


Buyer


Buyer


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Buyer


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Supplier


Unloading
charges


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Supplier


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Supplier
(buyer
assists)


Import
Issues:
license,
authoriz-
ation,
customs


Import Duty
(if
applicable)


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Supplier


Buyer


Supplier


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Buyer


Supplier


Supplier


Either


Either


Either


Either


Either


Supplier


Either


Supplier


Either


Either


Either


Either


Either


ii. The buyer must pay the cost of Pre-Shipment Inspection, except when such inspection is mandated by authority of
the country of export. iii. EDI – electronic data interchange (an electronic format for doing electronic transactions).


On-carriage –
delivery to
named frontier/
destination
point or place


Insurance i




ANNEX 9: SAMPLE ACCEPTANCE TEST LOGSHEET
FOR EQUIPMENT


ACCEPTANCE TEST LOGSHEET
Only when this form has been satisfactorily completed should the Registration Box be filled in by
the HTM Manager.


REGISTRATION BOX
ALLOCATED INVENTORY NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


EQUIPMENT TYPE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


DESTINATION LOCATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


ACCEPTANCE DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


WARRANTY EXPIRY DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


MAINTENANCE CONTRACT WITH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


HEALTH FACILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


NAME OF EQUIPMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


TYPE/MODEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


ORDER NUMBER . . . . . . . . . . . . . . . . . . . . . . . SERIAL NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


COST IN US$ . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE RECEIVED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


FUNDING SOURCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


MANUFACTURER . . . . . . . . . . . . . . . . . . . . . . SUPPLIER/AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ADDRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


PHONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PHONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


FAX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FAX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


DETAILS OF ALL ACCESSORIES, CONSUMABLES, SPARE PARTS AND MANUALS RECEIVED
ARE LISTED ON PAGE SIX OF THIS FORM.


Annex 9: Sample acceptance test logsheet for equipment


332


Page 1




ACCEPTANCE CHECKS
1. DELIVERY


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Representative of supplier present? . . . . . . . . . . . . . . . . . .
b) Correct number of boxes received? . . . . . . . . . . . . . . . . . .
c) After unloading, visible damage to the boxes? . . . . . . . . . . . . . . . . . .
d) If damaged, has this been stated on the delivery


note and senior management informed? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


2. UNPACKING (refer to invoices and shipping documents)


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Visible damage to the equipment? . . . . . . . . . . . . . . . . . .
b) Equipment complete as ordered? . . . . . . . . . . . . . . . . . .
c) User/operator manual as ordered? . . . . . . . . . . . . . . . . . .
d) Service/technical manual as ordered?
e) Accessories as ordered? . . . . . . . . . . . . . . . . . .
f) Consumables as ordered? . . . . . . . . . . . . . . . . . .
g) Spare parts as ordered? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Annex 9: Sample acceptance test logsheet for equipment


333


Page 2




3. ASSEMBLY (refer to manuals)


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Are all parts available? . . . . . . . . . . . . . . . . . .
b) Do they fit together? . . . . . . . . . . . . . . . . . .
c) Mains lead with plug included? . . . . . . . . . . . . . . . . . .
d) Do all the accessories fit?
e) Are markings and labels OK? . . . . . . . . . . . . . . . . . .
f) Any damage? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


4. INSTALLATION (refer to manuals)


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Was the work carried out satisfactorily? . . . . . . . . . . . . . . . . . .
b) Were technical staff present as learners? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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5. COMMISSIONING/TESTING


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Were electrical, mechanical, gas, radiation safety tests
and performance checks carriedout in accordance with
the test sheets on pages 7 to 9 of this form? . . . . . . . . . . . . . . . . . .


b) Was the work carried out satisfactorily? . . . . . . . . . . . . . . . . . .
c) Were technical staff present as learners? . . . . . . . . . . . . . . . . . .
d) Were operators present as learners?


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


6. ACCEPTANCE – to be certified by the HTM Manager only
Yes/ No/ Corrected
done not done if applicable


a) Is the equipment accepted? . . . . . . . . . . . . . . . . . .
b) If rejected, have the shortcomings been summarized


on page 10 of this form?
c) If so, has a report gone to senior management


and formal complaints procedures started? . . . . . . . . . . . . . . . . . .
d) Should payment be withheld pending corrections? . . . . . . . . . . . . . . . . . .
e) Is payment approved? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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7. TRAINING


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Were the expected training courses given? . . . . . . . . . . . . . . . . . .
b) Were the training courses satisfactory? . . . . . . . . . . . . . . . . . .
c) Were suitable operators present? . . . . . . . . . . . . . . . . . .
d) Were suitable technical staff present? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


8. REGISTRATION – to be undertaken by the HTM Manager
Yes/ No/ Corrected
done not done if applicable


a) If accepted, has an inventory number been allocated? . . . . . . . . . . . . . . . . . .
b) Has the Registration Box on Page 1 of this form


been filled in? . . . . . . . . . . . . . . . . . .
c) Has the Stores Controller been provided with the location


for the equipment and all necessary data, so that the
Stores Receiving Procedure can be followed and a
Goods Received Note completed? . . . . . . . . . . . . . . . . . .


d) Have the accessories, consumables, spare parts, and manuals
all been issued to the correct holding authorities? . . . . . . . . . . . . . . . . . .


NAME


SIGNATURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


NOW PLACE THIS FORM AS THE FIRST RECORD IN THE EQUIPMENT FILE/SERVICE HISTORY
(see Guide 5)


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Describe and quantify all items received, and complete a Register of New Stocks form
(see Annex 11):


ACCESSORIES RECEIVED
1. 2.
3. 4.
5. 6.
7. 8.


CONSUMABLES RECEIVED
1. 2.
3. 4.
5. 6.
7. 8.


SPARE PARTS RECEIVED
1. 2.
3. 4.
5. 6.
7. 8.


MANUALS RECEIVED
1. 2.
3. 4.


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COMMISSIONING/TESTING PROCEDURES (see manuals and relvant technical standards)


i. ELECTRICAL INTEGRITY TESTS


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .


Classification (applies to medical equipment only) Fill as applicable
a) Class I - II - III? . . . . . .


b) Type B - BF - CF? . . . . . .


c) Type AP - APG? . . . . . .


Yes/ No/ Corrected
done not done if applicable


Mains Connection
a) Are cables and plugs intact? . . . . . . . . . . . . . . . . . .
b) Is cable colour code correctly connected? . . . . . . . . . . . . . . . . . .
c) Are connectors intact? . . . . . . . . . . . . . . . . . .
d) Are the fuses correct? . . . . . . . . . . . . . . . . . .
e) Is equipment protection correct? . . . . . . . . . . . . . . . . . .
f) Is voltage setting correct? . . . . . . . . . . . . . . . . . .
g) Is there an earth terminal? . . . . . . . . . . . . . . . . . .


Electrical Measurements with Safety Tester
a) Is protective earth continuity correct? . . . . . . . . . . . . . . . . . .
b) Is insulation resistance correct? . . . . . . . . . . . . . . . . . .
c) Are the leakage currents correct? . . . . . . . . . . . . . . . . . .
d) Is the voltage measurement correct? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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ii. MECHANICAL INTEGRITY TESTS


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Are knobs and switches intact? . . . . . . . . . . . . . . . . . .
b) Do the weheels/castors move? . . . . . . . . . . . . . . . . . .
c) Are the handles intact? . . . . . . . . . . . . . . . . . .
d) Are the mechanical movements okay? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


iii. GAS INTEGRITY TESTS


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Are the cylinders full? . . . . . . . . . . . . . . . . . .
b) Are appropriate gauges available? . . . . . . . . . . . . . . . . . .
c) Is there a cylinder key? . . . . . . . . . . . . . . . . . .
d) Is the pressure reading correct? . . . . . . . . . . . . . . . . . .
e) Is the cylinder colour code correct? . . . . . . . . . . . . . . . . . .
f) Are the hoses and fittings correct? . . . . . . . . . . . . . . . . . .
g) Is the system leaking? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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iv. RADIATION INTEGRITY TESTS


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


a) Is the kV calibration correct? . . . . . . . . . . . . . . . . . .
b) Is the mAs calibrated correctly? . . . . . . . . . . . . . . . . . .
c) Was the line voltage compensation performed? . . . . . . . . . . . . . . . . . .
d) Was the exposure test correct? . . . . . . . . . . . . . . . . . .
e) Were the step wedge test results correct? . . . . . . . . . . . . . . . . . .
f) Were the small and large focus calibrations done? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


v. PERFORMANCE TESTS (see manuals for manufacturer’s recommendations)


Undertaken by: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Witnessed by: Name . . . . . . . . . . . . . . . . . . . . . Position . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . .
Yes/ No/ Corrected
done not done if applicable


Note: carry out all operational tests as specified by the manufacturer
a) Are the function verification tests correct? . . . . . . . . . . . . . . . . . .
b) Is the equipment calibration acceptable? . . . . . . . . . . . . . . . . . .


Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Annex 9: Sample acceptance test logsheet for equipment


FAULT REPORT – to be completed by a member of the Commissioning Team
(describe any shortcomings with the equipment or services provided)


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


NAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


SIGNATURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Page 10




Annex 10: Equipment data to record


342


ANNEX 10: EQUIPMENT DATA TO RECORD
There is no hard and fast rule about the location for storing particular pieces of information. However,
the decision should be made based on practical considerations. The Equipment Inventory, which may
be kept manually or entered in a computer, needs to be easily updated. The Record Sheet for taking
the inventory has limited space, and the staff taking the inventory must be able to find most of the
information required on the actual piece of equipment being inventoried. Therefore you must
prioritize the most useful information to keep on the inventory. All other relevant data can be kept in
the maintenance file for the equipment. See Guide 2 on planning and budgeting for details of
designing your Equipment Inventory.


Data to Record on the Equipment Inventory
As a minimum the following data should be gathered when taking an equipment inventory:
◆ date inventory taken
◆ health facility name
◆ department
◆ section
◆ location/room where equipment is used
◆ type of equipment
◆ inventory code number (your own number)
◆ name of manufacturer
◆ model name and/or number
◆ manufacturer’s serial number (factory number)
◆ year made or bought
◆ supplier bought from
◆ status/condition
◆ your property or leased.
Other information about the equipment should also be kept on file, but does not necessarily have to
form part of the inventory (see below).


Other Types of Equipment Information to Keep
Additional information about the equipment should be gathered from manuals, invoices, contracts,
and delivery documents. This data should be kept in the maintenance service history of the
equipment – the Equipment File (see Guide 5), and includes:
◆ the address of the manufacturer and local agents
◆ the address of the supplier and local representative
◆ technical ratings
◆ when the warranty expires
◆ the price paid
◆ any external funding agency involved
◆ stocks of consumables, accessories, and spare parts received
◆ results of inspection tests undertaken on commissioning
◆ the frequency of PPM required
◆ details of any maintenance contract and maintenance contractor
◆ maintenance history.




Annex 11: Stores forms


343


ANNEX 11: STORES FORMS
Whenever new equipment and its equipment-related supplies arrive, the Commissioning Team
should enter relevant details onto a Register of New Stocks form (shown in Figure 33 over page)
which is handed over to the Stores Controller so that he has sufficient information to make them a
part of the stores system. The Stores Controller must complete a Goods Received Note for all
equipment and supplies received (shown in Figure 34 over page).
For the bulk stocks of equipment-related supplies (that arrive with new equipment) and the regular
recurrent orders for these supplies, stores staff will allocate them their correct stores code numbers.
The stores staff registers each type of item on a Stock Card (bin card) that is stored with the items on
labelled shelves. The type of information that should be recorded for re-ordering purposes is shown in
Figure 35.


Figure 35: Sample Stock Card (Bin Card)


Once a month the information on the stock cards is transferred to a Stock Control Ledger (stores
record book). It is simpler to make an order using the summary in the stock control ledger than using
all the individual stock cards. The stock control ledger is also a useful tool for analyzing stock
management and reviewing the accuracy of stock levels. Figure 36 shows two different sample layouts
for the ledger.


Stock Card (Bin Card)


Date Received from/
issued to


No.
received


No.
issued


New
balance


Remarks Signature


Item description:
Unit/pack size:
Maximum level:
Reserve stock level:


Cost:
Minimum/Reorder level:
Order quantity:


Card no:
Item code no:
Location:
Lead time:




Annex 11: Stores forms


344


Figure 36: Sample Layouts for the Stock Control Ledger


When ordering supplies from some form of health service store, staff use a Stores Requisition and
Issue Voucher (see Figure 37 over page). It acts as both a requisition voucher for goods from stores
and a record of the items issued. Its multiple copies can be used by both the user department as a
record of the goods ordered and by stores staff for stock management purposes. When ordering
supplies from suppliers, a Purchase Order is used (see Figure 38 over page).


Stock Control Ledger


Date Quantity received Quantity used Balance Quantity to order Signature


Item description:
Unit/pack size:


Item code no:
Order quantity:


Stock Control Ledger


Date Previous count
(physical)


Amount
received


Amount
used


Present count
(physical)


Signature


Item description:
Unit/pack size:


Item code no:
Order quantity:


Example 2:


Quantity to
order




Annex 11: Stores forms


345


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Annex 11: Stores forms


346


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