CHALLENGES IN PROCUREMENT AND USE OF DONATED MEDICAL-EQUIPMENTS: STUDY OF A SELECTED REFERRAL HOSPITAL IN TANZANIA

Abstract

ABSTRACTMajority of the hospitals and research units in the developing countries largely rely on the donated equipments. Tanzania also depends on the partner donors for its' medical equipment needs. In Tanzanian public sector organizations, the donated equipments are also procured as per the provisions of the applicable procurement act of the land. This creates some practical challenges, as the requirement of donated equipment supply chains differ significantly. Further, the use of donated equipments often reported to trigger challenges due to some context-specific factors. Keeping these issues at focal point, the paper aims to explore the issues in procurement and use of donated medical equipments. The paper is informed by information collected using a study which focused on a selected national hospital in Dar Es Salaam region. The study was based on case-design and aimed to analyze the different interdependent issues on the basis of qualitative and quantitative responses recorded from 46 employees of the organization. The findings indicate that due to the absence of clear dedicated framework and other resource issues, often the quality assurance of donated equipments become a challenging task.Keywords: Public Procurement; Donated Medical Equipments; Procurement in Tanzania; Donated Equipment ProcurementINTRODUCTION:The quality of medical equipments directly affects the quality of healthcare services at different stages from diagnosis to cure and post-cure. The resource challenge often force the developing world to depend on the medical equipments donated from the donor countries from the developed or emerging economies. Although, the donation of equipments significantly helps the developing countries in improving the healthcare services, sometimes, the quality issues creep-in and adversely affect the spirit of the process. The quality assurance and maintenance of the standards are linked to the effectiveness of the procurement process, which in public sector organizations, must confirm to the applicable regulatory framework.The studies show that as much as 96% of medical equipment in developing countries is donated and about 40% of medical equipment in the developing world is out of services. These facts have clear repercussion for health outcomes in these countries with the patients suffering from lack of accurate diagnostic or adequate treatment. Large amounts of unused donated equipment in storage put a marked strain on facilities funds (MOHSW 2008). The medical system in Tanzania too, relies heavily on the equipment's which are procured via donated projects. These equipments are usually used and second-hand but technically suitable for the intended purpose.Realizing the high importance of quality many international agencies have developed clear guidelines for procurement of donated medical equipments (WHO, 2000). As most of the procurement is done by the public sector organizations, the process is also subject to the provisions of the Public Procurement Act (URTPPA, 2004; URTPPA; 2005). Procurement of medicines and medical supplies for public health facilities in Tanzania, particularly the goods procured under government budget and budget support by development partners, are procured by either of the Ministry of Health and Social Welfare (MOHSW), Ministerial Tender Board (MTB), Medical Stores Department (MSD) or by multilateral procuring agent. It is understood that MOHSW, MTB and MSD award contract to successful bidders and initiate contract management activities for each award. Most of MOHSW tenders and awards are based on lots whereas the MSD tenders and awards are on individual item basis. The later strives to get the lowest or competitive price of individual items, whereas the former benefit on managing fewer contracts at a time.The Government's effort to undertake public procurement reform in Tanzania Mainland started in 1992 and consequently in year 2001 new version of Public Procurement Act introduced (Nkinga, 2003). …