“It is not the knowing that is difficult, but the doing” Chinese proverb
Equipment should not be replaced just because it is old or a newer model is available. Only buy replacements for items that have reached the end of their useful life, that are not economical to repair or that are technically obsolete – the manufacturer is no longer producing spare parts, consumables and accessories (see Box). Sometimes an item of equipment becomes clinically obsolete, because the technology or technique is no longer considered appropriate, or a more cost-effective or more clinically effective model becomes available.
You also need to check reliability and durability under local conditions. For example, it may be important to find out if supplies or equipment function well in an environment that is hot, humid, dry or dusty, and if special storage conditions are required. Some supplies and equipment are particularly sensitive to certain conditions, for example, condoms are sensitive to heat and microscopes are sensitive to humidity. Supplies and equipment should be compatible with existing equipment and appropriate for the level of service provided by your facility. You also need to check that supplies and equipment will be familiar to staff and culturally acceptable to patients.
Avoid buying items that are too technically sophisticated for local conditions. The latest model often requires more expertise to use and maintain, and complicated items tend to break down more frequently. If you are thinking about procuring a particular item, it can be useful to talk to someone in a facility that has experience of using that model.
The quality of performance you need depends on how often an item will be used and how long you are expecting it to last. Buy the quality that is best suited to your needs. It is worth buying better quality supplies and equipment if they are going to be used frequently or are expected to last a long time. However, it is not always necessary to buy the very best quality. For example, good ‘mid-range’ quality stainless steel instruments are probably the best buy. It is not cost-effective to buy the most expensive because instruments are easily misplaced, or the cheapest because these are more likely to rust or fall apart.
Safety and performance standards All medical supplies and equipment should meet international, regional or national safety and performance standards. The most important standards include: IEC – which are international standards for the electrical safety of electrical and electromechanical equipment, and apply to refrigerators for example. IEC 601 is the international standard specifically for electrical and mechanically safe medical equipment for use by staff and with patients. ISO – which are international standards for quality management and systems. ISO 9000–9004 is a series of standards covering the quality of manufacturing processes, design and development, construction, installation and service. ISO standards do not currently exist for all medical supplies and equipment, but do apply to syringes, needles, gloves, instruments and scales, for example. CE mark – which indicates that a product meets European Union directive standards, and apply to sterile medical supplies for example. Pharmacopoeia specifications – which establish 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 WHO International Pharmacopoeia (IP). Quality certificates or export certificates – which are issued under various national and regional standards such as ISO 9000 or the equivalent EN 29000.
Better quality supplies and equipment are more expensive, but cheaper supplies and equipment are often of poor quality. Buying the cheapest items can be a false economy, because they 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 that lasts longer. Supplies that are close to their expiry date are sometimes offered for sale at low prices. Be careful not to buy more than you can use before the expiry date, otherwise you will waste resources. Packaging also adds to the cost of supplies and equipment, but it is usually worthwhile purchasing goods that are well packaged. Poorly packaged goods are more likely to be damaged in transit.
In addition to the purchase cost, other initial costs to consider include: • Import tax and customs duty • Transportation and insurance • Installation • Staff training You also need to check that your budget will cover operational (running) costs throughout the lifespan of the equipment, including: • Consumables and accessories – allow for continuity of these supplies • Maintenance and servicing – allow 5-7% of capital cost for this • Spare parts • Kerosene, electricity or other fuel • Safe waste disposal
Sometimes it is more cost-effective to buy new rather than used equipment, which only has a limited life. Obtaining accessories, consumables and spare parts can also be difficult for older models that are no longer made. Find out the cost of a new model of the same or a similar item of equipment and compare this with the cost of a used model.
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