‘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 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 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 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. i Preface 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 ii Acknowledgements 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