Mega-buying based on modest planning

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There exists a gap between government procurement of medical equipment and planning based on needs assessment. From what has been published in Prothom Alo on October 13, certain aspects of this disarray between planning and procurement come to light. Besides a failure to assuage demand of what equipment is required by which health facility nationwide, little thought is given to whether trained technicians are available to operate the machinery being bought.
First some basic facts: There are 422 upazila hospitals in the country. Machineries supplied to these facilities include x-ray, E.C.G., ultrasound, anesthesia equipment, defibrillator, incubator, blood pressure measurement instruments, etc. On top of these 422, there are another 120 district-level, general and specialised hospitals and centers, medical colleges, which require a far greater array of instruments and equipment. Two important studies, i.e. "Bangladesh Health Facility Survey 2009" (BHFS 2009) and the "Bangladesh Medical Equipment Survey - 2008" conducted on behalf of the Ministry of Health and Family Welfare outline the problems associated with equipment purchase and their lack of proper utilisation.
According to BHFS 2009, nearly 50% of all equipment supplied was inoperable. There is no contention that purchase of medical equipment is necessary investment for the public health sector. However, the proper functioning of such equipment is an essential prerequisite for providing effective and efficient health services. The plight of district hospitals may serve as a key example in that the major thrust of government health sector decision-making has been geared towards procurement.
This is best exemplified when one takes a look at the scenario existing in district hospitals of Bogra, Dinajpur and Rangpur. Shaheed Ziaur Rahman medical college, Bogra has new equipment worth Tk.13 crore that remain unused due to lack of operators. List of supplied equipment include x-ray, mammography, insulator, E.T.T., anesthesia machinery, etc.all essential machinery required for proper treatment. A similar situation exists in Rangpur and Dinajpur medical colleges. Tk. 23 crore and Tk. 10 crore worth of medical equipment were purchased for Dinajpur and Rangpur Medical Colleges respectively. Again, most of the purchased items remain packed or unused since no provision or financial allocation has been made for the hiring of trained technicians.
It remains a mystery as to why the ministry of health remains first and foremost committed to procurement despite being armed with facts and figures about unused equipment. As stated in the "Bangladesh Medical Equipment Survey 2008" there is a general lack of "needs assessment." "In this current study it transpired that the documents that underlay the procurement requests from the different Line Directors (LD) of the Directorate General Health Services (DGHS) to the Central Medical Stores Depot (CMSD) do not represent references to needs assessments that might motivate these requests. By needs assessment, the Consultant refers to the process by which the need for medical equipment in terms of type and quantity is established and updated based on an ongoing inventory of the established list of equipment for each tier of the health services. Rather it seems, and this was confirmed in this study during interviews at the CMSD and with LDs of the DGHS, that the procurement requests are essentially based on the needs as expressed by the Civil Surgeon (CS) in response to an annual circular by the DGHS. At the DGHS it is not known whether a request that is submitted by CS is based on a proper needs assessment in the district. The probability of performing such needs assessment is reportedly small indeed, partly because of the absence of a tool to make such an assessment and partly because of the absence of a Tables of Equipment (TOE) for each level of health services. Also the relative high turnover of CSs and the subsequent lack of continuity and opportunity for substantial involvement in the district and its upazilas must be taken into account. The high turnover of senior officers at the upazila level itself is another contributing factor here." Entering into any sort of procurement regime without first identifying requirements is a suicidal plan of action, one that appears to be very much in vogue in Bangladesh. Indeed, lack of proper planning exists in practically all stages of the medical equipment life cycle, from needs assessment, procurement, installation and commissioning to operating.
While it is impossible to touch upon every facet of the lifecycle of medical equipment, it is possible to touch upon the critical subject of shortage of manpower. Due to lack of latest data on the training of technicians, we can refer back to Bangladesh Medical Equipment Survey 2008' which stated: "During the medical equipment survey it became apparent that virtually no training has been carried out on the equipment. Partly, this can be attributed to the fact that no training requirements have been formulated in the tender documents. This is however changing; in the current tender documents under HNPSP training requirements are included more often. On the other hand as shown in this study, it takes on average 2.5 years before equipment arrives at the hospital department. At that time suppliers are not interested anymore to carry out training nor do the terms of the contracts oblige them to do so." From the examples stated above, it would appear that not much has improved in this area over the last four years.
Procurement running into hundreds of crores of taka per annum is literally going to waste. Thanks to a combination of inadequate planning on what is needed and the failure to develop human resources to properly operate complex pieces of machinery. Unless a fundamental rethinking occurs along these lines, the national exchequer will continue to be bled and the general populace be deprived of public health services they are entitled to.

The writer is Assistant Editor, The Daily Star.