Describing healthcare technology management practices in the procurement of medical devices in the Dr Kenneth Kaunda District Municipality

Abstract

This study delves into Healthcare Technology Management (HTM) practices, with a focus on the procurement of medical devices within public healthcare facilities, particularly Community Healthcare Centres (CHCs), in the Dr Kenneth Kaunda District Municipality, North West Province, South Africa. It uncovers a prevalent procurement approach prioritising technology safety and clinical efficacy, often at the expense of cost-effectiveness. This focus, while guaranteeing quality and safety, tends to neglect efficient financial management in medical device procurement, a challenge acutely felt in low- and middle-income regions faced with financial limitations, scarce technical expertise, and a shortage of trained healthcare personnel. The objective of this research is to describe and recommend augmentations to procurement practices by emphasising healthcare technology management principles. These principles encompass needs assessment, adherence to specifications and standards, technology assessment, cost analysis, and comprehensive life cycle management, offering insights for more balanced and efficient procurement strategies in resource-constrained settings. Employing a qualitative research approach, this study gathered primary data through interviews with healthcare officials from the procurement and technical departments of the Dr Kenneth Kaunda District Municipality. A stratified sampling method provided insights from individuals involved in medical device procurement from strategic (managerial positions) and operational (supply chain officers, clinical engineering technicians/engineers) perspectives. Despite aiming for 13 participants, data saturation was achieved after the 5th interview, with 6 participants (46% of the target) solidifying the findings. Analysis of the interview data across both strata resulted in 48 codes condensed into 8 comprehensive themes. These themes elucidate shared and distinct concerns between strategic and operational layers. The strategic layer uniquely focused on "Committees and Decision- Making" and "Guidance, Policy, and Standardisation in Procurement," indicating an emphasis on policy formulation and strategic oversight. In contrast, the operational layer uniquely or more prominently addressed "Service Delivery and Impact" and "Standard Operating Procedures," highlighting operational challenges in service delivery and procedural application. This detailed examination reveals the complex nature of HTM challenges, spanning strategic policy formulation to operational execution, and underscores the necessity for holistic and adaptable improvement strategies within the municipality. The research identifies a significant disparity between the acknowledged importance of cost effectiveness and its practical implementation, with a tendency to prioritise technological safety and efficacy over cost-efficiency. Furthermore, it emphasises the critical role of HTM principles in refining procurement practices to enhance healthcare outcomes, particularly in low- and middle income settings like South Africa's Dr Kenneth Kaunda District Municipality. The study concludes that the Dr Kenneth Kaunda District Municipality partially applies HTM principles in its procurement processes but lacks full adherence, particularly in aspects like needs assessment, specification adherence, technology assessment, cost analysis, and life cycle management of medical devices. Budget constraints further complicate procurement planning, underscoring the absence of a dedicated committee for HTM concerns and a specific procurement policy for medical devices.