Methods for medical device and equipment procurement in low and middle-income countries

40-70% of medical devices and equipment in low- and middle-income countries (LMICs) are broken, unused or unfit for purpose: ad-hoc, undiscerning and inefficient procurement methods and processes contribute towards this problem. This thesis presents the findings of four original studies on medical device and equipment procurement within LMICs. Chapter I reports findings of a systematic literature review on procurement and prioritization methods; recommendations from reviewed literature are synthesised. Chapter II describes fieldwork conducted in The Gambia and Romania to explore the processes and dynamics behind medical device procurement in contrasting settings. Findings suggest procurement processes are strongly influenced by political/cultural power dynamics; health technology assessment evidence is rarely considered. Chapter III discusses the feasibility of conducting medical device specific economic evaluations for informing procurement planning. A case study on the costeffectiveness of alternative treatment interventions for femur-shaft fracture fixation in Sub-Saharan Africa is presented. Chapter IV consists of a critical appraisal of the medical device specific elements of the One Health Tool for health system planning. The thesis concludes with a discussion contextualizing the findings and suggestions for further research

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland