Health Technology Assessment Framework for Medical Equipment Procurement in Federal Teaching Hospitals in South East Nigeria

Procurement of medical equipment in Nigerian federal teaching hospitals has historically been driven by availability and price rather than structured health technology assessment, resulting in mismatched equipment acquisitions, high total cost of ownership, and poor clinical outcomes alignment. This study develops and validates a health technology assessment framework for medical equipment procurement applicable to federal teaching hospitals in South East Nigeria. The framework was developed through a structured consultation process involving procurement officers, clinical engineers, clinicians, and finance officers at four federal teaching hospitals in Anambra, Enugu, Abia, and Imo states. Framework components were informed by WHO guidance on health technology assessment and benchmarked against best practice frameworks from Ghana, South Africa, and the United Kingdom. The resulting framework specifies seven assessment domains: clinical evidence of effectiveness, safety and regulatory compliance status, technical specifications and fitness for purpose, total cost of ownership analysis, local service and spare parts availability, training requirements and vendor support, and environmental and infrastructure compatibility. Each domain is operationalized through a scoring rubric with weighted criteria appropriate to the Nigerian institutional context. Pilot application of the framework to three procurement decisions at one teaching hospital demonstrated improved documentation quality and identified significant total cost of ownership differentials between competing bids that had been ignored in previous procurement processes. Staff interview data confirm framework usability with modest training. The study recommends adoption of the framework across all Federal Ministry of Health-affiliated institutions. Keywords: health technology assessment, medical equipment procurement, federal teaching hospitals, South East Nigeria, total cost of ownership.