Analytical Framework for Evaluating the Total Cost of Ownership of Medical Imaging Equipment at Nigerian Secondary Health Facilities

Procurement decisions for medical imaging equipment at Nigerian secondary health facilities are typically based on acquisition cost alone, without systematic consideration of total cost of ownership over the equipment lifecycle, resulting in systematic underestimation of real healthcare costs and frequent post-procurement financial distress when service and consumable costs emerge. This study develops and applies an analytical framework for evaluating the total cost of ownership of medical imaging equipment at Nigerian secondary health facilities, addressing the absence of such a framework from Nigerian health facility management practice. The framework was developed through systematic review of healthcare capital equipment cost modelling literature, structured interviews with hospital administrators, biomedical engineers, and equipment procurement officers at secondary facilities in Abuja, Kaduna, and Oyo, and analysis of equipment financial records where available. Total cost of ownership components specified by the framework include acquisition cost, installation and commissioning cost, operator training cost, consumables and reagents, scheduled maintenance and calibration, unscheduled repair costs including parts and labour, facility preparation and utility costs, end-of-life decommissioning, and productivity loss cost from downtime. The framework was applied retrospectively to evaluate the true ten-year total cost of ownership of a digital X-ray system and an ultrasound machine at two secondary facilities, revealing that total cost of ownership was 2.4 times and 1.9 times acquisition cost respectively. Downtime productivity loss cost was found to represent a frequently neglected but economically significant element. The framework provides a standardized decision tool for procurement committees. Keywords: total cost of ownership, medical imaging equipment, secondary health facilities, procurement decision, Nigeria.