In a report released in May, the British Medical Association (BMA) urged the country's National Health Service (NHS), to ensure that all procurement of surgical instruments is carried out ethically.

The move come as step towards achieving a broader initiative of sustainable development in the healthcare sector. Highlighting that there was limited awareness about the origin of surgical instruments owing to indirect purchases through companies in Germany and the US, it requested the NHS to use it's influence to curb unethical practices prevalent in the surgical instrument manufacturing industry.

A lot of UK's supplies of medical instruments originate from third world countries. For instance, the Sialkot region in Pakistan annually produces 100 million surgical instruments with a range of more than 10,000 items. The yearly produce is worth about US$191 million, and US being the largest buyer of these items purchases 30%, followed by Germany's 14%, and 9% of the produce reaches the UK.

Very often the manufacturing units of surgical instruments including neurosurgery instruments are mired by unhealthy working conditions and use of child labor for production. The reports addresses 3 chief ethical concerns.

Child Labor

Out of the estimated child labor of 3.3 million in Pakistan, approximately 2,000 to 5,000 are employed in the surgical instrument sector segment. Often poverty is the reason behind it.

Unhealthy and Unsafe Working Conditions

Workers of surgical instrument manufacturing units are vulnerable to exposure from the machinery used to in the processes viz. forging, grinding, drilling, milling, poor wiring, etc. Additional exposure pertains to toxic and corrosive chemicals, e.g. sulphuric acid, nitric acid, etc. Despite the threats, there aren't enough funds or systems to provide training or attach a high priority to the workers' safety.

The Rights of Workers

About 73% or 36.5 million of the Pakistani workforce is employed on a contractual basis. This means that they work in poor conditions, work long hours, there's insecurity and insignificant legal rights, if any. There's hardly any unionization or access to social security schemes.

Is There A Solution?

Since, the problem isn't superficial it requires long drawn and sustained efforts to set things right. Executing policies favoring ethical trade within the surgical instrument supply chain have the potential to improve the situation.

Still challenges such as conceiving and executing ethical policies trade practices in the business environment might be tough, as conventionally the focus is on price, quality and delivery times. Considerations such as awarding contracts on the basis of ethics, may be somewhat hard to implement.

Howsoever challenging, the work towards attaining the objectives is already underway as the NHS Supply Chain works to ensure international labor standards for the supply and purchase of healthcare products.

Furthermore, the NHS in a recent report on the issue, has outlined several barriers against, and its own recommendations towards the achievement of ethical procurement. Some of the insightful barriers are:

● Limited knowledge/experience of ethical procurement.

● Limited resources/competing pressures to procure.

● Complex/fragmented procurement system.

● Limited culture of audit or due diligence.

● Non-availability of systems to store or access ethical performance information about suppliers.

● The impact on potential/perceived profitability/costs/ when ethics are given a high priority.

No matter how difficult it might be, the establishment of ethical procurement, positively is fundamental to sustainable procurement. The report beautifully articulates the thought as, "Any change is dependent upon enthusiasm and support within the market for adoption of ethical labour standards when purchasing surgical instruments, whether in the NHS or in non-UK markets."