DEVELOPMENT BANK OF ETHIOPIA

APPLIED RESEARCH DIRECTORATE

A STUDY ON MEDICAL DIAGNOSIS SERVICE

Medical imaging machines and clinical laboratory equipment

Prepared By:

Asmamaw Haile Sr. Statistician

Gizachew Nadew Sr Research Officer

Revised By:

Anteneh Mulugeta Team Manager

Approved By: Commodity and Market Research Review & Approval Team
Members

September 2023

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 Table of Contents

LIST OF TABLES ....................................................................................................................................... iv

LIST OF FIGURES ...................................................................................................................................... v
1. INTRODUCTION ............................................................................................................................... 1
1.1. Background of the Study ....................................................................................................... 1
1.2. Objectives of the Study .......................................................................................................... 2
1.2.1. General Objective................................................................................................................. 2
1.3. Methodology of the Study ...................................................................................................... 2
1.3.1. Method of Data Collection ................................................................................................... 2
1.4. Scope and Limitations of the Study ....................................................................................... 2
1.4.1. Scope of the study ................................................................................................................ 2
1.4.2. Limitation of the Study ......................................................................................................... 2
2. COMMODITY DESCRIPTION.............................................................................................................. 3
2.1. Medical Imaging Machines .................................................................................................... 3
2.1.1. X-Ray Systems ................................................................................................................. 3
2.1.2. CT Scanners ..................................................................................................................... 3
2.1.3. Ultrasound ...................................................................................................................... 4
2.1.4. Magnetic Resonance Imaging (MRI) ............................................................................. 6
2.1.5. An X-ray ......................................................................................................................... 7
2.1.6. MRA Scans ..................................................................................................................... 9
2.1.7. Mammography ............................................................................................................. 10
2.1.8. Bone Density Scans ....................................................................................................... 10
2.1.9. Arthrogram ....................................................................... Error! Bookmark not defined.
2.1.10. Myelogram ..................................................................................................................... 11
2.2. Clinical Laboratory Equipment........................................................................................... 12
2.2.1. Haematology Analyzer ................................................................................................... 12
2.2.2. Coagulation Analyser ................................................................................................... 15
2.2.3. Hormonal Analyser ...................................................................................................... 18
2.2.4. Biochemistry Analyser ................................................................................................. 21
2.2.5. Electrolyte analysers..................................................................................................... 23
2.3. Operating Room Equipment ................................................................................................ 23

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 2.3.1. Operating Tables (OR table) ........................................................................................ 23
2.3.2. Electro surgical Unit ..................................................................................................... 25
2.3.3. Anaesthesia machine .................................................................................................... 26
2.4. Other Diagnostic Equipment’s ............................................................................................ 28
2.4.1. Electrocardiogram (ECG) ............................................................................................ 28
2.4.2. Endoscopy ..................................................................................................................... 30
3. REAGENTS AND CONSUMABLE MATERIALS OF MEDICAL EQUIPMENTS ......................................... 33
3.1. Reagents ............................................................................................................................... 33
3.2. Consumables ........................................................................................................................ 33
3.3. Source of reagents and consumable materials..................................................................... 33
3.4. Supply and Demands of reagents and consumable materials ............................................. 33
3.5. Marketing arrangements of reagents and consumable materials ....................................... 33
3.6. Current price of Reagents and consumable materials........................................................... 34
4. MARKET STUDY ............................................................................................................................. 56
4.1. Market Segmentation ........................................................................................................... 56
4.1.1. Market Segment by Destination ................................................................................... 56
4.2. Demand driving Factor of medical diagnosis ...................................................................... 57
4.2.1. Use of Point of Care Diagnostic Products ....................................................................... 57
4.2.2. Increased determination to address disease burden .......................................................... 57
4.2.3. Rising healthcare coverage ............................................................................................. 57
4.2.4. Progressive growth of the Ethiopian population and economy ......................................... 58
4.3. Domestic Market demand of medical diagnosis in Ethiopia ............................................... 58
4.3.1. Non communicable disease and Injuries.......................................................................... 59
4.4. Supply for Advanced medical service in Ethiopia ............................................................... 60
5. PROBLEMS, CONSTRAINT, RISK, AND SUCCESS FACTOR ................................................................. 64
6. PARAMETERS AND BASIC ASSUMPTIONS ....................................................................................... 65
6.1. Assumptions for both products ............................................................................................ 65
6.2. Revenue ................................................................................................................................ 65
6.2.1. Medical diagnosis Service charges .................................................................................. 65
6.2.2. Medical equipment performance ..................................................................................... 72
6.3. Investment Items required ................................................................................................... 73

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 6.4. Operational Cost .................................................................................................................. 74
6.5. Overhead expense ................................................................................................................ 75
6.6. Insurance .............................................................................................................................. 76
6.7. Fuel and lubricants .............................................................................................................. 76
6.8. Depreciation ......................................................................................................................... 77
6.9. Repair and maintenance ...................................................................................................... 77
6.10. Land Lease Cost ............................................................................................................... 77
6.11. Working Capital Determination ...................................................................................... 78
REFERENCES .......................................................................................................................................... 79

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 LIST OF TABLES
Table 1: Chemistry machines and reagent price ................................................................................ 34
Table 2: List of medical chemistry reagent and their current price .................................................. 51
Table 3: List of consumable material and their price ........................................................................ 55
Table 4: Distribution of Outpatient (OPD) attendance per capita by region .................................... 59
Table 5: Distribution of health facilities in Ethiopia across regions .................................................. 61
Table 6: Regional Distribution of Medical Laboratory Equipment (between 2011-2015 E.C)* ....... 62
Table 7: Regional Distribution of Medical Imaging Machine (2011-2015 E.C)................................. 63
Table 8: Problems, Constraints, Risks and Success Factors .............................................................. 64
Table 9: Clinical Laboratory Equipment’s and its service charge per person as per the service
delivered .............................................................................................................................................. 65
Table 10: Medical imaging machine and their service charge ........................................................... 67
Table 11: OR Equipment and their service charge ............................................................................ 71
Table 12: Other diagnostic machines and their service charge .......................................................... 72
Table 13: Clinical laboratory Machines performance........................................................................ 72
Table 14: Medical Imaging machine and their average diagnostic service performance per hour .. 73
Table 15: Table List of vehicles ........................................................................................................... 73
Table 16: Cost of reagent and consumable per test ............................................................................ 74
Table 17: Cost of Other consumables ................................................................................................. 75
Table 18: The major insurance categories .......................................................................................... 76
Table 19: Truck Fuel consumption and cost ...................................................................................... 76
Table 20: Depreciation ........................................................................................................................ 77
Table 21: Repair and maintenance ..................................................................................................... 77
Table 22: Working capital Requirement ............................................................................................ 78

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 LIST OF FIGURES

Figure 1: Hematology analyser ........................................................................................................... 13

Figure 2: Coagulation machine ........................................................................................................... 16
Figure 3: Snibe Maglumi 800 Fully Automatic Immunoassay analyser machine ............................. 18
Figure 4: SD Biosensor Semi-Automatic Immunoassay Analyzer, Immunoassay machine.............. 19
Figure 5: Blood serum testing machine .............................................................................................. 20
Figure 6: OR Table .............................................................................................................................. 24
Figure 7: Electrosurgical unit device .................................................................................................. 25
Figure 8: Anaesthesia machine ........................................................................................................... 28
Figure 9: ECG machine ....................................................................................................................... 29
Figure 10: Endoscopy machine ........................................................................................................... 31
Figure 11: Global trends of diagnostics service market ..................................................................... 56

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 1. INTRODUCTION
1.1. Background of the Study

Health is one of the basic rights for human beings. Therefore, according to the WHO framework
for health systems, a well-functioning health system ensures equitable access to and sound
scientific use of essential medical products, vaccines, and technologies of assured quality, safety,
efficacy, and cost-effectiveness. Supported by the health infrastructure, which is the fundamental
feature includes the availability of health facilities and medical equipment, roads for
transportation, access to water, electric, and network/ telecommunication supplies, and
computers for medical recording.
Medical technologies are an important component of medical care, provide significant benefits to
patients, advance the identification and treatment of disease, more comfortable treatment and
reduce pain, offer new treatment options for ill individuals existed, provides a safer for both
patients and providers. Medical technology includes all hospital equipment used for the
diagnosis, therapy, monitoring, rehabilitation, and care. Quality of diagnostic and treatment care
provided to patients largely depends on the availability of sophisticated medical equipment.

Ethiopia is one of the fastest growing countries in Africa, having more than 110 million people
(the second most populous in the region). It experiences the public health problems typical of an
underdeveloped country, such as communicable diseases (HIV, malaria, tuberculosis etc ),
maternal and child health problems (diarrhoea & dehydration, pneumonia, neonatal problems
etc) and malnutrition; these account for the majority of public health problems. But there is also
significant growth in non-communicable diseases (cardiovascular syndromes, cancers, mental
illness etc) and injury.

The Ministry of Health (MoH) and the regional health bureaus have implemented activities to
strengthen primary healthcare in Ethiopia. The MoH is developing a national primary healthcare
strategic framework. Today’s medical environment is highly dependent on various types of
medical equipment to complete the diagnosis and treatment for patients with care. Provision of
medical equipment plays a very significant role in the health care delivery system. Essential
medical products must be functional and available at all times at the appropriate level within the
health care system to predict, prevent, diagnose and cure many illnesses, and to alleviate

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 functioning problems using treatments and technologies. Therefore Development Bank of
Ethiopia recently took the initiative to provide financial access for advanced medical equipment.

This raw data & information document compiled by Applied Research Directorate of the bank
mainly focusing on the establishment Medical service of diagnostic and marketing of its service
rendering in the country.

1.2. Objectives of the Study

1.2.1. General Objective

The general objective of the study is to produce a document that will serve as a source of data
and information (reference) for appraisal of projects related to the sector and for making proper
decision in the process of delivering credit to prospective borrowers.

1.3. Methodology of the Study

1.3.1. Method of Data Collection

Both primary and secondary data used to conduct the study. The primary data collected from
government and private health care centers through interview, questionnaires and site visit.

On the other hand, secondary data obtained from reviewing of all relevant sources in the internet
websites, publication and reports of various governmental organizations.

1.4. Scope and Limitations of the Study

1.4.1. Scope of the study

The scope of the study mainly focused on the service provision of advanced medical diagnostic
facilities related with radiology, clinical laboratory, operation room and other general laboratory.

1.4.2. Limitation of the Study

The major limitation of this study is due to the complexity and its unmanageable nature of the
Medical diagnosis service, it was not possible to include conversion factors in the study. Besides,
to this due to the absence of biomedical expertise in the Bank, this study did not considered
technical part.

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 2. COMMODITY DESCRIPTION
2.1. Medical Imaging Machines

Medical imaging is the procedure used to create images of the human body (or parts and function
thereof) for clinical purposes, medical procedures seeking to reveal, diagnose, or examine
disease or medical science including the study of human anatomy and physiology. Medical
imaging technology and equipment offers an unprecedented aid to medical professionals to
diagnose and treat a number of diseases which were not possible before.

The range of MDI equipment products include:

2.1.1. X-Ray Systems

X-Ray technology is the oldest and most commonly used form of MDI equipment. X-Rays use
ionizing radiation to produce images of a person’s internal structure by sending X-Ray beams
through the body, which are absorbed in different amounts depending on the density of the
material. Also included in X-Ray devices are mammography, interventional radiology, and
computed radiography (CR) and digital radiography (DR);

2.1.2. CT Scanners

CT, is also known as a Computerized Axial Tomography (CAT) scanning. It is a medical

imaging method that combines multiple X-Ray projections taken from different angles to
produce detailed cross-sectional images of areas inside the body. CT images allow doctors to get
very precise, 3-D views of certain parts of the body, such as soft tissues, the pelvis, blood
vessels, the lungs, the brain, the heart, abdomen and bones. CT is often the preferred method of
diagnosing many cancers, such as liver, lung and pancreatic cancers. The pictures the CT scans
produce allow doctors to quickly make medical decisions if required. Because of this quality, CT
scans are commonly performed in both imaging centres and hospitals. They help physicians find
injuries and diseases that could previously only be found in a surgery or autopsy. While CT
scans use low doses of radiation, they’re still relatively non-invasive and safe.

These scans are useful in a variety of medical situations where diagnostic imagery is required.
They can assess slight abnormalities in soft tissue like the brain as well as other organs. Doctors
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also use the images when patients have certain symptoms like dizziness or pain. They’re even
useful in examining the spread of certain conditions, such as cancer.

A CT scan has many uses, but it’s particularly well-suited for diagnosing diseases and evaluating
injuries. The imaging technique can help the doctor to:

 diagnose infections, muscle disorders, and bone fractures

 pinpoint the location of masses and tumours’, including cancer

 study the blood vessels and other internal structures

 assess the extent of internal injuries and internal bleeding

 guide procedures, such as surgeries and biopsies

 monitor the effectiveness of treatments for certain medical conditions, including cancer
and heart disease

Depending on where the technologist directs the CT scan in your body, there are various uses for
it, including:

 Brain or head CT scans: Check for stroke, bleeds, masses and other abnormalities and
examine the skull
 Chest CT scans: Provide further insight into abnormalities after a standard chest x-ray
 Neck CT scans: Look for enlarged glands or lymph nodes and study lumps.
 Spine CT scans: Detect spine problems like spinal canal narrowing, a herniated disc or
fractures
 Sinus CT scans: Detect and diagnose obstructions or sinus disease
 Pelvic or abnormal CT scans: Check organs in this area and diagnose unexplained pain
in the abdomen.

2.1.3. Ultrasound

Also referred to as “sonography,” ultrasound imaging is a safe imaging method that creates
images of the inside of the body. It doesn’t use radiation, but rather high-frequency waves. As a

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result, it’s a safe procedure during pregnancy. The ultrasound images are in real-time and show
the structure and movement of internal organs and the blood flow through vessels. It uses sound
waves traveling through soft tissue and fluids, and as it hits denser surfaces, it echoes or bounces
back, which is how the images are created. More ultrasound echoes back when the object is
denser.

Doctors can diagnose a large variety of health conditions with an ultrasound. The images it
creates also help physicians come up with treatment plans. If you have symptoms such as
swelling, infection or pain, your doctor might suggest an ultrasound to determine the cause.
Ultrasounds are also used to assist anaesthesiologist during surgical procedures when they’re
guiding needles near nerves.

In a lot of cases, ultrasounds are tools that allow doctors to examine problems related to
abdominal issues, circulation, urology, obstetrics, new born care and even musculoskeletal
conditions. Some common body parts physicians use ultrasounds for include:

 Heart  Muscles
 Joints  Bladder
 Uterus  Kidneys
 Blood vessels  And more

2.1.3.1. Types of Ultrasound

 Endoscopic ultrasound.

 Doppler ultrasound.

 Colour Doppler.

 Duplex ultrasound.

 Triplex ultrasound (colour-flow imaging)

 Trans vaginal ultrasound

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 2.1.4. Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging is a medical imaging technique used in radiology to form pictures
of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic
fields, magnetic field gradients, and radio waves to generate images of the organs in the body.
An MRI (magnetic resonance imaging) scan is a test that creates clear images of the structures
inside your body using a large magnet, radio waves and a computer. Healthcare providers use
MRIs to evaluate, diagnose and monitor several different medical conditions. An MRI (magnetic
resonance imaging) scan is a painless test that produces very clear images of the organs and
structures inside your body. MRI uses a large magnet, radio waves and a computer to produce
these detailed images. It doesn’t use X- rays (radiation).Because MRI doesn’t use X-rays or other
radiation, it’s the imaging test of choice when people will need frequent imaging for diagnosis or
treatment monitoring, especially of their brain.

2.1.4.1. Uses of MRI

The development of the MRI scan represents a huge milestone for the medical world. The
following are examples in which an MRI scanner would be used:

 Anomalies of the brain and spinal cord

 Tumors, cysts and other anomalies in various parts of the body

 Breast cancer screening for women who face a high risk of breast cancer

 Injuries or abnormalities of the joints, such as the back and knee

 Certain types of heart problems

 Diseases of the liver and other abdominal organs

 The evaluation of pelvic pain in women, with causes including fibroids and
endometriosis

 Suspected uterine anomalies in women undergoing evaluation for infertility

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 2.1.4.2. Types of MRI machines

There are four types of MRI machines:

1. True open: The true open MRI design is open on all sides. It removes a lot of the
discomfort for individuals who get claustrophobic in a regular MRI machine.
2. Closed: This closed machine — or traditional tube machine — is one in which you lie
down and go inside for the images.
3. 3T: The “T” means Tesla and is a unit of measurement the technologist uses to quantify
the magnetic field strength. The 3T MRI is the most innovative and advanced test of all
the MRIs used today. It’s a closed design, like the traditional MRI. It takes less time to
perform the test using the 3T MRI, and the images are detailed and high-resolution,
enabling the radiologist to determine whether you have a benign or more severe medical
condition.
4. Wide bore: Sometimes called an “open MRI,” this machine resembles a closed MRI, but
with a wider opening.

An MRI exam generally takes about 30 to 60 minutes from beginning to end. The doctor might
include contrast, or fluid injected into your vein to make specific details clearer in the generated
images. This step can make the exam last longer.

2.1.5. An X-ray

X-rays is an imaging study that takes pictures of bones and soft tissues. X-rays use safe amounts
of radiation to create these pictures. The images help healthcare providers diagnose a wide range
of conditions and plan treatments. Usually, providers use X-rays to evaluate broken bones,
dislocated joints and other bone injuries.

An X-ray study (also called a radiograph) is a type of medical imaging (radiology) that creates
pictures of your bones and soft tissues, such as organs. X-rays use safe amounts of radiation to
make these pictures. The images help your provider to diagnose conditions and plan treatments.

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Most often, providers use X-rays to look for fractures (broken bones). But X-ray images can help
providers diagnose a wide range of injuries, disorders and diseases. X-rays are a safe and
effective way for providers to evaluate your health.

2.1.5.1. Types of X-ray studies

Several types of X-rays take pictures of different areas inside our body. Some X-rays use
contrast material (also known as dye) to make the images clearer. Some of the most common
types of X-rays include:

 Abdominal X-ray: This X-ray shows images of your kidneys, stomach, liver and
bladder. It helps providers diagnose conditions like kidney stones and bladder stones.
There are some special kinds of abdominal X-rays such as a barium enema that use
special dyes (called contrast) to evaluate parts of the digestive system.
 Bone X-ray: Your provider uses a bone X-ray study to see broken bones (fractures),
dislocated (joints and arthritis. Images from bone X-rays can also show signs of bone
cancer or infection. A spine X- ray looks at the bones and tissues in the spine.
 Chest X- ray: This test looks for abnormalities in the heart, lungs and bones in the chest
like pneumonia.
 Dental X-ray: Regular dental X-rays allow your provider to evaluate your teeth and
gums, look for infection and check for cavities.
 Fluoroscopy: A fluoroscopy shows moving images of organs and soft tissues (such as
your intestines). Your provider views your organs in motion on a screen (kind of like an
X-ray movie). GL X- ray exams often use fluoroscopy.

Among the Functions of X-ray some are mentioned bellow:

 To check for a broken bone (fractures).

 To identify the cause of symptoms, such as pain and swelling.
 To look for foreign objects in your body.
 To look for structural problems in your bones, joints or soft tissues.
 To Plan and evaluate treatments.
 To provide routine screenings for cancer and other diseases.
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 2.1.6. MRA Scans

MRA stands for magnetic resonance angiogram, a test that provides very detailed images of the
blood vessels in the body. MRA scans are a form of MRIs.

Using radio wave energy pulses and a magnetic field, the MRA provides information that CT
scans, ultrasounds or x-rays can’t always obtain. MRA tests are typically used on the legs, neck,
brain and kidneys to collect information about the condition of blood flow and blood vessel
walls. Doctors also use MRAs to look for calcium deposits, aneurysms and clots within the blood
vessels. In some cases, they may order a contrast dye to get a better definition in the scan’s
images of your blood vessels.

MRA scans offer definite benefits to both patients and doctors, who use the images for
diagnosing health problems. These benefits include the following:

 They do not use radiation, unlike CT scans and x-rays.

 They are non-invasive.
 In many cases, an MRA scan can detect information that x-rays, ultrasounds and CT
scans miss.
 MRA scans can detect issues with blood vessels that lead to reduced blood flow.

An MRA scan is a helpful diagnostic tool with the main purpose of finding issues that might
exist within the blood vessels. These scans are commonly used for:

 Detecting calcium deposits, aneurysms or clots in blood vessels

 Finding existing blood vessel narrowing
 Identifying abnormalities in the blood vessels of the brain, like congenital disabilities and
inflammation
 Defining blood supply to the brain’s vascular tumors
 Evaluating stroke patients
 And much more

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 2.1.7. Mammography

Mammograms are a type of x-ray image of the breasts. They check for early breast cancer signs
like small lumps you or your doctor can’t feel through the use of a low-dose x-ray.
Mammograms also show breast tissue changes that could be a sign of early-stage breast cancer.

A radiologist uses digital mammography to identify and diagnose cancer nodules that older
systems can’t detect. Mammograms are the best way to detect early breast cancer because — in
some cases as much as a few years before you can feel it. Having mammograms regularly comes
with various benefits, including the following:

 They detect breast cancer early on, which saves lives.

 They reduce your risk of dying because of breast cancer by 30 percent.
 Getting treatment early means you can keep your breasts and don’t have to resort to
mastectomy.

Mammograms, to some women, can be uncomfortable and sometimes even painful. A lot of this
feeling depends on how big your breasts are and the amount of pressure needed to be applied.
The discomfort will last only a few minutes, and the fact that this procedure can save your life
makes it worth it.

2.1.8. Bone Density Scans

A bone density scan is an indirect test that physicians use to determine whether or not you have
osteoporosis. The procedure is also referred to as “bone mineral density testing,” and it measures
the amount of bone material you have per square centimetre in your bones.

Osteoporosis is a condition that makes the bones fragile and susceptible to fractures. A bone
density scan uses x-ray equipment to measure the bone minerals and calcium packed into a small
bone segment. Typically, you’ll have this scan conducted on your hip, spine or forearm. Your
bones are denser if you have higher bone mineral content, meaning they’re less likely to break.
The bones are at risk of being fractured if they have a low bone mineral content, which can
indicate osteoporosis.

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Prior to using a bone density scan, the only way doctors could diagnose a patient with
osteoporosis was if they broke a bone. At this point, the bones would already be weakened by the
condition and in a poor state. Older women are more at risk for this disease, but anyone can
develop the condition, no matter their sex or age.

Your physician might suggest a bone density scan if you have the following risk factors:

 Fragile bones that are more susceptible to fractures

 Reduced height of a minimum of an inch and a half
 Lowered sex hormone levels
 The need for certain medicines that interfere with the rebuilding process of your bones,
like steroids
 The need for anti-rejection medication after a transplant

2.1.9. Arteriogram

When your joints are not functioning as they should be, it stops your movement ability and
makes daily tasks harder. An arteriogram is one of the various types of medical imaging used for
diagnosing joint problems that other types of imaging might not be able to detect. Also referred
to as “arthrography,” arteriograms consist of various images taken using x-ray, fluoroscopy, CT
scans or an MRI specifically of the joints.

The radiologist will inject your joint with a contrast dye such as iodine before your arthrogram.
They’ll use a fluoroscope to guide the injection placement into your joint. This dye will coat
your joint structure linings, making them look white on the images and highlighting any
problems so that the doctor can evaluate the function of the joint and come up with a diagnosis.

2.1.10. Myelogram

When the doctor needs specific imaging of the spinal canal, like the spinal tissue, spinal cord and
surrounding nerves, they’ll order a myelogram. A myelogram is an exam during which the
technologist injects contrast dye into the spinal cord space while using fluoroscopy to take
moving x-ray images. As this dye flows through the spaces, the doctor will examine the area for
any abnormalities, including tumors, infection and inflammation.
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A CT scan typically follows a myelogram procedure to help better define any possible issues.
Combined with CT technology, myelograms can give your doctor more detailed information
than they would get with x-rays alone.

2.2. Clinical Laboratory Equipment

Pharmaceutical and scientific research laboratories perform several chemical and biological tests
on a daily basis. In order to generate accurate and precise results, the labs require a wide range of
effective and sophisticated equipment. The complexity and range of equipment required by the
lab varies with the applications or tests they need to perform. Today, hundreds of manufacturers
of laboratory equipment exist in the market, that offers certified and robust lab instruments for a
variety of scientific applications. Under this study only the following clinical laboratory
equipment are considered:

2.2.1. Haematology Analyzer

Haematology analyzers are used to accurately quantify blood cells. It is a highly sophisticated
automatic computerized device that enables a technician to precisely count blood cells using the
technique of flow cytometry, light scatter phenomenon, use of fluorescent dyes, as well as
radiofrequency. The analyzer is very useful to diagnose and monitor blood cancers and bleeding
disorders.

The haematology analyzer is used for:

 White blood cell count

 Complete blood count
 Reticulocyte analysis
 Coagulation tests

The analyzer can be used to monitor diseases such as- leukemia, lymphoma, multiple myeloma,
as well as types of bleeding disorders such as blood clotting – measuring blood cells and blood
cell count can help diagnose these disorders properly as these disorders affect several properties
of the blood.

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Figure 1: Hematology analyser

2.2.1.1. Types of Haematology analyzer technology

The three main physical technologies used in haematology analyzers are electrical impedance,
flow cytometer, and fluorescent flow cytometer. These used in combination with chemical
reagents that lyse or alter blood cells to extend the measurable parameters. For example,
electrical impedance can differentiate red blood cells (RBCs), WBCs, and platelets by volume.
Adding a nucleating agent that shrinks lymphocytes more than other WBCs makes it possible to
differentiate lymphocytes by volume.
A. Electrical impedance
The traditional method for counting cells is electrical impedance, also known as the Coulter
Principle. It used in almost every haematology analyser. Whole blood passed between two
electrodes through an aperture so narrow that only one cell can pass through at a time. The
impedance changes as a cell passes through. The change in impedance is proportional to cell
volume, resulting in a cell count and measure of volume.

Impedance analysis returns CBCs and three-part WBC differentials (granulocytes, lymphocytes,
and monocytes) but cannot distinguish between the similarly sized granular leukocytes:
eosinophils, basophils, and neutrophils. Counting rates of up to 10,000 cells per second can be
achieved and a typical impedance analysis can be carried out in less than a minute.

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 B. Flow cytometer

Laser flow cytometer is more expensive than impedance analysis, due to the requirement for
expensive reagents, but returns detailed information about the morphology of blood cells. It is an
excellent method for determining five-part WBC differentials. A single-cell stream passes
through a laser beam. The absorbance is measured, and the scattered light is measured at
multiple angles to determine the cell’s granularity, diameter, and inner complexity. These are the
same cell morphology characteristics that can be determined manually from a slide.

C. Fluorescent flow cytometer

Adding fluorescent reagents extends the use of flow cytometer to measure specific cell
populations. Fluorescent dyes reveal the nucleus-plasma ratio of each stained cell. It is useful for
the analysis of platelets, nucleated RBCs, and reticulocytes.

Proprietary technologies: Manufacturers combine these three technologies with innovative uses
of reagents, hydro fluidics, and data analysis tools to produce proprietary methods, each of which
has strengths in terms of accuracy, speed, or breadth of parameters.
Time per analysis

Time per analysis depends on the parameters being measured. The rate limiting step is the
reaction time for reagents. A simple CBC can typically be returned in 1 min. More sophisticated
analyses can take up to 10 min.

2.2.1.2. 5-Part Differential Hematology Analyzer

A complete blood count (CBC) is typically the first test requested by a physician to evaluate a
patient’s general health. Automated hematology analysers frequently used in physician office
laboratories, small standalone labs and clinics for CBC screenings. Laboratories with low-
volume solutions typically rely on 3-part differential hematology analysers. However, older 3-
part differential technology maybe holding busy laboratories back and trends show there is
growing interest in 5-part differential haematology analysers.

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A 5-part differential hematology instrument uses the principle of flow cytometry to differentiate
white blood cells (WBC) into their five major sub-populations—neutrophils, lymphocytes,
monocytes, eosinophils, and basophils—based on cell size and complexity (granularity).
For specialty laboratories, a 5-part hematology instrument can provide a more detailed and
targeted assessment of the blood status. To distinguish eosinophils and basophils from
neutrophils, for example, a 5-part differentiation is necessary.
The most important aspect of automated hematology analyzers is the ability of the analyzer to
detect and flag for abnormal samples. Workflow efficiencies gained by significantly reducing
suspicious flagging and the number of manual differentials. The number of samples that require
manual examination greatly reduced with more detail information and improved accuracy
provided by a 5-part differential.

2.2.1.3. 3-part Differential Hematology Analyzers

A 3-part hematology instrument provides enough information for typical physician office
laboratories. With a simple CBC, the neutrophil and lymphocyte counts will answer the question
of a viral infection or a bacterial infection that treated with antibiotics.
About 30% of samples generate a suspicious flag with a 3-part analyzer requiring a manual
differential. The more detailed information provided by a 5-part differential analyzer can reduce
suspicious flagging by about 10%.

2.2.2. Coagulation Analyser

Blood-clotting function is crucial in numerous routine and emergency situations including

diagnostic and therapeutic management of hemostasis disorders, unexplained bleeding situations,
and the perioperative management. Coagulation is the process by which a blood clot is formed in
order to stop bleeding. It involves two main pathways, extrinsic and intrinsic pathways. The
extrinsic pathway initiated by tissue factor produced because of damaged blood vessels.
A blood coagulometer is an analyzer used to test the coagulation efficiency of blood to diagnose
and assess bleeding disorders such as haemophilia or to monitor patients who are taking
anticoagulant medicines such as aspirin, heparin, or warfarin. Coagulation analyzers provide
measurement of blood platelet levels in a fast and simple process.

15
Coagulation analyzer’s operation principle based on the clotting method using a monitoring ball
and magnetic transducers. The coagulometer consists of a recording unit and a unit of a
thermostatic switch and a ball dosing apparatus. The device may operate off-line or may connect
to a personal computer.

Figure 2: Coagulation machine

As completely, coagulation analyzers provide physicians with hemostasis (the process of
stopping bleeding) test results from patients. They used as point-of-care testing devices in
cardiothoracic surgical suites and cardiac catheterization laboratories. Clinicians use results from
coagulation analyzer tests to monitor the effectiveness of heparin therapy, an anticoagulation
therapy used during cardiopulmonary bypass surgery, angioplasty, hemodialysis, and other
clinical procedures.

2.2.2.1. Coagulation Products

While most coagulation analyzers are heading toward accuracy, ease of use, and timely results,
focus has shifted to better bioinformatics and integrated software across multiple platforms and
analyzers. “Informatics is an area of growing interest for clinical laboratories,” Hauser states.
“Customers are looking for IT solutions that will help them leverage data management, improve

16
process flow in their lab, and monitor instrument events, for example, error flags and service
events.” The idea behind the products is to yield enhanced diagnostic value for clinicians.
Generally, coagulation analyzers have come a long way from measuring the optical density of a
clot in a cuvette. Now, not only are there multiple factor analyses across runs that are
standardized, but improved and ever-precise software allows for facilities and hospital runs to be
standardized, easy to use, and quality controlled. Monitoring of perioperative patients using
coagulation analyzers is now significantly faster, easier, and more accurate.

2.2.2.2. Types of Coagulation Equipment

Coagulation equipment has two main areas of use, the medical industry and the wastewater
treatment industry. In the wastewater treatment industry, coagulation induced to remove
contaminants from water. This process carried out either by electrocoagulation or through
chemical means.
Electrocoagulation: uses electricity to induce coagulation. Electric charge dispersed through a
solution and reduces colloid charge which causing the particles to suspend in the water. Electro
coagulators are becoming more common due to decreasing energy costs and ever-present
wastewater treatment needs. They treat wastewater containing foodstuff, oil, dyes, pulp and
paper, mining and metal processing, mechanical polishing, and organic matter from landfill
leachates.
Chemical coagulation: uses aluminum sulphate or poly aluminum chloride to neutralize charges
in a solution and encourage flocculation (clumping or binding together of particles). Coagulants
added and stirred vigorously into the solution. The equipment that distributes and
mixes coagulants vary based on the type of application and scale of the system.
Factors affecting coagulation operations are temperature, sequence of chemical addition, and
residual aluminum. Temperature significantly affects coagulation operations, particularly for low
turbidity waters, by shifting the optimum ph. Sequence of chemical addition is traditionally is to
first add chemicals for pH correction, then add the metal coagulant, then add the flocculent aid.
However, there are instances when other sequences are more effective. The best sequence for a
particular application can determine by jar test experiments. Residual aluminum, if the aluminum
is in particulate form, indicates improvements to filter retention or whether it is soluble, which
would require improving the chemistry of coagulation, particularly the pH before filtration.
17
 2.2.3. Hormonal Analyser

Hormonal Assay test performed on a sample of blood to measure the level of Serum Cortisol,
TSH, FT3, FT4, LH, FSH, Prolactin, Estradiol and Testosterone in blood. It is performed to
confirm Hormonal Abnormalities and also during treatment and after treatment of Hormonal
Abnormalities.

Hormones analyzers help, measure growth purity, and control of the body's energy levels. These
hormones analyzers helps, measure growth purity, and whether one is maintaining a healthy
stock in the home or office for various medical diagnostic purposes. Hormones analyzers vary in
size, function, and environment.

The most common procedures currently used are immune- and immunometric assays but gas
chromatography mass spectrometry (GCMS) and high-performance liquid chromatography
(HPLC) have a place.

2.2.3.1. Type of hormone analyzer machine

According to its degree, hormonal analyser is classified into two types;

1. Fully automatic immunoassay analyser: Automated IA analysers can process multiple

samples at the same time, the total number of samples and on board determinations being
dependent on the particular analyser.

Figure 3: Snibe Maglumi 800 Fully Automatic Immunoassay analyser machine

2. Semi-automatic immunoassay analyser: Is faster, more precise, cheap, and compact as
compared to fully automated analysers and are capable to perform tests on whole blood,
serum, plasma, and cerebrospinal fluid and urine samples.
18
Figure 4: SD Biosensor Semi-Automatic Immunoassay Analyzer, Immunoassay machine

2.2.3.2. Types of hormone tests

Practitioners can test hormone level using blood, urine, or saliva samples. Each type of test has
advantages and disadvantages with regard to an individual’s health, the hormones to be tested,
the hormone treatments already underway, and other variables. In some cases, an individual
performance may also be a factor in choosing the best types of test. The most common hormone
test types are;

 Saliva: A saliva test is perhaps the most simple hormone test when it comes to sample
collection. After splitting into a tube multiple times over the course of one day or several
days, a laboratory can analyze individual or combined samples to determine individual or
average measurements of hormone levels. Samples can collect at home.
Saliva tests offer a good picture of free hormones that are actively available to the body
as opposed to the total amount of hormones in the bloodstream. However, some hormone

19
 concentrations are inherently higher or lower in saliva than in blood or urine, so there can
be limitations to this type of hormone testing. There are also additional variables to take
into account with saliva testing, such as pH levels in the mouth, the effects of teeth
brushing, food intake, and make-up use. In general, hormones for which saliva testing is
well suited include:
 estrogen  testosterone
 estriol  DHEA-S
 estradiol (dehydroepiandrosterone)
 estrone  Cortisol
 progesterone
Ultimately, saliva tests can play a vital role in diagnosis and are often the preferred method of
assessing the progress of hormone replacement therapy especially topical HRT treatment
options. Saliva testing can also ideal for measuring cortisol, as the anticipation of blood tests
themselves can cause a stress response in some people, temporarily inflating cortisol numbers. It
is also easy to produce saliva samples throughout the day to determine patterns of stress.

 Blood serum: The blood serum test for hormone levels is a typical blood draw taken in
the practitioner’s office or lab and used to determine the concentration of specific
hormones in the bloodstream. Unlike a blood spot test, which is stored as dried blood and
then rehydrated for analysis, a blood serum test analyses blood in its original form? As
such, it may have a shorter shelf life than blood spot samples but a slightly wider range
for hormone testing. To ensure efficacy, it may be required to fast for a period prior to the
blood draw.

Figure 5: Blood serum testing machine

20
Blood serum testing can used to assess a wide range of hormones and other analyses, including:
 Insulin
 thyroid hormones
 testosterone
 estrogen
 estradiol
 progesterone
 LH (luteinizing hormone)
 FSH (follicle-stimulating hormone)
 prolactin
 DHEA-S
 SHBG (sex hormone-binding globulin)
 PSA (prostate-specific antigen)
 cortisol

While highly versatile, blood serum tests may not be ideal for measuring hormone levels
influenced by HRT gels, creams, and other topical therapies. However, it can reliably use to
monitor hormone levels in those using HRT injections or pellet therapy.

2.2.4. Biochemistry Analyser

Biochemistry Analyzer is medical laboratory equipment used extensively in clinical laboratories.

It designed to conduct tests to measure chemicals at various stages of the biological processes on
a wide range of test samples from blood, plasma, serum, and cerebrospinal fluid to urine. In other
words, it helps to study, analyze, and evaluate the characteristics of different body samples and
tackle a broad spectrum of medical industry challenges.

The performance of biochemistry analyzers can be evaluated based on several criteria such as
operation method (automatic or semi-automatic), speed (number of samples analyzed by the
analyzer per hour), and random access mode (to allow random and continuous sample loading
and obtain results of different patients as quickly as possible). When choosing a biochemistry
analyzer it is important to check whether assay automation is needed, the accuracy level of

21
measurements, capacity (maximum number of samples that can be analyzed at a time), and speed
of testing.

2.2.4.1. Applications of Biochemistry Analyzer

A biochemistry analyzer commonly used in different medical settings and laboratories by

healthcare providers or medical practitioners to diagnose and treat various health concerns and
identify critical problems including health issues.

Biochemical analyzers used in hospital laboratories to perform various tests like albumin tests,
sugar level tests, or to detect levels of enzymes and creatinine in the blood. In clinics, some
types of biochemical analyzers used to determine the antigen-antibody interactions in the
biochemical reactions. There are high-precision biochemistry analyzers that used in the
pharmaceutical industry to diagnose fatal diseases. Therefore, it applied to various areas of life
sciences including cellular metabolism, protein synthesis, genetics, clinical laboratories, and
even pharmaceuticals.

2.2.4.2. Kind of Biological Specimens

 Blood

 Urine

 Cerebrospinal Fluid

 Amniotic Fluid

 Gastric Juice

 Gall stone

 Kidney Stone

 Stools/Feces

 Sputum & Saliva

 Synovial Fluid (joint fluid)

 Tissue

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  Specimen

2.2.5. Electrolyte analysers

Electrolyte analyzers used in medical laboratories to detect electrolytes in body fluids such as
blood, urine, and plasma. Electrolyte analyzers in medical laboratories are the best option for use
in hospitals, physician labs and other related medical facilities. They are easy to use and provide
fast sample analysis, which account for their popularity.

Electrolyte analyzers ensure fully automatic operation within a lesser counter space. You get
precise results within one minute. These are design with easy to use, microprocessor-based
technology to enhance operational characteristics. The unique feature seen in these electrolyte
analyzers are maintenance free electrodes. A cuvette holder for 18 positions and test panel are
other significant features seen in these models.

Some models of electrolyte analyzers come equipped with a thermal printer to hold permanent
data of each test along with test results, date, time, sample number and mode. Their features
include disposable electrodes and an interactive dialog program.

2.3. Operating Room Equipment

Operating rooms are designed for surgeons and surgical staff to perform surgical procedures that
require time, patience, focus, and safety. Various pieces of equipment are required for use in the
operating room.

2.3.1. Operating Tables (OR table)

Operating tables, also known as surgical tables, are essential to any operating room. A patient
lies on the operating table during a surgical procedure. The purpose of the table is to keep the
patient in place while the surgical team operates, and may aid in moving parts of the patient’s
body using surgical table accessories. General operating tables are designed to perform a wide
range of procedures while others are designed for specific procedures, for example orthopedic
tables.

23
Figure 6: OR Table

2.3.1.1. Classification of operating table

The following main types of operating tables are available :

A. Multi-function operating table

This type of table is multi-purpose used for many different specialized operations such as:
cardiac surgery, paediatrics, gallbladder, cosmetology. Extremely flexible design. The height can
be adjusted, the length can also be tilted to the side and tilted horizontally. The head section is
also removable and can be replaced with many other headrest accessories.

B. Orthopedic trauma operating table

This table model is used for orthopaedic surgery. This desk model is designed to be easy to
operate and has the necessary mobility. The doctor needs to control the accuracy and flexibility
in manoeuvring the patient’s position for the surgery to be successful.

C. Radioactive operating table

This type of operating table has a special feature that it allows X-rays to pass through. This type
of table is designed for invasive procedures requiring fluoroscopy. Some procedures include

24
endovascular, vascular, or pain management. This type of table is an ideal choice for operations
that require high quality and sharp images.

2.3.2. Electro surgical Unit

Electrosurgical units (ESUs) are among the most frequently used devices in surgeries since they
conduct electricity through a surgical tool to the patient’s body. By creating hemostasis during
surgery, ESUs enable the surgical team to make a surgical incision without causing bleeding and,
thus, have a better view of the area under operation.

Figure 7: Electrosurgical unit device

2.3.2.1. Types of electrosurgical instruments

Electrosurgical technology offers essentially two types of devices for energy delivery:
monopolar and bipolar.

The monopolar instrument: A surgical procedure in which only the active electrode is in the
surgical wound; electro surgery that directs current through the patient’s body and requires the
use of a patient return electrode.

The most common example, delivers current through an active electrode, which then travels
through the patient and back to the generator through a conductive adhesive grounding pad
applied to the patient before beginning the procedure.

Monopolar determine whether the patient has any metal implants, including cardiac pacemakers.
There is potential for injury if a patient return electrode placed on the skin over a metal
orthopedic implant.

25
Monopolar is the most commonly used electrosurgical modality. This is due to its versatility and
clinical effectiveness. In monopolar electro surgery, the active electrode is in the surgical site.
The patient return electrode is somewhere else on the patient’s body. The current passes through
the patient as it completes the circuit from the active electrode to the patient return electrode.

Electrosurgical delivery of energy using monopolar instruments enhanced by incorporating a

stream of argon gas to improve the surgical effectiveness in maintaining hemostasis over larger
surfaces

Bipolar instruments: It is electro surgery where current flows between two bipolar electrodes
that positioned around tissue to create a surgical effect (usually desiccation). Bipolar instrument
resemble surgical forceps, with both the active electrode and the return electrode functions
performed at the surgical site. The electrosurgical energy does not travel through the patient but
confined to the tissue between the forceps. Be- cause of this configuration, bipolar delivery of
energy clearly offers very little chance for unintended dispersal of current.

Bipolar electrosurgical instruments have evolved from used in the coagulation of tissue to the
creation of complete fusion of the intimal layers of vascular structures. With recent
improvements in computing technology integrated into electrosurgical generators, the use of
sophisticated closed-loop feedback control algorithms has created the ability to fuse vascular
structures up to 7 mm in diameter. Electrosurgical instruments are undoubtedly some of the most
useful and most-often used tools at the surgeon’s disposal.

2.3.3. Anaesthesia machine

Anaesthesia machines are specialized medical equipment used to administer an anaesthetic agent
to a patient during a surgical process. This gas, or anaesthetic agent, promotes inhibition of
skeletal muscle function. This equipment is a mixture of electrical, mechanical and pneumatic
components, and incorporates all the components needed to perform general anaesthesia,
including vaporizers, ventilators, a respiratory system, monitors and scanning systems.

26
This medical equipment provides safe, adequate, programmed and continuous or intermittent
administration of oxygen, medicinal gases and anaesthetic agents, and enables spontaneous or
controlled patient ventilation.

Anaesthesia machines receive medicinal gases and precisely distribute the flow and pressure of
each gas according to the patient’s needs; these adjustments are usually inserted manually. They
must be operated by highly qualified personnel trained in their use, who must also periodically
check their calibration and operation.

The machine performs four essential functions:

 Provides O2,
 Accurately mixes anaesthetic gases and vapours,
 Enables patient ventilation and
 Minimises anaesthesia related risks to patients and staff.

27
Figure 8: Anaesthesia machine

2.3.3.1. Types of anesthesia machine

When choosing an anaesthesia machine for your facility, you need to bear in mind that it offers
the possibility of monitoring the patient’s condition to ensure full functionality for anaesthetists
and other healthcare professionals involved in the surgical procedure. The most common models
include :

 Continuous flow: These are the most widely used. They designed to provide a precise
supply of medicinal gases (oxygen, nitrous oxide and air) mixed with a precise
concentration of anesthetic vapor, continuously and safely delivering this gas mixture to
the patient. They used for general anesthesia of patients during medical interventions in
operating theatres, delivery rooms, diagnostic rooms or ambulatory surgery.
 Intermittent flow: This type of anesthesia machine delivers a flow of gases on demand,
when activated by the patient’s own inspiration.

2.4. Other Diagnostic Equipment’s

2.4.1. Electrocardiogram (ECG)

An ECG is simply a representation of the electrical activity of the heart muscle as it changes with
time, usually printed on paper for easier analysis. Like other muscles, cardiac muscle contracts in
response to electrical depolarisation of the muscle cells. It is the sum of this electrical activity,
when amplified and recorded for just a few seconds that we know as an ECG. The devices are
indispensable for assessing heart rhythm, diagnosing poor blood flow to the heart and detecting
heart abnormalities such as chamber enlargement. They also recognize abnormal electrical
conduction and heart attack. Individuals with chronic heart problems may want to have an ECG
machine available at home.

A heart specialist (cardiologist) may request an ECG or any doctor who thinks you might have a
problem with your heart, including your GP.

An ECG can help detect:

28
  Arrhythmias –where the heart beats too slowly, too quickly, or irregularly
 Coronary heart disease –where the heart's blood supply is blocked or interrupted by a
build-up of fatty substances
 Heart attacks – where the supply of blood to the heart is suddenly blocked
 Cardiomyopathy –where the heart walls become thickened or enlarged

A series of ECGs can a be taken over time to monitor a person already diagnosed with a heart
condition or taking medication known to potentially affect the heart.

Figure 9: ECG machine

2.4.1.1. Types of ECG Machines

ECG machines vary in size, shape and functionality. Despite the differences, they all employ the
same working principles. They monitor patient heart function and help to detect and diagnose
abnormalities. Depending on your specific uses and application, they will vary in the type of data
they’re able to record, output and monitor.

A. Standard 12-Lead ECG machine

29
The 12 lead ECG machine is the standard machine utilized in many clinical settings today. It
provides 12 different views of the heart from varied angles. The number of different views helps
furnish doctors with the information they need to make accurate diagnoses when monitoring a
patient. Ten electrodes are positioned on the chest, arms and legs to capture electrical impulse
information. Results are output via printer and/or LCD display.

B. 12-Lead ECG machine with spirometry

Some ECG machines are equipped with or can be upgraded with spirometry instrumentation.
Spirometry is a common medical test to evaluate how well the lungs work by measuring the
volume of air that is inhaled, exhaled and how quickly air is exhaled. Spirometry is used to
diagnose asthma, COPD, and other breathing disorders.

C. Stress ECG Machines

A stress test can be helpful in discovering heart disease. These stress tests, also known as
exercise tests, are performed while walking on a treadmill or pedaling a stationary bike. The
ECG, heart rate and blood pressure are tracked.

2.4.2. Endoscopy

Endoscopy is a medical procedure that allows a doctor to inspect and observe the inside of the
body without performing major surgery. An endoscope is a long, usually flexible tube with a lens
at one end and a video camera at the other. Usually, an endoscope is inserted through one of the
body’s natural openings, such as the mouth, urethra or anus.

30
Figure 10: Endoscopy machine

2.4.2.1. Types of Endoscopies

There are several types of endoscopies that are used for different medical purposes. Here is a
brief overview of the different types of endoscopies and their uses:

A. Colonoscopy: This procedure used to diagnose and treat medical conditions affecting the
colon or also known as the large intestine. A specialist inserts a long tube, which contains
a camera, into the anus to look inside the large intestine. This procedure can help to
identify and diagnose conditions such as cancer, polyps, and other abnormalities.
B. Upper gastrointestinal (GI) endoscopy/gastroscopy: This endoscopy used to examine
the upper GI tract meaning the oesophagus, stomach and duodenum. It often used to
diagnose and treat conditions such as ulcers and inflammation. The upper GI tract
approached via the mouth.
C. Cystoscopy: This endoscopy used to diagnose and treat medical conditions that affect the
bladder and urethra. A thin, flexible tube with a camera inserted through the urethra and
into the bladder to diagnose and treat conditions such as bladder cancer, infections, and
kidney stones.
D. Laparoscopy: This endoscopy used to diagnose and treat medical conditions that affect
the abdominal organs, such as the liver, gallbladder, and appendix. A small, usually rigid

31
 tube with a camera inserted through small incisions in the abdomen. Laparoscopy can
also use to identify and diagnose endometriosis and other conditions.
E. Bronchoscopy: This procedure used to diagnose and treat conditions that affect the
lungs, such as pneumonia, asthma, and cancer. A thin, flexible tube with a camera
inserted through the nose or mouth and into the lungs.

32
 3. REAGENTS AND CONSUMABLE MATERIALS OF MEDICAL
EQUIPMENTS
3.1. Reagents

Reagents are chemical substances of diverse nature and composition that help the bio analyst or
clinical professional to carry out a series of reactions, involved with the determination of a great
variety of clinical tests. The reagents can be solid, liquid or gaseous according to their physical
state, and according to their chemical nature they can be acids, bases, salts, alcohols, aldehydes,
among others. All areas of a clinical laboratory require the use of various reagents, which differ
from one another. Reagents and stains can be prepared or purchased from the market based on
their feasibility. Reagents and stains are stored at room temperature in clean containers with
leak-proof, airtight screw caps and stoppers.

3.2. Consumables

Laboratory consumables are defined as equipment used in the lab that does not have a limited
use capacity. The equipment typically is limited in its number of uses before it is disposed of.
Use may be single, as is the case for pipette tips, gloves, and filter paper, or multiple-use, for
example syringes, cuvettes, and plates. Examples of laboratory consumables include pipettes,
falcon tubes, syringes, beakers, funnels, filter paper, pipette tips, test tubes, plates, cuvettes, etc.

3.3. Source of reagents and consumable materials

According to data obtained from field survey the reagents and consumables used in the
delivering diagnostic service are imported from abroad.

3.4. Supply and Demands of reagents and consumable materials

The reagents and consumable materials are available in international markets if the importer has
enough foreign currency. Hospitals, diagnostic centres and clinics which deliver clinical
laboratory service are the major demanders of those reagents and consumable materials.

3.5. Marketing arrangements of reagents and consumable materials

Among import based materials and inputs; Direct purchase from main sources or Purchase from
the brokers of foreign countries. In either of the two options, the purchaser passes several

33
procedures from opening of LC to post clearing up on the delivery of ordered goods. Cost of
transportation depends on the agreement between the buyer and seller.

3.6. Current price of Reagents and consumable materials

According to the field survey conducted by the study team, there are several brands of reagent that can
consumed in line with the chemistry machine.

NB: the name or brands of the reagent used during medical diagnostic services are different
types, those are the most common reagents distributed by Ethiopian Pharmaceutical Supply
Service. The reagents accordingly utilized in line with the band and type of specified chemistry
machine.

Table 1: Chemistry machines and reagent price

laboratory reagents list with price

Machine Type *
Item Name Unit Unit Price Currency
Cobas 6000 - 9% Sodium Chloride
50ml 5.74 $US
Solution

Cobas 6000 - Acid Wash Solution - 2x1800ml 66.42 $US

Cobas 6000 - Adrenocorticotropic

100tests 145.08 $US
Hormone (ACTH) -

Cobas 6000 - Adrenocorticotropic

4x1ml 43.15 $US
hormone (ACTH) Calibrator -

Cobas 6000 Cobas 6000 - Alanine Aminotransferase -

ALT (Serum Glutamic Pyruvic 500tests 65.87 $US
Transaminase - SGPT) -

Cobas 6000 - Albumin - 225tests 7.73 $US

Cobas 6000 - Alfa Feto Protein (AFP) - 100tests 71.52 $US

Cobas 6000 - Alfa Feto Protein (AFP) G2

4x1ml 41.01 $US
Calibrator -

Cobas 6000 - Alkaline Phosphatase (ALP) 400tests 19.51 $US

Cobas 6000 - Alpha Amylase - 300tests 60.86 $US

Cobas 6000 - Amylase-P - 200tests 242.10 $US

34
Cobas 6000 - Aspartate Aminotransferase -
AST (Serum Glutamic Oxaloacetic 500tests 65.87 $US
Transaminase - SGOT) -

Cobas 6000 - Assay Tip - 4032 864.43 $US

Cobas 6000 - Bilirubin Direct (BILD) - 350tests 22.21 $US

Cobas 6000 - Bilirubin Total (BILT) - 250tests 17.77 $US

Cobas 6000 - Blood Sugar - 200tests 21.16 $US

Cobas 6000 - Blood Urea Nitrogen - BUN
500tests 37.16 $US
(Urea) -

Cobas 6000 - C.f.a.s. PUC Calibrator - 5x1ml 88.03 $US

Cobas 6000 - Calcium - 300tests 14.27 $US

Cobas 6000 - Cancer Antigen 125 (CA-
100tests 204.26 $US
125) -
Cobas 6000 - Cancer Antigen 125 (CA-
4x1ml 32.01 $US
125) G2 Calibrator -
Cobas 6000 - Carcino Embryonic Antigen
100tests 261.48 $US
(CEA) -
Cobas 6000 - Carcino Embryonic Antigen
4x1ml 99.16 $US
(CEA) Calibrator -
Cobas 6000 - Cardiac G2 Control - 4x2ml 55.83 $US
Cobas 6000 - Cfas Calibrator - 12x3ml 126.13 $US
Cobas 6000 - Cfas HbA1c Calibrator - 3x2ml 111.02 $US

Cobas 6000 - Cfas Lipids Calibrator - 3x1ml 463.47 $US

Cobas 6000 - Chloride Cartridge - 100tests 35.74 $US
Cobas 6000 - Cholesterol - 400tests 35.93 $US
Cobas 6000 - Clean Cell - 2x2000ml 88.39 $US
Cobas 6000 - Clinical Chemistry Multi 1
20x5ml 215.75 $US
Control -
Cobas 6000 - Clinical Chemistry Multi 2
20x5ml 230.23 $US
Control -
Cobas 6000 - Cortisol Calibrator - 4x1ml 99.16 $US
Cobas 6000 - Cortisone - 100tests 237.36 $US
Cobas 6000 - Creatinine - 700tests 51.89 $US
Cobas 6000 - Creatinine Kinase CK - 200tests 32.43 $US
Cobas 6000 - Creatinine Kinase CK-MB - 100tests 86.09 $US

35
Cobas 6000 - Creatinine Kinase CK-MB
4x1ml 38.19 $US
Calibrator -
Cobas 6000 - Detergent 1NAOH - D - 2x1.8L 0.00 $US
Cobas 6000 - EcoTergent - 12x59ml 319.88 $US
Cobas 6000 - Estradiol (E2) - 100tests 73.18 $US
Cobas 6000 - Estradiol G3 Calibrator - 4x1ml 30.03 $US
Cobas 6000 - Ferritin - 100tests 69.02 $US
Cobas 6000 - Ferritin Calibrator - 4x1ml 22.27 $US
Cobas 6000 - Folate - 100tests 144.64 $US
Cobas 6000 - Folate G3 Calibrator - 4x1ml 52.16 $US
Cobas 6000 - Follicle Stimulating
100tests 169.83 $US
Hormone (FSH) -
Cobas 6000 - Follicle Stimulating
4x1ml 36.75 $US
Hormone (FSH) Calibrator -
Cobas 6000 - Gamma-Glutamyl
400tests 34.83 $US
Transferase (GGT) -
Cobas 6000 - Haemolyse Reagent
1000ml 87.14 $US
HBA1C-
Cobas 6000 - Halogen Lamp - Each 0.00 $US

Cobas 6000 - HBA1c Normal Control - 4x1ml 207.08 $US

Cobas 6000 - HBA1c Pathological Control 4x1ml 207.08 $US
Cobas 6000 - HbA1c TQ Haemolyzing
2x22.5ml 35.55 $US
Reagent -
Cobas 6000 - Hemoglobin A1c - 150tests 240.24 $US
Cobas 6000 - High Density Lipoprotein
Cholesterol Direct Colorimetric Test 200tests 75.63 $US
(HDL-C) -
Cobas 6000 - Human Chorionic
100tests 96.83 $US
Gonadotropin (HCG) -
Cobas 6000 - Human Chorionic
4x1ml 34.84 $US
Gonadotropin (HCG) Beta Calibrator -
Cobas 6000 - Internal Standard - Each 0.00 $US
Cobas 6000 - Iron - 200tests 27.09 $US
Cobas 6000 - Iron (Fe) Standard Calibrator
75ml 32.18 $US
-
Cobas 6000 - Iron Binding Capacity
100tests 25.11 $US
Unsaturated (TIBC) -
Cobas 6000 - ISE Cleaning Solution - 5x100ml 31.03 $US
Cobas 6000 - ISE Diluent - 5x300ml 0.00 $US
Cobas 6000 - ISE HIGH - 10x3ml 0.00 $US

36
Cobas 6000 - ISE INT STANDARED - 5x600ml 0.00 $US

Cobas 6000 - ISE LOW - 10x3ml 0.00 $US

Cobas 6000 - ISE Reference Electrode - 5x300ml 0.00 $US

Cobas 6000 - Lactate Dehydrogenase

300tests 29.98 $US
(LDH) -
Cobas 6000 - Lipase - 200tests 96.34 $US
Cobas 6000 - Low Density Lipoprotein
Cholesterol Direct Colorimetric Test 200tests 136.70 $US
(LDL-C) -

Cobas 6000 - Luteinizing Hormone (LH) - 100tests 169.83 $US

Cobas 6000 - Luteinizing Hormone (LH)

4x1ml 34.29 $US
G2 Calibrator -
Cobas 6000 - Magnesium - 250tests 58.21 $US

Cobas 6000 - Micro Sample Cup 13/16 - Pack 22.76 $US

Cobas 6000 - Multimarker Control - 6x2ml 78.45 $US

Cobas 6000 - PC/CC Cup - 12 36.84 $US

Cobas 6000 - Phosphate - 250tests 23.35 $US

Cobas 6000 - Potassium Cartridge - 100tests 35.74 $US

Cobas 6000 - PreClean - 5x600ml 52.02 $US

Cobas 6000 - Pro Cell - 2x2000ml 92.03 $US
Cobas 6000 - Probe ISE - Pack 590.23 $US
Cobas 6000 - Probe Sample - Pack 819.40 $US
Cobas 6000 - Probe Wash - 12x70ml 59.19 $US
Cobas 6000 - Progesterone - 100tests 97.06 $US
Cobas 6000 - Progesterone G3 Calibrator
4x1ml 51.40 $US
-
Cobas 6000 - Prolactin (PRL) - 100tests 79.12 $US

Cobas 6000 - Prolactin G2 Calibrator - 4x1ml 33.53 $US

Cobas 6000 - Prostate Specific Antigen,

100tests 127.10 $US
Free (PSA-F) -
Cobas 6000 - Prostate Specific Antigen,
100tests 109.50 $US
Total (PSA-T) -

Cobas 6000 - Prostatic Specific Antigen-

4x1ml 36.25 $US
Free (PSA-F) Calibrator -

37
Cobas 6000 - Prostatic Specific Antigen-
4x1ml 32.81 $US
Total (PSA-T) G2 Calibrator -

Cobas 6000 - PUC Normal Control - 4x3ml 86.26 $US

Cobas 6000 - PUC Pathological Control - 4x3ml 83.24 $US

Cobas 6000 - Reaction Cell set - 3 0.00 $US

Cobas 6000 - Reference Electrode - Each 0.00 $US

Cobas 6000 - Sample Cleaner 1 - 12x59ml 21.80 $US

Cobas 6000 - Sample Cup - 5000 71.04 $US

Cobas 6000 - Sipper Nozzle - Pack 336.77 $US
Cobas 6000 - Sipper Tube - Pack 9.67 $US
Cobas 6000 - SMS - Pack 12.47 $US

Cobas 6000 - Sodium Cartridge - 100tests 35.74 $US

Cobas 6000 - Sodium Hydroxide Solution

50ml 5.00 $US
NaOH-D -
Cobas 6000 - Testosterone - 100tests 81.04 $US

Cobas 6000 - Testosterone G2 Calibrator - 4x1ml 34.05 $US

Cobas 6000 - Thyroid Stimulating

200tests 272.03 $US
Hormone (TSH) -

Cobas 6000 - Thyroid Stimulating

4x3ml 27.27 $US
Hormone (TSH) Calibrator -

Cobas 6000 - Thyroxine (T4) - 200tests 271.89 $US

Cobas 6000 - Thyroxine (T4) G2
4x1ml 99.16 $US
Calibrator -

Cobas 6000 - Thyroxine, Free (T4-F) - 200tests 65.24 $US

Cobas 6000 - Thyroxine-Free (T4-F) G2

4x1ml 44.45 $US
Calibrator -
Cobas 6000 - TM Control - 4x3ml 172.84 $US
Cobas 6000 - Total Protein - 300tests 18.82 $US
Cobas 6000 - Total Protein (TP) Urine
150tests 29.60 $US
CSF -
Cobas 6000 - Triglycerides - 250tests 65.61 $US

Cobas 6000 - Triiodothyronine (T3) - 200tests 271.89 $US

38
 Cobas 6000 - Triiodothyronine (T3) G3
4x1ml 99.16 $US
Calibrator -
Cobas 6000 - Triiodothyronine, Free (T3-
200tests 117.15 $US
F) -
Cobas 6000 - Triiodothyronine-Free (T3-
4x1ml 48.61 $US
F) G3 Calibrator -
Cobas 6000 - Troponin - 100tests 138.34 $US

Cobas 6000 - Troponin Calibrator - 4x1ml 41.58 $US

Cobas 6000 - Troponin PC Control - 4x2ml 53.28 $US

Cobas 6000 - Universal Control - 4x3ml 91.63 $US

Cobas 6000 - Universal Diluent - 2x36ml 83.71 $US

Cobas 6000 - Uric Acid - 400tests 29.51 $US

Cobas 6000 - Varia Control - 4x3ml 70.83 $US
Cobas 6000 - Vitamin B12 - 100tests 135.48 $US

Cobas 6000 - Vitamin B12 G2 Calibrator - 4x1ml 58.09 $US

Cobas C 311 - 9% Sodium Chloride

50ml 5.75 $US
Solution -

Cobas C 311 - Acid Wash Solution - 2x1800ml 66.43 $US

Cobas C 311 - Activator - 9x12ml 0.00 $US

Cobas C 311 - Alanine Aminotransferase

ALT (Serum Glutamic Pyruvic 500tests 65.88 $US
Transaminase - SGPT) -

Cobas C 311 - Albumin - 225tests 7.74 $US

Cobas C 311 - Alkaline Phosphatase
Cobas c 311 200tests 17.69 $US
(ALP) -
Cobas C 311 - Alpha Amylase - 300tests 60.87 $US
Cobas C 311 - Amylase-P - 200tests 242.11 $US

Cobas C 311 - Aspartate Aminotransferase

AST (Serum Glutamic Oxaloacetic 500tests 65.88 $US
Transaminase- SGOT) -

Cobas C 311 - Bilirubin Direct (BILD) - 350tests 22.22 $US

Cobas C 311 - Bilirubin Total (BILT) - 250tests 17.78 $US

39
Cobas C 311 - Blood sugar - 800tests 119.36 $US
Cobas C 311 - Blood Urea Nitrogen-BUN
500tests 37.17 $US
(Urea) -

Cobas C 311 - C.f.a.s. PUC Calibrator - 5x1ml 88.04 $US

Cobas C 311 - Calcium - 300tests 14.28 $US

Cobas C 311 - Cell Set - Each 970.18 $US

Cobas C 311 - Cell Wash Solution - 2x1800ml 37.41 $US

Cobas C 311 - Cfas Calibrator - 12x3ml 126.14 $US

Cobas C 311 - Chloride Cartridge - 100tests 35.74 $US

Cobas C 311 - Cholesterol - 400tests 35.94 $US

Cobas C 311 - CK-MB Calibrator - 3x1ml 61.96 $US

Cobas C 311 - Clinical Chemistry Multi 1

20x5ml 215.76 $US
Control -
Cobas C 311 - Clinical Chemistry Multi 2
20x5ml 230.24 $US
Control -
Cobas C 311 - Creatinine - 700tests 51.90 $US

Cobas C 311 - Creatinine Kinase CK - 200tests 32.44 $US

Cobas C 311 - Creatinine Kinase CK-MB - 100tests 48.92 $US

Cobas C 311 - ECO Tergent - Each 20.30 $US

Cobas C 311 - Haemolyse Reagent HBA1c
1000ml 87.15 $US
-

Cobas C 311 - Halogen Lamp 12V/50W - Each 306.29 $US

Cobas C 311 - HBA1c Calibrator - 3x2ml 111.03 $US

Cobas C 311 - HBA1c Normal Control - 4x1ml 207.09 $US

Cobas C 311 - HBA1c Pathological

4x1ml 207.09 $US
Control -
Cobas C 311 - HBA1C TQ Haemolyzing
2x22.5ml 35.56 $US
Reagent -

Cobas C 311 - Hemoglobin A1c - 150tests 240.25 $US

40
Cobas C 311 - High Density Lipoprotein
Cholesterol Direct Colorimetric Test 350tests 143.05 $US
(HDL-C) -

Cobas C 311 - ISE Cleaning Solution - 5x100ml 0.00 $US

Cobas C 311 - ISE Diluent - 5x300ml 0.00 $US

Cobas C 311 - ISE HIGH - 10x3ml 0.00 $US

Cobas C 311 - ISE INT STANDARED - 5x600ml 0.00 $US

Cobas C 311 - ISE LOW - 10x3ml 0.00 $US

Cobas C 311 - ISE Reference Electrolyte - 5x300ml 0.00 $US

Cobas C 311 - Lactate Dehydrogenase

300tests 29.99 $US
(LDH) -
Cobas C 311 - Lipase - 200tests 96.35 $US
Cobas C 311 - Lipid Calibrator - 3x1ml 463.48 $US
Cobas C 311 - Low Density Lipoprotein
Cholesterol Direct Colorimetric Test 200tests 136.71 $US
(LDL-C) -
Cobas C 311 - Magnesium - 250tests 58.22 $US
Cobas C 311 - Phosphate - 250tests 23.36 $US

Cobas C 311 - Potassium Cartridge - 100tests 35.74 $US

Cobas C 311 - PUC Normal Control - 4x3ml 86.27 $US

Cobas C 311 - PUC Pathological Control - 4x3ml 83.25 $US

Cobas C 311 - Reference Electrode - Each 0.00 $US

Cobas C 311 - Sample Cup - 5000 71.05 $US

Cobas C 311 - Sipper Nozzle - Each 336.78 $US
Cobas C 311 - Sipper Tube - Each 9.68 $US
Cobas C 311 - SMS - Each 12.48 $US

Cobas C 311 - Sodium Cartridge - 100tests 35.74 $US

Cobas C 311 - Sodium Hydroxide Solution

50ml 5.01 $US
NaOH-D -
Cobas C 311 - Special Cell Cleaning
50ml 0.00 $US
Solution -
Cobas C 311 - Total Protein - 300tests 18.83 $US

41
 Cobas C 311 - Total Protein (TP) Urine
150tests 29.61 $US
CSF -
Cobas C 311 - Triglycerides - 250tests 65.62 $US
Cobas C 311 - Uric Acid - 400tests 29.52 $US

Cobas C311 - ISE insert internal standard - 20pcs 0.00 $US

Cobas C311 - Sample Cleaner - 12x59ml 0.00 $US

Dimension EXL 200 - Alanine

Aminotransferase -ALT (Serum Glutamic 240tests 68.00 $US
Pyruvic Transaminase - SGPT) -

Dimension EXL 200 - Alanine

Aminotransferase -ALT (Serum Glutamic 240tests 68.00 $US
Pyruvic Transaminase - SGPT) -

Dimension EXL 200 - Albumin - 480tests 57.40 $US

Dimension EXL 200 - Albumin - 480tests 57.40 $US
Dimension EXL 200 - Alkaline
360tests 81.00 $US
Phosphatase (ALP) -
Dimension EXL 200 - Alkaline
360tests 81.00 $US
Phosphatase (ALP) -
Dimension EXL 200 - Alkaline
6x1ml 57.00 $US
Phosphatase (ALP) Calibrator -
Dimension EXL Dimension EXL 200 - Alkaline
6x1ml 57.00 $US
200 Phosphatase (ALP) Calibrator -

Dimension EXL 200 - Alpha Amylase - 240tests 43.25 $US

Dimension EXL 200 - Alpha Amylase - 240tests 43.25 $US

Dimension EXL 200 - Aspartate

Aminotransferase -AST (Serum Glutamic 360tests 73.00 $US
Oxaloacetic Transaminase- SGOT) -

Dimension EXL 200 - Aspartate

Aminotransferase -AST (Serum Glutamic 360tests 73.00 $US
Oxaloacetic Transaminase- SGOT) -

Dimension EXL 200 - Bilirubin Direct

320tests 51.73 $US
(DBIL) -
Dimension EXL 200 - Bilirubin Direct
320tests 51.73 $US
(DBIL) -

42
Dimension EXL 200 - Bilirubin Total
480tests 43.95 $US
(TBI) -
Dimension EXL 200 - Bilirubin Total
480tests 43.95 $US
(TBI) -
Dimension EXL 200 - Blood Urea
480tests 87.00 $US
Nitrogen-BUN (Urea) -
Dimension EXL 200 - Blood Urea
480tests 87.00 $US
Nitrogen-BUN (Urea) -
Dimension EXL 200 - Calcium - 480tests 39.21 $US
Dimension EXL 200 - Calcium - 480tests 39.21 $US
Dimension EXL 200 - Cardiac Marker
6x3ml 95.00 $US
Plus Control L1 -
Dimension EXL 200 - Cardiac Marker
6x3ml 95.00 $US
Plus Control L2 -
Dimension EXL 200 - Cardiac Marker
6x3ml 95.00 $US
Plus Control L3 -

Dimension EXL 200 - Check Flex - 8 21.50 $US

Dimension EXL 200 - Check Flex - 8 21.50 $US

Dimension EXL 200 - Chemistry Assay

12x5ml 89.00 $US
Control L1 -
Dimension EXL 200 - Chemistry Assay
12x5ml 89.00 $US
Control L1 -
Dimension EXL 200 - Chemistry Assay
12x5ml 89.00 $US
Control L2 -
Dimension EXL 200 - Chemistry Assay
12x5ml 89.00 $US
Control L2 -

Dimension EXL 200 - Chemistry I 2x3levelsx

43.70 $US
Calibrator Revised - 2ml

Dimension EXL 200 - Chemistry I 2x3levelsx

43.70 $US
Calibrator Revised - 2ml

Dimension EXL 200 - Chemistry II

6x1.2ml 49.00 $US
Calibrator -
Dimension EXL 200 - Chemistry II
6x1.2ml 49.00 $US
Calibrator -

Dimension EXL 200 - Cholesterol Total - 480tests 67.26 $US

Dimension EXL 200 - Cholesterol Total - 480tests 67.26 $US

43
Dimension EXL 200 - Cholestrol
6x1ml 57.80 $US
Calibrator -
Dimension EXL 200 - Cholestrol
6x1ml 57.80 $US
Calibrator -
Dimension EXL 200 - CK/CK-MB
4x2ml 51.60 $US
Calibrator -
Dimension EXL 200 - CK/CK-MB
4x2ml 51.60 $US
Calibrator -

Dimension EXL 200 - Creatinine - 480tests 81.00 $US

Dimension EXL 200 - Creatinine - 480tests 81.00 $US

Dimension EXL 200 - Creatinine Kinase

480tests 67.84 $US
CK -
Dimension EXL 200 - Creatinine Kinase
480tests 67.84 $US
CK -

Dimension EXL 200 - Creatinine Kinase

120tests 71.00 $US
CK-MB - Flex -

Dimension EXL 200 - Creatinine Kinase

120tests 71.00 $US
CK-MB - Flex -

Dimension EXL 200 - Cup - Small - 1000 12.10 $US

Dimension EXL 200 - Cup - Small - 1000 12.10 $US

Dimension EXL 200 - Cuvette Cartridge - Each 101.00 $US

Dimension EXL 200 - Diabetes Control

6x0.5ml 123.00 $US
(L1,L2) -

Dimension EXL 200 – Dilution Check - 50ml 36.70 $US

Dimension EXL 200 – Dilution Check - 50ml 36.70 $US

Dimension EXL 200 - Enzyme Calibrator - 4x1.5ml 63.00 $US

Dimension EXL 200 - Enzyme Calibrator - 4x1.5ml 63.00 $US

Dimension EXL 200 - Enzyme II

6x1.5ml 60.10 $US
Calibrator -
Dimension EXL 200 - Enzyme II
6x1.5ml 60.10 $US
Calibrator -
44
Dimension EXL 200 - Enzyme Verifier - 6x2ml 59.50 $US

Dimension EXL 200 - Enzyme Verifier - 6x2ml 59.50 $US

Dimension EXL 200 – Flush Solution - 3x1000ml 66.40 $US

Dimension EXL 200 – Flush Solution - 3x1000ml 66.40 $US

Dimension EXL 200 - Glucose - 1440tests 223.85 $US

Dimension EXL 200 - Glucose - 1440tests 223.85 $US
Dimension EXL 200 - HDL Cholesterol
6x1ml 47.00 $US
Calibrator -
Dimension EXL 200 - HDL Cholesterol
6x1ml 47.00 $US
Calibrator -
Dimension EXL 200 - Hemoglobin A1c
120tests 330.00 $US
(HB1C) -
Dimension EXL 200 - Hemoglobin A1c
120tests 330.00 $US
(HB1C) -

Dimension EXL 200 - High Density

240tests 101.00 $US
Lipoprotein (HDL) Cholesterol -

Dimension EXL 200 - High Density

240tests 101.00 $US
Lipoprotein (HDL) Cholesterol -

Dimension EXL 200 - Lactate

480tests 53.65 $US
Dehydrogenase (LDH) -
Dimension EXL 200 - Lactate
480tests 53.65 $US
Dehydrogenase (LDH) -
Dimension EXL 200 - LDL Cholesterol
6x2ml 67.27 $US
Calibrator -
Dimension EXL 200 - LDL Cholesterol
6x2ml 67.27 $US
Calibrator -
Dimension EXL 200 - Lipase - 120tests 51.00 $US
Dimension EXL 200 - Lipase - 120tests 51.00 $US

Dimension EXL 200 - Lipase Calibrator - 6x1ml 56.23 $US

Dimension EXL 200 - Lipase Calibrator - 6x1ml 56.23 $US

Dimension EXL 200 - Low Density

120tests 79.56 $US
Lipoprotein (LDL) Cholesterol -

45
Dimension EXL 200 - Low Density
120tests 79.56 $US
Lipoprotein (LDL) Cholesterol -

Dimension EXL 200 - Magnesium - 120tests 29.41 $US

Dimension EXL 200 - Magnesium - 120tests 29.41 $US

Dimension EXL 200 - Phosphate - 480tests 41.00 $US

Dimension EXL 200 - Phosphate - 480tests 41.00 $US

Dimension EXL 200 - Salt Bridge Solution

3x150ml 33.20 $US
-
Dimension EXL 200 - Salt Bridge Solution
3x150ml 33.20 $US
-

Dimension EXL 200 – Sample Dilution - 6x500ml 55.20 $US

Dimension EXL 200 – Sample Dilution - 6x500ml 55.20 $US

Dimension EXL 200 -

4000tests 329.00 $US
Sodium/Potassium/Chloride -
Dimension EXL 200 -
4000tests 329.00 $US
Sodium/Potassium/Chloride -

Dimension EXL 200 – Standard A IND - 3x1000ml 57.80 $US

Dimension EXL 200 – Standard A IND - 3x1000ml 57.80 $US

Dimension EXL 200 – Standard B IND - 3x300ml 57.70 $US

Dimension EXL 200 – Standard B IND - 3x300ml 57.70 $US

Dimension EXL 200 - Thermal Paper - 4Rolls 4.50 $US

Dimension EXL 200 - Total and Direct

4x1ml 53.25 $US
Bilirubin Calibrator -
Dimension EXL 200 - Total and Direct
4x1ml 53.25 $US
Bilirubin Calibrator -

Dimension EXL 200 - Total Protein - 480tests 59.00 $US

Dimension EXL 200 - Total Protein - 480tests 59.00 $US

46
 Dimension EXL 200 - Total Protein
80tests 53.00 $US
CSF/Urine -
Dimension EXL 200 - Total Protein
80tests 53.00 $US
CSF/Urine -
Dimension EXL 200 - Total Protein
10x4ml 53.40 $US
CSF/Urine Calibrator -
Dimension EXL 200 - Total Protein
10x4ml 53.40 $US
CSF/Urine Calibrator -
Dimension EXL 200 - Total
6x2ml 59.20 $US
Protein/Albumin Calibrator -
Dimension EXL 200 - Total
6x2ml 59.20 $US
Protein/Albumin Calibrator -

Dimension EXL 200 - Triglyceride - 480tests 89.00 $US

Dimension EXL 200 - Triglyceride - 480tests 89.00 $US

Dimension EXL 200 - Uric Acid - 480tests 57.00 $US

Dimension EXL 200 - Uric Acid - 480tests 57.00 $US

Dimension EXL 200 - Urine Control1 - 12x10ml 96.35 $US

Dimension EXL 200 - Urine Control1 - 12x10ml 96.35 $US

Dimension EXL 200 - Urine Control2 - 12x10ml 96.35 $US

Dimension EXL 200 - Urine Control2 - 12x10ml 96.35 $US

DXC 700 AU - CK MB control serum

9x2ml 0.00 $US
Level 1 -

DXC 700 AU - Multichem U Assayed

10x15ml 0.00 $US
Level 1 (TP/ urine/ CSF control) -

DXC 700 AU - Multichem U Assayed

10x15ml 0.00 $US
Level 2 (TP/ urine /CSF control) -
Unicel DxC 700
AU/Unicel DxI800
DxC 700 AU - Alanine Aminotransferase -
ALT (Serum Glutamic Pyruvic 4x980tests 59.77 $US
Transaminase - SGPT) -

4x1120test
DxC 700 AU - Albumin - 35.38 $US
s
DxC 700 AU - Alkaline Phosphatase 4x1450test
80.88 $US
(ALP) - s

47
DxC 700 AU - Alpha Amylase - 4x400tests 228.55 $US

DxC 700 AU - Aspartate Aminotransferase

4x1935test
- AST (Serum Glutamic Oxaloacetic 159.40 $US
s
Transaminase - SGOT) -

DxC 700 AU - Bilirubin Direct( BILD) - 4x780tests 130.10 $US

DxC 700 AU - Bilirubin Total (BILT) - 4x590tests 90.24 $US

DxC 700 AU - Blood Urea Nitrogen - 4x1280test

103.15 $US
BUN (Urea) - s

DxC 700 AU - Breast Monitor Cancer

6x4ml 70.76 $US
Antigen 15-3 Calibrator -

4x1313test
DxC 700 AU - Calcium - 51.57 $US
s
4x1830test
DxC 700 AU - Cholesterol Total - 92.59 $US
s
DXC 700 AU - CK MB control serum
9x2ml 0.00 $US
Level 2 -

DXC 700 AU - CK MB Mass calibrator - 6x2ml 70.76 $US

DxC 700 AU - Creatinine - 4x990tests 43.12 $US

DxC 700 AU - Creatinine Kinase CK - 4x230tests 215.66 $US

DxC 700 AU - Creatinine Kinase CK-MB

2x230tests 199.24 $US
-
DxC 700 AU - Gamma-Glutamyl
600tests 70.33 $US
Transferase (GGT) -
4x1600test
DxC 700 AU - Glucose - 98.45 $US
s
DxC 700 AU - HbA1C Control - 2x2ml 168.85 $US
DxC 700 AU - HDL Cholesterol
2x3ml 178.02 $US
Calibrator -
DxC 700 AU - HDL/LDL Cholesterol
6x5ml 297.34 $US
Control -
DxC 700 AU - Hemoglobin A1c - 2x250tests 1,332.77 $US
DxC 700 AU - High Density Lipoprotein
Cholesterol Direct Colorimetric Test 4x350tests 356.30 $US
(HDL-C) -
DxC 700 AU - Iron - 4x500tests 58.60 $US

48
DxC 700 AU - Iron Binding Capacity
4x200tests 217.82 $US
Unsaturated (UIBC) -

DxC 700 AU - ISE High Serum Standard - 4X100ml 164.75 $US

DxC 700 AU - ISE Low Serum Standard - 4X100ml 119.42 $US

DxC 700 AU - Lactate Dehydrogenase

4x640tests 96.11 $US
(LDH) -
DxC 700 AU - LDL Cholesterol Calibrator
2x1ml 238.84 $US
-
DxC 700 AU - Lipase - 4x70tests 450.02 $US
DxC 700 AU - Low Density Lipoprotein
Cholesterol Direct Colorimetric Test 4x350tests 623.53 $US
(LDL-C) -
DxC 700 AU - Magnesium - 4x250tests 38.70 $US
DxC 700 AU - Micro Total Protein
4x125tests 83.26 $US
(Urine/CSF) -
DxC 700 AU - Phosphate - 4x590tests 64.46 $US
DxC 700 AU - Serum1 Control - 20x5ml 371.52 $US
DxC 700 AU - Serum2 Control - 20x5ml 412.42 $US

DxC 700 AU - System Serum Calibrator - 20x5ml 383.69 $US

DxC 700 AU - Total Protein - 4x750tests 40.91 $US

DxC 700 AU - Triglycerides - 4x750tests 125.41 $US
DxC 700 AU - Uric Acid - 4x250tests 131.57 $US

DxC 700 AU/ Unicel DxI 800 - Citranox - 1gallon 90.73 $US

DxC 700 AU/ Unicel DxI 800 - Cl

Each 506.37 $US
Electrode -
DxC 700 AU/ Unicel DxI 800 - Cleaning
4x54ml 56.39 $US
Solution -
DxC 700 AU/ Unicel DxI 800 - Contrad
1L 89.80 $US
70 -
DxC 700 AU/ Unicel DxI 800 - Cuvette -
10 239.11 $US
5x6mm -
DxC 700 AU/ Unicel DxI 800 - Electrode
Each 962.10 $US
Reference -
DxC 700 AU/ Unicel DxI 800 -
1L 137.34 $US
Haemoglobin Denaturant -
DxC 700 AU/ Unicel DxI 800 - ISE
4x2L 90.24 $US
Buffer -

49
DxC 700 AU/ Unicel DxI 800 - ISE
6x500ml 99.25 $US
Cleaning Solution -
DxC 700 AU/ Unicel DxI 800 - ISE
2x25ml 122.73 $US
Internal Reference -
DxC 700 AU/ Unicel DxI 800 - ISE Mid
4x2L 90.24 $US
Standard -
DxC 700 AU/ Unicel DxI 800 - ISE Na/K
2x25ml 119.42 $US
Selectivity Check -
DxC 700 AU/ Unicel DxI 800 - ISE
4x1L 151.48 $US
Reference -
DxC 700 AU/ Unicel DxI 800 - K
Each 506.37 $US
Electrode -
DxC 700 AU/ Unicel DxI 800 - L-Shape
2 65.65 $US
Mixing Bar -

DxC 700 AU/ Unicel DxI 800 - Peristatic

2 25.79 $US
Tubing - Roller Pump -

DxC 700 AU/ Unicel DxI 800 -

Each 151.19 $US
Photometer Lamp - 20W -
DxC 700 AU/ Unicel DxI 800 - Sample
1000 62.64 $US
Cup - Hitachi -
DxC 700 AU/ Unicel DxI 800 - Spiral
2 157.06 $US
Mixing Bar -
DxC 700 AU/ Unicel DxI 800 - Substrate
4x130ml 86.07 $US
-
DxC 700 AU/ Unicel DxI 800 - System
6x4ml 91.66 $US
Check Solution -
DxC 700 AU/ Unicel DxI 800 - Wash
10L 87.00 $US
Buffer -
DxC 700 AU/ Unicel DxI 800 - Wash
6x2L 152.37 $US
Solution -
DxC 700 AU/ Unicel DxI 800 - Carbon
Each 27.76 $US
Powder Filter -
DxC 700 AU/ Unicel DxI 800 - Improved
Each 7.94 $US
GAC -
DxC 700 AU/ Unicel DxI 800 - LC 174
Each 227.15 $US
MEDPURE Cartridge -
DxC 700 AU/ Unicel DxI 800 - LC 177
Each 355.98 $US
Protek L1 -
DxC 700 AU/ Unicel DxI 800 - LC175
Each 1,127.15 $US
(Protek L1) -

50
 DxC 700 AU/ Unicel DxI 800 - Micron
Each 52.53 $US
Filter with Antibacterial -

DxC 700 AU/ Unicel DxI 800 - Na

Each 506.37 $US
Electrode -
DxC 700 AU/ Unicel DxI 800 - Reaction
10x1000 87.93 $US
Vessel -
DxC 700 AU/ Unicel DxI 800 - Sample
1000 88.87 $US
Cup - 2ml -
DxC 700 AU/ Unicel DxI 800 - Swabs -
100 92.59 $US
Polyster -
DxC 700 AU/ Unicel DxI 800 - Waste Bag
20 85.14 $US
-

Unicel DxI 800 - Technopath Multi Level - 12x5ml 801.87 $US

Source: Ethiopian Pharmaceutical Supply Service, August 2023

* Each of the above mentioned chemistry machines can handle bio chemistry analyser, hormonal
analyser, coagulation analyser and electrolyte analyser.

Table 2: List of medical chemistry reagent and their current price

Machine laboratory reagents list with price

type Item Name Unit Unit Price Currency
ADVIA 560 - 5 Part Diff Consumable - 1L 89.25 US $
ADVIA 560 - 5 Part Diff Consumable - 1L 89.25 US $
ADVIA 560 - 5 Part Diff Consumable - 1L 89.25 US $
ADVIA 560 - 5 Part Tri-Level (L, N, H)
6x3ml 209.77 US $
Control -
ADVIA 560 - 5 Part Tri-Level (L, N, H)
6x3ml 209.77 US $
Control -
ADVIA 560 - 5 Part Tri-Level (L, N, H)
6x3ml 209.77 US $
Control -
Haematology
ADVIA 560 - Calibrator - 2X3ML 88.23 US $
Analyser
ADVIA 560 - Calibrator - 2X3ML 88.23 US $
ADVIA 560 - Diluent - 20L 59.98 US $
ADVIA 560 - Diluent - 20L 59.98 US $
ADVIA 560 - Diluent - 20L 59.98 US $
ADVIA 560 - Hypoclean - 100ml 58.57 US $
ADVIA 560 - Hypoclean - 100ml 58.57 US $
ADVIA 560 - Hypoclean - 100ml 58.57 US $
ADVIA 560 - Lyse - 5L 556.63 US $

51
ADVIA 560 - Lyse - 5L 556.63 US $
ADVIA 560 - Lyse - 5L 556.63 US $
Micro CC-20 Plus - Calibrator - 1x2.5ml 0.00 US $
Micro CC-20 Plus - Cleaner - 1L 47.22 US $
Micro CC-20 Plus - Cleaner - 1L 47.22 US $
Micro CC-20 Plus - Cleaner - 1L 47.22 US $
Micro CC-20 Plus - Controls Tri-Level (L,
3x2.5ml 50.00 US $
N, H) and Calibrator -
Micro CC-20 Plus - Controls Tri-Level (L,
3x2.5ml 50.00 US $
N, H) and Calibrator -
Micro CC-20 Plus - Diluent - 20L 90.00 US $
Micro CC-20 Plus - Diluent - 20L 90.00 US $
Micro CC-20 Plus - Diluent - 20L 90.00 US $
Micro CC-20 Plus - Enzymatic Cleaner
50ml 41.00 US $
Concentrate -
Micro CC-20 Plus - Enzymatic Cleaner
50ml 41.00 US $
Concentrate -
Micro CC-20 Plus - Enzymatic Cleaner
50ml 41.00 US $
Concentrate -
Micro CC-20 Plus - Lyse - 1L 151.00 US $
Micro CC-20 Plus - Lyse - 1L 151.00 US $
Micro CC-20 Plus - Lyse - 1L 151.00 US $
Sysmex XN-550 - Cell Clean - 50ml 51.50 Euro
Sysmex XN-550 - Cell Clean - 50ml 51.50 Euro
Sysmex XN-550 - Cell Clean - 50ml 51.50 Euro
Sysmex XN-550 - Cell Clean - 50ml 51.50 Euro
Sysmex XN-550 - Cell Pack - 10L 34.50 Euro
Sysmex XN-550 - Cell Pack - 10L 34.50 Euro
Sysmex XN-550 - Cell Pack - 10L 34.50 Euro
Sysmex XN-550 - Check Level 1 - 3ml 29.79 Euro
Sysmex XN-550 - Check Level 1 - 3ml 29.79 Euro
Sysmex XN-550 - Check Level 1 - 3ml 29.79 Euro
Sysmex XN-550 - Check Level 2 - 3ml 29.79 Euro
Sysmex XN-550 - Check Level 2 - 3ml 29.79 Euro
Sysmex XN-550 - Check Level 2 - 3ml 29.79 Euro
Sysmex XN-550 - Check Level 3 - 3ml 29.79 Euro
Sysmex XN-550 - Check Level 3 - 3ml 29.79 Euro
Sysmex XN-550 - Check Level 3 - 3ml 29.79 Euro
Sysmex XN-550 - Fluoro cell WDF - 2x22ml 491.00 Euro
Sysmex XN-550 - Fluoro cell WDF - 2x22ml 491.00 Euro
Sysmex XN-550 - Fluoro cell WDF - 2x22ml 491.00 Euro

52
Sysmex XN-550 - Lyser cell WDF - 2 Liter 132.97 Euro
Sysmex XN-550 - Lyser cell WDF - 2 Liter 132.97 Euro
Sysmex XN-550 - Lyser cell WDF - 2 Liter 132.97 Euro
Sysmex XN-550 - Sulfolyser - 3x500ml 79.03 Euro
Sysmex XN-550 - Sulfolyser - 3x500ml 79.03 Euro
Sysmex XN-550 - Sulfolyser - 3x500ml 79.03 Euro
UniCel DxH 800 - Body Fluid Control - 12x3.3ml 518.53 US $
UniCel DxH 800 - Body Fluid Control - 12x3.3ml 518.53 US $
UniCel DxH 800 - Body Fluid Control - 12x3.3ml 518.53 US $
UniCel DxH 800 - Calibrator Kit - 3.3ml 89.11 US $
UniCel DxH 800 - Calibrator Kit - 3.3ml 89.11 US $
UniCel DxH 800 - Cell Control - 12x3.3ml 465.58 US $
UniCel DxH 800 - Cell Control - 12x3.3ml 465.58 US $
UniCel DxH 800 - Cell Control - 12x3.3ml 465.58 US $
UniCel DxH 800 - Cell Lyse - 5L 243.70 US $
UniCel DxH 800 - Cell Lyse - 5L 243.70 US $
UniCel DxH 800 - Cell Lyse - 5L 243.70 US $
UniCel DxH 800 - Cleaner - 5L 47.28 US $
UniCel DxH 800 - Cleaner - 5L 47.28 US $
UniCel DxH 800 - Cleaner - 5L 47.28 US $
UniCel DxH 800 - Diff Pack - 2.75L 89.11 US $
UniCel DxH 800 - Diff Pack - 2.75L 89.11 US $
UniCel DxH 800 - Diff Pack - 2.75L 89.11 US $
UniCel DxH 800 - Diluent - 10L 41.83 US $
UniCel DxH 800 - Diluent - 10L 41.83 US $
UniCel DxH 800 - Diluent - 10L 41.83 US $
UniCel DxH 800 - LATRON CP-X Control- 8x3ml 120.03 US $
UniCel DxH 800 - LATRON CP-X Control- 8x3ml 120.03 US $
UniCel DxH 800 - LATRON CP-X Control- 8x3ml 120.03 US $
UniCel DxH 800 - Retic Pack - 2.28L 98.21 US $
UniCel DxH 800 - Retic Pack - 2.28L 98.21 US $
UniCel DxH 800 - Retic Pack - 2.28L 98.21 US $
UniCel DxH 800 - Retic-X Cell Control - 12x3.3ml 425.57 US $
UniCel DxH 800 - Retic-X Cell Control - 12x3.3ml 425.57 US $
UniCel DxH 800 - Retic-X Cell Control - 12x3.3ml 425.57 US $
Unicel DxI 800 - Alfa Feto Protein (AFP) - 6x50tests 787.27 US $
Unicel DxI 800 - Beta Human Chorionic
2x50tests 152.59 US $
Gonadotropin (BHCG) -
Unicel DxI 800 - Breast Monitor Cancer
2x50tests 256.52 US $
Antigen 15-3 (CA-15-3) -

53
Unicel DxI 800 - Cancer Antigen 125 (CA-
2x50tests 197.92 US $
125) -
Unicel DxI 800 - Cancer Antigen 125 (CA-
6x4ml 152.59 US $
125) Calibrator -
Unicel DxI 800 - Carcino Embryonic
2x50tests 285.27 US $
Antigen (CEA) -
Unicel DxI 800 - Carcino Embryonic
6x2.5ml 80.72 US $
Antigen (CEA) Calibrator -
Unicel DxI 800 - Cortisol - 2x50tests 121.63 US $
Unicel DxI 800 - Cortisol Calibrator - 6x4ml 103.93 US $
Unicel DxI 800 - Estradiol (E2) - 2x50tests 157.01 US $
Unicel DxI 800 - Estradiol Calibrator - 6x4ml 110.57 US $
Unicel DxI 800 - Ferritin - 2x50tests 95.09 US $
Unicel DxI 800 - Ferritin Calibrator - 6x4ml 71.87 US $
Unicel DxI 800 - Folate Calibrator - 6x4ml 57.50 US $
Unicel DxI 800 - Follicle Stimulating
2x50tests 133.79 US $
Hormone (FSH) -
Unicel DxI 800 - Follicle Stimulating
6x4ml 86.25 US $
Hormone (FSH) Calibrator -
Unicel DxI 800 - Human Chorionic
6x4ml 57.50 US $
Gonadotropin (HCG) Calibrator -
Unicel DxI 800 - Luteinizing Hormone (LH)
2x50tests 142.63 US $
-
Unicel DxI 800 - Luteinizing Hormone (LH)
6x4ml 77.40 US $
Calibrator -
Unicel DxI 800 - Progesterone - 2x50tests 138.22 US $
Unicel DxI 800 - Progesterone Calibrator - 6x2.5ml 93.99 US $
Unicel DxI 800 - Prolactin (PRL) - 2x50tests 127.15 US $
Unicel DxI 800 - Prolactin Calibrator - 6x2.5ml 101.73 US $
Unicel DxI 800 - Prostate Specific Antigen,
2x2.5ml 86.25 US $
Free (PSA-F) Calibrator -
Unicel DxI 800 - Prostate Specific Antigen,
6x2.5ml 105.04 US $
Total (PSA-T) Calibrator -
Unicel DxI 800 - Prostate Specific Antigen-
2x50tests 316.23 US $
Free (PSA-F) -
Unicel DxI 800 - Prostate Specific Antigen-
2x50tests 256.52 US $
Total (PSA-T) -
Unicel DxI 800 - Serum and RBC Folate - 2x50tests 144.85 US $
Unicel DxI 800 - Testosterone Total - 2x50tests 169.17 US $
Unicel DxI 800 - Thyroid Stimulating
2x100 tests 193.66 US $
Hormone (TSH) -

54
 Unicel DxI 800 - Thyroid Stimulating
6x4ml 68.18 US $
Hormone (TSH) Calibrator -
Unicel DxI 800 - Thyroxine (T4) - 2x50tests 97.31 US $
Unicel DxI 800 - Thyroxine (T4) Calibrator- 6x4ml 85.14 US $
Unicel DxI 800 - Thyroxine-Free (FT4) - 2x50tests 97.31 US $
Unicel DxI 800 - Thyroxine-Free (FT4)
6x2.5ml 85.14 US $
Calibrator -
Unicel DxI 800 - Total Testosterone
6x2.5ml 87.35 US $
Calibrator -
Unicel DxI 800 - Triiodothyronine (T3) - 2x50tests 97.31 US $
Unicel DxI 800 - Triiodothyronine (T3)
6x4ml 85.14 US $
Calibrator -
Unicel DxI 800 - Triiodothyronine-Free
2x50tests 97.31 US $
(FT3) -
Unicel DxI 800 - Triiodothyronine-Free
6x2.5ml 85.14 US $
(FT3) Calibrator -
Unicel DxI 800 - Troponin Calibrator - 6x4ml 57.50 US $
Unicel DxI 800 - Troponin I - 2x50tests 238.84 US $
Unicel DxI 800 - Vitamin B12 - 2x50tests 152.59 US $
Unicel DxI 800 - Vitamin B12 Calibrator - 6x4ml 60.81 US $
Source: Ethiopian Pharmaceutical Supply Service, August 2023

Table 3: List of consumable material and their price

Ser.no Consumable material UOM Price

1 Omniscan 20ml 2000

2 hydroxyzine 1 dose 150

3 Syringe pcs 6.5

4 Normal saline 1000ml 240

5 Glove pack 540

6 Alcohol pcs 115

7 Omnipaque 20ml 2884

Source: Field Survey, August 2023

55
 4. MARKET STUDY
This market study deals with advanced medical diagnosis service in Ethiopia. The global
diagnostic testing market size was valued at USD 165.58 billion in 2021 and is projected to
surpass around USD 348.75 billion by 2030, registering a CAGR of 8.63% over the forecast
period of 2022 to 2030. The healthcare diagnostic market will continue to experience growth in
the market for medical diagnostics. The world's healthcare resources are under tremendous strain
because of the growing burden of chronic diseases and an ageing population. Additionally, the
sector is dealing with increasing demands from a variety of stakeholders, including doctors
looking for tools to aid in decision-making, hospitals looking for quicker, more precise solutions,
labs looking for ways to make the most of their current resources, and health systems changing
their delivery models to lower healthcare costs.

Figure 11: Global trends of diagnostics service market

4.1. Market Segmentation

4.1.1. Market Segment by Destination
The market for medical advanced diagnosis service is segmented based on destination of the
service. The medical equipment service of Radiology, clinical laboratory and other diagnostic
services are included in this market segment. Hence, the medical equipment services of this
commodity segmented in to domestic markets.

56
 4.2. Demand driving Factor of medical diagnosis

4.2.1. Use of Point of Care Diagnostic Products

The market is anticipated to be driven by the rising popularity of decentralised health systems.
Additionally, it is anticipated that the market would grow in the future due to the adoption of
new breakthroughs and technical improvements in the sector by major market players. In the
upcoming years, growth in the point of care diagnostics market is anticipated as a result of these
factors.

Globally, the ageing population is increasing the chance of developing a wide range of illnesses,
including diabetes, cancer, cardiovascular disease, obesity, and neurological problems. A UN
research estimates that 727 million people worldwide will be 65 years of age or older in 2020.
Additionally, it is anticipated that by 2050, there will be twice as many people aged 80 and older
than there are today, or more than 1.5 billion people. The forecasted increase in the worldwide
geriatric population over the course of the projected period is likely to have a significant
influence on the market.

4.2.2. Increased determination to address disease burden

Awareness, diagnosis and treatment of diseases are increasing for both communicable and non-
communicable diseases in Ethiopia. Ethiopia is affected by the burden of communicable
diseases; the country is among the highest burden countries for Malaria, HIV/AIDS and TB. In
addition, prevalence of non-communicable diseases, such as diabetes, cancer, and hypertension
has also increased.

4.2.3. Rising healthcare coverage

The Ethiopian government is increasing healthcare coverage to its large rural population, thus
promoting the need for increased access to medical diagnostics. Ethiopia has a Health Extension
Programme (HEP), which is a community based strategy to deliver health promotion and
awareness creation among the public. The overall primary health care service coverage has
reached 100% in 2015 and a social health insurance scheme has been introduced to the public
aiming to increase access to health services.

57
 4.2.4. Progressive growth of the Ethiopian population and economy

With a population size of > 100M, Ethiopia has the second-largest population in Africa. Ethiopia
is expected to become a middle income country by 2025 with an average economic growth of
10% per year resulting in an increase in the disposable income of the population; the increase in
disposable income will influence spending on medical diagnostics service.

4.3. Domestic Market demand of medical diagnosis in Ethiopia

The main motive of these services is to aid healthcare providers in identifying the disease and
selecting the right treatment option. The demand for diagnostic services market is growing due to
the rising technological developments in MRI modality and increasing the application of MRI in
the healthcare profession. In addition, increasing healthcare insurance for medical imaging
offerings expected to supplement the market expansion.

Diagnostic services, either through pathology in laboratories, or imaging like scanning,

ultrasound and radiology, play a vital role in spotting health problems and informing medical
interventions. In the world, for example, the average citizen has 14 tests per year performed by a
laboratory medicine specialist.

Early diagnosis can increase the chances of a positive outcome, helping to improve the lives of
patients and save costs of further treatment. Additionally, diagnostics also play a vital role in
patients’ ongoing care programs. As health systems worldwide move from treatment to
prevention, and from volume to value, diagnostic scan accelerate this shift. Yet, despite rising
demand in most of the world’s largest healthcare economies, many diagnostics companies face a
continuing struggle against commoditization. It seems that the increasing strain on health
budgets is causing public and private payers to seek regular price cuts, with diagnostics too often
viewed as a relatively easy source of additional savings.

Diagnostic services are a critical component of many healthcare industries across the globe.
These services defined as diagnostic examination that includes clinical services of pathology and
laboratory medicine, psychological testing, and radiology. They help to determine the nature and
cause of a disease, illness, or injury in less time with high quality. Some of examples of

58
diagnostic services are sonograms; nuclear medicine scans, X-Ray, MRIs, and computed
tomography.

4.3.1. Non communicable disease and Injuries

In Ethiopia, the most common cancers among adults include breast cancer (30.2%) and cervical
cancer (13.4%). About two-thirds of reported annual cancer deaths occur among women. The
main reasons for high cancer mortality include low awareness of cancer signs and symptoms,
inadequate screening and early detection and treatment services, and inadequate diagnostic and
treatment facilities. In 2015, about 16% of the population is hypertensive, with higher prevalence
among urban (22%) than those rural dwellers (13%). In addition, the prevalence of rheumatic
heart disease was 17 per 1000 children and young adults aged 4-24 years. Diabetes, asthma,
chronic kidney disease, and eye diseases are among the major NCDs affecting Ethiopians (NCDI
Commission, 2018) .Despite the increasing burden of NCDs, available health services are very
limited. The 2018 SARA assessment revealed that only 36%, 49%, 53% and 9% of health
facilities, excluding health posts, offered diagnosis and treatment for diabetes, cardiovascular
diseases, chronic respiratory diseases, and cervical cancer, respectively. Overall readiness score
for these services is very low, ranging from 18% for chronic respiratory disease
diagnosis/management to 51% for cervical cancer diagnosis.

In addition to this the data collected from MoH, average number of outpatient visits (including
new and repeat visits) per person per year in Ethiopia is increasing time to time across the
regions.

Table 4: Distribution of Outpatient (OPD) attendance per capita by region

Regions 2009 2010 2011 2012 2013 2014

Tigray 9,564,568 10,357,346 9,923,260 11,406,878 _ _
Afar 636,473 338,169 686,327 705,057 696,386 650,615
Amhara 22,471,474 25,350,083 25,599,605 29,293,295 33,592,659 32,028,312
Oromia 17,257,361 11,100,643 23,153,123 29,390,929 36,339,624 47,177,388
Somali 1,356,923 1,023,601 1,245,113 1,550,692 1,588,682 1,886,810
B/Gumuz 815,747 608,998 823,993 970,084 1,654,103 867,623
SNNPR 12,020,274 7,737,161 19,270,477 20,551,606 19,365,863 23,497,030
Sidama _ _ _ _ 4,245,569 5,209,046
South west _ _ _ _ _ _
59
Gambela 290,667 246,632 418,902 323,676 199,468 272,803
Harreri 321,817 318,596 295,815 303,204 383,444 505,856
Dire Dawa 5,723,216 3,223,211 864,422 729,560 635,620 819,598
Addis
606,640 421,362 6,155,956 7,114,111 6,749,292 9,791,352
Ababa
National 71,065,160 60,725,802 88,436,993 102,679,418 112,116,962 151,372,745

Source: MoH

4.4. Supply for Advanced medical service in Ethiopia

The Government of Ethiopia (GOE) is working to strengthen the healthcare system to align it
with the Sustainable Development Goals. The government has made significant investments in
the public health sector that have led to improvements in health outcomes. Nevertheless,
communicable diseases like HIV/AIDS, TB, malaria, hepatitis B&C, respiratory infection,
leprosy, and diarrhea remain a serious challenge in Ethiopia. Premature death, suboptimal quality
of life, and nutritional diseases constitute a major health challenge. With a growing middle class,
the GOE is facing an increase in non-infectious diseases such as cancer, diabetes, heart diseases,
and high blood pressure. Mental health and eye problems are also becoming major issues in
Ethiopia.

Medical diagnostic services are available to hospitals, clinics, and other healthcare facilities.
According to the standards of MoH, health centers facility and equipment are required to be
fulfilled based on the level of each health facilities. The following data show the distribution of
health centers across different regions of Ethiopia.

60
Table 5: Distribution of health facilities in Ethiopia across regions

Health Facilities
Region
Hospitals Health Centres Clinics Total
Addis Ababa 552 1,200 12,996 14,748
Afar 120 1,176 672 1,968
Amhara 1,188 10,476 14,676 26,340
Benishangul Gumuz 72 792 2,088 2,952
Dire Dawa 84 204 456 744
Gambella 60 348 2,148 2,556
Harari 48 108 204 360
Oromiya 1,488 17,112 45,708 64,308
SNNP 696 6,012 6,564 13,272
Sidama 312 1,620 588 2,520
Somali 204 2,652 156 3,012
South west Ethiopia 156 1,584 1,680 3,420
Tigray 516 2,712 2,472 5,700
Total 5,496 45,996 90,408 141,900
Source: Ministry of Health

61
Table 6: Regional Distribution of Medical Laboratory Equipment (between 2011-2015 E.C)*

Sr.No Count of Hematology machine Chemistry machine Grand

Facility Total
Name ADVIA Micro Sysmex Unicel Unicel DxH Cobas Cobas Dimension Unicel Analyzer
560 cc 550 DxH 800/Unicel c 311 6000 EXL 200 DxC 700
800 DxH Slide AU/Unicel
Maker DxI800

1 Tigray 15 14 3 1 27 1 61

2 Afar 2 2 5 9

3 Amhara 25 26 1 3 1 9 41 1 107

4 Oromia 14 20 22 3 1 31 1 18 110

5 Somali 3 4 5 12

6 B/Gumuz 1 3 4 5 1 14

7 SNNPR 3 7 1 10 21

8 Sidama 12 18 3 1 1 15 1 19 70

9 Gambela 1 1 1 3

10 Addis Ababa 8 9 15 8 3 37 1 7 1 89

11 Dire Dawa 6 8 2 13 29

Grand Total 81 109 57 21 7 142 4 102 2 525

Source: Ethiopia Pharmaceutical Supply Service

62
NB: Each of the above mentioned chemistry machines could handle biochemistry analyser, hormonal analyser, coagulation analyser and
electrolyte analyser

*This regional distribution only considered governmental health facilities that distributed with in the last five years.

Table 7: Regional Distribution of Medical Imaging Machine (2011-2015 E.C)

Count of Imaging Machine

Sr.No Facility Digital Electrosurgical Grand
Name Ultrasound CT Scan MRI Endoscopy ECG Mammography
x-ray unit Total

1 Tigray 6 1 - 2 9
- - - -
2 Afar _ 1 - - 1
- - - -
3 Amhara 6 1 8 - 11 26
- - -
4 Oromia 16 8 3 1 3 8 - 19 58
5 Somali - -
- - - - - - -
6 B/Gumuz 1 1 2
- - - - -
7 SNNPR 4 1 2 1 4 - 7 19
-
8 Gambela _ - -
- - - - - -
Addis
9 24 11 7 5 3 31 - 19 100
Ababa
10 Dire Dawa 6 5 2 5 - 2 20
- -
Grand Total 63 26 16 6 7 56 - 61 235

63
 5. PROBLEMS, CONSTRAINT, RISK, AND SUCCESS FACTOR
Problems, Constraints, and Risk factors are external factors that are outside the control of the
business owner, but significantly have impact on the business. Whereas, Success factors are
under the control of the business owner and should followed in order to make the business
successful:

Table 8: Problems, Constraints, Risks and Success Factors

Problems Constraints

 Market competition  Lack of highly skilled health professional

in the country
 Shortage of foreign currency to import
reagents  High capital investment requirement in
infrastructure and diagnostic equipment
 Power interruption
and supplies:
 Lack of well-organized maintenance service
for medical equipment

Risk Factors Success Factors(Internal)

 Technological obsolesce of medical  Expansion of health facility

equipment at various time
 Rise in the incidence of Non
Communicable Chronic diseases

 Strong governmental commitment

64
 6. PARAMETERS AND BASIC ASSUMPTIONS
This part of the study devoted on the assessment of the coefficients and parameters, which helps
on the determination of costs and revenue. The very important caution, which has to consider by
the users of this study, is that the parameters and prices determined are just indicatives, which
can help to understand where the real parameter lays.

6.1. Assumptions for both products

Working days per annum ….......365

Working hours per day …...24

6.2. Revenue
The prices of Medical diagnosis services are different for variety of reasons as discussed in the
market part of the study. They are different from institution to institution. Here we put service
charge across different medical diagnostics service as indicative for revenue.

6.2.1. Medical diagnosis Service charges

Table 9: Clinical Laboratory Equipment’s and its service charge per person as per the service
delivered

Name of the
Sr.No Service types Service charge Remark
equipment’s
WBC Count 160
Differential Count 180
Hemoglobin 150
Hematocrit 125
Hematology
1 ESR 150
Analyzer
Blood Morphology 230
Blood Group & Rh 140
CBC 225
CBC With Differential 250
PT 210
Coagulation
2 PTT 210
Analyzer
INR 210
FBS 85
Biochemistry
3 SGOT, AST 155
Analyzer
SGPT, ALT 155
65
 Alkaline Phosphates, ALP 155
Bilirubin, Total 155
Bilirubin, Direct 155
Urea / Bun 155
Creatinine 155
Uric Acid 165
Total Protein 155
Triglycerides 170
Cholesterol 155
HDL -C 215
LDL -C 170
LDH 180
Sodium (Na) 155
Electrolyte
4 Potassium (K) 155
Analyzer
Chloride (Cl) 155
T3, Total 450
T3, Free 460
T4, Total 450
T4, Free 460
Hormone
5 TSH 440
Analyzer
FSH 570
LH 570
Prolactin 650
PSA 900

66
Table 10: Medical imaging machine and their service charge

Name of the Service

Service types
equipment’s charge

BRAIN CT SCAN 1900

Neck CT Scan 2500
Brain and Neck CT Scan 3100
CHEST CT SCAN 2800
HIGH RESOLUTION CHEST CT SCAN 3100
Chest and Abdominal CT Scan 3700
ABDOMINAL CT SCAN 2800
Abdominal and Pelvic CT Scan 2800
Pelvic Organ CT Scan 2800
Cervical Spine 1900
Thoracic Spine 1900
LUMBAR SPINE 1900
Facial Bone CT Scan (InCKuding 2200
Temporal Bone and Middle Ear C 2500
CT-scan Para nasal Sinus CT Scan 2500
(Computerized Shoulder CT Scan 1900
tomography) CKavicular CT Scan 1900
Humeral CT Scan 1900
Forearm CT Scan 1900
HIP CT SCAN OR PELVIC BONE SCA 1900
Femoral CT Scan (InCKuding Hip 1900
Leg CT Scan (InCKuding Knee and 1900
HAND CT SCAN 1900
Foot CT Scan 1900
Brain and Neck Arteriography 3700
Brain and Neck Venography 3700
Chest Angiography (Pulmonary A 3700
Abdominal Arteriography (Renal 3700
Liver triphasic Angiography 3700
Abdominal Venography (Renal, S 3700
Abdominal Arteriography & Veno 4000

67
 Lower Extremity Arteriography 4000
Lower Extremity Venography 4000
Lower Extremity Arteriography 4300
Upper Extremity Arteriography 4000
Upper Extremity Venography 4000
Upper Extremity Arteriography 4300
CT Film 250
EXTRA CD 75
Subspecialty CT Scan Reading 350
CT Guided FNA(Procedure fee only) 4500 1700
CT Guided Biopsy(Procedure Fee Only) 5100 2300
Extra DVD for CT-SCAN 150
Barium Swallow 2750
Barium Meal (UGI Series ) 3150
Barium Meal with follow throug 3500
Barium enema 3600
Intravenous Urography(IVU) -wi 3500
HYSTEROSALPINGOGRAPHY(HSG)without contrast 3250
Cystourethrography 3250
Fistulography 3250
INTRAVENOUS UROGRAPHY(IVU)without contrast 3500
X-RAY FILM (IF NEEDED ) 300
Mammography Film single breast 300
Mammography Film Both breast 500
Digital X-ray
X-Ray Report (For External) 200
Mammography single breast 1000
Mammography Both breast 1500
Digital X-Ray Abdomenal (Plain 510
Digital X-Ray Ankle Joint AP & 575
Digital X-Ray CalCaneum 620
Digital X-Ray Cervical Spin PA 620
X-Ray Chest 510
DIGITAL X-RAY CHEST PA 510
Digital X-Ray Chest PA& LA 610
Digital X-Ray CKaviCKe 510
Digital X-Ray Coccyx AP & LA 610

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 Digital X-Ray Elbow Joint AP & 530
Digital X-Ray Femur AP &LA 610
Digital X-Ray Foot AP & LA 530
Digital X-Ray For Arm AP & LA 530
Digital X-Ray Hand AP & LA 530
Digital X-Ray Hip Joint AP & A 620
Digital X-Ray Hummers 530
Digital X-Ray Knee Joint AP & 560
Digital X-Ray Leg AP & LA 560
Digital X-Ray Lumbo Sacrlal Sp 620
X-Ray Mandabel PA & LA 610
X-Ray Maxilla Bone 460
X-Ray Nasl Bone 460
X-Ray Optic Foremen 460
Digital X-Ray Para Nasal Sinus 510
Digital X-Ray Pelvis 560
X-Ray Plain Film of abdomen, e 610
IVP X-RAY 3500
X-Ray Sacroilliac Joint 610
Digital X-Ray Sholder 560
X-Ray Scapula 510
Digital X-Ray Skull PA & LA 610
X-Ray Sterno CKaviCKes 510
Digital X-Ray Tempoho Mendibul 610
Digital X-Ray Thoracis Spin AP 615
X-Ray Toes 460
Digital X-Ray Wrist APL 560
X-Ray Zygomatic Bone 510
X-Ray Skull PA 510
X-Ray Skull Lateral 510
After hour X-ray Physician fee 100
Abdominal ULTRASOUND 610
Chest Ultrasound 610
Ultrasound Lingual Canal & Scrotal Ultrasound 610
Neck U/S 610
OBST U/S 610

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 Pelvic U/S 610
Submandibular U/S 610
Thigh Ultrasound 610
Trans Vaginal Ultrasound 610
Ultrasound Single Breast 610
Ultrasound Both Breast 1220
Testicular U/S 900
Ultrasound One Breast 610
Doppler Ultrasound - Breast 860
Doppler Ultrasound - Vein 860
Doppler Ultrasound - Artery 860
Doppler Ultrasound - Pediatric 860
Doppler Ultrasound - Carotid(B 1000
Doppler Ultrasound - Abdomen 860
Doppler Ultrasound - Corrotid 860
Doppler Ultrasound - Vein 860
Doppler Ultrasound - Lower Extremity 860
Doppler Ultrasound - Upper Extremity 860
After hour Ultrasound service 500
ULTRASOUND BOTH BREAST 1000
Abdomeno Pelvic Ultrasound 900
4D Ultrasound 860
Chest Ultrasound 860
MRI of the shoulder Joint 5000
MRI of the brain 4000
MRI of the breast 4500
MRI of the cervical spine 4000
MRI
MRI of the chest 4500
MRI of the wrist joint 5000
MRV of the brain 4000
MRV of the extremity 5000
Source: Field Survey, August 2023

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Table 11: OR Equipment and their service charge

Name of the Service

Service types
equipment’s charge
ECG 400
Pediatric ECG 550
ECG/ Fetal Anatomic Sonographic Study 1000
Electrocardiography Echo cardiograph 1000
Holtor monitoring test (24Hr) 1200
Treadmil test 1200
General Anesthesia with ASA I 7000
General Anesthesia charge for 15 Min. 650
Spinal anesthesia For first 1 hour 6500
Spinal anesthesia for every additional 15 min. 500
General Anesthesia For First 1 hour ER 9000
Spinal anesthesia For first 1hr ER 5375
Sedation and Anesthesia 4000
Patient with ASA CKass IV and 9500
Anesthesia
Patient with ASA II and age <1 8000
Patient with ASA III 9000
Neuro anesthesia I for the first 1hr 10000
Neuro anesthesia II for the first 1hr 13000
Neuro anesthesia for additional 15 min. 800
Anesthesia for Hepatectomy 13000
Anesthesia for Thoracotomy 15000
Epidural Anesthesia 8000
Less than 2 hours 2000
OR rooms and other
More than t hours 4000

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Table 12: Other diagnostic machines and their service charge

Name of the Service

Sr.No Service types Remark
equipment’s charge
UGI-ENDOSCOPY (rev.on Jan'23) 4,250
Sigmoidoscopy 4,250
1 Endoscopy
Colonoscopy 5,200
Endoscopy band ligation aid 8,200
ECG 400
Paediatric ECG 550
ECG/ Fetal Anatomic Sonographic Study 1000
2
Electrocardiography Echo cardiograph 1000
Holtor monitoring test (24Hr) 1200
Treadmil test 1200
Source: Survey from health facilities, August 2023

6.2.2. Medical equipment performance

Table 13: Clinical laboratory Machines performance

S.No Sample Haematology machine capacity of testing per Hr

1 advia 560 haematology 60
2 micro cc 100
3 sysmex 200
4 Beckman DXH 100
5 cobas c 311 300
6 dimension EXL 200 200
Sample chemistry Machines
1 cobas 6000 100
2 beckman dxi dxc 700 800
Source: Survey from health facilities, August 2023

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Table 14: Medical Imaging machine and their average diagnostic service performance per hour

Ser.no Type of Diagnostics Average capacity of testing per Hr

1 CT Scan 3

2 MRI 2

3 Ultrasound 3

4 X ray 3

5 Endoscopy 2

6 ECG/ Electrocardiography 2

Source: Survey from health facilities, August 2023

6.3. Investment Items required

A. Machine and equipment

Existing medical machine, equipment, and available technologies requirements excluded from
this study due to the absence of biomedical expertise.
B. Vehicle

Table 15: Table List of vehicles

Types of vehicles Purpose

Automobiles For CEO and MD-Specialists
Service vehicle For employees service
Stand by Ambulances For Ambulatory service
Remark: Quantity of vehicles required depends on the capacity of the diagnosis center

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 6.4. Operational Cost

Due to the complexity and its unmanageable nature of the Medical diagnosis service, only
reagent cost and consumable cost per test considered for medical laboratory under this study.

Table 16: Cost of reagent and consumable per test

consumable
Type of Clinical laboratory Reagents Cost per test Total cost
cost per test
Haemoglobin 26 11 37
Haematocrit 26 11 37
Blood Morphology 26 17 43
Blood Group & Rh 18 11 29
CBC 54 11 65
CBC With Differential 74 11 85
PT 18 28 46
PTT 21 28 48
FBS 12 16 28
RBS 12 16 28
SGOT, AST 19 16 34
SGPT, ALT 14 16 30
Alkaline Phosphates, ALP 16 16 32
Bilirubin 11 16 26
Bilirubin, Direct 22 16 37
Urea / Bun 13 16 28
Uric Acid 16 16 32
Total Protein 10 16 25
Triglycerides 19 16 35
Cholesterol 10 16 26
HDL -C 100 16 115
LDL -C 174 16 189
LDH 16 16 31
Sodium (Na) _ _
Potassium (K) _ _
Chloride (Cl) _ _
Phosphorous (PO4) 12 22 34
Magnesium (Mg) 16 16 32
T3, Total 350 15 365
T3, Free 345 15 360
T4, Total 350 15 365
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T4, Free 345 15 360
TSH 209 15 224
Prolactin 488 15 503
PSA 789 15 804
Reticulocyte Count 26 33 59
Testosterone 579 15 595
Progesterone 514 15 529
Troponin, Quantitative 680 22 702
Vitamin B 12 468 15 483
Vitamin D 669 15 684
T3, Free 345 15 360
T4, Free 345 15 360

Source: Survey from health facilities, August 2023

Table 177: Cost of Other consumables

Type of Consumables UoM Price Remark

Ultrasound Jel Oil Litter 1000-1200 Used for 600Patient
Thermal paper for X-Ray Result Roll 148 Used for 10-15Patient
Laboratory Cotton Gram 88 Used for 50Patient

6.5. Overhead expense

A. Utilities
 Electricity Cost/KWh: It will depend on the specification of the proposed medical
equipment machine requirement.
 Water Tariff Rate Water Tariff Rate: It will depend on the specification of the proposed
machine.
B. Travel and per diem …………………………………….2% of salary
C. stationary Expense……………………………………… 0.14 % of service charge
D. Telephone, fax and internet cost………………………….0.19% of service charge
E. Medical expense………………………………………….5% of wage and salary
F. Employee Uniform............................................................ the appraisal shall use submitted
Performa invoice

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 6.6. Insurance
Table 188: The major insurance categories

Description Types of Insurance

Buildings Earthquake and fire

Machinery, equipment’s and Fire and lightning

Furniture

Vehicles Accidents( life and property damage, and third party

insurance)

Life insurance Working hrs and work man composition for employee
and 24 hrs personal and work team for managers

 For Insurance Premium refer to the updated “Cross Cutting Project Supporting Data
2022”

6.7. Fuel and lubricants

 Fuel cost:
a) For Automobile: 13-15 Km per liter
b) For Service Vehicle : 0.013559 lit/seat/ km

c) The cost of oil and grease: 2% of fuel cost

d) For Truck:
Table 199: Truck Fuel consumption and cost

Distance Fuel Fuel Consumption AVERAG

Gross Vehicle E
Pay Load travelled in one Consumption per Km for each
Weight
liter per Km ton of load lit/km/ton

7.5 TON 3.124 Ton 5.840 km/lit 0.171 lit/km 0.055 lit/km/ton

12 TON 6.311 Ton 5.500 km/lit 0.182 lit/km 0.029 lit/km/ton 0.035

18 TON 10.198 Ton 4.540 km/lit 0.220 lit/km 0.022 lit/km/ton

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 6.8. Depreciation
Table 2020: Depreciation

Sr. No. Description Rate (Percentage of original value)

1. Building and Construction 5

2. Machineries and equipment 10

3. Furniture and fixture 10

4. Vehicles 20

5. Generator 10

6. Auxiliary machineries 20

6.9. Repair and maintenance

Table 211: Repair and maintenance
Sr. No. Item Percentage of Original Value

1. Building and construction 2

2. Office Furniture and fixture 5

3. Machinery and Equipment 5

4. Vehicle 5

5. Generator 5

6. Auxiliary machineries 5

6.10. Land Lease Cost

Refer to land lease agreement between the project and concerned office from where the land
would be availed.

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 6.11. Working Capital Determination
Table 222: Working capital Requirement
Description Period (months) Remark

Raw material and Import 4 Lead time for importation

inputs
Domestic/local 1

Salary and Wages 1

Fuel and Lubricant 1

Stationary and office supplies 1

Travel and Perdiem 1

Electric bill 1

Insurance 12

Work in progress -

Finished stock period -

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 REFERENCES

 Betezata Hospital
 Ethiopian Food and Drug Authority
 Ethiopian Pharmaceutical Supply Service
 Federal Ministry Of Health
 https://www.healthimages.com/what-is-diagnostic-imaging/
 https://www.precedenceresearch.com/diagnostic-testing-market
 International Trade Center
 Korean Hospital
 Nader N Massarweh, MD, Ned Cosgriff, MD, Douglas P Slakey, MD, MPH, FACS
 Principles of Electrosurgical Description note
 The official journal of the international society for laboratory hematology (ISLH)
 Wudase Diagnosis center

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