Unifix Care

With Unifix Care we are developing an automated distribution platform to offer affordable surgical instruments to hospitals in low- and middle-income countries.

Gerard van Smeden
TU Delft
Engineering and Policy Analysis

Over het initiatief / About the initiative

Unifix Care

In welke fase zit jouw initiatief? / In what stage is your initiative?


Heb je jouw initiatief al gevalideerd? / Did you validate your initiative?

We have established a partnership with Van Straten Medical and Pro-Motion medical, giving us access to plenty of supplies. We also have gathered a cluster of 7 Nigerian hospitals that are willing to participate in the pilot and pay for the instruments. We still have to validate our plans for efficient logistics.

Meer informatie over jouw initiatief / More info about your initiative

More than five billion people worldwide don’t have access to essential surgical care. These cases are mostly in Low- and Middle-Income Countries (LMIC), where 9 out of 10 people can’t access basic surgical care. To put the urgent need for surgical care in perspective; research conducted by the Lancet Commission on Global Surgery in 2015 showed that almost 17 million lives (32,9% of deaths worldwide) were lost each year due to insufficient surgical care. This is more than 4 times higher than death due to HIV/AIDS, tuberculosis, and malaria combined. Furthermore, 77.2 million disability-adjusted life-years (DALYs) could be avoided by having access to basic surgical care. The economic impact for the families affected is estimated at more than one trillion dollars per year. This is mainly related to a lack of skilled personnel, a shortage of proper medical equipment, and poor infrastructure. Because of the high costs of surgical equipment, most hospitals in LMIC lack the equipment to perform several basic surgical procedures. With the financial resources they have, the hospitals have to resort to buying low-quality, uncertified equipment. Local surgeons experience this equipment as unreliable and inconvenient, but high-quality surgical equipment is above their budget.


Meanwhile, medical waste is a global issue for all healthcare institutions. For example, US hospitals alone are already producing over 5,9 million tonnes of waste per year. The majority of this waste comes from the operating room, where used equipment, unused equipment, and packaging make up 20-30% of a hospital’s waste. Of the equipment that is disposed by Western hospitals, 20% is still of high quality, and 4-5% has even never been taken out of its original packaging. This waste is because hospitals regularly renew their inventory, change to a different brand, or a new version of their equipment. When this happens they clear out their old stock, which is still perfectly good to use and sometimes completely new. An average Dutch hospital even pays an estimated €200,000 – €300,000 for the disposal of its equipment per year.


Individual initiatives based within hospitals are trying to solve the lack of surgical equipment problem in LMIC by transferring the wasted equipment from western hospitals. These actions are taken by western surgeons or Operation Room (OR)-assistants who experience the waste firsthand. They build one-on-one relationships between their Dutch hospital and an LMIC-hospital. Unfortunately, these initiatives experience a mismatch between the supply and demand of equipment, high transport costs, and complex regulations to overcome. Because of a lack of scale and expertise, the majority of the Western equipment continues to end up in landfills and LMIC-hospitals still have to resort to low-quality surgical equipment from China to fulfill their demands.

With Unifix Care we are developing an automated distribution platform for affordable, high-quality surgical equipment in LMIC. We take care of the quality checks, sales, and transport of the equipment. The products offered on the platform will initially be second-life equipment from Western hospitals that we obtain through our partner Van Straten Medical. They have an existing system to collect surgical equipment (waste) from almost all the Dutch hospitals and recycle the raw materials. When the equipment arrives, it is first disinfected. Thereafter, the usable equipment will be separated and quality checks will be performed. We match the usable equipment with the demand of hospitals in LMIC, package the equipment, and arrange the logistics. 

Through this system, Western excess equipment will not be wasted but instead transported and sold to hospitals in LMIC at minimal costs. For hospitals in LMIC, the platform will provide a continuous supply of high-quality equipment at a comparable price, possibly even lower than what they currently buy their low-quality equipment for.

The platform will also create insights into the demand for surgical equipment in LMIC and show gaps between the supply of second-life equipment and the demand for affordable surgical equipment. These insights can be used for new product development or show opportunities for healthcare start-ups to enter the market. We currently have a partnership with the Surgery for All department at the TU Delft to start new development projects collaboratively.

In the future, the platform will also be a gateway for other healthcare start-ups to sell their equipment to hospitals in LMIC. These companies can also use the existing logistic system and value chain developed for the supply of second-life equipment. For this service, we can ask for a percentage of the equipment manufacturers’ revenue.

Furthermore, we will also develop local repair and recycle hubs in LMIC countries together with Van Straten Medical similar to their business in the Netherlands. Through these centers, we want to expand the economic life of our surgical equipment and recycle the equipment when it reaches the end of life. By melting the equipment when it reaches its end of life, we can obtain new resources to locally produce new surgical equipment for the demand that can not be met with second-life equipment. This way we do not only reduce the waste in the Western world but also avoid it will end up as waste in the LMIC. 

We are not sure what the best design of the platform will be, but as of now, it is expected that the platform will get the format of an online marketplace, which makes it easily accessible for all LMIC hospitals and very scalable. During pilot projects with a concierge service, the specific design requirements of the platform will be discovered and tested. 

In short:

  • 17 million people worldwide die because of poor access to surgical care.
  • One of the main causes is the shortage of proper equipment.
  • On the other hand, 20% of the equipment in hospitals going to the landfill is still of high quality, and 4-5% is even never used.
  • Current initiatives trying to solve these are not scalable, and rely on personal relationships and – motivations, but will never fill the existing gap.
  • With Unifix Care, we are developing a scalable platform that is providing high-quality equipment at low costs for LMIC-hospitals and reducing waste from Western hospitals.
  • Partially, this equipment consists of high-quality second-life equipment that is being wasted by Western hospitals, increasing the efficiency of existing second-life equipment programs organized within individual hospitals.
  • The created network of customers and the optimized logistic system will provide an efficient system for new healthcare innovations to enter LMIC-healthcare markets at low costs. 
  • The data obtained from handling these transactions will provide valuable insights to start new affordable healthcare innovations, specifically targeting the unmet demand.

Wat zijn jouw volgende stappen om het verder te ontwikkelen? / What are your next steps to develop the initiative?

Phase one – Pilots

In the first phase, we are running pilots in Nigeria, Kenya, and Libya. We will sell our products to different customers; government medical depots, local vendors, and directly to hospitals. We are currently running our first pilot in Nigeria with seven local hospitals and got the supply covered through Van Straten Medical.

During this pilot, we want to learn which equipment is mostly needed, which unforeseen logistic challenges will occur, learn more about the cost structure and learn what our preferred customer, transport route, and the export country will be.

Phase two – operational excellence in a single country

In phase two, we want to focus on a single country and work closely with a small set of customers. Our supply will mostly come from Van Straten Medical, but in this phase, we will already start testing our proposition with new healthcare equipment manufacturers. 

Our goal is to improve our logistic system, build relationships with key stakeholders and develop and test the first prototype of the platform.

Phase three – expansion

After the first iterations and solving our technical problems, we want to expand to more customers and possibly even to more countries. We want to sell our equipment to 1.800 hospitals (50% of total private and public hospitals in Nigeria) and sell equipment from 10 new equipment manufacturers

Phase four –  increasing our local presence / scaling local sustainability and upcycling

After successfully entering multiple national markets and optimizing our logistic system, we want to develop our local repair, recycling, and manufacturing centers. Together with Van Straten Medical and local universities we want to develop hubs where surgical equipment can be repaired and surgical waste can be recycled. The recycled equipment can then be used to manufacture new surgical equipment for unmet demand.

Wat heb je nodig om (nog meer) impact te maken met dit initiatief? / What do you need to make (more) impact with this initiative?

We are building partnerships with healthcare manufacturers, distributors, and hospitals to ensure. Every support we can get in this process would be very valuable to us.

Additionally, we are piloting the logistical process and learning the best and most efficient way to package, transport, and distribute the instruments. We already have obtained €12,5k in grants from the TU Delft to finance some of these pilots, but additional funding would be very valuable to us to enable more parallel pilots and therefore speed up our learning process.