Thousands of surgical instruments are used every day in operations throughout Sweden and the UK. A large proportion of simple surgical instruments, like scissors and forceps, that reach healthcare providers are manufactured in Sialkot, Pakistan. Swedwatch´s previous studies of the industry exposed hazardous working conditions and widespread use of child labour.In the report Healthier Procurement, Swedwatch and the British Medical Association (BMA) show that since social criteria have been imposed in public contracts of surgical instruments, significant improvements have been noticed on the workshop floors...Challenges remain in health and safety, with workers still operating machinery without personal protective equipment. A specific challenge emphasized by Pakistani manufacturers is the issue of pricing...The cost of improving labour standards needs to be considered both by importing companies and public procurers...