Imagine a large 300 bed hospital that only has 11 patient monitors in the whole facility.  Of these, only 6 function and there are four different monitor manufacturers.  This is exactly what we encountered on a recent trip to Haiti.  At yet another facility, we saw a large, new autoclave perfect for supporting several surgical suites that had been donated to the hospital. The clinical and administrative staff were thrilled to receive such a great gift.  That is until they realized that the volume of distilled water and electricity that were needed to keep the unit operational greatly exceeded the capacity of their facility to provide. 

As a result, the unit sat as a monument of sorts reminding everyone of the pitfalls of medical equipment donations.  These basic realities highlight some of main challenges organizations face when it comes to medical equipment procurement and management in the developing world. In fact, an average of 38.3% of medical equipment in developing countries is out of service. This number goes even higher when you only consider donated equipment. 

The three main causes of equipment downtime are lack of:

  • Training
  • Health technology management
  • Infrastructure to support (Perry, 2011)

The WHO estimates that 95% of medical equipment in LMICs is imported and 80% of it is funded by international donors or foreign governments.  Medical equipment donation can be an expensive undertaking with little proven impact on health outcomes and it is estimated that only 10%–30% of donated equipment becomes operational. + While “well intentioned” donations can keep initial investment costs down, these practices can lead to lack of standardization, inappropriate donations, and increased staff time costs in managing the inevitable medical equipment graveyard that follows poor donation practices. 

When procuring or donating medical equipment to LMIC there are many things to consider to ensure the equipment is utilized to its full potential.  First and foremost, there needs to be a meaningful, long term relationship between donor and recipient.  Ask questions.  Visit the facility.  Get a medical equipment inventory from the facility to understand the big picture.  Both donors and recipients need to ask questions to ensure the proper items are sent.  Think through the entire process.  Don’t just focus on how to get the equipment to the facility. 

Key Considerations for DonorsKey Questions
InstallationIs the facility ready for this equipment?  Do they have the infrastructure to support this equipment?  Electricity?  Internet? Who will install the equipment?
TrainingWho will train the clinical staff?  Who will train staff on maintenance and repair?  How will the facility find spare parts and get equipment repaired?
Ongoing operational costs for the facilityWhat will it cost the facility to keep this equipment operational?  What disposables does this equipment need?  How will we find these disposables?  What will the ongoing costs be to the facility? When software is involved- What licenses are needed to operate the equipment?  Who “owns” these licenses?  At what cost and for how long?

Whether you are a donor or recipient, having a well thought out, thorough process can ensure that donated equipment fulfills its intended purpose and impacts patient care.  Consider this type of process before procuring or donating any type of equipment.

The need for high quality, appropriate medical devices in LMICs is immense.  The potential to increase access to care and improve the quality of patient care is profound.  Patience in developing and maintaining relationships coupled with a well thought out medical equipment management strategy can dramatically increase the impact of any and all medical donations. 

For more information or to learn more about our Medical Equipment Modernizations and Standardization Programs, please contact us at info@relinkglobalhealth.org

Sources:

  • Perry L, Malkin R. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world?. Med Biol Eng Comput. 2011;49(7):719-722. doi:10.1007/s11517-011-0786-3
  • 10.1136/bmjgh-2019-001785