Access to Medical Devices in Low-Income Countries

In eastern Uganda, a regional hospital receives a much-needed donation: an x-ray machine that appears to be in good working condition upon arrival. The hospital staff quickly puts the machine to use, only to have it fail during a procedure.

With no trained biomedical technicians at the hospital, the machine sits unused for months. Eventually, an available technician is located in Kampala. He travels to the hospital and examines the machine, identifying the replacement part that is likely needed, but he cannot verify the part without the machine’s accompanying manual. The hospital finds the new part to be more costly than anticipated and must be special ordered because it is not available in the country.

When balancing the costs against the other demands on its limited budget, the hospital administration regretfully decides it cannot afford to spend time and money on securing the new part. Despite the need for its services, the x-ray machine remains out of use.

Medical devices [the terms “medical device” and “medical equipment,” are used interchangeably here (see [1] for full definitions)] like the x-ray machine have been deemed essential to health care systems in the prevention, diagnosis, and treatment of illness and disease for all populations. The advances and innovation of medical devices over time have improved accuracy, efficiency, and efficacy within health care systems, allowing people to live longer, healthier lives. However, health systems in low-income countries (LICs) often have limited access to even seemingly commonplace medical devices (the authors chose to direct their discussion toward low-income countries due to the greatest need for medical device donation in these settings).

As a result, these countries rely heavily on donations, with some LICs receiving donations that make up 80 percent of their supply of medical devices [2]. While most donations are given with the intent to strengthen health systems and improve the well-being of the populations being served, an estimated 40 percent of donated medical equipment in developing countries is out of service [3]. As the example from Uganda illustrates, this mismatch between intentions and usability results from breakdowns that can occur at many points in the complex system of donations.

As countries evaluate the capacity of their health systems in response to the United Nations Sustainable Development Goals [4], the lack of available appropriate medical devices and the impact on health outcomes in LICs are put into clearer focus. Health systems depend in part on a supply chain that ensures access to high- quality, safe, and reliable medical products (http:// www.wpro.who.int/health_services/health_systems_ framework/en). If the supply chain, which is inclusive of all activities and resources involved from acquisition to delivery, results in medical devices that are unusable or inappropriate to treat patients, then the health system is disadvantaged—impeding the delivery of the highest quality of care. In LICs, health systems are often less equipped to handle any breakdown in the supply chain. In these countries, the donation of medical devices that are inappropriate or unusable can be costly, burdensome, and potentially detrimental to the health system that it is purporting to aid.

To increase the percentage of donated medical devices that succeed in strengthening the capacity of health systems in LICs, we, the authors of this paper, have identified three key areas for further exploration and research: quality and appropriateness of the donations, sustainability after the donation is made, and visibility of the flow of donations globally.

In this paper, we aim to:

  1. Describe the major identified barriers impacting these three areas;
  2. Acknowledge existing guidance that has been developed to address them;
  3. Introduce approaches employed by donors based on existing guidance or experience, and;
  4. Recommend targeted action to improve the system of donations overall.

Download the full paper here: Access-to-Medical-Devices-in-Low-Income-Countries-final-1.pdf

Authors: Bruce Compton, Catholic Health Association of the United States; David M. Barash, MD, GE Foundation; Jennifer Farrington, MA, Becton, Dickinson and Company; Cynthia Hall, ExxonMobil; Dale Herzog, UPS Foundation; Vikas Meka, MEng, MBA, US Agency for International Development; Ellen Rafferty, Becton, Dickinson and Company; Katherine Taylor, PhD, MSc, University of Notre Dame; and Asha Varghese, GE Foundation

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