Advertisement

Health and Technology

, Volume 8, Issue 1–2, pp 129–135 | Cite as

Problems with systems of medical equipment provision: an evaluation in Honduras, Rwanda and Cambodia identifies opportunities to strengthen healthcare systems

  • Dane Emmerling
  • Alexander Dahinten
  • Robert A. MalkinEmail author
Original Paper
  • 101 Downloads

Abstract

A substantial amount of equipment is out-of-service in the developing world. Out-of-service equipment limits access to important medical procedures. We measured the amount of out-of-service donated, purchased and loaned medical equipment and documented the barriers to returning them to service in hospitals in Honduras, Rwanda and Cambodia. From 2010 to 2012, we completed a cross-sectional survey of 3421 pieces of medical equipment in five departments from 64 hospitals. The time since arrival, source (donated, purchased or loaned), service contract status and functionality were determined. For any partially or non-functional equipment, the barriers to placing the equipment back into service were documented. In the first year, donated equipment was significantly more likely to be out-of-service than purchased and loaned equipment combined (p < 0.01), where the latter presumably gets more hospital scrutiny before acquisition. But, purchased equipment was more likely to be out-of-service than donated equipment 5 to 6 years after arrival (p < 0.05). Loaned equipment had the highest in-service rates. Service contracts did not significantly decrease out-of-service rates, except for high-complexity equipment (p < 0.001). The largest barrier to placing equipment back into service, according to technicians, was access to spare parts, accessories and consumables. Given the considerable out-of-service rates, the most sustainable and efficacious points of intervention could be the training of local technicians and leasing (rather than donating or purchasing) equipment in order to improve the availability of medical equipment and thus increase access to medical procedures.

Keywords

Donations Low-resource Medical equipment Service contracts 

Notes

Funding

This work was funded by the GE Foundation.

Compliance with ethical standards

Conflict of Interest

The authors hereby declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Perry L, Malkin RA. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world? Med Biol Eng Comput. 2011;49:719–22.CrossRefGoogle Scholar
  2. 2.
    Cheng M. An overview of medical device policy and regulation. World Bank, HNP Brief # 8. Washington DC; 2007.Google Scholar
  3. 3.
    Organisation for Economic Co-Operation and Development. Multilateral aid report. Enabling Effective Development. Paris; 2012.Google Scholar
  4. 4.
    Mullally S. Clinical engineering effectiveness in developing world hospitals. Doctoral Thesis, Carleton University; 2008.Google Scholar
  5. 5.
    Mullally S. Making it work: A toolkit for medical equipment donations to low-resource settings. London: THET Publications; 2013.Google Scholar
  6. 6.
    Howie SR, Hill SE, Peel D, Sanneh M, Njie M, Hill PC, et al. Beyond good intentions: lessons on equipment donation from an African hospital. Bull World Health Organ. 2008;86:52–6.CrossRefGoogle Scholar
  7. 7.
    Catholic Health Association of the United States. How Effective Surplus Donation Can Relieve Human Suffering. Washington DC: CHA Medical Surplus Donation Study; 2011.Google Scholar
  8. 8.
    World Health Organization. Barriers to innovation in the field of medical devices. Medical Devices: Managing the Mismatch. Geneva; 2010.Google Scholar
  9. 9.
    Hockel D, Hamilton T. Understanding Total Cost of Ownership. Exec Insight. 2012;3:44–7.Google Scholar
  10. 10.
    Humatem. Kitting Out a Health Facility: 5 Steps to Success. Les Houches: Humatem Publications; 2013a.Google Scholar
  11. 11.
    The Partnership for Quality Medical Donations. PQMD Guidelines for Quality Medical Product Donations. PQMD Guidelines and Standards. Maryland; 2014.Google Scholar
  12. 12.
    World Health Organization. Medical device donations: considerations for solicitation and provision. WHO Medical Device Technical Series. Geneva; 2011.Google Scholar
  13. 13.
    Gaertner H. Equipment support for operating in emergency and post emergency situations. Equip'Aid Conference, Humatem, European Hospital and Healthcare Federation, French Hospital Federation, Chamonix; 2013.Google Scholar
  14. 14.
    Dyro JF. Clinical Engineering Handbook. Biomedical Engineering Series. Massachusetts: Academic Press; 2004.Google Scholar
  15. 15.
    Humatem. From the maintenance man to the biomedical operator for optimal use of all the medical equipment. Les Houches: Humatem Publications; 2013b.Google Scholar
  16. 16.
    Malkin RA, Perry L. Evaluation of the impact of a new biomedical equipment technician curriculum in Rwanda. Appropriate Healthcare Technologies for Developing Countries, 7th International Conference. London: IET; 2012.Google Scholar
  17. 17.
    Whittle C, Malkin R. Capacity Building for Medical Equipment Technicians Improves Healthcare. J Clin Eng. 2014;39:142–7.CrossRefGoogle Scholar
  18. 18.
    Malkin RA, Whittle C. Biomedical equipment technician capacity building using a unique evidence-based curriculum improves healthcare. J Clin Eng. 2014;39:37–44.CrossRefGoogle Scholar
  19. 19.
    Wang B, Fedele J, Pridgen B, et al. Evidence-Based Maintenance: Part I: Measuring Maintenance Effectiveness With Failure Codes. J Clin Eng. 2010;35:132–44.CrossRefGoogle Scholar

Copyright information

© IUPESM and Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Dane Emmerling
    • 1
  • Alexander Dahinten
    • 1
  • Robert A. Malkin
    • 1
    Email author
  1. 1.Developing World Healthcare Technologies LabDuke UniversityDurhamUSA

Personalised recommendations