Report: Why 40% of Donated Medical Equipment Goes Unused in Poor Countries

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High-tech medical equipment is largely wasted in the developing world, a new report finds, because donated machines are not designed to run in the settings they’re sent to.

As much as 40% of health-care equipment in poor countries is out of service, according to the new report on global health technology recently published by the medical journal The Lancet and by Imperial College London. That’s compared to less than 1% out of service in high-income countries. But technology does have the potential to do much, much more for global health and longevity, the report says.

The problem is one of allocating resources. The report notes that almost all of the planet’s medical technology today is designed for rich-world markets, and for rich-world medical communities — characterized by reliable infrastructure and electricity, along with a well-trained health-care workforce and relatively high spending. The report states:

By contrast, low-income and middle-income countries have little money, underdeveloped infrastructure, and few health-care workers. However, technologies from high income countries are often deployed in these settings without enough thought of the consequences, and such technologies might rapidly become useless.

A major reason that so much equipment sits idle, the report says, is that donors from hospitals and charities in the rich world don’t properly think through health-care delivery elsewhere before they ship off their surplus gear. If they have secondhand or excess medical equipment, many donors assume that, as long as it’s in good condition, it can be useful in settings that lack the equipment — not realizing that lack of resources can extend to basic infrastructure needed for operation.

According to the report:

Some low-income countries receive as much as 80% of their medical devices as donations. Although well-intentioned, donations can place a burden on recipients; [for example,] oxygen concentrators donated to a Gambian tertiary hospital required a voltage incompatible with the electricity supply in that country. Time-consuming attempts were made to find a solution without success.

The report recommends that, instead, donors and would-be donors work with low-income health facilities to figure out what kind of surplus equipment the recipients could really use.

But in many cases, the authors say, developing-world patients will see greater benefit not from hand-me-downs, but  from innovations specific to their setting. The report recommends more “frugal technologies” — new medical devices that are neither expensive to make nor to operate, such as the renowned Jaipur foot, a cheap but effective prosthetic that was designed in India, or the eRanger motorcycle ambulance, designed to handle sub-Saharan Africa’s poor-quality roads.

Big improvements can also be made through what the authors call “process innovations,” attempts to streamline health-care delivery and logistics so that limited medical resources are used more effectively, given local constraints. Finally, the authors say, innovations or new efficiencies in sanitation, agriculture, and road safety can also have a big impact on population health, of course.

“Technology is making a substantial contribution to global health. Yet it could do much more,” the authors conclude. And that wouldn’t only be good news for the poorest regions of the world, they say.

“Although poor people will be the primary beneficiaries of cheaper, simple technology, such technologies might also help to reduce costs of health care in high-income countries,” the authors write. “Technology for the poorest people can benefit all.”