Improving the quality of medical equipment projects for health centres in developing countries
Barbara Comte & Cathy Blanc-Gonnet
A lot of medical equipment in health centres in developing countries no longer works. A large proportion of this equipment is given, often for free, by international aid organisations. In order to try to resolve this very problematic situation, the association Humatem specializes in supporting actors involved in medical equipment projects. The Equip’aid symposium, organized by Humatem in partnership with HOPE, with support from the WHO, showed the need to improve aid in this domain. Concrete solutions were discussed, such as increasing the responsibility of organizations, improving the technical quality of the equipment which is transferred and strengthening biomedical human resources.
Reducing infant mortality, improving maternal health and combating HIV/AIDS, malaria and other infectious diseases: three of the eight Millennium Development Goals (MDG) aim to improve healthcare rights. This depends on the existence of operational and well-equipped health centres which are accessible to all. Also, to achieve the MDGs, it is essential to strengthen the technical facilities of health centres which are generally defective at the moment.
In such a context, medical equipment projects by international aid organizations have an important role to play. As developing countries do not have a great deal of resources to buy medical equipment, and as there is only a limited amount of equipment of this kind on local markets, donations of medical equipment, which are a characteristic of the majority of these projects, remain essential.
However, the large amount of dysfunctional medical equipment in health centres in developing countries raises questions about the responsibility of Northern countries, notably regarding the effectiveness of the aid they provide as part of medical equipment projects. Indeed, a great deal of medical equipment which is donated is incomplete, has no documentation, has not been serviced or is already out of order; other equipment is sent without really taking into account the real needs of the destination health centre, the opinion of local authorities or the local environment (human resources, infrastructure, technological level, financial resources, etc.). The data available from the World Health Organisation (WHO) shows that only 10-30% of the equipment which is donated can be used in the new context. This is not surprising when one knows that only 15% of countries apply the WHO’s guidelines on donations of medical equipment.
A central issue in international discussions
As the principle event of a programme of EuropeAid actions, and with the support of the WHO, Humatem, the European Hospital and Healthcare Federation and the French Hospital Federation organized the first edition of the international symposium, « Equip’aid – Sharing for better healthcare » on 19 & 20 November 2013 in Chamonix Mont-Blanc. This founding symposium brought together for the first time 183 actors from 33 different countries, all concerned by medical equipment projects by international aid organisations. The participants included civil society representatives from the North, from countries in transition and developing countries, international organisations, health centres who donate and who receive medical equipment, medical technology businesses, experts, training institutes, researchers, actors and state representatives. The symposium was an opportunity to:
- share information and experiences, by encouraging dialogue between organisations involved in medical equipment support projects,
- highlight synergies by examining different practices and policies in transferring and making available medical equipment,
- encourage cross-sector discussion about problems in the sector with a view to improving practices.
The conclusions of this symposium  point towards the need to improve the quality of medical equipment based on the following areas:
- Increase the levels of quality and responsibility in projects
Hospitals and industries in the most advanced countries need to learn to give in a more civic and responsible manner, and in particular, they should improve the way they select the medical equipment they want to give (in working order, complete, not out of date and not obsolete).
Those running the projects should revise their practices, make partnerships central to the process and adopt a structured project methodology which is specific to medical equipment projects. For example, they should commit themselves to partnership agreements with their health centre partners, which formalize the responsibilities of each and have specific articles about project logistics, staff training, maintenance, etc. These are key points which are often forgotten.
They should give priority to the acquisition of medical technology which is appropriate for developing countries, that is to say, equipment which is easier and cheaper to operate and maintain. The WHO is raising awareness amongst industrialists, purchasing offices, NGOs, research institutes, etc. about designing, producing and supplying medical equipment which is genuinely adapted to the realities of the field. There are still too few technologies of this kind available on the market, but they already deserve to be taken into account in medical equipment projects and technological monitoring should be organized.
In addition, those in charge of projects should give priority to acquiring equipment available on the local market in order to support the economy of the country.