Authors: Lora Perry Robert Malkin
Publish Date: 2011/05/20
Volume: 49, Issue: 7, Pages: 719-722
Abstract
It is often said that most of the medical equipment in the developing world is broken with estimates ranging up to 96 out of service But there is little documented evidence to support these statements We wanted to quantify the amount of medical equipment that was out of service in resource poor health settings and identify possible causes Inventory reports were analyzed from 1986 to 2010 from hospitals in sixteen countries across four continents The UN Human Development Index was used to determine which countries should be considered developing nations Nonmedical hospital equipment was excluded This study examined 112040 pieces of equipment An average of 383 42925 range across countries 083–47 in developing countries was out of service The three main causes were lack of training health technology management and infrastructure We hope that the findings will help biomedical engineers with their efforts toward effective designs for the developing world and NGO’s with efforts to design effective healthcare interventionsMany authors in this publication and elsewhere have dramatically stated that most of the medical equipment in the developing world is broken Some statements have been vague In these pages for example Bracale and Pepino reported only that “a great deal of equipment is out of order in most of the health structures in developing countries” 3 Some have been more precise For example Frize and Cheng 7 stated also in this journal that up to 60 of medical equipment is out of service in developing countries The World Health Organization Guidelines for Healthcare Equipment Donations states that 70 of medical equipment in subSaharan Africa is out of service The Director General of the World Health Organization stated at the Medical Device Meeting in the fall of 2010 that “about 70 of the more complex medical devices do not function when they reach their destination” Other papers state that up to 96 of medical equipment is out of service 4 11 14 15 16While the shock factor of such statistics is great the scientific value is limited because they have rarely been supported with verifiable data We have analyzed data from over 100000 pieces of medical equipment in resource poor settings The facts do not support the most dramatic claims In fact on average only about 40 of medical equipment in resource poor settings is out of serviceThe only verifiable way to determine what equipment is working is to take an inventory There are only a few published studies that have documented their inventory methods We examined original inventory data from fifteen countries spanning the Americas Africa and Southeast Asia over the years 1986–2010 2 5 6 8 12 13 For each inventory we considered the country to be a developing nation if it was ranked as having “Low” or “Medium” human development by the UN Human Development report UN Human Development Index UNHDI in the year the inventory was taken or for those countries that were studied before the UNHDI was created the 1991 UNHDI We only included inventories that stated that they were exclusively inventorying medical equipment or where we could remove the nonmedical equipmentMost of the inventory reports included an introductory section We attempted to extract and compile reasons for the equipment being out of service from these introductions Using this method the reasons could be extracted but the numbers of affected pieces could not
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