Key topics include proper use and safety, interpretation of results, troubleshooting and preventative maintenance.27 Clinicians and maintenance staff training together helps rapport development and aids future communications should equipment malfunction.27. The Jaipur foot, a prosthetic designed in India in 1968, is now used in 22 countries in Asia, Africa and South America. A concerted advocacy effort is required to encourage ethical donation and procurement by donors. Adherence to the WHO principles of good donation is recommended, ensuring maximum benefit for the recipient and respecting their wishes and context (see box 1). A push towards publication of the impact of donation may help to raise awareness of the pitfalls of donation projects, increase adherence to WHO guidelines and further the creation of evidence-based national and hospital policies. Material Resources - ancillary equipment supplied either locally or from overseas, as well as replacement parts and associated supply chains. Lifebox Foundation, Lifebox, London, UK. Under-reporting breakdown is common, and the use it until it breaks and then request a new one attitude is widespread.12 Engaging donors, recipients, users and support staff may help to guide practice and improve equipment lifetime. The avoidance of quality double standards. HHS Vulnerability Disclosure, Help Significant work is required to redress the imbalance of investment between the frontline health workforce and maintenance departments in LMICs. Lazzara EH, Benishek LE, Dietz AS, et al.. World health organisation (who), Innovating for the global South: towards an inclusive innovation agenda. Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. We defined medical equipment as medical devices used for the specific purposes of diagnosis, treatment and/or rehabilitation of disease that require calibration, maintenance, repair, user training and decommissioning.26 We searched PubMed for the terms equipment, donation, equipment and supplies, global surgery, anaesthesia and LMIC. Careers. There is a paucity of evidence on the causes of success or failure in medical equipment donation, despite its domination of equipment sourcing across many low-resource settings. Thirty-three biomedical equipment donation guidelines were identified from governments, WHO, World Bank, academic colleges and non-governmental organisations, and 36 relevant studies in peer-reviewed literature. Articles that did not describe the process of medical equipment donation for surgical and anaesthesia care were excluded. HNP Brief #8: an overview of medical device policy and regulation. government site. Approximately 60% of LMICs demonstrated maintenance departments that were understaffed, and studies found that 80% of hospitals in the African region struggled to find appropriately experienced engineers.1 52 This problem is even more pronounced on the subspecialty level, where items described as high maintenance, such as high-speed drills used in neurosurgery, were found to be broken and out of use after donation in a global review.53, Follow-up of donation aids the long-term sustainability of equipment and helps to avoid repetition of mistakes. The sourcing of equipment remains problematic and requires further study. Funding for maintenance teams and biomedical engineers is a particularly neglected area and should be considered during donation planning. Medical device donations: considerations for solicitation and provision. Medical Council of India, Survey of clinical engineering effectiveness in developing world hospitals: equipment resources, procurement and donations. Reviewing the literature identified five key areas that should be considered when assessing the feasibility of equipment donation: This pragmatic literature review has a number of limitations. Kingsnorth AN, Tongaonkar RR, Awojobi OA. Primary Care and Public Health, Imperial College London School of Public Health, London, UK, 4 In LMICs, however, continuous electricity is estimated to be accessible to 59.1% of hospitals providing essential surgical care.17 Perry and Malkin describe a lack of Health Technology Management, including the absence of regular checks, failure to report problems and a paucity of technical knowledge.18 Such shortages curtail services; in Niger, half of referrals at a district orthopaedic hospital were made due to a lack of necessary materials for treatment at the referring healthcare centre.19, With momentum growing to address the inequalities in surgical provision, it is necessary to critically examine medical equipment donations to LMICs. It is clear, however, that good intentions are not enough to ensure useful, relevant and sustainable donation. An official website of the United States government. Standardisation with local equipment, low energy consumption, ease of maintenance and avoidance of environmentally hazardous substances. We limited our search to literature published between 1980 and 2018, in accordance with the growth of literature in the field. Hsia RY, Mbembati NA, Macfarlane S, et al.. Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap. This way we ensure that the donations are used sensibly, distributed fairly and not misused for private doctors offices. Palestinian national authority Ministry of health, Health TIGoAMo, Department HCaP, Affairs DoP, Guidelines on medical equipment donations. IBAN: CH57 0483 5086 0287 1100 0 Especially ultrasound equipment, incubators, heat lamps, monitoring monitors, infusion pumps and similar devices are welcome. Contributors: IHM and EF conceived the project. Concurrently, we searched for grey literature using internet searches and via Ministry of Health websites to find pre-existing non-governmental organisations (NGOs) and governmental medical equipment donation guidelines. The Catholic Health Association found that 60% of donors were providing broken equipment, the sorting and disposal of which consumed valuable staff time at recipient hospitals.15, Adequate communication between recipients and donors during the planning stages was commonly discussed as an important attribute for donation success.27 28 Fostering long-term partnerships improves sustainability, builds capacity, and guarantees stable and reliable supply chains.27 Unsuitable donations can be costly to both sides; therefore, recipients must be free to turn down inappropriate equipment and discuss donor mistakes.39 Reports from LMICs suggest that short-term interest of donors can adversely affect donations and that short-term healthcare trips without follow-up can mean that errors are not identified or fed back.40. Operations and service manuals are necessary in assessing the usability of the donated equipment and in providing a checklist for supplies.25 Such documents are cited in almost every guideline reviewed but have been found in less than half of surveyed donations in LMICs.18, Donating single-use items to settings where reuse is inevitable is problematic, and there is little evidence of long-term benefit.12 Guidelines vary in the expiration date standards; some require donations to be in date at the time of donation,41 while others require items to be donated at least 12 months35 to 2 years before expiration.42 The risk of reuse must be considered: needles must never be reused, whereas reusing sterilised tracheal tubes and face masks may be acceptable.43 Expired equipment may also be suitable for teaching purposes.44 Decontamination may be required to remove pre-existing patient material, and some governments require certification of this.34 There was also no mention of the environmental impact of the donation of consumables within our literature search; however, this is emerging within the procurement literature.45 46, Transporting medical equipment can be an arduous process and may involve many stages, as demonstrated in figure 2. Inventory management techniques are useful for keeping track of spare parts and ensuring that critical components are always in stock.36 Documentation, including names of manufacturers or refurbishers, and details of the previously repaired parts should be provided to the recipient hospital, along with any manufacturer guarantees.25, It has been recommended that posters in local languages should be placed on the wall close to the equipment with key steps in equipment use, as well as instructions on cleaning and storage.27 40 Health centres in Tanzania, for example, have kept systematic equipment records on the wall of each ward, to be signed and dated by supervisors, allowing for easy identification of non-functioning or missing equipment.28, Biomedical maintenance departments remain one of the most neglected services in many hospitals. Medical equipment donation to low-resource settings is a frequently used strategy to address existing disparities, but there is a paucity of reported experience and evaluation. Ng-Kamstra JS, Greenberg SLM, Abdullah F, et al.. Managing equipment for emergency obstetric care in rural hospitals, PQMD guidelines for quality medical product donations. Guidelines encourage recipient hospitals to create lists of their prioritised equipment needs, including model specifications, spare parts and training requirements.8 29 In the absence of locally identified equipment priorities, a needs assessment should be undertaken.1, Review of the published literature revealed many examples of failed donation planning. Effective donorrecipient communication and planning. The partnership for quality medical donations (PQMD), Guidelines for Donating Medical Equipment and Supplies to Developing Countries. This way, we have been able to distribute 50 second-hand ultrasound devices throughout the country. FOIA Shipping containers to Laos is not cheap and requires a lot of work by our volunteers. Dr. med. Biomedical engineer training has been slow to develop to help address this. Marion Mnkhoff The site-specific nature of these makes broader generalisation of the findings difficult. Donors were advised to consult national guidelines to ensure equipment was appropriate, desirable and non-costly to both parties. Unintended consequences of donation for humanitarian purposes can be devastating, such as the use of mosquito nets for fishing, to the extreme detriment of marine wildlife.57 This is particularly poignant, given the rise in single-use medical equipment worldwide. Bethesda, MD 20894, Web Policies Reviewed literature recommended approaching donation as a collaborative process, with an equitable partnership between donors and recipients. We conducted a narrative synthesis to identify key factors that were condensed thematically. Pediatric Anesthesia in Developing Countries : Cot CJ, Lerman J, Anderson BJ, A practice of anesthesia for infants and children (sixth edition. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development, Global access to surgical care: a modelling study, Mortality of emergency abdominal surgery in high-, middle- and low-income countries.