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

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.