The existing conceptual model for medical technology innovation management is a poor fit for low- and middle-income countries as it overlooks their unique challenges and constraints. The purpose of this article is to investigate key governing factors and underlying challenges and barriers of medical technology innovation in low- and middle-income countries and how they impact firm-level activities of innovation management. A two-fold qualitative research methodology was adopted for data collection, comprised of a literature review and multiple case study analyses via semi-structured interviews. A thematic coding approach and multiple theoretical perspectives were used for data analysis and drawing conclusions. The study identified 23 challenges and barriers to medical technology innovation, then categorized these under six factors: healthcare context and system, organizational capabilities, innovation ecosystem, demographic burdens and characteristics, market forces, and science and technology. It was found that compared to high-income countries, in low- and middle-income countries, issues associated with country-specific healthcare context and system, innovation ecosystem, and demographic burdens and characteristics influence innovation management activities and make medical technology innovation more challenging. The study contributes to the technology innovation model research by demystifying new factors and proposing a comprehensive conceptual model for understanding the roadmap of medical technology innovation and the influence of various factors on innovation management activities.