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In the last 50 years, development of new medical technologies and devices has played an important role in improving health outcomes in high-resource settings. Innovations ranging from the delivery of nasal oxygen, to obstetric ultrasound, to tools for minimally invasive surgery have reduced morbidity and mortality when patients have access. However, access to medical technologies varies widely throughout the world. Most technologies have been designed for high-resource settings and do not work effectively in settings that lack critical infrastructure such as constant, high-quality power, routine maintenance, and regular supply chains. Technologies that are appropriately designed to work in resource-limited settings can increase access to quality healthcare, bringing screening, diagnosis, and treatment closer to patients who face the greatest burdens of disease globally and reducing morbidity and mortality related to preventable and treatable conditions.

An estimated 80% of medical equipment in resource-limited settings is donated from high-resource settings.1 Most of this equipment cannot function in the challenging environment of a resource-limited setting, and even operational medical devices often have a brief useful lifespan in these settings before being discarded in “equipment graveyards,” storage locations for nonfunctional medical equipment in need of repair (Fig. 27-1a). This is the fate of approximately 70% of donated medical equipment in resource-limited settings.2 Factors reducing the lifespan of medical technologies include harsh environmental conditions, such as open-air settings and the absence of climate control, as well as limitations in infrastructure and in the availability and quality of power and water. The improper use and maintenance of equipment, often due to the limited availability of training and maintenance tools as well as shortages in maintenance staff, can also reduce equipment lifetime. In general, spare parts must be ordered from a distributor and are often unavailable for outdated equipment. Even when affordable spare parts are available, the nearest distributor may be in another country, and the resulting shipping costs, import fees, and taxes can further increase the cost of the part. Furthermore, facilities in remote locations often require travel across poor quality roads and difficult terrain, and many facilities lack a physical street address, additionally complicating supply chain logistics. Similar challenges can affect access to consumables, preventing even functional medical equipment from being used when consumables run out.


Differences in technology lifespans based on appropriate design for resource-limited settings. (a) “Equipment graveyard” filled with discarded oxygen concentrators and other equipment not suitable for resource-limited settings and in need of repair, at Queen Elizabeth Central Hospital in Blantyre, Malawi. (Source: Reprinted with permission from Rice University.) (b) The Universal Anesthesia Machine, from Gradian Health Systems, provided with appropriate and sustainable financial models, training, and local maintenance networks, in use in Ghana. (Source: Reprinted with permission from Gradian Health Systems.)

Thus, there is an important need to design innovative health technologies that specifically address ...

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