WHO calls for better access to medical devices in poor nations

BMJ 2010; 341 doi: (Published 15 September 2010) Cite this as: BMJ 2010;341:c5052
  1. John Zarocostas
  1. 1Geneva

    Too many people are missing out on the potential benefits of medical devices, says a report from the World Health Organization. A rigorous assessment of public health needs that is based on prioritisation and evidence is needed to help deliver lifesaving medical devices to poor nations, it says.

    Margaret Chan, WHO’s director general, told a global forum in Bangkok on 9 September: “The unquestionable benefits of medical devices are unevenly and unfairly distributed.” The situation “illustrates profoundly the great difference in the ability of wealthy and developing countries to reap the benefits of advances in medicine and technology,” she added.

    A recent WHO survey, which collected data from 140 countries worldwide, showed that the average availability of computed tomography scanners is about one for every 65 000 people in average to high income nations but only one per 3.5 million people in low income countries.

    The survey also showed that at least 10 poor nations had no radiotherapy unit at all, leaving almost 100 million people without access to critical treatment for cancer.

    WHO says that medical devices are indispensable for effective prevention, diagnosis, treatment, and rehabilitation.

    At present about 10 500 different medical devices are available on the world market, says WHO, ranging from expensive, high tech diagnostic and therapeutic equipment such as linear accelerators to treat cancer to stethoscopes, sphygmomanometers, and anaesthetic equipment.

    Availability and use of vital medical devices is low in many resource poor nations for a number of reasons, the report says. Most of the devices used in poor countries are imported from rich countries, it says. But about 70% of the more complex devices do not work when they reach their destination. The main reason for this is the difference in the availability of stable electricity supplies, clean water, and personnel trained to operate the devices.

    Manufacturers have not taken steps to design and produce devices that will function in countries where sources of electricity are unreliable and water quality is uncertain and which have extreme temperatures and dusty environments, says the report.

    Inadequate power supply was responsible for nearly a third of equipment failures, according to data collected from 33 hospitals in 10 poor countries.

    Limited financial resources, poor planning, and lack of expertise in efficient management of medical devices add to the problems by making it difficult to maintain the equipment.

    A World Bank study cited in the report estimated that “over 50% of medical equipment in developing countries is not maintained and is out of order.”

    A separate study found that, as a result of poor planning and inadequate funds, about 75% of district hospitals in developing nations “had no access to the oxygen needed to operate life-saving ventilators.”

    To improve public health, devices need to be safe, affordable, accessible, and appropriate, concludes the report. It highlights the advantages of technologies that use alternative power supplies; resist heat, humidity, and dust; lessen the workload; require little maintenance; and can be operated, with no risk to patient safety, by personnel with little specialised training. These include devices such as simple glucose meters and test strips for patients with diabetes that perform well even in hot and humid homes.


    Cite this as: BMJ 2010;341:c5052


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