Donations should benefit the recipient...
WHO Guidelines for Donations of Health Care Equipment
Von S.Yunkap Kwankam / Weltgesundheitsorganisation WHO
Many developing countries are increasingly dependent on donor assistance to meet the objectives of their health care systems. Such assistance often includes equipment, and in some countries, nearly 80 Per cent of health care equipment is funded by international donors or foreign governments. However, resources needed to keep this equipment operational (financial, organizational and human) are sometimes not considered. Other problems also plague the donation process. The result is that the donations do not achieve their intended objectives, and could even constitute an added burden to the health care system they are intended to assist.
It is instructive to look at some of the problems with health care equipment in Sub-Saharan Africa (SSA). In 1990 this region represented 9% of the world’s population but accounted for 21.5% of the burden of disease as measured in Disability Adjusted Life Years (DALYs). In this region a large proportion of equipment (up to 70 per cent in some countries) lies. Technology is not used for a number of reasons ranging from inappropriateness for local needs through lack of knowledge by staff on how to use it, to inadequate supply of consumables
Equipment is broken down because of: misuse, lack of maintenance, absence of planned preventive maintenance, inadequate utilities (electricity, water), and adverse environment (heat, humidity, dust). Repair service is not available because of the lack of repair and maintenance facilities, shortage of competent staff in-house or outside, little commitment from a local representative, insufficiency of funds to pay for spare parts or service, absence of service manuals, and unavailability of spare parts. This is expensive in terms of both additional cost (anywhere from 10-50%) and reduced lifetime of equipment (30-80%).
The need for donor aid guidelines
The situation in other developing regions is not very different. As developing countries are usually the target beneficiaries of most health care equipment donations, there is a strong need to improve the process and the contribution of donated equipment to health care delivery, to the mutual benefit of both donors and recipients. The key is to link the donation to the health care delivery process in the recipient’s health system.
Further justification for guidelines for health care equipment donations are:
- Donors mean well, but often do not realize the possible inconveniences and unforeseen consequences at the recipients end.
- Donor and recipient do not communicate on equal terms. Recipients may need support in specifying how they want to be helped.
- Health care equipment donations must be based on a sound analysis of the needs, and their selection and distribution must fit within existing technology policies and administrative systems.
- The quality requirements of health care equipment are more complex than for other donated items, such as food and clothing.
WHO has developed guidelines (1) to this effect, derived from similar work published by a number of organizations – the American College of Clinical Engineering, the Association for Appropriate Technology (FAKT) in Germany, Churches’ Action for Health of the World Council of Churches, and the International Medical Device Group (2).
The guidelines aim to improve the quality of equipment donations by addressing the context, content and process of donations. They are designed for use everywhere, although there is a deliberate emphasis on developing country health systems. They are not an international regulation, but rather meant to serve as a basis for national or institutional guidelines, to be reviewed, adapted and implemented by governments and organizations dealing with health care equipment donations.
Scenarios under which donations are made differ. But there are some basic rules which apply to all situations. These guidelines describe this core of Good Donation Practice.
Core principles for equipment donations
1. First and foremost, health care equipment donations should benefit the recipient to the maximum extent possible, as determined by an expressed and validated need of the recipient.
2. Donations should be given with full respect for the recipients and their authority within the health system, and be supportive of existing health policies and administrative arrangements.
3. There should be no double standards in quality: items not acceptable in the donor country are unacceptable as donations.
4. There should be effective communication between the donor, the recipient authority and, whenever possible, the end-user, before, during and after the donation.
Recipient policy on health care equipment donations
The guidelines provide detailed practical recommendations on how both donors and recipients could make use of the guidelines in their own situation to maximize the quality and potential impact of health care equipment donations. They strongly recommend, inter alia, the following:
- Define national or organizational guidelines for health care equipment donations.
- Define detailed administrative procedures, with clear responsibilities, for receiving health care equipment donations, in addition to general guidelines about selection, quality and management of health care equipment donations.
- Specify the need for donated health care equipment, providing as mush information as possible.
- Identify a lead donor, if this can be done.
A set of flow diagrams illustrate the recommended process and activities associated with each part of the process, provide checklists for donors, recipient governments, advisors and beneficiaries, and indicate the recommended assignment of responsibilities among the stakeholders.
Used and refurbished equipment
Often donations involve equipment removed from service in hospitals in industrialized nations, and provided to hospitals in other areas. Most such equipment never works for any significant length of time. Even when it does work, estimates are that less than 30%, perhaps as low as 10%, of used equipment ultimately becomes operational. Careful economic analysis should be done of both new and used equipment options.
Refurbishers of medical devices should restore equipment to the original equipment manufacturer's specifications for the purpose of resale, and are subject to general principles of liability.
Additional guidelines for used equipment are:
- Document the source of all purchased equipment.
- Document the components that were replaced in, and the repair services that were performed on, the equipment.
- Document the source of the repair parts and provide an acceptance report for these parts.
- Label the equipment with the re-manufacturer's name.
- Verify and document the operation of the equipment and the performance standards used to calibrate it.
- Maintain a customer complaint file and document the actions that were taken to resolve customer complaints.
Health care equipment donations play an important role in the provision of quality health care services. Although the donation process is not optimal, tools such as the WHO guidelines are available to help improve the process. This requires commitment on the part of all stakeholders to address both current and anticipated problems. Above all, all parties involved in health care equipment donations should adhere to Good Donation Principles and Practices.
S.Yunkap Kwankam et al., Department of Health Service Provision (OSD), World Health Organization, Geneva, Switzerland, http://www.who.int/health-services-delivery
1. WHO Guidelines: Word Document, 294 KB
2. NGO Guidelines: English - French - German - Spanish (HTML and PDF) on www.drugdonations.org