Literature review of best practice for medical equipment donations
Scotland has a wide network of public and voluntary sector organisations who have been involved in the donation of equipment to partners in low- and middle-income countries for many years, often as part of long standing health partnerships.
More recently, as a result of awareness of the impacts of COVID-19 across the world, particularly in low-resource settings, and recent international humanitarian causes such as the crisis in Ukraine, a number of new actors, including from across civil society, have become involved in the collection and donation of goods and equipment.
The Scottish Government Ready Scotland website provides advice on supporting humanitarian causes, including donating and managing goods. However given the particular risks to patient safety that the donation of medical equipment raises, the Chief Medical Officer for Scotland commissioned a review of the current available global guidelines on these type of donations to identify areas of good and avoidable practice to help to guide a sustainable ethical donation system for medical equipment from Scotland.
The World Health Organisation (WHO) estimates that up to 70% of donated equipment is non-operational. This suggests that globally we are still not getting equipment donations right and this is leaving a deficit and a burden on the receiving country as well as wasting resources in the donor country in time, effort and cost of arrangements, as well as potentially damaging relationships between partners. There is a need for good quality donations, done in a considered and collaborative way. We have reviewed the current available global guidelines on medical equipment donations and used these to guide a sustainable ethical donation system for medical equipment from Scotland.
The main guidelines reviewed included:
- Making It Work, THET 2013 (Tropical Health and Education Trust)
- Guidelines for Quality Medical Product Donations 2021 – PQMD 2021 (Partnerships for Quality Medical Donations)
- Medical device donations: considerations for solicitation and provision - WHO Medical device technical series, WHO 2011 (World Health Organization)
- Guidelines For Health Care Equipment Donations - WHO 2000 (World Health Organization WHO | World Health Organization).
- Managing the Medical Equipment Lifecycle, THET 2015 (Tropical Health and Education Trust)
There were common themes throughout the guidelines highlighting a united front on what is seen as good practice. The first consideration is that all donations should be request driven from the receiving partner country or organisation. WHO noted that problems with donations often come from a lack of good communication between the donor and recipient and when the donor does not fully consider all of the challenges of donating at the offset. When WHO published its 'Guidelines for Health Care Equipment Donations' in 2000 they described four core principles underlying their guidance and these are still very much relevant today.
WHO's Four Core Principles:
1. A health care equipment donation should benefit the recipient to the maximum extent possible.
2. A donation should be given with due respect for the wishes and authority of the recipient, and in conformity with existing government policies and administrative arrangements of the receiving country.
3. There should be no double standard in quality: if the quality of an item is unacceptable in the donor country, it is also unacceptable as a donation.
4. There should be effective communication between the donor and the recipient, with all donations resulting from a need expressed by the recipient. Donations (solicited) should never be sent unannounced.
Once communication is established with the receiving partner the next consideration is whether a site visit is required; this is generally considered good practice and this can ensure the donor has considered the partners infrastructure for receiving the donations, including technical information about electricity and connections as well as transport links, customs and local maintenance expertise. A site visit and a deep understanding of the system in which the equipment will be used helps to support the vital communication between partners.
Given the current climate crisis and the different scales of organisations making donations a site visit will not always be the right thing to do. It may be of higher importance to engage with a technical expert at the receiving partner site who can advise on these aspects of the donation from their side and engage a clinical/ biomedical engineer on the donation side to capture this information.
If a donor is unable to undertake this kind of preparation then consideration of engaging a distributing partner who can demonstrate this knowledge and expertise would be essential.
If expert advice and support is not available to support the donation then consideration should be to given to not taking the donation forward or considering other forms of support which are beyond the remit of this working group.
As well as recognising there should be no double standard in quality of the medical equipment it is suggested that careful consideration be given to used vs. refurbished vs. new equipment when donating; they all have pros and cons for both the donor and the receiving partner and they should be considered by both groups and the receiving partner should have the final say in accepting a donation or not.
No equipment whatever the age should ever be shipped without confirmation that it is fully functional. Whatever the age of the equipment being donated it should always include manuals, service manuals (both in a language understood by the partner country), accessories, consumables, reagents, warranties and complaint processes and spare parts. No expired consumables should ever be shipped and if it is expected that there will be no availability for spare parts or technical assistance within the next two years then it should not be donated.
Where there are local markets for equipment or supplies these should be considered and if the decision is for new equipment to be bought then consideration of doing it through these established local channels takes away the need for transportation, and supports the local economy and local expertise.
Very importantly for any donations there should be an agreed plan for disposal of equipment so as not to leave partner countries with the cost of this – both monetary and environmental. Continuing the good practice of open communication between partners, feedback and evaluation of the donation process and the usefulness of the donation should be sought from the receiving partner.
A 2019 review looking at compliance of the WHO guidance for donating medical equipment found that the majority of donations reviewed had not fully complied with the guidelines. The working group considered the reasons behind this and identified the main barrier being that the guidance is not all in one place and is not always easy to find. To ensure all donations do meet the required standards, there appears to be a real need for a further, easy to follow signposting exercise to help donors achieve and maintain the highest standards of medical equipment donation. Given the burden unusable donations have on the receiving partner, if a group looking to donate find that they are unable to follow guidance, then they should reconsider progressing the donation and look at other forms of support. In many cases, not donating medical equipment will be the right thing to do if it cannot be done properly.
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