Research Methods and Results
Two surveys were carried out in the summer of 2021 to help clarify the need for the review and the current levels of adherence to existing guidance. The first of these surveys focused on healthcare providers in countries that had linked to one of the organisations supported by the group members who were recipients of medical equipment donations. This survey was available in English and French. The second survey focused on organisations and people based within Scotland who were active in donating medical equipment to healthcare providers in low- and middle-income countries.
Both surveys were promoted online, and they were sent to known organisations, clinicians or hospitals and members of the Scottish International Development Alliance. Everyone who received the survey was encouraged to share it within their networks. Reminders were sent.
In addition to this, three in-depth interviews were carried out. These were with one clinician in Rwanda, one in Malawi and one in Scotland, who had successfully delivered medical equipment to a project in Malawi, to help shape the surveys. Meetings also took place with Partners in Quality Medical Donations to understand their work and their annual review of their guidance.
A full set of results from both surveys is available on request. The numbers are small although indicative of certain traits. The following highlights were drawn from the results.
Survey 1: Recipient hospitals
16 respondents to the first survey came from 12 countries. 11 of them were in Africa: Malawi, Zambia, Zimbabwe, Nigeria, Sierra Leone, Uganda, Kenya, Madagascar, Burkina Faso, The Gambia and Democratic Republic of the Congo. 1 of the respondent countries was in Latin America: Ecuador.
The findings of the survey are shown below:
Approximately 90% of respondents (14) confirmed they had received medical donations from an overseas donor. Encouragingly, a corresponding number (14) confirmed that the donors had engaged with the hospital in the process of making the donation.
However, despite engagement with the donor around the donation, 75% (12) of the respondents had not received any handover training as part of the donation. This situation is further confounded with 25% of recipients (4) confirming they had received donations of medical equipment without manuals in their language, making safe and full use of the donation challenging.
Of those who had received donations, nearly 70% (11) reported that the donation did not come with a warranty or maintenance programme, which leaves the hospital open to additional fees or, more likely, leads to the equipment quickly becoming broken and unusable.
Furthermore, despite evidence of donor engagement, 12% of donations (2) were found to be unsuitable for use in the recipient hospital. In these cases, the energy put into making the donation is often fruitless and the recipient hospital is left with equipment they have no use for. One hospital reported receiving a donation of medical equipment that had the wrong power consumption (e.g. 240v given for use in a 110v country). In this case the hospital were able to use the equipment but had to incur additional expenditure purchasing power convertors.
When it came to the provision of consumables and necessary spare parts to use the donated equipment, 75% (12) of the respondents confirmed they had not received all the necessary provisions (50% reported receiving some and 25% reported receiving none).
Respondents' comments included:
"Sometimes items donated were of an age that availability of consumables and spares was limited."
"A diathermy was provided with very few pads that lasted a few weeks."
"Sometimes we get equipment and all the parts not there. For example, missing cables."
With 75% of recipient hospitals reporting donations of this nature, it is clear that the guidelines on donating medical equipment are not currently being followed consistently; even when there is engagement with the hospital.
Finally, when participants were asked directly if they had received any medical equipment that they weren't able to use, 80% (13) confirmed that they had.
Respondents' comments included:
"We have had many items of old, obsolete and incomplete equipment."
"Broken equipment that didn't work in the donor country, wrong power connection, missing parts."
With such a high rate of participants confirming that they had received donations in the past that were never used, the need to provide clear support to the donating organisations to maximise their impact appears to be clear.
Survey 2: Scottish Based Donors Survey
The survey was shared widely within Scotland including to all members of the Scottish International Development Alliance through the contact email address listed on the Alliance membership page. 19 respondents replied to the survey.
The countries donated to by those responding were: Peru, The Philippines, Afghanistan, Greece, Haiti, Tanzania, Kenya, Malawi, Sierra Leone, Liberia, Madagascar, Guinea, Nigeria, Zambia, Rwanda, Democratic Republic of Congo, Senegal and one respondent who confirmed that 'key partners distribute to 65+ countries'.
Those who were not actively involved in donating medical equipment donations cited reasons including:
"Whilst I have access to equipment no longer required, shipping costs are prohibitive."
"Just about to try."
Of those who were actively donating (14 respondents), 80% of responses (11) confirmed that they responded to requests for help. 14% (2) of respondents led the process by offering donations. However, in commenting most respondents alluded to a mixture of requests and offers, as summarised by the comment:
"Donations have been made in both ways. First, as a response to a request as part of a project, we have sourced equipment, mainly through donations and had it sent out. Secondly, a piece of equipment which has been offered to us by a hospital/clinic/individual. We then contact our in-country partners to see if this would be useful, what maintenance support there is locally etc."
When it came to discussing the recipient hospital's needs, 80% (11) of respondents confirmed they did discuss these in advance of a donation, but this left 20% (3) of respondents who did not. One organisation confirmed that their role was to facilitate the donations on behalf of others, but this still leaves 14% (2) of the responders sending medical equipment donations without consultation with the recipient hospital.
When it comes to handover training, the responses were evenly split with 50% (7) providing training and 50% (7) not. Most of the comments were by those who appear to have provided training or who assessed that the donation was sufficiently well known to the recipient team that training was not necessary.
Respondents were then asked about the provision of manuals in the local language with only 20% (3) of the respondents saying this was done. 80% (11) of the respondents did not provide manuals in the local language either because they weren't deemed necessary ("not relevant for the equipment donated"), or because they were provided only in English ("Manuals are provided are only in English"), or because they weren't available ("country x speaks English – any manuals (and often none) are in English").
On the provision of a warranty or maintenance programme for any donated medical equipment, 86% (12) of respondents did not provide this. The comments in this section were revealing on where some of the recipients felt the boundary of responsibility lay:
"This is the responsibility of the recipient."
"We gave some help and advice but essentially when machines broke, they were not repairable due to lack of access to parts and bio engineering know how."
"Not thought worthwhile or relevant. Would be worth considering for expensive multi-use kit."
It should be stressed that some responses were exemplary. For example, one commented that:
"We had trained local BioMeds to look after the equipment and provided them with test equipment and tools. Also providing ongoing support via video link and email."
When asked if the equipment donated was suitable to the hospital (e.g gasses, water and power) 93% (13) of respondents confirmed that it was. However, 1 respondent confirmed that their donation had not been suitable for the hospital. Respondents noted they had tried to ensure suitability.
On the question of providing necessary consumables and spare parts, only 36% (5) of respondents confirmed that these were provided. 45% provided some of them and 20% did not provide any consumables. Respondents' comments broadly aligned with the views given on the topic of warranties. Comments included:
"We are a small administrative team of 6 staff, not a health facility. It would be counter-productive for us to spend charitable funds on procuring consumables and spare parts to accompany second-hand equipment not chosen by the recipient facility and for whose shipping we don't pay – we generally accept only equipment which we can hand-carry."
"We send what we are given!"
The survey probed whether respondents had sent any medical equipment that they knew hadn't been used. 28% (4) participants confirmed that this had happened. The comments highlighted why this might be:
"At the beginning of country x project (2010) sent container of equipment including level 1 infuser never used."
"Some items are beyond the current needs of the local hospitals. The local staff is not highly trained and the budget is low, so there are many things which they do not diagnose and cannot treat."
When asked about whether a pre-shipment customs clearance process has been undertaken, 36% (5) of respondents confirmed that it had. 57% (8) had not arranged this with 7% reporting that it wasn't needed. Comments on why certain actions had been taken with regards to customs included:
"We took the equipment in person."
"We work with partners who manage the customs process."
"We purchase most of the equipment in country x. Most is available in country and the cost of shipping is prohibitive."
This led on to a question about whether participants had experienced any problems with the logistics of the shipping and clearing equipment through customs. 36% (5) of respondents confirmed they had problems. Some respondents noted they did not have the arrangements to clear customs on behalf of recipients.
43% (6) had not experienced problems and 20% (3) of respondents stated that customs clearance was not required.
When considering why problems might have been encountered, comments included:
"Even with prior planning, customs very rarely goes smoothly, with long delays in processing any donation from the UK."
"Corruption and inefficiencies within local Customs teams."
"Takes a long time from memory nearly a year to get operating microscope to Town Y."
Finally, participants were asked whether they would find it useful to have access to a guide showing all the steps that should be taken to safely donate medical equipment for maximum impact. 75% of respondents confirmed it would, 25% did not feel this would be helpful.
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