









































5 J Global Clinical Engineering Vol.4 Issue 3: 2021

Received April 10, 2021, accepted June 4, 2021, date of publication July 30, 2021

The Status of Medical Devices and their Utilization in 9 
Tertiary Hospitals and 5 Research Institutions in Uganda

By Robert Tamale Ssekitoleko1, Beryl Ngabirano Arinda1, Solomon Oshabahebwa1, Lucy Kevin Namuli1, Julius Mugaga1, Catherine 
Namayega1, Emmanuel Einyat Opolot, Jackline Baluka, Charles Ibingira2, Ian Guyton Munabi2, Moses Lutakome Joloba3 

1 Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere 
University, Uganda
2 Department of Anatomy, School of Biomedical Sciences, College of Health Sciences, Makerere University, Uganda
3 School of Biomedical Sciences, College of Health Sciences, Makerere University

ABSTRACT

Backgrounds and Objective: Advancements in technology have led to great strides in research and innovation that have 
improved healthcare provision around the world. However, the majority of the technology available is underutilized in Sub-
Saharan Africa. In addition, the ever-increasing sophistication and cost of medical equipment means that access and proper use 
is limited in low- and middle-income countries (LMICs). There is, however, a general paucity of well-documented evidence for 
the utilization of medical equipment in LMICs. Therefore, this study evaluates the current availability and utilization of medi-
cal equipment in tertiary hospitals and research facilities in Uganda and provides baseline information to clinical/biomedical 
engineers, innovators, managers, and policymakers.
Material and Methods: The study evaluated the equipment currently used in 9 purposively selected public tertiary hospitals 
and 5 research laboratories representing different regions of Uganda. Data were collected by personnel specialized in biomedi-
cal engineering utilizing a mixed-method approach that involved inventory taking and surveys directed to the health workers 
in the designated health facilities. 
Results: The hospitals contributed 1995 (85%) pieces of medical equipment while the research laboratories contributed 343 
(15%) pieces amounting to 2338 pieces of equipment involved in the study. On average, 34% of the medical equipment in the 
health facilities was faulty, and 85.6% lacked manuals.
Discussion and conclusion: Although innovative solutions and donated equipment address the immediate and long-term 
goals of resource-constrained settings, our study demonstrated several issues around existing medical devices, and these need 
immediate attention. 

Keywords – Medical Devices, Biomedical Engineering, Healthcare Technology, Clinical Engineering, Appropriate Healthcare 
Technologies, Health Technology Management.

Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

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J Global Clinical Engineering Vol.4 Issue 3: 2021  6

Ssekitoleko, Arinda, Oshabahebwa, Namuli, Mugaga, Namayega, Opolot, Baluka, Ibingira, Munabi, Joloba : The 
Status of Medical Devices and their Utilization in 9 Tertiary Hospitals and 5 Research Institutions in Uganda

INTRODUCTION

Advancements in technology have led to great strides in 
innovations and research, resulting in a general improve-
ment in healthcare provision, greatly impacting diagnos-
tics, monitoring, and therapy. Medical device technology 
has played a key role in preventing, diagnosing, treating, 
and rehabilitating many diseases and contributes to 
complex research and innovations such as understanding 
the entire human genome.1–3 Many innovative devices 
have been applied to the early diagnosis of complicated 
diseases, including non-communicable diseases such 
as cancer, and management of chronic illnesses such as 
diabetes and HIV/AIDS. They have also been utilized to 
invent and track many drug regimens for most deadly 
diseases such as tuberculosis and HIV.4–7 Access and ef-
fective use of healthcare technologies leads to improved 
quality of healthcare provision to most of the population 
worldwide.8,9 It is therefore essential to have functional 
equipment. This is particularly urgent in Sub-Saharan 
Africa,10–13 a region with 24% of the world disease burden, 
1% of the global financial resources and 3% of the human 
resource capacity.14 Lack of functional equipment has a 
devastating effect on the quality of healthcare provision 
and research in resource-poor settings and affects the 
overall healthcare system.10,15

Many medical technologies have been made available 
to improve healthcare services in hospitals and research 
laboratories in Sub-Saharan Africa.16 Application of these 
technologies in service delivery ensures improved work 
efficiency and enhanced quality, leading to cost-effective 
medical care for patients.9 However, the availability of medi-
cal equipment does not necessarily translate to improve 
health service delivery in health facilities in low resource 
countries.17 Indeed, health institutions worldwide are still 
struggling with managing quality healthcare delivery in 
resource-constrained conditions.18 Most Sub-Saharan 
countries hugely depend on medical equipment donations 
to facilitate healthcare and research technology needs.19 In 
fact, nearly 80% of medical devices available in healthcare 
facilities in developing countries are donated or funded 
by international donors or foreign governments.20 Most 
of these devices are poorly maintained, under-utilized, 
and or out of service due to various reasons such as inac-
cessibility to spare parts, accessories, and consumables.21 
In addition, the high rate of dysfunctional equipment is 

attributed to the rising costs of medical devices, lack of 
reliable power and water, lack of public infrastructure such 
as air-conditioned rooms, and inadequate planning.16,22 
Perry and Malkin23 report that 38.3% of medical equipment 
in developing countries is non-functional because of the 
lack of trained professionals able to execute the needed 
repairs or maintenance, mainly biomedical engineering 
technicians (BMET) or biomedical engineers.23

Several approaches were been taken to spur innova-
tions in contextually appropriate healthcare technologies 
to respond to the challenges outlined above. Funding 
mainly came from international donors and philanthro-
pists.24 However, with the recent cessation or reduction 
of this funding due to shifting priorities such as the recent 
COVID-19 pandemic, most of these innovations have been 
abandoned due to the absence of sustainability plans. 
This has led to a setback in this field with actual progress 
showing little clinical efficiency.25,26 Apart from limited 
funding, WHO highlights other barriers that hinder the 
effective adoption of innovative solutions in low- and 
middle-income countries: inadequately trained support 
staff to manage the novel equipment, shortage of technical 
expertise, and designs not being suitable for the African 
setting.27

Steps have been taken to avert the challenges in medi-
cal equipment management, including designing novel 
medical equipment suitable for sub-Saharan Africa set-
ting,28,29 developing policies on donations and equipment 
procurement,30 and training biomedical engineers locally 
to enhance technical support.31 There is little evidence 
published on how these efforts have improved medical 
equipment access to the people in most need. 

Therefore, this paper aimed to evaluate the current 
availability, status, and utilization of medical equipment 
in tertiary hospitals and research facilitates in Uganda. 

METHODOLOGY

Study design and setting

This was a cross-sectional study that utilized a mixed-
method approach that involved inventory taking and 
surveys. The study evaluated the equipment in current 
use in 9 purposively selected public tertiary healthcare 
facilities and five research laboratories to represent 



7 J Global Clinical Engineering Vol.4 Issue 3: 2021

Ssekitoleko, Arinda, Oshabahebwa, Namuli, Mugaga, Namayega, Opolot, Baluka, Ibingira, Munabi, Joloba : The 
Status of Medical Devices and their Utilization in 9 Tertiary Hospitals and 5 Research Institutions in Uganda

different regions of Uganda in January 2017. The research 
laboratories included three research-based institutions, 
that is, the microbiology laboratory at Makerere University 
College of Health Sciences (central region), the microbiol-
ogy and molecular biology laboratories at Gulu University 
(Northern Region), and Mbarara University of Science 
and Technology (MUST) clinical and research laboratory 
(Western Region) and two independent research labora-
tories; Uganda Virus Research Institute (UVRI) and Infec-
tious Disease Institute (IDI). Each of these laboratories 
serves as a reference laboratory receiving samples from 
neighboring hospitals for clinical diagnosis support and 
analyzing samples for research and academic purposes. 
Figure 1 below shows the spread of the facilities sur-
veyed. The healthcare facilities selected serve about 21% 
of Uganda’s Population, translating to about 7.9 million 
people as of 2017 Uganda population census estimates.

Data collection and analysis

All data collectors had a bachelor’s degree in biomedi-
cal engineering and were given uniform data collection 
tools and were trained to conduct interviews and collect 

inventory. Data on the collection inventory was aimed at 
generating information on the working condition of the 
various devices currently available in the study facilities. 
The inventory assessment included all medical equipment 
available at the study site when conducting the study 
and excluded furniture, instruments, drugs, computers, 
computer accessories, and disposable tools and instru-
ments. The equipment details collected in the inventory 
included the medical equipment name, type, model, equip-
ment number, serial number, functionality, manufacturer, 
year of manufacturer, and location. The condition of the 
medical equipment was recorded using an A to F scale 
recommended by the Uganda Ministry of Health32 and the 
non-functional equipment in categories B, C, D, E, and F 
were further categorized as shown in Table 1. 

The data were analyzed using STATA version 14.0. 
Discrete variables were summarized by their means and 
standard deviations, whereas categorical variables were 
presented as frequencies and percentages. Logistic regres-
sion was used to compare the functionality of equipment 
between groups, and results were reported with odds 
ratios. All differences with a p-value less than 0.05 were 
considered statistically significant.

Ethical consideration 

Ethical approval was obtained from Makerere Univer-
sity School of Biomedical Sciences Institutional Review 
Board and the Uganda National Council of Science and 
Technology (UNCST; # SS 4166). Informed consent was 
obtained from all participants before enrolment into the 
study. Confidentiality was assured through de-identification 
of the data. 

FIGURE 1. A map of Uganda showing the different locations 
of the study sites and nearby regional Biomedical Engineering 
workshops.

TABLE 1. Key to the A-F Scale of Medical Equipment Conditions 
Used To Assess Medical Equipment in this Study

Category Interpretation

A Equipment in good working condition and in use
B Equipment in good working condition but not in use
C Equipment in use but need repair
D Equipment in use but needs replacement
E Equipment out of use but repairable
F Equipment out of use, to be disposed of



J Global Clinical Engineering Vol.4 Issue 3: 2021  8

Ssekitoleko, Arinda, Oshabahebwa, Namuli, Mugaga, Namayega, Opolot, Baluka, Ibingira, Munabi, Joloba : The 
Status of Medical Devices and their Utilization in 9 Tertiary Hospitals and 5 Research Institutions in Uganda

RESULTS

This study included 2338 pieces of medical equipment 
categorized in 255 medical equipment types, of which 
the hospitals contributed 85% (1995). Table 2 shows the 
characteristics of the facilities included in the study. The 
out-patient department attendance per day character-
ized the study, number of admissions per day, population 
served, number of biomedical engineers and technicians 
(BMETs), number of pieces of medical equipment found, 
the percentage of medical equipment classified as non-
functional, the number of pieces of equipment without 

manuals, and the number of manufacturers supplying the 
hospital with medical equipment. A total of 12 biomedical 
engineers and technicians (BMETs) were identified to be 
working in the hospitals studied, out of which only 3 had 
a bachelor’s degree while the 9 were diploma holders. 
In the hospitals where the availability of manuals was 
recorded, more than 50% of the medical equipment had 
no manuals. On the other hand, the IDI research labora-
tory had manuals for all their equipment. The number of 
manufacturers was also relatively high, with the highest 
recorded being 120 manufacturers supplying a single 
hospital served by 2 BMETs.

TABLE 2. Characteristics of the Hospitals and Research Laboratories Included in the Study

Health Facility
Location 

(Region in 
Uganda)

OPD 
attendance 

per day

Admissions 
per day

Population 
served

No. of 
BMETs 

employed

No. of pieces 
of equipment 

included (% of 
equipment non-

functional *)

% of 
equipment 

without 
manuals

No. of 
manufacturers 

recorded

Regional Referral 
Hospitals (RRH)

Arua RRH North Western 443 65 3.5 
million 1 200 (50%) 91% 78

Fortportal RHH Western 254 70 2 240 (4%)
Hoima RHH Western 413 65 3 million 2 53 (26%) 77% 31
Kabale RHH South Western 178 33 2 million 2 510 (30%)
Mbale RHH Eastern 210 135 1 347 (36%)

Mbarara RHH South Western 468 85 4 million 2 392 (52%) 53% 120

Moroto RHH North Eastern 160 20 1.5 
million 1 138 52%) 74

General hospitals
Kotido Hospital North Eastern 77 15 0 59 (54%) 75% 29
Health centre IV

Kawolo hospital Central Region 217 30 1.2 
million 1 56 (50%) 68% 25

Research 
laboratories

MUST Western 24 (29%) 14
UVRI Central 153 (29%)

Makerere Univ. Central 23 (22%) 11
Gulu Univ. Northern 114 (10%) 41% 57

IDI Central 29 (7%) 0% 20
*All medical EQUIPMENT IN CONDITIONS B, C, D, E, F WERE CLASSIFIED AS NON-FUNCTIONAL.



9 J Global Clinical Engineering Vol.4 Issue 3: 2021

Ssekitoleko, Arinda, Oshabahebwa, Namuli, Mugaga, Namayega, Opolot, Baluka, Ibingira, Munabi, Joloba : The 
Status of Medical Devices and their Utilization in 9 Tertiary Hospitals and 5 Research Institutions in Uganda

Table 2 shows the percentage of non-functional equip-
ment was 4 to 54% with an average of 37%, while the 
research laboratories had a better performance with the 
non-functional equipment ranging from 7 to 29% with a 
mean of 20%. According to the A-F scale, further break-
down of the equipment categories (see Table 1) revealed 
that the non-functional medical equipment was spread out 
in categories B, C, and E, as shown in Table 3. Out of 2338 
pieces of equipment, 157 were identified in category B, 
296 in category C, and 193 identified in category E. The 
top reasons identified for equipment in category B were 
lack of user training and lack of consumables. On the other 
hand, the equipment in categories C and E was usually 
there because of a lack of spare parts, testing equipment 
to identify faulty equipment, and technical knowledge on 
performing repairs.

The medical equipment manufacturers were recorded 
at 6 of the health facilities and 4 of the research facilities. 
The number of manufacturers supplying the facilities 
ranged from 11 to 120, with an average of 46. This number 
varied with the number of pieces of medical equipment 
at each facility (Figure 2). 

According to the study, 358 (15%) pieces of equipment 
were donated and the facilities bought 195 (8%) pieces 
of equipment. The remaining 77% of the equipment was 
classified as unknown because the interviewees could 
not ascertain whether they were donated or bought. The 
study also assessed the availability of user and technical 
manuals for the equipment and revealed that 345 (14.4%) 

pieces of equipment had manuals, whereas 2055 (85%) 
pieces of equipment had no manuals available (Table 2). 
Thus, 80% of the donated equipment had no manuals, 
whereas 86% of the equipment purchased had manuals.

Table 3 also shows the distribution of some of the equip-
ment types identified in the six equipment categories. This 
table shows that a high number of oxygen concentrators 
and pipettes were found in category C. This was because 
the facilities did not have working oxygen sensors to de-
termine the concentration of oxygen concentrators and 
lacked a clear basis for their use. Similarly, the pipettes 
were never or rarely calibrated. Many glucometers were 
not used despite being in good working conditions (cat-
egory B) because of a lack of strips, while a large number 
of infant incubators and nebulizers in the same category 
were mainly due to lack of user training.

The non-functional equipment (categories B, C, D, 
E, and F) was further categorized according to the host 
departments, and analysis revealed that dental and 
sterilization departments had the highest percentage of 
non-functional equipment. In contrast, the laboratory 
equipment in both laboratories within the hospitals and 
research laboratories had a significantly lower percent-
age of non-functional equipment than the mean. Indeed, 
when all pieces of laboratory equipment were excluded 
from analysis, the average percentage of non-functional 
equipment in the other departments increased from 37 
to 47%, as seen in Figure 3.

FIGURE 2. Bar graph showing variation in the number of equipment 
manufacturers supplying 6 of the 9 healthcare facilities and 4 of the 5 
research facilities included in this study. The number corresponding 
to the highest point of each bar is the number of pieces of equipment 
in each facility and the number represented by the dot above each bar 
is the number of equipment pieces in that facility.

FIGURE 3. Percentage of non-functional equipment categorized 
according to the department, the mean percentage of non-functional 
equipment and then mean percentage of the non-functional equipment 
excluding medical and research laboratory equipment.



J Global Clinical Engineering Vol.4 Issue 3: 2021  10

Ssekitoleko, Arinda, Oshabahebwa, Namuli, Mugaga, Namayega, Opolot, Baluka, Ibingira, Munabi, Joloba : The 
Status of Medical Devices and their Utilization in 9 Tertiary Hospitals and 5 Research Institutions in Uganda

DISCUSSION

This study found that, on average, 37% of the medical 
equipment found both in the hospitals were not in use, 
needed repair, and was completely non-functional. These 
results agree with a similar study done in Southwest 
Ethiopia in 2016 that reported that 32.1% of healthcare 
equipment was broken.10,23 In addition, Malkin in 2011 

reported that, on average, 40% of medical equipment in 
resource-constrained countries is out of service.23 Our 
studies showed that the percentage of non-functional 
equipment in research laboratories was reduced to 20%. 
Strategies identified that led to this improvement included 
(1) the provision of technical and user manuals. The IDI 

TABLE 3. The Condition of Medical Equipment in the Hospitals, Health Facilities, and Top Medical Equipment Types Are Broken 
Down Into Each of the Six Categories in the A-F scale

Equipment condition categories Total # of pieces 
of equipmentA B C D E F

Total 66% 7% 13% 1% 8% 6% 2,338

Hospitals 63% 7% 13% 1% 9% 6% 1995
Research laboratories 80% 3% 11% 0% 4% 2% 339

Medical Equipment Types
Refrigerator 77% 1% 5% 2% 4% 10% 135

Weighing Scale 58% 5% 9% 2% 18% 9% 126
Patient Monitor 66% 9% 12% 0% 11% 2% 117
Suction Machine 48% 5% 9% 0% 15% 24% 105

Autoclave 53% 8% 19% 1% 8% 10% 98
Microscope 76% 7% 8% 1% 6% 3% 90
Centrifuge 76% 1% 4% 1% 1% 17% 78

BP Machine 69% 9% 10% 0% 6% 5% 77
Oxygen Concentrator 67% 4% 21% 0% 3% 5% 76

Operating Light 57% 3% 10% 13% 11% 6% 63
Examination lamp 59% 17% 7% 0% 9% 9% 46
Infant Incubator 65% 30% 4% 0% 0% 0% 46

Pipette 7% 0% 70% 0% 0% 23% 43
Freezer 74% 5% 5% 0% 13% 3% 39

Anesthesia Machine 62% 11% 14% 0% 8% 5% 37
Glucometer 43% 37% 10% 0% 10% 0% 30

Operating Table 83% 3% 7% 7% 0% 0% 30
Nebulizer 39% 25% 14% 0% 18% 4% 28

Vortex Mixer 88% 0% 8% 0% 0% 4% 24
Ultrasound Machine 43% 0% 13% 0% 30% 13% 23
Hematology analyzer 86% 0% 0% 0% 9% 5% 22

Ventilator 17% 11% 6% 0% 67% 0% 18



11 J Global Clinical Engineering Vol.4 Issue 3: 2021

Ssekitoleko, Arinda, Oshabahebwa, Namuli, Mugaga, Namayega, Opolot, Baluka, Ibingira, Munabi, Joloba : The 
Status of Medical Devices and their Utilization in 9 Tertiary Hospitals and 5 Research Institutions in Uganda

research laboratories had manuals for all their medical 
equipment, whereas all the hospitals surveyed did not have 
manuals for more than 50% of their equipment, implying 
a lack of technical support in proper use, maintenance, 
and repair; and (2) the laboratory equipment in both 
hospitals and research laboratories were supplied with 
service contracts usually from a local distributor. The 
distributor is tasked with user training, regular preventive 
maintenance (usually on a 6-month basis), and corrective 
maintenance upon breakdown. In general, medical equip-
ment in the other department was procured with hardly 
any plans for their service and maintenance during their 
life span; (3) Research laboratories usually have funds 
to support medical equipment maintenance and repair.

It was observed that 7% of medical equipment was in 
good condition but out of service. These results fall within 
the same range as another study conducted in Ethiopia, 
which found the frequency of equipment in good condi-
tion but not in use ranging from 3 to 21%, with a mean of 
12%.10 An example we saw in our study was glucometers, 
which have a huge potential in the fight against diabetes 
by providing fast and affordable point-of-care blood glu-
cose measurement in low-resource settings. While the 
devices are cheap, the glucometer strips are unaffordable 
for many patients in low-resource settings thus are never 
used. Other reasons for not putting functional equipment 
to use included not knowing how to use the equipment 
correctly, lack of installation space, and lack of required 
infrastructure and utilities.21

The results also show that 13% of the medical equip-
ment identified in the health facilities was faulty but 
used on patients. For example, we found some oxygen 
concentrators in use but delivered oxygen concentrations 
as low as 45% compared to the recommended concentra-
tions greater than 82%.33 This was often due to a lack of 
the right tools or testing equipment for the equipment 
functionality. There were also cases where the users were 
aware that the equipment was faulty but used it due to 
a lack of alternative options. This was usually coupled 
with a lack of spare parts and technical personnel and 
insufficient funds to support corrective maintenance. The 
use of faulty equipment on patients affected the overall 
outcomes in diagnosis and therapy.34

Factors aFFecting medical equipment utilization

Medical equipment management 

This study found that hospitals did not have manuals 
for 68% of their medical equipment. Logistic regression 
analysis showed that the lack of equipment manuals was 
statistically related to medical equipment being non-func-
tional (p-value <0.001). Without these guides, equipment 
maintenance becomes very difficult, especially in Uganda, 
where nearly all medical equipment is imported with limited 
contact with the manufacturers. A survey conducted by 
the ministry of health in 2015 supported these findings, 
which found that only 13.4% of the health facilities in 
Uganda had scheduled medical equipment maintenance 
and that only 37% of the health facilities in Uganda have 
a budget for routine maintenance and repair of medical 
equipment.35  This failure to follow routine maintenance 
procedures results in the escalation of equipment faults. 
Therefore, collective efforts from medical equipment 
manufacturers, local distributors, health facilities, and the 
ministry of health are essential to provide the technical 
and user guides for medical equipment, put measures 
in place to provide technical support, source and avail 
funding for medical equipment management, and carry 
out routine user training and preventive maintenance. 

Technical human resource

Our results show that in each of the hospitals included 
in the study, one or two BMETs, was responsible for 
maintaining and repairing the medical equipment at the 
health facility. When this workload is compared with the 
number of pieces of equipment identified and the num-
ber of manufactures supplying each hospital, on average, 
each BMET was charged with maintaining 167 pieces 
of equipment and from 51 variant manufacturers, each 
supplying a unique model of medical equipment. In addi-
tion, the BMETs in the regional referrals were expected to 
maintain the medical equipment in the lower-level health 
facilities. With little funding, lack of spare parts, manuals, 
and limited technical support from the manufacturers, 
these BMETs are indeed overwhelmed. 

There have been considerable efforts to train BMETs 
locally; as of March 2021, seven teaching institutions train 
biomedical engineers and technicians at various levels. 
Makerere University, which pioneered bachelor’s training 



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Ssekitoleko, Arinda, Oshabahebwa, Namuli, Mugaga, Namayega, Opolot, Baluka, Ibingira, Munabi, Joloba : The 
Status of Medical Devices and their Utilization in 9 Tertiary Hospitals and 5 Research Institutions in Uganda

for Biomedical Engineers in Uganda, has graduated 150 
biomedical engineers at bachelor’s level. However, the level 
of uptake by the Ministry of Health into the public health 
care system has been low. This is reported to be due to 
limited financial recourses. In addition, inadequate person-
nel available in health facilities to guide the procurement 
process, train users, and conduct routine maintenance and 
repair of medical equipment significantly contributes to 
medical equipment failure.31,36

Administrative support

Administrative structures play a crucial role in medical 
equipment management. This can explain the variations 
observed in the percentage of non-functional equipment 
among the health facilities in this study. For example, most 
research laboratories have autonomous or semi-autonomous 
administrative structures and considerable donor funding 
that enable fast procurement of the required spare parts, 
consumables, and contracting skilled human resources to 
increase medical equipment utilization.37 Public hospitals, 
on the other hand, are characterized by long bureaucracies 
in the procurement process and minimal funding to sup-
port medical equipment maintenance.38 Some hospitals 
have, however, streamlined their procurement process 
to support infrastructural and resource utilization. The 
Biomedical Engineering workshop in one of the hospitals, 
for example, operates with a framework contract in which 
a comprehensive list of spare parts and consumables 
is submitted to procurement at the beginning of each 
financial year, and the items are purchased in a batch.39 
This, therefore, eases repairs of medical equipment that 
require spare parts previously identified and listed. Thus, 
practical approaches to abridge convoluted administra-
tive procedures to enhance infrastructural and resource 
utilization are paramount to improving medical equipment 
utilization in health facilities in low-resource settings.

Procurement guidelines

Despite recommendations by WHO30 and Ministry of 
Health40 to regulate donated equipment, many hospitals in 
Uganda still accept medical equipment donations without 
following the guidelines to ensure that the equipment is 
fit for purpose and the setting.41 Additionally, there is still 
a lack of adequate procurement tools to assist hospital 
administrators in the appraisal of new equipment before 

purchasing in low-resource settings.42 This primarily con-
tributed to the observed 7% of medical equipment being 
purchased or donated but never put to use due to lack of 
installation space, lack of consumables, or incompatibility 
with existing infrastructure and resources in this study. 
Additionally, it seemed that hospitals were eager to acquire 
medical equipment at low initial costs without consider-
ing the lifetime / hidden costs of the medical equipment, 
such as cost of consumables, maintenance costs, and 
cost of required utilities, among others. It was observed 
that medical equipment suppliers commonly offer health 
facilities medical equipment at low or no cost but charge 
them highly to procure reagents and consumables over 
long periods. However, the equipment procured under this 
contract ends up unused as the hospitals and patients can-
not afford the cost of reagents. Another example observed 
was sterilization equipment procured by the hospital, but 
it later realized that the equipment’s electricity consump-
tion was way above the hospital’s budget, thus putting it 
out of use. These point to deficiencies in the procurement 
appraisal process and a lack of technical guidance during 
procurement.

Supporting infrastructure and resources 

System-wide deficiencies in infrastructure and resources 
to support medical technologies in low-resource countries 
have been shown to affect the utilization of medical devices. 
The lack of clean water, stable electricity supply, space, and 
administrative structures also affects medical equipment 
utilization, especially in the lower level health facilities 
and facilities in hard-to-reach areas. For example, some 
of the equipment identified in the study was designed 
for use with a 110V power supply, and yet Uganda has a 
240V power supply. Without a step-down transformer, 
this equipment will remain unused in category B for years. 
Another example is autoclaves designed to operate with 
distilled water, yet the hospitals struggle to get access to 
distilled water. These are thus used with ordinary tap 
water, which significantly reduces their lifespan. This is, 
therefore, vital to consider in the design of novel medical 
equipment or during the procurement process. 

Innovations and implications 

Novel approaches custom-made to suit low resource 
settings provide an alternative to the hugely dependent 



13 J Global Clinical Engineering Vol.4 Issue 3: 2021

Ssekitoleko, Arinda, Oshabahebwa, Namuli, Mugaga, Namayega, Opolot, Baluka, Ibingira, Munabi, Joloba : The 
Status of Medical Devices and their Utilization in 9 Tertiary Hospitals and 5 Research Institutions in Uganda

on donated equipment. Development of these innova-
tive inventions have been supported and financed by 
international donors and philanthropist.25 However, the 
majority of the funding comes to an end, and the inven-
tions are abandoned26 while those that progress fails to 
translate to the African setting. The WHO highlighted that 
one significant barrier to the effective adoption of these 
inventions is that the design technology incorporated in 
these innovations does not suit the African setting.28 This 
study showed that most unused equipment in category 
B was new technologies that could not be applied to the 
Ugandan setting. An example was the microscopes; con-
tributing to the 7% equipment in category B were new 
microscopes in storage because of inadequately trained 
support staff to manage the novel equipment while other 
models applied sophisticated technologies that were not 
suitable for the Ugandan settings. These findings align 
with WHO findings on the reasons for hindrances to the 
effective adoption and utilization of innovations in low- 
and middle-income countries.28 There is, therefore, a 
need for more emphasis on the context when designing 
new technologies for low- and middle-income countries.

CONCLUSION

Although innovative solutions and donated equipment 
address the immediate and long-term goals of resource-
constrained settings, our study showed that most of 
this equipment does not translate to the African setting, 
with an average of 37% of the equipment in hospitals 
non-functional. Research laboratories have successfully 
reduced non-functional equipment to 20% by ensur-
ing that medical equipment is supplied with manuals 
and technical assistance, negotiating service contracts 
with the distributors, and securing funding for medical 
equipment management. Other factors noted as affecting 
medical equipment utilization include medical equipment 
management, technical human resource, administrative 
support, procurement procedures, supporting infrastruc-
ture, and resources. 

GRANT SUPPORT

This research was funded by the NIH Forgarty Inter-
national Center under grant number 1D71TW010337-01. 
The funder provided funds as part of a large study and 

did not contribute in the design of this study and collec-
tion, analysis, and interpretation of the data or writing 
of the manuscript.

REFERENCES

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