








































J Global Clinical Engineering Issue 2:22-34; 2019  22

Received January 30, 2019, accepted April 12, 2019, date of publication April 15, 2019

Medical Device Donation Practices in Canada: A 
Survey of Donor and Recipient Perspectives

By B. Bradley1, C. Yoon2, S. Zahedi2, Y. Adusei-Poku3, J. Zienaa3, N. Adjabu3, Y. Cheng1, W. Gentles4, 
1 Centre for Global Engineering and the Department of Chemical Engineering and Applied Chemistry, University of Toronto, 
Toronto, Canada
2 Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
3 Ghana Health Service, Ghana, Africa
4 The Canadian Medical and Biological Engineering Society, Ottawa, Canada

ABSTRACT

Background and Objective: Although developing countries have been receiving donations of medical equipment for 
many years, a number of studies have indicated that a high percentage of donated equipment is never put into use.1,3,4 
Many of the reasons for this can be traced back to inadequate donation practices on the part of donor organizations.  
The objective of this study was to gain an improved understanding of the practices and challenges associated with 
medical equipment donations by Canadian charitable organizations. 
Material and Methods: Forty-one organizations (registered and non-registered charities, non-governmental or-
ganizations (NGOs), non-profit organizations, medical clinics, and hospitals) completed an online survey, and 16 
respondents were interviewed via telephone or in person. In addition, representatives from 28 hospitals in Ghana 
were interviewed in person to gain an understanding of the recipient experience. 
Results: We observed that for many Canadian donor organizations there is room for improvement in formalizing 
procedures, testing to verify equipment functionality before shipping, providing additional support for recipients 
in the form of manuals, spare parts and training, and long-term monitoring of donated items to measure effective-
ness. For recipients, the most common challenges faced were lack of spare parts, and lack of operating or service 
manuals. Despite these challenges, all of the Ghanaian survey respondents said that donated medical equipment 
benefited their hospitals. 
Conclusion: We concluded that because of staffing limitations in smaller donor organizations, and in order to better 
meet the needs of recipients, it would be beneficial for Canadian organizations to communicate and collaborate with 
one another to share resources and expertise when planning donations overseas.  

Keywords – Medical equipment donations, Low resource settings, Canada, Ghana, Best practices. 



23 J Global Clinical Engineering Issue 2:22-34; 2019

Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
A Survey of Donor and Recipient Perspectives

INTRODUCTION
Previous reports have estimated that as much as 40% 

to 70% of medical equipment in developing countries is 
out of service or never put into use. 1,3,4  The reasons for 
this include a lack of infrastructure and resources (includ-
ing spare parts and accessories), poor health technology 
management, and lack of training. 3 Given that so many 
developing countries rely on medical equipment dona-
tions, donations that meet recipient needs are crucial to 
mitigating these challenges and reducing the burden of 
non-functional equipment. 

In the past two decades, numerous guidelines for the 
donation of medical equipment to low resource countries 
have been published. 2,4,11,12 Despite the existence of these 
guidelines, recent studies suggest that equipment donation 
practices are a continuing problem. For example, a study 
in Tanzania found that 78% of surveyed staff in a national 
hospital were dissatisfied with the quality of donated 
medical equipment, citing lack of supporting manuals 
and training, poor communication between the donor 
and the hospital, lack of clear equipment specifications, 
unneeded equipment, and poor donor planning as reasons 
for their dissatisfaction. 5 A case study about a donation of 
oxygen concentrators to The Gambia demonstrates how 
something as simple as a mismatch in electrical require-
ments can lead to unusable equipment, not to mention 
wasted effort. 6

While many organizations across Canada donate medi-
cal equipment and supplies to developing countries, no 
previous study has explored the donation practices of 
these organizations. The objectives of this study were: 
(a) to determine the scope of medical equipment dona-
tions by Canadian charitable organizations, and better 
understand their specific donation practices and chal-
lenges; (b) to interview representatives of recipient health 
facilities in Ghana, and learn from their experiences; and 
(c) to disseminate good practice guidance to donating 
organizations in Canada and around the world. This study 
was initiated by the International Outreach Committee of 
the Canadian Medical and Biological Engineering Society 
(CMBES), which has had a long-standing partnership with 
the Ghana Biomedical Engineering Association to support 
clinical engineering capacity in Ghana. 7 

METHODS

Canadian study
Canadian organizations actively engaged in the dona-

tion of medical equipment and/or supplies to developing 
countries were surveyed using an online survey tool. 
Follow-up interviews were conducted with a subset of 
surveyed organizations. The list of prospective study 
participants was compiled through project partner con-
nections and networks, Internet search, and through 
Canada’s registered charity search engine. 8 This phase 
of research resulted in a database of approximately 80 
registered and non-registered charities, non-governmental 
organizations (NGOs), non-profit organizations, medical 
clinics, and hospitals.

Organizations were then contacted by telephone and 
informed of our study and survey. Organizations that 
were actively donating medical equipment were sent a 
link to a survey in a follow-up email. The online survey 
consisted of 20 multiple choice and short answer ques-
tions, grouped into the following categories: (a) general 
organization information; (b) process for determining 
recipient needs; (c) communication involved in planning 
donations; (d) sources of equipment; (e) process for 
verifying quality and safety before shipping equipment; 
and (f) follow-up methods for evaluating success of the 
donations. Forty-one organizations completed the survey. 

From the organizations that participated in the survey, 
a list of 16 organizations was identified for follow-up in-
terviews. The short list of organizations was strategically 
selected to cover a wide geographic range across Canada, 
as well as a range in size of operations.  The goal of the 
interviews was to gain a deeper understanding of different 
organizational processes. Sixteen interviews of approxi-
mately one hour duration were conducted.  Interviews 
were conducted in person when possible, and by phone 
otherwise.  The breakdown by province (in-person; phone) 
was as follows: British Columbia (3; 1), Saskatchewan 
(0; 1), Ontario (2; 2), Quebec (2; 0), Maritime provinces 
(4; 1). The research protocol, survey tool and interview 
question guide were approved by the Office of Research 
Ethics at the University of Toronto.



Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
A Survey of Donor and Recipient Perspectives

J Global Clinical Engineering Issue 2:22-34; 2019  24

Ghanaian study
A second survey, consisting of 35 questions, was de-

veloped to gather information from Ghanaian hospitals 
about their experiences receiving medical equipment 
donations. Four questions collected information about 
the respondent. The remaining questions were a mix of 
multiple choice questions and open-ended long answer 
questions on topics such as: types of medical equipment 
received, communication with the donor before and 
after the donation, discussion of equipment needs, level 
of support from donors in terms of provision of training, 
manuals and supplies, maintenance and availability of 
spare parts for donated equipment, logistics such as ship-
ping and customs, and common challenges encountered 
with donations. 

A geographically representative sample of 28 health 
facilities was chosen for the survey; at least two facilities 
were visited in each of Ghana’s ten regions. We also sought 
to ensure that facilities receiving donations from Canadian 
organizations were well represented in the sample (14 
out of 28), and that a range of different hospital types 
was chosen (government, teaching, mission, etc.). Since 
many hospitals did not have reliable access to the Inter-
net, surveys were administered in person and on paper 
by a research assistant (“surveyor”) rather than online.  
In some cases, the surveyor waited for respondents to 
complete the survey, while in other cases the survey was 
administered as an interview with the surveyor filling in 
responses. 

The research assistant in Ghana was supervised by 
the Deputy Director, Clinical Engineering Department, 
Ghana Health Service.  Before conducting the survey, all 
respondents were given an introductory letter explain-
ing the project.

FINDINGS
The types of Canadian organizations that donate equip-

ment include NGOs, registered charities, and healthcare 
institutions. Some donor organizations have been in op-
eration for over 25 years (one for almost five decades), 
others are much newer (five years or less) or are just 
receiving charitable status. To date, these organizations 
have provided critical medical equipment to 48 countries 

around the world (Fig. 1). The most common recipient 
countries were Haiti, Cuba, Guatemala, and the Philippines.

From simple frontline equipment (e.g. thermometers, 
blood pressure monitors, pulse oximeters) to more com-
plex and larger devices (e.g. x-ray, ultrasound machines) 
Canadian donations help address everything from basic 
healthcare to supporting a healthy community. Medical 
devices and consumables are the most commonly donated 
items, although clinical laboratory and dental equipment, 
and other items including pharmaceuticals, vehicles and 
computers, have also been provided as part of donation 
activities (Fig. 2a). Supplies and small, low complexity 
equipment are more commonly donated than large, highly 
complex devices (Fig. 2b). The survey presented the cat-
egories as options for the respondents, with examples for 
each category.  The respondents decided which category 
their equipment fell in to.

The scale of operations varied considerably across 
organizations in terms of the frequency and size of ship-
ments. There were also considerable differences in orga-
nizational structures and human resources. Most relied 
entirely on volunteers for day-to-day operations, with 
no paid staff. For example, one organization has a team 
of about 50 volunteers, with about half in the recipient 
country who receive small monthly stipends, and the rest 
in Canada or elsewhere. On the other hand, a minority 
of organizations have a mix of paid and volunteer staff 

FIGURE 1. Global distribution of recipient countries. Shad-
ing indicates number of surveyed Canadian organizations that 
send equipment to these countries. 



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Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
A Survey of Donor and Recipient Perspectives

(e.g., one having ten paid full-time employees and about 
40 volunteers, and another having one paid staff and a 
volunteer board of directors.

The next three sections summarize survey results on 
donor experiences related to three main phases of the 
donation process: consultation and communication with 
recipients, planning the donation process, and follow-up 
and monitoring. 

Consultation 

How Recipients are Chosen

Most organizations chose recipient countries organically, 
through personal connections or member suggestions. For 
example, two interviewees told stories of having visited a 
certain country where they noticed a great need. In one 

case, this experience led to the inception and founding 
of the organization. In many other cases, the recipient 
country reached out to an organization because of hav-
ing heard about their charitable work. Another model 
that emerged for recipient selection (at least three or-
ganizations) was the existence of a ‘sister organization’ 
in the recipient country that could act as a partner for 
the donation initiative. In one case, the recipient cannot 
always be controlled because the organization relies on 
volunteers to bring supplies overseas and to find a suitable 
recipient upon arrival. Unfortunately, when relationships 
are formed informally, they can also easily dissolve. For 
example, one organization said that they will no longer 
work with certain countries due to poor experiences that 
made them not want to go back.

Communication

Another key element of a donation initiative is com-
munication between all stakeholders involved. Fifty eight 
percent of 38 survey respondents said they communicate 
directly with the recipient hospital or clinic when planning 
a donation.  With these cases of direct communication, 
the recipient contact person varied and included people 
involved in receiving/distribution, medical directors, 
and Ministry of Health representatives. One organization 
has local volunteers in the recipient country (1 to 3 per 
hospital) that help coordinate the donations and provide 
training to healthcare staff at the recipient hospitals. 

For those Canadian organizations that do not com-
municate directly with the recipient hospital, their main 
point of contact was often another NGO working locally 
to coordinate the donation, or a sister or satellite branch 
of their own organization. Forty-seven percent reported 
communicating with a sister charity or organization and 
44% with an independent organization in the recipient 
country. Only 31% reported they correspond with govern-
ment officials in the recipient country. Other stakeholders 
included sister organizations in the US, religious groups, 
and equipment providers in the US. Sixty-one percent of 
organizations communicated with multiple stakeholder 
groups.

The most common mode of communication was email 
(94% of 35 responses), however in-person communica-
tion was also common (71%). Telephone was used more 

FIGURE 2. Percentage of organizations that reported donat-
ing (a) different types and (b) different sizes/complexity 
of equipment. In (a), the Other category includes mobility aids, 
pharmaceutical supplies and medicines, school supplies, vehicles 
(buses, ambulances), office furniture, computers, and funding (to 
support other organizations that donate equipment) (n = 41). In (b), 
the Other category includes medicines, vitamins and wound care 
supplies (n = 36).



Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
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J Global Clinical Engineering Issue 2:22-34; 2019  26

than Skype (54% versus 20%), which could be indicative 
of widespread use of cellphones in low-resource settings 
and poor internet connections. One organization said they 
use shared file systems as a mode of communication (e.g., 
Dropbox and Google Drive) when planning a donation. 
Seventy-four percent of organizations rely on more than 
one mode of communication.

Meeting Recipient Needs

One of the most important stages in planning a donation 
is determining the needs of the recipient. Our interviews 
revealed many different needs assessment strategies 
employed by donor organizations. One organization has 
a system in place where potential recipients can submit a 
‘wish list’ that the organization will try to fill. Another said 
they perform a thorough needs assessment and impact 
assessment in person every three months at each of the 
hospitals they work with; the organization’s founder speaks 
directly with the health care staff (doctors and nurses) in 
every ward and asks what they think they need more than 
anything else. From this feedback, they produce a list of 
the most needed pieces of equipment. Other organizations 
tend to respond to requests from recipients; one stated 
the needs assessment process is a long email exchange 
with potential partners in which they determine whether 
the partner is serious, credible, and capable of receiving 
a container and getting the equipment to work; another 
said that they identify needs through a doctor that has 
actually travelled to the country.

Two of the organizations interviewed deal exclusively 
in mobility devices. In one case, an advocate in the recipi-
ent community (typically a school principal, mayor, doc-
tor) prepares applications for each potential wheelchair 
recipient - hip size, length, what type of leg support is 
needed, etc. along with photos. The donor organization 
then works with the advocate who receives the shipment 
and coordinates getting the chairs to the right recipients. 
Another organization mentioned that they are not always 
able to match needs directly and, based on the available 
supply, will send a standard set of equipment in their 
shipments, whether the recipient country has indicated 
a specific need or not. 

Planning and the Donation Process
While many individuals and organizations are highly 

motivated to provide aid where needed, all donors face 
significant challenges with the logistics of the donation 
process. Unfortunately, for many donors, these challenges 
can prevent donations from reaching their intended 
recipients. 

Equipment Sources

Most organizations (62% of 37 responses) rely on 
several different sources for the equipment they donate 
to developing countries. For example, one organization 
stated in their interview that they collect equipment 
from hospitals, seniors’ homes, private homes, and group 
homes. Another said about 75% of the equipment they 
send overseas is sourced from the US, some of it brand 
new but acquired at a considerable discount. Based on 
the survey responses, medical clinics and hospitals were 
the most common source of equipment (about half of 
the organizations sourced equipment from such places), 
however manufacturers, second-hand equipment vendors, 
seniors homes, other non-profit organizations, institutions 
such as universities and colleges, and individuals (mainly 
from home care situations) were also listed as sources 
of equipment. Pharmaceutical and drugstore companies 
also donate surplus pharmaceutical products such as pain 
killers, flu medication and burn gauze that are fully FDA 
regulated, newly packaged and have six months or more 
until expiration.

Equipment Testing 

Once the equipment has been procured from their 
respective sources, some of the surveyed organizations 
conduct technical quality control and repairs before ship-
ping to the recipient (Fig. 3a). The most common check 
was for power compatibility (63% of 27 responses) and 
the least common was equipment calibration (30%). 
Fifteen per cent of organizations performed no testing 
at all on the equipment they donate. Only 13 organiza-
tions (43% of 30 responses) reported having a volunteer 
or staff biomedical engineer available, which may have 
implications for the level of technical testing that is pos-
sible before equipment is shipped overseas. For example, 
two organizations shared in their interviews that they get 



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Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
A Survey of Donor and Recipient Perspectives

volunteer technologists or engineers to inspect equip-
ment as a quality control measure before it is shipped. 
One international organization relied on a workshop in 
their US location for repairs; they also partnered with a 
repair shop in the recipient country so that repairs could 
be done locally. Due to limited time, resources, and capacity 
some organizations reported that they are simply unable 
to perform any equipment testing. 

Shipping

Most organizations surveyed (72% of 32 responses) 
send shipments in 20’ or 40’ foot containers by sea. The 
next most common form of shipping was via checked 
baggage of volunteers traveling to the recipient country 
(25%) followed by air freight (19%). Some organizations 
are able to send containers overseas monthly or every 
two months, while others send shipments annually. One 
organization estimated that they send 35 containers 
per year. It is also common that shipments are sent ir-
regularly, for example, whenever a container is filled or 
when volunteers are traveling overseas and are able to 
take donations with them. 

Shipping costs represent a major challenge for donor 
organizations when planning donations overseas. The 
surveyed organizations have reported shipping costs rang-
ing from $4,000 - $12,000 CAD per shipment. These large 
sums of money are mostly gathered through fundraising 
efforts and sometimes through grant applications. In other 
cases, organizations have negotiated agreements with 
shipping companies to waive fees, arranged for embassies 
of the recipient countries to cover the costs of shipping, 
or even used connections to arrange for free transport 
between warehouses. One organization reported that in 
their case the recipient assumes the cost of shipping and 
that it depends on the organization whether they organize 
the shipping details or not. In an effort to help reduce 
overall shipping costs, it was reported in an interview 
that a Canadian shipping company offers complimentary 
domestic shipping of wheelchairs from any Canadian 
city to Vancouver (to then ship internationally). Unfor-
tunately, donors often cannot transport the wheelchairs 
to the shipping company itself, so this service remains 
heavily underutilized. Another organization was able to 

arrange free air cargo transport of donations through a 
Canadian airline. 

FIGURE 3. Percentage of surveyed organizations providing 
different types of support (a & b) before and (c & d) after 
shipping a donation.  (a) Technical quality control prior to ship-
ping, including compatibility with line voltage/frequency of destination 
country, functionality, electrical safety, completeness of accessories, 
and checking calibration against manufacturer specifications (n = 
27). (b) Supplementary materials or services provided with donated 
equipment (n = 27). Other includes packaged goods, donations, cloth-
ing, funding to support sustainable projects, and biomedical engineer 
visitations. (c) Information collected from recipients after the donated 
equipment has been delivered (n = 36). Other includes installation, 
follow-up onsite visitations, ongoing usage reports, and patient data. (d) 
Post-donation requests from recipients for additional support (n = 20).



Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
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Customs

Once the equipment has successfully been shipped 
outside of Canada, the next major challenge is getting 
through customs. In addition to paying duties, differences 
in culture and infrastructure of the recipient country need 
to be considered. While some organizations prefer not to 
donate to countries if they are charged duty fees, others 
have partner organizations based in the recipient country 
who can negotiate the receipt of the equipment. Orga-
nizations that deal directly with customs have reported 
incidences of port officials expecting bribes or additional 
payment. For example, in one case an entire shipment had 
to be abandoned at the port because the cost of storage 
was greater than the value of the goods being shipped. 

Donating organizations have found that shipping items 
that are available in the local market, such as clothing, 
can introduce difficulties with customs clearance due to 
the impact these products can have on the local economy. 
One organization said they try to purchase goods locally 
whenever possible in an attempt to provide cash flow 
to the recipient country, helping the local economy in 
a different way and avoiding custom fees and shipping. 

Regulatory and policy considerations

Another challenge organizations face is deciding how 
to interpret Canadian Medical Device regulations drafted 
by Health Canada.9 As a result, some organizations have 
stopped donating altogether to avoid the issues of perceived 
liability. Others have created their own legal documents 
and have the recipients sign a medical release waiver 
when they accept the donated equipment.

Support for Recipients

In addition to donating medical equipment, many 
organizations provide additional support materials and 
services in order to ensure successful equipment usage. 
Operator manuals are the most common resource provided 
to recipients, but only about half of the organizations 
surveyed provide service manuals, spare parts, and dis-
posables (Fig. 3b). One organization told us since not all 
manuals are available online, it is difficult for recipients 
to find them, further exacerbated by downloading issues 
due to poor network connections. This could also explain 

why so few organizations (4% of 27 responses) make use 
of video-conferencing as an additional mode of support. 

Sending people overseas to help with the arrival, instal-
lation, and training of donated equipment is a challenge 
for many organizations due to the cost and time commit-
ment involved, but some (35%) are able to provide this 
extra support by one of the following ways:

• returning to the same country year-after-year and 
has established a three-week camp where they repair 
and help fit users to wheelchairs;

• providing training programs on how to use the equip-
ment once it has been donated, and has contacts 
affiliated with their organization in the recipient 
country that play an ongoing role with equipment 
use and support;

• sending a team of biomedical technicians overseas 
around four to five times a year along with service 
manuals, and ensures that the equipment is fully 
serviced before shipping it out;

• sending volunteers overseas to help set up equip-
ment (volunteers pay their own way).

Follow-up and Monitoring 
The final stage in the donation process is long-term 

monitoring in order to measure the effectiveness of the 
donation. We asked organizations about the information 
they gather from recipients after a donation has been made, 
and whether or not they receive any follow-up requests 
from the recipients. Most of the surveyed organizations 
(70% of 36 responses) request confirmation that the 
equipment was received and put into service, but only 
50% verify that it arrived in good working condition 
(Fig. 3c). Even fewer (36%) collect reports of equipment 
faults or failures after it is put into service. Seventeen per 
cent of survey respondents said they do not collect any 
information at all. 

We learned from the interviews that while some 
organizations request formal documentation or reports 
confirming receipt and/or functionality of equipment, in 
general the feedback that many receive is informal (e.g., 
thank you notes, pictures of the equipment at its final 
destination) and sometimes indirect (e.g., newsletters of 
recipient organizations). One organization we interviewed 



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Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
A Survey of Donor and Recipient Perspectives

was particularly committed to monitoring their effective-
ness. They had a public health specialist conduct a program 
evaluation, identifying what their organization was do-
ing well and where they were weak. Their commitment 
to data collection and transparency has helped them to 
improve their effectiveness as an organization. Another 
said they track each item they donate in case there is a 
manufacturer recall, in which case they are able to notify 
the recipient country. 

Another measure of the effectiveness of a donation 
is the extent to which the recipient requests additional 
support and/or materials (Fig. 3d). The most common 
follow-up request is for spare parts (which is consistent 
with our findings from the survey of recipients in Ghana 
summarized in 3.2 Recipient Perspective) followed by 
disposables and training. As discussed above, not all 
organizations include operator and user manuals with 
their donations, and so it is perhaps not a surprise that 
these manuals are often requested. Only three surveyed 
organizations (15% of 20 responses) reported that they 
did not receive any additional requests from recipients.

Recipient Perspective 
Surveys with stakeholders at 28 hospitals in Ghana 

provided valuable insight into the recipient perspective 
with respect to medical equipment donations. Note that 
not all of these hospitals necessarily received donations 
from Canadian organizations. 

Consultation

Communication 
An important element of the equipment donation 

process that we wanted to learn about was communica-
tion between donors and recipients, particularly when 
it came to the identification of equipment needs. When 
asked about the last donation received, 96% of respon-
dents reported that there was communication with the 
donor agency before the donation was shipped, and 86% 
reported that the donor discussed their needs or asked 
what their greatest needs were in advance. Equipment 
needs were requested or identified in several different 
ways, either through a form or survey given by the donor 
(18%), a wish list submitted in advance by the recipi-
ent hospital (18%), or simply via direct communication 

between the donor and hospital administrators (11%). 
In a couple of cases (7%), a representative of the donor 
organization came to the hospital to discuss the needs of 
the hospital in person. 

Meeting Recipient Needs
Two-way communication between the donor and 

recipient to identify needs prior to delivery is extremely 
important for a donation to be effective. 7% of respon-
dents added that this communication enabled them to 
make additional requests, some for very specific parts 
(e.g. fuses), allowing them to better operate medical de-
vices they already had. The communication of equipment 
needs, however, did not always result in needs being met. 
One hospital mentioned that despite supplying a list of 
needed equipment, those items were not included in the 
shipment. 11% said they were not consulted at all about 
the equipment they needed, and one hospital commented 
that they had received a “surprise package” 

Planning and the Donation Process

Equipment Testing
All recipient hospitals reported that donated equip-

ment typically arrives in working condition, however 
25% said they had received donations in the past that 
were missing accessories essential to the operation of the 
device, and 18% had received equipment that was faulty. 
For equipment that does arrive in working condition, 
61% of respondents estimated that it lasts less than two 
years before breaking down. Although 46% of hospitals 
said they can often repair broken equipment, repairs can 
take weeks or even months depending on the parts and 
or expertise required. 

Support for Recipients
Upon receipt of donated medical equipment, most donor 

organizations provide on-site installation of equipment, 
verification of functionality, and user training. On-site 
service training was less commonly provided (Fig. 4). The 
types of support provided were installation, verification, 
user training and service training with service training 
providing the least support (Fig. 4d) and verification the 
greatest support (Fig 4b). 

When asked about common problems encountered 
with medical equipment donations, the most common 



Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
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problem mentioned was a lack of spare parts (57%), fol-
lowed by lack of operating and/or service manuals (32%) 
and issues with consumables, either lacking or expired 
(21%). These percentages are based on responses to an 
open-ended question. For example, Figure 5 shows the 
percentage of recipients who reported that the received 
donations included spare parts, and whether spare parts 
were available locally. All responses were either some or 
none (Fig. 5).

Figure 6 shows that less than 35% of recipients always 
receive operating manuals, service manuals, consumables 
or accessories. Other common problems encountered in-
cluded: power issues (e.g., the equipment was meant for 
the wrong voltage, or was too sensitive to power fluctua-
tions), or the equipment was not durable or appropriate 
for the setting (e.g., the climatic conditions impaired the 
functioning of some equipment).

FIGURE 4. On-site support for donated equipment – Recipi-
ent facilities (n = 28) were asked if donor organizations provided (a) 
installation assistance, and (b) verification of functionality. They were 
also asked if donor organizations provided (c) user training, and (d) 
service training. Yes = blue, No = red. Recipient responses are given 
as a percentage.

Recipient Feedback
Recipients were also asked to describe in their own 

words what they thought could be done to improve the 
effectiveness of medical equipment donations to Ghana. 
The following are some illuminating responses:

• “Thorough needs assessments of beneficiary facili-
ties should be done. Equipment donated must meet 
these needs.”

• “All donations must go with initial user trainings and 
monitoring by the donors as to the functionality of 
the equipment.”

• “Should make available consumables and if pos-
sible link users to sources of this items they can be 
procured by users when it’s finished.”

• “Tax exemptions on these equipment. Removal of 
bureaucratic barriers.”

 Despite the challenges and common problems encoun-
tered, when asked whether donated medical equipment 
benefited their organization 100% responded positively. 
Donated electronic medical equipment allowed greater 
efficiency and accuracy for diagnosis, therefore reduc-
ing the burden on the nurses and staff, and allowing for 
better quality of care. 48% of respondents answered 
that donated equipment helped in cost reduction, with 
51% stating that donated supplies either reduced the 
burden on health care providers or helped with patient 
management. Furthermore, one of the facilities noted that 

FIGURE 5. Availability of spare parts.  Percentage of surveyed 
recipient hospitals (n = 28) that  reported (a) donations included spare 
parts, and (b) spare parts were locally available. Yes = blue, Some but 
not all = green, No = red. 

FIGURE 6. Support materials for donated equipment.  Per-
centage of surveyed recipient hospitals (n = 28) that reported receiving 
(a) operating manuals, (b) service manuals, (c) consumables, and (d) 
accessories with donated equipment. Yes = blue, Some but not all = 
green, No = red.  



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A Survey of Donor and Recipient Perspectives

medical equipment allowed for reduction in premature 
fetal mortality rates. 

DISCUSSION AND NEXT STEPS 
Over 40 organizations and hundreds of volunteers 

across Canada are involved in the donation of medical 
equipment to developing countries. We have found that 
these organizations varied considerably in terms of the 
size of their operation, the types of equipment donated 
and the processes they follow when carrying out a dona-
tion initiative. 

There are many resources available to help donor or-
ganizations effectively plan and execute all of the phases 
of a donation activity. 2, 10, 11, 12, 13, 14  These resources cover 
everything from deciding whether to donate to how to 
deal with international shipments to putting equipment 
into service at the recipient institution. A common theme 
in all the published guidelines on equipment donations 
is the importance of three core elements (Fig. 7): (a) 
consultation - ensuring that the needs of the recipient 
are well understood and have been established through 
communication with all parties involved; (b) planning 
and process - having a clear donation plan identified 
and agreed to in advance by all stakeholders, including 
comprehensive quality assurance assessments; and (c) 
monitoring and follow-up - developing a sustained and 
supportive relationship with the recipient institution, 

FIGURE 7. Three main phases of a medical donation pro-
cess. Consultation, Planning & Process, and Follow-up & Monitoring .

ensuring long-term success and impact We have created 
a video which clarifies the benefits of including these core 
elements in the donation process.10 

We have found through this study that many Canadian 
organizations find it challenging to adhere to such guid-
ance due to limited staff and financial resources. 

Donation Strengths and Opportunities for 
Improvement

Most Canadian organizations appear to be doing well at 
identifying needs and communicating with a wide range of 
stakeholders in the recipient country - including healthcare 
workers, representatives from the Ministry of Health, and 
sister or local charities - when planning a donation. The 
recipient survey corroborated this finding as well, with 
the majority of respondents reporting their needs were 
discussed with the donor in advance. There is also much 
evidence of how these different Canadian organizations 
are having a positive impact on the communities in which 
they work, for example, providing wheelchairs and other 
mobility aids to help people to become more active mem-
bers of their community, or training local staff to repair & 
maintain wheelchairs. Working with sister organizations 
in recipient countries helps the sister organization to 
continue actively working in their communities. Despite 
these strengths, however, there are still opportunities for 
improvement (Fig. 8).

In the area of planning and process, we found that 
donor organizations had limited written policies and 
procedures to guide and govern their operations (e.g., only 
one interviewed organization had developed standard 
operating procedures (SOPs), and very few had systems 
in place for documentation). Formalizing procedures is a 
widely accepted practice in well-run organizations. Docu-
menting every step in a process helps maintain quality 
and ensures that consistent practices are followed. (e.g. 
one organization uses a computerized inventory system 
such that boxes leaving a warehouse can be scanned and 
removed from inventory automatically; another organiza-
tion uses an online tool, Google Forms, to solicit and track 
equipment donations.)

Based on our survey, we found a general lack of com-
prehensive quality assurance testing before equipment 
is shipped. Recipients reported incompatible voltage, 



Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
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J Global Clinical Engineering Issue 2:22-34; 2019  32

faulty equipment, and missing accessories as common 
problems, which could have been mitigated with proper 
inspection and testing. The fact that 57% of organizations 
did not have a volunteer or staff biomedical engineer to 
help with testing represents an opportunity for the bio-
medical engineering community in Canada to become 
more involved and engage with donor organizations to 
help improve the effectiveness of donations. 

Canadian organizations can also improve when it comes 
to providing additional support with equipment dona-
tions in the form of operator and service manuals, spare 
parts, accessories and training. Spare parts in particular 
were the number one follow-up request from recipients 
(according to donors), and the number one problem 
encountered by recipients in Ghana. 

When it comes to monitoring and evaluation, in gen-
eral there is a lack of information sharing post-donation 
about short-term and long-term equipment functionality. 
This means that most organizations cannot measure the 
success of their donations or the impact they are having 
in the recipient countries. It was apparent from our inter-
views that organizations that have developed a long-term 
relationship with a particular recipient and return to the 
same location year after year are better able to monitor 
progress and identify issues, even without any formal 
feedback system. 

Donors should be formally requesting feedback, and 
recipients should be proactive in communicating how well 
things are working, so that both parties can mutually track 
donation effectiveness. This process is facilitated when a 

FIGURE 8. Four main areas of improvement for Canadian organizations to focus on: formalizing procedures through documenta-
tion, better equipment testing prior to shipping, better long-term support for recipients, and monitoring that includes evaluating donation impact.

long-term partnership is formed between the donor and 
recipient, and the donation is not a one-off transaction. 

The wide range of capabilities among donor organiza-
tions suggests an opportunity to share knowledge and 
best practices, so that they can learn from each other 
and better address the four areas for improvement as 
shown in Fig. 8.

Recommendations
Based on the disparities in practices observed in Cana-

dian donor organizations, and the disparities in resources 
available, it would be beneficial for all donor organizations 
to communicate and collaborate with one another when 

planning donations overseas (Fig. 9). There could also 
be opportunities to economize (e.g., sharing a shipping 
container), improve the matching of available equipment 
with known needs, or share resources (e.g., volunteers, 
engineering expertise), to improve the efficiency of op-
erations. It would also be beneficial for organizations to 
share their donation experiences and challenges with 
one another (positive and negative) so that others can 
learn from them, especially if they are doing something 
innovative. It may be beneficial to create a network for 
such communication, for example many Internet based 
tools are available that could facilitate building such a 
community for the sharing of information.



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Bradley, Yoon, Zahedi, Adusei-Poku, Zienaa, Adjabu, Cheng, Gentles: Medical Device Donation Practices in Canada:  
A Survey of Donor and Recipient Perspectives

Lastly, since many organizations do not have the 
resources or volunteers available to travel to recipient 
destinations to help with equipment installation, training 
and maintenance, innovative solutions to the challenge of 
long-distance equipment support and maintenance are 
needed. While most organizations are able to use email 
for basic communications, other tools such as WhatsApp, 
Viber, or file-sharing applications such as Dropbox or 
Google Drive, which are not bandwidth-heavy or do not 
require constant internet connections, could be used 
more frequently to help plan and support donations and 
share resources.

CONCLUSION
Thanks to the generous donations of Canadian chari-

ties and non-profit organizations, almost 50 countries 
around the globe have received critical medical equipment 
to help improve the delivery of healthcare and support 
healthy communities. Through this study, we found that 
these donations have provided everything from simple 

FIGURE 9. Donation Community in Canada. Individuals, groups 
of volunteers, and small and large organizations across Canada col-
lectively have valuable knowledge and experience that could benefit 
others engaged in donation work. Better communication, collabora-
tion, and sharing of resources and expertise among these groups 
could lead to more effective donation practices for everyone and 
better impact globally.

frontline equipment such as blood pressure monitors and 
pulse oximeters, to MRI and x-ray machines.. The dona-
tion process presents challenges to donating organiza-
tions, most significantly in shipping equipment, passing 
customs barriers, ensuring compatibility of equipment, 
and providing support for recipients. Based on our in-
terviews with hospitals in Ghana, the most prominent 
recipient challenges include a lack of spare parts, access 
to service manuals, and replenishment of consumable 
items. To overcome the challenges for both parties, suc-
cessful donor practices include consultation with recipient 
countries to ensure needs are met, careful planning of the 
entire donation process to provide a clear plan, and finally 
monitoring and follow-up to facilitate long term success. 
We strongly believe that more effective collaboration and 
communication between Canadian donor organizations 
would reap tremendous benefits for recipient countries, 
and create opportunities to economize and improve the 
effectiveness of medical equipment donations.

ACKNOWLEDGEMENTS
Project partners include: The International Outreach 

Committee of the Canadian Medical and Biological Engi-
neering Society (CMBES); Food for the Hungry, Canada; 
Centre for Global Engineering, University of Toronto; and 
the Ghana Biomedical Engineering Association (GBEA), 
with whom the CMBES has had an ongoing partnership. 
Shahrzad Mirzazadeh is acknowledged for conducting the 
survey and interviews in Canada. We gratefully acknowl-
edge all the Canadian organizations that participated 
in our survey and/or interviews, as well as the health 
professionals in Ghana that provided responses to our 
recipient survey. This work was carried out with the aid 
of a grant from the International Development Research 
Centre, Ottawa, Canada. 

COMPLIANCE WITH ETHICAL STANDARDS

Ethical approval
Informed consent was obtained from all individual 

participants included in the study.

Conflict of interest
The authors declare that they have no conflict of interest.



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