As global sustainable development organisations, we have a responsibility to our global south partners to ensure we are listening. Donating can be an effective way to get supplies and resources to those who need them, but this requires a collaborative approach, not only sending what we think might be helpful, but ensuring it will be helpful. Donating anything, especially to those in the global south who face the worst environmental impacts, needs thoughtful and ethical consideration to ensure it provides an overall benefit. Even with the best of intentions, when we don’t work closely with partners, we can often send items which are unusable and ultimately end up creating more harm than good. However, donating can be complex and lacking accessible guidance makes it difficult for organisations to do the diligence required for the most beneficial donating.
What about medical equipment and supplies donations?
Donated medical equipment is often at the heart of patient care in many hospitals across Low-and-Middle-Income Countries (LMICs) and safely donated medical equipment can save lives and give health professionals throughout LMICs the tools they need to deliver quality care. However, the donation of medical equipment is complex and dealing with donated goods comes with risks and difficulties to both the donor and the recipient.
The World Health Organisation estimates that up to 70% of donated equipment is non-operational.
Dr Tatian Muwanga from KidsOR, a Scottish global health charity, explains their work and the considerations which must be made.
“Our mission and vision, and the work that we do gives us a unique privilege and power, as we are a leading and future oriented charity working in a space of great need that is yet to be prioritized for financing by LMIC countries, aid donor countries, and philanthropists. As such, ethical principles are at the core of our work in all aspects of our intervention including our engagement with patients, LMICs, and donors.
Our work is aligned with the health systems strengthening agenda. Veering from the broader vertical programming agenda that has come to define global health interventions, all our work is nested within, and not parallel to the health system. In addition, our work embraces cross cutting themes such as gender equity, climate change mitigation and adaptation, and healthcare facility electrification.
Stories abound in global health, of well-wishers often from the Global North, donating medical equipment to health facilities in the Global South that is old, out of service, broken, or outright impractical for the setting. The old, out of service of broken equipment usually does not meet use criteria in the donor countries but will be utilized for healthcare in recipient countries often putting patients at risk of harm. Equipment that is impractical for the setting usually is utilized when donors offer support such as maintenance costs or supplies that often ceases when donors leave. This usually results in pauses to healthcare delivery which can impact patient outcomes negatives when said equipment stops function.
Kids Operating Room (KidsOR) installs only brand new paediatric surgical equipment. We also ensure that supplied equipment is in line with country essential equipment lists so that national medical stores can maintain supplies beyond the three-year project support period that we usually provide. We also offer biomedical engineering support during the three-year period, including supplying a maintenance kit for hospital biomedical engineers to use in case of any required support as well as offering trainings for the biomedical engineers to be able to handle any maintenance challenges including beyond our support period.”
In Spring 2021, the Chief Medical Officer for Scotland commissioned KidsOR to lead a review of the standards required for donations of medical equipment to LMICs with the aim to ensure Scotland is at the forefront of good practice when donating overseas.
The review found that there is a wealth of good advice available but it is difficult to find and/or digest, particularly for smaller organisations. It identified the need for a short user-friendly guide to take donors through the key steps of making a donation, signposting to key guidance and exploring an education and training offer for Scottish stakeholders involved with donations.
The published 10 Step Guide provides a clear roadmap through the important considerations for a safe and effective donation. It is for anyone in Scotland involved in the donation of medical equipment to LMICs. The Guide does focus on the donation of medical equipment specifically however the key messages are also applicable to other types of donated equipment e.g. consumables, rehabilitation and therapeutic equipment.
Feedback from the review’s focus group participants within and outside Scotland on the 10 Step Guide:
- “I never considered that not providing the donation may sometimes be the best option”
- “I hadn’t thought about what happens at the equipment end of life”
- “It made me think about communication with partners and what is actually useful”
This review highlights ethical considerations and questions the risks and environmental considerations on shipping waste to LMICs.
“The 10 Step Guide will make sure we are at the forefront of best practice where the donation of equipment can be done safely and effectively. It will also encourage potential donors to consider alternative forms of support where this is more appropriate.” (Professor Sir Gregor Smith, Chief Medical Officer for Scotland)
Join our event on 20th Mar 10-11.30am to hear more about responsible and ethical donating and helpful ways to ensure you are being the most effective partner you can be.