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UN convenes meeting on access to medical devices in poorer countries


Health experts from more than 100 countries gathered in Bangkok today under the auspices of the United Nations World Health Organization (WHO) to discuss ways to make life-saving medical equipment more accessible to people in developing countries.

“The medical device industry holds great promise for public health, sometimes spectacular promise, sometimes seductive promise,” Margaret Chan, the WHO Director-General, told the more than 350 experts meeting in Thailand’s capital.

“Health officials and hospital managers in all countries, at all levels of development, need guidance. We are also holding this forum because the unquestionable benefits of medical devices are so unevenly and unfairly distributed,” she added.

There are currently an estimated 10,500 different types of medical devices on the market, according to WHO. They range from high-cost, high-tech diagnostic and therapeutic equipment such as linear accelerators to treat cancer to stethoscopes and other basic technologies that help doctors and nurses provide health care on a daily basis.

Some of the equipment, such as wheelchairs, hearing aids, eyeglasses, pacemakers and prostheses improve the quality of life for millions of people.

However, according to a new WHO study and an ongoing survey that has so far mapped medical device use in 140 countries, too many people are currently excluded from their benefits.

Revenue from sales of medical devices worldwide was estimated at around $210 billion in 2008. Four fifths of that revenue came from sales in the Americas and Europe. The ongoing WHO survey shows that the average availability of computed tomography (CT) scanners is one per 64,900 people on average in high-income countries, but one per 3.5 million people in low-income countries.

Ten countries have so far reported to WHO that they have no radiotherapy units at all, depriving almost 100 million people of access to cancer treatment.

Affordability is one problem. Worldwide, annual government expenditure on health ranges from well over $7,000 per person to less than $10. Low levels of expenditure on health in general lead to low levels of expenditure on medical devices. This, in turn, leads to inadequate investment in all forms of medical devices. In some countries, shortages of needles, syringes, and sterilizing equipment mean that up to 40 per cent of injections are unsafe.

A second problem is that most medical equipment used in low-resource settings is imported or donated from industrialized countries. Many of these devices do not function properly.

In many areas, devices are not used to full effect because of erratic power supplies, uncertain water quality, a shortage of health personnel, limited training capacity, difficulties in getting spare parts, and poor or inadequate maintenance.

There is also the challenge of the absence of a single naming system, harmonized regulatory processes and universally standardized medical devices. This is often exacerbated by the lack of effective management of medical devices at government level and within health-care facilities.

To have public health impact, devices need to be safe, affordable, accessible and appropriate. The new study highlights the advantages of technologies that use alternative power supplies, resist heat, humidity, and dust, relieve the workload, require little maintenance, and can be operated, with no risk to patient safety, by personnel with little specialized training.