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The Problem

"Those who need care the most are the least likely to receive it”
(The Inverse Care Law – Tudor-Hart 1971).

  • Of the 7.6 million childhood deaths that occur annually, 99% are in the developing world.
  • 3.1 million children die in the first month of life 1.
  • Every year 3.2 million babies are stillborn and up to 40% of newborns die in the first 2 days after birth which are linked to complications during birth 2.
  • Many complications during birth are preventable with safe birth practices. A critical measure to identify which babies are at risk is the fetal heart rate during labour.
  • Over 80% of infant deaths are due to an acute illness including children with pneumonia or newborn complications including preterm birth or asphyxia 3 , many of whom are hypoxic and should receive oxygen therapy.
  • Globally there is a critical shortage of healthcare workers although the need is unequally distributed. A healthcare worker in Guinea is expected to meet the needs of 7,143 people. In contrast, a healthcare worker in Norway will be responsible for only 53 people4 .
  • Sub-Saharan Africa has only 10% of the healthcare workers for its population that Europe has.
  • Only 10% of the world’s health research focuses on the health problems of the developing world, even though those countries are burdened with 90% of the world’s disease.
  • While health systems, healthcare workers, infrastructure and supply of drugs receive much attention, only recently has there has been recognition of a critical gap in need-driven technology and equipment in providing quality care.
  1. United Nations Inter-agency Group for Child Mortality Estimation. 2011.Levels & Trends in Child Mortality. United Nations Children Fund, New York.
  2. Lawn,J.E., Lee, A.C.C., Kinney, M. 2009. Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done? International Journal of Gynecology and Obstetrics; 107: S5-S19
  3. Black, R.E., Cousens, S., Johnson, H.L., et al. 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis.
  4. Watt, P., Brekci, N., Brearley, L. and Rawe, K. 2011. No child out of reach, time to end the health worker crisis. Save the Children UK, London. 

Problems with medical equipment in developing countries

  • Most hospitals in developing nations have a “graveyard” of unused medical technology because they are too complex and require specialized training, or are not working because of lack of maintenance or replacement parts.
  • Development of medical devices is driven towards increasingly complex, consumable, expensive equipment, targeted towards a global market where 78% of spending is for countries that carry only 2% of the global burden of disease.
  • There is consistent evidence that much of the medical equipment which is currently employed in primary and secondary health care settings in poor countries is inappropriate and unfit for purpose.

Specific problems with existing medical technology include:

  • Too fragile – unable to cope with robust user behaviour, high temperatures, humidity, dust, etc.
  • Too complex – most health professionals have no training in the use of advanced medical technology
  • Too sophisticated – inappropriate design specifications for low resource settings
  • Dependent on uninterrupted mains power – even large hospitals may have frequent power outages and small facilities may have no mains power
  • Dependent on consumables such as probes, sensors, replacement batteries etc. which are expensive and unavailable in many low resource countries
  • No reliable support services for maintenance, repair, recalibration and updating
  • Too expensive

The net effect is that there is a gross shortage of working and suitable medical devices across hospital and clinic services in most poor countries.