The World Health Organisation yesterday called for the rational use of and greater accessibility to medical devices after finding that people around the world are being excluded from the benefits of livesaving devices.
"This is a challenge we need to address," said Dr Margaret Chan, directorgeneral of the WHO.
She was speaking at the First Global Forum on Medical Devices, which brought 350 leading health experts from more than 100 countries to Bangkok to review new evidence and agree to ways to improve developing country access to lifesaving medical devices.
Today about 10,500 types of medical devices are on the market, ranging from highcost, hitech diagnostic and therapeutic equipment such as linear accelerators to treat cancer, to stethoscopes and other basic technologies that help doctors and nurses provide healthcare on a daily basis.
Some of the devices help improve millions of people's lives such as wheelchairs, hearing aids, eyeglasses, pacemakers and prostheses.
A new WHO study, "Medical Devices: Managing the Mismatch", and a survey that has so far mapped medical devices in 140 countries, reveal that too many people are excluded from their benefits.
Sales of medical devices worldwide were estimated at about US$210 billion (Bt6.5 trillion) for 2008, with fourfifths of that coming from the Americas and Europe. The ongoing WHO survey reveals that the average availability of computed tomography (CT) scanners is one per 64,900 people on average in highincome countries, but one per 3.5 million people in lowincome countries. Ten countries have so far reported to WHO that they have no radiotherapy unit at all, depriving almost 100 million people of access to cancer treatment.
"Affordability is one problem," Chan said.
Worldwide, annual government expenditure on health ranges from well over $7,000 per person to less than $10. The low level of expenditure on health in general leads to low 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 sterilising equipment mean that up to 40 per cent of injections are unsafe.
A second problem is that most medical equipment used in lowresources settings is imported or donated from industrialised countries. Many of these devices do not function properly.
The third problem is lack of capacity. 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.
Chan also addressed the fourth challenge - single naming, or the harmonising of regulatory processes and universally standardised medical devices. This is often exacerbated by the lack of effective management of medical devices at the government level within healthcare facilities.
The fifth issue is the need to focus more on ensuring that medical devices fulfil their potential to improve public health. This means increasing access to the devices that are required to deliver basic services - bloodtransfusion equipment to prevent women experiencing complications in labour from bleeding to death, anaesthesia machines, oxygen supplies and basic surgical equipment.
It also means addressing new challenges in public health, notably the ongoing rise of chronic illnesses such as cardiovascular disease, stroke, cancers and diabetes, and providing medical devices enabling patients to selfmonitor their health.
"To have a public health impact, devices need to be safe, affordable, accessible and appropriate," Chan said.
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 specialised training. These include such devices as simple glucose meters and test strips for diabetes patients that perform well even in hot and humid homes.
"Medical devices require and deserve their own unique agenda," she said.
Dr Yot Triwattananont, of Health Intervention and Technology Assessment, said Thailand was facing a problem with the distribution of medical devices. Most essential devices are available only in Bangkok and most medical devices are imported, such as PET (positron emission tomography) CT scanners, which are used to diagnose cancer, heart disease and brain disease.
This machine costs Bt800 million and there are only five in the country. The price for using one runs Bt50,000Bt60,000. That is why people could not access this medical device, he said.
"We found that Thailand has more of these machines than the United Kingdom. There were a lot of orders to import this equipment in the past, but they were just installed in the hospitals and are not functioning," he said.