Access to medical technology saves lives. How can we make it more accessible in low- and middle-income countries?

The medical device sector is large, diverse, competitive, and highly innovative, but these devices are not reaching people around the world equally. From wheelchairs to blood tests, ultrasound machines and more advanced imaging tools, availability is often highly limited in low- and middle-income countries, putting another barrier in front of people’s ability to access impactful health care.  

As governments, development organizations, and other stakeholders focus on what’s needed to reach the UN Sustainable Development Goals for health, part of success requires identifying what’s undercutting access to affordable health care—including medical devices that make lifesaving diagnoses—and putting in place a strategy for overcoming this.

Why access to medical devices matters

Making medical technologies more widely available is a necessary part of making health care accessible and effective.

Take diagnostics, for example: Only 19% of the people in low-income and lower-middle-income countries have access to the simplest of diagnostic tests. The Lancet Commission has estimated that 1.1 million deaths in these countries could be avoided just by improving diagnostics for six conditions: diabetes, hypertension, HIV and tuberculosis in the general population, and Hepatitis B virus infection and syphilis among pregnant women.

What is the impediment to expanding access?

One reason is that in many countries, these devices must be imported -- often from the US, Europe Japan, and China – making them more costly because of the added expenses of transportation, distribution, and limited access to hard currency. Depending on imports also puts health systems in developing countries at risk during times of crises, when countries may keep supplies for themselves or when supply chains break down, as happened during the COVID-19 pandemic.

When equipment is available, keeping it working can be challenging because of a lack of trained staff, replacement parts, or repair technicians. In addition, complex machines designed for the temperature-controlled comfort of developed nations may not work as well in the heat, humidity, and other challenging conditions in poorer regions.

Finally, not all developing countries have the necessary regulations for using advanced medical equipment from other countries. According to Global Health: Science and Practice, because many African countries don’t have the resource and knowledge to regulate certain medical devices, countries often rely on European or US regulatory bodies’ approvals or clearances, which were not designed to meet local needs and issues, and the compliance costs can be prohibitive for local manufacturers.

Solutions for local needs

Overcoming these challenges requires a multidimensional approach, but identifying routes for investing in the local manufacture of medical devices should be a first step. Localizing production – which can include setting up regional production centers that can be supported through diverse and closer supply chains – is a necessary part of improving access to care in lower-income countries. Expanding production in these markets also helps support local research and development, which can spark new solutions that directly target local clinical and market needs.

The path isn’t straightforward and there are numerous complexities, which is why IFC, together with the World Bank, is working with partners, among them the World Health Organization, to help public and private stakeholders identify what’s needed to support regionalized solutions. A big challenge is that complicated technology often requires long lead times and major commitments of research and development dollars. And manufacturers setting up locally will need to know that there is an ongoing market for these devices.  

This does not mean that investors and manufacturers need to wait. The initial focus can be on producing less complex products, such as personal protective equipment and other medical consumables. Items like syringes and bandages, offer the most direct opportunities for scaling up local production and improving supply chain security. Revital Healthcare, a Kenyan medical supply manufacturer launched about 15 years ago, is now one of the continent’s largest manufacturers, employing more than 650 workers and producing 45 different devices, some for export.

Another route is to focus on assembly of products. High demand for medium-complexity devices such as patient monitors and electrocardiogram machines offers opportunities for moving the final steps to emerging markets. Recently, Ethiopia launched the first ultrasound assembly plant in Africa. Besides local assembly, there are market opportunities via technology transfer, joint ventures, and foreign investments that could further help develop local capacities.

It should come as no surprise that the World Health Organization has issued an urgent call to action: Governments and private entities must work closer and coordinate their efforts to improve and invest in the local production of health supplies and medical technology.

Here at the IFC, we’re urging stakeholders to collaborate and discuss the challenges they face in localizing production and the solutions needed, so we can help bring about sustainable and resilient health systems. We cannot wait until the next crisis. We must act now. 

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