Recently, I’ve seen a few interesting pieces about the wisdom of donating used medical equipment to the developing world. The idea that it is acceptable and welcome to send one’s discarded or unwanted stuff (clothes, food, medical supplies. etc.) to those who have little is widely accepted. Many organizations have taken this approach to address several issues. In some cases, it works incredibly well, including: Toys for Tots, foodbanks, and Goodwill. But, in all of these cases, these organizations have policies or procedures in place to insure that only high quality products reach the beneficiaries.
– Toys for Tots distributes only new toys because it is “legally not feasible to distribute dangerous or dirty toys” and because one of the principle goals of the program is to “send a message of hope” and “this goal cannot be accomplished through ‘hand me down’ toys.”(1)
– The Greater Boston Foodbank provides a list of the most desirable food items to donate and list guidelines for donations, including having “tolerance for expired foods but they must be no more than 3 months past expiration.” (2)
– Goodwill screens all donations against a system of quality and selection criteria and in addition to asking for items in good, working condition also have a list of items they will not accept. (3) Given that these items are then sold, albeit at reduced rates, the market and customer preference also play an integral role in what reaches beneficiaries.
Criteria like are even more important when dealing with issues of medical equipment for the plain fact that these items are integral to life and death. Moreover, programs that donate items to a foreign country, with significantly different infrastructure and resource requirements and a different cultural context, must consider carefully the impact that donations may have.
The Tina Rosenberg’s commentary in the NYT online Opinator Blog highlights a few programs taking this approach. The home page for Doc2Dock reads “Here we waste supplies, there they could save lives,” the organization redistributes the waste from US hospitals, including “unused, sterile medical supplies discarded for regulatory reasons and fully functional equipment.” A similar organization, MedShare collect “surplus medical supplies and equipment from landfills and incinerators that, for various regulatory reasons, hospitals and medical companies must discard.”
In addition to wondering about the US policies that encourage waste, these programs bring up a few concerns, based on my experience in the developing world. Practically, I wonder if the products that are sent are actually appropriate for the context in which they will be used.
– Infrastructure: Does it require constant electricity? What if there are surges? What does the plug look like? Does it require water?
– Logistics: Does it require consumables? Are those readily available? Are replacement parts available? Are the products safe?
– Human capacity: Does proper use require training? What level of professional is needed to use it? Is that training available? If it’s not used properly what safety issues may exist? Will anyone know how to fix it if it breaks?
A number of these concerns as well as the question as to whether these donations are impacting the market in the same way that clothing donations can (remember the 100,000 t-shirts controversy?) have been raised. At TEDxChapelhill, Dr. Robert Malkin gave an interesting talk about how “donations hurt” focusing on these questions and the issue of lack of communication between donors and recipients and lack of accountability from donors There is also a concern that perhaps these donations will prevent the success of local device manufacturing. These are not new issues, and in fact in 2000 the WHO issued Guidelines for Health Care Equipment Donations that still ring true, highlighting four principles of a good donation:
1) Health care equipment donations should benefit the recipient to the maximum extent possible;
2) Donations should be given with due respect for the wishes and authority of the recipient, and in conformity with government policies and administrative arrangements of the recipient country;
3) There should be no double standard in quality. If the quality of an item is unacceptable in the donor country, it is also unacceptable as a donation;
4) There should be effective communication between the donor and the recipient, with all donations made according to a plan formulated by both parties.
While there is much good that can be done with donations, we must continue to be mindful about how they are done. It is of paramount importance to create real partnerships in order to understand the context of the people and place, the needs and constraints of the time and situation, and to foster a long-term relationship in which dialogue exists to address the inevitable mistakes that will be made and issues that will arise. This kind of work is not done when the contained is loaded, the ship sails, or donation arrives. It requires commitment and collaboration in order to be successful.
(1) TFT 2006 Local Campaign SOP 10-2-06