Application of Science and Technology Studies to Global Medical Device Donation Policy

In low and middle income countries, the World Health Organization estimates that nearly 80% of medical devices and equipment are procured through donation (WHO 2000). While these donations have the potential to play a critical role in the recipient communities’ health, the donated devices sometimes fall short of their potential due to improper use or lack of support—despite the existence of a variety of guidelines and regulations for medical equipment donations. While conducting volunteer biomedical equipment technician work in Guatemala and Uganda, I came to notice the disparity between the guidelines and the reality on the ground. This study aims to identify and address the underlying processes and attitudes fueling this disparity using critical frameworks from the discipline of Science and Technology Studies: critical innovation studies, maintenance studies, feminist technoscience, and discard studies. This is a multi-sited mixed-method study incorporating nearly three cumulative months of fieldwork in various healthcare facilities throughout Guatemala and Uganda. Interviews with a variety of stakeholders in Uganda and the US were iteratively coded using qualitative analysis software (MAXQDA). Analysis was based in grounded theory to bring forward the lived experiences of all stakeholders. In order to improve existing donation policies and guidelines, a number of tenets of “useful donations” are identified. These include continuous and multidirectional dialogue, ethics of empowerment and care, and emphasis on long-term system-level change. By situating the analysis in the specific contexts and struggles of my research sites, the conclusions take into account the existing infrastructural and maintenance systems. Despite the study design’s specificity, the conclusions are applied to the larger context of organizational and governmental policy for donations, community health, engineering, and advocacy.