Assessment of the medical equipment supply chain in the Democratic Republic of Congo: a qualitative methods study

Efforts to improve health-related supply chains in the Democratic Republic of Congo (DRC) have typically focused on medicines and vaccines, while medical equipment has often been either overlooked or considered incidental. While national guidance exists on the procurement, maintenance, and reporting on medical equipment, the extent to which these norms are implemented in practice is unclear. This study qualitatively assessed the design and operational functioning of the medical equipment system in the DRC, with a focus on information systems, procurement processes, maintenance, and depreciation, and examined how roles and responsibilities shape equipment availability and functionality at health facilities. A qualitative research design combined a desk review of national policies and in-depth interviews with key stakeholders at health facilities, health zone offices, provincial health departments, the Ministry of Health, and developmental partner organizations in the DRC. Interviews were analyzed using a hybrid approach of content and thematic analysis. Findings revealed several weaknesses in the medical equipment system in the DRC. Many health facilities, particularly health centers, lacked the minimum required equipment, which adversely affected the quality of services provided. Responsibility for equipment procurement and maintenance was not clearly defined, leading to a lack of accountability and coordination. We identified a disconnect between data availability, resource mobilization, and decision making within the health system. Both equipment procurement and maintenance were governed by unclear and fragmented processes. Overall, the medical equipment system in the DRC is not designed to meet population needs, and in practice the system is not functioning as designed, which contributes to inadequate availability and maintenance of equipment in health facilities. Based on the barriers identified, recommendations include establishing a formal process to keep facilities informed of equipment requests as well as exploring regular planning and budgeting exercises for equipment procurement. The potential benefits of subsidies for equipment purchases, in certain cases, are also highlighted. The findings from this study offer a blueprint for assessing medical equipment systems in low-income countries, highlighting the importance of this often-overlooked component of quality health services.