Medical appliances are essential for healthcare delivery, yet their performance is often compromised in resource-constrained settings. In SubSaharan Africa (SSA), healthcare facilities face high rates of equipment underutilization, driven not only by limited electricity access but also by the unsuitability of medical devices for low-resource environments.
A new report, developed by Sustainable Energy for All (SEforALL) and CLASP, explores how energy-intensive, wrong sized, and poorly maintained medical equipment undermines healthcare services, with a focus on findings based on direct measurements as well as interview-based anecdotal evidence from 29 facilities in Kisumu County, Kenya.
Key findings
The availability of medical equipment does not ensure functionality. Devices such as autoclaves, oxygen concentrators, and infant warmers (also commonly known as resuscitaires) – although present in many facilities – are frequently idle due to high power consumption, sensitivity to voltage fluctuations, poor equipment quality or inadequate technical support. Monitoring data from the facilities studied revealed inconsistencies between manufacturer-rated power and actual energy use, indicating inefficiencies and operational challenges. In many facilities, alternative devices like oxygen cylinders are favored due to their simplicity and independence from power supply.
Many medical appliances are unsuitable for weak-grid and off-grid conditions. Over 45% of devices assessed were incompatible with local power infrastructure, either due to voltage requirements or durability issues. Power instability leads to frequent equipment breakdowns, while the lack of appropriate maintenance access to spare parts further reduces uptime. As a result, essential appliances are often stored rather than used, creating medical equipment graveyards and contributing to the growing burden of e-waste.
Donation practices and procurement systems exacerbate the problem. Up to 70% of donated medical equipment in low- and middleincome countries (LMICs) is unused. Donated devices often arrive without prior consultation, are mismatched with facility needs, or are delivered without training or ongoing maintenance and support infrastructure. Procurement decisions prioritize cost savings over efficiency and usability, often overlooking the long-term performance, maintenance requirements, and energy implications of medical equipment.
Inefficient devices increase costs and limit service delivery. Energy-inefficient appliances raise operational costs and strain fragile power systems. In response, some facilities limit the frequency of equipment use—such as sterilizing instruments biweekly—to reduce energy bills. Meanwhile, nearly all of the 29 health professionals interviewed stressed the importance of acquiring energy-efficient appliances to ensure consistent service delivery during power outages and minimize operating expenses.
Local innovation and testing capacity are underutilized. The African region has emerging potential for local manufacturing and adaptation of medical equipment tailored to lowresource settings. However, these efforts are hindered by bureaucratic hurdles, lack of financial support, and weak regulatory frameworks. Even promising locally produced devices, such as ventilators or patient monitoring systems, often struggle to commercially scale due to fragmented policy and procurement landscapes.
Targeted policy interventions and procurement reforms are urgently needed. The report recommends the development of minimum energy performance standards (MEPS), and quality assurance frameworks tailored to energy-constrained environments. Establishing testing labs and supporting capacity building for biomedical engineers are key strategies. Priority should be given to procuring energy-efficient, context-appropriate medical appliances designed for durability, low maintenance, and compatibility with decentralized energy systems.
Ultimately, effective healthcare in SSA requires more than electricity—it requires the right equipment. Ensuring the suitability, efficiency, and maintainability of medical appliances is critical to improving health outcomes, reducing waste, and enabling sustainable, scalable healthcare delivery in low-resource settings. Addressing these challenges at the intersection of design, policy, and practice is essential to realizing the full potential of medical technology in advancing public health across the region.
Reliance on diesel generators is prevalent. All the healthcare facilities assessed during the study are grid-connected; however, the majority rely on diesel generators as a secondary power source due to frequent grid instability and outages. Given the critical nature of continuous power supply in clinical environments— where medical devices such as oxygen concentrators, incubators, and diagnostic equipment must operate without interruption to ensure patient safety—diesel generators remain the dominant form of backup. Despite their operational reliability, diesel generators pose significant environmental and operational challenges, including high fuel consumption, greenhouse gas emissions, and increased maintenance requirements. Their continued use underscores the urgent need for resilient, cleaner energy alternatives capable of delivering stable and uninterrupted power in resource-constrained healthcare settings.
Excerpt of: Medical appliances for resource- constrained settings: Strategies for context-aware, energy- efficient and scalable healthcare solutions (SEforALL / CLASP 2025)