Medical Equipment Management and Failure Factors in Ethiopian Teaching Hospitals: A Survey-Based Study of Systemic Challenges and Operational Gaps

Medical Equipment Management and Failure Factors in Ethiopian Teaching Hospitals: A Survey-Based Study of Systemic Challenges and Operational Gaps | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Medical Equipment Management and Failure Factors in Ethiopian Teaching Hospitals: A Survey-Based Study of Systemic Challenges and Operational Gaps Esubalew Belay Yihunie, Beshatu Debala Wako, Anteneh Mekuria, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6735317/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Background : Frequent failures of medical equipment and poor management practices remain major obstacles to effective clinical service delivery in developing countries. This study examines the key factors contributing to medical equipment failure and the common challenges in equipment management system within Ethiopian hospital settings, aiming to inform national policy makers and enhancing the performance of healthcare technology management in the healthcare ecosystem. Method: A facility-based cross-sectional study was conducted from September to December 2024 in seven university hospitals in Ethiopia. The study assessed medical equipment management and key factors contributing to equipment failure using structured data collection tools and a double data entry process to ensure accuracy. Trained personnel collected data across all sites. The result was reported using descriptive statistics. Result: This study investigated core challenges related to medical equipment management and cause of equipment failure across study sites. Among the identified causes of equipment failure, delays in spare part procurement (100% hospital agreed), emerged as the most critical issue in Ethiopian teaching hospitals. This was followed by shortage of maintenance budgets, absence of spare parts, and maintenance skill gap each reported by 85.71% of the hospitals. Electric Power fluctuations and a lack of training (57.14%), equipment mishandling by users (more than 50%) and inadequate maintenance tools contains (28.57%). Conclusion: This study highlights critical shortcomings in medical equipment management in Ethiopian teaching hospitals, identifying key technical and organizational factors contributing to equipment failure. Addressing challenges such as spare part shortages, limited maintenance budgets, inadequate technical capacity, power fluctuations, and inefficient procurement practices is essential for improving equipment reliability and clinical service delivery. The findings emphasize the need for systemic and nationwide reforms to improve equipment utilization, strengthen healthcare infrastructure and service quality. Medical equipment management Equipment Failure factors Systemic challenges Teaching hospitals Healthcare technology Operational gaps Low and middle-income countries Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background In the healthcare technology landscape, medical equipment plays a vital role in disease diagnosis, patient monitoring system, effective healthcare delivery, and overall patient care management [ 1 , 2 , 3 ]. This medical equipment includes a broad spectrum of tools, ranging from basic instruments like thermometers to advanced technologies such as mechanical ventilators, heart-lung machines, X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and the like. The proper functionality and availability of such equipment in hospitals significantly enhance diagnostic accuracy, treatment efficiency, patient safety, and ultimately save lives while improving healthcare outcomes. The World Health Organization (WHO) underscores the essential role of functional medical devices in achieving universal health coverage and responding to public health emergencies [ 4 , 5 , 6 ]. However, the overall management of medical equipment including procurement, installation, commissioning, storage, clinical use, and handling remains a critical challenge in many healthcare institutions, especially in low and middle-income countries (LMICs). Developing countries face not only a shortage of medical devices but also significant challenges related to equipment handling and maintenance [ 7 , 8 ].These issues hinder effective healthcare delivery, disrupt the continuum of care, and contribute to poor patient outcomes, extended hospital stays, and, in severe cases, preventable deaths further driving unnecessary health expenditures [ 9 ] Medical equipment procurement in developing countries often lacks standardization, with decisions driven more by financial considerations than clinical needs or equipment quality whereas developed countries prioritize quality to meet clinical need. Bureaucratic, biased, and lengthy procurement processes further contribute to delays, mismatches between equipment supply, and healthcare facility needs [ 10 , 11 , 12 , 13 ]. These challenges are compounded by poor inventory management practices, leading to equipment wastage: some devices remain unused, while others become obsolete or expire prematurely without ever serving their intended purpose [ 14 ]. A shortage of skilled personnel for equipment handling and maintenance further intensifies the problem. Inadequate technical expertise results in frequent breakdowns, increased downtime, and inefficient use of resources. Delayed repairs and the unavailability of spare parts in the local market exacerbate these issues, ultimately hindering the timely delivery of critical healthcare services [ 15 , 16 , 17 ] Ethiopia introduced a Biomedical Engineering training program at the bachelor’s level in 2008/9 at Jimma University Institute of Technology to address national concerns related to medical devices. Following this initiative, other Ethiopian universities such as Addis Ababa University, Hawassa University, and the University of Gondar also took institutional responsibilities and launched Biomedical Engineering Training programs in the country. However, implementing a systematic and scientific approach to solve medical equipment management challenges in various hospitals remains a significant issue. Disruptions in equipment availability and functionality continue to negatively influence patient care. For example, presence of non-functional diagnostic tools delay disease identification and treatment initiation, while malfunctioning therapeutic devices such as ventilators and dialysis machines pose serious risks to patient safety and outcomes. Furthermore, inefficient handling and maintenance practices lead to increased operational costs, which are often passed on to patients or result in referrals to other sites, reducing both affordability and access to healthcare [ 18 , 19 ]. Although Ethiopia has been training biomedical engineers for over a decade, their engagement in critical areas such as equipment management, procurement, specification development, and decision-making remains limited. This issue, compounded by the lack of locally available spare parts and delays in repair services, disrupts patient care, causes diagnostic and treatment delays, and escalates operational expenses. Addressing these barriers is especially important in Ethiopia's teaching hospitals, which serve as both major service delivery centers and clinical training institutions. Their pivotal role in the healthcare system makes improvements in these facilities particularly impactful Strategic policies that focus on standardizing procurement processes, regulatory system, enhancing professional training, and strengthening medical equipment management systems are essential [ 20 , 21 ]. By tackling these challenges, Ethiopia can ensure the functionality of medical equipment, improve healthcare delivery, and make significant progress toward achieving universal health coverage. This study aims to identify the critical challenges in medical equipment management and the key factors contributing to equipment failure in Ethiopia, using selected university teaching hospitals as study hubs. The ultimate goal of the study is to develop evidence-based solutions that improve healthcare outcomes and strengthen the broader healthcare system by addressing the underlying issues in clinical service delivery. The research findings are expected to serve as valuable evidence for government officials and healthcare policymakers towards healthcare technology improvement, strategic planning and the development of evidence based national directives focusing on medical device [ 22 , 23 , 24 ]. Methodology and Material Study Design and Setting This study was conducted in seven selected university hospitals in Ethiopia (n = 7). Such studies are resource and time-intensive; a sampling approach was employed, focusing specifically on university hospitals. By applying the principles of sampling techniques, the results are expected to provide insights that can be generalized to other hospitals with similar characteristics and challenges. The data collection took place from September to December 2024. A facility-based cross-sectional study design was employed. This multi-center study aimed to assess and comprehensively evaluate the status of the medical equipment management system, as well as the technical and organizational factors contributing to equipment failure and related challenges in Ethiopian teaching hospitals. Study Population : The study population at seven university hospitals comprised biomedical engineers, medical equipment users, hospital administrators (CEO and clinical directors), pharmacy and procurement department heads directly involved in the management, maintenance, and utilization of medical equipment within the selected teaching hospitals. 63 Participants were recruited for face-to-face interview from seven major teaching hospitals across Ethiopia: University of Gondar Specialized Hospital, Tibebe Ghion Specialized Hospital (Bahir Dar University), Jimma University Specialized Hospital, Black Lion Specialized Hospital (Addis Ababa University), Hawassa University Specialized Hospital, Haramaya University Hospital, and Saint Paul’s Hospital Millennium Medical College (SPHMMC, Addis Ababa). These institutions were selected using purposive sampling based on their role as teaching hospitals with diverse and extensive inventories of medical equipment, as well as their geographic distribution and institutional capacities. Individuals were eligible to participate if they had at least two year of experience in medical equipment use and management, maintenance, or related decision-making roles. The study excluded temporary staff, interns, and those not directly involved in the medical equipment management process. Data Collection and Quality Assurance Well-trained data collectors gathered information from seven university hospitals. Structured questionnaires, checklists, and key informant interviews were employed to obtain accurate data across all sites. Data collection tools were designed to assess multiple dimensions of equipment management, including the medical device acquisition system, procurement processes, equipment installation and commissioning, maintenance procedures and related challenges, the status of capacity-building training initiatives, user handling practices, and the overall management system at each facility (Supplementary file 1). The data collection team conducted in-depth interviews with hospital executive directors, clinical service heads, procurement and pharmaceutical coordinators, biomedical service heads, and other healthcare professionals closely involved in medical equipment utilization. In addition to interviews, data collectors reviewed medical equipment records and performed on-site inspections to assess the condition and functionality of medical devices. To ensure the consistency and reliability of data collection tools, a pilot study was conducted in a non-study hospital prior to the main data collection phase. Pre-testing helped to refine the tools, and all data collectors and supervisors received intensive training on standardized data collection and entry procedures. Data entry was conducted using a double-entry method to minimize errors [ 25 , 26 ].Finally, the research team performed crosschecking and validation of the collected data before proceeding with the actual data analysis. Study Variables and Data Analysis In this study, the variables examined included the availability of medical equipment, maintenance budget, accessibility of spare parts, procurement processes, and presence of trained biomedical personnel, financial resources (budget), capacity-building training, and other essential factors. These key elements were assessed through open-ended (Yes/No) questions. A descriptive statistical data analysis approach was employed to ensure accurate interpretation of the findings. Results The assessment revealed that all the major university hospitals in Ethiopia offer a comprehensive range of clinical services, extending from general medicine to highly specialized and subspecialty care. These services include full-scale outpatient and inpatient care, emergency services, core specialties such as internal medicine, surgery, pediatrics, obstetrics and gynecology, ophthalmology, oncology, cardiology, and neonatology. In addition, institutions such as St. Paul’s Hospital Millennium Medical College (SPHMMC) and Tikur Anbessa (Black Lion) Hospital provide advanced tertiary services, including neurosurgery, cardiac surgery, and organ transplantation. All hospitals functions not only as healthcare providers but also as major teaching, specialty training, and referral centers within their respective regions. Each facility employs thousands of multidisciplinary healthcare professionals to support these functions. These advanced institutions also maintain a significant inventory of medical equipment, with the number of registered devices per hospital ranging from approximately 560 to 2,400, as illustrated in Fig. 2 . These devices are utilized across various clinical departments to support diagnostic and therapeutic services. To meet the objectives of the study, 63 active participants from those hospitals took part in the survey. The participants included: 14 biomedical engineers (22.2% of participants), 21 medical equipment users (33.3%) comprising physicians, nurses, and medical laboratory technicians, 28 administrative staffs (44.5%), which included 7 hospital chief executive officers (CEOs), 7 medical directors, 7 heads of procurement units, and 7 heads of pharmacy departments (each representing 11.1%). The detailed research findings from the study are presented in the following sections point by point. Medical equipment procurement and acquisition process The medical device acquisition and procurement process was one of the key factors examined in this study to evaluate the level of professional involvement and adherence to scientific procedures aligned with the overall research objectives. The findings revealed that 57.14% of the teaching hospitals did not include the running costs of medical equipment in their procurement documents. These running costs encompass expenses related to spare parts cost, periodic inspections and maintenance services over the entire lifespan of the equipment. This omission is a critical finding that helps to explain why maintenance budgets are frequently overlooked during the procurement process. Consequently, it has become one of the major contributing factors to the prolonged failure of medical equipment in various hospitals, as illustrated in the data presented in (Fig. 1 ). Furthermore, only 28.57% of the hospitals included training packages as mandatory components in their procurement orders. Scientifically, ensuring adequate maintenance budgets and provision of training are essential for extending the operational lifespan of medical equipment [ 27 , 28 ]. These findings highlighted a significant gap in the technical management of medical equipment procurement process in Ethiopian hospitals. Medical equipment installation and commissioning According to the findings, the primary responsibilities for equipment installation were shared between local suppliers and hospital biomedical personnel’s, with site preparation and installation tasks managed by these groups. Most medical devices ranging from simple to complex machines were procured through the Ethiopian Pharmaceutical Supply Service (EPSS) up on request from the institute. However, the equipment acquisition lifecycle faced technical and organizational challenges, particularly during the equipment delivery, installation, and handover phases. Notably, only St. Paul’s Hospital Millennium Medical College and the University of Gondar Hospital (28.57% of hospitals) reported about receiving official procurement documentation from EPSS partially. i.e., supplier’s agreement, equipment specifications, and warranty certificates. In contrast, 71.42% of hospitals either did not receive or were unaware of such documentation for medical equipment procured by EPSS. In many cases, equipment are delivered to the institute but there is huge limitation in accessing enclosed documents. All teaching hospitals (100%) reported facing common challenges during installation, commissioning, and training phases of equipment supplied by EPSS. These includes the involvement of unidentified local suppliers, absence of agreement document, and delay in equipment installation, inadequate training, and the delegation of installation tasks to hospital biomedical personnel, many of whom lacked proper technical training. These factors significantly increase the risk of early equipment failure and hinder effective utilization. Additionally, biomedical engineers were often not fully involved in the installation of newly acquired equipment. Regarding equipment documentation, only 28.41% of hospitals’ biomedical departments reported receiving all necessary digital materials from suppliers (service and user manuals, accessory’s part number, equipment passwords, and supplier contact information) upon completion of installation. Furthermore, several challenges were identified during medical equipment installation process including inadequate site preparation, insufficient support from suppliers, absence of technical documentation, unstable power supply, lack of uninterruptible power supply (UPS), and infrastructure issues related to water and network availability. Equipment Maintenance and related challenges Based on the collected data and analysis results, (Fig. 2 ) below illustrates the quantity and operational status of medical equipment across the seven university hospitals as of December 2024. The data is categorized into three key indicators: the total number of registered medical equipment at each hospital, the number of functional equipment, and the number of non-functional equipment recorded during the study period. The graph clearly indicates that St. SPHMMC has the highest number of registered equipment among all the surveyed hospitals, followed by Hawassa University Hospital and Black Lion Hospital. In most facilities, a substantial portion of the medical equipment is functional. However, there remains a significant share of non-functional devices across all hospitals. Gondar, Bahir Dar, Jimma, and Haromaya University Hospitals have comparatively fewer registered medical devices, though the ratio of functional to non-functional equipment remains relatively consistent across these institutions. Notably, all university hospitals report a considerable number of non-functional equipment, reflecting persistent maintenance and operational challenges. The final set of bars on the far right of the graph aggregates the total figures across all hospitals, showing that while the majority of medical equipment is functional in part due to the presence of experienced biomedical professionals. During the study period, the total number of available medical devices across all hospitals was investigated as 8,187. Among these, 21.2% (n = 1,736) were non-functional due to various factors such as the absence of spare parts, spare part procurement delays, limited maintenance budgets, shortage of skilled personnel, lack of calibration and testing tools, inadequate technical support from suppliers, poor handling by users, and frequent power fluctuations. Table 1 Responses from 07 University Hospitals Regarding Medical Equipment Maintenance Variables [N = 7, Number of hospital] N Response Percentage, % Yes No Yes No Does the hospital have a medical equipment maintenance budget? 7 1 6 14.29 85.71 Does the hospital have well trained & skilled Biomedical Engineers/Technicians? 7 1 6 14.29 85.71 Does the hospital have maintenance agreement with suppliers for high-tech equipment (Oxygen plant, CT, MRI, X- ray…)? 7 5 2 71.43 28.57 Does hhigh-tech devices have spare part in the hospital stock? 7 1 6 14.29 85.71 Is there periodic preventive maintenance for high-tech devices by local suppliers? 7 1 6 14.29 85.71 Does your hospital have preventive maintenance schedule and appropriately implemented by local technical persons? 7 3 4 42.86 57.14 Do the local biomedical engineers handle most of the corrective maintenance, including both hardware and software? 7 3 4 42.86 57.14 Is there well-organized documentation (data registration) for all corrective and preventive maintenance in your hospital? 7 3 4 42.86 57.14 Are most spare parts easily accessible from the local market? 7 0 7 0 100 Can the hospital purchase spare parts without any delay? 7 0 7 0 100 Can the hospital facilitate outsource maintenance when required? 7 4 3 57.14 42.86 Does the hospital have backup generator? 7 7 0 100 0 Does medical equipment have UPS to protect power fluctuation? 7 1 6 14.29 85.71 Does the absence of maintenance budget is bottleneck for equipment maintenance in your hospital? 7 6 1 85.71 14.29 Is the absence of spare parts in the local market a challenge for medical device maintenance in your hospital? 7 6 1 85.71 14.29 Is the absence of medical device information (manual, suppliers address, equipment password and software are challenging for equipment maintenance? 7 7 0 100 0 Is the technical skill gap on advanced equipment is bottleneck for maintenance and calibration task? 7 7 0 100 0 Is there periodic calibration and inspection of equipment in your hospital? 7 2 5 28.57 71.43 Is the overall institutional concern for medical equipment maintenance issue is lower than that of other clinical services? 7 4 3 57.14 42.86 As indicted in (Table 1 ) above, Most notably, the absence of a maintenance budget and the lack of spare parts in the local market were identified by six out of seven hospitals (score: 6/7), which equates to 85.71%, as major bottlenecks and significantly hinders the financial backing required for spare parts procurement and annual service costs. A significant skill gap was observed among biomedical staff, particularly in the maintenance of advanced equipment. Preventive maintenance and documentation are applied inconsistently across the facilities. Furthermore, none of the hospitals are able to procure spare parts immediately (100% of hospitals reported spare part procurement delays), and all hospitals (100%) confirmed that they have no access to spare parts locally. This scarcity represents a significant barrier to effective maintenance implementation and considered as key factor contributing to prolonged equipment downtime. Periodic preventive maintenance is conducted by biomedical technicians/engineers in some hospitals (score: 4/7), and they are able to handle some corrective maintenance tasks (score: 4/7). However, there is a notable shortage of well-trained biomedical engineers (score: 6/7), which equates to 85.71% skill gap in managing the maintenance and calibration of advanced medical equipment. Regarding power backup and protection, all hospitals (100%) have backup generators, which is considered a notable strength (score: 7/7). However, most medical devices lack uninterruptible power supply (UPS) systems to protect power fluctuations. A significant majority of hospitals (85.71%, score: 6/7) confirmed that the absence of UPS systems is a critical issue, often leading to equipment failure due to unstable power supply. Additionally, 28.57% of hospitals reported that they lack maintenance and calibration tools, further hindering effective maintenance. Capacity Building Training There is limited training trend in all facilities and most hospital administrators do not consider it as critical institutional concern. Nearly 85.7% of hospitals did not prioritize the importance of training packages for biomedical engineers and medical equipment users. Equipment suppliers also fail to provide technical and application training after completing the installation tasks. While majority of hospitals remained neutral regarding the adequacy of user knowledge for operating medical equipment, only Hawassa University Hospital perceived that its medical equipment users possessed relatively sufficient knowledge to use various devices. SPHMMC users received periodic refresher training to update their skills on various medical equipment. As illustrated in (Fig. 3 ) above, among all hospitals, only 42.86% agreed that 5–20% of their clinical staff received capacity-building training from suppliers after the installation of new equipment. In contrast, 28.57% of hospitals reported that less than 5% of their clinical staff received training from suppliers. The remaining hospitals had no information regarding the provision of application training for users. According to feedback from hospitals, only 1–5% of equipment suppliers show an interest in providing training after the delivery of new medical equipment. This suggests that most users operate medical equipment without receiving adequate training, which contributes to equipment breakdowns. Equipment handling by users The study revealed that not all medical equipment users in the selected hospitals handled the equipment with the necessary care and attention. In all teaching hospitals, there is a lack of equipment cleaning, protection from dust, covering, and proper shutdown practices for medical equipment. Nearly More than half of the teaching hospitals conducted periodic equipment safety inspections by biomedical engineers. Additionally, more than 50% of equipment failures were attributed to mishandling by users. Furthermore, 57.14% of medical equipment failures in teaching hospitals were caused by electrical fluctuations and the absence of standard uninterruptible power supplies (UPS). The graphical representation of medical equipment handling is indicated in (Fig. 4 ) below. Medical Equipment data management system All selected hospitals (100%) confirmed they have a medical equipment inventory. 71.43% of them conducted manual-based inventories using Excel and spreadsheets, with the exception of St. Paul’s Hospital, which managed its inventory through a web-based. All hospitals partially utilized the Medical Equipment Management Information System (MEMIS) developed by the Ministry of Health (MOH), although Gondar Hospital had not yet started using due to a skill gap in its application. For medical equipment data management, 71.42% of university hospitals reported partial use of MEMIS. skill gaps, resource shortages, and issues related to network or server connectivity were identified as MEMIS utilization barriers. Top identified factors for medical equipment failure The top identified factors for medical equipment failure are illustrated in (Fig. 5 ) below. the most critical causes of equipment failure each reported by 85.71% of hospitals include a shortage of maintenance budgets, unavailability of spare parts, and gaps in maintenance skills. Spare part procurement delays were reported by all hospitals (100%), making it the most widespread issue. Power fluctuations, lack of professional training and user mishandling of equipment was reported by 57.14% of respondents (4 hospitals from 7). The shortage of maintenance tools was the least factor, reported by 28.57% of hospitals. The above result is normalized statistically to 100% to know the relative contribution of each factors from 100% using the formula: Normalized (percentage) = (Original value from hospitals response / Total Sum) × 100 . The normalized analysis of medical equipment failure factors in Ethiopian teaching hospitals is indicated in (Fig. 6 ) below. The figure highlights spare part procurement delay accounts for 18.15% of the total. Shortage of maintenance budget, non-availability of spare parts, and maintenance skill gaps each contribute equally at 15.57%, reflecting critical weaknesses in both financing and technical capacity. Electric power fluctuation and lack of professional training follow, each with a weight of 10.38%, while equipment mishandling by users accounts for 9.08%. The shortage of maintenance tools is the least reported, with a relative impact of 5.30%. Discussion The study analysis revealed that all hospitals face major challenges in the functionality, servicing, and overall management of medical equipment throughout its lifecycle as detailed above in the result part. Key factors contributing to equipment failure and poor management were identified, highlighting systemic issues in Ethiopian university teaching hospitals that may also affect other healthcare facilities nationwide. In terms of equipment management and utilization system, the absence of proper data registration systems, and limited adoption of automated inventory systems have contributed to poor equipment management. Moreover, shortage of sense of ownership among users undermines accountability and long-term sustainability in equipment use. These challenges collectively point to the need for strategic interventions that include capacity building; medical equipment handling focused equipment utilization policy reforms, and infrastructural investment to enhance the efficiency of equipment management in Ethiopian healthcare institutions. To address these critical issues, coordinated efforts from the government, healthcare administrators and non-governmental organizations (NGO) are required. First, it is essential to allocate sufficient budget for the medical equipment operating cost. This financial commitment should be complemented by efforts to strengthen the supply chain for spare parts and accessories, ensuring their availability and minimizing equipment downtime [ 29 , 30 , 31 ]. Enhancing the technical capacity of biomedical engineers and users is also critical, as addressing the maintenance skill gap will significantly improve equipment performance and longevity. Biomedical Engineers have significant role in the medical equipment handling and maintenance ecosystem. Regular training sessions should be conducted to educate healthcare professionals on the proper handling of equipment and to promote a sense of ownership, reducing misuse and negligence [ 32 , 33 ]. Standardized, transparent, and quality compliant procurement practices must be enforced to ensure equipment long-term usability [ 34 , 35 ]. On a broader scale, regulatory framework should be developed to guide equipment management, define maintenance standards, and enforce accountability among those who mishandle the medical device [ 36 ]. The adoption of digital inventory management systems, particularly those integrated with the Medical Equipment Management Information System (MEMIS) should be prioritized. This will enable centralized tracking, efficient data retrieval, and scheduled maintenance planning. Furthermore, improving healthcare infrastructure, particularly in terms of a stable power supply, is essential to protect equipment from damage. To ensure sustained equipment functionality, clear service agreements with suppliers should be established, holding them accountable for timely maintenance support and cooperation. Medical equipment management and maintenance should be recognized as a national healthcare priority, receiving comparable attention to other clinical services. This includes emphasizing the importance of technical maintenance at the healthcare policy level. Lastly, healthcare facilities should be equipped with appropriate testing and calibration tools to conduct routine inspections and maintenance. Aligning equipment performance with manufacturers’ guidelines will ensure compliance and operational safety [ 37 , 38 ]. Given the sensitivity of medical equipment, it is crucial to adopt a careful approach to its care and protection, ensuring patient safety, equipment reliability, and cost-effectiveness. This involves handling equipment with care, following established maintenance and calibration protocols, and understanding the specific requirements for each piece of equipment based on industrial standards, manufacturer requirements and government regulations [ 39 , 40 ]. Implementing these recommendations will significantly enhance the functionality, sustainability, and efficient utilization of medical equipment across Ethiopian healthcare institutions, ultimately contributing to improved healthcare service delivery. Limitations of the Study This study has some limitations that should be acknowledged. First, the data analysis is based on descriptive and cross-sectional methods, which do not allow for establishing cause-and-effect relationships. Second, the study was limited to University hospitals, which may not fully represent the experiences and conditions in other types of healthcare facilities across the country. Lastly, there is a potential for recall bias, as the data relied on respondents' memory and self-reporting, which may affect the accuracy of some responses. Conclusion This survey study identifies critical technical, organizational, and systemic factors contributing to medical equipment failure and poor management practice in Ethiopian university hospitals. The most prominent issues include delays in spare part procurement, insufficient maintenance budgets, shortage of technical skills, inadequate training, equipment mishandling by users and problems related to power supply. These challenges collectively undermine equipment reliability and clinical service delivery in various hospitals. To address these gaps, strategic interventions are needed, including allocation of dedicated maintenance funding, strengthened supply chains, continuous technical training, user education, and the implementation of digital inventory systems. Elevating medical equipment management as a national healthcare priority is essential for ensuring equipment functionality, patient safety, and sustainable healthcare service delivery in Ethiopia. The authors recommend further in-depth investigations, by incorporating a sufficient number of hospitals, to identify the root causes and develop effective solutions for the frequent interruptions of medical equipment in Ethiopian healthcare institutions Abbreviations BME Biomedical Engineering CT Computed tomography EPSS Ethiopian pharmaceutical supply service JUMC Jimma University Medical Centre KGA KOFIH global alumni KOFIH Korea foundation for international healthcare LMICs Low and middle-income countries MEMIS Medical equipment management information system MOH Ministry of health MRI Magnetic resonance imaging NGO Non-governmental organization SPMMC St. Paul’s Hospital Millennium Medical College UPS uninterrupted power supply WHO World health organization Declarations Acknowledgments: The research team gratefully acknowledges the Korea Foundation for International Healthcare (KOFIH) for providing financial support for this study. We also extend our sincere appreciation to all participating university hospitals and the respective officials whose collaboration and contributions were essential for the success of this research. Authors Contribution: EBY conceived the study idea, designed the data collection tools, and lead the overall research process. SLC and TKC were responsible for data analysis, while AMW handled data cleaning and narrated the results. EBY and TKC drafted the manuscript. BDW, and SGT, TDG involved in revising the manuscript. All authors reviewed and approved the final version of the manuscript and agreed for submission. Source of funding: This research was fully funded by the Korea Foundation for International Healthcare (KOFIH) under the KGA-2024 Activity Project. Data availability: This is a survey-based study and the primary data are presented within this report. Additional data will be available from corresponding authors upon reasonable request. Ethics Approval and Consent to Participate Ethical approval was obtained from the Institutional Review Board (IRB) of Jimma University, Ref No. JUIH/IRB/0500/25. The study was conducted in accordance with national regulations and the Declaration of Helsinki. Although the study was a non-clinical survey, informed consent was obtained from all participants prior to data collection, and the data collection tools were reviewed and approved by the IRB. (Supplementary file 2). Consent for publication: Not applicablefor this research Data collection tools: The interview questions (data collection tools) were developed specifically only for this study and have not been published elsewhere. (Supplementary File 1) Conflict of interest: All authors declare that they have no conflicts of interest References Chandan BVMM. Applications of Medical Devices in Healthcare Industry. J Evol Med Dent Sci. Sept. 2021;10:3419–23. Alem Endeshaw NMMWMW, Woldeyohanins. 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MO. A. MariaTheresa Chinyeaka Kelvin-Agwu, Strategies For Optimizing The Management Of Medical Equipment In Large Healthcare Institutions, International Journal Of Engineering Research And Development , vol. 20, no. 9, pp. 162–170, September, 2024. Alieu Sam SMS. Assessing The Factors Affecting Maintenance of Medical Equipment at The Kenema Government Hospital, Sierra Leone, African Journal of Biomedical Research , vol. 28, pp. 1351–1362, March 2025. Z. e. al., A Systematic Review of Medical Equipment Reliability Assessment in Improving the Quality of Healthcare Services, Frontiers in Public Health , vol. 09, pp. 01–12, Sept 2021. WHO. Medical equipment maintenance programme overview, WHO Medical device technical series , pp. 01–92, 2011. Madzivire Mea. Biomedical engineers are crucial for effective health-care systems, The Lancet Global Health , vol. 13, no. 3, pp. e396 - e398, March 2025. WHO, HUMAN RESOURCES FOR MEDICAL, DEVICES. The role of biomedical engineers, WHO Medical device technical series , pp. 01-240, 2017. Maurice JN, Atiende J. Transparent procurement practices and performance of medical supply chain in Kenya, INTERNATIONAL JOURNAL OF BUSINESS AND MANAGEMENT (IJBM) , pp. 01–09, 2025. Jillian Clare TW, Kohler. The Urgent Need for Transparent and Accountable Procurement of Medicine and Medical Supplies in Times of COVID-19 Pandemic. J Pharm Policy Pract, pp. 01–4, 2020. G. J. v. d. W. M. Y. D. B. R. P. Th. Houngbo, Policy and Management of Medical Devices for the Public Health Care Sector in Benin, Public Health Methodology, Environmental and Systems Issues , pp. 313–324, 2012. Nwoke J. Regulatory Compliance and Risk Management in Pharmaceuticals and Healthcare, International Journal of Health Sciences , vol. 7, no. 6, pp. 60–88, Sep 2024. ORGANIZATION WH. MEDICAL DEVICE REGULATIONS Global overview and guiding principles. Med DEVICE REGULATIONS, pp. 3–42, 2003. Altayyar SS. The Essential Principles of Safety and Effectiveness for Medical Devices and the Role of Standards. Med Devices: Evid Res, pp. 49–55, 2020. Rupesh Kumar RK. Calibration of Medical Devices: Method and Impact on Operation Quality, Internationale Pharmaceutica Sciencia , vol. 16, no. 1, pp. 1–15, Sep 2023. Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1Datacollectiontool.pdf Supplementaryfile2IRBEthicalApproval.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 18 Dec, 2025 Reviews received at journal 19 Nov, 2025 Reviews received at journal 07 Aug, 2025 Reviewers agreed at journal 07 Aug, 2025 Reviewers agreed at journal 04 Aug, 2025 Reviewers agreed at journal 28 Jul, 2025 Reviewers invited by journal 20 Jul, 2025 Editor assigned by journal 16 Jul, 2025 Editor invited by journal 30 Jun, 2025 Submission checks completed at journal 30 Jun, 2025 First submitted to journal 30 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Yihunie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIie3OMUvDQBjG8bccnMvVWxOSD/FKICIN8atYDjJFdNJONRC4yeLq4OdwvnBQl9KugS5m7+AkCpV6aaHgcLZjofcfkhDulycALtdhRgFuzc2DjgJICKyfdxLcHDMk25L/2B+iYSfhfBK/f2HSL4JSqW85O0FFqjmDZGgj/nN+fvaIWb8Ix1fVSM4JKip6DDLrCtYs9hjq68LLUXXXhMUBA20ll7NJ7C9xZcjNR/Ujp4bwT0NW9hXIzTdRtSugu1K1K9QQZSVend1HIYoHGY5Rh1NBfE2jixcUfmEh/Em/NotBGvGgbJrFXSpO38qmNm+4bWUbbS8dCgLI5of3bQnp3mddLpfraPoF3gdRni/8UfkAAAAASUVORK5CYII=","orcid":"","institution":"Jimma University Institute of Technology","correspondingAuthor":true,"prefix":"","firstName":"Esubalew","middleName":"Belay","lastName":"Yihunie","suffix":""},{"id":488242643,"identity":"7f064dfd-7235-4b89-8bc5-b0f9072d3ea8","order_by":1,"name":"Beshatu Debala Wako","email":"","orcid":"","institution":"Jimma University Medical 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19:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6735317/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6735317/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87438749,"identity":"a1b035d4-18f2-4512-9dc4-e87c604d55a1","added_by":"auto","created_at":"2025-07-23 19:19:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38982,"visible":true,"origin":"","legend":"\u003cp\u003eHospitals, which includes medical equipment running, cost in their budget, December 2024\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/f364272a588e89955dba4180.png"},{"id":87439782,"identity":"723210a0-036c-43de-8174-ce340e53ba6e","added_by":"auto","created_at":"2025-07-23 19:27:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30042,"visible":true,"origin":"","legend":"\u003cp\u003eMedical equipment status at seven university hospitals during study period\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/9a31a2c42fc20701f78206b6.png"},{"id":87438752,"identity":"eae781ea-b6a4-4fa9-91fb-5f5126499028","added_by":"auto","created_at":"2025-07-23 19:19:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":50822,"visible":true,"origin":"","legend":"\u003cp\u003eDepicts response related capacity-building training for BME and clinical staff, Dec 2024.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/b3eedfe6907fbcb9d8b5b447.png"},{"id":87439784,"identity":"c079f247-00a4-4fdd-b7a2-cf58d66c77ca","added_by":"auto","created_at":"2025-07-23 19:27:30","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":23924,"visible":true,"origin":"","legend":"\u003cp\u003eLevel of medical equipment handling in the seven teaching hospital, December 2024\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/e26f7a7c3a1f286535559a58.png"},{"id":87438755,"identity":"71b1097f-9f36-49af-9a68-dc542c8bed61","added_by":"auto","created_at":"2025-07-23 19:19:30","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":25960,"visible":true,"origin":"","legend":"\u003cp\u003eMedical equipment failure factors according to response from study facilities\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/c481e226dc9d5c057d90f25f.png"},{"id":87440038,"identity":"f7140b02-8952-40c0-8d23-4d4e72c396e3","added_by":"auto","created_at":"2025-07-23 19:35:30","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":69620,"visible":true,"origin":"","legend":"\u003cp\u003eMedical equipment failure factors normalization result (all factors from 100%)\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/710447831e94753b54a69ce3.png"},{"id":87440513,"identity":"17a03303-200c-4a1d-89a1-968828f2e251","added_by":"auto","created_at":"2025-07-23 19:51:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1050767,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/1153a275-725e-484f-b6ce-c0a9e3327b02.pdf"},{"id":87440469,"identity":"da031786-c433-44b7-a04d-c3a162631e83","added_by":"auto","created_at":"2025-07-23 19:43:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":474755,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1Datacollectiontool.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/848ae345f52ba0e670495aa7.pdf"},{"id":87438758,"identity":"fedb605b-d8d5-41fd-b107-11a4f1571ee0","added_by":"auto","created_at":"2025-07-23 19:19:30","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":430949,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile2IRBEthicalApproval.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6735317/v1/ca399009376ae8277426a75d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Medical Equipment Management and Failure Factors in Ethiopian Teaching Hospitals: A Survey-Based Study of Systemic Challenges and Operational Gaps","fulltext":[{"header":"Background","content":"\u003cp\u003eIn the healthcare technology landscape, medical equipment plays a vital role in disease diagnosis, patient monitoring system, effective healthcare delivery, and overall patient care management [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This medical equipment includes a broad spectrum of tools, ranging from basic instruments like thermometers to advanced technologies such as mechanical ventilators, heart-lung machines, X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and the like. The proper functionality and availability of such equipment in hospitals significantly enhance diagnostic accuracy, treatment efficiency, patient safety, and ultimately save lives while improving healthcare outcomes.\u003c/p\u003e\u003cp\u003eThe World Health Organization (WHO) underscores the essential role of functional medical devices in achieving universal health coverage and responding to public health emergencies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, the overall management of medical equipment including procurement, installation, commissioning, storage, clinical use, and handling remains a critical challenge in many healthcare institutions, especially in low and middle-income countries (LMICs). Developing countries face not only a shortage of medical devices but also significant challenges related to equipment handling and maintenance [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].These issues hinder effective healthcare delivery, disrupt the continuum of care, and contribute to poor patient outcomes, extended hospital stays, and, in severe cases, preventable deaths further driving unnecessary health expenditures [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eMedical equipment procurement in developing countries often lacks standardization, with decisions driven more by financial considerations than clinical needs or equipment quality whereas developed countries prioritize quality to meet clinical need. Bureaucratic, biased, and lengthy procurement processes further contribute to delays, mismatches between equipment supply, and healthcare facility needs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These challenges are compounded by poor inventory management practices, leading to equipment wastage: some devices remain unused, while others become obsolete or expire prematurely without ever serving their intended purpose [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A shortage of skilled personnel for equipment handling and maintenance further intensifies the problem. Inadequate technical expertise results in frequent breakdowns, increased downtime, and inefficient use of resources. Delayed repairs and the unavailability of spare parts in the local market exacerbate these issues, ultimately hindering the timely delivery of critical healthcare services [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eEthiopia introduced a Biomedical Engineering training program at the bachelor\u0026rsquo;s level in 2008/9 at Jimma University Institute of Technology to address national concerns related to medical devices. Following this initiative, other Ethiopian universities such as Addis Ababa University, Hawassa University, and the University of Gondar also took institutional responsibilities and launched Biomedical Engineering Training programs in the country. However, implementing a systematic and scientific approach to solve medical equipment management challenges in various hospitals remains a significant issue. Disruptions in equipment availability and functionality continue to negatively influence patient care. For example, presence of non-functional diagnostic tools delay disease identification and treatment initiation, while malfunctioning therapeutic devices such as ventilators and dialysis machines pose serious risks to patient safety and outcomes. Furthermore, inefficient handling and maintenance practices lead to increased operational costs, which are often passed on to patients or result in referrals to other sites, reducing both affordability and access to healthcare [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough Ethiopia has been training biomedical engineers for over a decade, their engagement in critical areas such as equipment management, procurement, specification development, and decision-making remains limited. This issue, compounded by the lack of locally available spare parts and delays in repair services, disrupts patient care, causes diagnostic and treatment delays, and escalates operational expenses. Addressing these barriers is especially important in Ethiopia's teaching hospitals, which serve as both major service delivery centers and clinical training institutions. Their pivotal role in the healthcare system makes improvements in these facilities particularly impactful Strategic policies that focus on standardizing procurement processes, regulatory system, enhancing professional training, and strengthening medical equipment management systems are essential [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. By tackling these challenges, Ethiopia can ensure the functionality of medical equipment, improve healthcare delivery, and make significant progress toward achieving universal health coverage.\u003c/p\u003e\u003cp\u003eThis study aims to identify the critical challenges in medical equipment management and the key factors contributing to equipment failure in Ethiopia, using selected university teaching hospitals as study hubs. The ultimate goal of the study is to develop evidence-based solutions that improve healthcare outcomes and strengthen the broader healthcare system by addressing the underlying issues in clinical service delivery. The research findings are expected to serve as valuable evidence for government officials and healthcare policymakers towards healthcare technology improvement, strategic planning and the development of evidence based national directives focusing on medical device [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methodology and Material","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003cp\u003eThis study was conducted in seven selected university hospitals in Ethiopia (n\u0026thinsp;=\u0026thinsp;7). Such studies are resource and time-intensive; a sampling approach was employed, focusing specifically on university hospitals. By applying the principles of sampling techniques, the results are expected to provide insights that can be generalized to other hospitals with similar characteristics and challenges. The data collection took place from September to December 2024. A facility-based cross-sectional study design was employed. This multi-center study aimed to assess and comprehensively evaluate the status of the medical equipment management system, as well as the technical and organizational factors contributing to equipment failure and related challenges in Ethiopian teaching hospitals.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Population\u003c/b\u003e: The study population at seven university hospitals comprised biomedical engineers, medical equipment users, hospital administrators (CEO and clinical directors), pharmacy and procurement department heads directly involved in the management, maintenance, and utilization of medical equipment within the selected teaching hospitals. 63 Participants were recruited for face-to-face interview from seven major teaching hospitals across Ethiopia: University of Gondar Specialized Hospital, Tibebe Ghion Specialized Hospital (Bahir Dar University), Jimma University Specialized Hospital, Black Lion Specialized Hospital (Addis Ababa University), Hawassa University Specialized Hospital, Haramaya University Hospital, and Saint Paul\u0026rsquo;s Hospital Millennium Medical College (SPHMMC, Addis Ababa).\u003c/p\u003e\u003cp\u003eThese institutions were selected using purposive sampling based on their role as teaching hospitals with diverse and extensive inventories of medical equipment, as well as their geographic distribution and institutional capacities. Individuals were eligible to participate if they had at least two year of experience in medical equipment use and management, maintenance, or related decision-making roles. The study excluded temporary staff, interns, and those not directly involved in the medical equipment management process.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData Collection and Quality Assurance\u003c/strong\u003e\u003cp\u003eWell-trained data collectors gathered information from seven university hospitals. Structured questionnaires, checklists, and key informant interviews were employed to obtain accurate data across all sites. Data collection tools were designed to assess multiple dimensions of equipment management, including the medical device acquisition system, procurement processes, equipment installation and commissioning, maintenance procedures and related challenges, the status of capacity-building training initiatives, user handling practices, and the overall management system at each facility (Supplementary file 1).\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe data collection team conducted in-depth interviews with hospital executive directors, clinical service heads, procurement and pharmaceutical coordinators, biomedical service heads, and other healthcare professionals closely involved in medical equipment utilization. In addition to interviews, data collectors reviewed medical equipment records and performed on-site inspections to assess the condition and functionality of medical devices. To ensure the consistency and reliability of data collection tools, a pilot study was conducted in a non-study hospital prior to the main data collection phase. Pre-testing helped to refine the tools, and all data collectors and supervisors received intensive training on standardized data collection and entry procedures. Data entry was conducted using a double-entry method to minimize errors [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].Finally, the research team performed crosschecking and validation of the collected data before proceeding with the actual data analysis.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStudy Variables and Data Analysis\u003c/strong\u003e\u003cp\u003eIn this study, the variables examined included the availability of medical equipment, maintenance budget, accessibility of spare parts, procurement processes, and presence of trained biomedical personnel, financial resources (budget), capacity-building training, and other essential factors. These key elements were assessed through open-ended (Yes/No) questions. A descriptive statistical data analysis approach was employed to ensure accurate interpretation of the findings.\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe assessment revealed that all the major university hospitals in Ethiopia offer a comprehensive range of clinical services, extending from general medicine to highly specialized and subspecialty care. These services include full-scale outpatient and inpatient care, emergency services, core specialties such as internal medicine, surgery, pediatrics, obstetrics and gynecology, ophthalmology, oncology, cardiology, and neonatology. In addition, institutions such as St. Paul\u0026rsquo;s Hospital Millennium Medical College (SPHMMC) and Tikur Anbessa (Black Lion) Hospital provide advanced tertiary services, including neurosurgery, cardiac surgery, and organ transplantation. All hospitals functions not only as healthcare providers but also as major teaching, specialty training, and referral centers within their respective regions. Each facility employs thousands of multidisciplinary healthcare professionals to support these functions.\u003c/p\u003e\u003cp\u003eThese advanced institutions also maintain a significant inventory of medical equipment, with the number of registered devices per hospital ranging from approximately 560 to 2,400, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. These devices are utilized across various clinical departments to support diagnostic and therapeutic services. To meet the objectives of the study, 63 active participants from those hospitals took part in the survey. The participants included: 14 biomedical engineers (22.2% of participants), 21 medical equipment users (33.3%) comprising physicians, nurses, and medical laboratory technicians, 28 administrative staffs (44.5%), which included 7 hospital chief executive officers (CEOs), 7 medical directors, 7 heads of procurement units, and 7 heads of pharmacy departments (each representing 11.1%). The detailed research findings from the study are presented in the following sections point by point.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMedical equipment procurement and acquisition process\u003c/strong\u003e\u003cp\u003eThe medical device acquisition and procurement process was one of the key factors examined in this study to evaluate the level of professional involvement and adherence to scientific procedures aligned with the overall research objectives. The findings revealed that 57.14% of the teaching hospitals did not include the running costs of medical equipment in their procurement documents. These running costs encompass expenses related to spare parts cost, periodic inspections and maintenance services over the entire lifespan of the equipment. This omission is a critical finding that helps to explain why maintenance budgets are frequently overlooked during the procurement process. Consequently, it has become one of the major contributing factors to the prolonged failure of medical equipment in various hospitals, as illustrated in the data presented in (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Furthermore, only 28.57% of the hospitals included training packages as mandatory components in their procurement orders. Scientifically, ensuring adequate maintenance budgets and provision of training are essential for extending the operational lifespan of medical equipment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These findings highlighted a significant gap in the technical management of medical equipment procurement process in Ethiopian hospitals.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMedical equipment installation and commissioning\u003c/strong\u003e\u003cp\u003eAccording to the findings, the primary responsibilities for equipment installation were shared between local suppliers and hospital biomedical personnel\u0026rsquo;s, with site preparation and installation tasks managed by these groups. Most medical devices ranging from simple to complex machines were procured through the Ethiopian Pharmaceutical Supply Service (EPSS) up on request from the institute. However, the equipment acquisition lifecycle faced technical and organizational challenges, particularly during the equipment delivery, installation, and handover phases. Notably, only St. Paul\u0026rsquo;s Hospital Millennium Medical College and the University of Gondar Hospital (28.57% of hospitals) reported about receiving official procurement documentation from EPSS partially. i.e., supplier\u0026rsquo;s agreement, equipment specifications, and warranty certificates.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eIn contrast, 71.42% of hospitals either did not receive or were unaware of such documentation for medical equipment procured by EPSS. In many cases, equipment are delivered to the institute but there is huge limitation in accessing enclosed documents. All teaching hospitals (100%) reported facing common challenges during installation, commissioning, and training phases of equipment supplied by EPSS. These includes the involvement of unidentified local suppliers, absence of agreement document, and delay in equipment installation, inadequate training, and the delegation of installation tasks to hospital biomedical personnel, many of whom lacked proper technical training. These factors significantly increase the risk of early equipment failure and hinder effective utilization.\u003c/p\u003e\u003cp\u003eAdditionally, biomedical engineers were often not fully involved in the installation of newly acquired equipment. Regarding equipment documentation, only 28.41% of hospitals\u0026rsquo; biomedical departments reported receiving all necessary digital materials from suppliers (service and user manuals, accessory\u0026rsquo;s part number, equipment passwords, and supplier contact information) upon completion of installation. Furthermore, several challenges were identified during medical equipment installation process including inadequate site preparation, insufficient support from suppliers, absence of technical documentation, unstable power supply, lack of uninterruptible power supply (UPS), and infrastructure issues related to water and network availability.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEquipment Maintenance and related challenges\u003c/strong\u003e\u003cp\u003eBased on the collected data and analysis results, (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) below illustrates the quantity and operational status of medical equipment across the seven university hospitals as of December 2024.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe data is categorized into three key indicators: the total number of registered medical equipment at each hospital, the number of functional equipment, and the number of non-functional equipment recorded during the study period. The graph clearly indicates that St. SPHMMC has the highest number of registered equipment among all the surveyed hospitals, followed by Hawassa University Hospital and Black Lion Hospital. In most facilities, a substantial portion of the medical equipment is functional. However, there remains a significant share of non-functional devices across all hospitals. Gondar, Bahir Dar, Jimma, and Haromaya University Hospitals have comparatively fewer registered medical devices, though the ratio of functional to non-functional equipment remains relatively consistent across these institutions. Notably, all university hospitals report a considerable number of non-functional equipment, reflecting persistent maintenance and operational challenges. The final set of bars on the far right of the graph aggregates the total figures across all hospitals, showing that while the majority of medical equipment is functional in part due to the presence of experienced biomedical professionals.\u003c/p\u003e\u003cp\u003eDuring the study period, the total number of available medical devices across all hospitals was investigated as 8,187. Among these, 21.2% (n\u0026thinsp;=\u0026thinsp;1,736) were non-functional due to various factors such as the absence of spare parts, spare part procurement delays, limited maintenance budgets, shortage of skilled personnel, lack of calibration and testing tools, inadequate technical support from suppliers, poor handling by users, and frequent power fluctuations.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResponses from 07 University Hospitals Regarding Medical Equipment Maintenance\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables [N\u0026thinsp;=\u0026thinsp;7, Number of hospital]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eResponse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ePercentage, %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes the hospital have a medical equipment maintenance budget?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes the hospital have well trained \u0026amp; skilled Biomedical Engineers/Technicians?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes the hospital have maintenance agreement with suppliers for high-tech equipment (Oxygen plant, CT, MRI, X- ray\u0026hellip;)?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes hhigh-tech devices have spare part in the hospital stock?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIs there periodic preventive maintenance for high-tech devices by local suppliers?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes your hospital have preventive maintenance schedule and appropriately implemented by local technical persons?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo the local biomedical engineers handle most of the corrective maintenance, including both hardware and software?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIs there well-organized documentation (data registration) for all corrective and preventive maintenance in your hospital?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAre most spare parts easily accessible from the local market?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCan the hospital purchase spare parts without any delay?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCan the hospital facilitate outsource maintenance when required?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes the hospital have backup generator?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes medical equipment have UPS to protect power fluctuation?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes the absence of maintenance budget is bottleneck for equipment maintenance in your hospital?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIs the absence of spare parts in the local market a challenge for medical device maintenance in your hospital?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIs the absence of medical device information (manual, suppliers address, equipment password and software are challenging for equipment maintenance?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIs the technical skill gap on advanced equipment is bottleneck for maintenance and calibration task?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIs there periodic calibration and inspection of equipment in your hospital?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIs the overall institutional concern for medical equipment maintenance issue is lower than that of other clinical services?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs indicted in (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) above, Most notably, the absence of a maintenance budget and the lack of spare parts in the local market were identified by six out of seven hospitals (score: 6/7), which equates to 85.71%, as major bottlenecks and significantly hinders the financial backing required for spare parts procurement and annual service costs. A significant skill gap was observed among biomedical staff, particularly in the maintenance of advanced equipment. Preventive maintenance and documentation are applied inconsistently across the facilities.\u003c/p\u003e\u003cp\u003eFurthermore, none of the hospitals are able to procure spare parts immediately (100% of hospitals reported spare part procurement delays), and all hospitals (100%) confirmed that they have no access to spare parts locally. This scarcity represents a significant barrier to effective maintenance implementation and considered as key factor contributing to prolonged equipment downtime. Periodic preventive maintenance is conducted by biomedical technicians/engineers in some hospitals (score: 4/7), and they are able to handle some corrective maintenance tasks (score: 4/7). However, there is a notable shortage of well-trained biomedical engineers (score: 6/7), which equates to 85.71% skill gap in managing the maintenance and calibration of advanced medical equipment.\u003c/p\u003e\u003cp\u003eRegarding power backup and protection, all hospitals (100%) have backup generators, which is considered a notable strength (score: 7/7). However, most medical devices lack uninterruptible power supply (UPS) systems to protect power fluctuations. A significant majority of hospitals (85.71%, score: 6/7) confirmed that the absence of UPS systems is a critical issue, often leading to equipment failure due to unstable power supply. Additionally, 28.57% of hospitals reported that they lack maintenance and calibration tools, further hindering effective maintenance.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCapacity Building Training\u003c/strong\u003e\u003cp\u003eThere is limited training trend in all facilities and most hospital administrators do not consider it as critical institutional concern. Nearly 85.7% of hospitals did not prioritize the importance of training packages for biomedical engineers and medical equipment users. Equipment suppliers also fail to provide technical and application training after completing the installation tasks. While majority of hospitals remained neutral regarding the adequacy of user knowledge for operating medical equipment, only Hawassa University Hospital perceived that its medical equipment users possessed relatively sufficient knowledge to use various devices. SPHMMC users received periodic refresher training to update their skills on various medical equipment.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAs illustrated in (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) above, among all hospitals, only 42.86% agreed that 5\u0026ndash;20% of their clinical staff received capacity-building training from suppliers after the installation of new equipment. In contrast, 28.57% of hospitals reported that less than 5% of their clinical staff received training from suppliers. The remaining hospitals had no information regarding the provision of application training for users. According to feedback from hospitals, only 1\u0026ndash;5% of equipment suppliers show an interest in providing training after the delivery of new medical equipment. This suggests that most users operate medical equipment without receiving adequate training, which contributes to equipment breakdowns.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEquipment handling by users\u003c/strong\u003e\u003cp\u003eThe study revealed that not all medical equipment users in the selected hospitals handled the equipment with the necessary care and attention. In all teaching hospitals, there is a lack of equipment cleaning, protection from dust, covering, and proper shutdown practices for medical equipment. Nearly More than half of the teaching hospitals conducted periodic equipment safety inspections by biomedical engineers. Additionally, more than 50% of equipment failures were attributed to mishandling by users. Furthermore, 57.14% of medical equipment failures in teaching hospitals were caused by electrical fluctuations and the absence of standard uninterruptible power supplies (UPS). The graphical representation of medical equipment handling is indicated in (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) below.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMedical Equipment data management system\u003c/strong\u003e\u003cp\u003eAll selected hospitals (100%) confirmed they have a medical equipment inventory. 71.43% of them conducted manual-based inventories using Excel and spreadsheets, with the exception of St. Paul\u0026rsquo;s Hospital, which managed its inventory through a web-based. All hospitals partially utilized the Medical Equipment Management Information System (MEMIS) developed by the Ministry of Health (MOH), although Gondar Hospital had not yet started using due to a skill gap in its application. For medical equipment data management, 71.42% of university hospitals reported partial use of MEMIS. skill gaps, resource shortages, and issues related to network or server connectivity were identified as MEMIS utilization barriers.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTop identified factors for medical equipment failure\u003c/strong\u003e\u003cp\u003eThe top identified factors for medical equipment failure are illustrated in (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) below. the most critical causes of equipment failure each reported by 85.71% of hospitals include a shortage of maintenance budgets, unavailability of spare parts, and gaps in maintenance skills. Spare part procurement delays were reported by all hospitals (100%), making it the most widespread issue. Power fluctuations, lack of professional training and user mishandling of equipment was reported by 57.14% of respondents (4 hospitals from 7). The shortage of maintenance tools was the least factor, reported by 28.57% of hospitals.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe above result is normalized statistically to 100% to know the relative contribution of each factors from 100% using the formula: \u003cem\u003eNormalized (percentage) = (Original value from hospitals response / Total Sum) \u0026times; 100\u003c/em\u003e. The normalized analysis of medical equipment failure factors in Ethiopian teaching hospitals is indicated in (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) below.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe figure highlights spare part procurement delay accounts for 18.15% of the total. Shortage of maintenance budget, non-availability of spare parts, and maintenance skill gaps each contribute equally at 15.57%, reflecting critical weaknesses in both financing and technical capacity. Electric power fluctuation and lack of professional training follow, each with a weight of 10.38%, while equipment mishandling by users accounts for 9.08%. The shortage of maintenance tools is the least reported, with a relative impact of 5.30%.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study analysis revealed that all hospitals face major challenges in the functionality, servicing, and overall management of medical equipment throughout its lifecycle as detailed above in the result part. Key factors contributing to equipment failure and poor management were identified, highlighting systemic issues in Ethiopian university teaching hospitals that may also affect other healthcare facilities nationwide.\u003c/p\u003e\u003cp\u003eIn terms of equipment management and utilization system, the absence of proper data registration systems, and limited adoption of automated inventory systems have contributed to poor equipment management. Moreover, shortage of sense of ownership among users undermines accountability and long-term sustainability in equipment use. These challenges collectively point to the need for strategic interventions that include capacity building; medical equipment handling focused equipment utilization policy reforms, and infrastructural investment to enhance the efficiency of equipment management in Ethiopian healthcare institutions. To address these critical issues, coordinated efforts from the government, healthcare administrators and non-governmental organizations (NGO) are required. First, it is essential to allocate sufficient budget for the medical equipment operating cost. This financial commitment should be complemented by efforts to strengthen the supply chain for spare parts and accessories, ensuring their availability and minimizing equipment downtime [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEnhancing the technical capacity of biomedical engineers and users is also critical, as addressing the maintenance skill gap will significantly improve equipment performance and longevity. Biomedical Engineers have significant role in the medical equipment handling and maintenance ecosystem. Regular training sessions should be conducted to educate healthcare professionals on the proper handling of equipment and to promote a sense of ownership, reducing misuse and negligence [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Standardized, transparent, and quality compliant procurement practices must be enforced to ensure equipment long-term usability [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOn a broader scale, regulatory framework should be developed to guide equipment management, define maintenance standards, and enforce accountability among those who mishandle the medical device [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The adoption of digital inventory management systems, particularly those integrated with the Medical Equipment Management Information System (MEMIS) should be prioritized. This will enable centralized tracking, efficient data retrieval, and scheduled maintenance planning. Furthermore, improving healthcare infrastructure, particularly in terms of a stable power supply, is essential to protect equipment from damage. To ensure sustained equipment functionality, clear service agreements with suppliers should be established, holding them accountable for timely maintenance support and cooperation. Medical equipment management and maintenance should be recognized as a national healthcare priority, receiving comparable attention to other clinical services. This includes emphasizing the importance of technical maintenance at the healthcare policy level.\u003c/p\u003e\u003cp\u003eLastly, healthcare facilities should be equipped with appropriate testing and calibration tools to conduct routine inspections and maintenance. Aligning equipment performance with manufacturers\u0026rsquo; guidelines will ensure compliance and operational safety [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Given the sensitivity of medical equipment, it is crucial to adopt a careful approach to its care and protection, ensuring patient safety, equipment reliability, and cost-effectiveness. This involves handling equipment with care, following established maintenance and calibration protocols, and understanding the specific requirements for each piece of equipment based on industrial standards, manufacturer requirements and government regulations [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Implementing these recommendations will significantly enhance the functionality, sustainability, and efficient utilization of medical equipment across Ethiopian healthcare institutions, ultimately contributing to improved healthcare service delivery.\u003c/p\u003e"},{"header":"Limitations of the Study","content":"\u003cp\u003eThis study has some limitations that should be acknowledged. First, the data analysis is based on descriptive and cross-sectional methods, which do not allow for establishing cause-and-effect relationships. Second, the study was limited to University hospitals, which may not fully represent the experiences and conditions in other types of healthcare facilities across the country. Lastly, there is a potential for recall bias, as the data relied on respondents' memory and self-reporting, which may affect the accuracy of some responses.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis survey study identifies critical technical, organizational, and systemic factors contributing to medical equipment failure and poor management practice in Ethiopian university hospitals. The most prominent issues include delays in spare part procurement, insufficient maintenance budgets, shortage of technical skills, inadequate training, equipment mishandling by users and problems related to power supply. These challenges collectively undermine equipment reliability and clinical service delivery in various hospitals.\u003c/p\u003e\u003cp\u003eTo address these gaps, strategic interventions are needed, including allocation of dedicated maintenance funding, strengthened supply chains, continuous technical training, user education, and the implementation of digital inventory systems. Elevating medical equipment management as a national healthcare priority is essential for ensuring equipment functionality, patient safety, and sustainable healthcare service delivery in Ethiopia.\u003c/p\u003e\u003cp\u003eThe authors recommend further in-depth investigations, by incorporating a sufficient number of hospitals, to identify the root causes and develop effective solutions for the frequent interruptions of medical equipment in Ethiopian healthcare institutions\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBME\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBiomedical Engineering\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEPSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEthiopian pharmaceutical supply service\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eJUMC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eJimma University Medical Centre\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKGA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKOFIH global alumni\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eKOFIH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eKorea foundation for international healthcare\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow and middle-income countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMEMIS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMedical equipment management information system\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMOH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMinistry of health\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetic resonance imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNGO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNon-governmental organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPMMC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSt. Paul\u0026rsquo;s Hospital Millennium Medical College\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUPS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003euninterrupted power supply\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld health organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The research team gratefully acknowledges the Korea Foundation for International Healthcare (KOFIH) for providing financial support for this study. We also extend our sincere appreciation to all participating university hospitals and the respective officials whose collaboration and contributions were essential for the success of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution: EBY\u003c/strong\u003e conceived the study idea, designed the data collection tools, and lead the overall research process. \u003cstrong\u003eSLC\u003c/strong\u003e and \u003cstrong\u003eTKC\u0026nbsp;\u003c/strong\u003ewere responsible for data analysis, while \u003cstrong\u003eAMW\u003c/strong\u003e handled data cleaning and narrated the results. \u003cstrong\u003eEBY\u003c/strong\u003e and \u003cstrong\u003eTKC\u0026nbsp;\u003c/strong\u003edrafted the manuscript. \u003cstrong\u003eBDW, and SGT, TDG\u0026nbsp;\u003c/strong\u003einvolved in revising the manuscript. \u0026nbsp;All authors reviewed and approved the final version of the manuscript and agreed for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of funding:\u003c/strong\u003e This research was fully funded by the Korea Foundation for International Healthcare (KOFIH) under the KGA-2024 Activity Project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e This is a survey-based study and the primary data are presented within this report. Additional data will be available from corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB) of Jimma University, Ref No. JUIH/IRB/0500/25. The study was conducted in accordance with national regulations and the Declaration of Helsinki. Although the study was a non-clinical survey, informed consent was obtained from all participants prior to data collection, and the data collection tools were reviewed and approved by the IRB. (Supplementary file 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicablefor this research\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools:\u0026nbsp;\u003c/strong\u003eThe interview questions (data collection tools) were developed specifically only for this study and have not been published elsewhere. (Supplementary File 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eAll authors declare that they have no conflicts of interest\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChandan BVMM. Applications of Medical Devices in Healthcare Industry. J Evol Med Dent Sci. Sept. 2021;10:3419\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlem Endeshaw NMMWMW, Woldeyohanins. 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Global Health Res Policy, pp. 1\u0026ndash;17, 04 January 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarg N. Role and Advancements in Medical Equipment: Transforming Healthcare, \u003cem\u003eJournal of Medical Diagnostic Methods\u003c/em\u003e, vol. Vol.13, no. 6, p. 1, 26 December 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSirnan Humnesa Kabeta Y-FCCJMM-HL. Methods for medical device and equipment procurement and prioritization within low- and middle-income countries:findings of a systematic literature review. Globalization Health, pp. 1\u0026ndash;16, 18 August 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSirnan Humnesa TKCT, Kabeta. Medical Equipment Management in General Hospitals: Experience of Tulu Bolo General Hospital, South West Shoa Zone, Central Ethiopia. Med Devices: Evid Res, pp. 57\u0026ndash;70, 17 March 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eP. 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BMC Health Serv Res, pp. 1\u0026ndash;13, 2016.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eL. e. al, An approach to prioritization of medical devices in low-income countries: an example based on the Republic of South Sudan. Cost Eff Resource Allocation, pp. 1\u0026ndash;7, January 2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eK. e. al, Medical Equipment Management in General Hospitals: Experience of Tulu Bolo General Hospital, South West Shoa Zone, Central Ethiopia. Med Devices: Evid Res, pp. 57\u0026ndash;70, 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM. U. e. al, Practices and factors affecting onsite medical equipment maintenance at Wau Teaching Hospital, South Sudan. BMC Public Health, pp. 1\u0026ndash;12, 22 November 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohn Kwaku Kutor PAHA. Maintenance Practice, Causes of Failure and Risk Assessment of Diagnostic Medical Equipment. J Biomedical Eng Med Devices. 2017;2(1):1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVijay Kumar SK, Tadia. A comprehensive study on the maintenance of medical equipment at tertiary care hospital in India, \u003cem\u003eInternational Journal of Research in Medical Sciences\u003c/em\u003e, vol. 8, no. 2, pp. 464\u0026ndash;469, Feb 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeyene Wondafrash BTM, Ademe. Availability and utilization of medical devices in Jimma zone hospitals, Southwest Ethiopia: a case study. BMC Health Serv Res, pp. 1\u0026ndash;10, 14 July 2016.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eetl AWM. January, The availability and functionalitybof medical equipment and the barriers to their use at comprehensive specialized hospitals in the Amhara region, Ethiopia. Front Health Serv, pp. 01\u0026ndash;11, 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatience Okpeke JOOLE-U, Paul. Procurement in healthcare: Ensuring efficiency and compliance in medical supplies and equipment management, \u003cem\u003eInternational Journal of Science and Technology Research Archive\u003c/em\u003e, pp. 1\u0026ndash;10, July 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaba Hinrichs-Krapels BDBCES. Purchasing high-cost medical devices and equipment in hospitals a systematic review. BMJ Open access, pp. 1\u0026ndash;20, 12 Feb 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElisabetta Bianchini CCM. Medical Device Regulation: Should We Care About It? Artery Res, pp. 1\u0026ndash;6, 31 March 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eS JONHANLOA. 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Biomedical engineers are crucial for effective health-care systems, \u003cem\u003eThe Lancet Global Health\u003c/em\u003e, vol. 13, no. 3, pp. e396 - e398, March 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO, HUMAN RESOURCES FOR MEDICAL, DEVICES. The role of biomedical engineers, \u003cem\u003eWHO Medical device technical series\u003c/em\u003e, pp. 01-240, 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaurice JN, Atiende J. Transparent procurement practices and performance of medical supply chain in Kenya, \u003cem\u003eINTERNATIONAL JOURNAL OF BUSINESS AND MANAGEMENT (IJBM)\u003c/em\u003e, pp. 01\u0026ndash;09, 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJillian Clare TW, Kohler. The Urgent Need for Transparent and Accountable Procurement of Medicine and Medical Supplies in Times of COVID-19 Pandemic. J Pharm Policy Pract, pp. 01\u0026ndash;4, 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG. J. v. d. W. M. Y. D. B. R. P. Th. Houngbo, Policy and Management of Medical Devices for the Public Health Care Sector in Benin, \u003cem\u003ePublic Health Methodology, Environmental and Systems Issues\u003c/em\u003e, pp. 313\u0026ndash;324, 2012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNwoke J. Regulatory Compliance and Risk Management in Pharmaceuticals and Healthcare, \u003cem\u003eInternational Journal of Health Sciences\u003c/em\u003e, vol. 7, no. 6, pp. 60\u0026ndash;88, Sep 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eORGANIZATION WH. MEDICAL DEVICE REGULATIONS Global overview and guiding principles. Med DEVICE REGULATIONS, pp. 3\u0026ndash;42, 2003.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAltayyar SS. The Essential Principles of Safety and Effectiveness for Medical Devices and the Role of Standards. Med Devices: Evid Res, pp. 49\u0026ndash;55, 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRupesh Kumar RK. Calibration of Medical Devices: Method and Impact on Operation Quality, \u003cem\u003eInternationale Pharmaceutica Sciencia\u003c/em\u003e, vol. 16, no. 1, pp. 1\u0026ndash;15, Sep 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical equipment management, Equipment Failure factors, Systemic challenges, Teaching hospitals, Healthcare technology, Operational gaps, Low and middle-income countries ","lastPublishedDoi":"10.21203/rs.3.rs-6735317/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6735317/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Frequent failures of medical equipment and poor management practices remain major obstacles to effective clinical service delivery in developing countries. This study examines the key factors contributing to medical equipment failure and the common challenges in equipment management system within Ethiopian hospital settings, aiming to inform national policy makers and enhancing the performance of healthcare technology management in the healthcare ecosystem.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA facility-based cross-sectional study was conducted from September to December 2024 in seven university hospitals in Ethiopia. The study assessed medical equipment management and key factors contributing to equipment failure using structured data collection tools and a double data entry process to ensure accuracy. Trained personnel collected data across all sites. The result was reported using descriptive statistics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e This study investigated core challenges related to medical equipment management and cause of equipment failure across study sites. Among the identified causes of equipment failure, delays in spare part procurement (100% hospital agreed), emerged as the most critical issue in Ethiopian teaching hospitals. This was followed by shortage of maintenance budgets, absence of spare parts, and maintenance skill gap each reported by 85.71% of the hospitals. Electric Power fluctuations and a lack of training (57.14%), equipment mishandling by users (more than 50%) and inadequate maintenance tools contains (28.57%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study highlights critical shortcomings in medical equipment management in Ethiopian teaching hospitals, identifying key technical and organizational factors contributing to equipment failure. Addressing challenges such as spare part shortages, limited maintenance budgets, inadequate technical capacity, power fluctuations, and inefficient procurement practices is essential for improving equipment reliability and clinical service delivery. The findings emphasize the need for systemic and nationwide reforms to improve equipment utilization, strengthen healthcare infrastructure and service quality.\u003c/p\u003e","manuscriptTitle":"Medical Equipment Management and Failure Factors in Ethiopian Teaching Hospitals: A Survey-Based Study of Systemic Challenges and Operational Gaps","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 19:19:26","doi":"10.21203/rs.3.rs-6735317/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-18T07:03:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T18:17:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-07T07:21:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43516513057336522654302043211844551874","date":"2025-08-07T04:55:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29823742012213065487725875469389482049","date":"2025-08-04T19:54:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320775672395309629228847079495867049102","date":"2025-07-28T04:12:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-20T18:30:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-16T04:13:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-30T10:58:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-30T09:18:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-06-30T09:15:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"221bdb10-74e2-47e1-9e47-53872a2ad2c1","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T07:40:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 19:19:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6735317","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6735317","identity":"rs-6735317","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}