The design of medical equipment for low income countries (dual standards or common sense)

Medical equipment is usually designed to operate in a relatively constant environment, with stable, controlled temperatures and humidity, dust and insect free conditions, uninterrupted electrical supply and unlimited medical consumables. This ideal environment also includes expert users, advanced technical support and reserve equipment capacity. Change these basic fundamental conditions, for example as in low income countries, and the design process does not need modification - it needs to be turned upside down. In addition to the engineering challenges, equipment design needs to take account of international standards. One complication is that the requirements of international legislative and regulatory authorities invariably insist on standards written for an ivory tower medical environment, but which are far removed from what is actually needed in the average low income country. This paper deliberately leaves open a number of important questions in order to provoke debate.