The policy gap: when generosity has no rulebook

When a container of donated equipment arrives in a country with no donation policy, everything becomes negotiation: what's accepted, who clears it, where it goes, who's responsible when it breaks. The WHO's baseline country survey on medical devices found this is the norm, not the exception — roughly half of responding countries reported no national policy or guidance on medical device donations, and a similar share lacked procurement guidelines.

Policy sounds abstract until you watch its absence work. Without acceptance criteria, nothing can be politely refused, so everything arrives — including the unusable. Without standardization guidance, every donation fragments the national fleet a little further. Without disposal rules, the unusable never leaves. The storeroom full of dead donations is, in a real sense, a policy document that was never written.

The encouraging flip side: countries that do adopt clear health-technology policies give their hospitals a tool that costs almost nothing and works at the border, where it's cheapest to act. 'Thank you, but our national guidelines require manuals, parts, and training with every device' is a sentence that transforms donor behavior.

Networks like ours operate inside whatever policy environment exists — but we cheer loudly for the rulebooks, and our procurement guidance is designed to function as a private-sector stand-in where public policy hasn't yet arrived.