Abstract
Regulatory and other governance arrangements influence the introduction of medical devices into health systems and are essential for ensuring their effective and safe use. Challenges with medical device safety, quality and use are documented globally, with evidence suggesting these are linked to poor governance. Yet, medical device regulation and oversight remain inadequately defined and described, particularly in low-income and middle-income settings. Through this review, we sought to examine the literature available on regulatory and oversight processes for medical devices in African countries.Following a systematic approach, we searched academic databases including PubMed, Embase (Ovid) and MEDLINE (Ovid), supplemented by search for grey literature and relevant organisational websites, for documents describing medical device regulation and oversight in African countries. We summarised the data to present key actors, areas for regulation and oversight and challenges.A total of 39 documents reporting regulation and oversight of medical devices were included for analysis. Regulatory and oversight guidelines and processes were reported as inadequate, including limited pre-market testing, reliance on international certifications and limited processes for post-market monitoring and reporting of adverse events. Challenges for regulation and oversight reported included inadequate funding, personnel and technical expertise to perform regulatory functions. The literature highlighted gaps in guidelines for donated medical devices and in information on governance processes at the national level.The current literature provides a general overview of medical device regulatory guidelines and limited evidence on the implementation of regulatory/oversight processes at national and especially subnational levels. We recommend further research to elucidate existing governance arrangements for medical devices within African countries and propose a conceptual framework to inform future studies. The framework provides entry points for careful examination of governance and oversight in policy and practice, the exploration of governance realities across the health system and the influence of wider system dynamics.
Funder
National Institute for Health and Care Research
Subject
Public Health, Environmental and Occupational Health,Health Policy
Reference59 articles.
1. WHO . Medical devices: managing the mismatch: an outcome of the priority medical devices project. 2010: 1–36. Available: https://apps.who.int/iris/bitstream/handle/10665/44407/9789241564045_eng.pdf
2. Introducing new technology safely;Mytton;Qual Saf Health Care,2010
3. Greenhalgh T , Wherton J , Papoutsi C , et al . Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res 2017;19:e367. doi:10.2196/jmir.8775
4. Wiysonge CS , Paulsen E , Lewin S , et al . Governance arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017. doi:10.1002/14651858.CD011084.pub2
5. Sheikh K , Gilson L , Agyepong IA , et al . Building the field of health policy and systems research: framing the questions. PLoS Med 2011;8:e1001073. doi:10.1371/journal.pmed.1001073