The Graveyard of Donated Equipment: Shifting from Capital Expenditure to Value-Based Care in African Health Systems

Abstract

This opinion piece challenges the assumption that African health systems primarily fail because of insufficient medical equipment. It argues that the deeper crisis is ecosystem incompatibility: donated and imported technologies often fail when they are not supported by reliable power, biomedical engineering capacity, maintenance financing, spare parts, and appropriate procurement models. Using Nigeria as a case example, the article critiques capital expenditure-heavy models of medical equipment ownership and proposes a shift toward operational expenditure frameworks, particularly Equipment-as-a-Service. It further argues that linking Equipment-as-a-Service to health insurance purchasing and value-based care could improve equipment uptime, reduce provider debt exposure, and support more sustainable diagnostic access in low- and middle-income health systems.