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2.3 ESSENTIAL MEDICAL EQUIPMENT

Essential medical equipment means basic equipment needed for a specified

health service delivery. This section provides lists of essential medical equipment
in a general manner. Users of these lists should keep in mind that equipment is a
tool for a particular service. One must first identify what services are delivered in a
particular health facility before equipping that facility with appropriate equipment.
Furthermore, the type of equipment to provide depends greatly on the local health
practice, physical characteristics and culture of the population. These lists provide
a starting point for local health workers to work out their real needs.

2.3.1 Scope of clinical services of the sample district hospital

This sample is a first-referral level hospital for the district (about 50 beds).
The scope of services with equipment needs may vary from country to country.

DEPARTMENT

Clinical

Medicine
Surgery
Paediatrics
Obstetrics/Gynaecology
Dentistry
Orthopaedic surgery
Otorhinolaryngology
Neurology
Psychiatry

Clinical support

Anaesthesia
Radiology
Clinical laboratory
Pathology
Rehabilitation

Essential surgical equipment for general and specialty surgeries has been
extensively listed in other WHO publications (see selected biblio.: Cook, Sankaran
and Wasunna).

Essential equipment sets for departmental clinics are listed in part II.

Here only typical major equipment used in district hospitals shall be listed.
For hospitals, with larger numbers of beds, greater capacities of basically the
same type of equipment can be used. For example: instead of using a 100 mA,
120kV X-ray unit for a 50-bed hospital, use a 200 mA, 120 kV unit for a 100-bed
hospital. The number of the same equipment can also be increased. For example:
increase the number of microscopes for a larger workload; add a microscope,
refrigerator and portable cold boxes to set up a blood bank. It is important,
however, to ensure the availability of qualified users and service before supplying
equipment.
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WHO is in the process of developing a software package to be used by

countries to generate essential medical equipment lists within their own
requirements and conditions including financial considerations.

2.3.3.1 Diagnostic imaging equipment

Diagnostic imaging in small hospitals requires X-ray and ultrasound

equipment. In a general "community" hospital, X-ray equipment is the first and
essential item. Ultrasound can be added if money is available, but X-ray
examinations are needed much more often.

(1) Diagnostic X-ray equipment

X-ray equipment can be stationary, in one room, or mobile. Stationary

equipment is essential. Most small hospitals do not require a mobile
unit; however, if funding is available, a mobile unit is a useful, albeit
relatively infrequently used piece of equipment. It may be necessary for
orthopaedic procedures during surgery.

For optional Mobile X-ray and Fluoroscopic Equipment, see Annex 6.

Since X-ray units are the most expensive items among essential
equipment for district facilities, considerably more information is
provided in Annex 7, which is based on a recommended WHO Basic
Radiology System (BRS) and the World Health Imaging System for
Radiography (WHIS -RAD).

(2) Ultrasound equipment

Many varieties of ultrasound equipment are available, with varying

capabilities. The minimum specifications for a general-purpose
ultrasound unit are provided by WHO in a technical report from a
scientific group, The Future Use of New Imaging Technologies in
Developing Countries (Technical Report Series No.723). The generic
specifications are given in Annex S .

These minimum specifications must be met or exceeded, and

particularly the technical requirements for resolution, as poor-quality
images lead to inaccurate diagnoses. The WHO publication Manual of
Diagnostic Ultrasound contains information for testing ultrasound units
when first delivered, continuous quality assurance and essential
maintenance. The purchase of sub-standard equipment is a poor
investment. Comprehensive information on clinical diagnosis is also
provided.

For optional recording equipment for ultrasound, see Annex 6.

2.3.3.2 Laboratory equipment

(1) Microscope

An all-purpose microscope for general laboratory use should have a

1.25x binocular body tube and paired 10x wide-field -eye-pieces
combined with four objectives to provide magnifications of 59x, 125x,
500x and 1250x, with co-axial course and fine focusing controls. The
fine focus control should be graduated in 0.002-mm increments.

(2) Blood counter

The mechanical differential counter is still popular, especially in

developing countries, although electronic counters are becoming
common. A wide range of types is available, from which the laboratory
technician can select that which is needed.
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(3) Analytical balance

The balance should have a digital read-out. The housing should be

enamelled steel, and the pan of stainless-steel. The weighting range
should be from 0 to 1909; quantities of 0.1 mg should be readable. It
should operate on 220 V, 50 Hz, AC (or 110 V, 60 Hz).

(4) Colorimeter/spectrophotometer

This photoelectric device provides a photometric reading in direct

proportion to concentration. The unit should have dual photoelectric
cells to maintain accuracy even with line voltage fluctuation. It should
also have zero adjustment before readings are taken of standard and
sample and a range of filters to cover the visible spectrum.

(5) Centrifuge

A small centrifuge that can accommodate six 15-ml tubes should be

available, with a speed control from 0 to 5300 rev/min and an electronic
sensor that controls rotation within a tolerance of approximately 1%.
The rotational speed should be unaffected by power fluctuations.

(6) Water bath

A water bath is used in the clinical laboratory for stabilizing temperature

at 25, 37, 42 or 56°C, depending on the method of investigation. The
temperature of the bath must be maintained constant within a narrow
range (+ 0.1°C).

(7) Incubator/oven

A small, hot-air oven to carry out standard cultivation and sterilization

should be available, with a two-tray capacity and temperature setting
and time controls. The possibility of checking temperature using an
ordinary mercury thermometer is an advantage.

(8) Refrigerator

An ordinary household refrigerator with a freezer unit, for storing

preparations, vaccines, blood, etc., should be purchased. It should
stand on a simply constructed wooden plinth to keep it clear of the floor
to avoid rusting when there is risk of dampness or condensation.

(9) Distillation and purification apparatus

This apparatus should be housed in a cabinet, made of metal that

resists acids and alkali, and should be free standing. ,It should have an
output of one litre or more per hour and a distilled water storage cap
with a capacity of six litres or more.

2.3.3.3 General electro-medical equipment

(1) Portable electrocardiograph

A single-channel electrocardiograph unit with paper chart output should

be obtained. It should require a common mode rejection ratio of at least
60 dB, a high input impedance of at least 5 MΩ, with lead selection and
a two-speed chart motor drive.

(2) DC defibrillator (external)

This instrument should have an adjustable, synchronized output of 400

J maximum, with the output indicated by analogue or digital metering. A
suitable electrocardiograph monitor is required for use with
synchronization, if it is not built in; however, portable units containing a
small monitor and a defibrillator are readily available from 'most
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manufacturers. A rechargeable battery power source should also be

available, usually as an internal option. Battery-powered defibrillators
should have a trickle-charge option; replacement batteries should be
readily available, since batteries invariably have a limited life. Paediatric
paddles should also be available.

(3) Portable anaesthetic unit

Two small anaesthetic units should be obtained, complete with a range

of masks, incubators and hoses for use on infants and adults. Also
required are oxygen and nitrous oxide attachments, soda lime
rebreathing canisters and a cycloropane vaporizer.

(4) Respirator

This should be the pneumatic type, applicable for prolonged

administration during post-operative care. It should have a high-
pressure alarm for malfunctioning and power failure and should be
portable, if possible.

(5) Dental chair unit

A complete unit should be available to carry out standard dental

operations, including fillings, extractions and cleaning. Water should be
supplied through a water softener or filter; a cold light source should be
attached.

(6) Suction pump

One portable and one heavy-duty suction pump are required.

(7) Operating theatre lamp

The unit should consist of a main lamp with at least eight shadowless
lamps and an auxiliary of four lamp units.

(8) Diathermy unit ( electro-surgical unit, ESU)

A standard cut/coagulating unit should be obtained, operated by hand

or foot switch, with variable power control.

2.3.3.4 Other support equipment

(1) Operating theatre table

This should be standard and manually operated.

(2) Delivery table

This should be standard and manually operated.

(3) Autoclave -for general sterilization

(4) Small sterilizer -for specific services (e.g., dentistry)

(5) Cold chain and other preventive medical equipment

(6) Electrical generator

(7) Electrical power regulator

(8) Air conditioner, dehumidifier

(9) Refrigerator
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(10) Ambulance -four-cylinder diesel, four-wheel drive vehicle equipped

with medical equipment for emergencies; complete accessories,
spare tyres and tools.

(11) Gynaecological examination table.

(12) Small, inexpensive equipment and instruments

Equipment and instruments, such as blood pressure measuring

apparatus, oxygen manifolds, stethoscopes, diagnostic sets and
spotlights, although essential, are not included in these lists. The
decision on which and how many of these items are needed is left to
the discretion of individual hospital authorities.

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