Covid-19 pandemic has unveiled the major weakness of health systems across the world, being the shortage of intensive care beds and mechanical ventilators in low- and middle-income countries to provide acute care to critically ill patients one of this. Research has pointed to structural factors like the high cost of trained healthcare workers, infrastructure, and supplies. The main drivers of the limited development of intensive care units (ICUs) in low and middle-income countries. Based on the systematization of experience of the development and implementation of a mechanical ventilator based on a manual resuscitator with telemedicine capabilities for patients with ARDS (MASI) during the COVID-19 crisis in Peru, this paper argues that regulatory frames, including frameworks for prioritization of health interventions, including health technology assessment processes, are critical to guarantee the timely implementation of life-saving technology. The paper describes the regulatory gaps and challenges faced during the three steps of MASI´s development and implementation (prototype development, massive production, and technology transfer and implementation). MASI´s experience shows the negative effects of the lack of established decision processes to prioritize health interventions (including technology purchasing) on the efficient and transparent use of resources during a sanitary crisis, and in general on health system performance. MASI´s experience provides evidence on the importance of having systems to determine the value of health technologies and innovations to the health systems.
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