{"entity":{"id":"idea-acc-linac-uptime-contracts","kind":"idea","name":"Pay for radiotherapy machine uptime, not for the machine","aka":[],"tldr":"Governments and donors should buy guaranteed working hours from radiotherapy vendors, with remote monitoring and regional spare-parts depots, instead of buying machines that then sit broken.","summary":"Radiotherapy machines in low- and middle-income countries are frequently non-operational for months awaiting a part or a visiting engineer. A regional shared-service model would bundle continuous remote diagnostics, an in-region spare-parts depot, and locally trained engineers into a multi-country service contract with penalties for downtime. Vendors already run remote monitoring in high-income markets; the change is contractual, not technical.","asOf":"2026-09-08","links":[{"label":"IAEA Rays of Hope","url":"https://www.iaea.org/services/rays-of-hope"}],"tags":[],"related":[],"cancers":[],"sections":["radiation"],"technologies":[],"targets":[],"drugs":[],"companies":["varian","elekta"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-global-access","b-surgery-radiation-innovation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Uptime-linked service contracts covering a regional cluster of at least ten machines will raise annual scheduled-hours delivered by at least 30% within two years compared with machines under standard warranty terms.","rationale":"Availability-based contracting transformed aircraft-engine and hospital-imaging maintenance economics. Concentrating demand across countries makes an in-region engineer and parts depot affordable.","test":"A donor-backed pilot across one region (e.g., East Africa) comparing uptime, mean time to repair, and patients treated per machine between contracted and non-contracted sites, reported quarterly and published.","maturity":"early-clinical","actor":"policy","cost":"medium","horizonYears":3},"route":"/ideas/idea-acc-linac-uptime-contracts/","neighbours":{"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"company":[{"id":"elekta","kind":"company","name":"Elekta","route":"/companies/elekta/"},{"id":"varian","kind":"company","name":"Varian (Siemens Healthineers)","route":"/companies/varian/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"roadmap":[{"id":"global-access-roadmap","kind":"roadmap","name":"Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation","route":"/roadmaps/global-access-roadmap/"},{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"}]}}