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Purpose: This study measures the impact of implementation of the Improved Decentralized Maintenance Model on the functionality and availability of medical equipment in Burundi’s resource constrained health care system with hypothesis that the model has a measurable impact. Methods: The initial model was tested in 2 provinces before being improved and extended to the provinces of Bujumbura and Rumonge. It is composed by 4 interrelated main axes (Maintenance management, Human, Financial and Material resources,). This study analyses the effects of this implementation between October 2020 and February 2022. Results: The rate of medical equipment functional in service has increased substantially, respectively +8% in the province of Bujumbura and 2% in the province of Rumonge, and the rate of medical equipment requiring maintenance has fallen by 9.7% (Bujumbura) and 2% (Rumonge). The provinces implementing the model have convincing results in terms of functionality with scores of at least 80%, while the national average is 64%. Conclusions: There is a notable positive change between 2020 and 2022 in the functionality of medical equipment and a decrease in equipment awaiting maintenance, and therefore in its availability. This study proves that a sustainable implementation of a decentralized maintenance model is feasible and highly useful in low-resource settings due to its affordability. The context of a low-resource country is a challenge in itself, but the model developed shows that by tackling the low-resource levels of preventive maintenance, we can have some impact on the functionality of the equipment and therefore on the quality of care.