Background: Medical equipment (ME) maintenance retains an asset’s original anticipated useful life and preserves its reliability and cost-effectiveness. This study developed and trialled a multi-component program to improve ME maintenance in nine Sri Lankan hospitals. Methods: This pre-post study involved an initial baseline assessment of existing ME maintenance systems in nine hospitals, the development and implementation of a multi-component improvement program, and a three-month post-evaluation. Five target ME were selected for the study: oxygen regulators, electrocardiogram (ECG) machines, suction apparatus, blood pressure (BP) apparatus and mini autoclaves. A validated questionnaire of randomly selected nursing officers (n=101) and healthcare assistants (n=120) was used to obtain baseline ME maintenance data. Six focus groups and 24 interviews were conducted with key stakeholders to co-design the multi-component interventions, which included: developing a standard operating procedure (SOP) targeting preventive maintenance activities; establishing focal points to provide technical and logistic support; staff training; and the introduction of institutional ME maintenance documents. Program effectiveness was assessed at three months post-implementation. Results: Baseline assessment identified no ME maintenance programs implemented in any of the hospitals. Following program implementation, improvements were noted in: the availability (p<0.05) and functional level (p<0.05) of all selected ME; equipment maintenance processes (p=0.000); as well as staff knowledge, skills, perceptions and satisfaction. Conclusions: The program improved the use and maintenance of ME and was widely supported by key stakeholders. The approach is likely relevant to other resource-poor hospital settings where inadequate ME maintenance causes health system inefficiencies.