Quality medical equipment is essential for efficient healthcare services. It must be reliable, available, maintainable, and safe for use in healthcare facilities. Outsourcing maintenance of medical equipment is a cost-effective strategy for healthcare institutions aiming to provide quality services. However, challenges in maintenance management remain unexplored in existing literature. This study seeks to enhance the efficiency of outsourcing medical equipment maintenance in public primary healthcare facilities by identifying challenges, root causes, and mitigation strategies. Through semi-structured interviews, the study explores the motivations and themes related to this topic. The research findings reveal challenges in organizational and environmental aspects, with root causes including human, organizational, and environmental factors. Mitigation strategies focus on technology, organizational structure, process management, training, resource management, capabilities, stakeholders’ involvement and environment control. The originality of this article lies in the specific barriers, root causes, and mitigation strategies identified for public primary healthcare facilities in Malaysia which are not widely explored in existing literature. Furthermore, it introduces a novel dimension by discovering the Technology-Organization-Environment (TOE) theory as the explanatory theory to the body of knowledge of MEMM, highlighting technology adoption, system enhancement, stakeholders’ involvement, process management, organizational structure, and internal environment as its emerging elements in improving the effectiveness of outsourcing MEMM in public primary healthcare facilities.