Improving the Availability and Functional Status of Medical Equipment through a Clinical Audit Cycle: A Quality Improvement Study at a Secondary Care Hospital in Sri Lanka. Background Medical equipment is essential for effective healthcare delivery; however, in low- and middle-income countries, inadequate maintenance systems and weak governance often result in high rates of non-functional equipment. Clinical audit is a recognised quality improvement approach that can identify system gaps and drive measurable improvements. Objective: To assess and improve the availability and functional status of medical equipment through a structured clinical audit cycle. Methods: A full clinical audit cycle was conducted over six months (October 2025–March 2026) at a secondary care hospital in Sri Lanka. The audit included baseline assessment, gap analysis, implementation of targeted interventions, and re-audit. Data were collected using a structured checklist through direct observation, inventory review, and staff interviews. Key indicators included equipment functionality, preventive maintenance, maintenance documentation, and calibration status. Interventions included the introduction of repair tracking systems, preventive maintenance schedules, equipment logbooks, calibration programs, and staff training. Data were analysed using descriptive statistics. Results: A total of 660 medical equipment items were assessed. At baseline, only 61.7% were fully functional, while preventive maintenance (15.6%), maintenance documentation (17.0%), and calibration (4.3%) were markedly deficient. Following interventions, functionality improved to 91.8% (absolute increase: +30.1%), exceeding the ≥90% standard. Preventive maintenance increased to 92.4% (+76.8%), maintenance documentation to 94.5% (+77.5%), and calibration to 73.6% (+69.3%). The proportion of non-functional equipment decreased from 32.5% to 5.5%, with substantial reductions in repair delays. Conclusion: Structured, low-cost interventions implemented through a clinical audit cycle significantly improved medical equipment functionality and management. Clinical audit is an effective strategy for strengthening health technology management systems in resource-limited settings.