Background and Objective: In Pakistan, the demand for surgery is not being met due to a shortage of both surgical equipment and healthcare workers. This gap in the availability of surgical equipment hinders the provision of safe surgeries. To develop strategies to improve availability, it is essential to understand the use of surgical equipment in this context. This study aims to: (1) map out the different phases that surgical equipment goes through during its lifespan (i.e., the surgical equipment journey) in Pakistan, and (2) identify the barriers perceived by biomedical equipment technicians (BMETs). Material and Methods: Seven semi-structured, in-depth interviews were conducted with 17 BMETs working in Pakistan. These participants were from 6 different hospitals (4 public, one private, and one mission). The interviews took place between December 2016 and December 2018. Participants were asked to describe or illustrate the surgical equipment journey and to identify perceived barriers during this journey. Results: The surgical equipment journey comprises three phases: procurement, usage, and disposal. Key stakeholders in this journey include users, BMETs, procurement officers, local distributors, and, in the case of donations, donation agencies. Identified barriers include bureaucratic hurdles during procurement, difficulties in obtaining consumables and spare parts (especially for donated equipment), cleaning with harsh chemicals, and usage in challenging environments. Conclusion: To optimize the surgical equipment journey in Pakistani hospitals, sustainable interventions at multiple organizational levels are necessary. Participants in this study identified several strategies to increase the availability of surgical equipment in Pakistan: implementing policies on donations, procuring durable equipment, training more BMETs and university-trained biomedical engineers, and developing designs and business models suited to local conditions in Pakistan and potentially other countries in the region.