Medical devices and health technologies are an essential but often overlooked component of effective health care delivery. These technologies can require extensive training, ongoing preventive maintenance, and a reliable supply of specialized parts and accessories. Yet not enough attention has been given to the critical role of biomedical engineers and technicians in low- and middle-income countries (LMIC) in maintaining the equipment and technologies that keep patients alive.
The recent and first-ever Africa Regional Biomedical Engineering and Health Technology Conference spotlighted the critical barriers and opportunities to reinforce these vital resources. Below are four ways to advance biomedical engineering toward stronger health systems and universal health coverage.
1. Maximize longevity and sustainability of medical devices
Around 40% of medical equipment in LMIC eventually end up in equipment "graveyards" due to lack of proper infrastructure, training, and maintenance. This is particularly true for one-off donor procurements that lack continued investment in long-term device management. Considering equipment’s end of life is particularly important to minimize these “graveyards” and improve environmental sustainability of health technologies.
Global initiatives like Build Health International’s "Find & Fix" have brought numerous pieces of equipment back to life. But to maximize the longevity of that equipment, countries need to establish relevant policies, procedures, and budgets for equipment maintenance and disposal. And given their expertise, biomedical engineers should be involved in the entire medical equipment life cycle—from planning and procurement to developing job aides and collecting data to managing disposal arrangements.
Initiating proactive policies, procedures, and budgets for the use and disposal of medical equipment will ensure better economic, environmental, and equitable outcomes.
2. Bolster digital equipment management information systems
Data availability on medical equipment varies from one facility to the next, one device to the next, and even one month to the next. Countries should consider instituting or strengthening digital equipment management information systems, accounting for barriers around data literacy, resource availability, internet access, and data synchronization. These systems can generate timely reports that assist biomedical engineers in monitoring availability and functionality of medical equipment. This strengthens informed decision-making on when preventative maintenance should be performed or more significant repairs are needed, ensuring optimal performance and a longer life span. These data can also inform more accurate spare-part procurement and broader budgeting for equipment management. In countries like Malawi, Kenya, Tanzania, and Nigeria, Hatch Technologies (under the NEST360 initiative) is doing this for maternal and neonatal devices.
Ultimately, instituting equipment information systems can solve problems between engineers and health care workers and improve overall device performance, leading to better health outcomes for patients.
A biomedical engineer assesses an oxygen cylinder manifold at Dodoma Regional Referral Hospital in Tanzania. Photo: PATH/Conner House.
3. Strengthen the curricula for biomedical engineers in training institutions
A sufficient number of biomedical engineers with the capacity to support health technologies is a notable gap in LMIC—and without them, procurement, installation, and maintenance of technologies are simply not possible. Standardized, routine training of these engineers must be prioritized to ensure continued and effective equipment operations when and where it is needed most.
The University of Rwanda’s Regional Centre of Excellence in Biomedical Engineering and eHealth was created as a hub to build a relevant, highly skilled, and competitive workforce in biomedical sciences. Thus far, the Centre has led to more skills building on state-of-the-art technology and a higher graduation rate for biomedical engineers. With 20 biomedical engineering training institutions in East Africa alone, the Centre is a model for other countries to replicate if they are looking to improve the capacity of their biomedical engineers. So far, plans are underway to establish centers in Kenya, the Democratic Republic of the Congo, Uganda, and Southern Sudan.
Strengthening and standardizing biomedical engineering curricula and establishing these centers of excellence across LMIC will ensure capacity-strengthening that is more harmonious and universal and of higher quality.
4. Elevate global standardization and classification of medical equipment and devices
Brand proliferation of medical devices creates challenges in equipment management. Parts are typically not interchangeable across brands, and maintenance and repair protocols often differ. This can complicate efforts—particularly by biomedical engineers—to have standardized spare-part procurement, training, and overall device maintenance.
The World Health Organization (WHO) is currently working to establish global, standardized nomenclature and classification of medical equipment, which will be critical to see real change in medical device design and development. Countries should consider adopting these new standards and institute their own national list of priority medical devices, nomenclature system, and other guidelines around procurement and management of health technologies. Kenya is one example where the development of a national nomenclature system for medical equipment is ongoing.
Medical equipment standardization at global and national levels can support more efficient planning and procurement of devices and spare parts, more systemized training and guidance, and better overall equipment operations—and thereby maximize the impact of biomedical engineers.
A biomedical engineer in Senegal services a pressure swing adsorption oxygen generation plant. Photo: PATH/Conner House.
The essential role of biomedical engineers came to the forefront during the COVID-19 pandemic. They were called upon to rapidly install, maintain, and repair the devices and equipment necessary to monitor and treat critical patients. However, their impact goes well beyond COVID-19: they are fundamental to strong and sustainable health systems. Together, we need to address the current and future challenges that face health systems, biomedical engineers, academia, and industry on the pathway to equitable medical device access and universal health coverage. These four aims are just the start.
If you are interested in learning more about human resources for medical devices, please see the WHO book on the role of biomedical engineers and technicians.
