Issues on Clinical Engineering in Developing Countries

1
Issues on Clinical Engineering in Developing
Countries

• Prof. M. Frize, P. Eng., O.C.
• ELG5123/94.526

2
Types of issues

• The environment
• Needs and priorities of health plan
• Existing technology base
• Availability and training of human resources
• Organisational infrastructure
• Financial considerations
• National policy and enforcement
• A model Morocco

3
The Environment

• Harsh sand, salt, heat, humidity, frequent power
  failures and even rare availability of power,
  gases
• Few or no user-manuals
• Few or no service manuals
• Few or no spare parts
• Older technology, therefore no longer any support
  
• Expensive operating costs

4
Issues on Priorities of Health Plan

• Epidemiological studies determine countrys major
  diseases and trends
• This should guide the national policy on health
  care needs and expenditures
• Policy towards poisoned gifts
• Doctors dictating their needs

5
Existing Technology base

• Older technologies (around 30 percent or more)
• Too many brands and types
• 60-80 percent idle (not in use)
• Many safety issues (ex. Steriliser efficiency,
  electrical safety, fumes and gases in X-Ray film
  development, radiation levels, accuracy, etc)
• Equipment delivered, but not installed
• Parts and / accessories missing

6
Availability of human resources...

• Many countries have a good base of engineering
  and technician education
• Usually NO biomedical training
• Holding two jobs (public and private)
• Large turnover of staff
• Low morale and productivity
• Fraud, stealing, abuse of system

7
Education and Training

• On-the-job training for biomedical knowledge
  (techs and engineers)
• Train the trainors (WHO, UNDP, etc..)
• Many placements for periods of 2-12 months
  (France, Canada, USA, UK ...)

8
Organisational Infrastructure

• Mainly centralised for everything (Budget,
  hiring, training, purchasing parts, equipment..)
• Physicians in charge of hospitals is predominant
  model
• Minister of Health also a physician
• Nepotism in every aspect
• Status and power structure very present
• Communication rules and policies (tel, internet,
  travel allowances and permission)

9
Financial Considerations

• Budgets allocated for maintenance and equipment
  management are small
• Budgets centrally controlled
• Few spare parts in inventory or in each purchase
  order
• Soft currency
• Fraud at customs, transit, etc
• Control and power (ex. Cars)

10
A National Policy

• To determine health priorities
• To purchase equipment and technology
• For acceptance of gifts (equipment)
• For establishing equipment management and
  maintenance
• For establishing de-centralised and appropriate
  budgets and support
• Communications (telephone and internet)