Biomedical Technology and Laboratory Strengthening
In many low-income countries around the world, more than 95 percent of the medical equipment found in hospitals is imported. Unfortunately, much of this equipment is out of service, but could be easily repaired at minimal cost by trained professionals. According to a survey of 52 African hospitals conducted by experts at Carleton University in Canada, 85 percent of these facilities indicated that their medical device maintenance services had trouble finding qualified engineers and technicians locally.
To a great extent, biomedical engineers and equipment technicians in low-income countries are affected by the same challenges that doctors and nurses face, including inadequate numbers of qualified personnel to meet existing needs, limited educational opportunities, lack of on the job training, absence of regulatory bodies, brain drain to higher-income countries, and competition with the private sector for the limited pool of skilled professionals.
AIHA’s Biomedical Technology Program and Laboratory Strengthening Programs
AIHA’s Biomedical Technology and Laborartory Strengthening programs are helping countries meet the demands of today’s technology-driven healthcare systems, particularly in the context of providing high quality HIV/AIDS-related diagnostic, treatment, and care services.
AIHA started working in this field in 2013 with the first PEPFAR-supported project to address biomedical technology and laboratory strengthening in sub-Saharan Africa. In January 2013, AIHA initiated a partnership that applied our twinning model to engage multiple education institutions from the United States and Ethiopia in a concerted effort to rapidly train new biomedical engineers and equipment technicians, as well as to support the ongoing continuing education needs of existing biomedical technology professionals.
Jimma University Institute of Technology established Ethiopia’s first biomedical engineering degree program in 2008, while Tegbare-id Polytechnic College has been home to one of the country’s only diploma-level biomedical technician vocational training programs since 2006. Tasked with producing enough biomedical technology specialists to meet the country’s very high demands, both these institutions face significant challenges, including acute shortages of of qualified biomedical engineering instructors and a dearth of crucial professional development opportunities. They also lack training capacity and access to well-equipped skills labs and design workshops, as well as strong curricula and teaching methodologies. Yet another challenge is that most Ethiopian healthcare facilities do not adhere to evidence-based international standards for the management of biomedical equipment, which often hinders professional development
and growth opportunities for new biomedical engineers and technicians.
By linking Jimma University and Tegbare-id with Rice University and Texas Children’s Hospital in the United States AIHA helped the Ethiopian partners build the capacity to produce biomedical engineers and technicians capable of meeting the country’s burgeoning demands. Together, partners worked to strengthen pre-service biomedical engineering and equipment technician training programs at both the bachelor and diploma levels by updating curricula, training faculty, and providing evidence-based learning resources. Partners also collaborated to expand the capacity of these cadres to manage and maintain critical medical equipment through the expansion of practical in-service training opportunities. Finally, they worked to establish standardized protocols and processes to ensure ongoing equipment maintenance at the healthcare facility level.
In 2016, this partnership progressed to a second phase with the addition of a third Ethiopian institution: the Addis Ababa Institute of Technology. At this time, AIHA replaced the US partners with a consortium led by the University of Wisconsin at Madison to better address the evolving technical assistance needs of the Ethiopian schools.
Through this groundbreaking twinning partnership, AIHA helped develop a core group of biomedical engineering and biomedical equipment technology leaders in Ethiopia, who can identify local needs and gaps in healthcare delivery — with a special focus on technologies related to HIV/AIDS treatment and care — design and implement appropriate solutions, and repair and maintain existing biomedical equipment.
Selected Program Results
- AIHA has trained nearly 1,000 biomeds in support of the third “90” across five project countries in Africa since 2012.
- Leveraging the success of our biomedical technology project in Ethiopia, AIHA launched a public-private partnership with GE Foundation to help scale up and complement project activities through a comprehensive year-long in-service training program for biomedical technicians and engineers. In 2017, the project graduated 20 biomeds and opened a Biomedical Center of Excellence at “All Africa Leprosy Rehabilitation and Training Center” (ALERT Center), which now serves as a benchmark training center for biomedical engineers and technicians.
- In collaboration with the Ethiopian Ministry of Health, AIHA and our partners developed a mentorship plan that included experiential attachments at 10 government hospitals and five medical equipment dealers to promote the acquisition of hands-on practical skills for biomedical technology students.
- AIHA procured and distributed toolkits to the 17 Ministry of Health in Zambian labs seeking accreditation and conducted a study tour that brought three key biomedical personnel to our partner sites in Ethiopia as a way to expose them to more advanced biomedical engineering programs.
- AIHA began supporting efforts to ensure Zambia’s public health laboratories achieve accreditation in 2016. In collaboration with the Kenyan company, Biologics, we implemented a preliminary training on routine maintenance, repair, and calibration of non-automated laboratory equipment for 26 biomeds.
- Using a multi-step approach, AIHA and our partners in Kenya have been working to implement a sustainable in-service training program that includes short courses and distance-learning opportunities for biomeds, with a specific focus on preventive maintenance and repair skills for all levels of laboratory equipment since 2016, training 23 biomeds from target counties on non-automated equipment, six on refrigeration; and six as master trainers.
- AIHA supported training and development of National Laboratory Equipment Calibration Certification and Training Centers in Kenya and Uganda to empower countries for international accreditation to attain ISO17025:2017. Our Kenya team successfully received ISO17025:2017 accreditation as of October 2019.
- AIHA and our partners in Uganda developed training curricula for both non-automated and automated lab equipment that directly supports HIV and TB diagnosis and treatment, training 30 biomeds on non-automated equipment and identifying seven of those as master trainers, who have completed a training-of-trainers course to enable them to step down trainings in their respective regions.
- Also in Uganda, AIHA and our partners developed a refrigeration and air-conditioning training course to better support routine viral load testing, graduating 20 biomeds from the comprehensive two-week course and conducted the first GeneXpert training in East Africa, with 24 biomeds completing this initial two-phased course. Likewise, AIHA worked in partnership with Caroga Diagnostics’ Kenya office, the local representative for Cepheid, to train 21 biomeds on the GeneXpert point of care (POC) machine through a three-phased training and mentorship program.
- In 2017, four Ugandan biomeds completed a year-long, three-phase biosafety cabinet calibration and certification (BSCC) course. They have to date assessed 263 BSCs across the country, a function which was formally outsourced at high cost. Similarly, in 2018, AIHA engaged the Eagleson Institute from the United States to conduct a year-long, three-phased comprehensive BSCC course in Kenya.
- In 2017, the Ministry of Health’s National Public Health Laboratory (NPHL) in Kenya conducted a rapid response intervention to prepare 43 labs for accreditation. AIHA supported trained biomeds from our project sites to conduct the required equipment repairs and preventive maintenance at 24 of those labs across 14 counties, where biomeds worked on 385 pieces of equipment, a function that had previously been outsourced at great cost.
- At the National Equipment Calibration Center of Excellence AIHA helped establish in 2017, biomeds we trained in Kenya have to date calibrated more than 2,000 pipettes, nearly 500 thermometers, and 175 timers — a function that was previously outsourced or didn’t happen at all. Meanwhile since the calibration center became operational in Uganda, over 900 pieces of equipment have now been calibrated within the Ministry of Health.
- In Tanzania, AIHA trained 47 biomeds and faculty on routine maintenance and repair of viral load machines.