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ARTÍCULOS ORIGINALES
Biomedical Engineering in the Global South: A brief descriptive survey
David Gaus[1], Diego Herrera[2]
1. Andean Health and Development, Estados Unidos
2. Saludesa Ecuador, Ecuador.
Doi: https://doi.org/10.16921/pfr.v9i3.331
PRÁCTICA FAMILIAR RURAL│Vol.10│No.1│Marzo 2024│Recibido: 23/01/2025│Aprobado: 10/03/2025
Cómo citar este artículoLarco D, Pico Menendez L, Gaus D. La microbiología de la sepsis neonatal en un hospital rural ecuatoriano. PFR [Internet]. 9(3). Disponible en: https://practicafamiliarrural.org/index.php/pfr/article/view/331 |
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Abstract
Introduction: As national healthcare systems around the global south continue to evolve, technology and local biomedical engineering (BME) needs to be part of that evolution. There is a paucity of descriptions of the current state of BME in hospitals around the global south.
Methods: A questionnaire was designed, validated, and distributed online to healthcare institutions around the global south to gain a better understanding of the current state of their BME departments and challenges they face. The questionnaire was answered by convenience. This paper is an initial look at some of the questions answered on the survey.
Results: 55 surveys were opened and 46 were completed by several hospital facilities from 17 countries. A predominance of large, tertiary care hospitals responded. 44.4% of the respondents had more than 4 Biomedical engineers or technicians working at their facility and 40% of all BME personnel were university trained. Ventilators, CV Monitors, and diagnostic laboratory equipment were the most frequently damaged technology at these facilities. Lack of spare parts were the most common reason stated for the inability to recover or repair damaged equipment.
Conclusions: The preponderance of large tertiary care hospital responses does not capture the conditions lived in smaller rural hospitals, yet the kinds of equipment most frequently damaged and the reasons for their lack of recovery or repair are challenges frequently faced at even large tertiary care hospitals in the global south.Keywords: Biomedical engineering, medical equipment, developing countries, technological inequality, spare parts
Ingeniería biomédica en el Sur global: una breve reseña descriptiva
Resumen
Introducción: A medida que los sistemas nacionales de salud en el hemisferio sur continúan evolucionando, la tecnología y la ingeniería biomédica (BME) local deben formar parte de dicha evolución. Existe escasez de descripciones del estado actual de la BME en los hospitales del hemisferio sur.
Métodos: Se diseñó, validó y distribuyó en línea un cuestionario a instituciones de salud del hemisferio sur para comprender mejor el estado actual de sus departamentos de BME y los desafíos que enfrentan. El cuestionario se respondió por conveniencia. Este artículo presenta un primer vistazo a algunas de las preguntas respondidas en la encuesta.
Resultados: Se abrieron 55 encuestas y 46 fueron completadas por varios centros hospitalarios de 17 países. Respondieron predominantemente grandes hospitales de atención terciaria. El 44,4% de los encuestados contaba con más de 4 ingenieros o técnicos biomédicos trabajando en sus instalaciones y el 40% de todo el personal de BME tenía formación universitaria. Los ventiladores, los monitores cardiovasculares y los equipos de laboratorio de diagnóstico fueron los equipos tecnológicos dañados con mayor frecuencia en estos centros. La falta de repuestos fue la razón más común para la imposibilidad de recuperar o reparar equipos dañados.
Conclusiones: La mayoría de las respuestas de los grandes hospitales de atención terciaria no reflejan las condiciones de los hospitales rurales más pequeños. Sin embargo, los tipos de equipos dañados con mayor frecuencia y las razones de su falta de recuperación o reparación son desafíos frecuentes incluso en los grandes hospitales de atención terciaria del hemisferio sur.Palabras clave: ingeniería biomédica, equipos médicos, países en desarrollo, desigualdad tecnológica, partes de repuesto
Introducción
Healthcare facilities in Low- and Middle-Income Countries (LMICs) are faced with a continuous dependence on medical technology that frequently fails them or is unavailable to them. As discussions around universal healthcare coverage and quality of that coverage carry on, biomedical engineering (BME), the development of medical technology, and the repair and maintenance of that technology gain increasing importance [1]. As stated elsewhere, "healthcare technologies are necessary for modern medical practice, solving complex health issues, and in the long term, achieving health equity" [2].
While BME formation is available throughout the industrialized world and biomedical engineers are part of all healthcare systems, in the global south, conditions are distinctly different. Donated medical equipment, although potentially useful, bring with it the need for local knowledge to repair and maintain equipment. Furthermore, the lack of availability of replacements parts can render donated, or even locally purchased equipment, useless once the equipment falls into disrepair. Locally sustainable BME needs to develop alongside the development of locally sustainable clinical programs.
A brief review of the literature would suggest that well over half of medical equipment in LMICs is out of service [3,4]. The WHO Director-General stated in 2010 that, "about 70% of the more complex devices do not function by the time they reach their destination" [5]. In Nigeria there are less than 0.05 biomedical technicians per 10,000 population compared to 2.79 technicians in the United States in 2017 [6].
Primary Care physicians working in hospitals in LMICs need to be aware of the biomedical engineering challenges faced by their institutions and understand the importance of access to appropriate BM personnel and spare parts, in addition to budgeting for this service if these physicians are involved in hospital administration.
This article attempts to add to the paucity of literature on the state of BME and medical equipment in the global south.
Methodology
A questionnaire was created and validated by three biomedical engineers with previous experience in survey preparation. The questionnaire was distributed to public and private hospitals and other health care facilities known to an Ecuadorian foundation, Salud y Desarrollo Andino, and a UK foundation, Safe Surgery Initiative. The questionnaire was distributed around the global south to healthcare providers online starting in November 2024 up to the time of this manuscript preparation in February 2025 and answered by convenience. The questions are of a descriptive nature of the BME conditions at their facility. The results shared in this article are a first look at some specific responses from the participants.
Results
At the time of this manuscript preparation, 55 survey responses were initiated and 46 were completed. Countries included in the 46 completed responses were Nigeria, Tanzania, Democratic Republic of Congo, Liberia, Uganda, Ghana, Chad, Pakistan, India, Kenya, Ethiopia, Nepal, Sierra Leone, Laos, Zambia, The Gambia, and Ecuador. This demonstrates a preponderance of responses from nations on the African continent, a few scattered Asian countries, and one South American country. The hospitals ranged from large, university teaching hospitals in urban centers to smaller rural hospitals, with a predominance of tertiary care hospitals. (Table 1)
Table 1. Hospital Categorization
| Hospital Categorization | Percentage of Responses |
| Second Level Basic Hospital (small hospital without medical specialties | 2.2 % |
| Second Level General Hospital (mid-size hospital with some medical specialties) | 34.8 % |
| Tertiary Care Hospital (many specialties and broad Critical Care services | 63.0 % |
To further define the categorization of the hospitals that responded to the survey, a question about number of hospital beds across all departments revealed that the majority of the respondents came from hospitals with and excess of 100 beds. (Table 2)
Table 2. Number of Hospital Beds
| Number of Hospital Beds | Percentage of Responses |
| 10-20 | 0.0 % |
| 20-50 | 6.6 % |
| 50-100 | 21.7 % |
| More than 100 | 71.7 % |
In response to the survey question, “position occupied by the informant”, the most frequent response was biomedical engineer. (Table 3)
Table 3. Position Occupied by the Informant
| Position | Percentage of responses |
| Biomedical Engineer | 42.2 % |
| Technician | 28.9 % |
| Physician | 22.2 % |
| Administrator | 6.7 % |
In response to “how many biomedical technicians or engineers work at your hospital”, the most common response was more than four. (Table 4)
Table 4. Number of BM engineers/technicians work at your hospital
| How many biomedical technicians or Engineers work at your hospital? | Percentage of responses |
| 1 | 13.3 % |
| 2 | 15.6 % |
| 3 | 15.6 % |
| 4 | 11.1 % |
| More than 4 | 44.4 % |
The most common educational levels of the biomedical engineers/technicians were a mix of university trained, vocational (or non-university trained) and on the job training. (Table 5)
Table 5. Educational Level of Biomedical technicians/engineers
| Educational Level | Percentage of Responses |
| University trained | 40.0 % |
| Vocational, but not university trained | 33.3 % |
| On the job training | 13.3 % |
| Other | 13.4 % |
71.7% responded that their biomedical engineer/technician does not have dedicated, sufficient space and tools to perform maintenance. Only 32.6% responded that they have access to medical equipment repair companies within a 100-kilometer radius of their hospital.
The most commonly damaged medical equipment during that last 12 months were mechanical ventilators. (Table 6)
Table 6. Most frequently damaged equipment
Equipment most frequently damaged in previous 12 months |
Percentage of Responses |
Ventilators |
26.7 % |
CV Monitors |
22.2 % |
Laboratory Equipment |
22.2 % |
X Ray |
11.1 % |
Other: beds, incubators, ultrasound |
17.8 % |
The main reason for not being able to recover/repair damaged equipment was the lack of spare parts in the country. (Table 7)
Table 7. Reasons for inability to recover repair damaged equipment
| Reason for no recovery or repair of damaged equipment | Percentage of Responses |
| Lack of spare parts in country | 46.7 % |
| Lack of Budget | 31.1 % |
| Lack of trained human resources | 17.8 % |
| Lack of Maintenance | 4.4 % |
Some of the characteristics of the three hospitals that have less than 50 total hospital beds include the following: (Table 8)
Table 8. Specific Characteristics of the three hospitals with less than 50 beds
| Public or Private | Categorization | No. BM Eng/Tech and training | Most damaged equipment previous 12 months | Reason for inability to repair/recover | |
| Private | 2nd level hospital plastic surgery hospital | 1; on the job training | Ultrasound | Lack of budget | |
| Private | Tertiary care hospital | 2; university trained | CV Monitors | Lack of spare parts | |
| Public | 2nd level general hospital | 2; on the job training | Ventilators | Lack of human resources | |
Discussion
Many of the BME challenges faced by hospitals in general would seem to be even greater obstacles in smaller, rural hospitals. This study received most responses from large, urban, tertiary care hospitals that do not represent the BME challenges of smaller hospitals. However, in spite of the larger, urban hospital bias, there are several aspects worth highlighting. Over 50% of the hospitals that responded to the survey have four or more BME engineers or technicians working at their facilities. WHO data from 2019 looking at number of BM engineers per hospital bed in various countries show while the USA and Mexico average 2.4 BM engineers per 100 hospital beds, Argentina, Brazil, and Costa Rica average 0.6, 0.2 and 1.5 BM engineers per 100 hospital beds, respectively [7]. This survey results are consistent with this WHO data.
Industrialized countries have specific educational requirements for BM engineers and technicians. There are many chapters of the Institute of Electrical and Electronics Engineers -- Engineering in Medicine and Biology Society around the global north. As of 2007 it was stated that "no chapters of biomedical engineers on the continent of Africa and no chapters in any nation with low human development" [8]. A current review of the EMBS website suggests that there are many student chapters in Latin America and Asia, with few in Africa [9]. This study showed that less than 50% of the BME positions are occupied by university trained BM engineers, yet more than 70% of the hospitals surveyed were larger than 100 beds. Predictably, mechanical ventilators, cardiovascular monitors and lab equipment were the most frequently damaged pieces of equipment. Yet the explanation for why damaged equipment was not recoverable or reparable was due to lack of human resources only 17% of the time, suggesting that the BME staff were, for the most part, appropriately trained and qualified.
Only three respondents self-described as small hospitals of less than 50 beds, but one of these hospitals self-described as a private tertiary care facility and another self-described as a private secondary level hospital but specialized in plastic surgery. These generally do not represent the smaller, public rural hospitals that can face the profound challenges of poor infrastructure, limited human resources, severe financial restraints, and unpredictable public services like electricity, water, and internet access. The third smaller hospital is a public hospital and predicably lists lack of human resources as the main reason for inability to recover/repair medical equipment.
Conclusion
A preliminary review of some of the specific descriptive responses to a questionnaire about biomedical engineering in hospitals ranging from large tertiary care facilities to smaller hospitals in seventeen countries across the global south suggest that the number of personnel working in these facilities per hospital bed is within the range described by WHO in 2019. Although less than 50% are university trained BM personnel, it is difficult to establish what that percentage should be in hospitals across the global south. The other findings of reasons why equipment remains unrecoverable or non-repairable seem to be consistent with results from other studies. Primary care physicians working in hospital setting need to be aware of these biomedical engineering challenges and should be involved in discussion around the support for these services that add to the quality of care of their clinical services.
References