Building Human Resource Capacity for Medical Device Maintenance and management in Ethiopia

Achievements, Lessons Learned, and the Way Forward

For effective health service delivery, additional

resources are required to strengthen and
expand the pre-service education of qualified
biomedical equipment technicians and engineers.
This should be coupled with interventions at
health facilities and regional maintenance centers
to make spare parts available.

Need for Action Goals and Objectives

The Government of Ethiopia has implemented an
The HRH Project sought to increase the supply of qualified
ambitious plan to expand the number of health care
biomedical technicians and engineers and thereby ensure
facilities at all levels, with a goal of 16 specialized
the availability of working medical devices. Specific
hospitals, 80 general hospitals, 800 primary hospitals,
objectives were to:
and 3,200 health centers in the public sector by 2018,
plus more than 200 private hospitals and diagnostic • Strengthen the management of medical devices,
centers. The Federal Ministry of Health (FMOH) estimated
that these healthcare facilities would need 4,000 newly • Improve the quality of education of biomedical
trained biomedical equipment technicians and 600 technicians, and
biomedical engineers. However, expanding the size of • Strengthen the competence of biomedical
the medical device workforce is not the only challenge. engineers and technicians.
Existing biomedical technicians and engineers must be
equipped with the skills needed to install and maintain
medical devices and keep pace with emerging healthcare
Key Successes:
technologies.
• The groundwork for expanding the biomedical
To meet the growing demand for biomedical technicians
equipment workforce has been laid with the design
and engineers, the Government of Ethiopia sought
financial and technical support from the USAID-funded of curricula and training modules, capacity building
Jhpiego-led Strengthening Human Resources for Health for faculty, and equipping skills development labs.
(HRH) Project (2012 - 2019). The goal of the HRH Project
• Collaboration with FMHACA resulted in the
is to improve health outcomes for all Ethiopians by
improving human resources for health management; development of standards and guidelines for the
increasing the availability of midwives, anesthetists, effective management of medical devices, and
health extension workers (HEWs), and other essential minimum specifications were set for 1,207 pieces
health workers; improving the quality of education and of medical equipment.
training of health workers, and generating evidence to
inform HRH policies and programs.
Strategies and Interventions
Developing the curricula for biomedical technician Offering technical support to skills development labs. To
education and increasing the number of programs. The improve skills training, the HRH Project offered technical
HRH Project supported the FMOH to develop a curriculum support for the installation and maintenance of medical
for Level IV biomedical technician training and then led devices and other equipment at skills development labs
two workshops to develop seven training modules for this located at 13 New Innovative Medical Education (NIME)
program. The curriculum was implemented by seven new institutions that offer an accelerated training program
training programs for Level IV biomedical technicians that for physicians. An average of 50 new instruments and
were established at Technical and Vocational Education devices purchased by the FMOH were installed at each
and Training (TVET) colleges as well as by the one existing skills development lab. The Project’s biomedical team
program for biomedical technicians. Project staff also also maintained and repaired 496 existing pieces of
participated in workshops to revise the curricula for equipment in other higher learning institutions and
undergraduate and postgraduate biomedical engineering regional health Science Colleges.
programs.

Improving the quality of instruction in biomedical Identifying and setting minimum specifications for
technician education programs. The HRH Project required medical devices. Biomedical engineers
supported the development of five training packages seconded to Ethiopia’s Food, Medicines and Health
on operating room, maternal and child health, imaging, Care Administration and Control Authority (FMHACA)
laboratory, and ophthalmic medical devices. They were by the HRH Project led the development of a national
used during a series of technical updates for instructors medical devices list. This activity was the first of its kind
at health education institutions and practitioners at at FMHACA and at the national level. The next step was
hospitals, as well to build the capacity of government to categorize the medical devices required at different
regulators (Table 1). levels of health facilities.

Table 1. HRH Project Trainings on Biomedical Engineering

Participants
No. of
Content
trainings Organizations Number

Technical updates

Maintenance training on operating room equipment, including electro

Health education institutions
surgical unit (ESU), suction, anesthesia, autoclave, electrocardiography 1 23
and health facilities
(ECG) machine, and patient monitor

Maintenance training on laboratory equipment, including microscope,

Health education institutions,
centrifuge, incubator, biomedical safety cabinet, refrigerator, and 1 25
hospitals, and FMHACA
chemistry machine
Users’ training on laboratory equipment, including microscope, centri-
fuge, incubator, biomedical safety cabinet, refrigerator, and chemistry 1 Health education institutions 25
machine

Capacity building

FMHACA (including regional

Training on the life cycle of medical devices and regulation 2 60
bureaus)

Maintenance and management of medical devices and equipment, in

2 FMHACA and regional hospitals >50
collaboration with AIDSTAR One Project
A series of seven consultative meetings were organized Results and Lessons Learned
with stakeholders to collect comments and feedback
New training programs and curricula can be used to
before finalizing lists of medical devices (with minimum
increase the production of qualified biomedical engineers
specifications) for tertiary, general, and primary hospitals,
and technicians. The groundwork for expanding the
health centers, and specialty centers. A device list for
medical device workforce has been laid with the creation
specialty clinics is also being prepared.
or revision of curricula and training modules at Level
Developing management guidelines and technical IV, baccalaureate, and postgraduate levels. Technical
standards for medical devices. HRH Project staff played updates for instructors and the refurbishment of skills
a leadership role in three FMHACA technical working development labs also have contributed to efforts to
groups that developed guidelines on the disposal, media improve the quality of biomedical engineering education.
advertisements, and market authorization of medical However, newly established training programs for Level
devices. They also participated in FMOH technical IV biomedical technicians at seven TVET colleges will
working groups that developed Ethiopian Hospitals require ongoing support if they are to meet the growing
Reform Guidelines and Medical Devices Management demand for medical device workforce in Ethiopia.
Guidelines. A biomedical engineer from the HRH
Essential guidelines and standards for medical devices
Project chaired the National Medical Devices Standards
have been developed, but lack visibility. The HRH Project
Development Technical Committee, which compiled
existing standards and/or developed new
The supported development of specifications,
standards for 311 medical devices at the HRH Project standards, and guidelines for the
effective management of medical
request of government and private
organizations.
supported the devices, including their procurement,
development of installation, and maintenance.
Building the capacity of FMHACA.
FMHACA staff were trained on the life
5 training Notably, minimum specifications
were set for 1,207 pieces of medical
cycle and regulation of medical devices, packages equipment, and medical device lists were
including experiences from other countries, compiled for every type of health care facility.
and on the maintenance and management of medical However, awareness of these standards and guidelines
devices and equipment (Table 1). In addition, HRH Project must be raised in order for managers at all levels of the
staff offered technical advice to FMHACA managers on health system to take ownership and implement them.
an average of 10 cases per month related to medical
device procurement, appropriateness, functionality, Key Takeaways
and specifications. Technical support was also provided • Most biomedical engineering training programs are
to FMHACA’s quality control laboratory to maintain newly established, so focused investments and technical
inputs are required to support their implementation,
equipment and redesign the electrical system. including capacity building for faculty and the provision
of required equipment and supplies.
Equipping regional medical device maintenance
centers. To increase the efficiency and sustainability of • Addressing gaps in functioning medical devices at health
facilities will require innovative approaches to obtain
maintenance and repair services for medical devices, spare parts and equip and operate regional maintenance
the FMOH established 13 regional maintenance centers, centers.
only some of which were operational by the end of the
HRH Project. The project provided technical support for
the distribution and installation of equipment purchased
by the ministry and partner organizations and provided
training for the biomedical engineers and technicians
who staff the centers.
The scarcity of spare parts poses a major bottleneck in Next Steps
medical device management. Installing new devices is

1
just the first step; the bigger challenge is keeping them Improve and expand biomedical education.
running. The Project’s biomedical engineering team was Expanding the production of biomedical engineers
able to maintain functionality in 407 out of 496 pieces
and technicians requires increasing the number
at skills development lab in Jhpiego-supported university
of qualified instructors, and technical assistants at
teaching hospitals and Regional Health Science Colleges
(RHSCs). However, 89 pieces of equipment required biomedical training institutions. Capacity building
spare parts that were not available or were otherwise trainings should be conducted for each of these
unfixable. This experience is confirmed by a series of case
positions.
studies that found over half of medical devices in public

2
health facilities in Ethiopia were inoperable or not fully Build the capacity of regional maintenance
functional because of a lack of spare parts.
centers. The distribution and installation of
Regional maintenance centers offer an efficient and essential testing and measuring equipment at regional
sustainable solution for maintaining medical devices, but
maintenance centers should continue until all of
they must be fully equipped and staffed. It is inefficient
for biomedical technicians to travel to health facilities and them are fully equipped. Technical update trainings
training institutions to maintain medical devices, carrying should be offered to the biomedical technicians and
tools and spare parts with them. A better solution is to
engineers who staff the centers.
send the devices to the 13 regional maintenance centers
established by the FMOH at selected health care facilities.

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Assess and address the need for spare parts.
At many of these maintenance centers, however,
necessary testing and measuring devices have not yet A baseline assessment should be conducted
been installed. In addition, the biomedical engineers and to determine which spare parts are not readily
technicians on staff are few in number and could benefit
available and why and to calculate the amount and
from technical updates.
types of spare parts in greatest demand. Based on
the results of this assessment, a pilot program can
be devised to increase the availability of spare parts
for selected medical devices.

This program learning brief was prepared by Demeru Yeshitla and

reviewed by Dr. Tegbar Yigzaw, Dr. Sharon Kibwana, and Adrian Kols.

This program learning brief is made possible by the generous

support of the American people through the United States Agency
for International Development (USAID) under the terms of the
Cooperative Agreement No. AID-663-A-12-00008 Strengthening
Human Resources for Health (HRH). The contents of this publication
are solely the responsibility of Jhpiego and do not necessarily
represent the official views of USAID or the United States
Government.

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