Launched in February 2019, the project will help to build the systems and capacities needed to improve the management of medical equipment in Ethiopia’s health system.
Well-functioning health systems must ensure access to safe and appropriate equipment for medical care. Without this important component of broader health technologies, countries cannot hope to achieve Sustainable Development Goal 3 to ensure healthy lives and promote well-being for all, at all ages. However, in many low-income countries, health sector workers lack the practical skills to operate equipment effectively and technicians who can fix broken equipment either lack know-how or are unavailable.
Part of the problem is that Technical and Vocational Education and Training, or TVET as it is known, suffers from a bit of an image problem. Young people everywhere tend to prioritise academic over vocational qualifications, since academic qualifications are often associated with better earning potential. However, academic syllabuses sometimes pay scant attention to practical skills, assuming that these can be ‘learned on the job’.
When practical skills do form part of the curriculum, the tools and equipment for hands-on practice may not be available. Moreover, biomedical training courses tend to focus on building skills for technicians rather than health staff, ignoring the fact that nearly half of all equipment malfunctions are thought to be due to user error. It doesn’t help either that vocational training courses are usually anchored in education sectors, with little input by health specialists.
Ethiopia’s biomedical equipment is in a poor state
Problems with poorly maintained and broken equipment have a negative financial impact (i.e. high re-investment costs) and can also have life-threatening clinical implications. The maintenance and effective use of equipment is particularly critical in low- and lower-middle income countries, where financial and human resources are often limited and inequalities in access to care are deeply entrenched.
In Ethiopia, about half of all biomedical equipment in hospitals and health facilities is non-functional and in some remote areas, 70 percent of equipment needs attention. Existing equipment is often old and broken, while newer, more advanced equipment remains unused due to the lack of training, seriously impacting on the quality of care provided. Good quality health services and equity of access are key health sector priorities for Ethiopia, and yet the country currently has no national strategy nor any coherent regulations on the management of biomedical equipment.
German development cooperation is helping to tackle this challenge
Not only does vocational training suffer an image problem with students, the same is often true of health sector development partners. Practical training for biomedical technicians and health personnel, together with the development of systems and structures to ensure the consistent availability of functioning equipment, are often overlooked in the design of large-scale health system strengthening programmes.
This is why in February 2019, Ethiopia launched a new health sector project, ‘Capacity Development for Health Professionals and Biomedical Technicians’, which is being implemented by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) on behalf of the German Ministry for Economic Cooperation and Development (BMZ). Financed with 5.5 million Euro drawn from funds earmarked for health systems strengthening in Africa, Germany is supporting the Ministry of Health and the Ministry of Science and Higher Education to strengthen TVET for the biomedical technology. Crucially, this project works not only with the technicians who maintain Ethiopia’s medical equipment, but also with the frontline health staff, such as nurses and midwives, who use it. Correct use of medical equipment plays a critical role, both in prolonging the life of the equipment and in improving the quality of care received by patients.
At the launch, Mr Yakob Seman, Director General of Medical Services at the Federal Ministry of Health said “Poor management of physical assets directly affects the quality, efficiency and sustainability of health services at every level. We need clear policy and strategy, technical guidance, and practical tools for more effective and efficient management of Ethiopia’s healthcare technology.”
A network of institutions will develop and test the new approach
Participating institutions include Tegbare-id Polytechnic College in Addis Ababa and, at the regional level, the Specialized Hospital, the Health Sciences College and the Polytechnic College in Nekemte. The focus is on developing the students’ problem-solving approaches and practical skills, improving and up-dating curricula for technical and managerial training, and developing expert trainers. In the longer term, the project will support the development of a national equipment management strategy and systems, and aims to establish a transferable model of practical vocational training.
A prototype repair workshop will be established at Nekemte Specialized Hospital in Oromia Region, which will function as a supra-regional facility, well-positioned to serve health facilities in Eastern Wollega zone and beyond. Hospitals will be able to request biomedical trainers from a regional pool to train their staff more efficiently on site. While in the past, it was not uncommon to see 30 trainee technicians practicing on a single piece of outmoded equipment, the project will equip the Nekemte workshop and staff will maintain the equipment using their newly acquired skills. Research will analyse the impact and effectiveness of project activities, and findings will be used to inform the development of new training guidelines.
Germany is uniquely well placed to provide support
Germany has been supporting development activities in Ethiopia since 1964, and this project builds on many years of collaboration with the Ministry of Education to strengthen TVET. German specialist knowledge and competence in TVET are in great demand in partner countries, and TVET is an important part of Germany’s global development support as a key factor for sustainable economic development in partner countries. The project also draws on Germany’s extensive expertise in strengthening health systems in low- and lower-middle income countries, as well as its globally-renowned biomedical engineering sector back home.
Linkages across sectors and national borders will yield sustainable benefits
Although it is early days, important progress is already being made. Unaccustomed to collaborating on TVET interventions, the ministries of health and education have initiated dialogue, and a joint planning workshop and steering meetings have taken place. GIZ is encouraging the TVET team in the ministry of education to participate in the health sector Technical Working Group on Biomedical Equipment Management – this forum could serve as an important mechanism for shared oversight of equipment management systems at the federal level. Exchanges are being set up between Ethiopian and German institutions with the aim of transferring knowledge and expertise. In April, the Technical University of Munich signed a joint letter of intent to work with Tegbare-id Polytechnic College in Addis Ababa.
A replicable model - aligned with policy priorities - strengthens ownership
In March this year, the Ministry of Health and the heads of regional health bureaus reviewed the new National Health Policy and Essential Health Services Package, which is replacing the old policy dating back some 20 years. ‘Pharmaceutical and Medical Equipment Supply and Use’ is identified as one of 11 major policy issues, demonstrating the importance for the Government of Ethiopia of this often-neglected area. Furthermore, strengthening institutional capacity is a major plank of the new policy’s sustainable implementation framework.
With the help of this project and its German TVET expertise, Ethiopia aims to strengthen the availability and effective use of reliably functioning medical equipment across the country, underpinning the expansion of the country’s health infrastructure. It will do this through the development of a transferable model of practical vocational training, as well as facilitating interaction between equipment technicians and skilled health personnel, which can then be transferred nationally to other regions. No one is under any illusion that it will be easy to bring about sustainable change. However there is palpable excitement that this project can make a real contribution, and strong commitment and ownership by government. At the end of the planning workshop in May when stakeholders were asked to provide feedback, one participant wrote ‘Try not to give up - it’s going to be hard’!
Speaking about the new project, the Deputy Director of Oromia’s Regional Health Bureau Dr. Abdulkadir Gelgelu said “we own and support this project from the very beginning. We are keen to learn from the experience and to replicate this approach in other projects.”