• Pre-Collegiate Global Health Review

Limitations of Biomedical Innovations: A Roadblock to Quality Health for All

Abigail Phillips, Saline High School, Saline, Michigan, USA


In 2016, 19.3 million deaths were reported in low middle-income countries (LMICs). 15.6 million of these deaths were preventable by public health intervention (Kruk et al., 2018).


Many of these avoidable deaths were caused by non-functioning medical devices, unavailability of necessary treatments, or a limited amount of time to properly diagnose and outsource the treatments for these people. For example, in Ghana, Africa, there were roughly 75 to 91 deaths per 100,000 people in 2019 due to poor quality healthcare, as shown in Figure 1 (Kruk et al., 2018). Furthermore, the leading causes of death in Ghana in 2018 were Malaria and Lower Respiratory Infections, both of which can be prevented with the proper medical interventions such as the influenza vaccine or Malaria prevention medications (Centers for Disease Control and Prevention, 2019). Therefore, greater access to these interventions is necessary in order to decrease the amount of avoidable deaths in developing countries such as Ghana.

Figure 1. Deaths due to poor quality healthcare per one-hundred-thousand people by country (Kruk et al., 2018).

In the developing world, approximately 95% of medical equipment in public hospitals - where the majority of patients go for treatment - is imported (Malkin, 2014). In order to get the supplies, medicines, and vaccinations needed, patients and physicians in underdeveloped nations are relying on equipment from countries where there is greater access to resources. Consequently, these devices are often ineffective because the resources required to operate them, such as distilled oxygen, electricity, and operators, are inaccessible in underdeveloped countries. In fact, about 96% of outsourced or donated medical equipment is no longer functional after five years and 30% never worked (Malkin, 2014).


Furthermore, even when these medical devices are operating appropriately, many physicians do not have the proper training to be able to utilize them effectively. In order to appropriately, efficiently use such medical devices, biomedical technicians are needed to support, service, and repair the devices (Cleveland Clinic, n.d.). However, in a study that analyzed out-of-service medical equipment from sixty resource-poor hospitals in eleven nations, more than 60% of these hospitals had zero to one technical staff, most of which were not properly trained. In these hospitals, roughly 28.6% of the medical equipment was dysfunctional (Malkin 2010).


Not only is there an overall shortage of biomedical technicians in LMICs across the world such as Ghana, but there also is a shortage of those responsible for the design, implementation, and creation of healthcare technology: biomedical engineers (U.S Bureau of Labor Statistics, 2022). As evident in Figure 2, there is a large discrepancy in the number of biomedical engineers around the world, especially when comparing LMICs and wealthier countries. For example, in the United States, there are approximately 49 engineers per one million people compared to less than one biomedical engineer per one million people in Ghana (World Health Organization, 2018). This vast difference in the number of biomedical engineers between developing and developed countries is due to the lack of biomedical engineering programs in developing countries.

Figure 2. World map depicting number of biomedical engineers per ten-thousand people (World Health Organization, 2018).

A study assessing universities in Africa and North America found that there are only 12 universities in Africa - in comparison to the 229 universities in North America - that offer an education in biomedical engineering (Abu-Faraj, 2008). As a result, LMICs are forced to import their medical equipment because they do not have enough biomedical engineers to create such technology locally. Without engineers to create and innovate, efficient and effective medical devices made specifically for regions with limited resources are less accessible in developing countries.


How can the accessibility to medical devices in LMICs be improved so that efficient, effective, and functioning devices are available? One solution is a multifaceted approach that will address the main obstacle to accessing medical devices: outsourcing. Outsourcing is widely caused by the lack of biomedical engineers who are capable of producing devices locally, therefore countries, especially LMICs, must acquire them from other places around the world. This causes a domino effect, as the outsourced medical equipment is often not equipped for developing countries. “Basic resources” that these devices often rely on, such as oxygen and electricity, may be readily accessible in some areas, but not in all (Malkin, 2014).


To design and create new medical technology that is not limited by resource status, the number of biomedical engineers in LMICs must increase. This can be achieved by increasing the amount of biomedical engineering educational programs. These local engineers will be able to more effectively create medical technology than people from other countries, as they are more aware and knowledgeable about the lack of resources in those areas. This has already proven true by the number of successful medical devices created in African countries such as Cameroon, South Africa or Botswana. Arthur Zang, for example, recently created a detection device in Cameroon for cardiovascular disease that uses a wireless connection to a cardiologist, allowing for accurate diagnoses in remote areas (Fogarty International Center, 2019). By increasing the number of biomedical engineering programs in LMICs such as Cameroon or Ghana, more people like Zang will be able to create medical devices locally, thus increasing the number of functioning medical devices. These devices will meet the needs of communities in LMICs and prevent countless deaths in the long term.


 

References


Abu-Faraj, Z. O. (2008). Project Alexander the Great: A study on the world proliferation of Bioengineering/Biomedical Engineering Education. 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. doi:10.1109/iembs.2008.4649802


Bioengineers and Biomedical Engineers: Occupational Outlook Handbook. (2022, January 04). Retrieved from https://www.bls.gov/ooh/architecture-and-engineering/biomedical-engineers.htm


Biomedical Equipment Technician (BMET). (n.d.). Retrieved from https://my.clevelandclinic.org/departments/health-sciences-education/careers/career-options/biomedical-equipment-technician


Biomedical engineers density (per 10 000 population). (n.d.). Retrieved from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/biomedical-engineers-density-(per-10-000-population)


CDC Global Health - Ghana. (2019, August 12). Retrieved from https://www.cdc.gov/globalhealth/countries/ghana/default.htm


Focus on biomedical engineering in Africa: Fogarty grantees publish book to boost biomedical engineering - Fogarty International Center @ NIH. (n.d.). Retrieved from https://www.fic.nih.gov/News/GlobalHealthMatters/september-october-2019/Pages/biomedical-engineering-lmics.aspx


Information, A. M. I. S. O. M. P. (2014, February 5). 2014_02_04_Banaadir_Hospital-3. Flickr. Retrieved February 2, 2022, from https://www.flickr.com/photos/61765479@N08/12316155713

Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the universal health coverage era: A systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203-2212. doi:10.1016/s0140-6736(18)31668-4


Malkin, R. A. (2007). Barriers for medical devices for the developing world. Expert Review of Medical Devices, 4(6), 759-763. doi:10.1586/17434440.4.6.759


Malkin, R., & Keane, A. (2010). Evidence-based approach to the maintenance of laboratory and medical equipment in resource-poor settings. Medical & Biological Engineering & Computing, 48(7), 721-726. doi:10.1007/s11517-010-0630-1