When government agencies and private organizations in advanced economies make generous donations of medical equipment to low-resource countries in Africa, Asia, and Latin America, the donors intend to strengthen health care systems, reduce human suffering, and save lives.

But when assistance doesn’t take into account specific local conditions, the generosity doesn’t always live up to the donors’ good wishes.Unfortunately, the absence of technical support in hospitals and clinics in the low-income world too often limits the usefulness of the donation.

The problem is simple: medical equipment manufactured in the US, Japan, and Europe is designed for use in clean, air-conditioned environments with steady electrical currents. Even in the best of conditions, equipment requires maintenance by skilled technicians and careful user-training.

In low-income countries, however, machines are typically beset by power surges, intense heat, dust, and humidity. The more delicate and sophisticated the machinery, the more likely it is to fall out of service.

The need for more biomedical equipment technicians remains great throughout the low-income world.

Before long, hospitals have piles of junk taking up their storage space instead of usable equipment.

But there is a particular health worker who can remedy this problem: the biomedical equipment technician, or BMET.

With specialized training in health care technology management, BMETs provide a sustainable solution to keeping medical equipment functional. Sadly, there are only a few such educational programs. One, designed and run by Engineering World Health, has operated in Honduras, Rwanda, Cambodia, and Nigeria. Another program, in Zambia, is run by THET, and the Amalthea Trust is working to train technicians in Uganda. But the need for more BMETS remains great throughout the low-income world.

Governments and agencies committed to improving health care delivery have tended to emphasize the education and financial support of doctors and nurses. It’s a perfectly understandable priority.

But donors need to go beyond investing in frontline health workers to make sure doctors and nurses have the equipment they need to do their work. And that requires investment in training a local workforce to maintain and service equipment.

Such an educational effort has added benefits: it creates local jobs, builds skills, and protects the environment from mounds of prematurely discarded plastic and electronics.

A recent comparison of hospitals in Rwanda conducted by Duke University researchers Robert A. Malkin and Chelsea Whittle showed that hospitals where BMETs have been trained cut in half the number of broken machines.

Doctors can’t operate when anesthesia machines are leaking.

Superbly trained doctors and nurses, even in well-equipped hospitals, cannot save lives and provide high-quality patient care when the diagnostic and treatment equipment they need is not working.

Doctors can’t operate when anesthesia machines are leaking. Nurses are forced to guess about babies’ wellbeing when incubator sensors aren’t calibrated. Patients with broken bones may travel hours to get to a hospital, only to find the x-ray machine is out of order.

Not only do trained BMETs save lives, they save money.

A hospital in Nigeria purchased five intensive care unit beds at a cost of $9,000. However, three of the beds broke down after the warranty had expired. The vendor told them it would cost $6,500 to repair each bed. A team of Engineering World Health BMETs was able to redesign the beds’ control panels with a better power supply, new fuses, and simpler controls for a total cost of $275.Think of what the hospital can do with that saved $19,000!Training BMETs also empowers people within the community, giving them pride in their work. Leopoldo Zelaya, a student in EWH’s Honduras training program, said this type of professional training “generates for the country young skilled workers who are highly qualified…producing skilled workers and captivating and inspiring young people.”

We need more targeted support to build a workforce of certified BMETs and to develop local training programs that can continue to feed the pipeline with local technicians. Donations of equipment alone do not create sustainable change: training a technical workforce does.

Equipment donations must be paired with investments in a technical workforce to keep those machines humming.

Who stops to think about the technicians who service the machines that surgeons or neonatal nurses use? The average citizen may not, but it’s time that donors, medical equipment manufacturers, and aid agencies do. Equipment donations must be paired with investments in a technical workforce to keep those machines humming.

The return will far surpass the current wasteful system of pouring more equipment into countries that lack the workforces to maintain it. As Leopoldo Zelaya says, “Training is an investment that tomorrow will bring benefits to everyone.”

Engineering World Health inspires, educates, and empowers the biomedical engineering community to improve healthcare delivery in the developing world. With a combination of academic and industry expertise, EWH installs and repairs donated medical equipment and builds local capacity to manage and maintain the equipment. In addition to training BMETs, EWH's Summer Institute sends engineering students to hospitals in Nicaragua, Rwanda, and Tanzania, where they learn the local language, improve their hands-on technical skills, and repair vital broken medical equipment. Learn more.

Above: A BMET student works on an ultrasound video card. Photos courtesy of Engineering World Health.