|
 |
| LETTER TO EDITOR |
|
| Year : 2011 | Volume
: 14
| Issue : 1 | Page : 120-122 |
|
Health technology utilization in tertiary health centers in developing countries: The Nigerian experience
AM Tabari
Department of Radiology, Faculty of Medicine, Bayero University, PMB 3011, Kano, Nigeria
| Date of Web Publication | 11-Apr-2011 |
Correspondence Address:
A M Tabari
Department of Radiology, Faculty of Medicine, Bayero University, PMB 3011, Kano
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1119-3077.79246
How to cite this article:
Tabari A M. Health technology utilization in tertiary health centers in developing countries: The Nigerian experience. Niger J Clin Pract 2011;14:120-2 |
How to cite this URL:
Tabari A M. Health technology utilization in tertiary health centers in developing countries: The Nigerian experience. Niger J Clin Pract [serial online] 2011 [cited 2022 Mar 3];14:120-2. Available from: https://www.njcponline.com/text.asp?2011/14/1/120/79246 |
Sir,
In November 2002, the Federal Government of Nigeria (FGN) signed a multimillion Euro contract with a foreign firm for the rehabilitation of some selected teaching hospitals in the country. The signed contract was supposed to re-equip, maintain, and train personnel in these hospitals within a period of 5 years. The first phase of the project comprising eight teaching hospitals located in the cities of Zaria, Ibadan, Maiduguri, Lagos, Jos, Enugu, Ilorin, and Port-Harcourt have been commissioned. Under the contract, the firm supplied equipment ranging from wheel chairs and Mercurial sphygmomanometers to complex radiotherapy and radio diagnosis equipment. The later group formed the bulk of the equipment supplied so far.
This FGN project was welcomed with high expectations by the Nigerian citizenry. However, since the commissioning of the first phase of the project, there has been out cry from the end-users and the concerned general public on the low level of performance of these equipment. It is the aim of this communication to identify based on this author's opinion those factors militating against adequate management and utilization of these equipment in Nigeria and similar type of equipment in other developing countries, as well as highlighting possible cost effective and appropriate solutions to these constraints.
The literature on the subject was sourced from the authors experience in one of these facilities at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, and the recent author's involvement in the preparatory stage in one of the second phase of the same project at the Aminu Kano Teaching Hospital, Kano, Nigeria. On-line conference abstracts, articles in journals, and documents from international organizations concerned with appropriate health technology (HT) packages were also reviewed.
HT refers to those devices, medical and surgical procedures, and drugs used in the prevention, diagnosis, and treatment of diseases; the knowledge associated with these and the organizational and supportive system within which the care is provided. [1] HT is thus everywhere, from the simplest of health care system to the most advanced; in rich and poor countries alike, they form the backbone of health services. HT ranges from the tongue depressor to Magnetic Resonance Imaging equipment, from blood transfusion to emergency surgical procedures. [2]
HT is country specific and for it to be appropriate for a particular setting, it is better viewed in the context of the World Health Organization (WHO) level of health services of primary, secondary, and tertiary referral levels. This last referral level is usually the most sophisticated hospital, located in a national or provincial capital or other big city, typically a university teaching hospital providing the highest level of medical care available in the country or region. This level also follows the western model of centralized expertise and high technology; it is also a resource for education, training, and consultation. The recently launched FGN hospital modernization project in Nigeria targeted this level.
It is a fact that a small number of countries usually the rich ones are the producers of world's HT, while the rest depend on technology transfer. For a technology to be appropriate in developing countries, there must be a successful technology transfer from advanced to under developed countries; to achieve that, there is a need for shared responsibility among the stake holders in HT transfer, such as the manufacturers, vendors, buyers, end-users, and the patient/public.
Manufacturers/Vendors: The less developed countries have serious health problems which are solved in part with help from modern medical technology, supplied by manufacturers in developed countries. It usually entails a considerable amount of research and development to adopt a product to local conditions or to create a new one that can operate in typical harsh weather of tropical environment. The question of earning reasonable return on their investments often prevents the manufacturers from embarking on such projects. Many manufacturers consider the market in developing countries as too small to deserve such a large investment.
It is reasonable to expect that, with recent expansion of information technology on health care, the growth of information about the relative effectiveness of different technologies and liberalization of global trade, HT transfer would take place more rapidly and in greater quantity from developed to developing countries. There is no evidence that this is taking place and it could be attributed to the fact that, only less than 1% of global research and development is currently spent on technological innovations for poor countries and that the World Trade Organization (WTO) agreement enforcing trademarks and patents is likely to increase the price poor countries have to pay to gain access to new, patented technologies. [3],[4]
Buyers: In developing countries, buyers mean government or very rarely private wealthy individuals. The problem of buyers is usually traced to poor choice of equipment due to the lack of information about the range of available alternatives and the lack of technical expertise needed to evaluate the available alternatives from their part, which often leads to purchase of obsolete equipment, and also, failure to realize the need to budget for repairs and maintenance at the initial tender stage results in having recently installed equipment standing useless most of the time. Sometimes, political pressures are often responsible for the purchase of particular type of equipment without regard to the above factors or concern on how the equipment is going to be used.
End-users: These are trained professionals needed for proper calibration, maintenance, repair and use of all HT equipments. They are most often not available in developing countries. In connection to this, some of the equipments may not come with service or operational manual; where available, often they are written in foreign language making it difficult for the users to understand. Improper end-users training by the suppliers often result in underutilization, using HT equipment only to their minimum capacity.
Patients/Public: One of the main reasons why people cannot get the HT they need is because they cannot afford them. Thus, accessibility is hindered by poverty and distance as the cost of service exceed the income of most patients in developing countries just as in most cases HT equipment are concentrated in large cities disproportionately benefiting the well-to-do urban households at the detriment of the larger population in rural areas.
The above-mentioned FGN equipment are by far heavy for any economy such as Nigerian, characterized by unstable and erratic power supply, hence the observed frequent breakdown of these equipment. In the event of break down, the problem of inability to repair in time due to the lack of spare parts or expertise is often experienced as it takes from few weeks to more than 6 months for effective repairs to be achieved, this is despite the fact that, FGN equipment are covered with 5-year equipment maintenance contract signed between the FGN and the foreign supplier. Extra modification of buildings unforeseen at the initial tender stage which often lead to demolition and erection of structures in some of the centers visited by the foreign suppliers was also witnessed.
Also in some of the commissioned centers, improper use of equipment by the operators which often lead to reduced equipment life span was noticed. In fact, most of the end-users of FGN equipment found themselves in a tight situation of using a much newer and advanced version of the type of equipments they were trained on several decades before now. Where training is provided by the supplier, it was usually very short lived or if long enough it is often obtained in a non-English speaking country where language barrier becomes a problem for effective learning.
The decision to spread FGN equipment across a sizeable window of different manufacturers, such as general electric (GE) for CT scan, Siemens for MRI and Aloka for ultrasound is commendable, as this will avoid being trapped in the monopoly of a single manufacturer, but without running away from the disadvantage of additional maintenance cost; more so, the lack of standardization could lead to extra spare part costs and extra work load for maintenance staff.
Unless the above problems are tackled by the manufacturers and policy makers who are the key responsibility holders, the problem of availability, selection, acquisition, and maintenance of appropriate HT could be said to have come to stay in developing nations, until when the trend is reversed. As for the above FGN project, to snugly fit and succeed in the Nigerian health system there is a need to make the provision of power back up systems such as the UPS (Uninterrupted Power Supply) units attached to these equipment mandatory at the initial tender stage of the project. Also, due to the huge nature of the investment, the manufacturers should be encouraged to establish ware-house for spare parts in Nigeria, so as to close as much as possible that delay gap often experienced in the event of urgent need of spare parts.
The end-user training package should be overhauled to reflect the realities of the present day advancements in HT, in such away that the knowledge of clinicians should be updated within a reasonable length of time at a centre where similar model of equipment are in use. Similarly, the application training package provided to technologists by the suppliers should be enriched by increasing the length of teacher/student contact time. It is also suggested here that emphasis should be directed toward training local biomedical engineers by giving them specialized training on specific equipment, such as training on the maintenance of CT, MRI, angiography or ultrasound equipment. This is to prepare them for taking care of minor trouble shootings before the arrival of company engineers at least throughout the warranty period, after which they shall serve as on-site engineering specialists. Finally, the end-users should consider the opportunity of using these highly technical and complex equipments as a challenge that would prompt them to improvise in the event of equipment failure, to use local technologies to fit into the modern technology as practiced by previous authors from the tropics while working with such type of equipment. [5]
Nigeria and indeed developing nations could benefit from the assistance of local and international agencies concerned with appropriate HT, such as the Nigerian Institute for Biomedical Engineering (NIBE), the Department of essential HT of the WHO, and the HT Training and Task Group (HTTTG) of the International Union of Physical and Engineering Science in Medicine (IUPESM). These agencies are concerned with assisting countries in defining their HT needs, identify and rectify health system constraints for adequate management and utilization of HT through training, capacity building, development and the application of appropriate technology. If applied, the outlined above recommendations should provide a level of health service that will form an important milestone for developing countries in their aspirations for health development.
 References | |  |
| 1. | Issakov A. Health care technology and health system, global challenges and opportunities. Department for health policy development and health services, World Health Organization (WHO), 2006; London. Accessed online at www.iee.org/Events/Andrei Issakov, 2007. 
|
| 2. | World Health Organization (WHO) 2003. Health technologies-the backbone of health services. Department of essential health technologies, WHO Geneva: 27, Switzerland. Accessed online at www.who.int/eht, 2007.
|
| 3. | Anna D. Political economy of technology transfer. BMJ 1999;13:1298.
|
| 4. | Warner DC. The globalization of medical care. In: Zarrelli S, Kinnon C, editors. International trade in health services: a development perspective. Geneva: UN committee on trade and development, World health organization; 1998 .p. 71-7.
|
| 5. | Tabari AM. Low cost printing of computerized tomography (CT) images where there is no dedicated CT camera. J Telemed Telecare 2007;13:274-6.
[PUBMED] [FULLTEXT] |
|
