Author: Mebrahten Gebremariam
In moments of critical need for patient care, who comes to mind as playing a key role in saving the lives of our loved ones: the doctors, the nurses, or maybe the ambulance team?
What about the humming or quiet medical equipment that measures, records, and generates data in images and signals to vitally guide lifesaving decisions of the medics?
During a recent field mission across 20 war-ravaged hospitals across Tigray, I witnessed this reality alongside Biomedical Engineer, Atakilti Yirga, who was conducting an inventory of medical equipment. As a Communicator, I was documenting and handling communications. Until then, I had never considered the health and well-being of the actual medical devices as critical to the health and well-being of the people being treated. Have you?
Caring for patients with faulty beeping medical devices, at what cost?
For Atakilti Yirga, as a Biomedical Engineer, medical equipment is very much similar to us human beings. They pass through the cycles and challenges of life. They go through birth and death, sometimes thriving, other times facing traumas, aging, or even death and disposal. Hence, they require continuous treatment to properly serve as an intermediary between the life and death of the human patient.
Imagine the potential risk of a ‘sick’ medical device on the fate of a critical patient, perhaps on your own life. What the inventory work performed by Atakilti revealed is that the medical machines intended to save our lives often have undiagnosed issues that have been unattended for years.
In Adidaero Primary Hospital, for example, we found many ‘dysfunctional’ pieces of medical equipment, considered “broken” or “out of usage,” not officially marked or tagged as such, though.
In addition to his visit’s core mission to inventory medical devices, Atakilti made a quick test on these out-of-use machines. He realized that some of the causes of such massive malfunctions were as simple as sheer negligence or poor awareness and often could be remedied quickly.
A weighing scale (pictured above), for example, was completely out of use, simply because its dead battery had never been replaced, and eventually exploded inside, which in turn damaged the spring. Due to a simple battery not being replaced, the device could not serve the purpose of providing accurate measurement of newborn weight, which is vitally important data that informs decisions ranging from assessing the neonate’s overall health status, to guiding clinical decisions (including treatment dosages) as well as planning appropriate nutrition or feeding.
It’s in such a context that I heard Atakilti advising clinicians: “Treat medical devices not merely as tools, but as colleagues, devoted like you to serving humanity in critical times.”
Atakilti carried out curative maintenance, an intervention that brought nearly all of the dysfunctional devices back from death’s door to active life.
Then, the medical staff looked on in disbelief. “We thought the machines were severely damaged,” said the Medical Director, “Hence, we put them aside, though we need them very critically.”
Lack of skills and idle medical equipment
According to Rita Thapa et al. (2022), “…more than 50% of [medical] equipment in developing countries is non-functioning due to a lack of appropriate human resources to maintain [them].” These findings strongly reflect my own observations from the hospital visits alongside Atakilti. The very scarce and hard-earned lifesaving medical equipment is underutilized in the war-torn Tigray.
I wish the story of Adidaero Primary Hospital was unique. But it echoed in many of the hospitals we visited, including the one in Sheraro, a town very close to the border with Eritrea. Mr. Masresha Ayenew, the Head of Nurses at Mayani General Hospital, says their facility has declared more than 20 critically needed medical devices “unusable” simply due to a lack of skills to operate them. “We don’t have a biomedical expert, nor do we have any know-how of these machines,” he says, urging that something meaningful be done to address the lingering problem.
As this nurse pointed out, hospitals have another concern: the limited understanding and skills training for the clinicians who operate these medical devices. This lack of knowledge can not only lead to poor handling and premature breakdown of costly medical devices, but also increase the risk of medical errors that directly compromise patient safety.
Atakilti says, “For example, an improper use of a medical device called an oxygen concentrator can cause blindness.” If used properly, however, this medical device is known for being the lifeline for newborns suffering from a lack of oxygen. The secret, ultimately, lies in the skills of operating it.
Awet Gebremariam is a neonatal nurse at Selekleka Primary Hospital. He recognizes that there is a critical skills gap in operating the lifesaving medical devices in the neonatal intensive care unit (NICU), where he works. “We had been complaining about the unavailability of these medical devices,” he says, adding, “but now they are partly available, and yet we are unsure how to operate them.” He notes that even the same machines vary in their models, and knowing the specific features of each medical device matters while dealing with life and death decisions.
Grateful to donors and partners for supporting the war-ravaged health facilities, like Selekleka, Awet also underscores the need for building human capacities alongside equipment supply.
“We have an incubator machine that arrived last year, but has never been used, simply because we don’t know how to operate it,” he admits. “I think providing training on how to operate medical devices is as important as providing the critically needed devices themselves.”
Awet Gebremariam
A hospital bringing hope
A hospital bringing hope
Only 15 km from Selekleka Primary Hospital, we arrived at Wukro Maray Primary Hospital. There, we met BMET Zufan Gebremeskel, who guided us through the inventory of the medical devices. Atakilti and I noticed something different. Devices were not only functional but also well cared for. The difference lay in teamwork. We asked Zufan why the medical devices were so well-maintained.
“I think it’s because the clinicians are very eager to learn how to operate the machines,” she said, adding, “We collaboratively work and fix problems as they arise.”
Curious, we also asked her colleagues. Berihu Niguse, Head of the NICU at the same hospital, acknowledges Zufan’s diligent checks on each machine as the hospital’s BMET. He also recognizes the clinicians’ interest in learning how to operate the medical devices.
“Not only do we seek necessary help from our own BMET, Zufan, but we also consult the manuals of each device. There are also times when we reach out to expert colleagues from Axum Comprehensive Specialized Hospital,”
Berihu Niguse
What gaps and reasons are there in using newborn medical devices?
While there is a significant gap in equipping health facilities in the post-war Tigray, there is also a gap in effectively utilizing the few available resources. What are the specific gaps and reasons behind that, then?
Rahel Desta, Health Technology Management Team Leader at the Tigray Regional Health Bureau, notes that the Bureau had recently conducted an assessment on biomedical devices and their status in public hospitals across the region. And, she admits, the malfunctioning of medical devices is rampant. As identified by the study, Rahel says, the main reasons for such a massive dysfunction can be categorized into behavioral, skill, input, and incentive-related reasons.
Improper handling by end users, she says, is often caused by negligence, lack of accountability, and insufficient ongoing training. Many health facilities, she says, also lack Biomedical Engineering Technicians (BMETs), leaving devices without preventive maintenance (to avoid device failure) or curative maintenance (to restore them once they fail).
Another reason, according to Rahel, is the shortage of spare parts and accessories, which causes machines to be unusable after minor faults. Knowledge gaps and low motivation among BMETs, partly driven by inadequate structural incentives such as duty and hazard allowances, also further exacerbate the problem.
“There is no practice of conducting performance tests or calibration for medical equipment, chiefly due to the severe lack of calibrators, performance testers, and analyzers,” Rahel explains. The lack of a properly equipped biomedical workshop in most health facilities is another significant issue. Equally, the fact that the scarce biomedical training in universities at the degree or master’s level is worth giving attention to.
Besides, poor infrastructure support is another critical reason. One striking case was Mekelle General Hospital where power fluctuations crippled machines. Atakilti mentions the facility’s electricity service was literally equivalent to that of its neighborhood, supplying only 160V. It’s clear that power outages and fluctuations could cause some machines to malfunction and negatively affect the health and lives of patients seeking critical care.
Through advocacy under the SLL360-SSNC Program,[i] the hospital secured a dedicated electric power line, improving the power supply from 160V to 228V. This signifies the need to join hands for such practical and game-changing interventions.
Why does maintaining medical devices matter?
“Neonatal care has made significant advances in the last few decades,” reads a study by Syeda Taha et al. (2023). “As a result, mortality and morbidity in high-risk infants, such as extremely preterm infants or those infants with birth-related brain injury, have reduced significantly.”
Notably, the SLL360-SSNC Program, implemented in Ethiopia, including Tigray, aims to further reduce neonatal morbidity and mortality. To this end, it invests in medical equipment by supplying essential NICU devices and ensuring their proper installation and maintenance. Training and mentoring BMETs is also a key area of the program’s interventions.
Recently, the Small and Sick Newborn Care (SSNC) Program in Tigray has organized a four-day Training of Trainer (TOT) training in four tracks: BMET, clinical, data, and QI (quality improvement). The training sessions were given both jointly and separately.
As far as BMETs are concerned, the selected 10 trainees drawn from general and tertiary hospitals embraced the rare chance of empowerment in the sector. The training was largely practical, designed to bridge the common gaps encountered in their respective workplaces and ultimately contribute to the broader goal of reducing neonatal morbidity and mortality.
Following that, an integrated clinical mentorship whereby BMETs, clinicians, data professionals, and QI experts aimed at collaboratively building the capacities of healthcare providers, including BMETs, was carried out.
According to Haben Haileselassie, Implementation Coordinator of the SLL360-SSNC Program in Tigray, the mentorship ran for three days, in NICUs and Labor and Delivery (L&D) of each of the 20 target hospitals, providing the mentees with an excellent opportunity to practically learn from their day-to-day work challenges and successes. “This mentorship constitutes the first round in a series of six,” says Haben, highlighting the program’s plan to continuously empower healthcare providers and strengthen the health system to eventually reduce neonatal morbidity and mortality.
Interestingly, the Tigray Regional Health Bureau has joined hands with the SLL360-SSNC at MARCH Research Center of CHS-Mekelle University to collaboratively provide a five-day training for BMETs, in Axum town, starting from the end of August 2025.
Countries around the globe, Ethiopia included, are striving to achieve the Sustainable Development Goals by 2030. In its target 3 i.e., ending preventable deaths of newborns and children under 5 years of age, the SDGs expect all countries to reduce neonatal mortality to at least 12 per 1,000 live births.
In Ethiopia, initiatives such as the SLL360-SSNC Program, led by the Ministry of Health, are contributing to this goal by strengthening human capacity, providing essential medical devices, and improving neonatal care services.
[i] This work is funded through the NEST360 Alliance with thanks to the Gates Foundation, ELMA Philanthropies, The Children’s Investment Fund Foundation (CIFF), The Lemelson Foundation, Sall Family Foundation, and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University. Our alliance partner, Addis Ababa University, supports implementation through the Center for Implementation Sciences (CIS) under the Small and Sick Newborn Care (SSNC) project which builds on the SLL360 Program’s.
In Ethiopia, the SLL360-SSNC Program is implemented in Tigray, Amhara, Oromia, Sidama, Southern Ethiopia, Southwest Ethiopia, Central Ethiopia, Afar, and Somalia regions. The latter two are pastoralist regions, demanding for context bespoke program implementation approaches. The program has been implemented in 18 learning facilities and 80 platform facilities across the country, all working collaboratively to reduce neonatal morbidity and mortality. Gradually, the program is planning to expand to 126 hospitals, bringing the total to 206 Platform hospitals.
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