MEDICAL DEVICE MAINTENANCE AND LOCAL CAPACITY: A COMPARATIVE STUDY OF SENEGAL AND CAMBODIA
Résumé (anglais)
Achieving SDG 3 (Good Health and Well-Being) requires ensuring healthy lives and promoting well-being for all at all ages. Target 3.8 calls for achieving universal health coverage, including access to quality essential health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines for all. Medical devices, ranging from simple thermometers and stethoscopes to sophisticated imaging equipment, ventilators, infusion pumps, and surgical instruments, are essential for diagnosis, treatment, monitoring, and rehabilitation. However, in low- and middle-income countries, medical devices frequently remain non-functional after donation or purchase due to lack of maintenance capacity, including insufficient trained biomedical engineers and technicians, shortage of spare parts, unreliable electricity, harsh environmental conditions, weak supply chains, and poor equipment management systems. This study conducts a comparative analysis of medical device maintenance and local capacity in Senegal and Cambodia, two low-income and lower-middle-income countries with contrasting geography, health system structures, and biomedical engineering development trajectories. Senegal has made significant investments in health infrastructure and medical equipment, often through donations and development partner support, but maintenance gaps persist, with an estimated 70 percent of medical devices non-functional. Cambodia has also expanded health infrastructure after decades of conflict, but medical device maintenance capacity is weak, with an estimated 60 to 70 percent of medical devices non-functional and fewer than 50 trained biomedical engineers nationally. Using a qualitative comparative case study methodology, the study analyzes secondary data from government reports, WHO Global Atlas of Medical Devices, medical device assessments, peer-reviewed literature, and program evaluations over the period 2000 to 2025. The study finds that both countries face common challenges: a high proportion of non-functional devices, shortage of biomedical engineers and technicians, weak spare parts supply chains, donation management problems, and low political priority. Senegal has a national maintenance programme and a biomedical engineering school producing engineers, while Cambodia has fewer engineers but has benefited from targeted NGO and donor programs. The study concludes that medical device maintenance requires systemic solutions, including national biomedical engineering workforce planning, pre-service and in-service training, spare parts supply chain development, preventive maintenance, computerized maintenance management systems, and donation management following WHO guidelines. Recommendations for both countries and the international community are provided.
Mots-clés: Medical device maintenance; local capacity; Senegal; Cambodia; SDG 3; biomedical engineering; health technology management
Résumé (français)
Atteindre l'ODD 3 (Bonne santé et bien-être) nécessite l'accès à des services de santé essentiels de qualité. Les dispositifs médicaux sont essentiels pour le diagnostic, le traitement, la surveillance et la réadaptation. Cependant, dans les pays à revenu faible ou intermédiaire, les dispositifs médicaux restent souvent non fonctionnels après leur don ou leur achat en raison d'un manque de capacité de maintenance. Cette étude analyse la maintenance des dispositifs médicaux et la capacité locale au Sénégal et au Cambodge. Les deux pays connaissent des défis similaires : 60 à 70 pour cent des dispositifs non fonctionnels, pénurie d'ingénieurs biomédicaux et de techniciens, chaînes d'approvisionnement de pièces de rechange faibles, problèmes de gestion des dons. Le Sénégal dispose d'un programme national de maintenance (PNMEH) et d'une école d'ingénieurs biomédicaux (ESIB). Le Cambodge compte moins d'ingénieurs, mais a bénéficié de programmes ciblés des donateurs (JICA, KOICA, OMS). L'étude conclut que la maintenance nécessite des solutions systémiques. Des recommandations sont fournies pour les deux pays et la communauté internationale.
Mots-clés: maintenance des dispositifs médicaux, capacité locale, Sénégal, Cambodge, ODD 3, ingénierie biomédicale, gestion des technologies de la santé