TEVETA DEMAND JUSTIFICATION SURVEY FOR MEDICAL EQUIPMENT TECHNICIANS

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DEMAND JUSTIFICATION SURVEY FOR

MEDICAL EQUIPMENT TECHNICIANS

Research Team

Harry Gerson Kamdima

&

Francisco Daniel Makwinja

Technical, Entrepreneurial, Vocational, Education and Training Authority

Private Bag B460

Lilongwe3

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Acknowledgement

As a training authority, we would like to thank the Ministry of Health for entrusting us with the noble task of carrying out an assessment of the market on the demand of medical equipment technicians and coming up with the training intervention for these technicians. Physical Asset Management (PAM) did a good job in providing audience to the research team and also contact of the respondent to the survey. TEVETA also owes its thanks to its parent ministry, the Ministry of Education, Science and Technology for giving it the challenge from the Ministry of Health and giving all the needed support in this exercise. Special thanks should also go to the Hospital Management, both private and public, that participated in this study, the medical equipment suppliers and also the technical colleges for their timely response to the research team that went around. Lastly, and not least, thanks should go to TEVETA management for accepting the challenge and sending the research team to validate the demand for the technicians.

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ABSTRACT

The Ministry of Health, through Ministry of Education, Science and Technology, asked TEVETA to come up with training of medical equipment technicians. However before the training, this demand justification survey was instituted to validate the demand from the Ministry of Health. The study also sought to establish better modalities of training and gaps that could impede smooth implementation of the training. Purposive sampling of the service providers in health and medical equipment supplies was done. The study has finally concluded that the demand for medical technicians prompting the need to train medical equipment technicians is there on the market. However, the survey showed that it needs proper monitoring. In the opinion of the team that carried out the survey, this training can be best placed in technical colleges for theory and practical modules be done in the hospitals where equipment is found. It has further been observed that the hospitals are very willing to attach those undergoing medical equipment training and also are willing to help in training them especially in human physiology and anatomy.

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Table of Contents

1.0 Background of the study .............................................................................................................. 8

1.1 Justification.................................................................................................................................. 8

1.2 The objectives of the survey .............................................................................................................. 9

2.0 Development on training the technicians ................................................................................... 10

2.1 Training Gaps ............................................................................................................................. 10

2.1.1 Training Content ............................................................................................................. 10

2.1.2 Human Resource Gap ..................................................................................................... 11

2.1.3 Equipment Gap............................................................................................................... 12

2.1.4 Institutional Gap ............................................................................................................. 13

3.0 The Survey ................................................................................................................................. 14

3.1 Limitations of the survey ............................................................................................................ 15

3.2 Effect of absence of medical technicians .................................................................................... 15

3.3 Demand for Technicians............................................................................................................. 17

3.4 Environmental Analysis .............................................................................................................. 20

3.4.1 How should the training be organized ............................................................................ 20

3.4.2 Where could the training be offered? ............................................................................. 21

3.4.3 Position of technical colleges in training the technicians ................................................. 25

3.5 Content of the Training .............................................................................................................. 25

3.6 Availability of experts for curriculum development .................................................................... 27

4.0 Conclusion and Recommendations .......................................................................................... 30

Appendix I ............................................................................................................................................. 31

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List of Table

Table 1 Demand of Technnicians ........................................................................................................... 17

Table 2 Breakdown of CHAM Hospitals .................................................................................................. 18

Table 3 Actual Demand of Medical Equipment Technicians ................................................................... 18

Table 4 Market saturation years ............................................................................................................ 19

Table 5 Place where the training can be offered .................................................................................... 23

Table 6 Importance rating of categories ................................................................................................ 23

Table 7 Names of experts available on the market ................................................................................. 28

Table 8 The Respondents of the Demand Justification Survey ................................................................ 31

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Acronyms

CAPEX- Capital Expenditure

CBET- Competence Based Education and Training

CHAM- Christian Health Association of Malawi

DACUM- Develop a Curriculum

MoH- Ministry of Health

OJT- On Job Training

PAM- Physical Asset Management

PMD- Planning and Monitoring Division

PSTP- Private Sector Training Program

QAD- Quality Assurance Division

RMU- Regional Maintenance Unit

TEVETA- Technical, Entrepreneurial, and Vocation Education Training Authority

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Demand Justification Survey for Medical Equipment Technicians

1.0 Background of the study Following the request made by the Ministry of Health through Ministry of Education Science and Technology requesting Technical, Entrepreneurial, and Vocational, Education and Training Authority (TEVETA) to have its technical staff working in the hospitals their skills upgraded to cope up with the new medical equipment, Quality Assurance Division (QAD) in conjunction with Planning and Monitoring Division (PMD) within TEVETA conducted the Demand Justification Survey (DJS) as preliminary assessment to ascertain whether the demand from Ministry of Health was truly valid for the development of the medical equipment technicians to be working on medical equipment in the hospitals.

The study went beyond the request of developing the ministry’s staff in maintenance of hospital equipment. It also considered development of a specialized course in order have a caliber of people that can be working on the equipment.

It has to be acknowledged afore that currently there is no training in the country that can be taken as a model as far as medical technicians are concerned. Therefore the Ministry of Health has in the previous years been sending people to Kenya (Mombasa Polytechnic) and South Africa (Tswana University) to get them trained in maintenance of medical equipment. To the present time the government has trained up to fourteen technicians who are available in the system.

1.1 Justification In spite of this development, two clear challenges have been noted as far as training in these countries is concerned:

1. The entry into the South African Education System is not easy.

2. The Kenya training uses equipment that is obsolete on the market.

3. Lastly as a nation, we have been spending heavily in terms of training costs for technicians who could have been developed locally.

Due to these factors, it has to be stated that it is not easy to train the number of technicians that we may need as a country, and also the quality of the technicians

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might be compromised. This then means that if Malawi is to have adequate technicians, there is need to overcome the barrier to entry into South African University, and also for Malawi to have quality technicians, there is need to expose her medical equipment technicians to existing modern equipment. One other thing that can be clearly appreciated is that the machines that are used for training in Kenya (and those in South Africa?) are different from those we have in Malawi. It therefore means that the technicians that we may develop outside Malawi might not be fully effective in Malawian context.

1.2 The objectives of the survey Due to the points stated above, TEVETA organized a survey with the following objectives;

a) To justify the demand for the inclusion of medical equipment in the mechanical engineering curricula.

b) To establish maintenance gap existing on the machinery available in the hospitals.

c) To establish the best approach to up skill the technical workers (Either on-the-job or attach them to a training institution).

d) To identify availability of experts in the medical field that could participate during the development of this curriculum.

e) To establish availability of trainers from training institutions to competently deliver the curriculum.

f) To establish availability of equipment in training institutions for use during training

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2.0 Development on training the technicians The call by the Ministry of Health comes with the background that in the past four years, there has been an outcry to train medical equipment technicians to fill the existing gap. However nobody was coming forth to take up the challenge. Partly it might be because all communication channels were not exhausted.

Recently, the Ministry of Health has just recruited and deployed 15 more people to be medical equipment technicians in district hospitals. However, these, have not gone for any training in medical equipment maintenance. The challenge however is that, due to the nature of the machinery they have to work on despite their electronics background, they need specialized training on medical equipment. If not properly trained, their bid to help in preserving lives might destroy the very lives they intend to save.

Following this recruitment, the Ministry of Health has requested the Polytechnic to develop a short course to equip these new recruits with skills on medical equipment maintenance. One of the prerequisites of the training of these technicians is a bias in practice (hands on). However, from the initial analysis, it has shown that the Polytechnic training will be deficient on practical skills. The course has been put there as an intermediary measure to fill both the skills gap and the human resource gap.

Beyond the Polytechnic initiative, the Ministry of Health is continuing to discuss with the tertiary institutions including Mzuzu University on the need to train medical equipment technicians.

2.1 Training Gaps Despite all initiatives been put by the Ministry of Health, it has to be appreciated that on the ground there are some deficiencies that have to be worked on i.e. training gaps, among which are the content, equipment, and human resource.

2.1.1 Training Content From the training content perspective, it is worthy acknowledging that the training on medical equipment in Malawi has been partially covered in CBET Engineering Modules now being used in technical colleges. Though such is the case, the modules are wanting in that they do not give the artisans enough skills that would make them competent in maintaining hospital equipment. Secondly it has to be appreciated that the modules are biased towards engineering trades.

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Another crucial aspect to be noted is that the training content of medical equipment technicians has to include human physiology and anatomy a content that is missing in the current modules. It is worthy accepting that the basis of machines is human electron circuits, which are transferred to the interpretation of the medical equipment for diagnosis, therefore the understanding of human body comes in as a very critical component in medical equipment maintenance.

Besides the training done in colleges, the other windows of training like Private Sector Training Programs (PSTP) and On Job Training (OJT) have not addressed the medical equipment maintenance need. This may be attributed to that it might not have been demanded during the demand soliciting exercise done by the responsible offices. Besides the biased trained towards medical equipment, it has also been observed that there are some similarly important courses that would have contributed to effective medical equipment maintenance but have no patronage from medical bodies. Such courses include servicing of electronic equipment and servicing boilers. This might be because the hospitals are not sensitized on PSTP.

It has also been observed that the OJT that is done in the hospitals’ maintenance departments has also lacked the acquisition of skills in medical equipment not by default but by design. The structure in Ministry of Health has divorced maintenance of medical equipment from the hospital maintenance section to a centralized department known as Regional Maintenance Unit (RMU) which is under Physical Asset Management (PAM). This unit is the one which is responsible for the medical equipment and provides a referral system where the faults are referred to this unit for maintenance. One thing to note in this centralization is that the unit does not belong to the hospital though found in central hospitals and therefore reports directly to Capital Hill. Being central, it is responsible for the whole region including the central hospitals where they are located. Currently there are four regions each having its own RMU; Northern, Central, Eastern and Southern.

2.1.2 Human Resource Gap As earlier alluded to, there is a deficiency in medical equipment technicians in Malawi and those available are those working for PAM or else visiting. So far no hospital has its own technicians except the eleven belonging to PAM.

It has however to be appreciated that this does not mean people have not been trained in medical equipment maintenance. The survey that was done has revealed that most of the senior maintenance supervisors in the hospitals both district and

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central hospitals at one time were sent for a basic course in medical equipment however, they are not directly involved in medical equipment maintenance which creates an artificial gap.

Medical equipment maintenance has also been seen to be biased towards electronics; however, some of those who went for the training in Mombasa are coming from a construction background. This then means though they were sent, because of their background, not much can be achieved out of such people except where there is personal interest. This shows that there was an inclusion error in human resource development.

2.1.3 Equipment Gap As has been started on the initial analysis of the Polytechnic training of the newly hired technicians, equipment that can be used for training of medical equipment technicians is not currently available in the education institutions in Malawi. However, it has to be appreciated that the training of medical equipment technicians is not theory based, it is practical biased.

A critical component of this training is that the practical sessions that can be embedded into training would form a significant part for both visible and hidden curricula. The sessions would also help in better understanding of medical equipment right from training to work place. However the challenge that exists is how to get the equipment for training.

Culminating the problem of equipment is that for the past decades, procurement procedures have not allowed brand specification when purchasing medical equipment, a situation that has resulted in having several brands of the same equipment in stock. This then pauses a challenge as to which brand can be adopted as a model for training. The problem so far identified is not the brands but the procurement procedures in Malawi.

Beyond the training it is worthy acknowledging that this has resulted to diseconomies of scale as far as maintenance is concerned. For example, if similar machines but having different brands break down, it then means spear parts must be bought from different manufacturers. It has also been noticed that the procurement has often gone for machinery that is cheap than the best. These have compromised the work of technicians.

Beyond the procurement of equipment, it has also been seen that the procurement procedures also hamper effective time that can be allocated on a machine, because

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they take so long to follow the bureaucracy of procurement despite health being an essential service. This has further resulted to a lot of machines being kept in RMUs though they could have been rectified by the available technicians.

2.1.4 Institutional Gap The above sections therefore pauses a challenge as to which institution can best deliver the training if a curriculum is developed? If an institution is better placed and does not have equipment how best can it be equipped?

The Malawian education system has also divorced technical education from health schools. If health is being learnt in technical school where technicians are trained, is just for safety. Secondly the two institutions report to different ministries, which means if a training is to be developed, it must have the blessing of two ministries, one as a service ministry the other as a user ministry. Mostly education has been a service ministry which in this case might hold.

Several options exist: The first is that of internal development and consumption. The Ministry of Health has to develop technical people within its own schools and consume them in its own services; second option is where the Ministry of Education trains and the Ministry of Health uses the products of Ministry of Education; lastly where both contribute to training because of specialization and the ministry of health uses the product.

These options have been explored in section 3.3.

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3.0 The Survey The demand justification survey therefore aimed at addressing the objectives stated in the background and challenges in the subsequent chapter on developments in the training market. It further looked into the effect of absence of medical technicians from the hospital perspective, the demand for medical equipment technicians, environmental analysis of the training, the availability of technicians in case they were not recorded anywhere, the contribution of hospitals if the training is started after being justified, specific areas that exists as gaps in the hospitals, remedial measures that the hospitals have been putting in place in the absence of these technicians, the availability of medical equipment content as part of OJT, and availability of materials that can be used.

The targeted respondents of the survey were the Ministry of Health, hospitals both public and private, the medical equipment suppliers, and the technical colleges. The hospitals had two respondents, one from management usually the Hospital Director, District Health Officer, or Hospital Administrator from policy perspective, and the Maintenance Supervisors from the technical side.

Though it might seem not worthwhile to include the latter instead of RMU officers, the justification comes in that the RMU is part of the PAM which was very much represented at Ministry level. Furthermore the RMU might be involved much during curriculum development, but also was part of the call for training as it belongs to PAM, which therefore meant there was need of a third hand in justifying the demand.

Purposive random sampling was used targeting referral hospitals from the three regions like Mzuzu Central Hospital, St John of God Hospital, Nkhotakota District Hospital, Salima Central Hospital, Mangochi District Hospital, Zomba Central Hospital, Chiradzulu District hospital, Thyolo Central Hospital, Queen Elizabeth Central Hospital and Lilongwe Central Hospital. In these institutions the intent was determination of demand, searching for availability of experts, and determination of content.

The other group is the training institutions with the intent of establishing availability of trainers and equipment for the training like Soche Technical College, Polytechnic, and Lilongwe Technical College.

For the list of those consulted refer to Table 8 in the appendix.

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3.1 Limitations of the survey The survey had only two limitations;

1. The first is that it applies only to technicians not engineers. The bias is coming in because of the Mandate of TEVETA. Secondly the demand was for technicians not engineers. From the agreement with the Malawi Polytechnic, the engineering training will have to be developed by them and will follow later after the technician training. Therefore the results must be interpreted as such.

2. The fuel scarcity impeded the smooth running of the survey especially time. Due to the same, it was not possible to visit Thyolo District Hospital and Malamulo Hospital.

3.2 Effects of absence of medical technicians The effect of the absence of medical equipment technicians has so far not been quantified. The health surveys that have been done have been biased towards diseases, ethics, and approaches. This survey therefore made an effort to register the effects of this absence. Though in-depth approach was not done, the study still did a qualitative measurement of the effects of the absence.

The dominant effect is loss of effective medical time. It has been observed that once medical equipment breaks down, the doctors are unable to give services to the patients. This emanates from four factors. In case that is the only machine they have to use, it then means the doctors will have to wait until it is repaired, if a chance is there to get another one, the patients have to wait until it is sourced. In case referrals can be made, the patients have to be referred to other hospitals where they can have access to the service. It has also to be appreciated that the patients for the hospitals where the referrals have been done, are also waiting for the same service. This then results to over utilization of the equipment, and also delayed service for the patients that need immediate medical care.

The loss of effective medical time is also an effect of the way medical equipment servicing has been structured. The centralization of RMUs stated above and the availability of few technicians to work on the machinery culminates to delays in maintenance of breakdowns. It has been observed that the time that they are needed in one hospital, they are also required to service some equipment in another hospital, a situation that can be classified as “scramble for technicians”. This can

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also result in reduction of time the technicians have to maintain the equipment that they have taken from other hospitals to RMUs.

It has also been observed that the procurement procedures increase the down time of equipment. Hospital equipment that needs maintenance is being kept in the RMUs because the spares are not being bought on time. This has also been a resultant effect of having several types of machinery of the same use as stated earlier on. This is a derived effect of absence of the technicians’ technical advice in procurement.

The demand section presents information on the need of these technicians and this can help in better understanding this gap.

Secondly the absence of these technicians has resulted to increased expenditure from the side of the hospitals. In case there is a break down it then means referrals have to be done. These referrals means the hospital has to find transport for the cases they are referring, which translates to wear and tear, but also fuel costs for the vehicle in use. If there are several hospitals doing this it then means on aggregate expenditure on referrals will increase while having the equipment within the hospitals.

Beyond the referral expenses, the breaking down of medical equipment has also resulted to outsourcing of the maintenance services which has also increased expenditure on equipment. This is twofold: The first is the internal procurement of services from RMU. Since the medical technicians are centralized in their operations, they have to be called for them to work on the hospital equipment in the hospitals. One noticeable thing is that the RMU has only allocations for operations not servicing breakdowns. This then means the hospitals have to procure services from RMUs in form of transport cost and allowances. It has also been observed that the preventive maintenance is mostly not appreciated within the health departments such that break down of equipment is the only time that the RMUs have an opportunity to work on the machinery, a situation that increases the time the technicians have to work on the machinery in turn increasing the expenditure on these technicians.

The other outsourcing is that of experts from the companies who supply the medical equipment. Though we have local suppliers who have own technicians, it has still proven difficult in some instances such that foreign experts must be called. This has turned out to be expensive because the people must come from as far as Iran and Lebanon just to service medical equipment in Malawi. From the opportunity cost

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perspective, these resources could have been relocated to other things within the Capital Expenditure (CAPEX) Budget for the ministry.

Thirdly it has been observed that the breakdown of medical equipment in the absence of technicians has contributed to loss of lives. Some patients who are being referred have had their conditions worsening while in transit, or some not able to access hospital services because of breakdowns, which in one way or the other has contributed to their death. However no crude figure can be given.

3.3 Demand for Technicians As has been stated above it cannot be over-emphasized as to what extent the technicians are needed. The Ministry of Health has been going through functional review and has seen that the hospitals need at least one technician except community hospitals. The table below presents the envisaged demand of medical equipment technicians and engineers per category of hospital from the functional review of the Ministry of Health and also the structure of other health services providers.

Table 1 Demand of Technnicians

CATEGORY POSITION NUMBER IN THE

CATEGORY

DEMAND

Health Care Support and Infrastructure Management

Medical Engineer 1 2

Zonal Support Service Medical Engineer 5 10 Central Hospitals

Chief Medical Engineer 4 4 Principal Medical Engineer 4 4 Medical Engineer 4 12 Medical Engineering Technicians 4 16

Zomba Mental Hospital Medical Engineering Technicians 1 1 District Hospitals Medical Engineering Technicians 28 28 Christian Health Association of Malawi (CHAM)

Medical Engineering Technicians 172 20

Medical Equipment Suppliers Medical Engineering Technicians 6 5 Total 102

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Table 2 Breakdown of CHAM Hospitals

Total Number of CHAM Hospitals 172 Referral Hospitals 20 Community Hospitals 20 Health Centers 132

However it has to be acknowledged that it is in referral hospitals that the technicians will highly be needed.

Though Table 1 shows that at the mean time there is a demand of 102 technicians on aggregate, the actual demand stipulates almost doubling the number. The initial demand is based on the structural arrangement while the actual demand is based on the actual assessment of work on the ground.

For the Ministry of Health the survey shows that the actual demand is above those establishments in the functional review. In other words there is underestimation of the demand on the structure. Table 3 below presents averages for the categories in Table 2 above.

The survey has registered that every hospital visited need the technicians and currently they have none. Similarly the medical equipment suppliers indicated that they need technicians. At the mean time Inter-med has three and Medical Consult Africa has two. One thing to note is that though these technicians are operating in Malawi, they have not been trained in Malawi. Some were hired and sent for training in medical equipment engineering.

Table 3 Actual Demand of Medical Equipment Technicians

CATEGORY POSITION TODAY 10 YEARS TIME

TOTAL TODAY

TOTAL IN 10 YEARS

Private and Mission Hospitals

Medical Engineering Technicians

3 4 54 72

Central Hospitals Medical Engineering Technicians

8 15 32 60

District Hospitals Medical Engineering Technicians

4 7 112 196

Medical Equipment Suppliers

Medical Engineering Technicians

3 7 18 42

Total 198 328

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From the table above it shows that the demand is there for medical equipment technicians, however if not properly addressed, the market can easily be saturated. It therefore calls upon proper administration and monitoring of the intake and the market respectively.

So far the training for the medical equipment technicians takes two years after already acquiring some basics in electronics or engineering. This then follows that for proper control of the supply the intake has to be moderated. The table below presents some possible intake options for non saturation of the market all things being constant.

Table 4 Market saturation years

NUMBER TO BE RELEASED TO THE MARKET PER YEAR YEARS TO SATURATE THE MARKET 53 11 40 14 30 19 20 27 10 54

Marrying this analysis with the gaps that exist on the training market, it then shows that the saturation point cannot be easily met. The first thing to consider is, with this demand vis-à-vis the constraints, which institution is best placed get the numbers in question? It has to be noted that a normal class is of twenty people and the introduction of the training at any institution will have to occupy some class at a particular time displacing some event that was in the same class. Beyond this it will need experts and equipment for the training.

Getting twenty as a model class it then shows that it will take about 27 years to saturate the market all thing being equal. However it should also be noted that as time is going, more hospitals will be built and some hospitals upgraded, which will still require more work force. It then indicates that it will not be easy to saturate the medical equipment technicians market which comprises medical equipment suppliers, Ministry of Health, the public, mission and private hospitals, and also some brain drain effect. Beyond the domestic market, it has to be further noted that if the training is started in Malawi, it might be the first of its kind in Central Africa, a situation which is likely to lead to brain drain, or else Malawi will be exporting services of medical equipment technicians which will translate to higher

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demand of the same. Though such is the case a good monitoring mechanism should still be put in place to monitor the gaps in supply and demand of this work force.

This then justifies the demand for the training from employment part. However it is not conclusive until the other aspects are examined. The following section therefore does environmental analysis of the training.

3.4 Environmental Analysis The gaps stated earlier and the need to have hands on technicians, pause a challenge as to how best to deliver the training. It has to be noted that the hospital where they are supposed to be working is not a training ground, but also the colleges do not have equipment which the trainees can use in case there is need to practice what they have learnt in class. However several options exist;

1. Equip the colleges with medical equipment relevant for the training.

2. Provide lecture rooms at the hospitals and the training be taken as any other on job training.

3. Introduce the training in specialized colleges.

4. Come up totally with a new set up of training.

The survey tried to consider these options. However there are some areas to be considered before analyzing the environment, among which is the organization of the training.

3.4.1 How should the training be organized The study has found that the training has to be offered as a specialty in which people will have to undergo medical equipment training above engineering courses they might have gone through. That being the case the incorporation into other course like engineering or electrical has been ruled out.

It is thought that the medical equipment maintenance on its own is broad and the incorporation would compromise the attainment of other necessary skills. The survey also found that within the medical equipment maintenance there is a need for specialization on the type of equipment, for example some to specialize in X-Ray machines, others on autoclaves, and similarly other machines. However the training model that CBET adopted is that skills must be potable and transferrable. This

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though might be thought to compromise on specialty, but has a lot of advantages to the work force and the nation. Some of the advantages are as follows;

1. The technician will not be confined in terms of his work and changing of jobs i.e. increases the marketability of the technicians

2. It cushions the technicians of job loss and eventualities.

3. It smoothens the job of those interested to hire the technicians and also helps the employers to have an all rounder. What has to be noted is that hospitals will not have the same problems all the time. Therefore the technician who is trained in several machines will reduce the idle time and increase work efficiency because has a wide scope of knowledge.

4. In the end it will reduce costs because one person can do the work that several people could have done. In other words, one person would occupy seats of several people.

The usual time that the training has been taking in other countries has been two years. However this survey is not there to detect the time that the training has to take. This has to be stipulated basing on the content of the training.

Similarly the entry qualification has to be spelt out after the DACUUM Chart is developed.

3.4.2 Where could the training be offered? Looking at the gaps and the envisaged organization of the course, it still remains a challenge as to where the training will be offered so that it is specialized and gives the maximum benefit.

From the options existing above; equip the colleges with medical equipment relevant for the training, provide lecture rooms at the hospitals and the training be taken as any other on job training, introduce the training in specialized colleges, and come up totally with a new set up of training, none of these would see the training being started.

The equipping of colleges with medical equipment means depriving the small resources from being allocated to essential service which is already falling below the required levels. If the option of getting the equipment not being used in the hospitals to colleges would be a choice, then it has to be made sure that they are the latest models which likely might not be the case. This then would mean having

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training that is substandard from two perspectives; the machines may not be working and may be old.

The option of providing lecture rooms at the hospitals for training medical equipment technicians would turn the hospitals into training institutions which is not in line with the administration of such facilities.

Coming up with completely new institution might be the best. However with the current funding levels in both development and recurrent budgets the government might not be in a position to implement such a project, unless is funded from outside the government budget. This then calls for the Ministry of Health and Education to come together and present a proposal to possible funders of such a project. However this might be long term.

The last option is that of specialized colleges. The survey made an initiative in environmental analysis to consider hospitals and colleges, which were further divided into medical and technical colleges. From this survey, it has been found that technical colleges are best placed to handle the training of medical equipment technicians though they are not the best.

The tables below present an analysis of the option of colleges (medical and technical) and the hospital.

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Table 5 Place where the training can be offered

CATEGORY MEDICAL COLLEGE TECHNICAL COLLEGE HOSPITAL Peer effect Would benefit from those

doing health course Would benefit from a myriad of technical course available

None

Availability of medical equipment

Partially equipped None Full equipped

Availability of technical equipment

None Fully equipped Partially equipped

Availability of experts

Medical experts Technical experts Medical experts

Developing of experts

Have a history of developing medical experts

Have a history of developing technicians

Uses the experts

Specialization Medical in nature Technical in nature Service in nature Contribution

Would direct contribute by helping their friends

Would help the other supporting engineering courses to also be having an input in health equipment right from school

Would directly serve the hospital

Benefit of students Medical experts and equipment

Technical experts and equipment

Ready attachment

Practical biasedness for technicians

None

Very practical

Very practical

Support infrastructure

None Equipped Equipped

Table 6 Importance rating of categories

CATEGORY MEDICAL COLLEGE TECHNICAL COLLEGE HOSPITAL Peer Effect 5 5 0 Availability of medical equipment 3 0 5 Availability of technical equipment 0 5 3 Availability of experts 5 5 5 Developing of experts 5 5 0 Specialization 5 5 0 Contribution 5 5 5 Benefit of students 5 5 5 Practical biasedness for technicians 0 5 5 Support infrastructure 0 5 5 TOTAL 33 45 33

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From this rating all are falling below the requirement of fully fledged institution for the training of medical equipment technicians. However technical colleges are better placed especially on availability of technical equipment that can aid training. Though that is the case they are lacking in terms of experts in health and medical equipment.

This then indicates that though they are better placed to handle the training, they are supposed either to hire medical professional or outsource the service. The good part is that the survey found that the hospitals are willing to be providing experts to help in understanding human physiology and anatomy. They are also willing to provide verification services and assessment.

The other critical area of the training is the medical equipment. The technical colleges though having training aiding equipment, they do not have the machines they have to be working on. However the hospitals are best rated on this compared to the two.

It then shows that in the end there is a need for a training that will be integrating both hospitals and technical colleges. The latter for technical aspects, while the former for attachments to improve the hands on aspects. The other good aspect is that the survey has found that the hospitals are fully willing to offer attachment to those who are pursuing medical equipment training as is the case with those in medical colleges.

If there will be need of equipment for training in colleges, further consultations have to be made with the concerned appropriate authorities for the donation of the equipment that has broken down or else lying idle depending on their flexibility.

Lastly it is worthy acknowledging that there are proposals that the training be done either at the polytechnic or college of medicine. However it has to be acknowledged that the mandate of the two is that of offering degree programs, therefore when developing engineers training the two are better placed. This study only concentrated on technicians and the assessment of the two institutions was not done, as indicated on limitations.

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3.4.3 Position of technical colleges in training the technicians The question that can be asked is, are technical colleges ready to handle the training? Where do they stand in relation to gaps stated earlier?

Since the equipment gap has been addressed in passing in the above section, and the institution gap, the gap that remains to be addressed is the human resource gap. The question can be, are there well qualified people to handle the medical equipment training in technical colleges?

The history of technical colleges shows that so far no college has ever offered the course except Lilongwe Technical College which tried it at some point in time. However, this was done in isolation and did not receive the support it deserved though being a good innovation.

From the human resource development perspective, it has to be stated that no trainer in technical colleges has ever been trained in medical equipment maintenance. This is the major drawback of technical colleges as far as medical equipment technician course is concerned.

However, if they have to offer it as an applied science they are better placed. This therefore calls for two things. The first is upgrading of technical college teachers in medical equipment skills, or totally hire those who have specialized in medical equipment.

3.5 Content of the Training The study made an initiative to solicit ideas of the training before the brain storming exercise during the DACUM Chart. Below are some critical areas that have to be considered.

1. Procurement procedures

2. Management

3. Work ethics

4. Communication

5. Leadership skills

6. Occupation safety and health

7. Introduction to medical equipment

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8. Functioning of medical equipment

9. Installation of medical equipment

10. Servicing

11. Maintenance and repairing of medical equipment

12. Testing of medical equipment

For specific content of the curriculum, the following were proposed;

1. Working/operational principles

2. Electronics

3. Line diagram of medical equipment

4. Power voltage regulation

5. Upgrading of equipment

6. Troubleshooting/ diagnosing equipment

7. Identifying spare parts

8. Rectifying faulty parts

9. Plumbing techniques

10. Mechanical systems

11. Boiler system

Machines that the technicians have to be familiar with are as follows;

1. X-Ray machines

2. Dialysis machines

3. Autoclave machines

4. Washing machines

5. Drying machines

6. Cold room system

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7. Diathermy machines

8. Anesthetic machines

9. Dental machines

10. Claotherapy machines

11. Laboratory equipment

a. Oxygen concentrators

b. Incubators

c. BP machines

d. Microscope

12. Monitors

3.6 Availability of experts for curriculum development The past curriculum developments have had no pool of professionals who could participate in the development of curriculum. Starting from instrumentation curriculum development, there has been an initiative to provide a pool of professional who can be useful in developing a curriculum.

The survey has also tried to find some experts who could be of help in developing and vetting the curriculum. The table below presents some of the names that might be of help. Beyond these names, some experts from PAM and Inter-med can be contacted as well.

It has further to be noted that not all experts provided here are technicians and some are the users of the equipment who can also contribute towards the training and standards.

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Table 7 Names of experts available on the market

NAME QUALIFICATION YEARS OF EXPERIENCE

LOCATION

Mr. Kadzuwa Certificate in Mechanical Engineering Over 4 years Nkhotakota District Hospital

Mr. Anthony Sitiya Advanced Diploma in Construction/ Certificate of attendance in medical

equipment maintenance

Over 4 years Mangochi District Hospital

Mr. James Mlungu Diploma in Electrical Engineering Over 4 years Zomba Central Hospital

Mr. Saidi Moto Advanced Craft in Electrical Over 4 years Zomba Central Hospital

Mr. George Mubisa Bsc- Radiology Over 4 years Zomba Central Hospital

Mr. Edwin Bakali Diploma in Clinical Medicine Over 4 years Zomba Central Hospital

Mr. Bicton Chakachanza

Diploma in Electrical Engineering Over 4 years Zomba Central Hospital

Mr. Masautso Dzingomvela

Bsc- Dental Over 4 years Zomba Central Hospital

Mrs. Moyo Bachelor of Science in Medical Laboratory Technology

Over 4 years Chiradzulu District Hospital

Mr. Jabu Diploma in Radiology 3-4 Years Chiradzulu District Hospital

Mr. Nyengozino Diploma in Laboratory Over 4 years Chiradzulu District Hospital

Mr. Grant Kaluwa Radiology Technician Over 4 years Queens Central Hospital

Mr. Felozi Bachelors in Laboratory Technology Over 4 years Queens Central Hospital

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Mr. Godiya Diploma in Anesthesia Over 4 years Queens Central Hospital

Mr. Kamadzi Laboratory Technician Over 4 years Kamuzu Central Hospital

Mr. Tchipa Radiology Technician Over 4 years Kamuzu Central Hospital

Sis. Lajabu Nurse (Dialysis) Over 4 years Kamuzu Central Hospital

Chief nursing Chinkhata

Nurse Over 4 years Kamuzu Central Hospital

Mr. Mwalilino Diploma in Anesthesia Over 4 years Kamuzu Central Hospital

PAM

Medical Consult Africa LTD

Intermed

For PAM communication can be done through the Director:

Dr Lovemore Nkukuma on 0994299993

For Medical Consult Africa, the following contacts can be used:

Direct: +265 1 710 123 Switchboard: +265 1 711 893 Fax: +265 1 713 283

For Intermed, the following contacts can be used:

Tel: (265-1) 750035 Fax: (265-1) 752160

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4.0 Conclusion and Recommendations The survey has therefore managed to justify the demand of medical equipment technicians. It has further provided the market analysis on saturation years and recruitment levels. It has also shown the gaps that exist in training medical equipment technicians and also the effects that their absence has had on the market. Beyond these it has provided a best approach that can be taken as far as training is concerned; where to train and how to train them, and the modalities of training.

This report therefore makes the following recommendations:

Mounting of a full course on medical equipment engineering targeting technicians.

Instituting of this course in a technical college.

The training has to be hands-on and has to integrate the technical colleges and hospitals, the former for theory and the latter for practice.

Proper market monitoring mechanisms be put in place to closely monitor the supply and demand of the technicians, but also the gaps in their training.

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Appendix I

Table 8 The Respondents of the Demand Justification Survey

Name of respondent Location Position

Dr Lovemore Nkukuma Ministry of Health Director of PAM

Mr. Jacob Mazalale Ministry of Health Planner

Mr. Sidila Ministry of Health Medical Equipment Technician

Mr. Aquino Buddy Ministry of Health

Mrs Chimkono St Johns Hospital Acting Hospital Administrator

Mr. Goefry Mkonda St Johns Hospital Maintenance Supervisor

Mr Davie Mwale Nkhotakota District Hospital Hospital Administrator

Mr. Kadzuwa Nkhotakota District Hospital Senior Maintenance Supervisor

Mr Kambeni/ Mr Bilesi Salima District Hospital Administrator

Mr Clement Nkhoma Salima District Hospital Senior Maintenance Supervisor

Mr. H. Banda/ Mr Naluso Mangochi District Hospital Administrator

Mr. Anthony Sitiya Mangochi District Hospital Senior Maintenance Supervisor

Mr. Mathews Kamalonda/ Mr. Chisomo Chimbu

Zomba Central Hospital Assistant Human Resources Management Officer

Mr. James Mlungu Zomba Central Hospital Senior Maintenance Supervisor

Dr. D. Zolowere/ Dr. Msosa Chirdzulu District Hospital District Health Officer

Mr. Sochela Chirdzulu District Hospital Senior Maintenance

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Supervisor

Mr. Banda Mwayiwathu Private Hospital Hospital Services Manager

Mr. Kelvin Nkosi Mwayiwathu Private Hospital Senior Maintenance Supervisor

Dr. Gonani Queens Central Hospital Hospital Director

Mr. Francis Gwilanani Queens Central Hospital Senior Maintenance Supervisor

Mr. Lighton Kadewere Maintenance Officer Beit Cure

Dr. Alide Hospital Director Kamuzu Central Hospital

Mrs Rose Nyirenda Mzuzu Central Hospital Hospital Director

Mr. Katete Mzuzu Central Hospital Senior Maintenance Supervisor

Mr. Gladson Navitcha Soche Technical College Head of Engineering

Sibusisiwe Chimasula Medical Consult Africa LTD Sales Executive

Mr. Mohsin Inter-med

Ms. Mwakitete Bio-Clinical Partners Sales Representative –Mzuzu

Mr. Samuel Mtolo Bio-Clinical Partners Sales Representative-Blantyre

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