Medical Oxygen is a Clinical Priority

August 20, 2024 PLOS Global Public Health Global Health

By guest contributors Andrew Johnston, Britta Johnston, Dr. Christine Mutaganzwa, and David Acolatse

Declared essential medicine by the World Health Organization, medical oxygen is an indispensable resource in clinical settings. Oxygen therapy maintains adequate oxygen levels to ensure organ function, and it plays a crucial role in the treatment of various medical conditions, including respiratory distress and hypoxia. The COVID-19 pandemic revealed substantial gaps in medical oxygen coverage, leading to increased morbidity and mortality within LMICs. Yet, healthcare facilities in these regions often lack the availability and safe administration of medical oxygen to address emergencies. To sustain oxygen systems for decades to come, mechanisms for oxygen access must change.

Biomedical Engineering as a Medical Priority

Biomedical engineering is critical for maintaining hospital infrastructure, including oxygen. The WHO and the United Nations have identified biomedical professionals as critical stakeholders for successful service delivery alongside professionals outside of traditional health roles such as midwives, nurses, and physicians. In 2022, the WHO reported that biomedical engineers are crucial to the global strategy for the human resource workforce by 2030, and it recommended biomedical job creation in the health and social sectors. Technological advances related to medical devices encourage economic development and also support the health sector.

As biomedical engineers and oxygen educators at BHI, we know how and are expected to advance health and wellness through technologies for maintenance, prevention, diagnosis, treatment, and rehabilitation care. Our role in the health workforce is to apply tangible skills to healthcare systems that optimize and promote safer, effective, and accessible technology to the populations served. More recently, we have been compared to community health workers; we impart knowledge and best practices on how to maximize hospital equipment to improve patient health.

Challenges

Despite our critical roles in health service delivery, biomedical personnel are not always valued. First, power distance is a persistent issue. Biomedical professionals are often excluded from official definitions of the health workforce or policy frameworks, which can deter the advancement and sustainability of healthcare settings. This disparity contributes to gaps in service delivery, especially for trained and qualified biomedical engineering professionals to design, evaluate, regulate, acquire, maintain, manage, and train on safe medical technologies.

Second, processes and protocols that drive biomedical equipment procurement are often insufficient. Equipment procurement decisions are made by hospital managers, who may lack understanding around biomedical infrastructure requirements. Consequently, when medical equipment arrives at the hospital, there is no supplemental training on its proper usage or clear guidance on how to obtain spare parts in case of equipment malfunction. Compounded with regulations that differ across countries, all of these issues limit technological transfer and increase hospital costs.

Beyond these challenges, the biomedical profession is often undervalued within hospital settings. We know firsthand that issues include little recognition for the importance of biomedical expertise and its applications to healthcare; a lack of continuing education and specialized training opportunities for hospital-based biomedical personnel; and placement of unrealistic expectations of biomedical staff outside their job responsibilities.

Priority One: Implement Education and Training for Biomedical Personnel

There are several solutions to these challenges. Biomedical engineers and global health experts can collaborate to provide comprehensive maintenance, management, and advanced oxygen education training sessions to biomedical personnel who oversee oxygen systems. The end goal is to merge local skillsets with enhanced knowledge on how to properly operate and maintain PSA plants and support oxygen infrastructure. Biomedical personnel can then use this knowledge to raise awareness and educate others.

A formal, centralized facility location is the next step to legitimize biomedical training and research efforts. This center may build on shared learnings to develop contextualized mechanisms toward a formalized institute of biomedical learning and oxygen systems building and strengthening.

Priority Two: Integrate Biomedical Personnel into Healthcare Administration Systems

PSA plants often break down not due to a lack of expertise but because hospitals do not approve funding allocation for the required equipment and tools to service plants. This oversight leads to chronic oxygen shortages that could be avoided had oxygen been financially and administratively prioritized. Hospital systems throughout LMICs often exclude biomedical perspectives in administrative decision making, such as budgetary and resource allocation.

Suggestions for biomedical integration into hospital decision making include: clarifying the roles, responsibilities, and requirements of biomedical staff–-regardless of whether they are engineers, technicians, or other personnel; certifying the minimum number of needed biomedical staff per the set quantity of hospital beds; shifting social behaviors, knowledge, and attitudes among hospital administrators to recognize the importance of equipping biomedical staff with the tools they need, as well as continuing educational opportunities; and establishing standard operating procedures, protocols, or guidelines for hospitals that drive both implementation and funding.

Long-Term Financing for Medical Oxygen

Strategic planning and goal setting around oxygen access in the long term is critical. Such goals include continued international financing mechanisms and advocacy, which are paramount to successfully integrating biomedical importance into healthcare systems. The Global Oxygen Alliance (GO2AL) is one such solution that demonstrates strong commitment in certifying oxygen as a fundamental right to medicine, as well as the right of biomedical engineers to participate in health systems.

Further Reading and References

Colas Fustero, J., & Guillen Arredondo, A. (2010). The biomedical engineer as a driver for Health Technology innovation. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference, 2010, 6844–6846. https://doi.org/10.1109/IEMBS.2010.5626454

De Maria, C., Díaz Lantada, A., Jämsä, T., Pecchia, L., & Ahluwalia, A. (2022). Biomedical engineering in low- and middle-income settings: analysis of current state, challenges and best practices. Health and technology, 12(3), 643–653. https://doi.org/10.1007/s12553-022-00657-8

Mann M, Qavi I, Zhang N, Tan G. (2023). Engineers in Medicine: Foster Innovation by Traversing Boundaries. Critical Review in Biomedical Engineering. 2023;51(2):19-32. doi: 10.1615/CritRevBiomedEng.2023047838. PMID: 37551906

Ross M, Wendel SK. (2023, February 28). Oxygen Inequity in the COVID-19 Pandemic and Beyond. Global Health: Science Practice 11(1):e2200360. doi: 10.9745/GHSP-D-22-00360 . PMID: 36853634; PMCID: PMC9972372.

World Health Organization. (2022, August 31). Human resources for medical devices, the role of biomedical engineers. WHO Medical Device Technical Series. https://www.who.int/publications/i/item/9789241565479

World Health Organization. (2023). Oxygen. https://www.who.int/health-topics/oxygen#tab=tab_1

About BHI

Founded in Haiti, Build Health International (BHI) designs and builds healthcare infrastructure throughout low- and middle-income (LMIC) countries. Working in partnership with health and governmental organizations, BHI’s team of biomedical engineers, based around the globe, have improved and sustained access to medical oxygen by assessing and repairing pressure swing adsorption (PSA) plants, offering technical support, and training over biomedical and hospital personnel. Our concerted efforts are to strengthen global oxygen ecosystems; yet, in our work to strengthen and expand oxygen access, several challenges to expanding remain.

About the Authors:

Andrew L. Johnston, Director of Medical Oxygen Education and Training, is an experienced humanitarian relief and international development professional with nearly two decades of international experience, including extended assignments in Haiti, Uganda, Pakistan, the Democratic Republic of Congo, and Laos. Working on the medical oxygen program allows Andrew to combine the urgency of humanitarian emergency response with the complex planning and coordination of international development projects. LinkedIn

Britta Johnston, Biomedical Engineer, joined Build Health International as a biomedical engineer in 2022, supporting management and implementation of BHI’s biomedical engineering and medical oxygen education and training programs. She has provided biomedical equipment trainings at facilities throughout the globe, including Uganda, Zambia, and Bangladesh. Britta holds a master’s degree in biomedical and medical engineering with a concentration in bioimaging and biomedical devices from Northeastern University. LinkedIn

Christine Mutaganzwa, Global Health Program Manager, is a medical doctor who serves as Global Health Program Manager with the Oxygen Engineering Team at Build Health International. Prior to joining BHI, Christine has worked with referral hospitals in Kigali, the capital city of Rwanda, during her medical training and after graduation. In addition, she has extensive experience working with rural communities in the Eastern province of Rwanda, where she organized clinical and research activities in active collaboration with colleagues within and outside Rwanda. LinkedIn

David Acolatse, Facilities and Biomedical Engineer, is a Biomedical Engineer with over 7 years of professional experience working on medical equipment installation and maintenance. David previously worked at Universal Delft Limited in Ghana as Project Engineer where he managed, installed and maintained digital radiology equipment across Ghana, Nigeria, Liberia, Sierra Leone and Mozambique. He also has experience in medical equipment space planning. LinkedIn

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