MRC/WHO Collaborating Centre for Essential Technologies in Health

The Collaborating Centre has been established in response to the healthcare technology status quo in the sub-Saharan region specifically and developing countries more generally. The Centre, which is administered by the South African Medical Research Council and located at its head office in Cape Town, was officially recognised in October 1995. It is the only such centre in the African region focusing on healthcare technology and as such has received the full support of the major regional stakeholders, including key international organisations.

Background

Current health sector reforms in the African region involve the transformation of the entire healthcare delivery system. These reforms have been necessitated by many complex and inter-related factors, one of which is the increasing pressure placed on healthcare systems by financial and other constraints.

Since most of the healthcare technologies used in developing countries are imported, mismatches often occur because the technology development process has not considered the needs and realities of the target environments. However, little or no influence can be exerted on the development process, not least because of the comparatively small market share of these countries. These mismatches in the technology transfer process to developing countries are often of great significance, particularly in the case of technology acquisition through donor aid.

One important consequence is the inability of less developed countries to effectively absorb and fully utilise healthcare technologies, especially new and sophisticated technologies. This is due in large measure to the lack of adequate managerial and technical support infrastructures. Nevertheless, the rate at which new technologies are being developed and introduced into these markets is expected to continue to increase. In fact, failure to fully appreciate and provide for the enabling role of technology in the healthcare delivery process will significantly hamper the reforms needed to meet the healthcare challenges of the next decade.

Mission and goal

The Centre's mission is to contribute to the improvement of health outcomes in developing countries - and the Sub-Saharan Region in particular - through the optimisation of technology interventions in healthcare delivery. Its goal is to serve as a regional centre of excellence in the area of healthcare technology management.

Terms of reference

The terms of reference cover both designated areas of core activity and the responsibilities relating to these activities. Core competencies in the following areas have been realised in the Centre and its participating centres:

Technology management - Technology life-cycle analysis; maintenance and repair strategies; development of appropriate and sustainable technical support infrastructures; information systems; asset management; risk management.
Technology assessment, evaluation and utilisation - Macro- and micro-assessment of healthcare needs; strategic technology assessment (efficacy, cost-effectiveness, cost of ownership and social acceptance of technologies); evaluation of essential and competing technology interventions for different levels of healthcare delivery; procurement strategies for developing countries; user training and support.
Technology development and transfer- Research and development of appropriate/affordable technology solutions to existing or emerging healthcare needs; facilitation of production, distribution and implementation of healthcare technologies in specific target environments.

The Centre has the following responsibilities in fulfilling its mandate:

Information dissemination - Collection, appraisal and dissemination of information on important local, regional and global health technology issues (e.g. strategy, policy guidelines, and human resource development) in association with the WHO and making this information available to governments and other interested parties.
Contributing to effective and equitable healthcare - Promoting the development and utilisation of healthcare technologies that are likely to have a major impact in reducing morbidity and mortality in under-served areas.
Co-operation- Technical co-operation with national, regional and international institutions in all managerial aspects relating to the development, transfer, evaluation, acquisition and utilisation of essential technologies for health.
Capacity development - Support of human resource development in healthcare technology management by facilitating and strengthening educational and training programmes.

The Collaborating Centre, supported by the Health Technology Research Group (HTRG) of the Medical Research Council, also serves as a regional centre for many of the healthcare technology assessment activities in the African region. The Centre's role is enhanced by its participation in an African network of strategic alliances, its visibility on the Internet as a worldwide website and its close association with the HTRG as agents of ECRI for the African region.

Organisation

The Centre has formed a collaborative alliance with the following participating centres:

the Department of Biomedical Engineering at the University of Cape Town/Groote Schuur Hospital in the areas of healthcare technology management and capacity development
the Council for Scientific and Industrial Research (CSIR), Pretoria in the area of technology development and transfer.

Activities for 1994-1996

The Centre has been closely linked with initiatives undertaken to identify and address healthcare technology management and support issues in the Sub-Saharan region. Initiatives undertaken by the Medical Research Council and the University of Cape Town in 1994 included the planning, organisation and facilitation of important regional meetings at which the African Federation for Technology in Healthcare (AFTH) was launched and which led to the adoption of Resolution AFR/RC44/R15 on Selection and Development of Health Technologies at District Level during the Meeting of the WHO Regional Committee for Africa held in Brazzaville in September 1994. These initiatives were conducted with the active support of the WHO, the GTZ (Gesellschaft für Technische Zusammenarbeit), UNIDO, overseas development agencies and international organisations such as the IFMBE.

The 1994 Regional Workshop on Healthcare Technology in the Sub-Saharan Region was followed up by two workshops held during the April 1995 Medic Africa Exhibition in Johannesburg, viz. (i) the AFTH/WHO Consultation on Training of Human Resources for Healthcare Equipment Management in Sub-Saharan Africa and (ii) the AFTH/WHO/MRC Workshop on Healthcare Technical Services.

The Centre also conducted healthcare technology audits in the Southern African Region (South Africa, Swaziland and Zambia) which identified and reinforced the need for appropriate management and technical support infrastructures in the region.

Notable activities and achievements for 1996 included:

Symposium on Safety of Medical Equipment and Devices - This was held during the Medic Africa Exhibition in Johannesburg in April. The meeting, attended by key participants from both public and private sectors, was organised by the MRC/WHO Collaborating Centre under the auspices of the AFTH. Proceedings of the meeting will be published as a WHO/AFTH publication, as part of a series on healthcare technology management.
Special Group on Essential Health Technologies - The MRC/WHO Collaborating Centre was a founding member of the Special Group on Essential Health Technologies that was formed in Brazzaville, Congo in April. The experts group was established to assist the WHO Regional Director in promoting and optimising healthcare technology interventions in Africa.

Current projects (1997-1998)

Development of an essential technology package

This project includes the development of an essential equipment list for developing countries, with particular reference to the district level of healthcare delivery. The project has as its primary objective the identification of essential procedures, based on disease profiles, at the district level. These procedures will then be linked to the technologies, human resources, supporting technologies and infrastructure needed for effective healthcare delivery.

Development of a new framework for healthcare technology management (HTM) interventions

Developing countries, and the sub-Saharan region in particular, face severe systemic constraints in addressing deficiencies in the HTM status quo. In addition, any planned HTM interventions which do not address organisational and socio-cultural realities are destined to be sub-optimal, at best. What is required is a new framework which provides both analytical and managerial tools to (i) identify and prioritise systemic constraints and (ii) identify and prioritise appropriate, affordable and sustainable HTM interventions.

Quality assurance in healthcare technology management

This project deals with technology macro-assessments at health facility level. The Centre has entered into a partnership with the Council for Health Service Accreditation for Southern Africa (COHSASA) with the aim of developing and implementing quality assurance programmes in health service organisations. The collaboration has resulted in the addition of technology management issues to the standards portfolio.

Drafting of a healthcare technology policy document

Drafting of a framework for healthcare technology management with the aim of providing a reference for countries of the sub-Saharan region, in particular, in the development of their national healthcare technology policies.

Development of a healthcare technology resources database

The development, in collaboration with the WHO and the AFTH, of a healthcare technology resource database for the African Region which will greatly facilitate regional networking and collaboration. The database will include listings of healthcare technology experts, key policy/decision-makers and practitioners, training institutions and academic programmes, and publications and other documented material specific to developing countries.

Clinical engineering directory

The Centre is conducting, in collaboration with the AFTH, an update of the Directory of the IFMBE's Clinical Engineering Division. Questionnaires in both electronic and paper forms have been used to capture the data.

Development of technology assessment tools for health system reform in South Africa

One of the project objectives is to develop indicators for the measurement of service performance and the impact of technologies on these in the context of healthcare delivery. The project has been formulated to ensure that it will be applicable and transferable to other African countries, with the idea of encouraging and strengthening technology assessment activities in these countries.

Country situation guidelines

Updating of guidelines used by national ministries of health to perform situational analyses of healthcare technology management and related issues.

Guidelines on equipment donations

Collaboration with national and international organisations, agencies and NGO's has resulted in the development of guidelines to assists both donors and recipients - specifically developing countries – in the optimisation of the technology transfer process.

Appropriate Doppler ultrasonography

Extensive research at the MRC Perinatal Mortality Research Unit has established umbilical arterial waveform analysis (UAWA) using Doppler ultrasonography as an invaluable tool for identifying placental competence in fetal growth retardation. A joint project between the CSIR, an industrial partner and the MRC is in progress to develop an appropriate Doppler analyser for use by midwives.

Other activities

Formation of strategic networks

Strategic alliances have been established with both local and international organisations, institutions and professional societies as part of a facilitation and collaboration network in the areas of interest to the Centre.

Healthcare Technology Management Programme

The Department of Biomedical Engineering at the University of Cape Town, one of the Collaborating Centre's participating centres, is launching in 1998 a new programme in Healthcare Technology Management. The programme addresses the present and anticipated needs of developing countries, and the sub-Saharan Region in particular, and has both teaching and research components. As part of the programme, the Postgraduate Diploma in Healthcare Technology Management is expected to contribute to improved quality and sustainability of healthcare technology interventions in the region.

AFTH publication

The Secretariat of the African Federation for Technology in Healthcare (AFTH) is based at the Centre and has established the infrastructure for the publication and distribution of the official publication of the AFTH. While focusing on issues relating to healthcare technology interventions in Africa, the needs of developing regions in general will also be addressed. Two issues per year are planned initially, with the first issue due in April 1998.

AFTH healthcare technology summit

The AFTH Secretariat also has the responsibility for the planning and organisation of the Healthcare Technology Summit: Vision 2020 to be held in Harare, Zimbabwe in April 1998. The theme of the Summit is "Effective healthcare technology management: making health systems sustainable".

For further information on the Centre and its activities please contact:

Peter Heimann (Manager)

MRC/WHO Collaborating Centre for Essential Technologies in Health, c/o Health Technology Research Group, Medical Research Council, PO Box 19070, Tygerberg 7505 South Africa.

Tel: +27 21 938-0413; Fax: +27 21 938-0385

E-mail: pheimann@eagle.mrc.ac.za

Website: http://www.mrc.ac.za