1. Biomedical Engineering Technology Training in Rwanda Name: Anna Worm Organisation: Engineering World Health, AMPC, THET Location: Rwanda E-mail address for contact:anna@worm.nl Success Stories Submitted by BMET TRAINING SUCCESS STORIES1 April 2016

2. Rwanda Country Estimates in Brief Population (2013)11.78M (2013, World Bank) Population Growth Rate2.79 % Life Expectancy at Birth (m/f)63.49 years (2012) Infant Mortality Rate38.8/1000 live births (2013, UN WHO World Bank) Number of Health Facilities in Country4 Referral hospitals 48 district hospitals 440 health centers Health Facilities ownershipMost public owned, sometimes in PPPs (e.g. with Partners in Health). Privately owned: 1 general hospital, 50 clinics and polyclinics, 1 psychiatric hospital, 1 eye hospital, 4 eye clinics, 8 dental clinics, 142 dispensaries Total Expenditure on Health as % of GDP 9.7% (2009, WHO) 2 April 2016 BMET TRAINING SUCCESS STORIES

3. History 3 April 2016 In 2009 GE Foundation offered the Rwandan minister of Health, Dr Sezibera, a big donation of medical equipment. Dr Sezibera accepted the donation under the condition that GE Foundation would take responsibility for training Rwandese hospital technicians. GE-F took this request at heart and involved Engineering World Health to set up a BioMedical Technician training programme in Rwanda. BMET TRAINING SUCCESS STORIES

4. Setting up the training programme 4 April 2016 From the end of 2009 EWH started teaching the Rwandan hospital techs. The agreement between the MoH and EWH covered the training of 90 technicians (45 district hospitals, 2 techs per hospital) and that’s how the training was initially set up. 6 sessions of 8 weeks spread over 3 year would train the technicians on a semi-part-time basis. The first trainings of 8 weeks on equipment specific topics, HTM, Professional Development, some math and English were held at the Kigali Health institute, a school mostly training nurses and lab techs. The students were sent by the MoH and no accreditation was in place. Experts were flown in from the US and Europe to teach. In 2011 the country coordinator changed and sustainability became a major topic. The school indicated not feeling confident to run the programme independently in the future and a polytechnic college (IPRC, Kigali) became the new partner. IPRC indicated a strong interest in offering a BMET diploma programme and fitted it under their Electrical engineering department. The school had the space for extension and an appropriate infrastructure for e.g. soldering workshops After curriculum workshops with stakeholders from public and private sector as well as Ministry of Education guidelines the school launched a full time BMET diploma programme in 2013. BMET TRAINING SUCCESS STORIES

5. Challenges 5 April 2016 Several challenges have been faced and most have been resolved: Identification of appropriate educational partner- to be able to set up a sustainable solution an educational partner with a vision is crucial. That partner was found in IPRC. This could be avoided by a proper assessment of potential partners before starting the project Accreditation – skilled technicians and qualified technicians are two different things. By starting to teach without accreditation it was very difficult to guarantee the first cohorts to receive a national diploma, while going through a curriculum that was developed in the USA. Accrdeitation processes and requirements should be clear and accreditation should be achieved before starting to teach Workshop - Initially a class room was used for both practical as theoretic classes. No money and space was directly available to construct and equip a space. A reasonable amount of equipment was provided by GE Foundation and teaching was adequate with limited resources. IPRC has found funding for a beautiful workshop with wall outlets for medical gases and power, with benches and equipment. BMET TRAINING SUCCESS STORIES

6. Challenges I 6 April 2016 Several challenges have been faced and most have been resolved: Identification of appropriate educational partner- to be able to set up a sustainable solution an educational partner with a vision is crucial. That partner was found in IPRC. This could be avoided by a proper assessment of potential partners before starting the project Accreditation – skilled technicians and qualified technicians are two different things. By starting to teach without accreditation it was very difficult to guarantee the first cohorts to receive a national diploma, while going through a curriculum that was developed in the USA. Accrdeitation processes and requirements should be clear and accreditation should be achieved before starting to teach Workshop - Initially a class room was used for both practical as theoretic classes. No money and space was directly available to construct and equip a space. A reasonable amount of equipment was provided by GE Foundation and teaching was adequate with limited resources. IPRC has found funding for a beautiful workshop with wall outlets for medical gases and power, with benches and equipment. BMET TRAINING SUCCESS STORIES

7. Challenges II 7 April 2016 Trainers – the main challenge that will remain a challenge in the short future is the need for skilled and qualified teachers. BME is a young profession and the limited number of local experts is the reason we start training programmes. To find trainers is a challenge, the qualified people who are present in the country often prefer to earn more in the private sector. Some local train the trainer have been initiated but no structural solution exist. Life after school – no salary scales, career ladder, poor tools and workshop and no professional education make it difficult for graduates to remain motivated and not move to the private sector. However developing countries need good people in the private sector too, Data- Data remain an issue also in Rwanda. Consistent, recent and complete inventories are not available nation wide, altjough a national CMMS has been implemented by CHAI. With ;imited effort this good actually work and serve the country. Professional Association – Rwanda has started a professional association in 2014 but they struggle. Unfortunately they were the only known association that didn’t participate in the 2015 THET workshop for professional associations. BMET TRAINING SUCCESS STORIES

8. Successes 8 April 2016 Every year IPRC graduates between 20 and 30 BMETs, GE-Foundation funding has ended. The department has just opened a spacious well equipped workshop with resources sourced differently In collaboration with the MoH IPRC has developed part time solutions for working BMETs The first 2 cohorts who didn’t follow the accredited programme were offered to follow some extra courses to get their national diploma An unpublished study in Rwanda in fall 2015 shows that about 80% of the Rwandan medical equipment is more or less functional and in use. Although a baseline study has never been done, some smaller studies have been done by prof R. Malkin from Duke University showing at least 40% out of service. This suggest a significant improvement of the medical equipment status in Rwanda since 2009. Some of the graduates have shown great professional development. One was BMET at a district hospital ($120/month) and is now working a regional BMET in Liberia serving a region that has no BMETs at all (for $2000/month, enabling him to send his kids to good schools). Others have started their own business or joined manufacturer’s representatives. Most have staid on in their hospital and witness great change between their capabilities between now and before going to school. BMET TRAINING SUCCESS STORIES