«

»

About National Electro- Medical Equipment Maintenance Workshop & Training Center (NEMEMW & TC).

IMG_20150621_143424

The medical equipment  for the first time  were introduced in Bangladesh since about 1972. Only some conventional X-ray machines and pathological Instruments  were introduced in Dhaka Medical Collage Hospitals, SSH and so many in Bangladesh in 1974-78. Next time, Japan International Cooperation Agency( JICA) and WHO  have been donated lots of medical equipment and devices such as  ECG, bed side cardiac monitor, heart lung machine, X-ray, coronary Angioram and so forth at NICVD, DMCH, MMCH. NSH, N. Gangj since 1978- 83.Electronic engineering technicians from Japan were maintained the medical equipment as well as technicians from Germany was maintained the equipment supplied by WHO up-to 1984. With increasing of medical equipment of public hospitals in Bangladesh an organisation was established in 1983-84 with a vision to maintenance and repair of medical equipment of public hospitals. Thus. National Electro- Medical Equipment Maintenance Workshop & Training Center (NEMEMW & TC) is established in 1983-84 through development project……….

11 comments

Skip to comment form

  1. Md. Anwar Hossain

    Dear Health care personnel of BD and Globe
    EID MUBARAK

    1. Md. Anwar Hossain

      Dear Health Care Technology Personnel,.
      Please read the proposal and give feed back.

      Medical equipment Audit System:
      In context of Bangladesh a MEA( Medical Equipment Audit) & comparison with standard guideline a audit team is very important:
      Outcome of audit:
      – Users will be careful
      – Technicians will be attentive
      – Real case of fault to be identified
      – Reduce bad intention
      – All to be interested to use the equipment
      – Maintenance will be strengthen
      – Equipment use will be optimized
      – Exercise of new equipment will be decreased
      – National economy will be safe
      – Patient will be beneficiary
      – Government hospitals good well will be established

      Configuration of Audit team:
      – CEP/ BME
      – BMET
      – CET
      – Users Doctor
      – Senior Nurse
      – MT
      – One person from Ministry
      Policy :
      – This team will be regulated by MoH and Audit section
      – Should be impartial
      – Checked hospitals yearly and whenever likes
      – Worked as mobile and monitoring team
      – Look after performance of the users and vendors services
      Check any ill wish of operators, users and maintenance performance

  2. Md. Anwar Hossain

    Dear All in the Procurement Chain for medical Equipment procurement.
    Please Look and give me opinion
    Technical terms and conditions:
    The terms and condition to be included in the tender for the better maintenance and other wise equipment will not run the desired time:

    Technical terms and conditions are recommended to insert in PPR 2008 for Medical equipment

    Technical Specification includes
    – Application is designed as salient features to be prepared by related Doctors and Biomedical Engineers
    – Technical data for met up requirements
    – Power supply system (Back up battery,UPS, AVS) where which is applicable
    – Layout and place of installation should be mentioned
    – Product Quality standard certificate CE/EC/FDA/JIS
    – Safety Certificate IEC

    Technical Aspects for new procurement of Medical Equipment: Vendors/Manufacturer should have qualified Local Agent in Bangladesh:
    Eligibility Vendors/ Supplier/ Bidders:
    – Bidder should have a well reputation in his country and globally. In case of manufacturer, this requirement is not applicable.
    – Bidder should have minimum five years practical experience on the medical equipments.
    – Minimum three years experience on the quoted equipments
    – Bidder should have at least one graduate Biomedical/Clinical engineer and one Electromechanical Engineer
    – Bidder should have a office in Bangladesh or should have local agent in Bangladesh for the correspondence of Bid related work and contract singing agreement and back-up service
    – Bidder should strictly followed the rules and regulations prescribed in local agent eligibility criteria
    – Bidder should provide compressive guaranty for five years (should be declared by manufactures through his qualified local agent) and guaranty period should be count from the date of installation and for the tenure period
    – Bidder should mention individual cost of each spare part in USD and which will count during price evaluation.

    Technical terms and conditions
    – During bid submission, bidder should offer two copies of operating and service manuals; one sets for hospitals and one set for NEMEMW & TC, Dhaka.
    – Before shifting the equipment, a pre-inspection technical committed from purchaser will visit the equipment and Bidder Separately mentioned the cost in USD for each person as the standard of Bangladesh government and this cost come into account during price evaluation.
    – Bidder or his local agent qualified technical team will visit the site of installation place and submit an installation and commissioning cost separately including room renovation, Air condition, humidifier and other ancillary works. This additional cost should be added with equipment cost.

    – The supplier must have local agent with at least 5(five) years experience in this field.

    – The supplier/ his nominated engineers/local agent experts will visit the site of installation and accordingly submit tender.

    – Supplier/ manufactures should be complete work the installation by qualified biomedical engineer and handing over the equipment to the concern authority with full functional condition. Installation materials should be provided by the supplier.

    – The power supply system should be cover 180-240 VAC 50Hz for single phase and for three phase voltage tolerance should be 360-440 VAC 50Hz.

    – Bidder should provide the performance record with certification from the hospitals and NEMEMW & TC.

    – The bidder should provide a diploma qualified bio medical technician to the concerned hospitals for three months’ training.

    Spare parts and consumables:
    – Bidders should quote the fast and slow moving spare parts that are mentioned in tender documents with international price and validate their price for the next 10 years.

    – Quoted price must be included with equipment prices and should be considered for evaluation.

    Training:
     Locality/site:
    – Supplier will have to provide on-site training to the users, operators and also to two nominated technical personnel of NEMEMW/DEMEW. In this regards, training allowances should be met up by the supplier as per WHO/UNICEF standard.

    – The winning bidder should arrange for a training course at the training center on proper operation and preventive maintenance of six technical personnel for one week. Training allowance should be included in the price offer separately which will be considered during financial evaluation.
    – Foreign: One user from the hospital at the manufacturing country or any famous hospital in the world. One Biomedical engineer from NEMEMW/DEMEW at Manufacturing plant for mock-up and Maintenance management training.

    – The duration of training depends on the category of equipment and this will be decided during the Pre-tender meeting.

    Eligibility of Local Agent:
    Local agent selection criteria for Radiological imaging equipment
    – The most important indicators are to maintain during the local agent selection.
    – Minimum one year experience on the installation of such types of equipment.
    – Financial solvency to carry out the assigned project
    – Should have at least one graduate in biomedical/ clinical engineering or its equivalent degree engineer in electrical and electronic back ground with minimum three years’ practical experience on particular equipments including factory mock- up training on the products.
    – The engineer should have a license from Atomic energy commission of Bangladesh regarding radiation safety
    – Should have a dose meter for measuring dose.
    – Should have a tool box with all kinds of testing and repairing tools.
    – The firm should have at least an oscilloscope.
    – The firm should have reputation in public and private hospitals
    – Maintenance section should have a wagon type of car for carrying spare parts and service team
    – A minimum 200sft area should be kept for workshop and for spare parts
    – The service center should have the capacity to store the fast and slow moving spare parts.
    – Service center should have friendly software to record the inventory and documentation.
    – One service master trainer should be available to conduct the continuation of the training.
    – All service technicians should have the capability to write reports in English and have a minimum knowledge in English to understand the operation and service manuals.
    – A standard operating procedure should execute the normal service and should have a contingency plan for emergency.
    – Enlistment is mandatory for the local agent.

    – Minimum one B.Sc. Engineer (Electro-Mechanical) and one Electro-medical/ Biomedical Engineer having at least 3 years’ experience in related field and they should be the member of IEB.

    – Two Diploma Engineers in Electro-medical/Electrical & Electronic/Electronics discipline with minimum 3 years’ experience in Medical Equipment.

    – Two Electro-medical Technicians /Electrical/Electronic with 5 years Experience should be required.

    – Should have Logistic support and facility for repairing tools, calibration of instrument, and safely testing instrument.

    – A car with Emergency Maintenance of mobile workshop facilities is required.

    – All technical staffs should be trained under vendors/ manufacturers

    After Sales Service:

    – After sales, service centre should be available in Dhaka on “24(hrs) × 7(days) × 365 (days)” basis. Complaints should be dealt properly, maximum within 12hrs. The service should be provided directly by the Vendor/ Local Agent.

    – Undertaken by the Principals/Vendors, the spares for the equipment shall be available for at least 10 years from the date of supply.

    – The service provider should have the necessary equipments recommended by the manufacturer to carry out preventive maintenance tests according to the guidelines provided in the service/maintenance manual.

    – Bidders should offer a frame work contract on maintenance management for the next 9 years after completion of warranty period and cost of maintenance will be added with equipment cost and should be evaluated.

    Documentation:
    To be provided during Supply of equipment
    – Two copies of each of the User manual & Service manual in English.
    – One SOP in Bengali version with lamination.
    – Certificate of inspection from
    General form disposal:
    This is last stage of life cycle of equipment and to do so a continuous and updated inventory is prerequisite.

  3. Md. Anwar Hossain

    General form disposal:
    This is last stage of life cycle of equipment and to do so a continuous and updated inventory is prerequisite.

    General form disposal
    General form decommissioning
    Technical consideration for decommissioning
    Instruction: Please fillup the check list by Clinical Engineering & Technologist Professionals

    Form M6: Technical consideration for decommissioning

    Name of deparment Name of equipment Model Serial Date of Installation Frequency of repaired No of same model equipment procured

    A team of CEPT collect inventory report and technical assessment can be done by a committee
    Configuration of committee
    CE/BME Users Expert BMET MT HOSPA CMSD MoH
    NEMEMW Concern Department DEMEW Department Concern Hospitals AD ISM Sr. A.S. Hospital
    The committee name will be as MEDC(Medical equipment decommission) and this committee will do all procedure for MEDC

    Method of decommissioning:
    – Is same model equipment available in the hospitals or other hospitals?
    – Is manufacture same?
    – Is period of supply is same or near the same?
    – How many equipment are in hospitals/ Bangladesh are non functional?
    – How many years equipment are using?
    – Repairing and maintenance data of equipment?
    – Compare the repairing cost VS performance
    – If same model & manufacture equipment is more than 3 units and then decommissioning possible depend on situation.
    – Decommission should be done by In-house CEPT team and outsource support but it will be well perfect on inventory report

    1. Md. Anwar Hossain

      General form for maintenance reporting
      General form for maintenance reporting
      Form M3: Medical Equipment Maitnace Report

      Government of the People’s Republic of Bangladesh
      National Electro-Medical Equipment Maintenance & Training Center
      Ministry of Health & Family Welfare
      Mohakhali, Dhaka -1212

      NIBMEgoMM, MoH & FW, Mohakhali, Dhaka -1212
      GovementGTelephone:Hotline: +9898525
      Name of Organization Department name Equipment name Model No: Seral No: Manufactuere

      Date of installation, fault & probable cause
      Symptom of fault

      Fault findings

      Action taken

      Technical report of BMET

      Signature of User BMET User’s department Head
      Opinion of Unit Manger Engineer

      Technical Opinion of head of Unit

      AproOpinion val of CTM
      Opinion of Technical Manger Repair

      Approval of CTM

  4. Md. Anwar Hossain

    An Approach to develop Clinical /Biomedical Engineering Maintenance Management of Medical Equipment
    Back ground:
    Bio- Medical equipment has a typical life cycle and this cycle is very important to ensure the cost effective health management through clinical engineering and Technologist professionals. In 1972 century medical equipment were introduced in Bangladesh through donation and kinds from the development countries and World Health Organization and other development agencies have taken instigation for the better health service through diagnosis of diseases of our nation. JICA donated some radiological, pathological and therapeutic biomedical equipment to Bangla-desh Government in the health sector in 1974-82 in succession at Dhaka based hospitals and dur-ing the tenure period the supplied equipment were well managed by manufactures Engineers un-der the leadership of one Reputed Clinical Engineer and Doctor whose name are Dr. Anasyki and Engr. Suzuki of Japan. As proven record some equipment and instrument were store in Shaheed Shurawardy Medical College Hospitals (erstwhile Shaheed Shurawardy Hospital complexes). In 1983 Brig. Dr. Abdul Malick former Director of NICVD understood the necessity of Biomedical Engineer for medical equipment management and hence he created two posts of Clinical Biomedical Engineers and titled of post were Senior Service Engineer and Ju-nior Service Engineer which status were Associate and Assistant Professor respectively. Sequentially the Public hospital and clinics were increasing and hence for the first phase medical equipment management organization was born in 1984 as NEMEMW & TC as government pioneer Project by the assistant of WHO. The NEMEMW & TC started his journey with ninety seven of different manpower including technical and official supporting staffs. The government was very satisfied on the service of NEMEMW & TC and according to the volume of work the health ministry gauged the importance of engineer and technicians in the health services and in 1987 government expanded this organization in 18 greater districts as REMEW. REMEW were started with 162 technical manpower. This project was assisted by First ADB. The planners, policy makers and consultants did not dream/imagine that biomedical equipment will be rapidly increased and sophisticated. They could not imagine that near future CT scan, Digital X-ray, MRI, ICU Ventilator, LINAC, Cobalt-60, Gamma Camera, Cath-Lab equipment and so on costly and high technology equipment will be introduced in Bangladesh though they could easily collect the information through in-service training and education as the most of the Engineers were trained from developed countries like Japan, Hungary, London, America etc. It could assume that only electromechanical devices and instruments are hospital equipment because the name of this organization and most of the technical manpower are mechanical. More than 90% technical manpower are mechanical trade and architecture of management occupied only mechanical engineer and core management have been leading by the general mechanical engineering background since 1984-2012. Due to lake of their awareness and inferior accountability this organization would not devolve. On the divergent had not any chain of technical command from NEMEMEW as administrative was under the control of DGHS and Civil Surgeons. In 2001, Ministry of Health & Family welfare gauged the situation and MoH & FW stared to control the NEMEMW & TC only and REMEWs lost their technical radar and technical network. In 2011 NEMEMW & REMEWs were marched by the order of MoH & FW but some administrative control and recommendation are handed by Local Civil surgeon. Due to continuous fluctuation of decision of administrative Chain of command and an unskilled technical management for medical equipment were developed instead of skill Medical Equipment Management which is hampering the medical equipment management. As a result, health services are interrupting seriously.
    Objectivities:
    Users of equipment should be trained to do routine simple maintenance on equipment. This will increase user care of equipment and cooperation with maintenance technicians to reduce equipment breakdowns. At the same time, this will promote the cul-ture of equipment care and maintenance to improve the quality of health care. Proper maintenance of medical equipment is essential to obtain sustained benefits and to pre-serve capital investment. Proper maintenance has a direct impact on the quality of care. Various obstacles for expanding medical equipment maintenance capabilities in Bangla-desh have been discussed. Maintenance Management problems are complicated by the ever-increasing use of medical equipment as health care is modernized. To date, the maintenance situation in Bangladesh is getting worse and requires special attention. Maintenance capabilities are considered during the initial stage of making a decision to acquire equipment, maintenance problems can be minimized. The mission is to ensure that equipment used for patient care is safe, available, accurate, and affordable. A lot ob-jectives were imposed in Clinical Biomedical Engineering and technologist professionals for Medical Equipment Management System but only some important objectives related with Medical Equipment Maintenance Management are listed here and it will be a stand-ard and cost effective module for:
    – Preventive, predictive, periodic, corrective Maintenance of medical equipment by Clinical Engineering & Technologist professionals (CETP).
    – Faster and cost effective repairer
    – Reduce the breakdown repairing cost
    – Decrease the new procurement
    – Good diagnostic result from medical equipment
    – Regular calibration will ensure the reliable result from the equipment
    – Inventory management will ensure equipment planning and maintenance
    – In-service education & training Center will produce skill technical personnel
    – Feed from the team to be helpful to prepare technical specifications
    – To develop a proper and easy module for retirement of equipment
    – To develop a condemnation regulatory roles
    – To propose an expert committee for selection of condemnable equipment
    – To develop a periodic auction committee or discard committee
    – To develop a module for the national inventory committee and logout from stock ledger
    – To develop a cost effective but faster condemnation expert committee
    – To develop a training module for users, engineers, Local administration and Audit section
    – Health services will ensure through this management
    Definition of Medical Equipment Maintenance Management (DMEMM):
    The Medical Equipment Maintenance Management can be defined as different activities undertake-en/executed rightly from the very first stage of equipment planning, selection, preparation of specification, standardization, procurement through tendering process, installation, periodic calibration, maintenance and finally condemnation & decommissioning /disposal of equipment. Proper maintenance of medical equipment is essential to keep the instrument/device functional for a long time to provide reliable diagnosis and to secure capital investment. The mission is to ensure that equipment used for patient care is safe, available, accurate and affordable.
    Advantages of MEMM:
    This will improve user care of equipment, reduce equipment breakdowns and develop an attitude of cooperation between users and maintenance per-sonnel. Thus a culture of equipment care and maintenance will be developed among users and engineer, which will result in better health care services in public sector. The Equipment Inventory List (EIL) and equipment service history (ESH) can provide important in-formation. Models which show frequent breakdowns or which have high maintenance cost should be avoided.
    The main contributions of the proposed work are as follows:
    – To propose an approach to improve MEMM system in the HSOB for sustaining life cycle of ME as per standard of developed countries.
    – To propose a management system which will be helpful in need based spare parts selection, preventive maintenance, supervision and monitoring functional status, installation, calibration, in house maintenance, central level maintenance and equipment decommissioning.
    – A more practical approach is recommended here to combine in-house maintenance system with external services. The reasons are in general; for a given piece of equipment maintenance problems of different level of complexity arises.
    – The majority of the problems is relatively simple and can be corrected by a tech-nician trained in front-line maintenance by specialist engineer.
    – Everyone in our country knows that present day medical service is both expensive and improper.
    – With regard to equipment maintenance, it is experienced that simple first line re-pairs would be less costly if performed by in-house maintenance personnel.
    – Complex repairs requiring high-level expertise and non-available spares/consumables can be left to company trained specialists.
    – There is a need for a workshop in case of in-house medical equipment mainte-nance in large hospitals and district hospitals

  5. Md. Anwar Hossain

    The number of medical devices have been increasing and clinical engineering practice is not increasing rationality. As the result, we could not provide the desired efforts to the public hospitals. According to WHO Guidelines, we need more than 1000 clinical engineers, 2000 clinical engineering technologists and 4000 biomedical equipment technicians to sustain life cycle of medical equipment of public hospitals. But presently, we have 3 engineers but we are not clinical engineers. recently two assistant engineers for electricians and X-ray unit have joined in our office. We are deeply trying to enhance our services but due to sever lack of skilled manpower, every day, we are receiving calls from different level of hospitals. We are hoping and looking froward to our Ministry for kind approval and to employee more technical manpower to bat the healthcare technology management. Hoping your kind cooperation from each corner to enhance the patient safety and health care services

  6. Md. Anwar Hossain

    These paper offerings the necessity of Directorate General of Clinical Engineering Services (DGCES) to enhance present healthcare delivery system in Bangladesh. In few decades, it has observed that Ministry of Health & Family Welfare (MOH & FW, Government of People’s Republic of Bangladesh has been restructured healthcare management system (HCMS) by introducing different directorates to enhance the present healthcare delivery system (HCDS). But the most important DGCES is not included in the HCMS. As a result, the present HCMS becomes unbalanced with rapid growth of medical technology. This impact is seriously hampered the present HCDS. In this paper, we discuss the necessity of DGCES for HCMS to enhance the present unpleasant HCDS of Bangladesh. We describe the HCMS with and without DGCES for the enhancement of HCDS. This study describes the benefit to introduce DGCES in HCDS of Bangladesh and hence the healthcare policymakers will be encouraged to establish DGCES in the HCMS. We firmly believe that our proposal will enhance present unpleasant HCDS in Bangladesh. It concluded that DGCES was necessary to introduce in HCMS in Bangladesh for enhancement of HCDS.
    Introduction
    Over the years, traditional healthcare management system (HCMS) was renovated due to rapid growth of medical technology in the developed world. We have been observed that the developed world has been improved healthcare delivery system (HCDS) through enhancing HCMS. Most of the developing countries like India, Malaysia, Jordan, South Africa, Indonesia and etc. followed the HCMS policy of developed world and thus they also have been enhancing their HCDS. From literature review results, we have observed that developed and developing countries are being solved the everyday problems of medical technology by introducing healthcare technology management (HCTM) system because medical technology has been referring very complex medical devices for diseases diagnosis, monitor and healing the hospital’s patients. They analysis that without skill and well train HCTM personnel like Clinical Engineer( CE), Clinical Engineering Technologist( CET), Biomedical Equipment Technician (BET), Medical Technologist, ICU, CCU, OT Nurses, Intensivist, surgical medical doctors, medical equipment operators , technician, and etc. Medical equipment is the most costly assets in modern hospitals among other goods. On the other hand, medical equipment becomes decent tools for the medical personnel. From a simple nebulizer to CT scan, MRI, ICU ventilator etc. becomes very costly tools for HCDS. The aim of the HCDS is to ensure safe and cost effective treatments to patients. The aforementioned vision of the HCDS depends on safe and longer life use of medical equipment. That’s why most of the developing countries produced and introduced HCTM personnel in their HCMS and thus they have been enhancing their HCDS since 2008. We have seen that CE, CET and BET have been sharing the maximum load of HCTM among the HCTM team. When CE, CET and BET work together in healthcare organizations (Hospital, Clinic and Diagnostic center) for the welfare of the patients by applying engineering and technologist’s principle in the HCTM then these three professionals is known as Hospital in-house clinical engineering department (CED). It is very much essential to control the CEDs of Hospitals like other Directorates in the HCMS.
    Despite the further improvement of CED is still now desired by the developed world, the economically developing countries like Bangladesh could yet introduce any engineer or technologists or technician in hospital due to lack of awareness or less attention of the HCMS manager or HCDS managers. We have seen that more than 30 million USD capitals invested for the 2500 bedded Dhaka Medical College Hospitals (DMCH) in Bangladesh. More than 30 departments have been using costly and sophisticated medical equipment and more than 300 medical doctors, 500 nurses, 25 medical technologists and total about 2000 medical and co-medical personnel are working in this hospital but we do not find any engineers or qualified technicians on HCTM in this hospital. Same situation has been observed in each level of hospital in Bangladesh.

  7. Md. Anwar Hossain

    DEVELOPING AN IN-HOUSE CLINICAL ENGINEERING MAINTENANCE MANAGEMENT SYSTEM FOR NICVD & HOSPITAL
    Md. Anwar Hossain1,Engr. Nazrul Islam Md. Salah Uddin Yusuf, Md. Rafiqual 2, and Mohiuddin Ahmad2,*
    1Dept. of Biomedical Engineering, Khulna University of Engineering & Technology (KUET), Khulna-9203, Bangladesh
    2Dept. of Electrical and Electronic Engineering, KUET, Khulna-9203, Bangladesh
    3Affiliation (name of organization, country)
    * E-mail: mohiuddin0ahmad@gmail.com

    Abstract— In this paper the author proposes and explores the necessity of Clinical engineering professionals and technologist who manage biomedical equipments in national Institute of Cardio-vascular Diseases & Hospital, Dhaka, Bangladesh. The safety and reliability of medical equipment is mandatory. Equipment may be used on the patients who are unconscious. Other types of medical equipment function as life support and their failure may result in the patient’s death when the machine is in use. The maintenance program developed in the research determined the possible remedies for the respective faults and the personnel to rectify the problems. The system was not developed to enable the existing facility maintenance managers in any hospitals of Bangladesh to improve on their maintenance management of the medical equipment. The equipment is initially identified in its category by the program and guides the user to identify the causes of the medical equipment faults and the possible personnel to handle the fault in the equipment. The system would enable the hospitals achieve optimum utilization of hospital equipment and improve the management of medical equipment a proper time management.
    Keywords—Clinical engineering and technologist professionals. Maintenance, Medical Health facilities, biomedical equipments, biomedical engineer and biomedical equipment technician
    I. INTRODUCTION
    • Hospital and health care facilities are among the most complex, costly and challenging equipments to manage. One of the main challenges of managing hospital facilities is the highly diverse network and range of functions that are needed to maintain operations of the medical equipment and the complexity of services which are required to support them (Loose more, 2001). The maintenance facilities managers ensures that medical equipment are well calibrated and in proper operational condition. They are expected to have the ability to maintain the medical equipment to comply with standard performance characteristic set by the hospitals policies, the manufacturer’s specification and the clinical requirement. A major breakdown signifies that the maintenance and servicing program have failed. Productivity is a concept which is defined as a state of efficiency or the rate and quality of output based on the rate and quality of input (Kirkland, 1985). As it relates to hospital facilities management, higher productivity can mean safer and more reliable equipment, less service cost, less equipment downtime, more revenue and more effective use of man power (Hashem, 1986). Hospitals have been faced with a competitive environment which has resulted in the need for increasing high levels of capital investment to support facilities and equipment perceived necessary to retain top-quality physicians. Hospitals have continued to invest capital in touchable, and hopefully billable, equipment in order to retain a public image of being a “State-of-the-art” facility and attract and retain the needed physicians who in turn funnel their patients to the hospital that is best equipped (Kerry, 1995). When medical equipment does not work properly, blame for the resulting complication is always directed at clinicians, as the manufacturer and the technical support personnel are at least equally responsible. The extensive utilization of complex and sophisticated electro medical equipment by facility maintenance managers who have little technical background, however, has not only facilitated physicians in diagnosis, prediction and treatment of disease, but has also caused problems that are new to the world of medicine. But currently no in-house experience clinical engineers and biomedical technicians are available in this hospital although it was available in past year upto-2001. NICVD & H was 50 bed hospitals over the year 1982-1994 and it was integrated with Shaheed Surawardy Hospital complex from 1982- 1994.Japan International Co-operation Agency (JICA) donated a large number of medical equipment to manage the interventional cardiac and cardiac surgery with a clinical engineering team and this team was staying upto-1990 and later on two posts of clinical engineers were created by the government but qualified engineers are not found that time and these posts never filled up although the bed numbers and facilities departments are growing to 414 and 10. Coronary Angiogram, permanent pacemaker, angioplasty balloon, cardiac surgery , vascular surgery, ICU, CCU , pathology, clinical biochemistry , blood bank , radiology and imaging department have been using a lot of costly modern medical equipment but according to standard there was no clinical engineering team

    II. SATE OF ART IN BRIEF
    Standard CED and Present CED were shown in section III, in section IV standard education and training is described. Present Clinical engineers are described in section IV. Standard indicators of health care technology in Bangladesh are presented in section V. Relevant data analysis are given in section VI. Necessary recommendations are provided in section II describes the clinical engineering and health care technology in Bangladesh. Section III describes the responsibilities of clinical engineers in hospital. Present situation about VII. Finally, section VIII concludes this paper

    III. PROFESSIONALS’ AT NICVD &H. STANDARD & PRESENT IN-HOUSE CLINICAL ENGINEER
    The in-house Clinical engineer professionals in this hospital are very negligible and the clinical engineering department is standard as per WHO Guideline. The present scenario of clinical engineer professionals is shown in the in chart I with references of WHO Guideline and developed countries.
    CHART I. STANDARD REQUIRE CED FOR NICVD& H

    CHART I. PRESENT CED OF NICVD& H

    IV. EDUCATIONAL QUALIFICATION & EXPERIENCE
    Medical equipment is applied to human body and one engineer in this line should have basic knowledge on electricity Electronics, mechanical, material science, and human anatomy. Physiology, biochemistry, computer science and also medicine. Clinical/ biomedical course on cover the above all criteria. Normal engineer with training may work as biomedical technician but Clinical engineer is meant other and which is related with patient safety and require for clinical problems solution. Here some information is reflected the current situation of clinical engineering department of NICVD& H of Bangladesh. It is a critical care hospitals from this data any one can gauge the situation of other public hospitals of Bangladesh.

    Table I Standard vs. present condition of CED

    Measuring tools Level Standard Present
    Basic education Clinical Engineer manager M. Sc in Clinical /Biomedical engineering Vacant post since 23 years
    In-service education training Do. HND in the relevant field Nil
    Basic education Clinical engineer BS in CE / BME BS in EEE
    In –service education & training Do. HND in the relevant field Nil
    Basic education BMET Diploma in ME/ EME/ EEE. Nil
    In-service education & training Do Higher training on in the relevant field Nil
    Number Clinical engineer manager 01 0
    Clinical engineer 07 01
    BMET 18 01

    TABLE II. PRESENT KEY CONDITION OF CLINICAL ENGINEER AT NICVD & H

    Major performance indicators and responsibility Definition Present condition Remarks
    Safety This covers patient, operator and technical personnel safety Regular calibration could not be done due absence of clinical engineer Almost impossible to analyze the real situation
    Quality Perform all health care service properly Inferior As CE is nil in house and in health sector
    Cost Cost effective service Not ensure and costly For evaluation any system did not develop
    Medical equipment management Equipment selection to discard and in-service education & training to use the equipment safe and affordable for the patient Only electrical and mechanical engineers with inadequate knowledge is marinating instead of qualified clinical engineers Medical equipment management is very poor and Health care technology is very inferior

    V. PROBLEM IDETIFICATION

    A lot of problems are found during the study but here some crucial problems are state in this section.
    • Patient, operator, radiation safety are most of right but in this hospital could not maintain due absence in-house clinical engineering department and medical physicist
    • Patient and operator safety system check could not be done.
    • Equipment inventory system was not develop
    • Equipment breakdown maintenance frequency is high.
    • Error full result
    • Present engineers and technician has a small idea about clinical engineering
    • Calibration tools and workshop facilities are very poor
    • Quality of treatment deviated than before.
    • Most local currency is draining out which is seriously affected the economy
    • Cardiac treatment is not cost effective
    VI. RECOMEDATION:
    To overcome the undesirable present situation in Bangladesh the clinical engineer & professional technologist are a crying need on emergency basis. Considering the real facts and country context some points are noted and recommended by the authors:
    • Some professional clinical engineers and technologist can be hired from the abroad like Malaysia to properly train the existing engineers and staffs through a training center.
    • A clinical engineering institute initially starts under a public Engineering University where presently biomedical engineering department is available. This can be used for this above said purposes.
    • A pilot project can be started by the help of donor agencies like JICA, msh-USAID, CIDA, UNICEF, DEFID, WHO and World Bank considering highest priority project from Government of Bangladesh.
    • In this connection a joint venture pilot project with Japan already been proposed by KUET and it is under consideration of NEMEMW & TC for clearance. OSAKA Jieki College responded very well for this project.
    VII. CONCLUSION
    Requirements of Clinical engineering and professional technologist is a crying need for Bangladesh in order to improve the existing health care technology management, otherwise health services will be threaten for Bangladesh. Author wishes that Bangladesh Government and relevant sector should take seriously this urgent matter and create opportunity to produce clinical engineers and professional technologist in the country to ensure safe and sound health and take part in the world health care system early. The author also wishes that Government should have a kind attention on the recommendation as mentioned above other wish health care technology will be unbalance and patient safety and health risk factor will be increased rapidly.

    VIII. LIMITATION

    1. Data collection is very difficult
    2. Public and private hospitals are functioning with not same regulation and facilities
    3. Public and private Universities do not have any wing to research in this line
    4. The number of Teaching professionals could not include in this study
    5. The number of these professionals for manufacturing of medical equipment and for pharmaceutical industries could not identify due huge data collection
    ACKNOWLEDGMENT
    Authors acknowledged this work with Ministry of Health & Family Welfare, Ministry of Education, KUET, NEMEMW & TC, DGHS, DGFW, JICA & OSAKA Jieki Collage, Japan, msh-UASID, SIPAS-USAID, DFID, WHO, CIAD, UNICEF, UNFPA, World Bank, Asian Development Bank, UGC, All local vendors of medical equipment in Bangladesh and public and private engineering universities of Bangladesh
    REFERENCES
    [1] Md. Anwar Hossain, Mohiuddin Ahmad, Md. Rafiqul Islam, M. A. Rashid, “Improvement of medical imaging equipment management in public hospitals of Bangladesh,” in Proc. of the International Conference on Biomedical Engineering (ICoBE 2012), pp. 567-572, Penang, Malaysia, February 26-28, 2012.
    [2] Azman Hamid ,”Clinical Engineering in Malaysia” – A cause study
    [3] Md. Anwar Hossain and Mohiuddin Ahmad, “Improvement of in-service education and training on medical imaging equipment of Bangladesh,” in Proc. of International Conference on Informatics, Electronics & Vision (ICIEV12), pp. 536-541, 18-19 May, 2012, Dhaka, Bangladesh.
    [4] Md. Anwar Hossain and A.B.M. Siddique (NEMEMW & TC, Ministry of Health and Family Welfare, Bangladesh) “Improvement of Medical Imaging Equipment Inventory and Documentation System in Public Hospitals of Bangladesh”, S-4, Symposium (part 1) of Clinical Engineering of each Asian country – current situation, The 1st Forum for Asian Clinical Engineering (FACE), Osaka, Japan, 2012.
    [5] Engr. Md. Anwar Hossain and Mr. Fabrizio Germany consultant of MSH-USAID, Development of Table of Organization & Equipment for public hospitals of Bangladesh under the Directorate General Health Services, MoH & FW,
    [6] Md. Anwar Hossain, Mohiuddin Ahmad & Md.Salah Uddin Yusuf, “ Generation of Clinical Engineering & Technologist with interfacing Health and Education Ministry 2013, a project submitted to Osaka Jieki Collage, Japan
    [7] Survey of medical equipment prepared by SIMED International
    [8] Paper publication by WHO, June 2011.
    [9] W.Gwee & Dyro JF (2004),” The Clinical Engineering hand book” Elsevier Burlington, MA
    [10] A National Seminar on medical equipment condemnation held at DGHS Conference room on July 2013, Sponsored by Management Sciences for Health –UASID.
    [11] W.S. Tarawneh ,” Quality Assurance and control Clinical Engineering Activities
    [12] Bangladesh health policy, Wikipedia, the free encyclopedia

  8. Md. Anwar Hossain

    KUET

    Develop an Inventory of Clinical Engineering & Technologist Professionals

    Develop standard requirement of Clinical Engineer & Technologist Professionals for the Public Health Services of Bangladesh

    Engr. Md. Anwar Hossain & Dr. Mohiuddin Ahmad

    12/10/2013

    This paper deals with the standard requirement of Clinical Engineering & Technologists Professionals for the Public Hospitals of Bangladesh. Bangladesh health services has been using a lot of modernized costly medical equipment like developed countries although it is evaluated as low /middle income countries of Asian zone. Medical Equipment is the most important tools for diagnosis the diseases, treatment and patient restorative but in Bangladesh due lack of HTM CEPTs did not develop till to date. To develop CEPT it is very prerequisite to make an inventory of CETPs. From this inventory anybody can gauge the current demand and future demand. Here authors will describe the present situation of CEPTs, current & future requirement for public hospitals of Bangladesh and finally propose the way of development and implementation of these professionals by the National in the field of public hospitals .

    Abstract

    Key words: Health care Technology Management, medical equipment, Health Services & Clinical Engineers
    Introduction:
    Biomedical equipment are avialble in the public and private hospitals in bagladesh but acoordingly CETp profeesionals are not aviable in bangadesh although it is very important resources to keep the equipment in functional condition.
    Clinical Engineering & Technologist Professionals are utmost component of Health Care Technology Management. According to quantity of public hospitals medical equipment users (doctors, nurses, paramedics) were increased by the government but CETP could not been developed by the Health Ministry.
    Due to the absence of a biomedical equipment management policy as per standard WHO Guideline, this sector has historically been poorly managed throughout the Bangladesh public health system. The Directorate General of Health Services has stored large quantities of medical equipment through IDA credit fund since 1998 through oversight of the Ministry of Health and Family Welfare’s Line Directors. As per the guidelines of WHO, biomedical / clinical engineering professionals &technologists should be involved in equipment planning from procurement to disposal.Thus, biomedical equipment management throughout the GoB has been impeded due to a lack of skilled biomedical equipment and technology management.
    There is no medical equipment inventory report and also nobody how many CETPs are required for the HTM..
    Technological development is a continuous process. Accordingly, there has been little opportunity to accelerate the development health care technology management practices among Bangladeshi health service providers. In Bangladesh, however, due to the absence of clinical and biomedical engineering & technology management professionals, acceptable medical equipment management system and practices have not been established and implemented. As a result, medical equipment utilization has been sub-optimized throughout the public health services. Considering the real facts a standard national demand of CETPs are very important factor.

    Objectives:
    The objective is very broad, but the core goals of develop a standard Inventory of CETP are as :
    To develop quantity of CEP, CETP, BMEP, BMET, EMET& TECHNICIANS
    To develop a guidelines for implementation of CETP
    To develop a policy how they work together and for these purpose hospitals facilities will need develop
    Outcomes:
    Improve the delivery of modern health technology to all levels of public health care facilities;
    Need-based equipment to be selected
    To reduce the capital investment for the new procurement of equipment;
    To ensure proper use of medical equipment and cost effective maintenance management;
    Develop a standard medical equipment management system;
    Reduce equipment break down and extend the functional life of equipment;
    Sound health services network to be developed and the security of the national economy;
    To ensure quality and equitable health care for all citizens of Bangladesh.
    Methodology of calculation:
    A block diagram is shown in figure no I to assessment the national demand of CEPT for Bangladesh

    Y=∫▒〖(x1,x2,x3,Z〗)

    Where x1=Bed facilities No, x2=Equipment No, x3= Capital investment, z= existing CETP & Y= National requirement of CEPT up to Tertiary level Public Hospital of Bangladesh
    The sub-data of input are stated below :
    develope a national inventory on health facilities
    develope inventory of equipment user departments
    devlop Inventory of medical equipment
    Capital investment for hospital equipment
    determine National requirement of CEPTas per standard guidelines
    determine exsiting CEPT in the public health service
    compare with standard requriment and exsiting status

    Data sources:
    MoH, DGHS, NEMEMW & TC, CMSD, MSH, Survey of Simed international, TOE of 2008 , standard guidelines of WHO, Developed countries
    G. Inventory section:
    G1: National inventory on health facilities: It is defined assimilations of following components:
    Number of healt centers & bed numbers
    Number of district hospitals & bed numbers
    Numbers of medical collage hospital & bed numbers
    Nubmbers of Specialised hospitals & bed numbers
    Location and comunication and also interlink to each other.
    The result of the inventory will be given the facilities and bed numbers of a country. Depending on the result number of Clinical Engineer and technologist professionals can be distinguished
    The healthcare facilities mentioned above are under the Ministry of Health & Family Welfare and the classification is based on both the number of beds and the number of department are shown in figures and tables

    Figure 1 – data of Primary Level vs. number bed

    Figure 2– data of Secondary Level vs. number bed

    Figure 3 – data of Tertiary Level vs. number bed

    Here author uses the equation for an inventory for each level of facilities:
    Equation 1: Primary level hospital facilities formula

    P5=∑_x1^x5▒〖∫_x1^x5▒〖(p1x1+〗 p2x2+p3x3+p4x4+p5x5〗)
    Where P5 is total bed in primary level, p1, p2———bed numbers and x1, x2———hospital numbers
    P5= 16214
    Equation 2: District level hospital facilities formula
    S4=∑_x1^x4▒〖(s1x1+s2x2+s3x3+s4x4)〗
    S4=9550
    Where S4 is the total bed numbers secondary level s1, s2———bed numbers and x1, x2———hospital numbers
    Equation 3: Tertiary level & Post graduate medical college hospital facilities formula
    T14=∑_(tx1()^x3▒〖t1x1=〗 t2x2+t3x3)

    T14= 12500
    Where T14 is total bed in tertiary level t1, t2———bed numbers and x1, x2———hospital numbers
    Equation 4:
    SP23=∑_25^700▒〖∫_x25^x700▒〖(p1x1+〗 p2x2+p3x3+p4x4+p5x5+p6x6+——-+p23x23)dx〗
    Where SP23 is total bed in specialized level p1, p2———bed numbers and x1, x2———hospital numbers
    SP=
    Equation 5: total number of hospitals and bed numbers in Bangladesh

    Yb=∑_PHC^SPH▒〖(P5+S20+T14+SP23〗)

    Equation 6: Facilities department
    yd=∫_d7^d40▒〖d.dx〗
    Details department facilities are shown in table of I
    = Exsiting deparment
    G2. Inventory of equipment user departments
    Table I. Department facilities of up to tertiary level public hospitals of Bangladesh
    Sl No. Department 31 50 100 150 200 250 500 1000 2000
    1 Emergency & out patient x
    x x x x x x x x
    2 Medicine x x x x x x x x x
    3 Surgery x x x x x x x x x
    4 Anesthesia x x x x x x x x x
    5 Guyenne & Obstetric x x x x x x x x x
    6 Pathology x x x x x x x x x
    7 Radiology x x x x x x x x x
    8 Dentistry x x x x x x x x x
    9 Blood Transfusion x x x x x x x x x
    10 Vaccine & inoculation x x x x x x x x x
    11 Skin & VD x x x x x x x
    12 Pediatric x x x x x x x
    13 Cardiology &CCU x x x x x x x
    14 Orthopedics & Trauma surgery x x x x x x x
    15 ENT x x x x x x x
    16 Blood Bank x x x x x x x
    17 Eye &Ophthalmology x x x x x x x
    18 Cardiac Surgery & ICU x x x
    19 Casualty x x x
    20 Urology x x
    21 Nephrology x x
    22 Virology
    23 Neurology x x
    24 Mental health x x
    25 Microbiology x x
    26 Hematology x x
    27 Histopathology x x
    28 Biochemistry x x
    29 Serology x x
    30 Oncology surgery x x
    31 Gestroentrocology x x
    32 Radiation oncology x x
    33 Cardio thoracic Surgery x x
    35 Endocrinology x x
    36 Physical medicine x x
    37 Radiotherapy /oncology x x
    38 Burn unit x x
    39 Infertility x x
    40 Facio Maxillary Surgery x

    G3. Inventory of medical equipment: Total No of Equipment in the Public Hospitals of Bangladesh is More than 35,000 (different types).
    G4. National requirement of CETP as per standard guidelines: The national requirement of CEPT is dependable and variable on:
    Hospital be numbers
    Eqiuipment quantity
    Health facilty department
    Capital investment for the equipment
    Country context
    As per guidelines of World Organization and other development countries a national CEPT Chart with basic education & training level were given below and here level of post, label and quantity are mentioned by author. Here, x=Not require
    G4.1. Standard requirement of CETP for each level of hospitals: According to level of hospitals and bed here authors followed the guidelines of WHO and considered the country context. The number of CETPs is shown per unit of hospital in table G.4.1.Posts versus beds data are given here.
    Post 31-50bed 100-250 500 1000 2000 Centeral level NEMEW
    Chief Engineer x x x x x 1
    Addional Chief Enginner x
    x x x x 2
    Superindent engineer x x x x x 4
    Exeecutive Engineer x x x 1 7
    Sr. Clincal Engineer x x x 1 2 7
    Asst Clinical Engineer x x 1 2 4 7
    Sub-assitt clinical Engineer x 1 2 4 8 7
    BMET 1 2 2 6 8 7
    EMT 1 2 2 6 8 7
    Technician x 2 2 6 8 7
    Mechanics x 1 1 3 3 7
    Carpenter 1 2 2 2 3 2
    Plumber 1 2 2 2 3 2
    Total for per hospital 4 19 14 30 48 67

    G.4.1. Base data for each type of Hospitals up to Tertiary hospitals

    G4.2. Standard nation requirement up to tertiary level Public:
    In the Table G.4.1. Base data for each type of Hospitals up to Tertiary hospitals are shown and from this data total no of CETP can be calculated by using equation table G4.2.
    Post 31-50bed 100-250 500 1000 2000 Centeral level NEMEW Sub total acccording to posts for tertiary hospitals
    Number of Hospitals 421 64 5 8 1 1 1
    Chief Engineer x x x x x 1 1
    Addional Chief Enginner x
    x x x x 2 2
    Superindent engineer x x x x x 4 4
    Exeecutive Engineer x x x 1 7 8
    Sr. Clincal Engineer x x x 8 2 7 17
    Asst Clinical Engineer x x 5 16 4 7 32
    Sub-assitt clinical Engineer x 64 10 32 8 7 121
    BMET 421 128 10 48 8 7 622
    EMT 421 128 10 48 8 7 622
    Technician x 128 10 48 8 7 201
    Mechanics x 128 5 24 3 7 167
    Carpenter 421 128 10 16 3 2 580
    Plumber 421 128 10 16 3 2 580

    G4.3. Standard requirement of CETP for SPH: According to level of hospitals and bed. Here authors followed the guidelines of WHO and considered the country context. The CETP data is based on Equipment & bed Numbers. Specialized Public hospitals have been using more quantity & sophisticated equipment and data of CETP are very variable. Here, x=Not require

    Name of Org. BED ECE SCE ACE SACE BMET EMET TECH Mechanices CARPENTER PLUMBER Total Per hospital
    NICVD& H 500 1 1 3 6 6 6 4 1 3 3 33
    NIKDU 200 x 1 1 2 3 2 2 1 2 2 15
    NIMHH 100 x 1 1 1 2 1 1 1 2 2 11
    NIO 250 1 1 2 3 2 2 2 1 2 2 17
    NCRFHD x x 1 1 2 1 1 1 1 1 8
    TB CLINIC & H 250 x 1 1 2 2 1 1 1 1 1 10
    NITOR 500 1 1 3 6 3 3 2 1 2 2 23
    NINS 200 1 1 2 6 3 3 3 1 2 2 23
    MGH 500 1 1 2 2 2 2 2 1 2 2 16
    NICDH &R 660 1 1 2 3 3 3 3 1 2 2 20
    TB Laprosy 50 1 1 x 1 2
    NICDH 250 1 1 2 2 4 3 2 1 1 1 17
    Dental collge & Hospital 200 x x x 1 1 1 2 1 1 1 7
    Home medical College Hospital 100 x x x x x x 1 1 1 1 3
    Ayurbadic Medical college Hospital 100 x x x x x x 1 1 1 1 3
    Total no as per post 7 10 20 35 33 28 28 16 23 24 224
    G.4.3. Base data for each type of Hospitals specialized hospitals
    G4.4. Total national requirement of CETPs

    Posts CETPs For centeral level CEPTs Primary to tertiary level hospital CETPs For Specilized Hospitals CETPs for national level
    Chief Engineer 1 x x 1
    Addional Chief Enginner 2 x x 2
    Superindent engineer 4 x x 4
    Exeecutive Engineer 7 1 7 15
    Sr. Clincal Engineer 7 10 10 27
    Asst Clinical Engineer 7 25 20 52
    Sub-assitt clinical Engineer 7 114 35 156
    BMET 7 615 33 655
    EMT 7 615 28 650
    Technician 7 194 28 229
    Mechanics 7 160 16 183
    Carpenter 2 578 23 603
    Plumber 2 578 24 604
    Total 67 2890 224 3181

    G5. Existing CEPT in the public health service
    Basic post name as per guidelines Exsiting post as national rules Sanction post
    SCCE CTM 1
    Sr. CER TMR 1
    Sr. CET TMT 1
    ACE A E 10
    CET SAE/workshop supper 30
    BMET/ EMT Sr. Technican /Chief Mechanics 72
    Technician Technican/Junior Mechanices 48
    Jr. Technican Technical helper 27
    Computer programer Computer operator 1
    Total manpower 191

    G6. Compare with standard requirement and existing status

    Serial no Posts CETPs for national level CETPs exisitng
    1 Chief Engineer 1 0
    2 Addional Chief Enginner 2 0
    3 Superindent engineer 4 1
    4 Exeecutive Engineer 15 2
    5 Sr. Clincal Engineer 27 0
    6 Asst Clinical Engineer 52 10
    7 Sub-assitt clinical Engineer 156 30
    8 BMET 655 36
    9 EMT 650 36
    10 Technician 229 24
    11 Mechanics 183 24
    12 Carpenter/technical helper 603 27
    13 Plumber 604 0
    Total 3181 191

    Result & Discussion: From the above data it is found that a huge percentage of CETPs are shortage in the Public health services of Bangladesh. For this reasons medical equipment management of Public health services is suffering for health technology management.

    Acknowledgement

  9. Md. Anwar Hossain

    Necessity of Clinical Engineering Professionals in Bangladesh

    Md. Anwar Hossain1,2, Engr. Nazrul Islam3, Md. Rafiqual Islam4, and Mohiuddin Ahmad4,*
    1Dept. of Biomedical Engineering, Khulna University of Engineering & Technology (KUET), Khulna-9203, Bangladesh
    2NEMEMW & TC, MoH & FW, Dhaka, Bangladesh
    3NEMEMW & TC, MoH & FW (Former CTM), Consultant of Unity Limited, Banani, Road # 11, Dhaka, Bangladesh
    4Dept. of Electrical and Electronic Engineering, KUET, Khulna-9203, Bangladesh
    *E-mail: mohiuddin0ahmad@gmail.com

    ABSTRACT: In this paper the author proposes and explores the necessity of Clinical Engineering Professionals in the public and private hospitals of Bangladesh. Bangladesh is a country with population over 160 million and about 2.5% of world’s population. This large population needs an efficient, safe and cost effective healthcare system. In recent year increased use of technology has significantly improved quality effectiveness of the healthcare delivery. However increased use of technology has also resulted in increased overall costs. Therefore effective management and assessment of healthcare technology in use will be needed. There are so many hospital and diagnostic center in Bangladesh which are functioning with many upgraded and sophisticated medical equipment. The equipment demands safe operation, maintenance, monitoring, repair and development. Sound maintenance is an essential part of the return on the investment of health care equipment. That is why availability of well educated and trained clinical engineering professionals is of prime importance. This also point to a need to develop a comprehensive program for clinical engineering education and training in Bangladesh. Although professional technologists or equipment technicians maintain the equipment in hospitals and may participate in some basic equipment management, clinical engineers may dispute this arrangement of management by technologists in equipment-intensive hospitals. Clinical engineers design the specifications and procedures required to integrate equipment into properly working condition and to maintain them under local standard conditions. In this paper, our proposal for clinical engineers in Bangladesh is for improving equipment management system by providing an engineering viewpoint on planning & use of sophisticated scientific equipment, technology assessment, computer applications, quality improvement and in-service education & training to ensure proper diagnosis by equipment for delivering sound health services. Finally necessity of clinical Engineers, Biomedical Equipment Technicians will be found out with justifications and recommendations. Resultant to this the authors felt it obligatory to submit a proposal to introduce and produce these professionals for health care technology management in Bangladesh.

    Keywords—Clinical Engineering (CE); Clinical Engineering Technologist (CET); Biomedical Equipment Technician (BMET); Biomedical Equipment; Necessity of Hospital in house Clinical Engineering Department (HIHCED).

    INTRODUCTION
    The aims to introduced and produce new generations of clinical engineers through the department of Biomedical Engineering of Public, Private Engineering Universities and afflation with hospitals of Bangladesh whose individual efforts will make substantial contributions to society. Career opportunities for clinical engineers are excellent. To develop the innovative technologies that drive the biomedical industry requires personnel with the unique combination of skills, knowledge and experience in biology, medicine and engineering offered by undergraduates and graduates Program in Biomedical Engineering department. Clinical engineers work with health care professionals (e.g., physicians, nurses, therapists, and technicians) and may be called upon in a wide range of capacities such as designing instruments, devices, and software. Clinical engineers incorporate knowledge from many technical sources to develop new medical procedures and conduct research in an effort to solve clinical problems. Clinical engineers are employed in industry, in hospitals and diagnostic center, in research facilities of educational and medical institutions, in teaching, and in government regulatory agencies and so on and so forth. Clinical engineers can be doing something different every day and can angle their career to be working individually or part of a team. Here authors have reviewed a lot of literatures and publications on Clinical engineering professionals of different countries and found that the definition of clinical engineering are differed from country to country but the major responsibilities of this profession is same. Some definitions of Clinical Engineering Professionals (CEPs) of different countries are mentioned below:
    A Clinical Engineer is a professional who supports and advances patient care by applying engineering and managerial skills to healthcare technology [1].
    Clinical engineering is a specialty within biomedical engineering responsible primarily for applying and implementing medical technology to optimize healthcare delivery. Clinical engineers are required to understand all modern medical technologies, as well as train, troubleshoot, and design, while managing entire clinical settings [2].
    A professional who brings to health care facilities a level of education, experience and accomplishment which will enable him to responsibly, effectively, and safety manage and interface with medical devices, instruments, and systems and the user thereof during patient care [3].
    Definition of Clinical Engineering Technologist (CET): A Clinical Engineering Technologist is defined as a person who practices the operation, maintenance and inspection of clinical life support and control systems, for instance, dialyzers, mechanical ventilators and artificial heart-lung machines. He or she plays an important role in clinical practices such as cardiac operations, as well as in the education of medical doctors and nurses on the use of medical equipment. Accordingly, he or she is required to obtain medical knowledge and communication ability as a member of a medical practice team, in addition to engineering skills [4].
    Definition of Biomedical Equipment Technician: The BMET is the person responsible for direct support, service, and repair of the medical equipment in the hospital. BMET education and training is usually of a more directly technical nature, and is supplemented with specific schooling in service to the equipment. BMETs answer the call when medical equipment fails to function properly and must work closely with nurses and other hospital staff, as well as the equipment vendor, as they service and maintain the equipment. The job of the clinical engineer, however, is somewhat different.

    Combination of CEP: Different countries showed the combination of CEP in different ways. Table I shows different combinations of CEP. In the present situation and context of Bangladesh, It can also define CEP which is shown in Table I.

    TABLE I: Some definitions of CEP and our proposed definition
    SL# CEP Definition Country
    1 CEP = CE+ CET+BMET Japan
    2 CEP = CE+ BMET Developed countries
    3 CEP = Short trained of traditional engineers {BS (EEE/ME/Physics)+D(EE/ME/EME)+EMT}. Bangladesh.
    Very complex and conventional [5].
    4 CEP = BS (CE) + D(EME) + BMET Proposed CEP for Bangladesh as per country context
    Where, CE: Clinical Engineer; CET: Clinical Engineering Technologist; BMET: Biomedical Equipment Technician; BS (EEE) = BS in Electrical Engineering; ME= Mechanical Engineering; CSE= Computer Science & Engineering; DEME= Diploma in Electro-Medical Engineering; DEE= Diploma in Electrical Engineering; DEE=Diploma in Electronics Engineering, EMT=Electro -Medical Technicians.
    The historical of clinical engineering professionals are introduced in this sub section. Clinical Engineering is one of branch of biomedical engineering and biomedical engineering was introduced in America in 1970. Due to rapid improvement of medical technology, clinical engineering practice in the hospitals globally for safe operation and cost effective maintenance of medical equipment. Some developed countries were introduced and produced their clinical engineering professionals very earlier and some developing countries such as Malaysia, Jordan, Pakistan, Nepal, India, Indonesia and Hungry were introduced since 1987-1992 [6]. But in Bangladesh, clinical engineering is a new concept although a lot of sophisticated costly medical equipment were using by the public and private hospitals and diagnostic centers. Bangladesh government is introduced an organization in 1984-87 and name as National Electro-Medical Equipment Maintenance Workshop and Training center and in addition with 18 District Electro-Medical Equipment workshop only to control the breakdown maintenance with 10 conventional Graduate Engineers, 90 numbers of conventional diploma Engineers and some general trade technicians with limited education and training. Since 30 years have been passed, no improvement was done of the organizations by the government due to awareness of traditional engineering leader and top level policy-makers [7]. Presently the situation of these organizations became the poorest condition due to retirement of engineers and technicians. A lot of post was vacant since long. On the other hands a lot of public hospitals, clinics, and hospital equipment and health management providers were increased. No hospital in house clinical engineering department (CED) was introduced in any hospital to maintain the medical equipment management and day by day its situation is gowning to bad to the worst. A lot of costly modernized medical equipment is not being used and installed by the hospitals due to lack of knowledge [8]. Presently, only one Clinical engineer is working under the Health Ministry. Qualified graduate engineer in this filed will be zero balance within 2016 at NEMEMW & TC as no other expansion or new enrollment was done by government of Bangladesh. At a glance this organization seemed to be a disposable [9].
    The rest of the paper is organized as follows: Section II describes the objectives and necessity of clinical engineers & BMETs in Bangladesh. Section III describes responsibilities of clinical engineering professionals. Section IV describes the relationship between CE and medical equipments. Section V briefly states the contributions of the proposed work. Problems identification is noted in section VI. Present situation, data collection data analysis is described on clinical engineers is mentioned in section VII, where different subsections are described. Difference the performance of clinical engineering professionals and conventional trained engineers of Bangladesh described in section VIII. Relevant summery of data analysis and discussion is given in section IX. Necessary recommendations are provided in section X. Finally, section XI concludes this paper.
    OBJECTIVES AND NECESSITY OF CE
    In order to find out necessity of any new innovation certain objectives should have behind the background. Necessity of CEP depends on medical equipment and hospital facilities departments, population and other medical and co-medical professionals in the health care delivery system of a country [9, 10].
    – To find out the performance of Hospitals with CED and without CED
    – To know the cost versus treatment of patients
    – To know the result from equipment by CED and without CED
    – To know the investment versus profit or beneficiary of the patient
    – To understand the accurate diagnosis result from the medical equipment
    – To deliver the cost effective treatment to the patient within a short interval.
    – To understand the results of a hospital with and without CETs & BMETs
    – To understand Health Technology versus CETs & BMETs in Bangladesh
    – To understand cost effective, a safe operation & preventive maintenance of life supporting medical equipment through in-house CED
    – To understand the reliable diagnostic results from medical equipment through this professions
    – To understand the emergency roles of CE, CET & BMETs in a hospital to manage patients through medical devices
    – To know country context and capital investment for medical equipment
    – Introduce Clinical engineering professionals in the Health Services for the safe operation and cost effective maintenance of medical equipment

    RESPOSIBILITIES OF CLINICAL ENGINEERS & CED IN EACH LEVEL HOSPITAL
    The responsibilities of clinical engineers and BMET are varied due to manufacturing countries and non manufacturing countries but crucial responsibilities are similar in all countries. Some core responsibilities are reflected by the authors in this section [11, 12].

    – Proper operation/use of an Equipment/Device; train nurses/operators
    – Enhance accuracy of desired result/output from a Medical Equipment/Device
    – Ensure safety of both Patient & Medics in a Clinical set-up
    – Handle emergency situation in wards/clinical set-ups when Medics/Nurses are absent
    – Arrange periodic/preventive maintenance of equipment in consultation with Bio-Medical Engineer
    – Ensure routine Calibration of equipment for ensuring accuracy of machine out-put
    – Ensure radiation safety for radiological/radioactive equipment
    – Ensure required stable electric power supply, suitable environmental conditions and other requisites for operating clinical devices, bio-medical equipment& instruments.
    – Arrange safe disposal of medical/clinical waste management system
    – Ensure/help Clinic/hospital administrator for disposal of equipment/devices
    – Perform the following on clinical equipment owned and/or used within the health system in compliance with international regulatory bodies:
    – Inspection of all incoming equipment (i.e., both new and returned after repairs) Installation,
    – Preventive and corrective maintenance & special request service
    – Provide pre-purchase evaluation/assessment of new technology and equipment
    – Assist clinical departments with service contract analysis, negotiations, and management
    – Provide cost-effective management of a medical equipment calibration and repair service
    – Coordinate clinical equipment installations by planning, scheduling, and correction of oversight
    – Research equipment issues for health system professional and administrative staff
    – Conduct device incident investigations
    – Coordinate external engineering assistance and technical services performed by vendors
    – Train medical personnel for safe and effective use of modern medical devices and systems
    – Perform clinical applications engineering, such as custom modification of medical devices for clinical research, evaluation of new non-invasive monitoring systems, etc.
    – Develop and implement documentation protocols required by external accreditation and licensing agencies
    – Last & not the least; ensure maximum/optimum utilization of equipment during its recommended/expected life for attaining economic viability of a clinic or hospital

    In addition, the knowledge, skills, and abilities of a Clinical engineer include:

    – Knowledge of human anatomy, physiology, electronics, and electro-mechanical, medical equipment operation, troubleshooting, and safety in healthcare facilities
    – Analytical skills to determine the cause of equipment malfunctioning /or failure
    – Practical skills to repair and perform preventive maintenance of electromechanical equipment
    – Ability to write reports and make clear presentations on technical and operational issues
    – Interpersonal skills to work effectively with clinical staffs, vendors and fellow Engineers

    SUMMARY OF CLINICAL ENGINEERS AND MEDICAL EQUIPMENTS
    There are some difference of Biomedical and Clinical Engineers. Actually, clinical engineers will ensure diagnostic result and patient treatment through equipment. The following equation can be used for the medication of patients.

    Patient Medications=∑_(i=1)^4▒y_i (1)

    Where, y1 = Diagnostic Results; y2 = Drug; y3 = therapy from instrument; y4=behavior therapy.

    Figure 1: Proposed diagnostic results of patients

    Diagnostic result from medical equipment: (i) Measuring & recording equipment were used for find out abnormality of physical organs of human body such as BP instrument, ECG, EEG, medical ultrasound, automated analyzers, medical microscope medical X-ray, CT scanner, MRI etc. (ii) Healing through instrument is grouped as therapeutic equipment such as physiotherapy, cobalt-60, pacemakers, linear accelerator, intensive care ventilator, surgical diathermy, medical suction machine, medical nebulizer, etc.

    The method for correct diagnostic result interface of medical measuring equipment with clinical engineering professionals is given by the following proposed expression.
    y_1=∑_(i=1)^6▒x_i (2)

    Where, x1= stable power source, x2 = equipment calibration, x3 = regular maintenance, x4 operator’s skill, x5 = room temperature control & humidity control, x6 = clinical setting. In Eq. (2), y1 is diagnostic result of a patient and y1 is the sum of 6 parameters and prerequisite requirement to get the correct result from diagnostic equipment, which is shown in Fig. 1.

    Here, x is depends on the number of CE, CET and BMET, i.e.

    x=f(CE,CET,BMET) (3)

    and x=m×CE+n×CET+o×BMET, where m, n, and o are the number of CE, CET and BMET per thousand populations.

    The performance of the proposed CEP, p(x) mainly depends on three factors and can be expressed as

    p(x)=f(BE,CEP,ISET) (4)

    Where, BE; basic education, and ISET: In-service education & training. Basic educational curriculum, attitude, behavior, willing, intention of professionals CE and traditional EEE/ME with short trained are huge different and hence performance of two different professionals are differed.

    Clinical Engineers will work in the clinical area with medical doctors and nurses for monitoring the clinical setting and calibration for safe operation and routine maintenance. Incorrect clinical settings and calibration may cause of death for patients. In globally, it was predictable that biomedical equipment could not keep in safe functional condition without the leading of clinical engineers and very risky to use during diagnostics and therapeutics medication to patients. Biomedical equipment is combination of electronics, electrical, mechanical, and computational medical software base. Only clinical engineering education and training is capable two cover the said same. In developed and developing countries already added this CEP as core professionals in the health services but some low/middle income countries like Bangladesh could not build this CEP in their health services due to lack of awareness and some bad intentions of some peoples.

    CONTRIBUTION OF THE PROPOSED WORK
    The main contributions of the proposed work are as follows: (i) propose an approach the necessity of CEP in the HSOB for sustaining life cycle of medical equipment management for safe and cost effective preventive maintenance of medical equipment as per standard of developed countries. (ii) Propose a work, which will be helpful for need based equipment planning, technology basement, need based equipment selection, spare parts selection, ensure preventive maintenance, supervision and monitoring functional, installation, calibration, in house maintenance, central level maintenance and equipment decommissioning which is not developed in Bangladesh [13].
    PROBLEM IDENTIFICATION
    The problem addressed in this series of publications is the ineffective use and subsequent poor operational and maintenance performance of medical equipment in Bangladesh. The chronic lack of maintenance management of medical equipment is generally considered as an important factor for the poor quality of health care delivery in Bangladesh. A number of previous studies [13, 14], conducted in low- and medium-income economies, indicates that more than 50% of the equipments in urban and rural medical institutions are inoperable and not in use. As a result the efforts of medical and Para-medical personnel are seriously impaired. Some developed countries have started medical equipment management through the clinical engineering professionals and biomedical equipment technicians near about thirty years ago and thus, built-up a qualified clinical engineering management team over the years [14]. But in Bangladesh clinical or biomedical engineering professionals is a new concept to the health providers and it becomes difficult to properly maintain and keep the equipment fully functional As a result accurate feedback could not achieve from the medical equipment and health care delivery system is interrupting seriously, increasing this complexity day by day. Some types of sophisticated medical equipment are designed by developed countries where the environment, disease patterns, trained users, and maintenance capabilities are different. One major problem of medical equipment in Bangladesh is the great variety of models from different manufacturers. This greatly complicates the use and maintenance of equipments. The Equipment Inventory List (EIL) and equipment service history (ESH) can provide important information. Models which show frequent breakdowns or which have high maintenance cost should be avoided. For new major equipments, the warranty period normally terminates one year after equipment is delivered to the health facility. The following problems are facing by the hospitals and patients of Bangladesh due absent of Clinical Engineers and Biomedical Equipment Technicians in Bangladesh [14, 15].
    Equipment could not be used accurately.
    Frequently fault condition is interrupting the health services.
    Spare parts and consumables were not found during repair.
    Break down maintenance increases cost.
    Equipment de-commissioning and disposal was not done.
    More currency is spending for procurement of new medical equipment.
    Equipment could not be used for desired longer time.
    Radiation safety from medical imaging equipment is not followed properly.
    Over all health services is interrupting and more currency was drained out and which is affecting our economy.

    PRESENT DATA COLLECTION AND ANALYSIS
    In this chapter, several items of present data collection and their analysis are presented.

    Performance of Present Health Care Delivery of Public Hospitals of Bangladesh in Clinical Engineering Professionals Views Point Of Standard Health Care Technology Management

    The Performance of present health care delivery of Public Hospitals of Bangladesh in CEPs views point of standard health care technology management are given in [17, 18]. More than 10 important standard health care technology indicators should be maintained by the health services system. A statement and evaluation report is shown in Table II.

    TABLE II: Performance of health care technology management of Bangladesh in reference with standard health care technology management
    Sl.
    SMEMMT SVODC EVOBD SD Input score of MEM professionals
    1 Equipment planning & Technology Assessment 10 5 5 CE=6, Dr=2, Planer= 1, TE=2
    2 Budget & Financing 10 3 7 CE=7, COM= 2 , TE=1
    3 Procurement & Logistic 10 6 4 CE/BME= 4, COM= 2, Dr= 1, PS=2, TE=1
    4 Inspection, installation & acceptance test 10 3 7 CE/BME=5, Dr/OP=2 TE=1, BMET=2
    5 Regular calibration 10 2 8 CE/BME=4, BMET= 4 TE=2
    6 Skill develop through in-service education & training 10 3 7 CE/BME= 5, Dr=1, BMET=2 TE=2
    7 Inventory & documents 10 2 8 CED= 8, SK= 2
    8 Preventive Maintenance 10 1 9 HIHCED= 5, BMET=4 OP=1
    9 Monitoring the performance of use 10 1 9 HIHCED= 8 OP=1
    10 Equipment decommissioning & disposal 10 2 8 HIHCED= 8, Users = 2
    11 Average performance of MEM 100 28 72 N/A

    Here, SMEMMT: Standard Medical Equipment Management Measuring Tools, SVODC= Standard Value of developed countries, EVOBD: Existing value of Bangladesh, SD = Standard deviation, TE: Traditional Engineer, Dr.: Medical doctor, Sk: Store keeper, PS: Procurement specialist, OP = Operator, HIHCED; Hospital in house clinical engineering department.

    Figure 2: Comparison of medical equipment management developed countries vs. Bangladesh
    From Table II, the performance of medical equipment management in the public hospitals is 28% only, which is shown in Fig. 2. In Bangladesh standard deviation of clinical engineering practice found 72%. It means that health care technology in Bangladesh is only 28% present.
    Clinical Engineering Professional’s Interaction with Other Medical Professionals in Bangladesh

    Patients are the important customers to endure the medical and co-medical professionals of hospitals. Patient’s demands to get safe and reliable treatment from the hospitals but it are directly related with the proper performance of medical equipment. Medical equipment is really a complicated implement to achieve the real feedback without clinical engineering professionals. Due to error full results and unsafe operation of equipment, may the causes of patient’s death or error-full treatment and a series of publications and newspapers frequently alarming to established in house Clinical engineering department in Bangladesh like developing countries and sequentially developed countries [18, 19]. A situation is illustrated in Fig. 3.

    Figure 3: Present Clinical interaction of medical professionals of hospitals of Bangladesh
    Hospital in-house clinical engineering department did not established in the modern technology of medical equipment in Bangladesh but all other professionals are near about in good status in hospitals of Bangladesh. A lot of medical equipment are using by the hospitals in inferior to standard, although most of the developed and developing countries were established CED in each level of hospitals. To keep equipment in safe functional conditions, it is very necessity of clinical engineering professionals in Bangladesh. Clinical engineering professional’s interaction with other medical professionals is near about 15% through conventional trained engineering professionals [19, 20].
    Clinical engineers are the most important arm force of handling, clinical settings, calibration and preventive maintenance of medical equipment/ medical devices. Through their professionals, they keep the equipment in safe functional condition with economic way. Developed countries understood its necessity and they introduced & produced these professionals in their health network by law. Most of the developing countries already stared and developing these professions continuously but in Bangladesh it is unknown and new concept for the health providers and policymakers. A lot of errors are finding from the diagnostic and therapeutic equipment of Bangladesh, as shown in Fig. 4, where the dotted red lines are shown with the information inside box. High technological equipment is introduced but professional engineers & technologists could not develop and hence equipment has been using in unsafe mode and expensive health services is continuing in Bangladesh. A lot of poor patients are not getting treatment from private and public hospitals because health services cost are related with costly modern medical equipment. Most of private hospitals and also specialized hospitals always be worried to withdraw their capital investment to earlier as equipment could not used expected longer time which is affected our economy and the poor patients [21 ,22, 23].

    Figure 4: Medical instrumentation basic block diagram and proposed correction for implementing CEP
    Due to implementing CEP and before implanting CEP, two types of data can be obtained, i.e. data with correct condition and data with incorrect condition. A situation is shown in Fig. 5.

    Figure 5: Diagnostic or therapeutic results in proper and improper condition
    A Cause Study of Intensive Care Unit Equipment Management by Conventional Engineers in a Hospital in Bangladesh
    Two case studies are presented here.
    (i) ICU ventilators, bedside and center patient monitor , syringe pump, blood gas analyzer, defibrillator, remote control bed , medical gas supply terminal, central suction pump and other ancillary equipment to be used for safe management of patient curative . During data collection authors were found the following lacking and fault but it is not possible to recover by traditional engineers, nurses and doctors. Here, an evaluation data were prepared by author’s trough practical visit and data from public hospitals of Bangladesh. The nature of basic education, in-service education and training are equipment oriented but in Bangladesh, it is very conventional nature. Course curriculum and in-service education & training are integration of skill score. As educational and training nature is not similar with standard, therefore the performance of Bangladeshi team is not acceptable level [23, 24]. In Table III and Fig. 6, the performances of ICU Equipment management are shown.

    TABLE III: Performance of ICU equipment management
    Professionals Basic education In-service education & training Professional skill to operate and maintain the ICU
    Standard Bangladesh Standard Bangladesh Standard Bangladesh
    Users doctor 10 2 10 2 20 4
    Paramedics 10 3 10 2 20 5
    Nurses 10 2 10 2 20 4
    CE/BME 10 3 10 2 20 5
    CET 10 2 10 1 20 3
    BMET 10 1 10 1 20 2
    Total 60 13 60 10 120 23

    Figure 6: Performance of intensive care equipment management performance of Public hospitals in Bangladesh
    (ii) Result from ICU Ventilator used in a Coronary Care Unit of two reputed hospitals of Bangladesh with CEP and without CEP is shown in Table IV. For practical cause study authors visited four specialized hospitals at Dhaka in Bangladesh and practical situation was recorded by the authors and here two records are shown in Fig. 7 for the necessity of clinical engineering professionals for Coronary patients at CCU [24, 25].

    TABLE IV: Performance of ICU Ventilator used in a CCU
    Measuring tools and parameter considered Result finding of Hospital H1 without CE Result findings in Hospital H2 with CE
    Cleaning and preventive maintenance Dirty and preventive maintenance have not done more than 6 months Ok
    Power supply system Power supply cord has not found any grounding for the safe operation and build in battery functional life time has expired and operators had no log book. Ok
    Clinical and alarm settings Equipment getting lees O2 and air from wall out let due to lose connection of mechanical adapter, equipment flashing alarm but it was stopped by the operator. Ok
    Musk and contamination Mask and tube are dirty and not sterile Ok
    Water level and dehumidifier Water is empty in the dehumidifier and other unit water used from normal water from pipeline instead of distilled water Ok
    Medical gas connection port Medical connecting gas pressure is less and pressure reducer valve is jam since long Ok
    Room temperature and humidity Room temperature is high and no humidifier is functioning mode Ok
    Operators skill level Users doctor and nurses has not good idea on this equipment and never received any training on this equipment Excellent
    Patient condition Patient is needs more O2 with Pressure control mode of ventilator but he is not getting. Good and patient is managed through CE

    Case study example: Visual condition of an intensive care ventilator used in Coronary Care Unit for emergency respiratory system of cardiac patient in a specialized hospital without clinical engineering professionals support and with clinical engineering support and the result are shown in Fig. 7.

    (a) Hospital H1 without CE (b) Result findings in Hospital H2 with CE

    Figure 7: Result finding of two hospitals with and without CE

    Present status of medical equipment of public hospitals in Bangladesh

    There four levels of public hospitals in Bangladesh such as primary (UHC), secondary (DH), tertiary (MCH) & Specialized (SPH). Four types of public hospitals have been using a lot of costly medical equipment to diagnosis and therapeutic purpose for the patient. For study has been collected directly, email and website of Directorate General of Health Services. To understand the situation a summary of inventory is shown in Fig. 8 and Fig. 9.

    (a) Hospital data in percentage
    (b) Hospital data in numeric

    Figure 8: Example of a hospital data

    (a) Medical equipment condition of public hospitals in Bangladesh
    (b) Public hospital equipment status of Bangladesh
    Figure 9: Medical equipment condition of Bangladesh

    Findings: 20170 equipment of different types and different station surveyed and found 65% functional (F), 24% repairable (R) but could not repair due absence of CED, 8% not repairable (NR) but has no expert to detect the face value and discard and 3% not installed (NI) due no CE of vendors and government [26].

    Present trends of clinical engineering professionals under the Ministry of Health & Family Welfare Government of Bangladesh

    Presently clinical engineering professionals are not introduced and produced. Only conventional graduate and diploma engineering in EEE/ ME/ CSE and some physics background qualified graduate with a short training on medical equipment are maintaining the responsibility of clinical engineering professionals. Their performance and job nature like as Biomedical Equipment technician. Regular calibration and need based clinical settings were not done by them as they have enough knowledge. The present performance of convention trained engineers and clinical engineering professionals are very different. However, Authors considered the existing traditional engineering professionals as Clinical engineering professionals. Present demands of clinical engineering professionals are very high to minimize the medical error of medical equipment. Demand depends on some criteria and these criteria have reviewed form some standard guidelines. According to guidelines of world health organization and some developed countries the clinical engineering professionals depends on the following factors [26, 27].
    Number of population of a country but in our country doctor hospitals and health services could not reach in the acceptable standard level but present structure is capable to cover more than 70% of desired standard demand. Due lack of miss management and weak health care technology management the actual result comes down near about 35%.
    Capital investment in the for the hospitals and capital invest for the medical equipment
    Category and sophisticated medical equipment
    Facilities department and services
    Considering all and according to country context the requirement of CEP in public hospitals in Bangladesh is shown in Fig. 10. Hospital in-house clinical engineering department (HICHED) practice is not introduced in any of public hospitals of Bangladesh. Only some traditional engineering professionals are providing an inferior service from central level without standard guidelines. Every hospital has only one junior mechanics as in house person and their job nature is to maintain only water pump and generator only. Present and near future requirement assessment data is shown in Table V and Fig. 10.
    TABLE V: Performance of ICU Ventilator used in a CCU
    Professionals Base standard Existing Remarks
    CE or BME 600 1 Only one is qualified and reaming 3 is conventional engineer
    CET 1200 80 Conventional & basic education is mechanical trade
    BMET 2400 36 Conventional only six month’s trade course on general trade with class VIII.
    General Technician 4800 400 Conventional technician , only trade course on Air cooler not in medical equipment

    Figure 10: Standard requirement of CE vs. Existing Conventional engineer in the health services of Bangladesh
    THE DIFERENCE OF THE PERFORMANCE OF CEPs & CONVENTIONAL TRAIND ENGINEERs (CTE) OF BANGLADESH
    As per standard guidelines of different countries a statement of CEP & CTE is shown in Table VI [27].
    TABLE VI: Average score of CE & CTE
    Basic education CE CTE Remarks / Justification
    Knowledge of human anatomy, physiology 10 1 In the syllabus of CTE is not included and after training a few idea is gathered
    Electronics, and electro-mechanical 10 6 Syllabus of Conventional engineer is included of general criteria
    Medical equipment operation 10 2 Acquire partial knowledge after training on a particular equipment
    Troubleshooting & calibration 10 3 After training achieved an inferior ideas
    Safety in healthcare facilities 10 2 Not clear
    Analytical skills to determine the cause of equipment malfunctioning /or failure 10 3 Do not find out easily and accurate cause could not find out
    Practical skills to repair and perform preventive maintenance of electromechanical equipment 10 4 After training acquired partial idea
    Ability to write reports and make clear presentations on technical and operational issues 10 2 As basic education has not and do not know, how to write
    Interpersonal skills to work effectively with clinical staffs, vendors and fellow Engineers & Attitude to work in the hospital environment 10 1 Comes from other professions and could not adapt with hospitals environment
    Total average score of CE & CTE 100 25

    SUMMERY OF RESULTS & DISCUSSIONS
    The percentages results are corresponding discussions in the previous chapters are shown in Table VII.

    TABLE VII: Average CE medical equipment management performance results
    Section VII [Different Subsections] Results Discussion
    Present performance of CE 28% Conventional trained engineering(CTE) with insufficient staffing in Health Ministry
    CE interaction with other medical professionals 15% Only CTE occasionally conducted to users on call
    Medical instrumentation system measuring applied method
    23% Due absence of HIHCED measuring method can be applied only a few percentage instead of cent percent
    Performance of occasional conventional engineer 25% Inadequate CTE performed only a breakdown maintenance
    Medical equipment functional with use mode 32.5% 65% equipment is running condition but due shortage of operator, consumables, reagent and lack of awareness of CTE only 32.5% equipment found to actual working condition
    Present trends of CEP 6.46% Presents trends of CTE performance of NEMEW & DEMEW are equivalent to trends of CEP is 6.46% only.
    Section VIII. Performance difference between CE & CTE 25% Basic education and training of present CTE is 25% only of CEP
    The average CE Medical Equipment Management Performance Result 22.13% The average result of present CTE is in average 22.13% of CE performance. It means that the CEP practice in Bangladesh is near about 22.13% only

    RECOMEDATION /SUGESSTIONS
    From the result and discussion it is found that only 22.13% clinical engineering professionals practice are staying in Bangladesh. An inferior Health Care Management of Bangladesh is continuing. Poor patients have not been getting the treatment from the clinical engineering point of views. Public and private hospitals have been using more costly modernized medical equipment but due absence of Clinical Engineering Professionals Practice Patients have been not getting proper treatment and on the other hand the stake holders could not establish the cost effective and safe treatment to poor patients. In this situation some core suggestions is recommended by the author.
    Clinical engineering professionals are very necessary to ensure the safe and cost effective health care management in Bangladesh.
    Introduce and produce of Clinical Engineering professionals for Bangladesh is a urgent issue to save the national economy and health services.
    Through short training in country and abroad the performance of CTE can be increased
    Through education CEP can be produced.
    Through national seminar/ conference CEP can be introduced.
    UGC can take decision to open an individual institute in each public engineering university to produce the CEP in affiliation with developed countries.
    A project can be design to introduce and produce the CEP and project can be affiliated with education and health ministry of Bangladesh Government.
    CEP will be included in national policy and law like other engineering professionals to each level of private and public hospitals in Bangladesh.
    In this project connection concern authority of Ministry of Health & Family Welfare, Government can make a project through development agencies such as JICA, USAID, WHO, WB, CIDA & UNFPA, etc.
    Presently an evening training certificate course can be started through NEMEMEW & TC under the Ministry of Health & Family Welfare very immediately.
    A clinical engineering institute initially started under a Public Engineering University where presently biomedical engineering department is available. This can be used for the said purposes.
    A pilot project giving highest priority by government of Bangladesh can be started with the help of donor agencies like JICA, MSH-USAID, CIDA, UNICEF, DEFID, WHO and World Bank. Considering this a joint venture pilot project with Japan has already been proposed by KUET and it is awaiting clearance from NEMEMW & TC. OSAKA Jieki College responded very well for this project.
    10% budget to be allocated separately in a new fiscal code during procurement of new equipment and this budget should be reflected in the operation plan of health sector for introducing and producing Clinical Engineering Professionals in Bangladesh

    CONCLUSIONS & FUTURE RECOMMENDATIONS
    Globally clinical engineering professionals are one of most valuable and important resources although in Bangladesh it is a new concept. From above data and discussion it is concluded that CEP is the utmost resources for health care technology management of Bangladesh. Requirements for Clinical Engineering professionals in hospitals & clinics are a crying need in Bangladesh in order to improve the existing health care technology management. Neglecting or delaying to do so will surely threaten the health services in Bangladesh. Author wishes that relevant government officials of Bangladesh government in health sector seriously consider this urgent issue and take appropriate initiative to generate & engage ‘Clinical Engineering Professionals’ in hospitals & Clinics of the country. Government may obtain the suggestion of KUET/NEMEW&TC in creating/establishing “Clinical Engineering” section in every hospital where as KUET & other private universities create opportunity and accelerate to produce clinical engineering professionals in the country. By this way only Bangladesh can hope to ensure safe and sound health to her citizen and participate in global health care system. The authors also wish that government should pay immediate attention and implement the recommendations as mentioned. Promptly to develop a module to introduce and produce clinical engineering professionals and biomedical equipment technicians in Bangladesh for sustain safe and sound health services of all kinds of patients in all level.

    ACKNOWLEDGEMENT
    Authors acknowledged this work to: Ministry of Health & Family Welfare, Bangladesh; KUET; UGC, HEQEP Sub-Project CP#3472; JICA; OSAKA Jieki Collage, Japan; MSH-UASID; DFID; World Bank Bangladesh Office; WHO, Dhaka office, Bangladesh, Dr. Eng. Sameh Hanna, President, biomedical engineering consultant, Hours consulting group LLC, USA, The Excellency Ambassador, The Arab Republic of Egypt, Gulshan-2, Dhaka, Bangladesh Office.
    REFERENCES
    ACCE Definition, 1992.
    Wikipedia, the free encyclopedia
    Clinical Engineering, written by Goodman, 1989
    Clinical Engineering Technologist of Japan
    Organization chart of NEMEW & TC, Ministry of Health & Family Welfare, Government of Bangladesh of health bulletin of 2013
    Web-based data and clinical engineering hand books of Dr. Joyperdesh
    Paper publication a Conference and motherly meeting held at Ministry of Health & Family welfare and news paper publication in Prhotom Alo and Dainik Shomokal – July 2014nd prepared by simed international agency of world bank supported program
    Organizational record of NMEMEM & TC, MoH & FW, GOVT of Bangladesh.
    Md. Anwar Hossain, Mohiuddin Ahmad, And Md. Salah Uddin Yusuf, Clinical engineering professional generation by interfacing public universities and health sectors of Bangladesh, Proc. of the 9th International Forum on Strategic Technology (IFOST), October 2014, Cox’s Bazar, Bangladesh.
    Clinical engineering hand book and web-based information & W. Gwee & Dyro JF (2004),” The Clinical Engineering hand book” Elsevier Burlington, MA.
    Azman Hamid,”Clinical Engineering in Malaysia” – A cause study.
    Md. Anwar Hossain, Mohiuddin Ahmad, Md. Rafiqul Islam, M. A. Rashid, “Improvement of medical imaging equipment management in public hospitals of Bangladesh,” in Proc. of the International Conference on Biomedical Engineering (ICoBE 2012), pp. 567-572, Penang, Malaysia, February 26-28, 2012
    Md. Anwar Hossain, Masrima Bari Jitu, Md. Rafiqul Islam, and Mohiuddin Ahmad, “Return on Investment of Introducing Clinical Engineering and Technologist Professionals in Bangladesh,” Proceedings of International Conference on Informatics, Electronics & Vision, ICIEV14, pp. 1-5, May 23~24, 2014, Dhaka, Bangladesh.
    A thesis was developed on Improvement Medical Imagining Equipment Management System of Bangladesh government by Engr. Md. Anwar Hossain under the supervision of Dr. Professor. Mohiuddin Ahmad, Head of Biomedical Engineering Department KUET, Bangladesh in June 2012.
    Developed a standard table of Organization & Equipment for the Directorate General Health Services under the Ministry of Health & Family Welfare, Government of Bangladesh by msh-USAID December 2013.
    Web-based information of dghs.gov.bd, and web-based information of moh
    Practical data from CMSD under DGHS and Record from NEMEMW & TC, MOH & FW, Bangladesh
    Feasibility study report prepared by a national consultant under the ministry of Health & Family Welfare for Privatization of TEMO & NEMEMW & TC, Dhaka, Bangladesh in December 2013.
    Information was published by national newspapers such as prthom Alo & Daienik somokal July 2014].
    Organizational chart of NEMEMW& TC, existing technical post position , manpower of NEMEMW & DEMEWs and a survey report prepared by world bank consultant in August 2008
    Web-based information from First Forum of Asian Clinical Engineering in Japan in May 2012.
    Md. Anwar Hossain and A.B.M. Siddique (NEMEMW & TC, Ministry of Health and Family Welfare, Bangladesh) “Improvement of Medical Imaging Equipment Inventory and Documentation System in Public Hospitals of Bangladesh”, S-4, Symposium (part 1) of Clinical Engineering of each Asian country – current situation, The 1st Forum for Asian Clinical Engineering (FACE), Osaka, Japan, 2012.
    Web-based data collection regarding biomedical instrumentation system and present country context practical data collection by world health organization and consultant from HOPE, America in May 2014.
    An evaluation was done according guidelines of world health organization, clinical engineering qualifications, training, skill and practical visit and situation analysis by the authors in 2014
    web-based guideline of Japanese Association for Clinical Engineering (JACE) in 2014
    A National Seminar on medical equipment condemnation held at DGHS Conference room on July 2013, Sponsored by Management Sciences for Health –UASID.
    Web-based information – Wikipedia, the free encyclopedia and clinical engineering roles of Italy 2013 and basic qualification and require training for CET in Japan 2010 and existing technical capacity assessed by development partners.
    Md. Anwar Hossain and Mohiuddin Ahmad, “Improvement of in-service education and training on medical imaging equipment of Bangladesh,” in Proc. of International Conference on Informatics, Electronics & Vision (ICIEV12), pp. 536-541, 18-19 May, 2012, Dhaka, Bangladesh.
    Md. Anwar Hossain, Mohiuddin Ahmad & Md. Salah Uddin Yusuf, “Generation of Clinical Engineering & Technologist with interfacing Health and Education Ministry 2013, a project submitted to Osaka Jieki Collage, Japan and acknowledged by the same by to Osaka Jieki Collage, Japan.
    Engr. Md. Anwar Hossain and Mr. Fabrizio Germany consultant of MSH-USAID, Development of Table of Organization & Equipment for public hospitals of Bangladesh under the Directorate General Health Services, MoH & FW, 2013.
    Walid Salameh Trarawneh, A. Ghawanmeh, I. Malkawi, and M. A. Ghannam, Quality Assurance and Control Of Clinical Engineering Activities, 4th Kuala Lumpur International Conference on Biomedical Engineering 2008, IFMBE Proceedings, vol. 21, 2008, pp 746-750.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

Return to Top ▲Return to Top ▲