HEALTH CARE TECHNOLOGY FOR DEVELOPING COUNTRIES

M. Refaee, Prof. M. A. Fayed*

Department of Engineering and Product Design, University of Central Lancashire, UK
*Faculty of Medicine, Department of Parasitology, Al-khar University, Egypt
e-mail: { m.refaee@uclan.ac.uk, mahmoudfayed@hotmail.com}
Abstract
The World Health Organisation (TWO) has set a goal for the year 2000 which is 'health for all
However a question has arisen concerning the appropriateness of health care technology f o ,
developing countries. This paper look at health care technology not simply as medical equipmen
and drugs, but as a multidisciplinary approach including disease management, informatiol
technology and medical engineering. Poverty is open a contributing factor for disease reoccurrenc,
in poor economic countries. For such disease hazards to be controlled, health risk assessment an1
disease management is needed through a programme of identification, evaluation, prediction an1
prevention. Some examples of current health management from Egypt, Ghana, and a project 01
Control of Cardiovarcular Disease in Developing Countries are used to illustrate how diseases arc
mismanaged in these countnes.
Information technology plays a major role in every field of modem development and is an essentia
tool in health care. It has been identiped that there is a widening gap between scientific researcl
conducted in developing and industrialised counbies.
A range of problems can hinder the development of medical engineering, such as bureaucraq
management issues blaming, selecting, purchasing and maintenance), outdated equipment an1
conflict with cultural values.
Solutions have been idenhfied to improve health care technology in developing countn'es and ar8
discussed in this paper. To achieve the goal of 'healthfor all' the international community needs tl
support, co-ordinate and financially assist a long-term programme of sustainable health care.

INTRODUCTION
"Most of the developing countries of the world are signatory to the Alma Ata Charter of 197
committed to provide health for all by the year 2000" [l].
The present situation shows that developing countries face particular problems in health car
technology due to severe shortage of funding, expertise and "structure. Most medical equipmer
is out of service, also inappropriate donations of equipment are sometimes made.
The International Society of Technology Assessment in Health Care (ISTAHC) has defined Healt
Care Technology (HCT) as "The interventions and applied knowledge used by health car
practitioners and systems. Included are drugs, devices, medical and surgical procedures, and th
organisational, administrative, and support systems in which health care is delivered. Thus, healt
care technology includes, but is not limited to, antibiotics, cardiac drugs, and vaccines; cardia
pacemakers, magnetic resonance imagmg, and diagnostic test kits, gall bladder remova
acupuncture, and psychotherapy; and electronic patient record systems, critical pathways, an
alternative health care financing mechanisms and delivery systems" (classic concept of HCT)[2].
However, some questions have arisen, such as; what is health care technology? What is tk
appropriate health care technology for developing countnes? What is the tool or method that coul
support a long-term prosam of sustainable development with optimum health care for developir:
countries?
Nevertheless, a wider concept of HCT is needed to suit the needs of the developing world to COT
with new challenges brought about by such health risks as epidemic diseases, environmental impa
assessment of biological hazards, and re-emerging diseases. This view of the concept is presented
this paper. The current health care technology in developing countries is presented briefly.
proposed solution in a form of a pre-model to quantify the actual situation of HCT with the abili
to be applied in developing nations is described.

' 2000 The Institution of Electrical

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SUGGESTED CONCEPTUAL APPROACH FOR WIDENING THE SCOPE OF HCT

Referring to the ISTAHC definition, HCT is simply defined as medical equipment, tools and
administration. This definition limits HCT to the medical engineering field and isolates other
important components, which are essential to the HCT system. Health care technology is not simply
medical equipment, drugs, financing mechanisms and admirustration, but it is the applied
multidisciplinary approach of knowledge including Information Technology (IT), Eco-epidemiology
(ecology and epidemioIogy interaction) and medicaI engineering to be used by health care
practitioners and systems in which health care is delivered (modem concept of HCT). Ths
definition gives HCT a wider perspective, and does not limit it to one field:
Information Technology: tools are designed to transfer information and allow a recipient to use and
analyse data to create information for a specific purpose [3] such as health and environment data
Imkage. Genetic engineering, also, will benefit and progress from the wealth of dormation
processing and enable us to unveil the secrets of living matter to manipulate life, with potential
extraordinary consequences [4]. The successful implementation of disease management
programmes relies upon information about practice patterns and variations, their costs and their
impact on patient outcomes, all in routine clinical circumstances [SI. Information is a key to the
growth of knowledge, and dissemination of information is crucial for scientific enterprise. IT can
play an important role in medicine and health care by providing useful dormation for scientists
and decision-makers in the health care field. IT elements or variables which constitute IT set are
devices and systems such as computer hardware, software, telephones, fibre optics lines, and
airwaves.
Ecology & Epidemiology (Eco-epidemiology): "Health is not an absolute quantity but a concept
whose standards are continually changing in different lands with the acquisition of knowledge and
the establishment of cultural objectives. To be truly healthy a person should enjoy a balanced
relationship of the body and mind and complete adjustment to the environment" [6]. From this
context &sese can be seen as a reaction between man and his environment which affects his well
being. Environmental factors such as population, quahty of d " g water, sanitation and nutrition
are often associated with the standard of living in tropical and sub-tropical climates. In addition, the
epidemiological variables include viruses, bacteria, other organisms of the biological environment
and transmissible diseases (bacterial and vectors), also poisoning and allergies [7].
Medical engineering: can be summarised from an ISTAHC d e h t i o n as the study of en-~eering,
physics, biology and their technological application in health care delivery. Their variables are;
equipment, drugs, administration mechanisms etc.
The union of the variables or elements of these three fields constitute the modem health care set and
mathematically cm be expressed as;
Modem HCT cInformation Technology U Eco-epidemiology ukfeaical Engineering.
From this equation it is seen that HCT is a three dmensional system where its dimensionality is the
number of inputs which are the three sets. Figure 1 shows HCT versus two sets of variables (IT and
Medical Engineering) as an example.

CURRENT HEALTH CARE TECHNOLOGY IN DEVELOPING COUNTRIES

Information Technolou: Most developing countries do not have the necessary infrastructure
(computer terminals, networks, communication channels, bandwidth, etc.) to contribute as equal
partners in the world-wide enterprise of knowledge production and dissemination. Also, many
journals have become electronic and are only available on the Web, at a fee that most university and
research laboratory libraries in developing countries cannot afford [4].

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Med. Eng. (equipment, drugs&.)

l IT ( s o k e , hardware,GIS, etc.)

i
i

Fi,we 1 HCT versus two sets of variables (IT and Medical En,keering)
Eco-epidemiology: Environmental conditions and changes often have an adverse effect upon the
population of a country. The "Toshka Project" is currently working in Upper Egypt to change the
area from being Nile govemed with plans for other water supplies and distribution. However it is
lackmg a health care feasibility study to predict diseases and re-emer,gg diseases due to ecological
changes to the area [SI.
In Ghana, a study assesses the feasibility of routine data U a g e of health and environmental
indxators. It was found that they do not have a coherent management information system covering
environmental and health aspects of the city for the purpose of health and environment data analysis

[91.

From a project for control of cardiovascular disease CVD in developing countries it was found that
patient follow-up is difficult because of a lack of a vital registration system, hgh population
mobility, and variable access to medical care. Most developing countries lack reliable estimates of
the level of disability caused by CVD and other diseases. Drug therapy is often expensive and
therefore not widely accessible for the majority of the population [ 101.
Medical Engineering: Developing countries have problems to face such as bureaucratic import
systems and safety regulations. Also management issues (planning, selecting, purchasing and
maintenance), outdated equipment, and a conflict of values can present problems.

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A SUGGESTED PRE-MODEL OF MODERN HCT

Models are simplified representations of objects and systems. They are like a map which allows us
to study, understand, configure and evaluate how a system works, e.g. a road map of the highways
will alIow us to understand the layout of London without having to drive on every road.
For this reason HCT can be modelled as a tool to quantify the variables of the three components
(IT, Eco-epidemiology and Medical Engineering) h s will enable monitoring of the actual health
care situation in the region under consideration in order to give the suitable developmental action
strength to be implemented.
Tlxs will give health organisations and developed countries a tool based on scientific rules to gain
information from developing countries to measure the quality of transferred HCT and its
assimilation.
Figure 2 shows a suggested HCT pre-model. In this figure a standard HCT block represents

Degrees of
Eco-epid

Developmental

Epid.

Degrees of
Med. Eng.

Feedback of Actual HCT

Monitoring

Figure 2 A pre-model of HCT

variables of the main three components. Those variables are already available and estimated by
scientific laboratories and organisations. Actual HCT represents the real variables in the region
(coast, desert, or forest etc.) under consideration. The basic idea of this pre-model is to map the
three components of actual HCT to a degree (for example; high, medium or low) of the three
components of standard HCT;

fi %actual

HCT components 3 Rdegreer of standard HCT components

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Where /function is the k c t i o n in the standard HCT block and maps the actual HCT set to the
standard HCT set.
This block can be designed by a method or a function that can deal with complex systems, e.g.
systems that are more complex but for which significant data exists. Artificial Neural Networks
(ANNs) provide a powefil means to reduce uncertainty through learning based on patterns in the
available data [l 11.
The output of standard HCT block can then be fed forward to a rule based system to give the
suitable developmental action streno* based on the reasoning of the degree of standard HCT
components. For instance; fuzzy logic provides a natural tool to model and process uncertainty,
allowing a suitable management of vague and uncertain knowledge. It represents knowledge using
lin,pistic labels instead of numerical values, thus it is more understandable for humans and more
easily interpreted.
Fuzzy rules are represented in a natural way as causality relationships between inputs and outputs of
a system, "IF a set of conditions is satisfied, THEN a set of consequences is inferrerf' [12], e.g.:
Rule 1: IF IT is hlgh and Eco-epid. is high and Med. Eng is hlgb THEN developmental action
stren,s$h is low.
Rule 2: IF IT is medium and Eco-epid. is mehum and Med. Eng. is medium THEN developmental
action seen,& is medium.
Rule 3: IF IT is low and Eco-epid. is low and Med. Eng. is low THEN developmental action
stren,ath is hi&.
Finally, the monitoring function is to measure, evaluate and confi,we the variables of the actual
HCT and feedback information to the standard HCT to be mapped to its proper degree of its
components.

DISCUSSION
In developing countries rapid development is characterised by chan,@ng demographic profiles,
complex mixes of traditional mfectious diseases, h1urban environmental conditions, and lifestyle related health problems. These combined factors have made HCT more complex. The classic
definition of HCT is lulliting so that technology is seen only as medical equipment, drugs and
management issues. Thus, a modem concept of HCT has been suggested to give a wider meaning
for health technology to include IT, Eco-epidemiology and medical en,gineering technologies, to
appropriately adapt to the needs of the developing world. However, after 22 years since the Alma
Ata Charter has been signed by most of the developing countries, the current HCT in these
countries has yet to achieve the goal of health for all. Therefore, we suggest a solution in a form of
pre-modelhg of modem HCT to be designed. The model will be a clear map for the developed and
developing world to indicate the actual situation of HCT in a form of fi,wes. This will prioritise
needs for health technology, monitoring the extent of assimilation and its ability to be reused in
different regions. In addition, it will direct the required developmental action stren,gth to areas of
greater need. This will be an environmental health planning tool, and assist the intemational
community to support and co-ordinate long-term progammes based on scientific rules of
sustainable health care.

ACKNOWLEDGEMENTS
The authors would like to thank Dr. M. R. Varley and Olga Refaee for their help and assistance.
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