Ineffective Healthcare Technology Management in Benin’s Public Health Sector: The Perceptions of Key Actors and Their Ability to Address the Main Problems

Document Type : Original Article


1 Ministry of Health, Cotonou, Republic of Benin

2 Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands

3 Polytechnic School, University of Abomey-Calavi, Cotonou, Republic of Benin


Low-income countries face many contextual challenges to manage healthcare technologies effectively, as the majority are imported and resources are constrained to a greater extent. Previous healthcare technology management (HTM) policies in Benin have failed to produce better quality of care for the population and costeffectiveness for the government. This study aims to identify and assess the main problems facing HTM in Benin’s public health sector, as well as the ability of key actors within the sector to address these problems.
We conducted 2 surveys in 117 selected health facilities. The first survey was based on 377 questionnaires and 259 interviews, and the second involved observation and group interviews at health facilities. The Temple-Bird Healthcare Technology Package System (TBHTPS), tailored to the context of Benin’s health system, was used as a conceptual framework.
The findings of the first survey show that 85% of key actors in Benin’s HTM sector characterized the system as failing in components of the TBHTPS framework. Biomedical, clinical, healthcare technology engineers and technicians perceived problems most severely, followed by users of equipment, managers and hospital directors, international organization officers, local and foreign suppliers, and finally policy-makers, planners and administrators at the Ministry of Health (MoH). The 5 most important challenges to be addressed are policy, strategic management and planning, and technology needs assessment and selection – categorized as major enabling inputs(MEI) in HTM by the TBHTPS framework – and installation and commissioning, training and skill development and procurement, which are import and use activities(IUA). The ability of each key actor to address these problems (the degree of political or administrative power they possess) was inversely proportional to their perception of the severity of the problems. Observational data gathered during site visits described a different set of challenges including maintenance and repair, distribution, installation and commissioning, use and training and personnel skill development.
The lack of experiential and technical knowledge in policy development processes could underpin many of the continuing problems in Benin’s HTM system. Before solutions can be devised to these problems, it is necessary to investigate their root causes, and which problems are most amenable to policy development.


Main Subjects

  1. Keller JP, Walker S. Best Practices for Medical Technology Management: A U.S. Air Force-ECRI Collaboration. In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation. Rockville (MD): Agency for Healthcare Research and Quality (US); 2005.
  2. World Health Organization. Medical Devices: Managing the Mismatch: An Outcome of the Priority Medical Devices Project.  Published 2010.
  3. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academies Press; 2001.
  4. Bloom GH, Temple-Bird C. Medical Equipment in Sub-Saharan Africa. Institute of Development Studies; 1988.
  5. Halbwachs H, Issakov A. Essential Equipment for District Health Facilities in Developing Countries. Eschborn; 1994.
  6. Heimann P, Poluta MA. Health Technology Management in the Sub-Saharan Region as a Pre-requisite for Optimizing the Donor Aid Intervention Process. Geneva: WHO; 1997.
  7. Fahlgren B. Access to Effective Medical Technology in Developing Countries-What Role for WHO. Geneva: WHO; 2004.
  8. Goodman CS, Ahn R. Methodological Approaches Used in Health Care Technology Assessment. USA: NICHSR; 2004.
  9. World Health Organization. Baseline country survey on medical devices. Published 2010.
  10. World Health Organization. Essential Health Technologies Strategy 2004-2007: Taking Basic Health Solutions to Countries: A Needs-Driven Programme Increasingly Based on Country-Prepared Proposals. Geneva: World Health Organization; 2004.
  11. Mallouppas A, World Health Organization. Division of Strengthening of Health Services. Strategy and proposed action concerning maintenance and repair of hospital and medical equipment. Published 1986.
  12. World Health Organization. Interregional Meeting on the Maintenance and Repair of Health Care Equipment. Geneva: WHO; 1986.
  13. Temple-Bird C, Mhiti R, Bloom G. Medical equipment in Botswana: a framework for management development. Published 1995.
  14. Mallouppas A. Healthcare equipment management in developing countries: the case of Cyprus. Published 1996.
  15. Remmelzwaal BL. Technological learning and capacity building in the service sector of developing countries: the case of medical equipment management. University of Sussex; 1996.
  16. Temple-Bird C. Managing the Import and Use of Healthcare Technology in Sub-Saharan Africa. Open University; 2005.
  17. Ministère de la Santé de la Protection Sociale et de la Condition Féminine. Politiques et Stratégies Nationales de Développement Du Secteur Santé, 1997-2001. Cotonou, Benin; 1997.
  18. Ministère de la Santé Publique. Etude Sur L’élaboration D’un Système Décentralisé de Maintenance Hospitalière (30 Mars Au 15 Avril 1995). Cotonou, Benin; 1995.
  19. Projet Bénino-Allemand des Soins de Santé Primaires. Guide D’entretien Du Matériel Des CSSP et CCS Du Projet Bénino-Allemand Des Soins de Santé Primaires. Cotonou, Benin; 1997.
  20. Ministère de la Santé Publique. Politiques et Stratégies Nationales de Maintenance Hospitalière En République Du Bénin (2001-2005). Cotonou, Benin; 2000.
  21. Guinand C. Maintenance Biomédicale, Zones Sanitaires Appuyées Par Le PBA-SSP. Evaluation et Suivi Des Activités Des Techniciens. Cotonou, Benin; 2000.
  22. Ministère de la Santé Publique. Politique de Maintenance Des Infrastructures, Des Équipements Médico-Techniques et Du Parc Automobile En République Du Bénin. Cotonou, Benin; 2002.
  23. Ministère de la Santé Publique. Rapport de La Mission D’expertise Thématique En Gestion et Maintenance Des Équipements et Infrastructures de La Santé. Cotonou, Benin; 2005.
  24. Ministère de la Santé. Recueil D’informations de La Cellule de Passation Des Marchés. Cotonou, Benin; 2006.
  25. Union Européenne. Assistance Technique Auprès Du Ministère de La Santé Du Bénin En Vue D’une Étude Préliminaire Sur L’élaboration D’une Politique En Matière D’acquisition, de Gestion et de Maintenance Des Équipements Médico-Techniques Au Bénin, Rapport Final Présenté Par D.; 2010.
  26. Ministère de la Santé Publique. Atelier National d’Orientation Des Politiques et Stratégies Nationales de Maintenance Hospitalière En République Du Bénin À Possotomè Du 21 Au 23 Février 2000. Possotomè, Benin; 2000.
  27. Ministère de la Santé Publique. Avant-Projet de Politique et Stratégies de Maintenance Des Infrastructures et Équipements Médicaux Au Bénin, Février 2000. Possotomè, Benin; 2000.
  28. Ministère de la Santé. Rapport de La Mission D’expertise Thématique En Gestion et Maintenance Des Équipements et Infrastructures de La Santé. Cotonou, Benin; 2005.
  29. Ministère de la Santé. Etude D’évaluation de La Situation Actualisée Des Plateaux Techniques Des Formations Sanitaires Publiques Par Niveau de Soin et Vérification de Leur Conformité Aux Normes Dans Les Six (06) Départements Du Sud Bénin. Cotonou, Benin; 2006.
  30. Kirigia JM, Sambo LG, Mensah O, Asbu CME, Makoudode P, Houmnankan A. Productivity changes in Benin zone hospitals. Afr J Health Econ. 2011.
  31. Pfeiff H. Hospital Engineering in Developing Countries - Tasks and Decision-making Aids for Coping with Problems. In: Damman V, Pfeiff H, eds. Hospital Engineering in Developing Countries, GTZ Symposium, 1983, Giessen, Germany. Eschborn: Deutsche Gesellschaft fur Technische Zusammenarbeit; 1986.
  32. Kouris K, Abdel-Dayem HM. Transfer of medical technology from a developed to a developing country. J Biomed Eng. 1988;10(4):326-330. doi:10.1016/0141-5425(88)90062-3
  33. Mckie J. The Management of Health Care Technology. In: World Health Organization, ed. Report on Interregional Meeting on the Maintenance and Repair of Health Care Equipment. Geneva: WHO; 1987:37-84.
  34. Prage L. Guidelines for Support to Procurement, Operation and Maintenance of Scientific Equipment in Developing Countries. Stockholm, Sweden; 1987.
  35. Temple-Bird C. Sound maintenance in Zambia mine hospital. In: Gasskov V, ed. Training for Maintenance in Developing Countries. Training Discussion Paper No. 97. Geneva, Switzerland: International Labour Office; 1992:13.
  36. South African Medical Research Council. Executive Report of the Regional Workshop on Health Care Technology in Sub-Saharan Region. Somerset West, South Africa; 1994.
  37. Halbwachs H. The Importance of Maintenance & Repair in Health Facilities of Developing Economies. In: Summit Conference of the African Federation for Technology in Health Care. Harare, Zimbabwe; 1998.
  38. Kachieng’a MO. Health technology assessment in sub-Saharan Africa: A cross-national study of Kenya and South Africa [Thesis]. South Africa: University of Cape Town; 1999.
  39. Kothari CR. Research Methodology: Methods and Techniques. New Age International; 2004.
  40. Halstead SB, Walsh JA, Warren KS. Good Health at Low Cost. New York: The Rockefeller Foundation; 1985.
  41. World Health Organization. The World Health Report 2000: Health Systems: Improving Performance. Geneva, Switzerland: World Health Organization; 2000.
  42. Dasanayaka S, Sardana GD. Management of healthcare equipment in Sri Lankan public sector hospitals. Int J Biomed Eng Technol. 2011;5(4):317-342.
  43. Houngbo PT, van der Wilt GJ, Medenou D, Dakpanon L, Bunders J, Ruitenberg J. Policy and Management of Medical Devices for the Public Health Care Sector in Benin. In: Public Health - Methodology, Environmental and Systems Issues. InTech; 2012. doi:10.5772/38449.
  44. Houngbo PT, Kishna M, Zweekhorst M, Medenou D, Bunders J. The effect of Benin’s first public procurement code and its amendment on healthcare equipment acquisition Prices. J Public Procure. 2017; Forthcoming.
  45. Houngbo PT, Coleman HL, Zweekhorst M, De Cock Buning T, Medenou D, Bunders JF. A model for good governance of healthcare technology management in the public sector: learning from evidence-informed policy development and implementation in Benin. PLoS One. 2017;12(1):e0168842. doi:10.1371/journal.pone.0168842
  • Receive Date: 08 July 2016
  • Revise Date: 04 December 2016
  • Accept Date: 07 February 2017
  • First Publish Date: 01 October 2017