**6. Conclusion**

The time required to perform the analyses is a very important parameter in the choice of equipment. On the one hand, it allows better management of the patient queue, and on the other hand, it ensures the management of reagents and consumables with a limited life. When the volume of samples to be treated in a routine manner is small, manual systems are suitable for both patient satisfaction and reactive management. If the volume of samples to be processed requires more than 1 day of work, the semiautomated system should be considered to resolve the queue. Finally, if the volume of samples increases further, the fully automated

*Comparison of systems in terms of hardware, installation constraints, acquisition cost, and maintenance level.*

**Manual Semiautomatic Automatic**



7000 15,000 3000


migration

or not)

Execution time Très long Long Court

Maintenance level Bas Moyen Haut



detection


Cellulose acetate -Agarose gel

The management of reagents in the laboratory depends heavily on two important parameters that should be noted: this is the expiry date and the stability time after opening of the reagent. The expiry date indicated on the label is usually the date after which the manufacturer no longer guarantees the validity of the results, while the stability time after opening of the reagent indicates the period after which

Since the stability time is shorter than the expiry date itself, it will be necessary to ensure that each open reagent is consumed before that time. For example, the use of a reagent that has a stability time of 60 days and can analyze 1000 samples in a laboratory that receives only 10 samples per day is a waste. The use of this reagent before maturity requires an average daily rate of 20 samples, considering that the laboratory operates 6 days a week. Ten samples/day instead of 20 samples/day will

The level of maintenance, and in turn cost, follows the same trend: more com-

Since the cost of acquiring systems increases with the complexity of the technology, it is important to ask good questions, find good answers, and make good choices based on real needs, to achieve savings. As an example, is it necessary to acquire a semiautomatic agarose gel system when, taking into account the medical needs and the volume of samples to be treated, the manual system on agarose gel support gives us satisfaction? Affirmative answer incurs an additional a

the manufacturer no longer guarantees its reliability after the first use.

system will better meet expectations.

**Systems**

*Human Blood Group Systems and Haemoglobinopathies*


generator -Tank migration -Densitometer

line



Migration support -Paper

Equipment -Power

Installation constraints

Acquisition cost (en €)

**Table 3.**

**194**

theoretically cause the damage of half the reagent.

pact system is provided and the higher level of maintenance.

The management of any pathology implies the appropriate choice of techniques and technologies. Indeed, beyond the medical needs that are priority, a control equipment acquisition cost is one of the major parameters providing effective support to strategies put in place.

Very often in sub-Saharan countries, the aspect of the consequent acquisition of the necessary technology is not always thorough, and this can lead a poor quality of reported results, the inaccessible test cost for the poorest people, and the delicate operation of projects being implemented.

The choice of equipment performed after an objective needs analysis enables to optimize the process of acquiring, to ensure the quality of reported results, and to provide more accessible costs to target populations generally poor.

According to WHO recommendations, technology assessment, device evaluation, needs planning, selection and acquisition, installation, commissioning, and finally monitoring should be part of a successful acquisition procedure [35].

Such an approach should involve all stakeholders, namely, doctors, managers, biomedical engineers, and users.

In the case of sickle cell anemia, the inventory of installed park shows that beside manual methods, diagnostic techniques most common in the Democratic Republic of the Congo and even in sub-Saharan Africa are phenotypic techniques. These include *the electrophoresis at different pH, the isoelectrofocusing, the capillary electrophoresis, and the high-pressure liquid chromatography.* The first three mentioned are most used for their reliability, flexibility, ease of installation, and maintenance.

The prices of the equipment listed in the table remain indicative. We have taken into account only good-quality equipment commonly used in the DR Congo and by extension in other countries of sub-Saharan Africa.

For low-income countries, the costs of such facilities are still high overall. Indeed, the increase in health expenditure, which represents 10% of the world's gross domestic product (GDP), is faster than the growth of the world economy. According to a new World Health Organization report on global health spending, it is increasing rapidly, particularly in low- and middle-income countries, where spending is increasing at an average of 6% per year, compared to 4% in high-income countries.

Health expenditure is assumed by governments, by individuals who pay for their own care (out-of-pocket payments), and by other entities such as voluntary health insurance schemes, employer-sponsored schemes, and nongovernmental organizations. On average, 51% of a country's health expenditure is assumed by general government and more than 35% by individuals in the form of direct expenditure. One of the consequences of this situation is that every year 100 million people are plunged into extreme poverty [36].

For the countries concerned, the acquisition of these health technologies requires new upstream procurement strategies to meet acquisition and operating costs. And from this point of view, some developed countries such as France are now developing group procurement procedures in public hospitals.

According to a recent study conducted in the Democratic Republic of the Congo on an investment in capillary electrophoresis equipment for a project on sickle cell disease, this can contribute to improve quality and low cost of tests, if a complete analysis of needs is carried out upstream.

In this study, for an equipment activity extending over a period of 7 years, the cost of acquisition and maintenance cost represent, respectively, 11.4% and 5.0% of the total life cycle cost.

But when the activity of the same equipment is done over a period of 2 years, the cost of acquisition and maintenance cost represent, respectively, 31.0% and 3.9% of the total life cycle cost.

Added to this, for the same annual rate, the minimum unit test cost is € 3.9 for a 7-year activity cycle, whereas it costs € 5 if the activity cycle is reduced to 2 years [37].

Therefore, it should be noted that when operating conditions remain the same, amortization of equipment carried on shorter lead times significantly increases the cost of the test at the expense of patients.

Even though this example only concerns electrophoresis capillary equipment, extrapolating conclusions on agarose gel equipment is possible for the following reasons: installation, operation, and maintenance are less demanding than for capillary technology.

While sub-Saharan Africa is the most affected region in the world for sickle cell disease, research and care are relatively slow.

At its 60th session held in Malabo from 30 August to 3 September 2010, the WHO was already raising the option of a strategy for its African region. Nine years after the effects are hardly noticeable.

The management improvement of this pathology solicits several challenges, including the one concerning the technical platform necessary for diagnosis. The costs of acquiring and operating equipment often require significant fundraising, which is often lacking. The missing financial means are often one of the first obstacles to the launching of the relevant programs.

The study mentioned above proves that it is possible to optimize the available resources, however modest they may be, in order to obtain good and lasting results.

In the case of biomedical equipment, it is sufficient to involve the right people to achieve the expected results. Policymakers in sub-Saharan African countries must therefore integrate the skills of biomedical engineers into the design and start-up of medical projects so that they, in turn, contribute effectively to improve the quality of medical care populations.

**Author details**

**197**

Vincent Mulunda-a-Mulunda<sup>1</sup>

Democratic Republic of Congo

1 Institut Supérieur de Techniques Appliquées (ISTA), Kinshasa,

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease…*

*DOI: http://dx.doi.org/10.5772/intechopen.92546*

2 Groupe Hospitalier Nord Essonne, Lonjumeau, France

3 Wagenia Sarl, Kinshasa, Democratic Republic of Congo

\*Address all correspondence to: vp\_amulunda@yahoo.fr

provided the original work is properly cited.

\*, Pierre Kouam<sup>2</sup> and Taty Oke Ingwen<sup>3</sup>

*Contribution of Biomedical Equipment Management to Better Management of Sickle Cell Disease… DOI: http://dx.doi.org/10.5772/intechopen.92546*
