**2.2 Attempt to address the funding gap for the management of sickle cell disease**

In the specific case of the management of sickle cell disease, are there other ways of compensating for this financial situation?

The first way already present in the field is that of the actions of charitable associations. The contribution of several nongovernmental organizations involved in the management of specific pathologies such as sickle cell disease is very significant and constitutes a major support, especially for the most deprived populations. The action is perceptible not only in the DR Congo but also in other countries of sub-Saharan Africa [8]. But these efforts remain insignificant compared to the magnitude of the disease, and a country's health policy cannot be based on impulses that are difficult to predict.

The second way is the frequent use of donated second-hand equipment to reduce the costs they (the equipment) represent in the health-care chain. This resource can make a great contribution if best practices for donors and donors' applicants are rigorously observed [9]. Unfortunately, very often this is not the case. Many donations still arrive in Africa without observing the prerequisites, which very often makes them either ineffective or unusable. On the other hand, recourse to donations of second-hand equipment should remain ad hoc, without becoming structural.

The third way is that of optimizing the use of the means available to approach the objectives set. At the international level, donors have understood the challenge of structured and well-executed health financing. This obliges the partners to accompany for decades the countries receiving aid through specific national programs in order to reduce deficits and achieve the objectives.

In the DR Congo, it is through the national health development program that the government and its partners express their willingness to provide effective and realistic solutions to the health problems of the DR Congo's populations. This is generally applied for a period of 5 years, iteratively after evaluation.

The partners in the health field remain practically the same for African countries, and their health problems are very similar: the fight against epidemics, malnutrition, and hereditary diseases. This probably explains why almost all countries in sub-Saharan Africa each develop a national health development plan, with virtually the same content except for a few differences. Examples include the DR Congo, Mali, Côte d'Ivoire, Burkina Faso, Benin, and Kenya. Therefore the methods applied by the partners for health support to the different countries will be very similar.

In the national health development plans drawn up in many sub-Saharan African countries since 2000 to date, the improvement of infrastructures and the strengthening of the capacities of the medical technical platforms, including the expression of

*disease* contrary; it is linked to a mutation that arose for us to defend against severe forms of malaria. It is due to the so-called *selective pressure* that has enabled AS carriers to resist severe forms of malaria. This advantage explains among other things why, although cosmopolitan, sickle cell disease predominates in Africa and

There are *four major outbreaks of sickle cell disease* based on genetic markers called

According to WHO estimates, approximately 300–500,000 children are born each year with hemoglobinopathy; 80% of them are born in developing countries, particularly in Africa. The sickle cell anemia is a hemoglobin disorder most common in Africa, where every year about *200,000 newborns with sickle cell disease* are

*In the Democratic Republic of the Congo (DRC)*, it is estimated that there are 25–30% heterozygous healthy carriers (AS) and about *50,000 homozygous newborns*

Sickle cell disease is particularly common among people from sub-Saharan Africa, India, Saudi Arabia, and Mediterranean countries. Migration has increased the frequency of the offending gene in the Americas. In parts of sub-Saharan Africa, sickle cell disease affects up to 2% of newborns. More broadly, the prevalence of sickle cell disease (healthy carriers that inherited the mutant gene from only one parent) in equatorial Africa is 10–40%, compared to only 1–2% on the coast of North Africa and less than 1% in South Africa. This distribution reflects the fact that the sickle cell trait confers an advantage in terms of survival against malaria and that the selection pressure due to malaria has made the mutant gene more frequent, especially in areas with high malaria transmission. In West African countries such as Ghana and Nigeria, the rate of trafficking is 15–30%, while in Uganda, where marked tribal variations are observed, it is 45% among the Bahamas of west of the

**2. Problems of financing of health systems and their corollary in the DR**

A country's problem of access to health care depends on its ability to finance the required health systems. This presupposes that the country concerned can offer structures, viable infrastructures, and competent personnel. However, low-income countries are struggling to find adequate budget balances to effectively meet the ever-growing health needs of their populations [3], and this is the case of the DR

Indeed, the current sources of financing useful for universal health coverage are essentially public expenditure, donor funding, and compulsory contributions to social health insurance [4]. Since under current conditions household contributions to health care remain relatively low, with a few exceptions when community initiatives are organized [5] or when the state is effectively involved, only two sources

With regard to public expenditure, the state budget is low, often well below Abuja's commitments (15%) [6]. In 2013, for example, the Congolese state allocated only 4.3% of its budget to health, while all projections for spending in 2020 are below 3%. Worse still, this state contribution has only decreased from 2013 to date.

haplotypes: Arabo-Indian, Beninese, Senegalese, and Central African or Bantu. Among Bantu haplotype carriers, the clinical expression of the sickle cell disease is more severe because of, among other things, the relatively low rate of the fetal

its geographical distribution is superimposed on the malaria one.

hemoglobin (HbF) and other genetic factors.

*Human Blood Group Systems and Haemoglobinopathies*

diagnosed and 80% will not reach the age of 5 years.

*(SS) each year*, equating to 2% of newborns [1].

**2.1 Deficit in sources of health-care funding**

are secure: public spending and donor funding.

Congo and many other countries in sub-Saharan Africa.

country [2].

**Congo**

**180**

needs, acquisition, and maintenance of the systems acquired, are among the issues addressed. These topics involve a lot of money that will have to be put to good use; otherwise they can be a source of conscious or unconscious waste of scarce resources. given the country's size, diverse supply methods, and ineffective control mechanisms. Nevertheless, some facilities stand out from the others in terms of their number, mainly for historical and geographical, economic, and commercial

hereditary, did not directly affect the Indo-European populations.

which is rare among indigenous populations [16].

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

disease was, this time, extended in whole France [17].

such as HELENA, TITAN, BECKMAN SEBIA, and BIORAD.

without a guaranteed return on investment.

screening in many clinical laboratories [19].

representation are HELENA and BECKMAN.

operation.

**183**

tion programs are now faced with the problems of uninformed couples of allochthonous origin, as well as variations in specific population characteristics,

Historically and geographically, sickle cell disease was first discovered in black populations in Africa and in the Arabian Peninsula; to date it remains more frequent in these geographical areas. Initially, this disease, which later turned out to be

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

However, due to massive immigration, countries with well-organized preven-

In the early 1970s, screening tests were launched in the United States, and the American population of African origin was indeed very affected. In 1981, an experimental neonatal screening program began in the French Antilles and metropolitan France. It is set up by the Association Française pour le Dépistage et la Prévention du Handicap (AFDPHE). It was only in 2000 that neonatal screening for sickle cell

As a result of the above, electrophoresis systems are initially more equipped with routine programs dedicated to serum protein analysis; programs for the analysis of hemoglobinopathies will gradually come into operation. Indeed, the implementation of new programs involves significant costs that the manufacturer cannot incur

Since the greatest need for sickle cell disease management is in Africa, countries with strong historical ties to the continent will find it easier to sell their technologies to this potential market. Among them we will mention the most prominent firms

In financial terms, the choice of equipment for routine needs will focus more on technical solutions that offer good results at lower cost. From this point of view, for the analysis of hemoglobinopathies, there is an established correlation between agarose gel electrophoresis on the one hand and capillary electrophoresis on the other [18]. On the other hand, high-performance liquid chromatography (HPLC) and capillary techniques are complementary and can be used routinely, knowing that capillary diagrams are easier to read and interpret than those obtained in HPLC. Even better, the development of the capillary technique for the characterization of hemoglobin variants suggested that it would become the first method of choice for

This trend is confirmed with regular innovations from certain manufacturers, and this is the case of SEBIA, which has added to its range for the screening of hemoglobinopathies [20]. In addition, the capillary technique is more sensitive than the HPLC technique for the detection of certain variants such as hemoglobin New York [21]. On the commercial level, thanks to their historical links with Africa, the first companies are more easily organized and set up local representations of their firms to facilitate the sale of their products. Among the first to obtain country-level

But for almost two decades, we have been observing the rise of the SEBIA company, which offers different models of equipment according to the needs and which regularly innovates its products. Today, this firm, now a world leader in the field of electrophoresis, is among those with a large number of distributors in Africa.

Apart from the abovementioned brands, it is worth noting a slow penetration of products of Asian origin in the field. However, while the financial offer is attractive, distribution is still struggling to be structured in terms of regularity, reliability, and

reasons.

In the case of the DR Congo, a reflection carried out on the medical technical platform shows that the objectives assigned to medical infrastructure and equipment through national programs are never achieved and the situation is getting more complicated every year. And yet, after evaluation, the same programs continue with the same objectives and use practically the same methods [10]. In order to minimize procurement costs, the WHO proposes a strategic procurement approach to achieve universal health coverage [11]. The illustration below is more explicit.

This diagram raises fundamental questions that need to be answered if we are to succeed in our efforts. Indeed, countries cannot simply spend their money on universal health coverage. They must master purchasing, define the relationships between suppliers and buyers, define a purchasing strategy on the basis of useful data before disbursement, and finally move from passive purchasing to strategic purchasing.

The fourth path, a corollary to the third, consists of mobilizing and structuring human skills, each in its own sector, to boost the strategic purchasing process. Since the problem of strategic purchasing concerns all sectors, what can the biomedical engineer's contribution be as far as it is concerned?

From this point of view, the biomedical engineer can play an important role as a technical interface between the hospital, suppliers, and industry to make the right choices, as he is considered responsible for the research and development, architecture, selection, management, and safe use of all types of medical devices including single-use, reusable, prosthetic, implantable, and bionic devices, among others [12].

For several decades, a developed country like France has been efficiently involving biomedical engineers in the medical equipment procurement process [13]. It organizes hospital purchasing, where biomedical engineers play a leading role in the purchasing function that has developed in companies over the last 30 years or so [14]. Better still, it is developing a purchasing policy that, among other things, brings together the skills of biomedical engineers to offer end customer equipment negotiated at attractive prices through group purchasing [15].

But in the Democratic Republic of the Congo in particular and in sub-Saharan Africa in general, the biomedical engineering component does not seem to be sufficiently integrated at its best in the administrative and technical response mechanisms for improving health care. This aspect of things can only lead to a waste of funds when the actors at this stage do not master the equipment.
