Ruggedising biomedical devices for field-testing in resource-constrained environments: Context, issues and solutions

Community Health Workers (CHWs) are community members who address primary health challenges through education, prevention, and awareness initiatives. CHWs conduct home visits, provide treatment for simple common illnesses, and offer health education on numerous topics including nutrition, child health, and family planning. Since they serve on the frontlines of healthcare in rural communities, ruggedised and low-cost biomedical devices could improve the efficiency and efficacy of their caregiving efforts. However, the vast majority of biomedical devices used in sub-Saharan Africa are designed by engineers in Western countries who are not familiar with the distinct physical, environmental, socio-cultural, and economic environment of the context for which they are designing. Systemic challenges include long distances, poor transportation, unreliable infrastructure, harsh climate, and limited operator education. Specifically, three sets of hurdles to the adoption, sustainability and usability of devices by the CHWs include vibrations and wire strain, dust and water penetration, and device usability. This article discusses the operational context of CHWs and then delves into the specific problems encountered, and practical solutions applied, during four years of field-testing ruggedised biomedical devices in rural Kenya.