Biomedical Engineering: The Missing Link in Healthcare Delivery in Gilgit-Baltistan
Why every public healthcare facility must have the services of qualified biomedical engineers
Healthcare is not merely about the availability of doctors, nurses, medicines and hospital buildings. In an increasingly technology-dependent medical environment, the quality and reliability of healthcare delivery also depend upon the availability, proper functioning, maintenance and timely repair of medical equipment. This is where biomedical engineering assumes a vital role.
An advanced diagnostic machine that remains out of order, a ventilator that is not properly calibrated, an oxygen concentrator that fails during an emergency, or a patient-monitoring system that provides inaccurate readings can undermine the very purpose for which a healthcare facility has been established. The presence of sophisticated medical equipment, without the technical personnel qualified to maintain and operate it safely, cannot by itself guarantee quality healthcare.
Biomedical engineering, therefore, is not an optional technical accessory to the health sector. It is an indispensable component of modern public healthcare infrastructure.
Understanding the role of biomedical engineering
Biomedical engineering is an interdisciplinary field that applies engineering principles and technology to medicine and healthcare. It bridges the gap between medical science and engineering, ensuring that the equipment used for diagnosis, treatment, monitoring and rehabilitation is safe, accurate, reliable and available whenever required.
Its responsibilities extend throughout the life cycle of medical equipment, from technical assessment and procurement to installation, inspection, calibration, preventive maintenance, repair and eventual replacement.
A qualified biomedical engineer is responsible for, among other things:
Medical equipment management: Maintaining an inventory of medical devices, assessing their condition and ensuring their proper utilization.
Preventive maintenance: Conducting scheduled inspections and servicing to identify faults before equipment breaks down.
Calibration and accuracy: Ensuring that diagnostic and monitoring equipment provides reliable readings and measurements.
Repair and troubleshooting: Identifying technical faults and restoring dysfunctional equipment to working condition.
Patient and operator safety: Checking electrical safety, equipment performance and compliance with relevant technical standards.
Procurement and installation: Advising hospital administrations on appropriate equipment specifications, installation requirements and technical suitability.
Training and technical supervision: Guiding healthcare personnel in the safe operation and routine care of medical devices.
Equipment replacement: Assessing the condition, remaining useful life and cost-effectiveness of ageing or obsolete equipment.
The distinction between operating a medical device and maintaining its technical integrity is particularly important. A doctor, nurse or laboratory technician may be trained to operate a particular machine, but that does not make them qualified to undertake its engineering inspection, calibration or repair.
Why biomedical engineering matters to public health
The relationship between biomedical engineering and public health is direct and consequential.
First, reliable diagnosis depends upon reliable equipment. Laboratory analysers, blood-pressure monitors, ECG machines, ultrasound systems and other diagnostic devices must function accurately. Faulty or poorly calibrated equipment can produce misleading results, potentially leading to incorrect diagnoses and inappropriate treatment.
Second, emergency and critical care depend upon uninterrupted equipment availability. Ventilators, defibrillators, oxygen concentrators, anaesthesia machines, infusion pumps and patient monitors are not merely hospital conveniences. They can be indispensable to saving lives. A technical failure at a critical moment can have serious consequences.
Third, infection prevention and control require properly functioning equipment. Sterilisation systems, autoclaves and other infection-control devices must undergo appropriate inspection and maintenance. Their malfunction can compromise patient safety and expose healthcare workers and patients to avoidable risks.
Fourth, equipment maintenance reduces unnecessary expenditure. Public hospitals frequently invest substantial amounts in expensive medical equipment. When machines remain dysfunctional for want of timely servicing, spare parts or qualified technical personnel, public investment is wasted. Regular maintenance prolongs equipment life, reduces replacement costs and improves the return on public expenditure.
Fifth, equitable healthcare requires geographical accessibility. Patients should not have to travel hundreds of kilometres simply because essential diagnostic or treatment equipment at their nearest public health facility is out of order. A properly organised biomedical engineering service can reduce such disruptions and improve the continuity of healthcare, particularly in remote and underserved communities.
The World Health Organization has consistently emphasised that medical equipment maintenance must encompass inspection, preventive maintenance and corrective maintenance. Its 2025 publication on medical-device inventory and maintenance management further underlines that equipment management is a continuous process extending from procurement and acceptance to maintenance and eventual decommissioning.
The particular urgency of the issue in Gilgit-Baltistan
The need for a functional biomedical engineering service is especially pressing in Gilgit-Baltistan, where geographical constraints, scattered settlements, difficult terrain and long distances between communities and referral hospitals create additional challenges for healthcare delivery.
Unlike densely populated urban centres, many communities in Gilgit-Baltistan depend upon a limited number of district hospitals, tehsil headquarters hospitals, rural health centres and basic health units. These facilities serve populations spread across distant valleys and mountainous settlements.
A dysfunctional medical device in a remote health facility is not simply an administrative inconvenience. It can mean the loss of an essential healthcare service for an entire surrounding population.
Consider a few practical situations:
A laboratory analyser at a district hospital becomes dysfunctional, forcing patients to seek investigations from private laboratories or travel to Gilgit.
An ultrasound machine remains unused because a technical fault cannot be rectified locally.
An oxygen concentrator or patient monitor develops a fault in a facility where no qualified biomedical engineer is available.
An autoclave fails to function properly, compromising the reliability of sterilisation arrangements.
A hospital purchases expensive equipment but cannot maintain it because the procurement process did not provide for technical support, spare parts and periodic servicing.
Such situations illustrate why healthcare infrastructure cannot be measured merely by the number of hospitals constructed, machines purchased or beds installed. Its effectiveness must also be judged by the actual availability, operational reliability and safety of the services those facilities are supposed to provide.
The problems reported at Gilgit's Provincial Headquarters Hospital in March 2025, including shortages of equipment, supplies and human resources, demonstrate the wider pressures facing public healthcare delivery in the region. This does not, by itself, establish the extent of biomedical engineering deficiencies, but it reinforces the need to examine equipment management as part of a broader health-sector assessment.
A policy gap that needs immediate attention
Pakistan already has a regulatory basis for proper medical-device management. The Medical Devices Rules, 2017, contain provisions requiring healthcare facilities to establish appropriate maintenance management systems. These include inspection and verification of equipment before acceptance, maintenance of an updated inventory, proper maintenance and calibration, and procedures for responding to defective devices and safety-related incidents.
Moreover, the WHO-supported guidance on biomedical equipment maintenance and oxygen supply systems in Pakistan emphasises scheduled preventive maintenance, calibration, technical training and the development of consistent equipment-management practices.
The issue, therefore, is not simply the absence of technical knowledge or internationally recognised standards. It is the need to translate these principles into an effective institutional arrangement within Gilgit-Baltistan's public healthcare system.
The Health Department must recognise biomedical engineering as an essential professional component of healthcare administration rather than treating it as an occasional repair service or an expenditure to be avoided.
It is equally important to appreciate that every small health facility may not require a full-time biomedical engineer. However, every public health facility must have assured access to qualified biomedical engineering services. This distinction offers a practical and financially sustainable way forward.
What needs to be done in Gilgit-Baltistan?
A comprehensive and phased policy intervention is required, with the following measures deserving immediate consideration.
1. Establish biomedical engineering units at major hospitals
The Provincial Headquarters Hospital in Gilgit and major regional and district headquarters hospitals should have dedicated biomedical engineering units staffed by qualified biomedical engineers and appropriately trained biomedical equipment technicians.
These units should be responsible for technical supervision, equipment inventories, preventive maintenance schedules, calibration arrangements, repairs and performance monitoring.
2. Ensure technical coverage of every public health facility
DHQ hospitals, THQ hospitals, rural health centres, basic health units, maternal and child health centres and other public healthcare establishments should be brought under an organised biomedical engineering maintenance network.
Where a full-time engineer is not economically or operationally justified, a cluster-based arrangement should be introduced. An engineer stationed at a district or regional hub could provide scheduled visits and emergency technical support to several surrounding facilities.
3. Conduct a comprehensive equipment audit
The Health Department should undertake a region-wide inventory of all medical equipment installed in public healthcare facilities, identifying:
Functional and non-functional equipment.
Equipment requiring repair or calibration.
Equipment lying unused because of missing accessories or spare parts.
Obsolete equipment requiring replacement.
Equipment requiring specialised manufacturer-authorised servicing.
This exercise would establish the actual scale of the problem and provide a sound basis for future budgetary allocations.
4. Introduce preventive maintenance and calibration schedules
Every public healthcare facility should maintain an equipment maintenance register, with documented servicing and calibration schedules.
Preventive maintenance must not be postponed until a machine breaks down. Equally, equipment should not be returned to clinical service after repairs until the necessary performance and safety checks have been completed.
5. Allocate a dedicated maintenance budget
Procurement of medical equipment should not be treated as a one-time purchase. Its entire life-cycle cost, including installation, accessories, consumables, maintenance, calibration, spare parts and technical support, must be considered.
The annual health budget should consequently include a distinct allocation for biomedical engineering and equipment maintenance.
6. Recruit qualified professionals and develop local capacity
The Health Department should create regular posts for biomedical engineers and biomedical equipment technicians, with recruitment based on recognised academic qualifications and relevant technical competencies.
Priority should also be given to the training and professional development of local youth in biomedical engineering. This would help create a sustainable technical workforce in Gilgit-Baltistan and reduce dependence on outside service providers.
7. Introduce a digital equipment-management system
A centralised digital database should record each medical device's location, installation date, manufacturer, warranty, operational status, maintenance history, calibration record and repair requirements.
A simple fault-reporting mechanism, with defined response times, would enable hospital administrations to report equipment failures and monitor their resolution.
8. Establish accountability and performance indicators
The performance of public healthcare facilities should be assessed not merely by the number of medical devices purchased but also by their operational availability.
The Health Department should regularly monitor equipment functionality, maintenance compliance, repair turnaround times, calibration status and equipment downtime.
9. Explore institutional partnerships
The government may explore partnerships with recognised engineering universities, technical institutions, medical equipment manufacturers and qualified service providers to facilitate specialised training, technical support and capacity building. Any outsourcing arrangement should retain clear government oversight, transparent service standards and accountability.
The way forward: A provincial biomedical engineering programme
Gilgit-Baltistan needs a coordinated provincial programme for medical equipment management and maintenance, preferably under a dedicated Biomedical Engineering and Health Technology Management Directorate or an appropriately empowered unit within the Health Department.
Such a programme should have a clear mandate to:
Develop uniform equipment-management standards for all government healthcare facilities.
Maintain a province-wide inventory of medical devices.
Establish regional biomedical engineering workshops and technical support centres.
Ensure timely preventive and corrective maintenance.
Monitor the performance of equipment and technical personnel.
Coordinate with manufacturers and authorised service providers.
Prepare an annual report on equipment functionality, maintenance expenditure and service deficiencies.
The programme should also distinguish between biomedical engineers, biomedical equipment technicians and clinical equipment operators. Their respective qualifications, responsibilities and professional boundaries must be clearly defined.
This is particularly important because the presence of a technician or an equipment operator cannot always substitute for the professional expertise of a qualified biomedical engineer, especially where sophisticated diagnostic, life-support and critical-care equipment is concerned.
A matter requiring the attention of the government and elected representatives
The issue deserves the attention of the Gilgit-Baltistan government, particularly the Chief Minister, Minister for Health, Secretary Health, the provincial Health Department and elected representatives of the Gilgit-Baltistan Assembly.
The Assembly's relevant committee should take up the matter and seek a comprehensive briefing from the Health Department regarding:
The total number of biomedical engineers presently employed in the government health sector.
The number of biomedical equipment technicians available across the region.
The existing arrangements for maintenance and calibration of medical devices.
The number and value of dysfunctional or underutilised medical machines in public hospitals.
The budget allocated for equipment maintenance and technical services.
The government's plans for establishing a province-wide biomedical engineering service.
On the basis of this assessment, the government should formulate a time-bound implementation plan, with defined staffing requirements, budgetary provisions and measurable performance targets.
Conclusion: Healthcare investment must be protected by technical expertise
Gilgit-Baltistan cannot afford to invest scarce public resources in expensive medical equipment only to see it become dysfunctional, underutilised or obsolete for want of qualified technical personnel.
The success of a hospital is not determined merely by its buildings, beds, doctors or the quantity of machinery installed. It also depends upon whether the equipment is functional, safe, properly calibrated and available when patients need it.
A modern healthcare system requires a close working relationship between medical professionals and biomedical engineers. While doctors and other healthcare professionals diagnose and treat patients, biomedical engineers ensure that the technological instruments upon which much of modern medicine depends remain safe, accurate and operational.
The demand, therefore, is straightforward: every public healthcare facility in Gilgit-Baltistan must be provided with assured access to qualified biomedical engineering services, either through an in-house professional or an organised regional maintenance network.
This should be recognised as a basic institutional requirement rather than an administrative luxury.
For a geographically challenging region like Gilgit-Baltistan, where patients often have to travel considerable distances to access specialised medical services, ensuring the functionality of existing healthcare equipment is as important as expanding the number of healthcare facilities.
Ultimately, biomedical engineering is not simply about maintaining machines. It is about protecting patients, safeguarding public investment, improving diagnostic reliability and ensuring that the people of Gilgit-Baltistan receive the healthcare services to which they are entitled.
The government must move beyond procuring medical equipment and establish the professional infrastructure necessary to keep it working. Public health cannot be assured by machinery alone; it requires the expertise of those who maintain its safety and reliability.
Comments