Context-Sensitive Design of a Device for Intermittent Auscultation during Labor and Implementation of a Health Technology Management System in a Low-resource Setting

The global disparity in access to quality healthcare technologies is particularly evident in low-resource settings, where the lack of functional and sustainable medical equipment compromises clinical outcomes. A key issue is the fragmentation of Health Technology Management (HTM) systems and the unsuitability of some devices for the local context. This thesis addresses both through a dual strategy: implementing a structured HTM system at Luisa Guidotti Hospital in Mutoko, Zimbabwe, and designing a context-sensitive medical device to optimize intermittent auscultation (IA) during labor. The HTM component was developed using a comparative approach. HTM practices at Sant’Orsola Hospital in Bologna were analyzed and adapted to the Zimbabwean context. On-site activities included a complete equipment inventory, identification of maintenance priorities, staff training, and implementation of preventive and corrective protocols based on WHO guidelines. The process highlighted both the advantages and limits of introducing structured HTM in low-resource settings. While the workflow was initially adopted, long-term sustainability remains challenged by limited resources and lack of specialized personnel.The second objective addressed intrapartum fetal monitoring. In low-risk pregnancies, continuous cardiotocography (CTG) does not improve neonatal outcomes and increases unnecessary interventions. IA remains a safer and cost-effective alternative but is limited by tools like the Pinard or DeLee stethoscope, which suffer from poor ergonomics, subjectivity, and lack of standardization. Field research involving interviews and observations led to the design of a new device concept integrating FHR and uterine contraction monitoring. By combining HTM implementation with the development of an appropriate device, this thesis highlights the role of biomedical engineering in addressing global health challenges through context-driven, interdisciplinary, and sustainable solutions.