Health Technology Management and monitoring of pregnancy in a low-resource setting: a case study

This thesis analyzes both the implementation of an Health Technology Management system and the first phase of the development of appropriate technological solutions for obstetric monitoring at Luisa Guidotti Hospital in Zimbabwe. The work is structured around two main pillars. Firstly, a management system based on WHO guidelines was studied appropriately for the context of Luisa Guidotti Hospital. Then it was implemented, starting with the creation of a digital inventory and the establishment of preventive and corrective maintenance protocols. This experience, compared with an internship at the Policlinico Sant'Orsola-Malpighi in Bologna, highlighted how, despite the positive reception from local staff, the long-term sustainability of such systems is heavily constrained by resource limitations and the need for administrative simplification. Secondly, the thesis addresses neonatal and maternal care through the Fetal Heart Rate (FHR) monitoring, with a particularl attention to the Moyo Fetal Heart Rate Monitor, a compact digital fetal monitor designed for intermittent auscultation. Based on the limitations identified in the FHR monitoring field, and the characteristics of the Moyo device, we started the biodesign process for a new medical device to optimize Intermittent Auscultation. This new proposal integrates the fetal heart rate monitoring of the original Moyo with uterine contraction tracking, aiming to reduce operator dependency and improve diagnostic accuracy without leading to excessive medicalization. In conclusion, the study demonstrates that the effectiveness of technology in constrained settings depends on a participatory approach and context-sensitive design. While digitalization can support staff in overcrowded wards, technological integration must always be accompanied by continuous training and a lean management structure to not increase the workload on clinical staff, and to ensure a real improvement in clinical outcomes.