Chapter 10
Clinical engineering in Mexico
Roberto Ayala
Health Technology Excellence National Center, Mexico City, Mexico
Mexico is proudly one of the first countries in the Latin-
American and Caribbean region to develop clinical engi-
neering (CE) programs, going back as far as early 1970s, and
being recognized as such by their regional peers. Nowadays
the CE practice has presence in all sectors that provide health
care in Mexico, and has one of the first Ministry of Health’s
agency dedicated to advance CE and health technology man-
agement (HTM). But there is still much work to be done,
like having national policies on HTM and CE practice. In
the this chapter the author discusses the HTM problem in
Mexico, the work done by biomedical engineers in hospitals,
how is the educational ground for CE, the achievements by
CE professionals and the challenges ahead.
Health technology management problems
in Mexico
One challenge for every health system around the globe is to
warrant the proper management of their health technology,
including medical equipment, as commanded by the World
Health Organization in the WHA60.29 resolution (World
Health Organization, 2017a). Unfortunately, medical equip-
ment does not always cover its purpose to help solve health
problems due to malpractices in HTM and Mexico is no
exception.
According to a diagnosis made by CENETEC (National
Center for Health Technology Excellence) (CENETEC,
2017c), which we talk about it in length further, there are
three main problems regarding medical equipment in health
facilities:
● Medical equipment in inappropriate state, inoperative,
and/or insecure, due to lack of maintenance and/or op-
erative capacity.
● Inadequate planning and management of medical
equipment.
● Lack of knowledge and inadequate formation of person-
nel in charge of medical equipment management.
As a result around 10%–30% of medical equipment in-
stalled in the country is not able to produce the results that
are expected from them.
82
In order to achieve the goal of an effective access to
medical technology, with efficacy and safety, for every pa-
tient who needs it, it is imperative to improve its manage-
ment, and in Mexico a biomedical engineer with specialty
in CE is a suitable professional for the task.
Biomedical/clinical engineering
in Mexican hospitals
The National Health System in Mexico, as of 2017, has
more than 33,989 establishments for medical care, di-
vided into three attention levels: primary care (first level),
hospitals (second level), and specialty care (third level)
(Fig. 1).
Mexico’s health system is a segmented one and is com-
posed of several sectors, each with administrative and legal
autonomy, thus having particular operative policies, includ-
ing those for managing medical equipment (Fig. 2).
The first biomedical engineering (BME) department in a
Mexican hospital, doing CE tasks, was founded in a public
hospital in 1977. In the private sector the first BME depart-
ment was set in 1984. Since then, at the time of publishing
this article, every health sector and at least 29 of the 32 states
that composed the Mexican Republic had at least one BME
department doing CE tasks. The social sector that provides
health care to the working class, Instituto Mexicano del
Seguro Social, has established a policy (Instituto Mexicano
del Seguro Social, 2017) to have BME departments in each
of their high specialty hospitals (UMAE, High Speciality
Medical Unit) and in each of their 32 state delegations.
In all of the 12 national health institutes (high specialty
healthcare organizations) there is a BME department and
according to the Ministry of Health database of resources
(Dirección General de Información en Salud, 2017b), there
is a register of 112 BME departments in public hospitals
across the country. There is no accurate data because an of-
ficial and updated census of BME departments in Mexico
has not been made, but the coverage on all the health estab-
lishments in Mexico is believed to be less than 20%, this be-
ing the biggest challenge of the CE practice in the country.
Clinical Engineering Handbook. https://doi.org/10.1016/B978-0-12-813467-2.00010-9
Copyright © 2020 Elsevier Inc. All rights reserved.

FIG. 1  Number of healthcare establishments in Mexico (Dirección General de Información en Salud, 2017a).
FIG. 2  Health sectors in Mexico.
According to a survey conducted by CENETEC in 2014
(CENETEC, 2017d), in 19 public hospitals, the following
results came regarding the participation of biomedical/clini-
cal engineers in HTM processes:
● 62% of BME departments participate in planning pro-
cesses for medical equipment; 23% don’t have any in-
volvement at all.
● 62% participate in the incorporation process for medical
equipment.
Clinical engineering in Mexico Chapter | 10  83
● 69% have an inventory of the medical equipment.
● 77% have a medical equipment maintenance program.
● 54% have involvement in the disposal procedure of
medical equipment.
Typically the highest position a biomedical/clini-
cal engineer in a hospital department can hold is Chief
of Department, but there are cases where a professional
in the field has had charges such as Operations Manager,
Technology Manager, Subdirector, and even as a hospital
84  SECTION | 2  Worldwide clinical engineering practice

General Director (at least two documented cases), among (ANUIES) (Asociación Nacional de Universidades e
other high organizational positions. Instituciones de Educación Superior, 2019). Fig.  3 shows
The number of personnel in a BME/CE department var- the distribution of students per state, Mexico City being the
ies much, in a range of 2–25 persons. There is no normative highest in concentration.
or regulatory requirement to have BME department in hos- Although the academic programs are very similar to
pitals, although there are two Official Mexican Normatives those for BME program, some institutions name their bach-
(NOM) that refer to the role of biomedical engineers; one for elor degree different, with equivalents such as bioengineer-
electrical installations, in the chapter of hospital installations ing, medical bioengineering, electromedical engineering,
(CENETEC, 2017a) and the other regarding medical device and biomedical systems engineering. CE is identified as
alerts, known as techno-vigilance (CENETEC, 2017b). a specialty in the BME academic programs, but not all re-
The CE departments in Mexico are looking to strength fer it as such. In 2017 the first master’s degree in CE was
their HTM responsibilities by incorporating procedures launched, in the Southeast State of Yucatan. There are also
such as quality assurance, medical equipment metrology, several independent companies offering CE/HTM courses
techno-vigilance, and interoperability, among other modern all year long, in both classroom and virtual modalities.
trends. It should also to be noted that some clinical engi-
neers have responsibilities in telemedicine/telehealth pro- BME associations in Mexico
grams of some public health providers.
In 1978 the first national BME society, Sociedad Mexicana
Biomedical/clinical engineering de Ingeniería Biomédica A.C., SOMIB (Sociedad Mexicana
de Ingeniería Biomédica A.C., 2019), was founded, rec-
education in Mexico
ognized internationally by institutions like the IFMBE
The first BME bachelor programs in Mexico were es- (International Federation of Medical and Biological
tablished in 1973, in Mexico City, by two universities, Engineering), AAMI (Association for the Advancement of
Universidad Iberoamericana and Universidad Autónoma Medical Instrumentation), and ACCE (American College
Metropolitana Unidad Iztapalapa. In 1981 it began the BME of Clinical Engineering), and have done until 2019 42 con-
bachelor program in the Instituto Politécnico Nacional. The gresses. The Society includes a CE committee.
first generation released just a couple of dozen professionals. In 2015 a BME professional college, Colegio de
By 2018, more than 11,000 Mexicans were studying BME Ingenieros Biomédicos de México A.C. (Colegio de
bachelor program in 49 universities throughout the coun- Ingenieros Biomédicos de México A.C., 2017), was founded
try, 57% male and 43% female, according to the National that requires its members to have concluded their professional
Association of Universities and High Education Institutes studies. This association does include a CE commission.

2500 8

2000
6

5
1500

1000
3

2
500

0 0
AGS

BC

BCS

CAM

CHIA

CHIH

COAH

COL

ED OMEX

DGO

GRO

GTO

HGO

JAL

MICH

MOR

NAY

CDMX

NL

OAX

PUE

QRO

Qroo

SIN

SLP

SON

TAB

TAM

TLA

VER

YUC

ZAC

Students number Universities number

FIG. 3  Number of BME students by state.

 Clinical engineering in Mexico Chapter | 10  85

FIG. 4  Infographics made by CENETEC about HTM.

86  SECTION | 2  Worldwide clinical engineering practice
Achievements of CE in Mexico
One important achievement of the BME/CE profession in
Mexico was the creation of the CENETEC (Centro Nacional
de Excelencia Tecnológica en Salud, 2017) (Fig. 4). Founded
in 2004 as part of Mexico’s Ministry of Health structure,
by the internationally recognized and CE certified Adriana
Velázquez, MsC, to support and advance health technol-
ogy assessment (HTA) and HTM for the National Health
System, it soon began to generate services and tools in those
areas, such as the following:
● Guidelines and recommendations for HTM processes.
● Technical specifications charts for medical equipment.
● Courses and workshops for CE/HTM education.
● Participation in workgroups for medical equipment
normatives.
● Participation in validation process for federal financing
of medical equipment.
In 2009 CENETEC became a Collaboration Center for
WHO and PAHO (Panamerican Health Organization) for
HTA and HTM functions, and has been recognized by inter-
national institutions like ACCE, HTAi (Health Technology
Assessment International), and IFMBE, among others.
In 2008 a Mexican biomedical/clinical engineer took
position at the Medical Devices Coordination Group for
the World Health Organization: Adriana Velázquez, MSc/
CCE, once again proving her commitment for the better-
ment of health technologies assessment and management.
Since then, a vast production of resources has been offered,
from HTA/HTM publications, guidelines, and statistics to
the organization of global forums regarding all topics about
medical devices (World Health Organization, 2017b).
Challenges for CE in Mexico
As mentioned earlier, there is still a worrisome shortage
of BME/CE departments in Mexican hospitals, both pub-
lic and private. Even though it is clear that there are suf-
ficient professional offers, with the growth of educational
instances with BME programs, and the recognized need for
them in health organizations, some issues should be solved
to make the match and those include a better payment and
the opportunity to prove that these professionals can do
more than just medical equipment repair. For that reasons,
and to strength the profession, there should be a norma-
tive and regulatory framework for CE practice in both
public and private institutions.
There is also a need to make sure that BME bachelor
programs include appropriate CE and HTM courses, with
proper educational resources and based on Mexico’s par-
ticular problematic regarding HTM in the National Health
System.
Regardless, Mexico’s CE and HTM experience has re-
corded an important progress and is keeping a steady pace,
looking not to be a region leader of sorts but to keep contrib-
uting for a better, safer, and good-quality health care.
References
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