Theoretical Framework for Designing Sustainable Biomedical Engineering Ecosystems in Sub-Saharan African Health Systems: A Nigerian Systems Model

Biomedical engineering capacity in sub-Saharan African health systems is typically developed through isolated device donation programmes, episodic training initiatives, and uncoordinated local innovation activities that fail to achieve self-sustaining ecosystem properties, resulting in perpetual external dependency and inability to respond to evolving health technology needs with indigenous resources. This dissertation develops an original theoretical framework for designing sustainable biomedical engineering ecosystems in sub-Saharan African health systems, using Nigeria as the primary system for theoretical grounding and empirical validation. Ecosystem sustainability is theorized through a systems science lens drawing on industrial ecology, innovation systems theory, complexity science, and institutional economics, defining sustainability as the self-perpetuating capacity for biomedical engineering knowledge production, technology development, maintenance capability, workforce reproduction, and regulatory governance within the health system. The theoretical framework specifies eight ecosystem subsystems and their mutual dependence relationships: education and training, research and development, local manufacturing, import and procurement, maintenance and service delivery, regulation and standards, health technology assessment, and financing. For each subsystem, sustainability criteria are derived theoretically and operationalized as measurable indicators. A cross-national comparative analysis of biomedical engineering ecosystem maturity across Nigeria, Ghana, Kenya, South Africa, and Rwanda using the indicator framework provides empirical calibration of the theoretical subsystem interdependencies. A dynamic systems simulation model of the Nigerian biomedical engineering ecosystem is constructed from the theoretical framework and empirical data, and used to test intervention scenarios targeting different ecosystem leverage points. Original contributions include the multi-subsystem ecosystem sustainability theory and the dynamic simulation model providing quantitative guidance for investment prioritization. Keywords: biomedical engineering ecosystem, sustainability, sub-Saharan Africa, systems theory, Nigeria.