1.2 / PROGRAMME FOR ORGANIZATIONAL DEVELOPMENT
1.2.2 / Medical Equipment management improvement(as of March 2008)
A / Focal Point / DDG(BES), Provincial Directors of Health Services.
B / Implementing Agencies / DDG(BES), Central BES, PDHS, Provincial BES, Respective Hospitals
C / Target Areas & Beneficiaries / Beneficiaries are all patients and the health care workers of the entire country
Project Summary
Ministry of Health is committed to ensure the availability of good quality, safe and effective essential drugs to the people. The aim is to make sure efficient supply with continuous availability of life saving, essential drugs vaccines in all health institutions.
This project covers supply and distribution of all essential drugs and all other medical supplies except medical equipments to all government and semi government health institutions. Also it is responsible to the supply of narcotic drugs to both public and privet sector. Prime problems at present the Medical Supplies Division is facing are incompatibility of physical drug estimates with the financial allocations. Increased receipt of poor quality drugs, delay of supply as per agreed schedules leading to extra expenditure on local purchases and absence of good guidelines for re-imbursement for quality failed drugs.
The "First in First out" principle is hardly practiced due to failure in quick identification of batch numbers and expiry dates on outer packages because of labels containing small illegible letters & figures. As a result ledger entries cannot be made as per batch amounts and no cross sectional age analysis of stocks can be made.
Reliable most recent information should be collected regularly on drugs & use of drugs from planers and consumers to improve the rational use of drugs to make the project efficient & effective.
Planning for future developments should take into consideration the adequate additional requirements of medical supplies in estimates in advance to avoid delays and problem of exceeding allocations.
1. Justification:
Medical equipment management in the country is still performed centrally by the Division of Biomedical Engineering Service, and this division is responsible for all the procurement, maintenance and management activities related to medical equipment, in most of the government hospitals in the country. Provincial councils also procure equipment but their maintenance capabilities are not in par with the required level.
The total assets maintained by the central BES is estimated to be Rs. 12,000 million. These assets are distributed among several levels of government hospitals scattered all over the country. Due to ever increasing sophistication and the ever-increasing quantities of equipment, this central equipment management system has become no more effective and sustainable. Therefore in order to increase the efficiency and cost-effectiveness, decentralised units need to be established at provincial level and at teaching hospital level. It is also required to strengthen the central BES as medical equipment technology is stedily growing in sophistication at a rapid pace. At present one technician is responsible for 750 hospital beds, and there is no mechanism/budget to upgrade their knowledge and skills resulting most of them are not in par with the current technological advancements.
It is also observed that more emphasis is given to procure sophisticated capital equipment and establishing new units, neglecting the maintenance of commonly used equipment. The present maintenance system has further deteriorated due to inadequate maintenance budget, skilled manpower, lack of a maintenance policy and lack of basic facilities required for the successful functioning etc. The available resources are hardly sufficient to implement periodic inspection and preventive maintenance system, though it is essential for safe and reliable operation of medical equipment. It is noteworthy that providing more budget on maintenance can definitely reduce the budget on new procurement and the net result would be a big saving to the health sector.
At present, approximately 50% of the medical equipment at government hospitals in the country is not in proper working condition due to lack of maintenance and non-availability of consumables, trained operators etc. Especially at provincial level, there are large number of sub-standard equipment and there is no uniformity in availability of equipment at similar institutions due to non-availability of standard equipment list and generic specifications. Still enough attention is not given for the decommissioning obsolete equipment out of the system. Lack of information required for decision-making and lack of coordination between BES and hospitals has also contributed adversely to this situation. Therefore it is paramount to have a computerised medical equipment information system including equipment inventories, equipment related policies, maintenance records, equipment planning methodologies and cost involved etc. Non-availability of this information has affected to the system by making it difficult to arrive at informed and evidence based decisions on medical equipment management. In addition, there shall be a methodology to monitor and evaluate the performances of equipment, to make decisions more precisely in the future.
In order to ensure good management and engineering practices, it is mandatory to train engineers at central BES and provincial BES on healthcare technology management and clinical engineering. There shall be a mechanism and a budget line for continues training of technical personnel, end-users, supporting staff, and decision-makers in both public and private sector. The central BES facility could be utilised to train technical staff from developing countries. There had been some successful programmes conducted by central BES for Biomedical Engineers/Technicians from developing countries in collaboration with Japan International Cooperation Agency (JICA).
2. Important Assumptions/Risks/Conditions:
Risks:
Government policies may be changed.
Sufficient budget may not be allocated.
Sufficient human resources and facilities may not be provided.
Equipment policy may be changed time to time.
Medical equipment has not been a correct priority as being an important component in
functioning of health sector.
Difficulty in coordinating with other agencies who are responsible for the project
implementation.
Delays in implementing related projects.
Accepting used/discarded equipment as donations which could not be serviced in Sri
Lanka.
3. Project Objective:
Objective / Indicators / Means of VerificationTo increase efficiency and cost-effectiveness of medical equipment in utilisation and management in the public health sector / Equipment up time
Mean time before equipment failure (MTBF)
Response time to attend repairs
Number of functional maintenance units at provincial level
Number of functional maintenance units at teaching hospital level
Number of hospital beds per technician
Number of training courses conducted for end-users, technical and other staff
Number of hospitals covered by the medical equipment information system
Number of IPM programmes conducted / Equipment maintenance records
Surveys
Equipment records and staff records
Training records Inspection and preventive maintenance records
4. Project Output/Product:
Outputs / Indicators / Means of VerificationAn efficient and effective medical equipment maintenance system established in public health sector / Availability of efficient and effective medical equipment maintenance system / Project report
An evidence based equipment procurement planning system established / Availability of evidence based equipment procurement planning system / Project report
A medical equipment management system established / Availability of medical equipment management system / Project report
A training centre established for continuous training on health care technologies and clinical engineering / Availability of a training centre / Project report
Public private partnership maximized / Number of private organizations working in partnership with the state / Reports
5. Related Projects:
Project No. / Project Title1.1.2 / Facility Development According to the Rationalized Health Services Delivery Plan
1.14 / Strengthening of Laboratory and Diagnostic Services
1.1.6 / Technology Assessment
1.2.1 / Medical Supplies (including drugs)
6. Relevant Agencies to be Coordinated:
MoH, Provincial Governments, Central BES, Respective hospitals.
7. Monitoring & Evaluation:
1. Who? Central MoH, Central BES, Respective hospitals, Provincial Health
authorities, Provincial BES.
2. When? Annual report, Annual survey, Periodic survey, Ad-hoc survey
3. What actions to be taken based on results of monitoring & evaluation?
Revision of procedures, Identification of performance gap and find
solutions in order to fill the gap.
8. Activities:
Activities / Expected Results / Process Indicators1 / Establish provincial maintenance units / Provincial maintenance units in place / Develop proposals
Purchase equipment Train HRs
2 / Establishment hospital based maintenance units at District Base / District General/Teaching Hospitals / Hospital based maintenance units established / Develop proposals
Purchase equipment Train HRs
3 / Strengthen the capacity at central BES / Capacity at central BES improved / Develop proposals
Train HRs
4 / Formulate a equipment purchasing, maintenance and replacement policy / Equipment policy developed / Nominate consultative team
Develop policy
5 / Establish a system for an equipment audit / Equipment audit system developed / Develop the system
Pilot the system
6 / Establishment of standard list of equipment for each category of Health Institutions / Institution specific standard developed / Nominate consultative team
Develop list
7 / Formulation of generic specification for all equipment and issue guidelines to provincial set up / Generic specifications identified / Nominate consultative team
Develop guidelines
8 / Establishment of evidence based spare parts procurement plan / Spare parts procurement plan developed / Nominate consultative team
Develop plan
9 / Establish a mechanism for better coordination between hospitals & MSD to assist procurement of reagents, consumables etc. / Coordination between hospitals & MSD to assist procurement of reagents, consumables etc. improved / Appoint a working group
Design the mechanism
10 / Establishment of a computer based medical equipment information system (data base) at centre/district general/teaching hospitals, including equipment inventory, maintenance information, stores management etc. / A computer based medical equipment information system developed / Identity the data field
Design the system
Pilot the system
11 / Organize post graduate opportunities in medical equipment management /clinical engineering for BES engineers and provincial engineers / Post graduate opportunities in medical equipment management /clinical engineering developed / Identity training needs
12 / Develop equipment utilization monitoring criteria / Equipment utilization monitoring criteria developed / Appoint a working group
Develop the criteria
13 / Establish a training programme and centre to provide CE for BES staff, end users, provincial BES staff, private sector personnel and others / Staff trained / Identity training needs
Design training programmes
14 / Establish a mechanism to assist private sector in their capacity building and in maintenance of equipment / A mechanism established to assist private sector in their capacity building and in maintenance of equipment / Appoint a working group
Develop the mechanism
15 / Develop a system to assist private sector in calibration /testing their equipment / A system developed to assist private sector in calibration /testing their equipment / Appoint a working group
Develop the criteria