CCIHBiomed Capacity

Building for Mission hospitals

CCIHBiomed Capacity

Building for Mission hospitals

NEED

What is the condition of the equipment well meaning donors

have sent to mission hospitals or that hospitals have purchased?

Estimates vary from 40 to 90 % of medical equipment shipped to hospitals in developing countries is inoperative at any given time, some of which has never worked after arrival.

WHO has documented that “50% of medical equipment

(in developing countries) is not in use”Found in:

*        Maintenance of Hospital Equipment, 21st Meeting of PAHOExecutive Committee of the Directing Council, Washington D.C., 9-10December 1993, SPP21/4, 8 November 1993

*        Investing in Health, World Development Report 1993, chapter 6on Health Inputs, p 134-155, World Bank, 1993

*        Health Care Equipment: A WHO Perspective, by A. Issakov, inMedical Devices: International Perspectives on Health and Safety, editedby C.W.D. van Gruting, p. 3-5, Elsevier, 1994

*        Service and Maintenance in Developing Countries, by A. Issakov,in Medical Devices: International Perspectives on Health and Safety,edited by C.W.D. van Gruting, p. 21-38, Elsevier, 1994

*        Better Health in Africa: Experience and Lessons Learned,chapter 7 on Infrastructure and Equipment, p. 98-108, World Bank, 1994"

Some of the reasons that at least 50% of equipment is inoperative

• Lack of maintenance

• Lack of spare parts

• Equipment is too sophisticated

• Medical staff do not know how to use it

• Equipment shipped in “as-is” condition and not properly prepared for use overseas

Lack of Maintenance:E-mail received April 28, 2008

“My name is Andreas Andoko. I'm the superintendent of the Imanuel Baptist Hospital in Bandar Lampung, Indonesia. As a former missionary hospital we have many medical equipments that we’ve had since the hospital was founded. Many of them discontinued (taken out of service) since:

(1) we couldn't repair(2) we couldn't find the spare parts(3) Buying new is too expensive for us.

Because of this our medical services to the public has to decrease.

In Indonesia more than fifty former missionary of Christian hospital that have same problem with us.”

Mother hand venting her child

Upstairs is room full of inoperative ventilators

Lack of Spare Parts:

• E-mail received April 28, 2008 (less than one month ago)

• “My name is Andreas Andoko. I'm the superintendent of the Imanuel Baptist Hospital in Bandar Lampung, Indonesia.

• As a former missionary hospital we have many medical equipments that we’ve had since the hospital was founded.

• Many of them discontinued (taken out of service) since:• (1) we couldn't repair or• (2) we couldn't find the spare parts• (3) Buying new is too expensive for us.

• Because of (the above) our medical services to the public has to decrease.

In Indonesia more than fifty former missionary of Christian hospital that have same problem with us.”

Difficulty finding and purchasing repair parts

Acquiring parts is the number one difficulty all developing world technicians face

Example:

My name is Carlos Amaral. I am biomedical engineer from Mercy Ships. We are starting one project to train and support West African Hospitals in the biomedical field. One of the ideas is to help with the acquisition of parts. Could International Aid help us to purchase such items?

Not knowing how to use it

New x-ray machine-has never been used. Why? Staff received no training on how to use it

Not knowing how to use it:

A very nice ultrasound that has never been used. Why? Staff received no training on how to use it

Equipment shipped “As-is”

• When new or used medical equipment is sent to a mission hospital without checking it out to make sure everything works

• Equipment shipped without making all necessary repairs

• Equipment shipped without preparing it to work on the electrical power in that country

• Equipment left for the hospital to figure out installation requirements and other details on their own.

CCIHBiomed Capacity

Building for Mission hospitals

NEED

TRAINING TECHNICIANS

Medical Equipment TrainingEmpowering Nationals to Help Their Own

Communities

Teaching valuable skills to improve healthcare

Empowering healthcare facilities with self-sustainable solutions

Providing instructors to teach electronics and medical equipment repair to hospital maintenance workers

Providing tools, test equipment and service manuals

Course Outline Mod 1 & 2 MODULE I

IA – Maintenance Management

– Maintenance Philosophy– Planned Preventive Maintenance– Inventory Control– Electrical Safety Practices– Standards and Regulations– Networking

IB – DC Electricity– Magnetism– Electrical Circuits– Ohms Law– DC Components– Troubleshooting Theory

IC – Equipment Troubleshooting I– BP Apparatus– Sterilizers– Microscopes– Suction Pumps– Oxygen Equipment

MODULE II

IIA – Shop Practice

Hand Tools, Care and Safe UseSoldering and DesolderingWeldingShop Safety

IIB – AC ElectricityAC WaveformsAC Test EquipmentVoltage DividersPower CalculationsAC ComponentsTransformers AC Power Production & Delivery

IIC – Equipment Troubleshooting IIEye Equipment Dental EquipmentRespirators and Ventilators

Course Outline Mod 3 & 4MODULE III

III A – Medical Education Anatomy & PhysiologyMedical Terminology

III B – Solid State Devices

DiodesTransistorsAmplifiersVacuum TubesReading/Extracting Circuit Diagrams

III C – Equipment Troubleshooting III Electrosurgical UnitsPhysical Therapy Equipment

MODULE IV

IV A – Radiation Theory & PracticesRadiation SafetyX-Ray PhysicsFilm Production & DevelopingX-Ray Quality Control

IV B – Circuit Reading & TroubleshootingCircuit ReadingTroubleshootingBuild Power Supply

IV C – Equipment Troubleshooting IVMobile and Stationary X-Ray MachinesSingle phase, 3 phase & high frequency generatorsHigh Voltage TransformersX-ray Tubes and CollimatorsTables and tube stands

V D – Instructor TrainingWriting Lesson ObjectivesUsing Audio Visual MaterialsConducting Evaluations

Course Outline Mod 5 & 6MODULE V

V A – Basic Laboratory Technology Role of Laboratory in DiagnosisBlood & Body FluidsBlood Typing

V B – Motors, AC and DCCommon Problems and SolutionsControl Systems

V C – Digital FundamentalsLogic GatesMicroprocessorsMicrocontrollers

V E – Equipment Troubleshooting VGeneral Laboratory EquipmentColorimetersSpectro and Flame PhotometersCentrifugesAutoanalyzers

MODULE VI

VI A – Biomed Computer ApplicationsElectronics Workbench SoftwareHospital Equip. Management programsOn-line CoursesInternet Search Techniques for technical information

VI B – Advanced TroubleshootingElectrocardiographsCardiac MonitorsDC DefibrillatorsPatient Care EquipmentPulse Oximeters

VI C – Equipment Troubleshooting VIDiagnostic UltrasoundMonitorsFetal Monitoring

VI D – Supervised Work ExperienceMedical Computer TechnologyCardiac equipment

Ghana

• How did we get there?- MET program began in Ghana in 1998

• What have we accomplished?- 140 students have participated- 86 students have graduated- 11th class will begin June 2 (45 students approved)- 13 countries benefiting to date (Cameroon, Chad, Dem Rep of Congo,

Ethiopia, Ghana, Kenya, Liberia, Nigeria, Sierra Leone, Togo, Uganda, United Kingdom and Zimbabwe)

- 4 graduates have participated as instructors- Will be certified by Ghana Education Service in July 2008

Active areas for IA

Honduras

• How did we get there?- MET began as a Development Project after

Hurricane Mitch

• What have we accomplished?- All lectures and training materials are in Spanish- 111 students have participated- 72 students have graduated- New class of 23 students began May 5

Active areas for IA

India

• How did we get there?- Rotary International Matching Grant

• What have we accomplished?- Program ran from 1999 to 2000- 19 students enrolled- 10 hospitals benefited in India- 21 hospitals benefited in Nepal

Active areas for IA

Indonesia

• How did we get there?- In response to Dec 2004 Earthquake and Tsunami

• What have we accomplished?- Medical Equipment Service Center opened Nov 2005- MET training began September 2006- All lectures and training materials in Indonesian Bahasa- 57 students participated

Active areas for IA

Kosovo

• How did we get there?- MET began in 2001 after NATO bombing

• What have we accomplished?- New training facility set up and equipped

- All materials translated into Albanian

- 45 students participated

- 43 students graduated

- 6 hospitals received new biomed workshops

Active areas for IA

Philippines

• How did we get there- 2001 Rotary Foundation 3-H grant

• What have we accomplished?- 192 students participated- 47 students graduated- 26 students enrolled in MET Extension- 3 colleges now use MET curriculum for training programs- Certified by Technical Education & Skills Development Authority

Active areas for IA

Correspondence Courses

- 7 students enrolled- 4 countries benefiting

Chile Guatemala Haiti India

-Conducted via e-mail and ftp file transfer

MET Global ImpactKosovo

Honduras Ghana

Indonesia

Philippines

India

540 Students have participated248 Technicians graduated from MET course

312 Hospitals have in-house biomed technicians 26 Countries have benefited

Guatemala

Chili

Haiti

CCIHBiomed Capacity

Building for Mission hospitals

NEED

TRAINING TECHNICIANS

TRAINING ADMINISTRATORS

Advanced Medical Equipment Management

A Program for Health Reform

A Presentation to CCIH

May 25, 2008

90% ofpopulation Primary Health

Care(promotion,

preventive, &basic curative

services)

SecondaryHospital Care

(hospitalservices)

Tertiary HospitalCare

(specializedservices)

9% of population

1% of population

10-15% of Expenses

45% ofExpenses

40% of Expenses

Health ExpendituresPopulation to be Served

Health Pyramid ShowingProportion of Expenses

with People Served

The Need

• Hospital operations not working at peak efficiency levels

• Dependence on foreign consultants & repair services

• Drain on foreign currencies• Compromises quality &

effectiveness of healthcare

A Proposed Solution to Improve Hospital Productivity

& Cost Efficiencies…

International Aid’s Advanced Medical Equipment Management Program

To improve health care delivery through professional equipment management for medical equipment

Hospital Equipment Management Training

• One Year – Learn & Do• Quarterly 1 week learning events• 4 Modules (one per quarter)• In partnership with World Health

Organization and Pan American Health Organization

Support Systems

• Equipment Inventory System• Preventive Maintenance System• Equipment Management Info

System• Equipment & Technology Acquisition

System

Process• 2-3 year process

• Assessment & Inventory

• Baselines

• Training Events (MET & AMEM)

• Systems Development /Installation

• Establish Repair Centers

• Evaluation (Measurable Results)

Benefits

1. Increased saved lives from proper equipment operations

2. Cost Savings from more efficient equipment operations for allocation to Primary Health Care

3. Sustainable Operations4. Professionalized hospital equipment

management

CCIHBiomed Capacity

Building for Mission hospitals

NEED

TRAINING TECHNICIANS

TRAINING ADMINISTRATORS

FUTURE DIRECTION

How is International Aid planning to build Biomed capacity worldwide?

• Spread Biomed training faster and farther• Institutionalization – Partner with public universities

and technical schools• Such instructors are already trained in pedagogy and

electronics• Focus training on teaching biomed applications• Curriculum-In-A-Box (for trained instructors)• Sustainability – Tuition funded: Partner schools will

offer the course as a part of their regular curriculum

2009-11 PlansHonduras Ghana

Indonesia

Philippines

Advanced Medical Equipment Management (AMEM) training planned for Ghana, Honduras and the Philippines

New MET program planned for East Africa (Uganda or Kenya)and South America

East Africa

South America

Other Possibilities

Haiti

Indonesia

China

PCUSA & MBF – Interested in Haiti MET80 Catholic hospitals and 60 Protestant hospitals

want Indonesia METChina Medical Foundation interested in METIraq MET - on hold until security improves

Iraq

QUESTIONS

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