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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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