Medical Equipment Maintenance in Uganda - DPHU care and first referral for the sub-county. ISSN 2313-285X = University without borders for the open society Volume 4 The Uganda National

Medical Equipment

Maintenance in

Uganda

Presentation to EARC 2014

by

Eng. Sam S.B. Wanda

UNAMHE

December, 2014“A variant of this Paper was presented at the Second Global Forum

on Medical Devices – 22 to 24 November 2013 in Geneva, Switzerland”

Presentation Outline

Introduction to Medical Equipment

Maintenance in Uganda

Background to Medical Equipment


Medical Equipment Maintenance status and

organisation

Challenges

Conclusions

ISSN 2313-285X = University without borders for the open

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Introduction

Factors that influence effective maintenance of

Medical Equipment in Uganda are the:-

a) National Health System and Services offered by

level of health care

b) Spread of Regional Medical Equipment

Maintenance Workshops (RMEMWs) based at

Regional Referral Hospitals (RRHs), and

c) Available Funding and Procurement

Procedures


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The Uganda National Health System

Levels of Health Care

Ministry of Health

National Referral Hospitals

Regional Referral Hospitals

District Health Services

General Hospitals

Health Centres II - IV


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The Uganda National Health System –

cont’d

HC II offers only ambulatory services, except in

strategic locations (e.g. poor access to HC III or

HCIV).

HC III offers continuous basic preventive,

promotive and curative care and provides

support supervision of HC IIs facilities under it.

There is provision for laboratory services,

maternity care and first referral for the sub-county.


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– cont’d 2

HC IV and General Hospitals (GHs) offer basic

preventive, curative and rehabilitative care in their

immediate catchments and provide a second level

referral services including life-saving medical,

surgical and obstetrical emergency care such as

blood transfusion, caesarean section, and other

medical and surgical emergency interventions


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– cont’d 2

Regional Referral Hospitals (RRHs) in addition to

the services offered at the general hospital, offer

specialist services such as psychiatry; Ear, Nose

and Throat (ENT); radiology; pathology;

ophthalmology; higher level surgical and medical

services, including teaching and research.


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– cont’d3

National Referral Hospitals (NRHs) in addition to the

services offered at the regional referral hospital, provide

comprehensive specialist services and are involved in

teaching and health research.

The services described above by level of health care

therefore determine the Medical Equipment available at

each level by specification and quantity as given in the

Medical Equipment Policy (1991), revised April 2009.

This in turn determines the equipment maintenance

requirements per RMEMW.


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Background - 1

Equipment in the Health Facilities fall in the

following categories:-

1) Medical Equipment – used for diagnosis, patient

treatment and therapy

2) Hospital Furniture – patient beds, patient trolleys,

instrument cabinets e.t.c.

3) Hospital Plants - generator, solar system, water

pump e.t.c.

4) Office Equipment – computer, printer, fax

machine e.t.c.ISSN 2313-285X = University without borders for the open

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Background - 2

Regional Medical Equipment Maintenance Workshops

(RWs) were conceived in 1992 with the aim of

decentralising medical equipment maintenance services to

regional level and developing in-house Biomedical

Engineering capacity.

Currently, there are eleven (11No.) RWs with 8 No. landed

RWs at Arua, Hoima, Lira, Gulu, Soroti, Mbale, Fort Portal

& Kabale RRHs; Central RW located in Wabigalo, Kampala

and since 1st July 2014 2No. RW operations in Mubende

and Moroto RRHs based on an equipped mobile workshop

vehicle.ISSN 2313-285X = University without borders for the open

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Background - 3

Central Workshop, Wabigalo is meant to be a referral

workshop – focussing on training, higher level

maintenance, bulk purchase and distribution of

specialized spare parts.

The following RRHs that do not have established Medical

Equipment Maintenance Workshops – i.e. Jinja, Masaka,

Mbarara and Naguru plus Mubende & Moroto with

mobile workshops also need to build Workshops.


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Medical Equipment Maintenance

Status and Organisation

Maintenance of Medical Equipment and Hospital plants is

carried out through the following ways:

1) Regional Medical Equipment Workshops - carry out

Routine Maintenance for Medical Equipment

2) Maintenance and Service Contractors – restricted to

sophisticated Equipment (e.g. Imaging and Laboratory

Equipment)

3) Outsourcing Maintenance Services on a case by case

basis – Hospital plants, Office equipment and other

sophisticated Equipment


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Objectives of the Medical Equipment

Maintenance decentralisation programme

Establishment of RMEMWs was intended to:-

bring HTM services nearer to the population

reduce travel time, hence down time for medical equipment

reduce costs (fuel and per diems) for maintenance activities

Facilitate quicker maintenance (routine and breakdown) of equipment to keep it in good working condition over its design life, and

enable timely diagnosis/operation of patients via imaging, laboratory and theatre equipment.


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Organisation of Medical Equipment


Prior to 1992 all HTM in Uganda was carried out from the

Ministry of Health (MOH) headquarters in Entebbe

The number of Health Facilities increased from 1073 in

1988 to 5229 in 2012 and population rose from 15.8

million to 34.1 million in the same period

Given the 3.4% population growth rate, MOH decided to

decentralise Medical Equipment Maintenance to regional

level

There are currently 9 RWs based at RRHs as per maps

below:-


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Catchment Areas of RRHs and

RMEMWs

RRHs catchments

Arua Gulu Moroto

Lira

Soroti

Mbale

Mulago

Hoima

Fort PortalMubende

Kabale

Mbarara Masaka

Jinja

CUFH Naguru

Arua RWGulu RW Moroto RW

Lira RW

Soroti RW

Mbale RW

Wabigalo CW

Hoima RW

Fort Portal RWMubende RW

Kabale RW

RMEMWs catchments


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Catchment Of Regional Workshops

(RWs)

Arua RWGulu RW Moroto RW

Lira RW

Soroti RW

Mbale RW

Wabigalo CW

Hoima RW

Fort Portal RW Mubende RW

Kabale RW


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Catchment Of Regional Hospitals

(RRHs)

AruaGulu

Moroto

Lira

Soroti

Mbale

Mulago

Hoima

Fort PortalMubende

Kabale

Referral Hospital

Mbarara

Masaka

Jinja

CUFH Naguru


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Status and Organisation of the Medical

Equipment Maintenance programme

As is seen from the maps, the catchment areas of the RRHs and RMEMWs is not the same

Some RMEMWs serve a larger area (more districts, hospitals and health centres) than the host RRHs due to:-

fewer established RMEMWs

geographical location and road networks to the capital


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Status and Organisation of the Medical

Equipment Maintenance programme 2

Areas covered by some RMEMWs are still too large

There is still need to establish RMEMWs in the 5 RRHs that do not have. Effective 1 July 2014 operations started at Moroto RRH (for Karamoja) and at Mubende RRH (for Mubende, Mityana, Kyankwanzi and Kiboga districts) using Mobile workshops only.


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Challenges of Medical Equipment

Maintenance - 1

Planning for Medical Equipment Maintenance is

currently fragmented and difficult to monitor and

evaluate outcomes – each RW/RRH comes up with

their own priorities and budget allocations.

Current funding is very inadequate for holistic

planning for medical equipment maintenance to be

realized – replenishment of workshop tools, transport

facilities, Maintenance contracting for sophisticated

equipment and training of Engineers/Technicians

cannot be catered for by HID/RWs.


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Challenges of Medical

Equipment Maintenance - 2

Lack of spare parts due to inappropriate

procurement methods used by PDUs – Medical

Equipment spare parts are specialized, not every

vendor may stock spare parts for all the medical

equipment .

Inadequate staffing with limited technical

knowledge and skills to maintain sophisticated

medical equipment – today HCIII have CD4

machines which need higher level electronics and

computer knowledgeISSN 2313-285X = University without borders for the open

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Challenges of Medical Equipment

Maintenance - 3

Despite the decentralisation for last 11 years

there are still challenges such as:-

long distances for some RMEMWs on a

poor rural road network especially in rainy

season

old mobile workshops

limited updated equipment Inventory

Insufficient tools for equipment repairs


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Conclusion - 1

The establishment of RMEMWs has contributed

significantly to availability of medical equipment in good

working condition and to reduction in costs of equipment

maintenance.

However,

There is urgent need to establish and equip the remaining 5

RMEMWs at the RRHs without.

There is still great need for more funding from GOU and

Partners to enable Medical Equipment in the Country.


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Conclusion - 2

Maintenance is a must if Government is to safeguard the

huge investments in Medical Equipment and Plants.

Development of the knowledge and skills of the Engineers

and Technicians through training will guarantee

sustainability and quality of health care.

Maintenance contracting for sophisticated equipment is not

an option because of the rapid and high level of

technological development.

The cost of corrective maintenance (10-35%) is just too high

for Government to look at as option.


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Thank you for listening

FOR GOD AND MY COUNTRY


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Documents

Medical Equipment Maintenance in Uganda - DPHU care and first referral for the sub-county. ISSN 2313-285X = University without borders for the open society Volume 4 The Uganda National