The mismanagement of medical equipment impacts on the quality, efficiency and sustainability of health services at all levels in the country

Biomedical equipments form the core of the any health care institution for the diagnosis, therapy and surgery. Therefore, it is crucial that biomedical equipments provide accurate information and operate to the optimum limit in order to allow proper diagnosis and ensure patient’s safety during therapeutic and surgical interventions. On the other hand, in any health-care institution biomedical equipments consume greatest capital investment. So, it goes without saying that health service provider ought to make the most out of these investments. This can be achieved only when these assets are used efficiently and effectively. Biomedical equipment management, in broader sense, is the right way to ensure patient’s safety and obtain the maximum benefit out of these physical assets of a hospital.

Biomedical equipment management is not merely a repair or maintenance task carried out in workshop by technicians. It starts even before purchasing equipment. Gathering reliable information about biomedical equipment, planning technology needs and allocating sufficient funds are the prerequisites before purchasing a suitable model and installing it effectively. Then, sufficient resources need to be allocated for its use, safety operation and effectiveness along with its proper maintenance and repair. Finally, biomedical equipment management completes with decommissioning, disposing, and replacing unsafe and obsolete items. Furthermore, ensuring that the staff has right skills to make the best use of equipments also comes under the area of biomedical equipment management.

Proper planning and policy in biomedical equipment management is vital in order to achieve quality health services and meet health service standards. A proper biomedical equipment management requires the coordination among all member staffs who deal with biomedical equipments be it in technical, clinical, financial or administrative levels.

Situation of biomedical equipment management in hospitals of Nepal

Currently, Nepal’s health-care system is far from satisfactory. Hospitals face a huge demand of medical services but are unable to comply with these needs due to lack of adequate resources. The limited health services in remote areas and the lack of sufficiently qualified staff further aggravates the already worsened situation.

The management of medical equipment in hospitals of Nepal is very poor. Medical equipments are used without adequate planning in an inefficient way. Procurement is generally made in unscientific and ad-hoc manner without proper need assessment resulting in import of a wide variety of equipments. Glaring equipment diversity is reported in the hospitals of Nepal which includes several unnecessary equipments. The expensive medical devices are left unused due to lack of handling and operating skills. High rotation of qualified staff between facilities, lack of competent personnel to operate the device and lack of clear legislative and policy strategy are leading to improper storage and manipulation. Some devices are not even installed or commissioned.

There are substantial delays from the time of request submission and actions taken for new equipment or maintenance and repair activities. The quality of equipment is either not in compliance with the international safety standards or is so poor that the equipment is out of order. Maintenance and repair facilities wherever available is not adequately utilized. Problems like lack of systematic management, clear job descriptions and properly qualified staffs are profound at all levels. Currently, hospitals are focused in procuring new equipment through various channels instead of increasing capacities of current equipment with appropriate Maintenance & Repair services. Even a national level hospital doesn’t have a proper biomedical workshop. Obsolete equipments are in rise not only due to age of equipment but also due to misuse and poor or inexistent preventive and corrective maintenance.

Hospitals don’t have an appropriate maintenance system or a proper record to evaluate the cost/benefit of in-house services available. Frequently, outdoor services are solicited for repair and maintenance due to lack of in-house competence. Such dependence even for minor cases charges the hospital a higher cost than needed. The mismanagement of medical equipment impacts on the quality, efficiency and sustainability of health services at all levels, from a tertiary hospital setting with sophisticated life-support equipment, to the primary healthcare level equipped with simple diagnostic and therapeutic tools. What is vital – at all levels and at all times – is a critical mass of affordable, appropriate, and properly functioning equipment and their correct application, with minimal risk to patients as well as operators. Clear policy, technical guidance, and practical tools are needed for effective and efficient management of medical equipment management for it to impact on priority health problems and the health system's capacity to adequately respond to health needs and expectations.

A study of the regional/zonal and district hospitals conducted by the Department of Health Services (DOHS) with the assistance of GTZ reveals a pitiable state of medical equipment at the hospitals. According to the information available in the document “Health Care Technology Policy, Ministry of Health & Population Nepal, 2006”, the status of the equipment is depicted in the following figures.

The graphs show that only 30 % of the equipments, in average, are in operation. Over 50 % of the equipment requires urgent maintenance, 10 % needs repairs and 10 % needs to be scrapped. Such a situation is indeed a matter of serious concern. Lack of spare parts and qualified maintenance personnel has plagued many equipment pieces in many hospitals. Maintenance resources are centralized and any breakdown of equipment at districts has to wait a long time for repair pending dispatch of personnel and spares.

Nepal Health Care Technology Policy

World Health Organization (WHO) recommends 3-5 percent of the total health budget to be allocated for equipment maintenance. However, overlapping of various divisions involved in the issues of biomedical equipment management hinders the improvement of current situation. Nonetheless, realizing the importance of effective health service implementation, the Nepal health care technology policy was introduced. The ministry of health and population submitted a document to the cabinet which was approved on 2060/11/11. This health care technology policy was to serve as a guideline for the proper utilization and management of the overall infrastructure of health care technology along with the medical equipment.

The Policy aims to meet the objectives like the promotion of appropriate Health Care Technology(HCT); improvement of policy planning and procurement procedures of medical devices, and facilities; Utilization Health Care Technology effectively and efficiently; Promotion of good clinical practices including safety aspects and risk management and ensuring conditions of appropriate Human Resource Development.

The strategies to attain the objectives also include, among others, Government Commitment to foster Public-Private Partnership (PPP) in the areas of HCT in the areas like: Human Resource Development in the equipment management; Sharing of knowledge; Outsourcing of services, acquisition and management of equipment and Leasing and Renting of equipment with an option to own.

Biomedical equipment management policy and present scenario:

Despite the establishment of health care technology policy in the country, the situation of biomedical equipment management remains worse, if not worst. The problem is still aggravating the health care in the hospitals of Nepal. So far some of the hospitals have come to realize the importance of biomedical equipment management and are establishing the biomedical equipment department in the hospital settings. This is a positive move as a result of some private initiatives in the national and international level. Much is needed to be improved to save money from poor or lack of biomedical equipment management. Health aspect is also equally benefitted besides money value. The present scenario is not worst like that of five to seven years ago. Enough biomedical man powers are produced within the country itself. So why don’t hospitals in Nepal try to setup a separate biomedical engineering department for the proper biomedical equipment management?

(Thakuri and Joshi are biomedical engineers from Nepal.)

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