1
HEALTH SERVICES DELIVERY
1.2
PROGRAMME FOR ORGANIZATIONAL DEVELOPMENT
1.2.2
Medical Equipment management improvement(as of March 2008)
A Focal Point
B Implementing Agencies
DDG(BES), Provincial Directors of Health Services.
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
To increase efficiency and  Equipment up time
cost-effectiveness of medical  Mean time before
equipment in utilisation and equipment failure (MTBF)
management in the public health  Response
time
to
sector
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
Means of Verification
 Equipment maintenance
records
 Surveys
 Equipment records and
staff records
 Training
records
Inspection and preventive
maintenance records
4.
Project Output/Product:
Outputs
An efficient and effective medical
equipment maintenance system
established in public health sector
Indicators

Availability of efficient
and effective medical
equipment maintenance
system
An evidence based equipment

Availability of evidence
procurement planning system
based equipment
established
procurement planning
system
A medical equipment management  Availability of medical
system established
equipment management
system
A training centre established for

Availability of a training
continuous training on health care centre
technologies and clinical
engineering
Public private partnership

Number of private
maximized
organizations working in
partnership with the state
5.

Project report

Project report

Project report

Reports
Related Projects:
Project No.
1.1.2
1.14
1.1.6
1.2.1
6.

Means of Verification
Project report
Project Title
Facility Development According to the Rationalized Health Services
Delivery Plan
Strengthening of Laboratory and Diagnostic Services
Technology Assessment
Medical Supplies (including drugs)
Relevant Agencies to be Coordinated:
MoH, Provincial Governments, Central BES, Respective hospitals.
7.
Monitoring & Evaluation:
1. Who?
2. When?
Central MoH, Central BES, Respective hospitals, Provincial Health
authorities, Provincial BES.
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 Indicators
Establish provincial maintenance units
Provincial
maintenance units in
place
Hospital based
maintenance units
established
Capacity at central
BES improved
Equipment policy
developed
Develop proposals
Purchase equipment
Train HRs
Develop proposals
Purchase equipment
Train HRs
Develop proposals
Train HRs
Nominate
consultative team
Develop policy
Develop the system
Pilot the system
Nominate
consultative team
Develop list
Nominate
consultative team
Develop guidelines
Nominate
consultative team
Develop plan
Appoint a working
group
Design the
mechanism
1
2
Establishment hospital based
maintenance units at District Base /
District General/Teaching Hospitals
Strengthen the capacity at central BES
3
4
5
6
7
8
9
Formulate a equipment purchasing,
maintenance and replacement policy
Establish a system for an equipment
audit
Establishment of standard list of
equipment for each category of Health
Institutions
Formulation of generic specification
for all equipment and issue guidelines
to provincial set up
Establishment of evidence based spare
parts procurement plan
Establish a mechanism for better
coordination between hospitals &
MSD to assist procurement of
reagents, consumables etc.
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.
11 Organize post graduate opportunities
in medical equipment management
/clinical engineering for BES engineers
and provincial engineers
12 Develop equipment utilization
monitoring criteria
Equipment audit
system developed
Institution specific
standard developed
Generic
specifications
identified
Spare parts
procurement plan
developed
Coordination
between hospitals &
MSD to assist
procurement of
reagents,
consumables etc.
improved
A computer based
medical equipment
information system
developed
Post graduate
opportunities in
medical equipment
management /clinical
engineering
developed
Equipment
utilization
monitoring criteria
developed
Identity the data
field
Design the system
Pilot the system
Identity training
needs
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
14 Establish a mechanism to assist private
sector in their capacity building and in
maintenance of equipment
Staff trained
Identity training
needs
Design training
programmes
A mechanism
Appoint a working
established to assist
group
private sector in their Develop the
capacity building and mechanism
in maintenance of
equipment
15 Develop a system to assist private A system developed Appoint a working
sector in calibration /testing their to assist private group
equipment
sector in calibration Develop the criteria
/testing
their
equipment