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2. MEDICAL EQUIPMENT

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2. MEDICAL EQUIPMENT

2.1 INTRODUCTION

Medical equipment has become an important component of modern healthservices. The main purpose of this chapter is to provide lists of essential medicalequipment for different levels of district health facilities, and to describemethodologies for equipment management and for training maintenancetechnicians.

Current trend indicates that major medical equipment is increasingly being

deployed in the districts to increase the diagnostic and treatment capabilities ofprimary health care. The spread of major equipment such as x-ray, ultrasoundunits and laboratory auto-analyzers is reaching facilities below the district hospitallevel, and the rate of such increase in equipment deployment is accelerating. Onthe other hand, the capabilities to manage or maintain medical equipment in mostdeveloping countries remain rather weak. This weakness is particularly seriousin the districts. The growth in capabilities to manage or maintain medicalequipment has lagged far behind the rate of deployment of equipment. Thissituation risks running out of control. Capital investment could become wastedwhile quality of care would suffer.

This chapter is written with the above situation in view. Thus, while providinglists of essential medical equipment, the need for better planning andmanagement is emphasized. In r addition to proposing a practical strategy forlarge-scale training of maintenance technicians for the districts, powerfulmanagement methods and tools are described. The establishment of nationalpolicies and strategies and the use of more effective management systems tomeet the challenge of increasing use of medical equipment are needed.

The key approaches are as follows:

1. Establishment of a national policy on medical equipment management.This will give a clear direction providing criteria and setting priorities toguide health workers who plan to acquire medical equipment. See2.4.1.

2. Utilization and management of medical equipment is a multi-phasictask. This task is best tackled by giving a multi-disciplinary team anational, community or organizational perspective. See 2.2.2 and 2.4.1.

3. The life cycle approach provides a more effective system to managemedical equipment. Appropriate technology and efficiency of use shouldbe ensured at the planning stage. Maintenance supervisors should betaught management skills based on objectives and informationpresented in 2.4.1 and 2.6.1.

4. Setting a priority to train a large number of technicians to maintainessential medical equipment is urgent in view of the rapid deployment ofmedical equipment in district health facilities. A practical strategy isrecommended (see 2.6) which also allows the co-existence anddevelopment of the public and private sectors in the maintenance field.

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Other topics discussed in this chapter include: the significance of genericspecification (2.2.1) with examples given for X-ray and ultrasound units (Annex 6).Considerations for potential medical equipment donors and recipients (2.2.3,

2.4.3). Planned preventive maintenance of major medical equipment (2.5 andAnnex 5) is described in order to reduce breakdown, to improve the quality ofcare, and to ensure the safety of patients and workers. Since X-ray units are oftenthe most expensive and complex items, considerably more information inselection, installation and use can be found in Annexes 7 and 8. Thespecifications of anew X-ray unit, the World Health Imaging System forRadiography (WHIS-RAD), are compared with those of the WHO Basic RadiologySystem (BRS). Special precautions are needed when deploying major medicalequipment in lower- level health facilities (see part II). The selected bibliographyprovides readers with further references.

Although this section is enclosed within the district hospital description,information here applies to all levels of health facilities.