Developing HTM Capacity for Haiti Parallel Session: Health Technology Management (HTM), Country Initiatives November 23, 2013 Tom Judd, MS, CCE, CPHQ, CPHIMS, FACCE National Project Director, Kaiser Permanente Clinical Technology WHO-PAHO Health Technology Advisor, USA
Situation Private and public initiatives are underway to build HTM capacity in Haiti, but there is a long way to go. Public: PAHO and an expert HTM team are developing a short and long-term strategy in 2013 to address identified medical device and HTM needs, with the MoH. 32 BMETs have received training via Tripartite (Cuba) but not hired. Private: Although there are many smaller projects, the most systematic has been that of Rotary Houston, Texas USA with its Haiti community partners who have trained 46 BMETs in a 2-year training program since 2011, with most hired into private hospitals from many cities. And are beginning to create some regional service centers.
Background Haiti s healthcare system faces many hurdles, particularly since the January 2010 earthquake. PAHO Haiti s web listing of public and private health facilities http://ais.paho.org/phip/viz/haiti_healthfacilities_v2.asp monitors location and distribution for health service response. However, many internal and external sources note the challenge of ensuring available and appropriate medical devices for care delivery at these sites. WHO-PAHO, NGOs, professional societies, and other countries and many healthcare workers are assisting initiatives to (re)build HTM capacity in the country; see NGO healthcare efforts at http://haiti.ngoaidmap.org/sectors/8
Assessment 1 Private: January 2013 meetings with approx. 20 private hospital leaders in Port-au-Prince (PauP) & Milot (north near Cap Haitien)with Houston Rotary & expert HTM team [Tom Judd & Jean Chery], topics: (1) BMET -biomedical equipment technician workspace, tools, & test equipment; (2) repair, parts, & supplies challenges; (3) device inventory management tools; (4) donations issues; (5) ongoing management (hospital leader) & BMET training; and (6) hospital leader partnerships (regional & national) for HTM. Toured HUEH(major public tertiary hospital) & PauParea private hospitals, saw huge HTM needs. Met with MoH who affirmed this segment of HTM capacity-building. Recent years: NGOs such as TriMedXFoundation (USA) send periodic teams for individual hospitals and systems (eg, Catholic Relief Services) to train BMETs & provide HTM support. Rotary BMET training and Repair Center initiative: 2 cohorts have received 4 two-week sessions/year for 2 years since 2011; see Curriculum Over 40 BMETs have been placed and are beginning to succeed in private hospital jobs. In Q4 of 2013, Rotary assisting HUM (Mirebalais) HTM leader & Carrefour Hospital BMET training to establish PauP area joint Central/West Service Center for participating private hospitals
Assessment 2 Public: The HTM expert team [Pat Lynch & Jean Chery] on PAHO mission in October 2013, met with public hospital leaders and toured hospitals in north Haiti [eg, Justinien in Cap Haitien], toured public Hôpital Universitaire La Paix[HoP - Hospital of Peace in PauP, and met with senior MoH officials, yielding the following observations: 1. Lack of (fully) trained BMETs -too few &/or lack experience. Engineer at HoPhad 1 year in US but ; an issue in private & public hospitals, and even in almost all developed hospital systems in Haiti (except HUM) 2. Focused BMET training based on specific hospital inventories; fast troubleshooting methods 3. Inventory how to collect (tutorial provided); consider use of scanned/cell pix 1-page per device 4. Self-Sufficiency although we want to empower hospital leaders & BMETs to be able to work at the single hospital level, the HTM model recommended requires significant management & technical partnership at the regional and national level, and across public & private hospital divide. HTM team to create Role of BMET in HTM at Hospital leveland Role of Hospital Director in HTM guidelines 5. Access to Spare Parts optimizing what is needed and to best get it in a timely manner 6. Scope of HTM what services provided for what devices, Surgery, ICU, Lab, Imaging 7. Donations if not used how to store; when not deployed why what accessories needed 8. Hospital Directors frustrated with HTM status; lack funding in-kind sharing of resources, etc.? Need clear HTM job responsibilities for Directors & BMETs, & career growth opportunity plan for BMETs 9. Logistics storage space for device awaiting repair; if share unused donated devices with regional service center, can they get credit to be used creatively as needed more
Assessment 3 Public, continued: 10. Use Existing HTM Resources eg, HTM Director MonetteValliereat HUM (and others in Haiti) to serve as Advisors to Service Centers; consider stipends based on level of involvement 11. Funding How to structure a National / Regional HTM Model (Business Plan) to enable: a. Human Resources: Paid national Service Center Manager and volunteer (in-kind) BMETs, etc. b. Parts (related to participating hospital inventories) and device-related supplies c. Tools & Test Equipment clarify if hospital or BMET owned, & whether used outside of hospital d. Envision external funding for National / Regional HTM Model that provides incentives to hospital directors to have skin in the game and make the Model self-sufficient after x years. 12. Five Year and Longer-term HTM Program Plans Will be important for acceptance in the Haitian culture; see next slide for 5-Year Plan
Recommendations Desired HTM initiatives over the next 5 years (proposed to PAHO in April 2013 by request) Equipment Support Make best use of existing trained BMETs (Rotary partnership-46, Tripartite partnership-32) Additional training cohorts to be determined by public/private hospital demand for BMETs Technician training only without Management Support component is not sustainable, as found in ACCE HTM training since 1991. Develop a Health Technology (HT) Unit (using best practice HTM, aka Service Center) with publicprivate partnership (PPP) in the capital, with regional satellites, eg, North, West, & South Haiti. Paid HT Manager, and volunteer BMETs (5-6) on-loan from local hospitals Satellite units (3-4) staffed by volunteer BMETs (2-3) locally on-loan under HT Manager oversight Best practice HTM developed jointly by paid HTM Coordinator(USA-based) and Haiti HTManager, under Partnership Advisory Board oversight Includes maintenance support of General Medical devices, as well as Medical Imaging and Laboratory. A PAHO equipment focus area Maternal and Child Health. Move this HT Unit toward full self-sustainability over time; activities to be identified with mutual agreement. Management Support Maintain a network of public and private health leaders to guide HT Unit(s) and provide rotating volunteer BMETs, formalized through the Partnership Advisory Board. Develop and enable ongoing training for health leaders and BMETs. Project Support Support hospital technology projects as encouraged by Partnership Advisory Board; eg, BMET staffing, equipment user training, ehealth mobile health, donation guidelines, etc.