Medical Equipment Maintenance in Uganda

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 Maintenance in Uganda Medical Equipment Maintenance status and organisation Challenges Conclusions

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

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

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.

The Uganda National Health System 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

The Uganda National Health System 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.

The Uganda National Health System 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.

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.

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 1 st July 2014 2No. RW operations in Mubende and Moroto RRHs based on an equipped mobile workshop vehicle.

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.

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

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.

Organisation of Medical Equipment Maintenance in Uganda 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:-

Catchment Areas of RRHs and RMEMWs RRHs catchments RMEMWs catchments Arua Gulu Moroto Arua RW Gulu RW Moroto RW Lira Lira RW Soroti Soroti RW Hoima Hoima RW Fort Portal Mubende Jinja Mbale Fort Portal RW Mubende RW Mbale RW Mbarara Masaka Mulago CUFH Naguru Kabale RW Wabigalo CW Kabale

Catchment Of Regional Workshops (RWs) Arua RW Gulu RW Lira RW Moroto RW Hoima RW Soroti RW Fort Portal RW Mubende RW Wabigalo CW Mbale RW Kabale RW

Catchment Of Regional Hospitals (RRHs) Arua Gulu Moroto Lira Hoima Soroti Fort Portal Mubende Jinja Mbale Mbarara Masaka Mulago CUFH Naguru Kabale Referral Hospital

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

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.

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.

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 knowledge

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

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.

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.

Thank you for listening FOR GOD AND MY COUNTRY