19 & 20 nov 2013 - weezevent€¦ · 19 & 20 nov 2013 chamonix mont-blanc / france the need...

19 & 20 Nov 2013

19 & 20 Nov 2013 Chamonix Mont-Blanc / France 2

TABLE RONDE 3 : Considérations émergentes et orientation à renforcer autour des projets d’appui à l’équipement médical

ROUND TABLE 3 : Emerging themes and directions to reinforce medical equipment support projects Modérateur / Moderator : Guillaume BATTIN Intervenants / Speakers : Dane EMERLING Shauna MULLALLY Santorino DATA Véronique DE GEOFFROY

19 & 20 Nov 2013 Chamonix Mont-Blanc / France 3

Dane EMMERLING

19 & 20 Nov 2013 Chamonix Mont-Blanc / France

Creating evidence-based interventions for increasing the lifespan of donated equipment and maintenance

capacities: data from Honduras, Rwanda, and Cambodia

• Intervenant: Dane EMMERLING

• Fonction : MPH

• Organisme : Robert Malkin’s Developing World Healthcare Technology Lab

• Pays: USA

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The need for intervention: What is the scope of the problem?

• How much medical equipment is

not functioning? • 30 to 70% not functional 1, 2, 3

• How much is being invested in

medical equipment?

• From 1997 to 2001 the World Bank invested $1.5 billion in medical equipment3

1. Perry, L., & Malkin, R. (2011). Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world?. Medical & biological engineering & computing, 49(7), 719-722.

2. WHO. (2010). Barriers to innovation in the field of medical devices. Background paper 6. Geneva, World Health Organization.

3. Cheng, M. (2007). An overview of medical device policy and regulation. World Bank, HNP brief, (8).

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Goals for this presentation

1. Donating more equipment 2. Training hospital

technicians to fix equipment

To provide evidence about the potential effectiveness for two points of intervention for increasing access to medical technology

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Methods • Survey of medical equipment in up to five departments in 65

hospitals in Cambodia, Honduras, and Rwanda • 3,283 pieces of equipment surveyed • Included interviews with maintenance technicians, hospital

directors, and equipment users

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Flaws in the donation process: tracking 824 pieces of donated, new equipment

1. Equipment delivery: 14% never arrived at target

hospital 2. Service contracts: 16% not functional with service

contracts, 14% with in house repair 3. Donated new vs. used equipment: comparing

equipment donated new vs. other in several age categories4

4. Compton B. & Thatcher A. (2012) Increasing responsible donations of medical surplus. 17th International Conference on Appropriate Healthcare Technologies for Developing Countries, page 55

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Donating New vs. Used Equipment Fu

nct

ion

al E

qu

ipm

en

t (%

)

Time Since Donation (Yr)

Donated, new (N=356)

Donated, other (N=818)

p<0.01

New

Other

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Training hospital technicians

• Study assessed 23 of Rwanda's 38 public district hospitals. 13 had technicians from EWH training.

• First cohort (17 technicians) entered the program in March of 2010 and the second cohort (21 technicians) entered in March of 2011

• Training included evidence based BTA curriculum5, Health Technology Management, professional development, anatomy and physiology, and mathematics

5. Malkin, R., & Keane, A. (2010). Evidence-based approach to the maintenance of laboratory and medical equipment in resource-poor settings. Medical & biological engineering & computing, 48(7), 721-726.

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Results of training in Rwanda

17.8%

10.2%

0%

5%

10%

15%

20%

25%

% o

f Eq

uip

me

nt

ou

t o

f se

rvic

e

BMET Training

% Out of Service

42.9% decrease X2 = 9.59, p<0.01

No Training Trained Untrained Trained

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Shifts in Barriers to Equipment Repair in Rwanda & Honduras, n=701

18.29%

12.57%

47.71%

2.86%

18.57% 15.38%

13.68%

56.70%

5.70% 8.55%

0%

10%

20%

30%

40%

50%

60%

Authority Communication Component Not needed Technician Limitation

Technician obstacle to repair

No Yes Trained technician?

p<0.05

p<0.05

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Future Directions

• Look for publications in Journal of Health Technology &

Management and Journal of Clinical Engineering • Continue to create an evidence base for effectiveness of

technician training (Cambodia & Ghana) • Greater attention to context factors (communication in

hospital, spare parts and supply chains, and user training) • Refining our measures to better provide recommendations

about service contracts, supply chains, technicians’ understanding of barriers

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A question for continued discussion

What evidence and to what audience do we need to make recommendations in

order to shift the practices and debate about increasing access to health

technology?

Thanks to Maurice Page & Dr. Bob Malkin

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19 & 20 nov 2013 - weezevent€¦ · 19 & 20 nov 2013 chamonix mont-blanc / france the need...

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