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MEDICAL EQUIPMENT
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2. MEDICAL EQUIPMENT
2.1 INTRODUCTION
Medical equipment has become an important component of modern health services. The main purpose of this chapter is to provide lists of essential medical equipment for different levels of district health facilities, and to describe methodologies for equipment management and for training maintenance technicians. Current trend indicates that major medical equipment is increasingly being deployed in the districts to increase the diagnostic and treatment capabilities of primary health care. The spread of major equipment such as x-ray, ultrasound units and laboratory auto-analyzers is reaching facilities below the district hospital level, and the rate of such increase in equipment deplo yment is accelerating. On the other hand, the capabilities to manage or maintain medical equipment in most developing countries remain rather weak. This weakness is particularly serious in the districts. The growth in capabilities to manage or maintain medical equipment has lagged far behind the rate of deployment of equipment. This situation risks running out of control. Capital investment could become wasted while quality of care would suffer. This chapter is written with the above situation in view. Thus, while providing lists of essential medical equipment, the need for better planning and management is emphasized. In r addition to proposing a practical strategy for large-scale training of maintenance technicians for the districts, powerful management methods and tools are described. The establishment of national policies and strategies and the use of more effective management systems to meet 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 to guide health workers who plan to acquire medical equipment. See 2.4.1. Utilization and management of medical equipment is a multi-phasic task. This task is best tackled by giving a multi-disciplinary team a national, community or organizational perspective. See 2.2.2 and 2.4.1. The life cycle approach provides a more effective system to manage medical equipment. Appropriate technology and efficiency of use should be ensured at the planning stage. Maintenance supervisors should be taught management skills based on objectives and information presented in 2.4.1 and 2.6.1. Setting a priority to train a large number of technicians to maintain essential medical equipment is urgent in view of the rapid deployment of medical equipment in district health facilities. A practical strategy is recommended (see 2.6) which also allows the co-existence and development of the public and private sectors in the maintenance field.
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Other topics discussed in this chapter include: the significance of generic specification (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 and Annex 5) is described in order to reduce breakdown, to improve the quality of care, and to ensure the safety of patients and workers. Since X-ray units are often the most expensive and complex items, considerably more information in selection, installation and use can be found in Annexes 7 and 8. The specifications of anew X-ray unit, the World Health Imaging System for Radiography (WHIS -RAD), are compared with those of the WHO Basic Radiology System (BRS). Special precautions are needed when deploying major medical equipment in lower- level health facilities (see part II). The selected bibliography provides readers with further references. Although this section is enclosed within the district hospital description, information here applies to all levels of health facilities.
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