Advanced Health Technology Management Workshop, Cape Town, South Africa
Health technology management leaders from twenty sub-Saharan African countries participated in an Advanced Health Technology Management Workshop in Cape Town, South Africa, 8-12 November 1999. Eight ACCE members were among the faculty presenting to some 65 attendees. Tom Judd (ACEW coordinator), Jim Wear, Frank Painter, Bob Morris, Binseng Wang, and Joe Dyro from the USA were joined by fellow ACCE members Andrei Issakov (Geneva, Switzerland) and Enrico Nunziata (Mozambique).
The Regional WHO Director has determined that Health Technology Policy in the Africa Region should address technology management, human resources development, research and communication, and access to information. The goal of the Workshop was to build strength and capacity for health technology management (HTM) in the Africa Region. The prime objectives were to (1) raise awareness of HTM for health decision-makers at policy level in the Region; (2) provide latest informa-tion and widen awareness on fundamental and advanced con-cepts and methods of HTM; and (3) share positive HTM experiences with decision-makers from other countries in the Region. The Work-shop addressed planning, funding and management of healthcare technology and the required infrastructure to achieve optimal outcomes.
The Workshop was organized by the ACCE, World Health Organization (WHO), African Federation for Technology in Healthcare (AFTH), Department of Health of South Africa, and the South African Medical Research Council (SAMRC) in association with the International Federation for Medical and Biological Engineering (IFMBE) and the International Federation of Hospital Engineering (IFHE). The event was co-sponsored by the Association for Appropriate Tech-nologies (FAKT), European Union (EU), Finnish International Development Agency (FINNIDA), German Technical Cooperation Agency (GTZ) and the Oregon Health Sciences University (OHSU).
Welcoming and opening remarks were made by Peter Heimann (SAMRC), Director of WHO Collaborating Centre for Essential Technologies in Health and Secretary-General of AFTH; Andrei Issakov (WHO); Robert Morris, Past President ACCE; Mladen Poluta, Director of Healthcare Technology Management Programme, Univer-sity of Cape Town and Chairman, IFMBE Working Group on Developing Countries; Nonkonzo Molai, Director of Health Technology Policy, on behalf of A. Ntsaluba, Director-General of the Department of Health of the Republic of South Africa; Nico Walters (MRC) on behalf of M.W. Makgoba, MRC President; and Bernard Shapiro, IFHE Secretary-General.
In his opening remarks the Director-General of the Department of Health of South Africa highlighted the following points:
- The level of health service delivery has not improved much in spite of considerable investment in importing new technologies and the operational expense of supporting these technologies. For example, the lack of equipment maintenance and repair is a major stumbling block in the effective provision of care and is related to poor planning and acquisition/procurement.
- The most important intervention is ensuring a stable supply of competent technology managers. The Workshop should assist decision-makers and planners in dealing with complex issues of planning, life cycle, transfer, management and utilization of health technology, so that organized plans for education, training and placement of HTM professionals can be developed.
- This workshop is intended to impart skills to the HTM community to take actions to ensure and enhance the safety of health technologies and facilities.
- HTM is one of the major cost drivers in our healthcare system within the area of resource mobilization. The broad framework for comprehensive HT policies has been created. Top priority is the creation of an HT system composed of acquisition, management, planning and assessment as subsystems.
- The major short-term strategic action is the conducting of a Comprehensive National HT Audit. A second action is to take the Essential Health Technology Package (EHTP) software for field-testing. The two will be merged to determine the level of intervention required from government.
The following are highlights from the Executive Summary of the Workshop. A full text of the Summary can be obtained by contacting ACEW Africa coordinator Tom Judd, Tom.Judd@kp.org.
Technology Trends and Impacts
Health outcomes and a country's economic system are linked. Health data is needed to understand and improve health system performance. Evidence supports the positive impact of HTM on health system performance. Technology trends impact future delivery systems for devices, supplies, medical procedures, and sites of appropriate care.
National Health Technology Management Policy and Communication Plan
Major changes in technology sophis-tication and complexity are expected in the next decade. Management capacity will determine a country's ability to absorb technology. HT policy is indispensable and will provide the framework for HTM.
Tom Judd
WHO Guidelines for Formulation of National Healthcare Equipment Policy Generic guidelines and framework implementation documents have been drafted, covering both process and content to assist countries with development and ongoing monitoring of national HT policy. Managerial competencies are required for the effective use of technology healthcare planning for district health management in Africa. Action learning is the best method for training technology managers with incremental changes expected over time. Leadership needs an effective district-level information system to do management by fact.
Y2K Issues
The magnitude and source of problems were identified. Strategies to ensure operation were discussed.
Macro-Technology Assessment and Strategic Planning
Evaluation of safety, efficacy, and cost-effectiveness of new procedures and equipment is appropriate in developing countries and ensures ‘evidence-based’ decision making. It creates a bridge between science and decision making and is the only real contribution toward ensuring sustainability. Objectives: (1) When should new technologies be adopted and older ones replaced? (2) Which clinical services should be offered to address the needs of the patient population? (3) What changes need to be introduced to the existing clinical services?
Micro-Technology Assessment
This includes evaluation of equipment to be purchased for a single hospital; an example was provided of developing a multidisciplinary committee for capital equipment assessment, including the evaluation of information available from clinical engineers. The content of technology audits was described using the book Medical Technology Management from Yadin David and Thomas Judd, published by Spacelabs, 1993. Examples of techniques for conducting the audits were provided from Senegal, South Africa and Namibia.
Planning, Selection and Procurement Strategies
Key issues discussed included importance of planning, life cycle costs or cost of ownership, pros and cons of the tender process, an evaluation of the need, impact, costs and benefits of new technology, an evaluation of available products on the market, and acquisition of the best product for the needs. Alternatives to acquisition discussed were lease, rental and donation.
WHO Essential Healthcare Technology Package (EHTP)
EHTP, a new making tool for effective HTM, links human resources, drugs, and equipment and facilities for diagnostic and therapeutic procedures. Available at no cost from WHO, it is adaptable and appropriate for developing countries, focuses on interventions and addresses all the necessary requirements, allows for various scenarios, and can be used to determine the criticality of equipment in the provision of care.
Healthcare Equipment Donations
Donation guidelines proposed by FAKT, ACCE and others have been combined into draft WHO guidelines, which can be adapted to each country (or organization's) circumstances. The WHO guidelines formalized the communication link between donors and recipients. Forms requiring essential information in this communication link are provided. Donations play an important part in providing needed services, including in some countries, up to 80% of equipment. Donations must be managed for appropriateness and effectiveness.
Healthcare Provider – Vendor Relationships and Partnerships
Identify vendors that have your interests in mind and partner with them. Everything is negotiable. Clear communications, documenting expectations, and supporting good vendors improves the quality of the service.
Maintenance and Service Management
A comprehensive inventory is the foundation of a good management program. Gathering financial data along with service activity permits evaluation of actual service costs. Data is needed for effective service management, followed by the ability to act on the data. Resources in an environment of fixed resources can be created through a demonstration of cost savings.
Budgeting and Financial Reporting
Budgeting for an in-house clinical engineering department, cost recovering methods, and financial planning for a for-profit service company were presented.
Human Resources Development
Key issues discussed were roles and responsibilities of biomedical equipment technicians and clinical engineers, what managers can do to improve the clinical engineering program, the productivity of maintenance personnel and how it can be improved, and how to determine the personnel requirements of a health care technical service (HCTS).
Professional development of clinical engineering personnel through education and professional organizations was discussed. Appropriate user training can enhance health outcomes.
Health Care Technical Services (HCTS)
HCTS provide a structure for a decentralized, countrywide pro-vision of HTM services. Case studies of various models were presented from Kenya, Malawi, Cameroon, Senegal, Nepal, Mozambique, and Tanzania. Key contributors to development of these models in the Region include GTZ, FAKT, EU and FINNADA. Decentralization necessitated a rethinking of older models and allowed greater opportunities for public/private mix of service provision.
Safety, Risk Management and Infection Control
Key issues presented were infection control and maintenance of medical equipment with protection of the staff, the identification of risks and hazards by incident review, risk reduction and sharing, use of a systems approach, an increase in training related to user errors, and a review of safety standards and regulations.
Quality Assurance and Improvement
Medical equipment quality assurance and improvement concepts such as user and service training, regulatory compliance and patient incident investigations were presented. Quality of care is improved through development of appropriate quality improvement infrastructure, use of evidence-based medicine to drive care, the provision of data feedback to practitioners on the effectiveness of their care versus peers, and the creative use of the EHTP to drive prioritization of quality improvement initiatives.
Computerized Management Systems
A computerized equipment management system is essential to manage a large inventory. The principles and philosophy of design and basic elements of a countrywide system for developing countries was described. Service costs, productivity, and quality improvement initiatives require a computerized data analysis system. Purchase price of hardware and software is only a small portion of the commitment for use of this system.
Utility Systems
Utility systems requirements should be included in HTM procedures. Clinical engineering should be involved in the design of facilities and their utility systems. Infection control is important with regard to all utilities, and particularly HVAC and water.
Professional Registration and Certification
Certification is the only professional standard available to measure practicing clinical engineers and biomedical equipment technicians. Certification is a voluntary, peer review process, not a mandatory countrywide registration. Certification has been used by developing countries to increase recognition of clinical engineers, and measurably raise the level of health care provided.
Outsourcing of Service Management
Elements of success for outsourcing include thorough knowledge and information, good initial data, and continuous monitoring of the relationship.
Medical Equipment Troubleshooting
A centralized approach was presented, with readily understood and practical techniques. A troubleshooting text guide was provided.
After the formal presentations, participants met to formulate recommendations for future workshops and means to implement the material presented at the present workshop. Evaluation forms were completed. On the final day, Tom Judd, Peter Heimann and Andrei Issakov summarized the Workshop goals, objectives, and conclusions. Certificates were presented to attendees. Senti Thobejane, Superintendent General for the Northern Province, Department of Health & Welfare, South Africa gave the official closing remarks.
Peter Heimann and Mladen Poluta handled all local arrangements and ensured that Workshop participants and faculty were warmly received and properly entertained.
Tom Judd, Email: Tom.Judd@kp.org
Joseph Dyro, Email: jfdyro@aol.com