How Equipment Maintenance Contracting is Positively Impacting Health Services in Nepal

Tuesday, April 15, 2014

The project Contracting-out of Maintenance Services as a component of the Sector Programme ‘Health and Family Planning’, co-funded by KfW and the Government of Nepal, has shown encouraging results which have contributed to improvements in quality and quantity of health service delivery.

Based on data collected independently and published annually by the national HMIS system, significant increases have been observed over the last two years for equipment-dependent healthcare services in the regions where the project was piloted.

The project, undertaken to improve quality of care and patients’ access by enhancing the functionality of the more complex medical equipment in target facilities through contracted but cost-effective quality maintenance services, is being implemented by the consortium EPOS Health Management and MEH Consultants of Kathmandu in 56 facilities in the 24 districts of the Far- and Mid-Western Regions and has shown positive results with indications of sustainable impact.

More than 9,000 interventions have been performed by the Maintenance Contractor since 2011 with some 1,300 items currently under contract.  As a result, the level of functional equipment in the target facilities has increased from 64% to over 98%, with the number of out-of-order equipment decreasing correspondingly.

The interventions during the pilot phase have also proven affordable from a cost perspective. Annualized contract cost per equipment amounted to around 230 Euro per year inclusive of 13% VAT. This may even decrease in future as economies of scale are achieved and efficiency gains through optimized contract terms and fee structures are realized.

“While a number of factors have contributed to the successful implementation of this project,” according to Team Leader Josef Riha, “success is continuing due in great part to the personal attitudes and resulting healthy relationships of the organizations and individuals involved.”

These factors include:

  • National consultants ensuring cultural and political sensitivities are correctly addressed;
  • Very good communication with Department of Health Services (DoHS) personnel on all levels despite frequent changes of senior managers due to inherent career mechanism of the DoHS;
  • Excellent team work between all members of the Consultant staff;
  • MC contract terms as motivating factor:  agreed fees are only payable for equipment maintained in functional status;
  • Well conceived procedures, willingness by all parties to adapt and modify these where considered necessary;
  • Open communication with the management and field personnel of the Maintenance Contractor;
  • Young and motivated field personnel of the Maintenance Contractor;
  • Regular supervision visits to Health Facilities and to Maintenance Contractor workshops;
  • Recent availability of training institutions in Kathmandu to feed the demand for biomedical technicians and engineers both within the Ministry and in the private sector;
  • Good and regular contact with the KfW Representative.

Because of encouraging results, the DoHS plans to take the pilot project to full scale into all five regions of Nepal as soon as possible using resources from the multilateral pool-fund mechanism. For this purpose a Rapid Inventory Assessment of the medical equipment present in target facilities of the three remaining regions has been launched by EPOS / MEH Consultants with results due by June 2014.  Discussions on the required tender process for countrywide outsourcing of maintenance, taking into account the pilot experience in MW and FW Regions while following World Bank tender procedures, have also been initiated.

In future the Consultants will be required to provide support along three main axes of interventions in order to develop the required long-term Physical Assets Management capability of the DoHS:

  • Technical support to the DoHS to effectively manage the maintenance outsourcing approach including tendering on a national scale;
  • Further capacity building of the DoHS structures to achieve competent contract and maintenance management through national personnel;
  • Steering of processes to lead to the development and implementation of a comprehensive Physical Assets Management Policy by the DoHS.

This process will definitively confront both to the DoHS and the Consultants with new challenges, but the signs are encouraging that the proposed maintenance approach can be cost-effective and lead to the desired results on the national level.