The project ‘Contracting-out of Maintenance Services’ is a component of the Sector Programme ‘Health and Family Planning in Nepal’, funded by the German Financial Cooperation through KfW and the Nepali Government. It aims at contributing to the programme objective of improving quality of care and patients’ access by institutional development of a dedicated Physical Assets Management (PAM) Section in the Management Division (MD) of the Department of Health Services (DoHS), by a functional in-house maintenance system for basic equipment and by outsourcing of maintenance services for the more sophisticated equipment in the two pilot regions of Mid- and Far-Western (MW & FW).
In a first phase of this project 2011 – 2014 considerable improvements of equipment functionality (2010: 64% operational, April 2014: 99% operational) as well as impact in terms of increased delivery of technology related health services in the regions MW & FW were achieved..
In view of these encouraging results the DoHS and KfW consequently agreed that a Rapid Inventory Assessment (RIA) should be conducted in the remaining three regions of Nepal, Eastern, Central and Western (E, C &W) as a basis for a roll-out of the concept on outsourcing maintenance services to a private provider nation-wide in a second phase. The Consultant shall carry out a comprehensive inventory of 124 facilities in the 51 districts of the Central, Eastern and Western Regions with a methodology that is consistent with the current approach developed in the pilot phase.
The comprehensive medical equipment inventory shall be conducted by the PAM Section with the support of a dedicated Consultant team and the results entered consistently into the PLAMAHS database according to the same inventory principles and guidelines developed and applied in the pilot phase.
Given the large number of facilities to be targeted by the inventory exercise, their wide-spread geographical distribution and often difficult access, the Consultant is encouraged to build three teams of two biomedical technicians each that work in parallel in different regions and districts in order to shorten the completion time.
All district level DoHS facilities were visited to record details on and the status of the more sophisticated equipment, excluding basic and elementary items, to be covered by in-house maintenance capacity. Inventory records were integrated into the existing PLAMAHS database, to be used for cost estimates for nationwide outsourcing of maintenance along the contract scope used for MW & FW.
Detailed activities comprised:
Detailed discussions with the PAM Section Chief and the PAM Section Maintenance Manager to agree on the inventory and data collection methodology through PLAMAHS taking into consideration the expected logistic and topographic challenges of the regions;
Compilation and training of three field teams consisting each of one experienced enumerator as Team Leader and one qualified Biomedical Equipment Technician (BMET) for the technical assessment of the equipment to assure consistent judgement and documentation throughout the RIA exercise;
Preparation of a concise Manual of Data Collection Procedures for the field teams;
Provision of small tablet computers to be used in parallel to paper records to also for an efficient data collection and data entry process while the redundancy would pre-empt device or software hitches and provide a reference for data cleaning and verification purposes, assuring good data quality and security;
Definition of criteria to judge equipment and its status (e.g. obsolete items, un-commissioned items, operational items, out of order items);
Preparation and planning of field visits;
Three months rapid inventory exercise, recording all equipment items and labelling them with a uniquely numbered self-adhesive sticker;
Supervision and support of field mission teams as per plan, visiting zonal, regional, sub-regional, district hospitals, district- and regional medical stores as well as selected primary healthcare centres (PHCC);
Supervision of data entry, data cleaning, verification and final integration into the PLAMAHS software;
Post-mission debriefing at central level with the PAM Section / DoHS
Data entry verification and Quality Assurance (QA) at central level jointly with the PAM Section;
Analysis and presentation of inventory report through a dedicated workshop with key stakeholders, indicating options and estimates of cost implications for future MC contracts.
127 Health Facilities were surveyed;
Over 3.600 equipment items were recorded;
The average status of medical equipment was observed at 71% operational or 29% out-of-order, meaning that essential elements or functions in almost one third of such equipment were judged as defective;
Non-medical items showed 17% out-of-order;
Despite some variations within and between the regions these figures point to inadequate maintenance provisions and capacity in all facilities surveyed;
Outsourcing of maintenance along the approach piloted in MW & FW could be an option to improve the situation.