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MAINTENANCE OF THE HEALTH ESTATE


ROBERTO MUSI, JEAN-MICHEL BONJOUR, ZIAD HAMZE, DENIS BELBES, DIEGO MAGGI, PENEL COQ, TANIA VIALA, JEAN FRANCOIS LAURENT – UNITED NATIONS OFFICE FOR PROJECT SERVICES (UNOPS), HAITI OFFICE


Health technology in complex settings


A project, financed by the Brazilian Ministry of Health, to implement a preventive maintenance programme in complex settings was undertaken by UNOPS Haiti.


UNOPS Haiti was previously appointed to build and equip three community reference hospitals (HCRs) in the capital city of Port Au Prince following the devastating earthquake in January 2010. The construction was completed in 2014 and the new facilities were handed over to the local Ministry of health. The HCRs, according to the Haitian


system, is a second level institution in the pyramid of health services that handles cases referred by first level institutions or community physicians. HCRs serve a population base of between 150,000 to 250,000 people with the primary mission of providing consultation, referral care, along with a certain number of medical interventions and surgeries.1 The new HCRs represented a step


forward in terms of technical complexity. They include an outpatient area, emergency room, four hospitalisation areas (adult males, females, ob-gyn and paediatric), adult ICU and neonatology, and three operating theatres. The level of medical equipment is middle high, with internationally known brands. Additional services include: laundry and sterilisation, external incinerator, basic dormitory with kitchenette, and administration. MEP systems include generators with


ATS, central gases, HVAC with hepa filtering, water well and osmosis treatment. While being an improvement over previous facilities, these characteristics also constitute a challenge. In this sense, proper maintenance policies and practices are essential in order to guarantee the operation and sustainability of these health facilities and their equipment. Unfortunately, field observation and an evaluation by USAID in 2013,2


found


that the maintenance activities, both preventive and corrective, of the health infrastructures and equipment, were in general inefficient and were not conducted under a systematic approach. This can be mainly attributed to lack of funds, human resources, capacity and proper management; operationally at the field level as well as centrally. Similarly, many developing countries do not have a


IFHE DIGEST 2017


Senior User MSPP, DOSS


Project Board Executive


MoH, UNDP Brazil


Senior Suppliers UNOPS


Project management UNOPS PM


Project Assurance UNOPS Eng.


Project Support


UNOPS Health Unit UNOPS Haiti Office


Service and Goods Providers The envisaged project structure.


comprehensive national health care technology policy that maps out national vision and strategy for rational introduction and application of technology.3 After a year of limited clinical activity


and utilisation, a new project was launched, in collaboration with the Haitian Ministry of Health (MSPP), to set up a roadmap for the introduction and implementation of proper health facility management policies and practices, to guarantee appropriate operations and maintenance of medical equipment and electromechanical installations and systems, together with their sustainability. While the primary objective of this project was to support the hospitals in terms of maintenance, technical support and training has also been included, in activities related to logistics, procurement of consumables, goods and services, essential for the appropriate maintenance and operation of the healthcare facilities. In a country where no national policy


on health technologies formally exists,4 the added value brought by this project was the introduction of a mindset of


preventive maintenance in a context where it is not generally adopted. Guided by international norms and standards, simplified procedures and processes, adapted to the local context, were produced and introduced. The present case study describes the


experience from Haiti, a limited resources country, with a local context generally characterised by gaps of capacity in terms of logistics, security and technical services availability. A description of the background, materials and methods used to implement the project will be exposed, as well as a formal discussion of the general outcomes. Finally, the impact that this project had along with the various challenges faced throughout the execution phase will be explained in the conclusions. Key lessons retained from this experience will equally be shared, together with general recommendations for projects of this nature. In the specific case of this project in


Haiti, after a careful assessment of the situation, several objectives have been set, aiming to bridge the identified gaps and respond to the observed challenges.


53


Partners HCR Adm.–Tech Staff/Cuban Experts


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