MAINTENANCE OF THE HEALTH ESTATE


While keeping the sustainability of the health facilities through capacity building as a long-term goal, other short-term objectives, practical and technical, have been identified to establish an effective operation and maintenance management model and a roadmap to lead the transition from the initial limited situation to a fully functional, sustainable and independent healthcare facility. UNDP requested UNOPS to undertake


a project with the principal objective of providing operational and maintenance management support to the MSPP for the three HCRs. The three main partners therefore, UNDP, UNOPS and MSPP, formally established a decision making body dedicated to the project, defined as ‘Project Board.’ The project entails a holistic approach


to manage and maintain facility operations. This includes managing the equipment assets for a period of 18 months as well as managing salary payments of the medical and technical staff, hired and supervised by MSPP.


Materials and methods This case study is based on extensive field observations conducted during the direct implementation of the activities, deriving from two main methodologies, project management and quality management, adapted and scaled to the local context and project needs. This strategy guarantees that the activities and deliverables are aligned with the desired outcomes of the project, according to the plan shared with the partners and stakeholders.


Project management UNOPS implements projects and provides support services based on the PRINCE2 (Projects in Controlled Environments) management methodology. Based on that methodology, the initial project team of UNOPS was formed: l A Project Manager with international experience in the health technical sector.


l A Biomedical Engineer with experience in international projects.


l A Civil Engineer with national health facility construction experience.


Following the initial period, the team was reinforced with the following resources: l An expert in MEP (mechanical, electrical and plumbing) installations and systems.


l Two biomedical engineering interns. l A public health expert.


At the HCR level, the general management is performed by the Medical Director, supported by the Administrative Director. Under the administrative direction, the hospital maintenance team formally belongs to the logistics unit.


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With the beginning of the project, the technicians (mechanical, electrical, plumbing and biomedical) were recruited by MSPP for each HCR. The organisation chart illustrates how the maintenance/ operation team is structured and the level at which UNOPS would intervene to provide technical and managerial support. During the initial phase of the project,


activities concentrated on the functional inventory and the retrofitting of the equipment and installations, that remained only partially used or without a proper maintenance coverage for several months. As part of the setting up of an


appropriate operations and maintenance system, areas for workshop and technical stores were identified and arranged with furniture, tools kit for each technician were also procured. As part of this set up, a technical library was re-organised. Meanwhile the original database of the medical equipment was imported in a customised CMMS (computerised maintenance management system) developed for the project by UNOPS, with the scope of being the basis for the standard management of the inventory, including MEP systems, and the recording of the main maintenance activities. During the activities of re-set up of


the installations, systems and equipment, on the job training was carried out almost on a daily basis by each UNOPS expert, focusing on the routine activities, technical principles of functionality, faults identification and basic diagnostics. For the mechanical and electrical technicians this included understanding the drawings and components functionality of each installation, implementation of preventive maintenance activities and settings, implementation of fundamentals corrective maintenance activities. For the biomedical technicians, explanations were passed by UNOPS, regarding the equipment definitions and functionality and the physiology principles, including basic set up, functional checks, preventive maintenance and basic corrective maintenance activities. Formal training events were also


organised with the involvement of users, in particular for the health technologies. At these events reference documentation is given, utilisation steps and basic maintenance checks are explained and simulations are performed, also with the scope of facilitating the exchange and communication between users and technicians. To motivate the technical teams of


each hospital, English language courses were also offered through an external school, to improve the understanding of technical references or documents related to the installations and medical equipment. In parallel to the implementation of the


technical activities, all the related procurement tasks were conducted. Where specialised technical support was needed, manufacturer-authorised distributors were contacted and missions organised. Similarly, selected HVAC contractors were identified for more advanced repairs or improvements to this system. Preventive maintenance service


contracts were also introduced for higher complexity MEP systems or medical equipment to guarantee a regular verification of the technologies such as generators, sterilisation, radiology, laboratory. An agreement was signed between


MSPP and UNOPS to define the quality and number of personnel that will benefit from the salary support programme. The last update list of personnel lists 41 medical specialists, seven maintenance technicians and eight support personnel. Finally, the component of the project


related to the support for essential supplies (diesel for generators and medical gases, etc) was introduced and implemented through a standardised communication chain from the hospital, through the MSPP referral unit, up to UNOPS and the identified supplier. The levels were verified daily and the requisition was launched at HCR stage, then passing to the other people involved in the authorisation and supply chain.


Quality management The project approached the framework of maintenance activities through a simplified but structured quality management system. Procedures were identified and prioritised for each sector, coded according to established frequency and related forms introduced. According to the established plan, the preventive maintenance protocols were introduced gradually. Each task was described in an instruction-like manner, with pictures and symbols, brief text, references to manuals. The tasks were explained during training sessions and related forms such as checklists and logbooks are also introduced, in order to set up daily, weekly or monthly routine activities.


Results The needs and technical issues identified during the initial phase of assessment and operational inventory were gradually processed and solved, either internally or by external contractors. A follow up scheme was used, arranged by sector and supervised by UNOPS to check on the procurement and logistics related to each point. For issues solved internally, the spare


parts, accessories and dedicated consumables were purchased and substituted and the majority of repairs were implemented, with the direct


IFHE DIGEST 2017


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