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MAINTENANCE OF THE HEALTH ESTATE


equipment, the central medical gas unit and major MEP installations. The coordination teams at the HCRs have been formally familiarised with a number of those procedures. When the activities related to the


procedures were introduced, training was performed to explain the various tasks related to it and the utilisation of the forms or check lists. For medical equipment, training requires the involvement of the users. The technicians have also received formal on the job training relating to the safe and secure operation and trouble-shooting of vital medical devices. To track inventory and plan preventive


maintenance activities, a working version of the computer-assisted inventory and maintenance management software (CMMS) has been installed in the HCRs’ biomedical technicians’ workshops. Under the fuel and medical gases supply programme, the diesel delivery continues to all three HCRs, on the basis of the level verification and requisitions. The level of medical gasses is verified daily and registered in a logbook, with the verification of the alarms panels and the network pressure gauges. Requisition and replenishment of the cylinders is then activated. Changing of the cylinders is performed by hospital technicians. In line with the efforts to build an


effective communication channel between UNOPS and MSPP, and in order to facilitate the project advancement, the project team has hired a national expert in Public Health, with an extensive knowledge of MSPP systems. This expert is in charge of following up and bridging the gaps between UNOPS, MSPP headquarter management teams of HCR, and the tri-party stakeholders. Biweekly meetings were put in place


with the focal points of the partners (MSPP and Brigada Medica Cubana), weekly update meetings with the hospital management (medical direction and administration), and every three months a workshop is held with the Brazilian Cooperation, to share experiences from the HCRs. Finally, to reinforce the importance of


capacity-building and collaboration, UNOPS helped to set up a national workshop at the faculty of medicine at Notre Dame University. Endorsed by the MSPP, the workshop entitled ‘Sustainability of hospital infrastructures through and appropriate maintenance programmes: Shared experiences’ brought together 75 specialists in the field of hospital maintenance, with case studies presented from five different hospitals in Haiti with the objectives of promoting good practices in healthcare facilities and sharing lessons learnt though experiences. This conference helped to establish a benchmark for future collaboration and


56


Planning/ Control


Organise/ Train/


Support {


Biomedical Technician


UNOPS


Technical Team


Coordination Team based in one HCR


{ Electrician


HCR Management


Maintenance/ Advanced Corrective and Preventive Maintenance*


Mechanic Plumber Standard User Support/Basic Preventive and Corrective Maintenance Organisation chart illustrating the maintenance/operation team.


meetings, by triggering networking among professionals. One of the findings was that, while Haiti lacks a structured national health technology assessment or management units and hence any formal maintenance framework, it was noticed that facilities funded by international organisations had a certain form of maintenance programme in place.


Obstacles During the implementation phase of the project, several obstacles were encountered. Some of the most significant challenges are outlined in this section along with the devised strategies used to overcome them. The geographical scattering of the


facilities in a large urban area like Port Au Prince, with the existing security and logistics implications, impacted on the duration of the tasks completion. This aspect emphasised the need to reinforce the project team during project implementation, in order apply a stronger and more continuous supervision of the activities on site. Although the initial phase of retrofit


and re-commissioning of the healthcare facilities was longer and more complex than expected, this was in part due to the fact that the equipment was under- utilised and without an initial maintenance follow up. It was only when the utilisation rate was raised to a more regular level, that the potential limitations or faults of the equipment and installations emerged. The preliminary activities also showed the need for specific additional medical technologies or improvements in the MEP systems that were not included in the original master plan. The selection of suppliers through


standard tenders also emphasised risks due to the actual technical capacity expressed by the local market. In certain cases, it was difficult to find the balance between the local dealers and regional/international distributors while managing the maintenance. Haiti is still an immature market, especially for the


medical equipment. In certain cases, therefore, it was necessary to contact and involve authorised external support from abroad. Yet the response of local dealers has been improving from a technical and organisational point of view during the project phases, which constitutes one of the desired outcomes of this project. The introduction of simplified


procedures for preventive maintenance activities, to be carried on by the hospital technical teams on site, together with the identification of better qualified service providers and authorised equipment distributors in the region, solved some of the initial issues identified and the continuity of the functionality of the systems, while maintaining a sustainability perspective. From a procurement point of view,


the supply chain of spare parts, dedicated consumables and accessories showed efficiency (time) issues, due to the limited local availability in certain cases, and because of the formality of UNOPS processes, compliant to a public-like tendering system. A delicate boundary has been


observed between the technical and clinical sectors for medical equipment. In particular, the consumables related to the standard clinical utilisation were not covered by the project. In some cases, it was necessary for UNOPS to activate procurement processes in order to obtain specific medications and single use devices for the proper utilisation of certain medical equipment. On an institutional level, the interaction


with the MSPP showed some inefficiencies – in particular with the supporting documents for the salaries, which resulted in payment delays. This had practical consequences on the motivation and commitment of the technicians and medical specialists. To avoid these inconsistencies and in line with strengthening the communication channels with MSPP, UNOPS hired a national expert to be formally in charge of follow-ups and project updates.


IFHE DIGEST 2017


Cleaning Team


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