BIOMEDICAL ENGINEERING CAPACITY BUILDING IN THEREPUBLIC OF PALAU

Nehal Kapadia,

SSCSiP Biomedical Engineering Coordinator, CMNHS, Fiji National University, Suva, FIJI

Alben Adelbai,Belau National Hospital, Koror, 96940 Republic of Palau

Sanjeev Hiremath, Australian Volunteers International, Fitzroy VIC 3065 Australia

REPUBLIC OF PALAU

• Republic of Palau is a remote island nation in the northern Pacific.Population of 20,000 served by - Public Health Bureau and Belau National Hospital

• One major hospital many health centers around the islands.

• Belau National Hospital

• 100 Bedded hospital with • 2-operating rooms, • Radiology with CT Scanner, Mammography, • Renal Dialysis, Orthopedics and Behavioral health• Tele-radiology and Tele-ophthalmology facilities,• Maternity and Neonatal care facilities

BIOMEDICAL ENGINEERING SITUATION

As of April 2013, the Ministry of Health had following biomedical engineering capacity:

• One workshop at Belau National Hospital with minimum test equipment and tools

• 3 Biomedical Engineering technicians and 1 Medical Equipment Specialist

• They catered for about 1000 pieces of medical equipment mostly situated in the national hospital and few in the health centers

• Very little formal training and continuing professional development available

SITUATIONAL ANALYSIS

• A situational analysis was carried out in the Pacific Island Countries by AusAID supported biomedical engineers.

• The method used involved obtaining responses to a questionnaire designed by the biomedical engineers from the host country hospital staff.

• The results were compiled by collating the scored responses and tabulating them country-wise.

• The questions were designed to minimize the effects of population variation

Results from Questionnaire on Biomedical Services for Pacific situational analysis

Number Question Palau ScoreRegional maximum score (best or worst

indicator)3.1 Preventive

maintenance 0 33.2 Safety & function

checks 0 43.3 Safety checks after

repair 1 43.4 Check due date

marked 0 43.5 Work documentation 4 43.6 Documentation

manual/PC 2 43.7 Equipment details on

delivery 3 43.8 Equipment Inventory

number 794 110003.9 Eqpt. Inventory Value

$US 3 million 88 million 3.10 Waiting Fault

Diagnosis today 1 183.11 Waiting spare parts

today 10 1173.12 Waiting disposal today 10 543.13 Service manuals

available 2 43.14 Specialised test eqpt 1 4

Weighted Total Score (maximum 98) 32 75

2012- AusAID supported situational analysis results

PACTAM – BIOMEDICAL ENGINEERING ASSITANCE

Australian overseas aid program – PACTAM

The Pacific Technical Assistance Mechanism (PACTAM) providesskilled international deployees to work with Pacific Island nations.

PACTAM deployees:

• Offer experience that may not be available locally• Help you respond to unexpected or emerging issues• Develop the skills and capacity of your current staff team• Work with you in a respectful and culturally appropriate

manner

PACTAM Biomedical Engineer deployment to the Republic of Palau (2013-15)

Australian Volunteers International (AVI) managed deployment began in April 2013.

This 24 months deployment is planned to be aligned to local needs of the host country.

Follows Lean Six Sigma (LSS) methodology in capacity building:The LSS based ‘5 – S’ steps follow:

1. Sort2. Set-up3. Shine4. Standardize5. Sustain

SORTThis is the first step of aligning the elements of the existing system so as to reduce the wasteful activities and processes.

TIMWOOD – 7 cardinal forms of ‘Waste’ in business processes:

T – TransportI – InventoryM- MotionW – WaitingO – Over-

processing O – Over

productionD – Defective

work

Transportation of spare-parts, workers and equipment for repairs/maintenance in the region is extremely time consuming and wasteful.

KEY: MINIMIZE THE POTENTIAL TRANSPORT

This was addressed by rationalizing the equipment inventory and work-schedules so that maximum utilization of workers time and minimum down time were achieved.

UNNECSSARY TRANSPORTATION REMOVED

Inventory managementPoor Inventory Management is the single most costly cause of

biomedical equipment unavailability in the hospitals.

It is compounded by the fact that good hospital inventory management systems are unaffordable for many small hospitals.

KEY : WHO PAYS and WHO CARES???

All the processes and systems used for managing the inventory in the hospital including equipment procurement, maintenance and disposal were reviewed by the biomedical engineer with the senior management.

A simplified and direct system of responsible inventory management system is being evolved.

PALAU: Current Scores on the same scale

Number Question Palau Score3.1 Preventive maintenance 23.2 Safety & function checks 33.3 Safety checks after repair 33.4 Check due date marked 23.5 Work documentation 43.6 Documentation manual/PC 33.7 Equipment details on delivery 33.8 Equipment Inventory number 8933.9 Eqpt. Inventory Value $US 3 million

3.10 Waiting Fault Diagnosis today 33.11 Waiting spare parts today 43.12 Waiting disposal today 13.13 Service manuals available 43.14 Specialised test equipment. 4

Weighted Total Score (maximum 98) 78

We are getting there….

…………………… Thank you.