Problems with systems of medical equipment provision: an evaluation in Honduras, Rwanda and Cambodia identifies opportunities to strengthen healthcare systems
Problems with systems of medical equipment provision: an evaluation in Honduras, Rwanda and Cambodia identifies opportunities to strengthen healthcare systems
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DOI：
10.1007/s12553-017-0210-6
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发表时间：
2018-05-01
影响因子：
2.5
通讯作者：
Malkin, Robert A.
中科院分区：
文献类型：
--
作者：
Emmerling, Dane;Dahinten, Alexander;Malkin, Robert A.
在发展中国家，大量设备已经报废。停用的设备限制了重要医疗程序的使用。我们衡量了洪都拉斯、卢旺达和柬埔寨的捐赠、购买和出借医疗设备的数量，并记录了这些设备在医院恢复服务时遇到的障碍。从2010年到2012年，我们完成了对64家医院五个部门的3421件医疗设备的横断面调查。确定了抵达后的时间、来源（捐赠、购买或借用）、服务合同状况和功能。对于任何部分或非功能性设备，记录了将设备重新投入使用的障碍。在第一年，捐赠的设备比购买和租借的设备更有可能停止使用（p < 0.01），后者在购买前可能会得到更多的医院检查。但是，购买的设备比捐赠的设备更容易在到达后5 - 6年停用（p < 0.05）。租借设备的使用率最高。服务合同并没有显著降低停用率，除了高度复杂的设备（p < 0.001）。据技术人员说，使设备恢复使用的最大障碍是获得备件、附件和消耗品。鉴于相当高的停用率，最可持续和最有效的干预点可能是培训当地技术人员和租赁（而不是捐赠或购买）设备，以改善医疗设备的供应，从而增加获得医疗程序的机会。
A substantial amount of equipment is out-of-service in the developing world. Out-of-service equipment limits access to important medical procedures. We measured the amount of out-of-service donated, purchased and loaned medical equipment and documented the barriers to returning them to service in hospitals in Honduras, Rwanda and Cambodia. From 2010 to 2012, we completed a cross-sectional survey of 3421 pieces of medical equipment in five departments from 64 hospitals. The time since arrival, source (donated, purchased or loaned), service contract status and functionality were determined. For any partially or non-functional equipment, the barriers to placing the equipment back into service were documented. In the first year, donated equipment was significantly more likely to be out-of-service than purchased and loaned equipment combined (p < 0.01), where the latter presumably gets more hospital scrutiny before acquisition. But, purchased equipment was more likely to be out-of-service than donated equipment 5 to 6 years after arrival (p < 0.05). Loaned equipment had the highest in-service rates. Service contracts did not significantly decrease out-of-service rates, except for high-complexity equipment (p < 0.001). The largest barrier to placing equipment back into service, according to technicians, was access to spare parts, accessories and consumables. Given the considerable out-of-service rates, the most sustainable and efficacious points of intervention could be the training of local technicians and leasing (rather than donating or purchasing) equipment in order to improve the availability of medical equipment and thus increase access to medical procedures.