Determinants of medical equipment performance to improve management capacity within health system in Viet Nam

1背景医疗设备是推动医疗卫生事业快速发展和公共卫生服务水平提高的主要因素之一。现有保健技术的种类和复杂性不断增加，需要良好的管理能力来有效地分配资源。对世界银行全球15亿美元医疗设备投资的审查显示，在某些情况下，更复杂的设备库存中有30%没有使用，其余的设备有25%-35%的停机时间。根本原因是包括规划、收购和后续操作在内的管理不力。在公共卫生保健资金有限的背景下，确保医疗设备和基础设施的资源对越南来说是具有挑战性的。越南卫生部(MOH)没有关于医疗设备投资、维护和整个卫生系统有效性的总预算的官方数据。世卫组织有关于如何根据设备生命周期组织管理的国际准则和建议，特别是对发展中国家。越南的设备管理实践在多大程度上遵循了建议的指南，以及世卫组织的指南和建议如何适用于越南，这些都是需要调查的基本问题。因此，这项研究将涉及越南卫生系统的一个重要但往往被忽视的组成部分：技术，特别注重寻找医疗设备性能的决定因素，以通过教育和培训干预提高管理效率。2合理在越南，与许多其他收入水平类似的国家一样，卫生技术管理不发达。没有可靠的证据表明卫生技术的有效性。根据最近的一份报告，使用状况良好的医疗设备占各级医院使用的医疗设备总数的比例从20%到50%不等。此外，在中央和省级医院维护设备的比例下降到30%，在地区医院甚至下降到10%。例如，公共卫生专家和/或临床工程师在卫生技术管理方面的教育在越南并不系统。然而，河内公共卫生学院(HSPH)的医疗设备管理系是越南唯一一所与卫生相关的大学，它正在回应这一领域的重要性，并迫切希望在医院管理硕士课程和卫生专业人员培训计划的持续培训中确定需要解决的优先领域。在护理点获得正常运行和安全的医疗设备是向民众提供卫生保健服务的关键。通常，技术“密集型”服务从改进的技术基础设施中获利更多。从这个意义上说，每个使用医疗保健服务的人最终都将从制度变化中受益。3.重要信息目前还没有类似的系统学或范围的数据或研究。因此，在卫生系统和政策领域，人们对获得这种参考数据非常感兴趣。这项研究是在越南特别提出的，因为它的发展水平--与适当的管理做法和教育的存在相关的卫生保健技术支出特别差，即有很大的改进潜力。研究影响在研究的所有阶段，相关的利益相关者和政策制定者都将密切参与。研究的结果一方面将为卫生部制定政策和行动提供参考，另一方面将使卫生部在课程开发和设计方面进行进一步的研究。

1 BackgroundMedical equipment is one of the major contributors to the rapid progress of healthcare and the improvement of public health services. The constant increase in the variety and complexity of available health technologies require good management capacity to allocate the resources efficiently. The review of the World Bank's global $1.5 billion investment in medical devices showed that there are cases where 30% of the more sophisticated equipment stock was unused and the rest had 25-35% downtime. A root cause turned out to be ineffective management including planning, acquisition and subsequent operations . In the context of limited public health care funding, ensuring resources for medical equipment and infrastructure is challenging for Vietnam. There is no official data by Vietnam Ministry of Health (MOH) on total budget for medical equipment investment, maintenance and effectiveness throughout the health system. There are international guidelines and recommendations by WHO, especially for developing countries, on how to organize the management according to the equipment life-cycle . How well Vietnam equipment management practice follow the recommended guidelines and how WHO guidelines and recommendations can apply in Vietnam are basic questions to be investigated. The research will thus address one important, but often neglected, building block of the Vietnamese health system; Technologies, with particular focus on finding determinants of medical equipment performance to improve management effectiveness via education and training intervention.2 RationaleIn Viet Nam, as in many other countries of a similar income level, health technology management is not well-developed. There is no sound evidence on the effectiveness of the health technologies. According to a recent report, the percentage of medical equipment in good use condition ranges from 20% to 50% of total medical equipment in use in hospitals at all levels. In addition, the percentage of equipment being maintained drops to 30% in central and provincial level hospitals, and even to 10% in district level hospitals .The education of e.g. public health experts and/or clinical engineers in Health Technology Management is not systematically taking place in Vietnam. However, Department of Medical Equipment Management at the Hanoi School of Public Health (HSPH), the only of its kind among all health related universities in Vietnam, is responding to the importance of this area and is eager to identify priority areas to be addressed in the curriculum of master of hospital management and continuous training for health professional training program.Access to functioning and safe medical equipment at the point-of-care is key for providing health care services to the population. Typically technology "intensive" services profit more from an improved technology infrastructure. In this sense, everybody using health care services will eventually benefit from the system change. 3. ImportanceThere is no current data or studies of similar systematics or scope. In the area of health systems and policies, there is thus a great interest in obtaining such reference data. The research is proposed specifically in Vietnam because of its development level - the health care expenditure on health technology in relation to the presence of appropriate management practices and education is particularly poor, i.e. there is great potential for improvement.4. Research ImpactAt all stages of the research, relevant stakeholders and policy-makers will be involved closely. The results of the research will on one hand inform the MOH in the development of policies and actions on the other hand allow the HSPH in curriculum development and on design further research.