Development, Implementation and Evaluation of Evidence-based Training Model and Computerized Maintenance Management System for Improved HTM: Case Study at Selected Jimma Zone Hospitals, Southwest Ethiopia

Abstract

In resource-poor environments, the shortage of usable medical equipment has a detrimental impact on healthcare. More than 50% of innovations in developing countries and over 40% in Ethiopia are projected not to be in use, not to be used correctly and optimally, and not to be maintained invariably. The shortage of spare parts and highly trained technicians are the most widely cited factors. There is little information, however, to support these theories and to produce evidence based solutions. This study determined and discussed the unique barriers that block the successful development and utilization of healthcare technology at 6 Jimma zone hospitals. To identify the need for changes, data was gathered and examined on the general characteristics of the hospitals, type and status of all available equipment, and major causes of failures and knowledge required to restore 11 most available types of equipment as well as the systems which provides utilization, maintenance, and repair of biomedical equipment. Afterwards, a unique model of evidence-based intervention solution incorporating technicians’ capacity building was designed and implemented by considering all major and directly contributing factors. In addition, a computerized maintenance management system (CMMS) package with a remote access feature, that best suits the needs in the hospitals was locally developed and implemented. After 4 months, a matched cohort study was conducted to determine the impact of the intervention program on healthcare infrastructure and technicians’ productivity. The condition of the hospitals is largely dependent on infrastructure and finances, management problems, and needs for training. All hospitals lacked a proper program scope, effectiveness, and efficiency for utilization, coupled with the maintenance and repair. A total of 161 repair conditions (88 out-of-service at the time of analysis and 73 completed) were examined. Among the 73 completed repairs, 34 were adequately recorded on paper, and among 39 cases registered from technician’s memory, only the 32 sufficiently described cases were selected to identify the required skills. Power fluctuation for problems related to power supply and other electrical components as well as aging, and lack of proper handling and PM operations for the mechanical and plumbing related problems, were among the main factors for equipment being out-of-service. After reviewing repair needs, we found that 82% of them involved electrical, mechanical, plumbing, and user training areas of knowledge. These variables have therefore become key elements of the established systematic intervention approach and customized CMMS package. With a 2.11 odds ratio (17% vs. 36%), hospitals with technicians in the program have substantially fewer out-of-service equipment. 70% of broken equipment is due to missing parts and consumables in intervention hospitals, compared with 36% in control hospitals (95% increase). Intervention hospitals have large quantities of repairs recorded on paper (73.5% vs. 25.5%) and report significant differences in all informal equipment interactions, including participation in the procurement process. In Ethiopia, they seek assistance twice as often and outside of Ethiopia, 4 times higher. Overall, by actively using and exchanging taught skills, the unique training curriculum greatly enhanced healthcare. Policy-based guidelines for the Federal Ministry of Health, regional and zonal health departments, Ministry of Science and Higher Education, and medical equipment managing staff and CEOs of the respective hospitals were recommended by the findings review and evaluation