The Governments of El Salvador and Nicaragua faced a mutual challenge on how best to protect recent investments in new and sophisticated medical equipment. On the other hand, Brazil had positive experiences in developing policies and administrative procedures for maintaining and repairing equipment that would increase longevity and efficiency of equipment used in the provision of health services. To assist El Salvador and Nicaragua with development of national plans to maintain and repair medical equipment, the Governments participated in a knowledge exchange with Brazil.

Challenge

The Governments of El Salvador and Nicaragua faced challenges concerning how best to protect recent investments in new and sophisticated medical equipment purchased to provide quality health services to their citizens. Previously, policies and structures to maintain such equipment to ensure longevity and improve performance were not necessarily a priority of the governments. This led to equipment that was not well maintained, causing technical challenges and shorter life spans. To protect their countries’ investments in health technologies and medical equipment, both governments realized the need for proper policies and administrative structures as well as the technical expertise to monitor and manage the technologies and properly maintain their medical equipment

However, the responsible agencies in both El Salvador and Nicaragua lacked the experience or know-how for how best to protect their investments in medical equipment for the provision of quality health services in the public system.  

Solution

The Governments of El Salvador and Nicaragua requested World Bank assistance in arranging an exchange with Brazil to learn from its recent experiences in developing the policy and administrative structures for protecting investments and improving the performance of new medical equipment over time. Participating in the exchange were staff of the Ministries of Health of El Salvador and Nicaragua, specifically those working in public hospitals and institutions carrying the latest medical equipment.

From Brazil, providing knowledge were technicians, practitioners, and academics who actively work in the maintenance of medical technologies in the health system at the Bioengineering Center of the University of Campinas (UNICAMP) and across the federal state of Campinas. The exchange consisted of the following activities:

• Study tour. Two participants from El Salvador and two from Nicaragua traveled to Brazil, September 22-26, 2014, to learn good practice approaches for managing, maintaining, and repairing medical equipment. The participants learned about the UNCAMP maintenance management model, which includes information on operational maintenance, thematic divisions, distribution of physical space, and other tools to strengthen health technology performance. Participants also prepared a report with a summary of the study tour activities, along with recommendations to their respective Ministries of Health.
• Face-to-face technical training. After the study tour, approximately 15 participants took part in two technical training sessions on the maintenance of medical equipment, including defibrillators, cardioverters, and electro-surgery equipment. The training increased participants’ knowledge and practical skills on maintaining and repairing sophisticated medical equipment.
• Follow-up expert visit. On September 14, 2016, Brazilian experts traveled to El Salvador for a peer consultation to help guide the development of its national maintenance management system, and to provide recommendations for the Ministry of Health’s Maintenance Management Project.

Results

The exchange:

• Increased participant knowledge and technical skills in the maintenance and repair of sophisticated medical equipment; according to the final report, the two training sessions conducted during the exchange increased participant scores from 5.4/10 average to 7.8/10 average as measures of knowledge gained.
• Increased participants’ capacity to begin developing their countries’ own national plan for medical equipment maintenance. They learned from their Brazilian cohorts about maintenance management models, which included operational models, thematic divisions, the importance of distribution of physical space required to work on equipment maintenance, and other tools to strengthen the performance of health equipment and technologies.
• Raised awareness and dissemination of good practice approaches in the maintenance of medical equipment. Upon return from the study tour, participants from each country presented technical proposals to their respective Ministry of Health and outlined the next steps needed to protect their national investments in medical equipment through the implementation of national maintenance plans. The National Maintenance Plan for Health Technologies was approved for implementation in El Salvador. Nicaragua’s plan is under final review.
• Strengthened networks among policy-makers and practitioners in both knowledge-providing and knowledge-receiving countries. Upon completion of the study tour, experts from Brazil traveled to El Salvador for a follow-up visit where they conferred with El Salvadorian experts and policy-makers to explore further pertinent issues with regard to maintenance of medical equipment. 

Lessons Learned

• Participating in exchanges, including site visits, allows participants to analyze their own realities and identify gaps in knowledge and assess what is possible or not possible in their own context.
• Working closely with experts from knowledge-providing and knowledge-receiving countries from development through the consultative process helps ensure the exchange content is relevant and can also lead to additional sources of support for the exchange.
• It is important to establish a well-defined program, build strong institutional relationships, and work with partners on technical cooperative activities to ensure that an exchange is successful and can extend beyond the scope of the initial exchange activities. 

World Bank Group Contribution

The World Bank’s South-South Facility provided the funding for this project, allowing the exchange to take place and leading to additional follow-up efforts. The Bank provided consultation through a medical equipment specialist also worked with the governments of each country and the knowledge-providing partners in the design and coordination of the exchange activities.

Partner

Providing knowledge in Brazil were representatives of the Bioengineering Center of the University of Campinas and representatives of the federal state of Campinas.

Moving Forward

The knowledge gained from the exchange was used by each country to develop and begin implementing their National Management Plan for Health Technologies. The exchange also provided the governments of both countries with evidence and practical skills needed to improve their abilities to plan for and manage maintenance programs for their medical technology investments. The two countries are investing additional funds to acquire the latest medical technologies and equipment and have each expressed an interest in protecting these investments by allocating specific amounts to fund capacity building and strengthening of maintenance units within their ministries.

Beneficiaries/Participants

From Nicaragua:

• Jessenia de los Angeles García Quintero, Coordinator of the Techno Medicine Service;
• Wiston Alberto Lopez, Technician in Electromedicine.

From El Salvador:

• Juan Carlos Campos Vasquez, Technician in maintenance of medical equipment;
• Francisco Antonio Molina Parada, Supervisor in Maintenance of Medical Equipment.