Guide 2.pdf

‘HOW TO MANAGE’ SERIES
FOR HEALTHCARE TECHNOLOGY


Guide 2
How to Plan and Budget for
Your Healthcare Technology


Management Procedures for
Health Facilities and District Authorities


TALCTeaching-aids At Low Cost




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Copyright © 2005 Ziken International
Ziken International (Consultants) Ltd,
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website: www.ziken.co.uk


‘How to Manage’ Series for Healthcare Technology
Guide 1: How to Organize a System of Healthcare Technology Management
Guide 2:How to Plan and Budget for your Healthcare Technology
Guide 3: How to Procure and Commission your Healthcare Technology
Guide 4: How to Operate your Healthcare Technology Effectively and Safely
Guide 5: How to Organize the Maintenance of your Healthcare Technology
Guide 6: How to Manage the Finances of your Healthcare Technology


Management Teams
Keywords: healthcare technology, management procedures,
health service administration, district health services, developing countries,
planning, budgeting, financial management, equipment
Any parts of this publication, including the illustrations, may be copied, reproduced, or adapted to
meet local needs, without permission, provided that the parts reproduced are distributed free or at
cost – not for profit. For any reproduction with commercial ends, permission must first be obtained
from the publisher. The publisher would appreciate being sent a copy of materials in which text or
illustrations have been used.
This document is an output from a project funded by the UK government’s Department for
International Development (DFID) for the benefit of developing countries. The views expressed
are not necessarily those of DFID.


ISBN: 0-9549467-1-5
All rights reserved
A catalogue record is available from the British Library
Design and layout by Jules Stock (email: julesstock@macunlimited.net
Illustrations and charts by David Woodroffe (email: davedraw@dircon.co.uk)
Edited by Rebecca Lowe, Swan Media Services (email: swanmedia@ntlworld.com)




‘How to Manage’ Series for Healthcare Technology


Guide 2


How to Plan and Budget for your
Healthcare Technology


by:
Caroline Temple-Bird


Healthcare Technology Management Consultant,
Ziken International Consultants Ltd, Lewes, UK


Willi Kawohl
Financial Management Consultant, FAKT, Stuttgart, Germany


Andreas Lenel
Health Economist Consultant, FAKT, Stuttgart, Germany


Manjit Kaur
Development Officer, ECHO International Health Services, Coulsdon, UK


Series Editor
Caroline Temple-Bird


Healthcare Technology Management Consultant,
Ziken International Consultants Ltd, Lewes, UK




CONTENTS
Section Page
Foreword i
Preface i
Acknowledgements iii
Abbreviations v
List of Boxes and Figures vii
1. Introduction 1
1.1 Introduction to the Series of Guides 1
1.2 Introduction to this Specific Guide 9
2. Framework Requirements 23
2.1 Framework Requirements for Quality Health Services 24
2.2 Background Conditions Specific to this Guide 33
3. How to Discover your Starting Point – Planning Tools I 41
3.1 The Equipment Inventory 42


3.1.1 Understanding Inventories 42
3.1.2 Establishing the Equipment Inventory 46
3.1.3 Establishing Inventory Code Numbers 50


3.2 Stock Value Estimates 53
3.3 Budget Lines for Equipment Expenditures 57
3.4 Usage Rates for Equipment-related Consumable Items 61
4. How to Find Out Where You are Headed – Planning Tools II 65
4.1 Reference Materials 66
4.2 Developing the Vision of Service Delivery for Each Facility Type 68
4.3 Model Equipment Lists 73
4.4 Purchasing, Donations, Replacement, and Disposal Policies 79


4.4.1 General Issues 79
4.4.2 Purchasing and Donations Policies 80
4.4.3 Replacement and Disposal Policies 85


4.5 Generic Equipment Specifications and Technical Data 87
5. How to Make Capital Budget Calculations


– Budgeting Tools I 99
5.1 Replacing Equipment 101


Contents




5.2 Purchasing New Equipment 106
5.3 Pre-Installation Costs 111
5.4 Support Activities to Enable You to Use Your


Purchases and Donations 116
5.4.1 Installation and Commissioning Costs 118
5.4.2 Initial Training Costs 122


5.5 Large-scale Major Rehabilitation Projects 127
6. How to Make Recurrent Budget Calculations


– Budgeting Tools II 133
6.1 Maintenance Costs 134
6.2 Consumable Operating Costs 144
6.3 Administrative Costs 153
6.4 Ongoing Training Costs 156
7. How to Use the Tools to Make Long-term Equipment Plans


and Budgets 161
7.1 Equipment Development Plan 162
7.2 Equipment Training Plan 172
7.3 Equipment Budget – Financial Plans 180


7.3.1 Core Equipment Expenditure Plan 180
7.3.2 Core Equipment Financing Plan 185


8. How to Undertake Annual Planning, Budgeting,
and Monitoring 191


8.1 Annual Equipment Planning and Budgeting (Setting Goals) 192
8.2 Monitoring Progress 206


8.2.1 How to Monitor Progress Against Annual Equipment Plans
and Budgets 209


8.2.2 How to Monitor Progress in General 215
Annexes 219
1. Glossary 219
2. Reference Materials and Contacts 224
3. Typical Equipment Lifetimes 255
4. Sample Long Generic Equipment Specification 270
5. Sample Technical and Environmental Data Sheet 277
6. Shortcut Planning and Budgeting When Starting Out 279
7. Source Material/Bibliography 281


Contents




Foreword
This Series of Guides is the output from a project funded by the UK government’s
Department for International Development (DFID) for the benefit of developing
countries. The output is the result of an international collaboration that
brought together:
◆ researchers from Ziken International and ECHO International Health Services in


the UK, and FAKT in Germany
◆ an advisory group from WHO, PAHO, GTZ, the Swiss Tropical Institute, and the


Medical Research Council of South Africa
◆ reviewers from many countries in the developing world
in order to identify best practice in the field of healthcare technology management.
The views expressed are not necessarily those of DFID or the other
organizations involved.


Garth Singleton
Manager, Ziken International Consultants Ltd, Lewes, UK


Preface
The provision of equitable, quality and efficient healthcare requires an extraordinary
array of properly balanced and managed resource inputs. Physical resources such as
fixed assets and consumables, often described as healthcare technology, are among
the principal types of those inputs. Technology is the platform on which the delivery
of healthcare rests, and the basis for provision of all health interventions. Technology
generation, acquisition and utilization require massive investment, and related
decisions must be made carefully to ensure the best match between the supply of
technology and health system needs, the appropriate balance between capital and
recurrent costs, and the capacity to manage technology throughout its life.
Healthcare technology has become an increasingly visible policy issue, and healthcare
technology management (HTM) strategies have repeatedly come under the spotlight
in recent years. While the need for improved HTM practice has long been recognized
and addressed at numerous international forums, health facilities in many countries
are still burdened with many problems, including non-functioning medical equipment
as a result of factors such as inadequate planning, inappropriate procurement, poorly
organized and managed healthcare technical services, and a shortage of skilled
personnel. The situation is similar for other health system physical assets such as
buildings, plant and machinery, furniture and fixtures, communication and information
systems, catering and laundry equipment, waste disposal, and vehicles.


Foreword


i




Preface (continued)
The (mis-)management of physical assets impacts on the quality, efficiency and
sustainability of health services at all levels, be it in a tertiary hospital setting with
sophisticated life-support equipment, or at the primary healthcare level where simple
equipment is needed for effective diagnosis and safe treatment of patients. What is
vital – at all levels and at all times – is a critical mass of affordable, appropriate, and
properly functioning equipment used and applied correctly by competent personnel,
with minimal risk to their patients and to themselves. Clear policy, technical
guidance, and practical tools are needed for effective and efficient management of
healthcare technology for it to impact on priority health problems and the health
system's capacity to adequately respond to health needs and expectations.
This Series of Guides aims to promote better management of healthcare technology
and to provide practical advice on all aspects of its acquisition and utilization, as well
as on the organization and financing of healthcare technical services that can deliver
effective HTM.
The Guides – individually and collectively – have been written in a way that makes
them generally applicable, at all levels of health service delivery, for all types of
healthcare provider organizations and encompassing the roles of health workers and
all relevant support personnel.
It is hoped that these Guides will be widely used in collaboration with all appropriate
stakeholders and as part of broader HTM capacity-building initiatives being
developed, promoted and implemented by WHO and its partners, and will therefore
contribute to the growing body of evidence-based HTM best practice.
The sponsors, authors and reviewers of this Series of Guides are to be congratulated
for what is a comprehensive and timely addition to the global HTM toolkit.


Andrei Issakov, Coordinator, Health Technology and Facilities Planning and
Management, World Health Organization, Geneva, Switzerland


Mladen Poluta, Director, UCT/WHO HTM Programme, University of Cape
Town, South Africa


Preface


i i




Acknowledgements
This Guide was written:
◆ with specialist support from:
Pieter de Ruijter, Consultant, HEART Consultancy, Holland
◆ with assistance from an Advisory Group of:
Hans Halbwachs, Healthcare Technology Management, Deutsche Gesellschaft für
Technische Zusammenarbeit (GTZ-GmbH), Eschborn, Germany
Peter Heimann, Director, WHO Collaborating Centre for Essential Health
Technologies, Medical Research Council of South Africa, Tygerberg, South Africa
Antonio Hernandez, Regional Advisor, Health Services Engineering and Maintenance,
PAHO/WHO, Washington DC, USA
Andrei Issakov, Coordinator, Health Technology and Facilities Planning and
Management, Department of Health System Policies and Operations, WHO,
Geneva, Switzerland
Yunkap Kwankam, Scientist, Department of Health Service Provision,WHO,
Geneva, Switzerland
Martin Raab, Biomedical Engineer, Swiss Centre for International Health of the
Swiss Tropical Institute, Basle, Switzerland
Gerald Verollet, Technical Officer, Medical Devices, Blood Safety and Clinical
Technology (BCT) Department, WHO, Geneva, Switzerland
Reinhold Werlein, Biomedical Engineer, Swiss Centre for International Health of the
Swiss Tropical Institute, Basle, Switzerland
◆ and reviewed by:
Dr P. Asman, Head of the Bio-engineering Unit, Ministry of Health, Ghana
Tsibu J. Bbuku, Medical Equipment Specialist, Central Board of Health,
Lusaka, Zambia
Juliette Cook, Biomedical Engineer, Advisor to Ministries of Health of Mozambique,
and Vanuatu
Peter Cook, Biomedical Engineer, ECHO International Health Services,
Coulsdon, UK
Trond Fagerli, Senior Advisor, Haraldsplass Deaconal Hospital, Bergen, Norway
(former Chief Bio-Medical Engineer, Ministry of Health, Botswana)
Freedom Dellosa, Chief of Hospital Equipment Maintenance Service Division,
Region 9 – Mindanao Peninsula, Department of Health, Zambonga City, Philippines


Acknowledgements


i i i




Roland Fritz, HCTS Coordinator, Christian Social Services Commission, Dar es
Salaam, Tanzania
Andrew Gammie, Project Director, International Nepal Fellowship, Pokhara, Nepal
Muditha Jayatilaka, Deputy Director General of Health Services (Biomedical
Engineering Services), Ministry of Health, Nutrition and Welfare, Colombo, Sri Lanka
Dyness Kasungami, District Director of Health – Kafue DHMT/Reproductive
Health Advisor – USAID, Lusaka, Zambia
Godfrey Katabaro, Biomedical Engineering Technologist, Kagera Medical Technical
Services, church health sector, Kagera, Tanzania
Alex Manu, National Director of Finance, Aga Khan Foundation Private Hospital,
Nairobi, Kenya
Sulaiman Shahabuddin, Director, Patient Services, Aga Khan Foundation Private
Hospital, Nairobi, Kenya
Khout Thavary, Chief of Financial Planning Office, Ministry of Health,
Phnom Penh, Cambodia
Birgit Thiede, Physical Assets Management (PAM) Advisor, Ministry of Health,
Phnom Penh, Cambodia
Dr K. Upadhyaya, Medical Superintendent, Western Regional Hospital,
Pokhara, Nepal
◆ using source material:
as described in Annex 7: Source Material/Bibliography
◆ with financial assistance from:
the Knowledge and Research Programme on Disability and Healthcare Technology,
DFID, government of the United Kingdom
◆ with administrative support from:
all the staff at Ziken International Consultants Ltd, UK, especially Garth Singleton,
Rob Parsons, and Lou Korda, as well as Thomas Rebohle from FAKT, Germany


Acknowledgements


iv




Abbreviations
ACA annual corrective activities
AEB annual equipment budget
AHA American Hospital Association
APA annual purchase activities
ARA annual rehabilitation activities
ATA annual training activities
BP blood pressure
CD-Rom compact disc – read only memory
CEEP core equipment expenditure plan
CEFP core equipment financing plan
CSSD central sterile supplies department
CT computed tomography (scanner)
DVD digital versatile disc
ECG electrocardiograph
EDP equipment development plan
ENT ear, nose and throat
ETP equipment training plan
FOB free-on-board
GTZ Deutsche Gesellschaft für Technische Zusammenarbeit


(German Government Technical Aid Agency)
HTM healthcare technology management
HTMS healthcare technology management service
HTMWG healthcare technology management working group
ICU intensive care unit
IEC International Electrotechnical Commission
INCO Terms international commercial terms (for transportation of trade)
ISO International Organization for Standardization
MOH Ministry of Health
MTBF mean-time between failures
NGO non-governmental organization
OPD out-patients department
p.a. per annum


Abbreviations


v




Abbreviations


vi


PPM planned preventive maintenance
UMDNS united medical devices nomenclature system
UPS uninterruptible power supply
US $ United States dollars
VEN/VED vital, essential, not so essential/desirable (prioritizing categories)
WHO World Health Organization




List of boxes and figures


vii


List of Boxes and Figures
Page


Box 1: Categories of items described as ‘healthcare technology’ 2
Box 2: Benefits of healthcare technology management (HTM) 4
Box 3: The planning and budgeting process described in this Guide 18
Box 4: Summary of issues in Section 2 on framework requirements 38
Box 5: Sample record sheet for taking the equipment inventory 44
Box 6: Other types of equipment information to keep 45
Box 7: Taking the equipment inventory 48
Box 8: Types of inventory code-numbering systems 51
Box 9: Example of equipment stock values for a 120-bed district


hospital (in 2003) 56
Box 10: Strategies for developing budget lines for


equipment expenditure 61
Box 11: Summary of procedures in Section 3 on discovering your


starting point 64
Box 12: Strategies for sourcing useful literature and expanding your library 67
Box 13: Equipment considerations for the vision at central level 71
Box 14: Equipment considerations for the vision at regional/district level 72
Box 15: Equipment considerations for the vision at facility level 73
Box 16: Exercise to develop your model equipment lists 78
Box 17: Example of valid reasons and order of priority for purchasing


and donations of equipment 81
Box 18: Example of good selection criteria for purchasing and


donations of equipment 82
Box 19: Example of valid reasons for condemning and replacing equipment 86
Box 20: Contents of a typical equipment specification 92
Box 21: Summary of procedures in Section 4 on discovering where


you are headed 97
Box 22: Principles behind replacement cost calculations 103
Box 23: How to make rough estimations of equipment purchase costs


for forward planning and bulk purchasing 108
Box 24: How to make exact estimates for specific equipment purchases 109
Box 25: Total purchase cost estimates depending on equipment type 109
Box 26: Suggestions for rough estimations of pre-installation costs for


forward planning 113




List of boxes and figures


viii


Box 27: Suggestions for rough estimations of large-scale major
rehabilitation costs for forward planning 129


Box 28: Summary of procedures in Section 5 on capital budget calculations 131
Box 29: Elements of annual maintenance budgets 141
Box 30: Suggestions for rough estimations of consumable operating costs


for forward planning 148
Box 31: Examples of calculations for consumable operating costs 151
Box 32: Suggestions for rough estimations of equipment-related


administrative costs for forward planning 155
Box 33: Resources required when training staff 157
Box 34: Suggestions for rough estimations of equipment-related


ongoing training costs for forward planning 159
Box 35: Summary of procedures in Section 6 on recurrent


budget calculations 160
Box 36: Analysis required for the equipment development


planning process (in Figure 23) 166
Box 37: Example of the layout for an equipment development plan


record sheet 169
Box 38: Example of a summary Equipment Development Plan 170
Box 39: Ways of categorizing equipment for a bulk EDP 171
Box 40: Strategies for developing equipment skills 175
Box 41: Example of an Equipment Training Plan 179
Box 42: Example of a Core Equipment Development Plan 184
Box 43: Example of a Core Equipment Financing Plan 188
Box 44: Summary of procedures in Section 7 on making plans and budgets 189
Box 45: The VEN (or VED) system for prioritizing actions 201
Box 46: Sample Annual Action Plan for Equipment 205
Box 47: Sample Annual Equipment Budget 206
Box 48: Examples of how to measure goals 207
Box 49: Procedures for emergency equipment purchase requirements 212
Box 50: Procedures for maintenance contingencies 212
Box 51: Procedures for consumable contingencies 213
Box 52: Procedures for monitoring expenditure against allocations 214
Box 53: Monitoring the establishment of ‘tools’ 215




List of boxes and figures


ix


Box 54: Summary of procedures in Section 8 on setting annual goals and
monitoring progress 217


Box 55: WHO’s definition of the technology management hierarchy
(Annex 1) 223


Box 56: Sample technical and environmental data sheet (Annex 5) 278
Box 57: Bare minimum planning and budgeting requirements (Annex 6) 279


Figure 1: The place of HTM in the health system 2
Figure 2: The relationship between the Guides in this Series 6
Figure 3: Healthcare technology performance related to your


management style 12
Figure 4: Cycle of planning and budgeting topics followed in this Guide 14
Figure 5: The structure of Guide 2 15
Figure 6: The healthcare technology management cycle 26
Figure 7: Sample organizational chart for the HTM Service 31
Figure 8: How to estimate total equipment stock values 55
Figure 9: The iceberg syndrome of life-cycle costs for healthcare technology 58
Figure 10: Exercise to establish your usage rates and requirements for


equipment-related consumable items 63
Figure 11: Steps for writing specifications 95
Figure 12: Steps for writing technical and environmental data sheets 97
Figure 13: The danger of a cyclical approach to funding equipment 101
Figure 14: How to make rough estimations of replacement costs for


forward planning 105
Figure 15: How to make specific estimates of equipment pre-installation costs 115
Figure 16: How to make specific estimates of installation and


commissioning costs 121
Figure 17: How to make specific estimates of costs for initial training linked


to purchases 126
Figure 18: How to make specific estimates of large-scale major rehabilitation


project costs 130
Figure 19: Traditional ‘bath-tub’ curve of maintenance costs over the lifetime


of equipment 137
Figure 20: How to make rough estimations of maintenance costs for


forward planning 139
Figure 21: How to make specific or annual estimates of maintenance costs 142
Figure 22: How to make specific or annual estimates of consumable


operating costs 151




List of boxes and figures


x


Figure 23: How to make specific estimates of assorted equipment-related
administrative costs annually 155


Figure 24: How to make specific estimates of annual equipment-related
ongoing training costs 159


Figure 25: The basic equipment development planning process 165
Figure 26: Example of prompts showing that training is required 174
Figure 27: Making an Equipment Training Plan 178
Figure 28: Making a Core Equipment Expenditure Plan 182
Figure 29: Making a Core Equipment Financing Plan 187
Figure 30: The planning and review cycle 191
Figure 31: Annual calendar for the planning and budgeting process 195
Figure 32: Updating the equipment inventory as part of the annual


planning process 196
Figure 33: Reviewing the EDP to determine your annual needs 197
Figure 34: Reviewing the ETP to determine your annual needs 198
Figure 35: Costing your annual needs 199
Figure 36: Reviewing the CEEP and CEFP, prioritizing the allocation of


funds, and preparing proposed annual plans and budgets 202
Figure 37: Updating all long-term plans and budgets with the final agreed


and financed annual actions 203
Figure 38: Shortened version of planning and budgeting (Annex 6) 280






1. INTRODUCTION
Why is This Important?
This introduction explains the importance of healthcare technology
management (HTM) and its place in the health system.
It also describes:
◆ the purpose of the Series of Guides and this Guide in particular
◆ the people the Guides are aimed at
◆ the names and labels commonly used in HTM, in this Series.


The Series of Guides is introduced in Section 1.1, and this particular Guide on
planning and budgeting is introduced in Section 1.2.


1.1 INTRODUCTION TO THE SERIES OF GUIDES
Healthcare Technology Management’s Place in the Health System


All health service providers want to get the most out of their investments. To enable
them to do so, they need to actively manage health service assets, ensuring that they
are used efficiently and optimally. All management takes place in the context of your
health system’s policies and finances. If these are favourable, the management of
health service assets can be effective and efficient, and this will lead to improvements
in the quality and quantity of healthcare delivered, without an increase in costs.
The health service’s most valuable assets which must be managed are its human
resources, physical assets, and other resources such as supplies. Physical assets such
as facilities and healthcare technology are the greatest capital expenditure in any
health sector. Thus it makes financial sense to manage these valuable resources, and
to ensure that healthcare technology:
◆ is selected appropriately
◆ is used correctly and to maximum capacity
◆ lasts as long as possible.
Such effective and appropriate management of healthcare technology will contribute
to improved efficiency within the health sector. This will result in improved and
increased health outcomes, and a more sustainable health service. This is the goal of
healthcare technology management – the subject of this Series of Guides.


1 Introduction


1




What Do we Mean by Healthcare Technology?
The World Health Organization (WHO) uses the broader term ‘health technology’,
which it defines as including:
‘devices, drugs, medical and surgical procedures – and the knowledge associated
with these – used in the prevention, diagnosis and treatment of disease as well as
in rehabilitation, and the organizational and supportive systems within which care
is provided.’


(Source: Kwankam, Y, et al, 2001, ‘Health care technology policy framework’, WHO Regional Publications,
Eastern Mediterranean Series 24: Health care technology management, No. 1)


However, the phrase ‘healthcare technology’ used in this Series of Guides only refers
to the physical pieces of hardware in the WHO definition, that need to be
maintained. Drugs and pharmaceuticals are usually covered by separate policy
initiatives, frameworks, and colleagues in another department.
Therefore, we use the term healthcare technology to refer to the various equipment
and technologies found within health facilities, as shown in Box 1.


BOX 1: Categories of Equipment and Technologies Described as ‘Healthcare Technology’
medical equipment walking aids health facility furniture
communications equipment training equipment office equipment
office furniture fixtures built into the building plant for cooling, heating, etc.
service supply installations equipment-specific supplies fire-fighting equipment
workshop equipment fabric of the building vehicles
laundry and kitchen equipment waste treatment plant energy sources
For examples of these different categories, see the Glossary in Annex 1.


Figure 1: The Place of Healthcare Technology Management in the Health System


1.1 Introduction to this series of guides


2


Funds
Human Resources


Facilities
Healthcare Technology
Consumable Supplies


Health Sector Organization
and Management


Health
Service


Provision


Healthy
Population


Health
System


Policies




Often, different types of equipment and technologies are the responsibility of
different organizations. For example, in the government sector, different ministries
may be involved, such as Health, Works, and Supplies; and in the non-government
sector, different agencies may be involved, such as Health, and Logistics.
The range of healthcare technology which falls under the responsibility of the health
service provider varies from country to country and organization to organization.
Therefore each country’s definition of healthcare technology will vary depending on
the range of equipment and technology types that they actually manage.
For simplicity, we often use the term ‘equipment’ in place of the longer
phrase ‘healthcare technology’ throughout this Series of Guides.


What is Healthcare Technology Management?
First of all, healthcare technology management (HTM) involves the organization and
coordination of all of the following activities, which ensure the successful
management of physical pieces of hardware:
◆ Gathering reliable information about your equipment.
◆ Planning your technology needs and allocating sufficient funds for them.
◆ Purchasing suitable models and installing them effectively.
◆ Providing sufficient resources for their use.
◆ Operating them effectively and safely.
◆ Maintaining and repairing the equipment.
◆ Decommissioning, disposing, and replacing unsafe and obsolete items.
◆ Ensuring staff have the right skills to get the best use out of your equipment.
This will require you to have broad skills in the management of a number of
areas, including:
◆ technical problems
◆ finances
◆ purchasing procedures
◆ stores supply and control
◆ workshops
◆ staff development.


1.1 Introduction to this series of guides


3




However, you also need skills to manage the place of healthcare technology in the
health system. Therefore, HTM means managing how healthcare technology should
interact and balance with your:
◆ medical and surgical procedures
◆ support services
◆ consumable supplies, and
◆ facilities
so that the complex whole enables you to provide the health services required.
Thus HTM is a field that requires the involvement of staff from many disciplines
– technical, clinical, financial, administrative, etc. It is not just the job of managers, it
is the responsibility of all members of staff who deal with healthcare technology.
This Series of Guides provides advice on a wide range of management procedures,
which you can use as tools to help you in your daily work. For further clarification of
the range of activities involved in HTM and common terms used, refer to the
WHO’s definition of the technology management hierarchy in Annex 1.
Box 2 highlights some of the benefits of HTM.


BOX 2: Benefits of Healthcare Technology Management (HTM)
◆ Health facilities can deliver a full service, unimpeded by non-functioning healthcare technology.
◆ Equipment is properly utilized, maintained, and safeguarded.
◆ Staff make maximum use of equipment, by following written procedures and good practice.
◆ Health service providers are given comprehensive, timely, and reliable information on:


- the functional status of the equipment
- the performance of the maintenance services
- the operational skills and practice of equipment-user departments
- the skills and practice of staff responsible for various equipment-related activities in a range of


departments including finance, purchasing, stores, and human resources.
◆ Staff control the huge financial investment in equipment, and this can lead to a more effective and


efficient healthcare service.


1.1 Introduction to this series of guides


4




Purpose of the Series of Guides
The titles in this Series are designed to contribute to improved healthcare
technology management in the health sectors of developing countries, although they
may also be relevant to emerging economies, and other types of country. The Series
is designed for any health sector, whether it is run by:
◆ government (such as the Ministry of Health or Defence)
◆ a non-governmental organization (NGO) (such as a charitable or


not-for-profit agency)
◆ a faith organization (such as a mission)
◆ a corporation (for example, an employer such as a mine, who may subsidize


the healthcare)
◆ a private company (such as a health insurance company or for-profit agency).
This Series aims to improve healthcare technology at a daily operational level, as well
as to provide practical resource materials for equipment users, maintainers, health
service managers, and external support agencies.
To manage your technology effectively, you will need suitable and effective procedures
in place for all activities which impact on the technology. Your health service provider
organization should already have developed a Policy Document setting out the
principles for managing your stock of healthcare technology (Annex 2 provides a
number of resources available to help with this). The next step is to develop written
organizational procedures, in line with the strategies laid out in the policy, which staff
will follow on a daily basis.
The titles in this Series provide a straightforward and practical approach to healthcare
technology management procedures:
Guide 1 covers the framework in which Healthcare Technology Management
(HTM) can take place. It also provides information on how to organize a network of
HTM Teams throughout your health service provider organization.
Guides 2 to 5 are resource materials which will help health staff with the daily
management of healthcare technology. They cover the chain of activities involved in
managing healthcare technology – from planning and budgeting to procurement,
daily operation and safety, and maintenance management.
Guide 6 looks at how to ensure your HTM Teams carry out their work in an
economical way, by giving advice on financial management.
How the Guides are coordinated is set out in Figure 2.


1.1 Introduction to this series of guides


5




Figure 2: The Relationship Between the Guides in This Series


Who are These Guides Aimed at?
These Guides are aimed at people who work for, or assist, health service provider
organizations in developing countries. Though targeted primarily at those working in
health facilities or within the decentralized health authorities, many of the principles
will also apply to staff in other organizations (for example, those managing health
equipment in the Ministry of Works, private maintenance workshops, and head offices).
Depending on the country and organization, some daily tasks will be undertaken by
end users while others may be carried out by higher level personnel, such as central
level managers. For this reason, the Guides cover a range of tasks for different types of
staff, including:
◆ equipment users (all types)
◆ maintenance staff
◆ managers
◆ administrative and support staff
◆ policy-makers
◆ external support agency personnel.


1.1 Introduction to this series of guides


6


Chain of activities
in the equipment


life cycle


Plann
ing a


nd


budg
eting


(Guid
e 2)


Procurement and
commissioning


(Guide 3)


Daily
oper


ation


and s
afety




(Guid
e 4)


Maintenance
management
(Guide 5)


Framework/structure
Organizing a network of
HTM Teams (Guide 1)


Ensuring efficiency
Financial management of HTM Teams (Guide 6)




They also describe activities at different operational levels, including:
◆ the health facility level
◆ the zonal administration level (such as district, regional, diocesan)
◆ the central/national level
◆ by external support agencies.
Many activities require a multi-disciplinary approach, therefore it is important to form
mixed teams which include representatives from the planning, financial, clinical,
technical, and logistical areas. Allocation of responsibilities will depend upon a
number of factors, including:
◆ your health service provider
◆ the size of the organization
◆ the number of decentralized levels of authority
◆ the size of your health facility
◆ your level of autonomy.
The names and titles given to the people and teams involved will vary depending on
the type of health service provider you work with.
For the sake of simplicity, we have used a variety of labels to describe
different types of staff and teams involved in HTM.
This Series describes how to introduce healthcare technology management into your
organization. The term Healthcare Technology Management Service (HTMS) is
used to describe the delivery structure required to manage equipment within the
health system. This encompasses all levels of the health service, from the central
level, through the regions/districts, to facility level.
There should be a referral network of workshops where maintenance staff with
technical skills are based. However, equipment management should also take place
where there are no workshops, by involving general health facility staff. We call these
groups of people the HTM Team, and we suggest that you have a team at every level
whether a workshop exists or not. Throughout this Series, we have called the person
who leads that team the HTM Manager.
At every level, there should also be a committee which regularly considers all
equipment-related matters, and ensures decisions are made that are appropriate to
the health system as a whole. We have used the term HTM Working Group
(HTMWG) for this committee, which will advise the Health Management Teams on
all equipment issues.


1.1 Introduction to this series of guides


7




Due to its role, the HTMWG must be multi-disciplinary. Depending on the
operational level of the HTMWG, its members could include the following:
◆ Head of medical/clinical services.
◆ Head of support services.
◆ Purchasing and supplies officer.
◆ Finance officer.
◆ Representatives from both medical equipment and plant maintenance.
◆ Representatives of equipment users from a variety of areas (medical/clinical,


nursing, paramedical, support services, etc.).
◆ Co-opted members (if specific equipment areas are discussed or specific interest


or need is shown).
The HTM Working Group prepares the annual plans for equipment purchases,
rehabilitation, and funding, and prioritizes expenditure across the facility/district as a
whole. It may have various sub-groups to help consider specific aspects of equipment
management, such as pricing, commissioning, safety, etc.


How to Use These Guides
Each Guide has been designed to stand alone, and has been aimed at different types
of readers depending on its content (Section 1.2). However, since some elements
are shared between them, you may need to refer to the other Guides from time to
time. Also, if you own the full Series (a set of six Guides) you will find that some
sections of the text are repeated.
We appreciate that different countries use different terms. For example, a purchasing
officer in one country may be a supplies manager in another; some countries use
working groups, while others call them standing committees; and essential service
packages may be called basic healthcare packages elsewhere. For the purpose of
these Guides it has been necessary to pick one set of terms and define them. You can
then modify them for your own situation.
The terms used throughout the text are outlined, with examples, in the
Glossary in Annex 1.
We appreciate that you may find it hard to pursue the ideas introduced in these
Guides. Depending on your socio-economic circumstances, you may face many
frustrations on the road to achieving effective healthcare technology management.
We recognize that not all of the suggested procedures can be undertaken in all
environments. Therefore we recommend that you take a step-by-step approach,
rather than trying to achieve everything at once (Section 2).


1.1 Introduction to this series of guides


8




These Guides have been developed to offer advice and recommendations only,
therefore you may wish to adapt them to meet the needs of your particular situation.
For example, you can choose to focus on those management procedures which best
suit your position, the size of your organization, and your level of autonomy.
For more information about reference materials and contacts for healthcare
technology management, see Annex 2.


1.2 INTRODUCTION TO THIS SPECIFIC GUIDE
Why Is There a Need for Equipment Planning and Budgeting?


Healthcare technology is such an important part of healthcare today that it cannot
easily be ignored. It has a very wide application; for example equipment is used to:
◆ help diagnose whether a patient has malaria
◆ treat a patient by removing their gall stones
◆ monitor the condition of a patient’s heart
◆ provide therapy in order to get a patient moving about again
◆ control the environment by supplying heat and light
◆ provide necessities such as running water
◆ transport patients and staff
◆ feed patients and staff
◆ provide clean surroundings.
The expansion in healthcare technologies has brought with it many new challenges.
For example:
◆ Health service providers and the general public believe that this technology offers


great promise for improving conditions for the sick.
◆ The public expects their health services to be continually improving.
◆ Manufacturers, professional staff, and the private health sector exert pressure to


introduce the latest technological advances.
◆ People commonly believe that quality of care is directly linked to the presence of


sophisticated technologies.


1.2 Introduction to this specific guide


9




Did you know?
◆ 80 per cent of the world’s population is not able to afford US$100 per head per year on health.
◆ Many sub-Saharan African countries cannot even spend US$15 per head per year on health.
◆ The majority of equipment is designed in countries that spend between US$1,500 and 2,500
per head per year on health.
◆ For 80 per cent of the world’s population, the standards and technology set by the equipment-
manufacturing nations are not sustainable.


Planning and Budgeting Equipment – Why Does It Matter?
1. Planning and budgeting helps you to control the direction of


technology development in your country.
Investing in expensive technologies can lead to many potential difficulties. For example:
◆ The capabilities of the technology may increase at a faster rate than the country’s


infrastructure and support systems can cope with.
◆ Large amounts of money may be spent on expensive and complex new


technologies which do not always lead to the improvements hoped for, in terms of
better access to healthcare and a better quality service.


◆ When investing in technology, planners may fail to take account of the potential
impact on other spending needs (for example, maintenance costs, extra staff
requirements, operational costs, replacement funding).


◆ Planners may fail to take into account the recurrent cost burden of such technologies.
This could have a negative impact on long-term health service budgets, creating a
serious imbalance in health service provision and existing services.


In order to maintain a quality health service, careful planning of your existing and
future healthcare technology needs is essential. Before investing in expensive and
complex technologies, ask yourself whether there are other, more effective means by
which you could improve the quality and level of health services which you deliver to
the public.


Did you know?
◆ In many poor countries, 50 per cent of health finances goes to the highest referral level, while
all the other services have to share the remaining 50 per cent.
◆ Thus, the equity statement that many countries have in their health plan/policy is not really served.
◆ It is possible to consider the cost-effectiveness of using different types of equipment.
◆ Although controversial, it could be argued that providing basic facilities for sterilizing
instruments is of a higher level of priority than an X-ray service, for example.


1.2 Introduction to this specific guide


10




2. Planning your equipment requirements helps to obtain the right
balance within your budget between various needs.


It is common in many developing countries to find:
◆ considerable cuts are made in recurrent expenditures
◆ funds for salaries are often protected
◆ money for other costs is frequently limited. For example, fuel is often not available


or reagents are insufficient for existing services
◆ there is no guarantee that the recurrent costs required for new services will be


provided sufficiently to run the equipment properly.


Did you know?
◆ European Community countries spend more than US$53 per person on medical equipment
per year, Japan more then $92, and the United States more than $118.
◆ But sub-saharan African countries spend on average less than $1 per person on medical
equipment per year, and the less developed countries in Asia spend only around $12
◆ In most countries, capital expenditure on buildings and equipment is typically not more than
five per cent of the total annual healthcare expenditure.
◆ In some developing countries, however, this can rise to as much as 40 per cent over short
periods (1–2 years), due to the injection of donor funds for the occasional construction or
rehabilitation project.
◆ In many developing countries, 66 per cent or more of the recurrent health budget is spent on
staff salaries.
◆ This leaves only a small fraction of the total budget for all the remaining requirements –
maintenance of buildings and equipment, skill development, and consumables.
◆ As a result, many staff do not have the tools required to do their jobs.


Health service providers may concentrate on obtaining the right staff for the delivery
of healthcare. But there is little use in allocating a large proportion of the health
budget on salaries, if the staff do not have the necessary tools to work with. Without
functioning facilities, equipment, and medicines, it does not matter if the knowledge,
skills and staff levels are high. The delivery of services will be poor.
Poor investment in technology will also have a negative impact on staff motivation,
leading to poor performance. Therefore, when planning and allocating your budgets,
it is important to maintain the right balance between staffing and technology costs.


1.2 Introduction to this specific guide


11




3. Planning is essential, in order to make the most of your assets.
Developing countries have limited funds, so it is important to ensure that any
investment in healthcare technology has been properly thought through.
Good management practices will
create sustainable circumstances for
your healthcare technology. To achieve
this, you will need to plan and budget
for the regular replacement of
equipment, effective maintenance,
and training needs. Figure 3 illustrates
how effective management can
improve the performance of your
healthcare technology.


Figure 3: Healthcare Technology Performance Related to Your Management Style


Curve A: Crisis Management:
◆ major periodic injections of new equipment
◆ poor preservation of existing stock
Curve B: Stable Healthcare Technology Management:
◆ preservation (maintenance) of equipment
◆ regular planned replacement
Curve C: Good Healthcare Technology Management:
◆ preservation of equipment
◆ regular planned replacement
◆ improved performance through internal learning processes


Source: Remmelzwaal, B, 1994, ‘Foreign aid and indigenous learning’, Science Policy Research Unit,
University of Sussex, UK


1.2 Introduction to this specific guide


12


Did you know?
◆ In one South American country, it is
estimated that the replacement value of
medical equipment is US$5 billion.
◆ But 40 per cent of this equipment is
not functioning.
◆ This represents a loss of assets of
US$2 billion.


Time


Eq
uip


me
nt


av
aila


bil
ity


(%
of


to
tal


)


Sustainable


Not sustainable


C


B


A




13


1.2 Introduction to this specific guide


Who is this Guide Aimed at?
This Guide is particularly suitable for the following:
◆ Managers, and planning and finance officers within your organization
◆ Technical (maintenance) and administrative staff in your Healthcare Technology


Management Service
◆ Other types of staff who have various responsibilities relating to planning and


budgeting, such as:
- administrators, heads of department
- purchasing, human resources, supplies and stores personnel


◆ Policy makers.
All these staff should have a good understanding of equipment planning and
budgeting issues, in their common effort to provide an effective and sustainable
health service.
The recommendations and procedures outlined in this Guide are aimed at personnel
at various levels of your organization (facility, district/region, central). The Guide
explains what the responsibilities are at all levels of the system, to enable you to see
the bigger picture.


Tip • The principles of planning and budgeting are the same wherever the money comes
from – whether received from patients, government funds, private support or any
other source.


What Topics are Covered?
Managing the planning and budgeting of equipment involves understanding and
developing a series of ‘tools’. These tools enable you to make your equipment plans
and calculate your budgets, which will ensure that you have sufficient stocks of
functioning equipment to be able to deliver your health services.
This Guide answers the following questions for your healthcare technology sector:
◆ What is my current equipment situation – where am I starting from?
◆ What are my future plans for my equipment?
◆ How do I make budget calculations for capital expenditure?
◆ How do I make budget calculations for recurrent expenditure?
◆ How do I develop the plans and budgets for my equipment in the long-term and


short-term?
◆ How do I review my plans and budgets annually, and monitor progress?




1.2 Introduction to this specific guide


14


Figure 4 shows how the topics covered in this Guide fit together to create a
planning and budgeting cycle. In Section 8, we go on to discuss the way in which
this planning and budgeting cycle relates to your annual calendar.


Figure 4: Cycle of Planning and Budgeting Topics Followed in This Guide


Tip • Putting into place the procedures outlined in this Guide may appear to be a
daunting task, on first sight. However, by taking a step-by-step approach, you can
minimize the effort involved. The discussion of tools (Sections 3–6) covers one-off
exercises which you can undertake to set up the tools initially. Section 7 goes on to
explain how to set up the long-term plans and budgets. Finally, Section 8 goes on to
explain how to regularly review and update the existing tools, plans, and budgets
during the annual planning process.


• If this Guide is still too daunting, Annex 6 offers advice on a shortened version of
planning and budgeting for those just starting out.
The system introduced in this Guide provides a solid approach to managing
equipment planning and budgeting. However, we recognize that there are other
ways of organizing these issues which may be more appropriate for your
administrative system. The most important thing is to implement a well-
functioning system.
As you read through the recommendations in this Guide, you may find it useful to
refer to advice in other Guides in the Series, as indicated in the text. Additional
useful reference materials and contacts are given in Annex 2.


a. Developing
planning tools


b. Understanding
budget calculations


c. Making
long-term plans


d. Making
annual plans


e. Monitoring
progress


Cycle of
Topics




How is This Guide Structured?
The structure of Guide 2 highlights the different steps you must take in order to
plan and budget for your healthcare technology, as shown in Figure 5.


Figure 5: The Structure of Guide 2


Who Does What in Planning and Budgeting?
Depending on how many staff you have with management skills, planning and
budgeting tasks may take place at any level. This will depend on:
◆ your country
◆ your health service provider
◆ which level of the health service you work at
◆ the degree of autonomy of your health facility.


1.2 Introduction to this specific guide


15


Introducing the Series, and this particular GuideSection 1


Understanding the central framework for HTM, and
background conditions specific to this GuideSection 2


Developing planning tools that tell you your starting
point for making plans Section 3


Developing planning tools that tell you the direction
in which you are headedSection 4


Understanding budgeting tools for capital budget
calculationsSection 5


Understanding budgeting tools for recurrent budget
calculationsSection 6


Using these tools to make long-term equipment
plans and budgetsSection 7


Reviewing and updating the plans and budgets
annually, and monitoring progress and expenditureSection 8




However if you have limited management skills at your level, and planning and
budgeting presents a heavy workload, much of this work should be undertaken at a
higher level in your organization.
We suggest that the HTM Working Group (Section 1.1) has a large role to play in
advising the Health Management Team on all equipment matters. Depending on
the size of your facility or what level of the health service you are operating at, your
HTM Working Group may prefer to set up a number of smaller sub-groups.
The suggestions given in this Guide are only intended as examples of the type of
background required for the members of the sub-groups. It is likely that many staff
will sit on more than one sub-group. If you are short of staff, you could use fewer
members, as relevant to the operational level of the sub-group.
In this Guide, the following groups and sub-groups are suggested:
A planning sub-group, which is responsible for equipment development planning
could have the following types of members:
◆ Head of the Health Facility or Head of Medical Services (as team leader)
◆ HTM Manager
◆ Finance Officer
◆ maintenance staff from various disciplines
◆ Nursing Services Manager
◆ Support Services Manager
◆ co-opted members (it is important to involve relevant users as each department


is considered).
A stock sub-group, which evaluates the usage rates and recurrent stock
requirements for equipment-related consumable items could have the following
types of members:
◆ Purchasing and Supplies Officer
◆ HTM Manager
◆ Stores Controller
◆ representatives from equipment user departments (as appropriate to the


equipment being considered).


1.2 Introduction to this specific guide


16




A training sub-group, which considers equipment-related training issues, could
include the following types of staff:
◆ Human Resource Manager
◆ Head of Medical Services
◆ Head of Support Services
◆ HTM Manager
◆ In-service Training Coordinator
◆ Infection Control Officer, senior users, and maintenance staff (as appropriate to


the equipment being considered).
A pricing sub-group, which is responsible for developing equipment price lists and
stock values, and which could include the following types of staff:
◆ Purchasing and Supplies Officer
◆ HTM Manager
◆ Medical Equipment Maintenance Technician.
A Specification Writing Group which is responsible for developing a library of
generic equipment specifications, and the technical and environmental data sheet.
This could include the following types of staff:
◆ HTM Manager
◆ maintenance staff from various disciplines
◆ Purchasing and Supplies Officer
◆ Stores Controller
◆ managers and representatives from equipment user departments


– clinical, paramedical, and support services (as appropriate to the equipment
being considered).


A Commissioning Team, which is responsible for overseeing or undertaking the
installation and commissioning of new equipment. This could include the following
types of staff:
◆ HTM Manager
◆ maintenance staff from various disciplines
◆ Purchasing and Supplies Officer
◆ Stores Controller
◆ Support Services Manager
◆ representatives from equipment user departments (as appropriate to the


equipment being considered)
◆ where necessary, stores and grounds staff to help move and open crates.


1.2 Introduction to this specific guide


17




A Tender Committee, which will decide which quotes to accept for the equipment
and services you plan and budget for. A full description of this team is described in
Guide 3.


Tip • There may seem to be a large number of sub-groups but the aim is to spread the work
around different members of staff so that the HTM Working Group (Section 1.1)
does not have to do everything.


• If you have a small health facility with few staff, the groups created to undertake
planning and budgeting could be much smaller. Try to use relevant staff with
experience and involve those who show an interest in the task.


A wide range of people will be involved in planning and budgeting, as can be seen
from the membership of these sub-groups. It is important for everybody involved to
understand the planning and budgeting process that will be followed in this Guide.
This process is described in Box 3.


Section 1 summary


18


Steps in the Process


Plan and budget within
the framework of
guidance and direction
from the central level of
your health service
provider


People Responsible


Health service managers
at central level in
consultation with
managers at other levels


Actions Described in this Guide
Framework Requirements (Section 2)
◆ follow regulations and standards set by government
◆ develop a Healthcare Technology Policy including


decisions on standardization, maintenance
provision, finances for HTM activities, and the
organizational structure for an HTM Service


◆ define the overall ‘Vision’ for healthcare delivery
at each level of the health service


◆ develop ‘Model Equipment Lists’ which define
the essential equipment stock for the healthcare
to be delivered at each level


◆ use ‘Generic Equipment Specifications’ for
acquisition of equipment


◆ develop good policies for purchasing, donations,
replacement, and disposal of equipment.


Continued opposite


BOX 3: The Planning and Budgeting Process Described in this Guide




Knowing where you are starting from (Section 3)
◆ establish an Equipment Inventory to keep up-to-


date records of the current equipment stock.
◆ estimate the equipment stock values
◆ define the usage rates of equipment-related


consumable items so that realistic estimates can
be made of the finances required for equipment
accessories, consumables, and spare parts.


◆ set up budget lines to record and monitor
expenditure on all the different equipment
activities.


Knowing where you are headed (Section 4)
◆ develop a library of literature and sources of


advice which will help with equipment planning
and budgeting


◆ adapt the Vision for healthcare delivery at their
service level


◆ adopt good policies for purchasing, donations,
replacement, and disposal of equipment.


◆ adapt the Model Equipment List for their
service level.


◆ develop Generic Equipment Specifications and
technical and environmental data.


Capital budget calculations (Section 5)
◆ calculate expenditure requirements for


replacement items
◆ calculate expenditure requirements for new


purchases
◆ calculate expenditure requirements for support


activities linked to purchases and donations.
◆ calculate expenditure requirements for pre-


installation work
◆ calculate expenditure requirements for major


rehabilitation work.


Section 1 summary


19


BOX 3: The Planning and Budgeting Process Described in this Guide (continued)


Increase the availability
of planning skills for
equipment at all service
levels, by developing
planning ‘tools’ through
one-off exercises


Ensure realistic
estimates are made for
all equipment-related
allocations at all service
levels, by using
budgeting ‘tools’ which
teach you how to
calculate the
expenditures required


HTM Managers


HTM Working Groups
and sub-groups


Finance Officers


Health Management
Teams


HTM Working Groups


HTM Working Groups
and sub-groups


HTM Working Groups
and sub-groups


HTM Managers and
their Teams


Continued overleaf




Section 1 summary


20


Recurrent budget calculations (Section 6)
◆ calculate recurrent expenditure requirements for


maintenance.
◆ calculate recurrent expenditure requirements for


consumable operating costs.
◆ calculate recurrent expenditure requirements for


administrative expenses
◆ calculate recurrent expenditure requirements for


ongoing training.


Long-term planning (Section 7)
◆ establish an Equipment Development Plan


covering the priorities for equipment needs across
their service level over time


◆ establish an Equipment Training Plan to cover
the ongoing rolling programme of training required
in relation to equipment activities


◆ establish a Core Equipment Expenditure Plan
which prioritizes equipment spending across the
facility over the long-term


◆ establish a Core Equipment Financing Plan which
identifies sources of funds for the long-term plans.


Annual planning (Section 8)
◆ update the Equipment Inventory.
◆ update the Equipment Development Plan
◆ update the Equipment Training Plan
◆ cost the capital and recurrent requirements for


the current year, and update the Core Equipment
Expenditure Plan and Core Equipment
Financing Plan


◆ prioritize across their service level to obtain the
Annual Purchase Activities, Annual Rehabilitation
Activities, Annual Corrective Activities, Annual
Training Activities, and therefore obtain their
Annual Equipment Budget.


BOX 3: The Planning and Budgeting Process Described in this Guide (continued)


Ensure realistic
estimates are made for
all equipment-related
allocations at all service
levels, by using
budgeting ‘tools’ which
teach you how to
calculate the
expenditures required


Use the tools to make
long-term plans and
budgets


Review the plans and
budgets annually, and
monitor progress in
order to improve
planning and budgeting


HTM Managers and
their Teams
Heads of Section


HTM Working Groups
and sub-groups


HTM Working Groups
and sub-groups


HTM Teams
HTM Working Groups
and sub-groups


Continued opposite




Section 1 summary


21


Monitoring progress (Section 8)
◆ ensure annual plans are implemented
◆ study the implications arising from planning and


budgeting.
◆ request help for any deviations from plans such as


emergency purchases, maintenance and
consumable contingencies


◆ monitor actual expenditure against allocations.
◆ seek the funding identified
◆ consider linking allocation of budgets to whether


departments achieve their performance targets
◆ monitor progress with establishing all planning


and budgeting ‘tools’
◆ ensure that the information generated by the


‘tools’ is used to improve stock control, training,
procurement, etc.


BOX 3: The Planning and Budgeting Process Described in this Guide (continued)


Review the plans and
budgets annually, and
monitor progress in
order to improve
planning and budgeting


HTM Working Groups


Heads of Department
and HTM Managers


Health Management
Teams


Tip • Remember – if you do not think you can undertake all this work initially, Annex 6
contains a shortened version of planning and budgeting for equipment based on parts
of this Guide.




22




23


2 Framework requirements


2. FRAMEWORK REQUIREMENTS
Why is This Important?
In order to deliver quality health services, it is essential to undertake effective
healthcare technology management.
There are various framework requirements to help you do this. These include
legislation, regulations, standards, and policies.
These framework requirements create the boundary conditions within which
you undertake healthcare technology management. They include central or
national guiding principles, policy issues, and high-level assumptions that can
impede or assist you in your work.
It is very difficult to function effectively if these framework requirements do not
exist, and you should lobby your organization to develop them.
Depending on how autonomous your health facilities are, you may be able to
develop these framework requirements at facility, region/district, or central level.


In most industrialized countries, laws, regulations, policies and guidelines form an
indispensable part of health service management. For many developing countries,
however, these regulatory procedures have yet to be developed.
Guide 1 provides a fuller analysis of how to develop these instruments, and shows that
effective healthcare technology management (HTM) is essential in order to deliver
quality health services. Section 2.1 summarizes these points and offers advice on:
◆ the regulatory role of government
◆ establishing standards for your health system
◆ policy issues for HTM
◆ the importance of introducing an HTM Service
◆ managing change.
Section 2.2 goes on to discuss the background conditions specific to this Guide, and
provides advice on:
◆ authorities responsible for guidance on equipment planning and budgeting
◆ central plans and policies, management skill requirements, and economies of scale


for planning and budgeting.




2.1 Framework requirements for quality health services


24


2.1 FRAMEWORK REQUIREMENTS FOR QUALITY
HEALTH SERVICES


Regulatory Role of Government
The World Health Organization (WHO) identifies four distinct functions for
health systems:
◆ The provision of health services.
◆ The financing of health services.
◆ The creation of health resources (investment in facilities, equipment, and training).
◆ The stewardship of health services (regulation and enforcement).
Health service provision and financing, as well as resource creation may be taken on by
both the government and private sector. Thus, there are various options for organizing
health systems:
◆ Mainly public.
◆ Mainly private for-profit (for example, run by a commercial organization), and


private not-for-profit (for example, run by faith organizations, NGOs).
◆ A mixture of government and private organizations.
However in all these systems, the government is solely responsible for the regulation
of health services. The reason for this is that the government has a duty to ensure
the quality of healthcare delivered in order to protect the safety of the population.
These regulations may then be enforced directly by government bodies or they may
be enforced by publicly funded bodies, such as professional associations, which apply
government sanctioned regulations.
Most governments would agree that the protection of health and the guarantee of
safety of health services is vital. However, in many countries this regulatory function is
underdeveloped, with weak legal and regulatory frameworks.
To regulate health services, the government should:
◆ adopt suitable quality standards for all aspects of health services, including


acceptable international or national standards for healthcare technology, drugs,
and supplies in order to ensure their efficacy, quality and safety


◆ establish systems to ensure standards are met, so that the bodies enforcing
regulations have legal sanctions they can use if standards are infringed


◆ establish wide-ranging policies covering all aspects of the utilization,
effectiveness, and safety of healthcare technology, drugs, and supplies


◆ establish systems to ensure these policies can be implemented.




2.1 Framework requirements for quality health services


25


For health services, the Ministry of Health is the body most likely to develop these
government regulations. Other health service providers need to be guided by
government laws, and should look to the Ministry of Health for guidance or follow
their direction if required to do so by law or regulation.


Establishing Standards for your Health System
The government should agree on which quality standards have to be met by the
health services in general. These will cover areas such as:


◆ procedures and training
◆ construction of facilities
◆ healthcare technology, drugs, and supplies
◆ safety
◆ the environment
◆ quality management.


Since drawing up these standards can be both time consuming and expensive,
governments may often choose to adopt acceptable international standards (such as
ISO), rather than develop their own. However, they must be suitable and applicable
to your country situation and fit in with your country’s vision for health services.
The adoption of suitable international or national standards for healthcare technology
is of particular relevance to this Guide. Such standards would cover areas such as:
◆ manufacturing practices
◆ performance and safety
◆ operation and maintenance procedures
◆ environmental issues (such as disposal).
These are important since countries can suffer if they acquire sub-standard and
unsafe equipment. Again, in the majority of cases ministries of health would save
money and time by adopting internationally recognized standards. For more
information on introducing internationally recognized standards into your
procurement procedures, refer to Guide 3 on procurement and commissioning.
It is not enough simply to establish these standards; they also need to be adhered to. For
this reason, you should establish a national supervisory body that has the power to ensure
that health service providers comply with the standards in force. To be effective, such
an enforcement agency must be allocated sufficient financial and personnel resources.
It should also be linked or networked with corresponding international bodies.
Much healthcare technology in developing countries is received through foreign aid
and donations, but such products don’t always meet international standards.
Therefore, your country will need to negotiate with external support agencies. The
best way to do this is to develop regulations for donors that supply equipment (see
Annex 2, and Guide 3 on procurement and commissioning).


Standard
a required or agreed level


of quality or attainment
set by a recognized authority,


used as a measure,
norm, or model.




2.1 Framework requirements for quality health services


26


The legal system plays an important role in enforcing such standards, by ensuring
that any infringements can be effectively prosecuted. It is therefore essential that
the legal system is allocated sufficient financial and human resources to enforce
claims against any institution operating equipment that does not meet the
prescribed standards.


Developing Policies for Health Services
Every country needs to establish wide-ranging policies covering all aspects of health
services. National health policies are usually developed by the Ministry of Health. If
these policies are linked to regulations, then other health service providers must also
follow them. Each health service provider can expand them internally, and must
establish systems to ensure they are implemented.
One key framework requirement for this Series of Guides is that your health service
provider should have started work on a Healthcare Technology Policy (for guidance
on this process, see Annex 2). Such a policy usually addresses all the healthcare
technology management (HTM) activities involved in the life-cycle of equipment,
as shown in Figure 6.


Figure 6: The Healthcare Technology Management Cycle


• Create
awareness
• Monitor
and
evaluate


Technology Assessment
and Selection


Budgeting and
Financing


Planning and
Assessment


Training and Skill
Development


Installation and
Commissioning


Procurement
and Logistics


Decommissioning
and Disposal


Maintenance
and Repair


Operation
and Safety




2.1 Framework requirements for quality health services


27


Here we will consider just four issues that provide key background conditions:
◆ A Vision for health services.
◆ Standardization.
◆ The provision of maintenance.
◆ Finances.


A Vision for Health Services
Every health service provider needs a realistic Vision of the service it can offer. This
should include a clear understanding of its role in relation to other health service
providers in the national health service. Only when this Vision is known can the
health service provider decide what healthcare technology is needed, and prioritize
the actions required to develop its stock of equipment.
It is unhelpful if lots of individual health facilities pull in different directions, with
no coordinated plan for the health service as a whole. The central authority of each
health service provider should be responsible for considering what sort of healthcare
should be offered at each level of their health service. Preferably they will collaborate
with the Ministry of Health, or follow their guidance if regulated to do so.
If there is no health service plan, there is no framework on which to base decisions.
Section 4.2 provides further information on developing a Vision and planning your
healthcare technology stock.


Standardization of Healthcare Technology
Introducing an element of standardization for healthcare
technology will help you to limit the wide variety of makes and
models of equipment found in your stock. By concentrating on a
smaller range for each equipment type, your technical,
procedural, and training skills will increase and your costs and
logistical requirements will decrease (see Guide 1).
It is easier to achieve standardization if equipment is planned and
ordered on a country-wide, district-wide or health service
provider basis. It is therefore important to combine forces with


other facilities or health service providers, and it may be wise to follow standardization
strategies of the Ministry of Health. It is important that these standardization efforts
do not just apply to products purchased by health facilities, but also to donations.
Standardizing your healthcare technology may be difficult for a number of reasons.
Your country and local businesses may have their own trade practices and interests.
National donors may have tied-aid practices, while the procurement procedures of
international funding agencies, health service institutions, and individuals may act
against your standardization strategies (see Guide 3).


Standardization
(also known as rationalization,


normalization and harmonization)
– the process of reducing the


range of makes and models of
equipment available in your stock,


by purchasing particular named
makes and models.




2.1 Framework requirements for quality health services


28


You may need to hold discussions with organizations such as the Ministry of Industry
and/or Trade, the chambers of commerce or specific business associations, as well as
external support agencies. However, it is well worth persevering, as standardization
offers many benefits, both in terms of cost and efficiency.


Provision of Maintenance
Proper maintenance is essential to ensure that the equipment you have purchased
continues to meet the standards required throughout its entire working life.
Undertaking maintenance belongs to the service provision function of health
systems, and could therefore, in principle, be carried out by the government, the
private sector, or by a mixture of the two.
It is useful to organize the maintenance system along similar lines to the health
service provision already existing in your country. For instance, if the health sector is
predominantly run by the government, it is probably simplest to let the government
run the maintenance organization as well. In contrast, if private organizations run the
health services, it makes little sense for the maintenance activities to be carried out
by a government body. In the majority of cases, a mixed system is most likely.
However, the government may wish to take a regulatory role and establish
regulations that guarantee that healthcare technology performs effectively,
accurately, and safely. The rules established are valid for all health service providers,
irrespective of their type of organization.
Specific maintenance requirements would not need to be prescribed by the regulatory
body. Instead, it is up to individual health service providers to decide how these will
be provided. However, the nature and the complexity of some maintenance services
often calls for partnerships between the public and private health service providers.
Partnerships may also exist between health service providers and private sector
sources of maintenance support. For more details, refer to Guide 1.
To provide maintenance services, you will normally need to establish good links
between maintenance workshops. This will create a network that supports the needs
of all your health facilities. Maintenance is, of course, only one of many HTM
activities that need to be carried out. However, the fact that maintenance workshops
usually already exist in most countries serves as a useful starting point for establishing
a physical HTM Service across your health service provider organization and across
your country. For more details on how to organize an HTMS, refer to Guide 1.




2.1 Framework requirements for quality health services


29


Finances
To ensure that healthcare technology is utilized effectively and safely throughout its
life, your health service provider will need to plan and allocate adequate capital and
recurrent budgets. See Sections 5 and 6 for more advice on this.
In a government-organized system these funds have to be provided by government
budgets, while private systems or mixed systems must generate the required funds
from their customers, or from benefactors and donors.
Depending on your health service provider and country, your HTM Service may be
able to generate income by charging for services provided. Whether this income can be
used to further improve the HTM Service depends on the policies of the responsible
financing authority (such as the treasury or central finance office). Guide 6 provides
advice on this.


The Importance of Introducing an HTM Service
We have established the importance of:
◆ adopting standards for healthcare technology
◆ developing healthcare technology policies
◆ establishing systems to ensure the policy is implemented.
All these aims could be achieved if each health service provider practised healthcare
technology management (HTM) as part of the everyday life of their health service.
The best way to do this is to have an HTM Service incorporated into each health
service provider organization.
Box 2 (Section 1.1) shows that HTM provides a wide range of benefits. Guide 1
attempts to express this in terms of the sorts of savings that can be made if HTM is
effectively carried out. Taking maintenance as an example, we can see that it has not
only a positive impact on the safety and effectiveness of healthcare technology, but
that it also has two important economic benefits:
◆ it increases the life-span of the equipment
◆ it enhances the demand for health services, since demand for services is crucially


dependent upon the availability of functioning healthcare technology.
Healthcare technology that is out of order quickly leads to a decline in demand, which
will in turn reduce the income and quality of services of the health facilities. You will
lose clients if, for example, it becomes known that malfunctioning of sterilization
equipment may endanger the health of the patients. Similarly, patients will avoid
visiting health facilities that do not possess functioning diagnostic equipment.




Thus the justification for introducing an HTM Service is that it will benefit you
economically and clinically, by ensuring that healthcare technology continues to
meet the standards required throughout its working lifetime.
The activities of an HTM Service belong to the service provision function of health
systems. However, the government may wish to take a regulatory role and establish
regulations that guarantee that HTM occurs. To achieve this, it will be necessary
to have:
◆ a government body to provide regulations that will ensure the continued


performance and safety of healthcare technology throughout its life
◆ a control mechanism to check that all health service providers pursue these


healthcare technology management activities effectively
◆ legal or other sanctions that are enforceable if the rules are infringed.
The government body responsible for providing regulations could be the central
level of the national HTM Service. Each health service provider could then develop
its own HTM Service. It should involve a network of teams and committees that
enable HTM to be practised in all facilities. In order to establish an effective HTM
Service, you will need to provide sufficient inputs, such as finance, staff, workshops,
equipment, and materials. Only in this way will you get the outputs and benefits that
you require. For details of how to develop such an HTM Service, see Guide 1.
The organizational chart for the HTM Service will vary depending on the size of your
country and your health service provider organization, and whether you are just
starting out. However, Figure 7 provides an example of the relationship between
HTM Teams and HTM Working Groups (Section 1.1) that we envisage.


2.1 Framework requirements for quality health services


30




2.1 Framework requirements for quality health services


31


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Figure 7: Sample Organizational Chart for the HTM Service




How to Manage Change
The regulatory requirements presented in this Section may appear somewhat
idealistic, compared to the reality in many health systems. However, the aim is not to
highlight the deficiencies of existing systems, but to provide a blueprint for a
functioning healthcare technology management system. Hopefully, this will enable
you to get the right framework conditions in place, and thus improve the
effectiveness and the safety of your health services.
We are not recommending that your health service provider:
◆ throw out all their current HTM strategies and start again
◆ make sudden and sweeping changes that are likely to fail if they are over


ambitious.
Rather it is better to take a step-by-step approach, introducing changes gradually,
with a careful review process. To implement an HTM system with all the
complexities described in this Series of Guides will take several years, and to try to
achieve everything at once could be disastrous. However for healthcare technology
management to improve, it is important to act.
It is possible to write down all the correct procedures and yet still fail to improve the
performance of staff. To ensure that your HTM procedures are effective, it is
important for there to be good managers who can find ways to motivate staff
(Section 8). Simply ordering staff to implement new procedures usually does not
work. It is much better to discuss and develop the procedures with the staff who will
implement them. This could take the form of discussion, working groups or training
workshops. People who are involved in developing ideas about their own work
methods are more likely to:
◆ understand the objectives
◆ understand the reasons why processes are necessary
◆ be encouraged to change their way of working
◆ be more interested in making changes which result in improvement
◆ see that the aim of the HTM procedures is to improve their delivery


of healthcare.
We recognize that many readers will face difficulties such as staff shortages, poor
finances, lack of materials, a lack of influence and time, and possibly even corruption.
Introducing new rules and procedures into a system or institution that has no real
work ethic, or which possibly employs dishonest workers, will not have any
significant effect.


2.1 Framework requirements for quality health services


32




33


2.1 Framework requirements for quality health services


Therefore, strategies may be required to bring about cultural and behavioural
change. For example:
◆ when materials are short, instead of focussing upon breakages and loss, place more


emphasis upon the importance of staff working hard and putting in the hours
◆ favour good managers who are seen to be present and doing what they preach
◆ encourage an atmosphere where staff are praised for good work, rather than a


culture of judgement and criticism.
Introducing rules and administrative procedures alone will not be sufficient to bring
about cultural change. You will also need to find ways of increasing performance and
productivity, and acknowledging/rewarding good behaviour is essential. For example:
◆ it is better to break a tool while actively undertaking maintenance, rather than


breaking nothing but never doing any work
◆ it is better to break a rule in an emergency (such as withdrawing stocks from


stores), rather than stick to the rules and risk the possible death of a patient.
Annex 2 has some examples of useful reference materials. To bring about such
changes, you will require skills in:
◆ managing change
◆ staff motivation
◆ effective communication
◆ encouragement, and
◆ supportive training with demonstrations.
All parties involved in the network of HTM Teams and HTM Working Groups need
to participate in developing the HTM Service. This will encourage a sense of
ownership of the Service and its responsibilities, and will lead to greater acceptance
and motivation among staff. If you are short of skilled staff (such as technicians,
managers, planners or policy-makers), you may need to obtain specialist support to
assist with some of these tasks.


2.2 BACKGROUND CONDITIONS SPECIFIC TO
THIS GUIDE
Your country and health service provider may have existing regulating principles
and conditions which will affect, or can inform, aspects of your planning and
budgeting work.
You will need to find out whether the regulations and policies discussed in this
Section exist in your country and organization. If they do, it makes sense to follow
them. If such regulations do not exist, you will need to highlight these issues at the
central level of your organization, and continue to follow the advice provided in this
Guide at your level.




2.2 Background conditions specific to this guide


34


Responsible Management Authorities
If you work for a health service provider organization, you must conform to:
◆ any existing regulations and guidelines concerning equipment planning and


budgeting, which are produced by the central management body.
In addition, there may be professional bodies which provide guidance for their area
of expertise. For example:
◆ the National Board of Survey, which has regulations and procedures on


decommissioning and disposal of equipment. These cover the condemning,
boarding, and auctioning of equipment at the end of its life.


Responsible Finance Authorities
If you work for a health service provider organization, you must work within the
financial resources allocated to you. Thus you must conform to:
◆ the regulations and guidelines produced by the central Finance Office (for


example, the treasury in the government system), such as:
- any accounting policies and procedures covering budgetary processes
- any budgetary limitations and criteria set by the central level of your health


service provider (such as guidelines on maintenance expenditure as a
percentage of health facility operational budgets)


- any financial policies and procedures which govern stock management and
expenditure accounting


- any local regulations regarding co-financing schemes.


Central Plans for the Health Service
When making plans which will introduce changes to your work, your health facility,
or your district/region, you must conform to:
◆ the overall central plans and aims of your health service provider.
Individual health facilities and district authorities should not work independently of
the plan for the health service as a whole. In equipment terms, there are several key
areas where this especially applies:
The ‘Vision’ for the Health Service
As explained in Section 2.1, every health service provider needs a realistic Vision of
the services it can offer, so that it can decide what equipment it should own, and
prioritize the actions to take to develop its stock of equipment. Section 4.2
describes how to develop a Vision.




2.2 Background conditions specific to this guide


35


Your country and health service provider may already have developed central level
guidance such as Essential Service Packages. But many countries and organizations
may not have defined the functions for each level of healthcare delivery, or written
them down in a policy document. This makes it very difficult to plan, since there is
no framework on which to base decisions. Thus, you should conform to:
◆ any guidance from your health service provider on the direction of healthcare


delivery for your level of facility.
When developing Essential Service Packages, be careful to ensure that you can
afford the technology implications. For example, you may wish to improve equity of
access and think it ideal to move a service, such as CT scanning, from central level to
regional (provincial) level. But if there are five regions, you will require not only five
times the pieces of equipment, but also five times the qualified staff, consumable
items, support services and energy supplies. You may find instead that it is more
cost-effective to transport patients to the central unit. Thus the money might be
better spent on improving the central unit and the patient referral transport system.
There are many issues affecting service delivery in the future which are still being
aired in international discussion documents. For example, the changing disease profile
is likely to affect both care and equipment requirements. Also, controversies are being
examined for lessons learnt, such as the need in some countries to re-centralize in
order to be able to afford and manage services (see Annex 2).
Model Equipment Lists
Once you have drawn up a Vision for health service delivery, you can determine what
types of healthcare interventions to offer at each service level. Next, you must
define what equipment is required.
This is done by drawing up Model Equipment Lists, which describe what
equipment is essential for providing each healthcare intervention. (The process of
developing such lists is described in Section 4.3). When drawing up Model
Equipment Lists, you should conform to:
◆ any guidance from your health service provider on equipping levels for your facility.
Since Model Equipment Lists are linked to the healthcare interventions you carry
out, they will not necessarily be tied to specific rooms. However, when drawing up
Model Equipment Lists, it is also important to consult with architects, to determine
factors such as room size, accessibility and flow patterns, based on the function of
the room. Such minimum room standards ensure that the furniture and equipment
can fit into the space in an orderly and effective way. Your plans should include the
number of square metres, the requirements for water, electricity, light levels and any
other factors which could have an impact on equipment use and accessibility (see
Annex 2). These building aspects are often forgotten. Thus, you should conform to:
◆ any guidance from your health architects on the space requirements for your


Model Equipment Lists.




36


2.2 Background conditions specific to this guide


When planning equipment, it is also important to remember the other capital
investments (outside the Model Equipment List), such as training requirements,
and buildings and utilities (power, water, waste management). These investments
are significant and often are a pre-condition, before you can start to make wise
equipment investments. Thus, you should conform to:
◆ any guidance from your health service provider on the other capital investments


arising from your equipment plans.
Purchasing, Donations, Replacement, and Disposal Policies
To avoid wastage, you need to ensure that equipment is acquired in a rational and
planned way. Equipment should be obtained according to good policies and
procedures, covering both the disposal and replacement of existing equipment, and
the purchase and donation of additional items. (The development of such policies is
described in Section 4.4). Thus, you should conform to:
◆ any policies of your health service provider which guide you on valid reasons for


replacing equipment and obtaining new items.
Where possible, you should introduce an element of standardization when acquiring
equipment in order to gain technical, financial, logistic, procedural, and training
benefits (Section 2.1). However, government or institutional procurement
guidelines often do not allow direct procurement, but stipulate procurement
through tenders based on generic specifications (see Guide 3). In such cases, the
only way to introduce a level of standardization is to procure for many health
facilities at one time. For example, the whole country, region, or organization might
replace all their suction pumps at the same time and a standard can evolve. Thus,
you should conform to:
◆ any standardization policies of your health service provider.
Procurement on an individual facility basis will almost certainly produce many one-
off examples of different types of equipment which are not economical to maintain.
To avoid such issues, it is very important to combine forces with other facilities
when planning and purchasing new equipment. In order to make the planning of
such procurement possible, it is almost mandatory to have a computerized inventory
and procurement system. Thus, you should conform to:
◆ any strategies introduced by your health service provider for collaboration


between bodies during planning and procurement.




2.2 Background conditions specific to this guide


37


Generic Equipment Specifications
Once you have developed Model Equipment Lists, it will be necessary to describe
the equipment required in detail. This is necessary to ensure that you acquire the
types of equipment you want (this applies equally whether your equipment is
received through procurement or via donations). Section 4.5 gives further advice on
how to write such Generic Equipment Specifications. Thus you should conform to:
◆ any equipment specifications developed by your health service provider.
Generic Equipment Specifications will also enable you to conform to the standards
set by government, and to continue to meet the standardization policy of your health
service provider.


Availability of Management Skills
This Guide presents a detailed and complete description of the planning and
budgeting process. To carry out the procedures outlined here, you will require a
reasonable number of well trained staff. In many countries, this level of management
skills may be available at national level or in large hospitals, but will be a problem at
district level.
The current decentralization efforts in the health sector will bring about significant
changes in the management and procurement of healthcare technology. District
managers may be asked to quantify and specify all future procurement activities.
This task is large and complex and the present skills of district managers in some
countries will be inadequate.
For these reasons, it may be necessary to:
◆ encourage planning, budgeting, and procurement tasks to be carried out at central


level for those facilities and service levels which cannot undertake the whole
management process themselves


◆ encourage district managers to understand the process and be aware of what they
are able to manage, and where they need help.


Economies of Scale
With an improved management system, decentralization can promote accurate and
timely decision-making. However, there will still be a need for central policy guidance
on equipment levels and technical specifications, because it will not be economical to
develop such knowledge at district level. This is an example of how the economy of
scale for technical knowledge will challenge the decentralization process.
A second example of a challenge to decentralization is the economy of scale required in
procurement. Procurement of small quantities increases the initial cost and the life-
cycle costs of equipment (Section 3.3), because you cannot benefit from the savings
that bulk-buying offers. More details of procurement options are provided in Guide 3.




When making a needs assessment for one hospital, you are likely to arrive at low
quantities of a broad variety of equipment. So undertaking calculations at facility
level will not enable you to benefit from economies of scale. Instead, by combining
procurement for several facilities at the same time, and gaining the resulting
standardization, you can obtain significant advantages. These include better prices
for new equipment and spare parts, shared training costs and improved after-sales
commitment from the supplier.
Thus it is preferable to:
◆ undertake equipment management and needs assessment at district or regional


level, and merge procurement needs for a number of facilities or districts. This
will result in the ideal combination of accurate management and procurement
advantages, proportional to the economy of scale.


You may face problems with this rationalization and savings strategy when donors
target funds at individual facilities or districts. Thus it is preferable to:
◆ ensure donors follow your Model Equipment Lists, Generic Equipment


Specifications, and standardization policy, in order to overcome the drawbacks.
Box 4 contains a summary of the issues covered in this Section.


2.2 Background conditions specific to this guide


38


BOX 4: Summary of Issues in Section 2 on Framework Requirements
Government


Qu
al


ity
H


ea
lth


S
er


vic
es


◆ actively regulates health services, whether they are delivered by public providers,
private providers, or a mixture of the two


◆ develops checking systems and legal sanctions for infringement of health
regulations


◆ adopts suitable standards for quality health services, in general
◆ specifically for healthcare technology, adopts standards for:


- design, development, and manufacturing
- performance and safety
- use and training
- waste disposal


◆ develops donor regulations to ensure all equipment received through foreign aid
and donations also comply with the standards


◆ establishes public or quasi-public supervisory bodies to enforce regulations and
standards.


Continued opposite




39


Section 2 summary


BOX 4: Summary of Issues in Section 2 on Framework Requirements (continued)
Ministry
of Health


All Health
Service
Providers
in general


Qu
al


ity
H


ea
lth


S
er


vic
es


◆ develops national policies for health services
◆ specifically develops a Healthcare Technology Policy to cover all healthcare


technology management activities including:
- a Vision
- an element of standardization
- the provision of maintenance
- provision of finances for all HTM activities
- the organizational structure for an HTM Service


◆ regulates on these issues (if required)
◆ develops an HTM Service made up of a network of teams and working groups
◆ uses the central level of the HTMS as the national regulatory body, if necessary, and to


ensure that HTM policies are implemented
◆ provides sufficient inputs to ensure the HTMS is effective
◆ uses strategies to manage the changes involved carefully, so that they can be successful.
◆ conform to regulations and guidelines provided by government
◆ conform to the standards set by government
◆ follow the policies of the Ministry of Health if regulated to do so
◆ develop their own internal Healthcare Technology Policy and expand strategies
◆ develop their own HTM Service made up of a network of teams and working groups,


with sufficient inputs to ensure it is effective, in order to ensure that HTM policies
are implemented


◆ follow MOH regulations on the HTMS if regulated to do so
◆ implement strategies to develop skills in managing change, staff motivation, effective


communication, encouragement, and supportive training with demonstrations
◆ introduce rules and procedures using discussion, working groups, training workshops,


etc. with the staff that will implement them
◆ include all parties involved in the network of HTM teams and working groups in the


development of the HTMS
◆ introduce changes to HTM step-by-step, with a careful review process.


Continued overleaf




40


Section 2 summary


BOX 4: Summary of Issues in Section 2 on Framework Requirements (continued)


All health staff
and managers


Health Service
Providers


Managers
(at each
level of your
organization)


Pl
an


ni
ng


a
nd


B
ud


ge
tin


g


◆ Conform to regulations and guidelines provided by relevant bodies on:
- equipment planning and budgeting
- decommissioning and disposal of equipment
- accounting policies and procedures
- budgetary limitations and criteria set for different activities
- financial policies and procedures that govern stock management and


expenditure accounting
- co-financing schemes.


◆ Provide central guidance on:
- the Vision for the health service and Essential Service Packages
- equipping levels for your facility (Model Equipment Lists)
- purchasing, donations, replacement, and disposal policies
- the development of Generic Equipment Specifications.


◆ only undertake planning and budgeting at suitable decentralized levels in your
organization where sufficient management skills are present


◆ use economies of scale to your advantage by:
- making use of technical skills and guidance from levels where the knowledge exists
- combining forces with other levels to undertake needs assessment, and


bulk-buy equipment and supplies in order to gain from procurement savings
and standardization.




41


3. How to discover your starting point – planning tools I


3. HOW TO DISCOVER YOUR STARTING
POINT – PLANNING TOOLS I


Why is This Important?
In order to manage your equipment effectively, you need to have a clear picture
of your current stock and supplies – it is very difficult to manage an unknown.
You need to know the value (quantity and cost) of your equipment, so that
financial planning is not guesswork. You also need to understand your likely
expenditure on equipment-related activities such as training and maintenance.
Finally, to help you budget effectively, you also need to determine your rate of
use of equipment. In this way, you can draw up a realistic estimate of the
inputs you need.


Before you can carry out any planning or budgeting, it is necessary to know where you
are starting from. Thus you need some baseline data which will help you to
understand your present equipment situation.
To analyze your equipment situation effectively, you need to draw upon some
important ‘planning tools’. This Section covers four such tools, and discusses how to
determine your starting point by:
◆ keeping an up-to-date Equipment Inventory (Section 3.1)
◆ knowing the value of your stock of equipment (Section 3.2)
◆ having budget lines that are sensitive enough to show equipment expenditures


(Section 3.3)
◆ discovering your rate of use of equipment-related consumable items (Section 3.4).
Some health providers may already know a great deal about their equipment. This
will vary, depending on how much planning and budgeting of equipment has already
been carried out. Your level of equipment knowledge will depend upon:
◆ your country
◆ your health service provider
◆ which level of the health service you work at
◆ the degree of autonomy of your health facility.
This Section describes how to undertake one-off exercises to establish the tools
needed to plan and budget for your equipment. Different activities are described for
the different health service levels. This work will help you to analyze your own
present situation.
How to use these tools in the planning and budgeting process is described in Section 7.
Section 8 discusses how to monitor and review these tools.




42


3.1 The equipment inventory


3.1 THE EQUIPMENT INVENTORY
3.1.1 Understanding Inventories


One planning tool you need is an Equipment Inventory. This provides you with all
the details of the equipment that you currently own.


Usefulness of Having an Inventory
It is very important to know all about your current stock of equipment, so that:
◆ any allocation of resources is an objective assessment, and not guesswork;


(therefore budgets are based upon the actual quantity of equipment owned)
◆ you can manage equipment effectively, because you are not dealing with unknown


quantities; (for example, the HTM Manager knows how many suction pumps to
include in the planned preventive maintenance programme)


◆ you can calculate what you can afford to operate or run; (therefore you do not
overestimate or underestimate the consumables required, and set your recurrent
budgets accurately)


◆ you can develop realistic plans for the future, because you know your current
equipment situation; (therefore you do not waste funds procuring new equipment
while neglecting the replacement of existing essential items).


As an example, we can consider the importance of an inventory for planning
maintenance activities:
◆ if you want your equipment to function, you must maintain it
◆ if you want to maintain your equipment stock, you must budget for maintenance
◆ to be able to budget adequately, you must have an idea of the value of what you own.


Did you know?
Knowing what you own means:
knowing - what there is type/sorts


- how much of it there is quantity
- where it is location
- what condition it is in status
- how far it is in its life-cycle age/expected life


having - some way of updating the information accuracy
The method for doing this is to keep an Inventory of your equipment.




3.1.1 Understanding inventories


43


An Equipment Inventory is an important tool because it enables you to:
◆ identify the shortfalls in your equipment stock (once you have developed a Model


Equipment List to compare it to – Section 4.3)
◆ implement your equipment replacement and disposal policies (Section 4.4)
◆ implement your equipment purchasing and donations policies (Section 4.4)
◆ calculate the new value of your equipment stock (using up-to-date prices) which


will be used for calculating your budgets (Sections 3.2, 5 and 6).


What is an Inventory?
An inventory can consist of several separate lists of specific types of equipment
(such as medical equipment, plant, furniture or workshop tools), or a combined list
of all equipment types.
Box 5 (overleaf) shows the sort of information to gather when taking the
equipment inventory as a minimum. Additional information can be gathered and
either kept with the inventory or separately (see Box 6). Your inventory can be:
◆ simply a compilation of these record sheets, containing lists of the equipment


found in each department
◆ or you can enter the information gathered onto an Inventory Form for each piece


of equipment
◆ or you can enter the information into a computer program.
Such a listing can then be organized and sorted in many ways. This is easiest if you
have a computerized inventory, although sorting information is possible with a card
index system. You can sort the information in ways which are of use to you, such as:
◆ alphabetically by product (for example, defibrillator, microscope)
◆ by location
◆ by manufacturer
◆ by use/function
◆ by age
◆ by your inventory code number.
If your Equipment Inventory covers a wide range of facilities or many items, you may
have to prioritize what to include on the listing. For example, are you going to list every
scalpel and stethoscope? Or can you simply list the number of different surgical sets
(so long as the contents have been agreed), or only list items above a certain value?




44


3.1.1 Understanding inventories


Da
te


Inv
en


tor
y T


ak
en


:
Fa


cil
ity


:
De


pa
rtm


en
t:


Se
cti


on
:


Lo
ca


tio
n/


Ro
om


Ty
pe


of
eq


uip
me


nt
Inv


en
tor


y
co


de
nu


mb
er


Na
me


of
ma


nu
fac


tur
er


Mo
de


l n
am


e
an


d/o
r n


um
be


r
Ma


nu
fac


tur
er'


s
se


ria
l n


um
be


r
Ye


ar
ma


de
or


bo
ug


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pp
lier


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ug


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fro


m
Sta


tus
/


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nd


itio
n


Yo
ur


pro
pe


rty
or


lea
se


d?
(yo


ur
ow


n
nu


mb
er)


(fa
cto


ry
nu


mb
er)


De
sc


rip
tio


n:


Da
te


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en


tor
y T


ak
en


:
Fa


cil
ity


:
De


pa
rtm


en
t:


Se
cti


on
:


Lo
ca


tio
n/


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om


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pe


of
eq


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me


nt
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en
tor


y
co


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nu


mb
er


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me


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ma


nu
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er


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de


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s
se


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um
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ma


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or


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ug


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ug


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Sta


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/


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nd


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ur


pro
pe


rty
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am
in


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io


n
De


li
ve


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et
al


d
op


pl
er


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ct


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n


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mp


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1


23
45


6
GR


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23


02
9


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E


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ag


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ch


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nn


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sp


it
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it


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ar


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Ex
am


ple
1:


Da
te


Inv
en


tor
y T


ak
en


:
Fa


cil
ity


:
De


pa
rtm


en
t:


Se
cti


on
:


Lo
ca


tio
n/


Ro
om


Ty
pe


of
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me


nt
Inv


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tor


y
co


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nu


mb
er


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me


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ma


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s
se


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l n


um
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ma


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or


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ug


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ug


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Sta


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/


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nd


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ur


pro
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ok
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ea
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p


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ld


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n


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n


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ue


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is


tr
ic


t
Ho


sp
it


al
Ki


tc
he


n/
Ca


nt
ee


n
Ki


tc
he


n


Ex
am


ple
2:


BO
X 5


: R
ec


ord
Sh


ee
t fo


r ta
kin


g t
he


Eq
uip


me
nt


Inv
en


tor
y (


sh
ow


ing
th


e b
as


ic
es


se
nti


al
da


ta
to


ga
the


r)




45


3.1.1 Understanding inventories


Other information about the equipment should also be kept on file, but does not
necessarily have to form part of the inventory. Box 6 shows the types of other data
that need to be kept. You may choose whether to keep this information on the
inventory itself, or to enter it into the maintenance Service Histories for the
equipment (see Guide 5).
One factor which will help you in deciding what data to include in the columns of
the record sheet, is the level of knowledge of those filling in the sheet. If there is
data which is kept by a different department (such as the purchasing department),
or is only known by specialists (such as HTM Managers), this information could be
kept in a separate record system.


BOX 6: Other Types of Equipment Information to Keep


◆ the address of the manufacturer and local agents
◆ the address of the supplier and local representative
◆ technical ratings
◆ date when the warranty expires
◆ the price paid
◆ any external funding agency involved
◆ stocks of consumables, accessories, and spare parts received
◆ results of inspection tests undertaken on commissioning
◆ the frequency of planned preventive maintenance required
◆ details of any maintenance contract and maintenance contractor
◆ maintenance history.


Experience in Kenya
The Aga Khan Foundation (private) hospital found that if they listed everything, the
contents of their Equipment Inventory would be quite comprehensive. Thus they decided
to agree on an accounting definition of what should be called a ‘capital item’. For
equipment, they chose a ‘capital item’ to be anything which:
◆ has a cost of US$250 or more
◆ has a life of at least one year; and
◆ is a distinct tangible object.




An initial exercise will be required to establish both the Equipment Inventory and
the inventory code numbering system. However, decisions on code numbers should
not delay the establishment of the Equipment Inventory. Specialist support may be
required to assist with these processes.
After the initial exercise, the upkeep of the Equipment Inventory and the inventory
code numbering system is part of the routine work of the HTM Teams, as part of
their equipment management activities (Section 8.1).


3.1.2 Establishing the Equipment Inventory
Who is Responsible for the Equipment Inventory?


Many health service provider organizations have a General Inventory for their
facilities kept by Stores personnel. This covers everything found in each
department (including such items as furniture, plastic and glassware, waste bins,
notice boards, wall clocks). A record of the contents of each room is kept on a card
(often found on the back of the door), and a paper copy is held in the Stores. Items
are often painted with their Stores code number.
However, the details contained within this General Inventory are generally
insufficient to enable equipment or maintenance plans to be made. Also, the data is
not easily updated or manipulated on a computer. For this reason, a separate record is
required, which is known as the Equipment Inventory. This covers technical
details and is restricted to items of equipment – in other words, those items which
require maintenance throughout their lives.


Preference
You should aim to introduce an equipment inventory system that is uniform across the whole
of your health service organization. This is preferable to allowing each facility to collect
different details and use different forms (though even that is better than having no inventory
at all). If all facilities collect the same type of information, the data can be compiled at some
point to form an inventory for the whole organization, and can more easily be entered into a
computer system using common software.


46


3.1.2 Establishing the equipment inventory




3.1.2 Establishing the equipment inventory


47


Tip • Your health service provider might not have developed a service-wide inventory. Do
not let this prevent you from having an Equipment Inventory at your health facility.
You can encourage your central HTM Service to establish an inventory system, but in
the meantime you can gather your own inventory data and use it for planning purposes.


Takes what action?
Manage the equipment inventory
Takes what action?
- Ideally, designs the inventory system (the forms


plus the data collection process).
- Probably computerizes the system as the team


must be able to manipulate data for the whole
health service.


- Shares a paper or computer version of the
inventory with each facility and district/region.


Gather the data, keep a paper copy of their
inventory, update the information annually, and feed
back any changes to the centre.


Who?
HTM Teams (Section 1.1)
Which level?
Central HTM Team


Facility and/or District
HTM Teams


How to Create the Inventory
An initial inventory should take place, in which a team of staff (including technical
personnel) visits each department, physically checking each piece of equipment,
and writing down all the details. Box 5 shows an example of a record sheet which
can be used for taking an inventory. A list of tasks involved is highlighted in Box 7.
The amount of work involved in undertaking such an exercise should not be
underestimated. This is a large task, since every room, cupboard, drawer, worktop,
shelf, and store room must be investigated. If you are undertaking an inventory for
the first time for a whole district or country, you may need to hire specialist support
to help you with the task.
The inventory can consist of a manual paper record or a computerized file. It does
not matter which, because the sort of data that you must record is the same whether
you are designing the layout of a card or the fields on your computer screen. The
master copy of the Equipment Inventory can be stored on computer, so that data
manipulation and updating is easy. However, for daily referral to the inventory, hard
copy print-outs can be used.
Annex 2 provides references which discuss the possibility of computerizing your
inventory, and provides details of some inventory software products that are available.
To ease the workload for the small HTM Teams, support from secretarial and
computing staff can be used to assist with data entry.




48


3.1.2 Establishing the equipment inventory


HT
M


Se
rvi


ce


Inv
en


tor
y T


eam


HT
M


Te
am


s


Cr
eat


es
an


d u
pd


ate
s t


he
Eq


uip
me


nt
Inv


en
tor


y


Ca
rrie


s o
ut


the
Eq


uip
me


nt
Inv


en
tor


y a
t e


ach
fa


cil
ity


Co
mp


ile
th


e E
qu


ipm
en


t
Inv


en
tor


y.
Ma


ke
ha


rd
cop


ies
.


Or
gan


ize
s t


he
ga


the
rin


g o
f in


ven
tor


y d
ata


.


Vis
its


ea
ch


de
par


tm
en


t in
th


e h
eal


th
fac


ilit
y, a


nd
:



loo


ks
in


all
roo


ms
, cu


pb
oar


ds,
et


c.


ph
ysi


cal
ly c


he
cks


all
eq


uip
me


nt
for


th
e d


eta
ils


req
uir


ed
(s


ee
Bo


x 5
)



fill


s in
th


e E
qu


ipm
en


t In
ven


tor
y R


eco
rd


Sh
eet


s
(se


e B
ox


5)
.


If e
xis


tin
g r


eco
rds


ar
e a


vai
lab


le:


mo
dif


ies
or


ex
pan


ds
the


in
for


ma
tio


n a
s


ne
ces


sar
y t


o c
ove


r n
ew


ite
ms



fill


s in
an


y g
aps



cor


rec
ts


en
tri


es


up
dat


es
dat


a in
or


de
r to


m
ake


th
e E


qu
ipm


en
t


Inv
en


tor
y a


s a
ccu


rat
e a


s p
oss


ibl
e.



En


ter
th


e d
ata


ga
the


red
, ei


the
r o


nto
an


inv
en


tor
y c


ard
or


a c
om


pu
ter


sc
ree


n,
for


ea
ch


ind
ivi


du
al m


ach
ine


.


Cr
eat


e s
um


ma
rie


s, p
rep


are
an


d p
rin


t o
ut


har
d


cop
ies



Pro


vid
e a


co
py


of
th


e E
qu


ipm
en


t In
ven


tor
y t


o
the


St
ore


s C
on


tro
lle


r fo
r in


clu
sio


n i
n t


he
Ge


ne
ral


In
ven


tor
y h


eld
by


St
ore


s.


Eit
he


r b
y:



fac


ilit
y s


taf
f fo


r th
eir


ow
n f


aci
lity



dis


tri
ct/


reg
ion


al s
taf


f fo
r th


e f
aci


liti
es


in
the


ir
dis


tri
ct/


reg
ion



cen


tra
l st


aff
fo


r th
e h


eal
th


ser
vic


e a
s a


wh
ole



usi


ng
sp


eci
alis


t h
elp


.
Du


e t
o t


he
wo


rkl
oad


an
d k


no
wle


dg
e r


eq
uir


ed
, it


is u
sef


ul
for


th
e t


eam
to


be
m


ade
up


of
:



tw


o m
ain


ten
anc


e s
taf


f (f
rom


th
e r


ele
van


t
HT


M
Te


am
)



a s


en
ior


eq
uip


me
nt


use
r fr


om
th


e f
aci


lity


a m
em


be
r o


f st
aff


fro
m


the
de


par
tm


en
t b


ein
g


stu
die


d (
wh


o c
han


ges
as


yo
u m


ove
fro


m
de


par
tm


en
t to


de
par


tm
en


t).
As


a b
are


m
ini


mu
m


you
co


uld
try


us
ing


on
e


me
mb


er
of


ma
int


en
anc


e s
taf


f a
nd


on
e m


em
be


r
of


de
par


tm
en


tal
st


aff
(w


ho
ch


ang
es


as
you


m
ove


fro
m


de
par


tm
en


t to
de


par
tm


en
t).


Ma
ke


us
e o


f tr
ain


ed
te


ch
nic


al s
taf


f a
nd


sec
ret


ari
al/c


om
pu


tin
g s


up
po


rt t
o a


ssi
st


wit
h d


ata
en


try
.


BO
X 7


: Ta
kin


g t
he


in
ve


nto
ry


Bo
dy


Re
sp


on
sib


ilit
y


Ac
tiv


ity
Pe


op
le


inv
olv


ed


Co
nti


nu
ed


op
po


sit
e




49


3.1.2 Establishing the equipment inventory


Ce
ntr


al-
lev


el
HT


M
Te


am
De


vel
op


s t
he


Eq
uip


me
nt


Inv
en


tor
y a


s a
n a


cti
ve


(re
gu


lar
ly


up
dat


ed
) c


om
pu


ter
fil


e, a
s w


ell
as


a h
ard


co
py


pr
int


-ou
t.


An
aly


zes
th


e E
qu


ipm
en


t
Inv


en
tor


y f
or


pla
nn


ing
pu


rpo
ses


(S
ect


ion
7.1


).



Us


es
the


co
mp


ute
r so


ftw
are


pa
cka


ges
re


qu
ire


d
for


th
is p


urp
ose


(fo
r e


xam
ple


, w
ord


-pr
oce


ssi
ng


spr
ead


she
ets


or
sp


eci
fic


co
mm


erc
ial


inv
en


tor
y


pro
du


cts
– s


ee
An


ne
x 2


), w
hic


h s
taf


f h
ave


be
en


tra
ine


d o
n.


Ma
ke


s u
se


of
sup


po
rt f


rom
st


aff
tra


ine
d i


n
ke


ep
ing


co
mp


ute
riz


ed
re


cor
ds.


BO
X 7


: Ta
kin


g t
he


in
ve


nto
ry


(co
nti


nu
ed


)
Bo


dy
Re


sp
on


sib
ilit


y
Ac


tiv
ity


Pe
op


le
inv


olv
ed




50


3.1.2 Establishing the equipment inventory


Periodic Updating of the Inventory
An inventory is an active record – in other words, it must be kept up-to-date if it is to
be of any use. Data used for planning purposes is of little use if it is out of date. You
should update your inventory periodically throughout the year, whenever new data is
received which is relevant to the inventory. There should also be a formal annual
updating process (Section 8.1).
The HTM Teams should use the many opportunities during their work throughout
the year to regularly gather data for updating the Equipment Inventory, such as:
◆ when new equipment purchases and donations arrive, information will be entered


onto the Equipment Inventory when the equipment is commissioned and the
‘Acceptance Test Logsheet’ is completed (see Guide 3 on procurement and
commissioning)


◆ whenever equipment is serviced or repaired throughout its life (see Guide 5 on
maintenance management)


◆ whenever equipment is taken out of service (see Guide 4 on operation and safety).
Possibly every month or quarter, HTM Managers should oversee the inventory
updating process and make sure the following happens:
◆ A record of any changes is kept on the hard-copy print-out of the Equipment


Inventory.
◆ The computer inventory file is regularly updated by entering into the computer


any comments from the hard-copy print-out, as well as removing from the
inventory any ‘written-off ’ (condemned) items (see Guide 4).


◆ A formal annual inventory update is organized (Section 8.1).


3.1.3 Establishing Inventory Code Numbers
What is an Inventory Code Numbering System?


Inventory codes are numbers that the HTM Service uses to label each separate
piece of equipment, so that individual machines can be identified from among many
similar items. It is important to be able to do this so that, for example, you could
consider the service history (see Guide 5) of a specific suction pump, for example,
compared to the performance of all suction pumps in general.
Various types of inventory code numbering systems can be used, and Box 8 shows
the advantages and disadvantages of the various options. It is possible to make your
system as sophisticated (complicated and informative) or as basic (simple but less
informative) as you like.




51


3.1.3 Establishing inventory code numbers


BOX 8: Types of Inventory Code Numbering Systems
Options Advantages Disadvantages
Basic Sequence Number
The inventory code numbers simply
start at ‘one’ and continue endlessly
into the thousands. Each new item is
simply allocated the next number on
the list, whatever type of equipment
it is or wherever it is going to be
located.


‘Speaking’ Numbers
This is a system where a code number
is used, which tells you something
about the equipment. Different parts
of the code are used to mean certain
things. For example, the code could
be T1 199 02. In this case, the first
part of the code (T1) tells you about
the location (Theatre 1).
The second part tells you the
equipment type (199 being your
code for suction pumps), and the
third part identifies the individual
machine (i.e. your second suction
pump in Theatre 1).
A Barcode
Commercial barcode stickers are
purchased, which can be read by
barcode readers. The information is
then transferred to a computer.
Software programming is required to
link the reading from the barcode to
details about the equipment.


By looking at the number you cannot
tell anything about the machine.
You need to have a centralized
master list to see which is the next
number to be allocated.


The list of numbers which make up
different parts of the code (e.g. 199
= suction pumps) has to be agreed,
allocated, and understood by the
HTM Teams.
If the location of the equipment
changes, the number will also have to
be altered.


By looking at the barcode, you cannot
tell anything about the machine.
It can only be used with a
computerized system.
You need a regular supply of barcode
stickers, barcode readers, and a
software program.


Ideal for computerized
inventories.
The number is used to
search the computer
database to reveal all the
data stored about that
particular machine.


From the code number
you can identify the
location of the
equipment, the
equipment type, and
which specific machine
you are dealing with.
Speaking numbers can be
made with as many parts
as you like which tell you
additional things about
the equipment (such as
the facility or the region)


You don’t need to paint
large sequences of
numbers onto the
equipment.
This is a computer-based
system.




52


3.1.3 Establishing inventory code numbers


Who is Responsible for Inventory Code Numbers?
Preference
You should aim to introduce an inventory code system that is uniform across the whole of
your health service organization. This is preferable to allowing each facility to use a different
code system (though that is better than having no system for identifying equipment at all).


Country Experiences
The central health ministry in Malawi uses a basic six-digit sequence number that refers
to the equipment record kept in a computerized database. Whenever work is undertaken
on a piece of equipment, typing in the basic number into the computer means that the
inventory details and maintenance history of that item are displayed on the screen.
The Central Maintenance Department of the public health service in El Salvador developed
a sophisticated 13-digit inventory code numbering system, which contained details of the
type of equipment and its location. This required a great deal of knowledge (technical,
medical, and administrative) among the staff responsible for allocating the numbers.
However, using the skills of the knowledgeable personnel, they were able to develop a
small code booklet, which is now used by technicians to look up the correct numbers.
The central health ministry in Namibia decided to stick barcodes onto their equipment,
instead of having an inventory code number painted onto each item. They acquired a
commercial barcoding system to program and install on their computers, and scanners
with which the technical staff can read the codes.


Tip • Your health service provider might not have developed a inventory code numbering
system. Do not let this prevent you from using some method of identifying
equipment at your health facility. You can encourage your central HTM Service to
establish an inventory code numbering system, but in the meantime you can label
your own equipment.


Takes what action?
Manage the inventory code numbering system
Takes what action?
Ideally, designs the inventory code numbering
system, and shares it with each facility and
district/region.
Implement the system, and put the numbers on the


Who?
HTM Teams
Which level?
Central HTM Team


Facility and/or District
HTM Teams




53


3.1.3 Establishing inventory code numbers


How to Create the Inventory Code Numbering System
The HTM Service should undertake an exercise to develop an inventory code
numbering system, and should consider the options available as shown in Box 8.
Specialist support may be required to assist with these processes. Once a system has
been set up:
◆ Existing machines and maintenance records (see Guide 5) must be labelled with


their inventory codes (stickers or marker pen can be used).
◆ New equipment must be allocated a code during the commissioning and


acceptance testing process (see Guide 3).


Tip • Never label your surgical instruments by scratching or etching letters onto them
(such as the name of the facility). This removes the protective layer and causes dirt
and water to collect in the grooves, which results in corrosion, staining, or rusting.
Rust weakens instruments and will eventually cause them to break. Also the grooves
make it very difficult to decontaminate the instruments adequately (see Guide 4).


3.2 STOCK VALUE ESTIMATES
It is preferable to have a planned approach to the financing of healthcare technology.
Many calculations which can help you to decide the finances required for equipment
are based on a percentage of the equipment stock value. For example, in Section 6.1
when calculating maintenance costs for your equipment you will use an internationally
recognized percentage of your equipment stock value. This is necessary because your
maintenance budget must be based on the capital value of your equipment.
If you do not know the value (quantity and cost) of the equipment you own, any
planning is likely to be purely guesswork. Therefore it is necessary to calculate your
Equipment Stock Value (your second planning ‘tool’). Once you have worked out
this figure, any other calculations you make will be directed towards providing the
resources needed to sustain your existing stock.
In many countries no equipment stock values have been estimated, usually because
no equipment inventories exist. This means that all equipment budget allocations
are based largely on guesswork, rather than being based on calculations of the real
finances required to keep equipment functioning.


Tip • When calculating stock values, it is best to use current and up-to-date prices for the
equipment. It is much more difficult to calculate the actual present value of the stock
because you will have to allow for depreciation in value over time, and decide which of
the many depreciation methods to use. Also, by basing your calculations on the price
you originally paid for the equipment, you will always be out-of-date. By calculating
Equipment Stock Values ‘as new’, your replacement and maintenance estimates will
always be linked to current prices.




54


3.2 Stock value estimates


Who is Responsible for Stock Value Estimates?
Takes what action?
Is responsible for developing equipment price lists
and stock values.


Takes what action?
Can develop stock value estimates.


Who?
The HTM Working Group,
or possibly a smaller pricing
sub-group (Section 1.2)
Which level?
Any level of the health
service (central,
region/district, facility)


How to Make Stock Value Calculations
Anyone can develop stock value estimates if they have access to two things:
◆ the Equipment Inventory (Section 3.1)
◆ a Reference Equipment Price List.
A Reference Equipment Price List is useful as you can look up the typical
approximate prices for any type of equipment. A list of possible types of
equipment, together with their expected product lifetimes, is given in Annex 3.
In the same way, you can also develop a list of typical prices against different
equipment types. You can develop this by:
◆ starting slowly with the prices of recent and known purchases
◆ building it up over time as you get further quotes
◆ researching current prices over time, for example on the internet (see Annex 2).
The next step is to calculate equipment stock values. Details of how to do this are
given in Figure 8.




55


3.2 Stock value estimates


Process Activity


Gathers data on current
equipment prices


Compiles a Reference
Equipment Price List


Use purchase contracts,
supplier information, data
from service contracts,
manufacturers’ websites etc.


The HTM Working Group (or its pricing sub-group) at facility, district/regional, or central level:


List typical prices for
different equipment types.


Improves planning and
budgeting


Ensure the correct stock
value is always used for
planning and budgeting
purposes (Sections 5 and 6).


Makes a stock value
estimate for your health
facility, or each facility type


Use one of the following
three calculations for your
facility:


If you want a rough
estimate of the ‘new’
stock value


Estimate the major expensive equipment
categories (for medical equipment, plant,
furniture, etc.) for the health facility. Then
multiply their approximate numbers by the
reference prices, as shown in Box 9


If you want a more
exact estimate


Cost the Equipment Inventory (Section 3.1)
using the reference prices


If you want an
estimate for the
future


Cost the Model Equipment List for your
facility (Section 4.3) using the reference
prices


When making estimates for
more than one facility:


Take the stock value for a facility type and
multiply it by the number of facilities of that
type in your district, region, country, or
organization.


Ensures the information is
kept up-to-date


Revise the prices regularly in
order to provide a database
of current equipment prices.


Revise the stock values
periodically (Section 8.2).


Figure 8: How To Estimate Total Equipment Stock Values


Box 9 shows a rough estimate of equipment stock values by equipment category, for
an imaginary 120-bed district hospital. We recognize that, in some countries, the
contents listed would be for a larger hospital, or for a hospital offering secondary level
healthcare services.




56


3.2 Stock value estimates


BOX 9: Example of Equipment Stock Values for a 120-bed District Hospital (in 2003)
Medical Equipment US$
X-ray machines (one suite, one mobile) and film processors 250,000
Anaesthetic machines with vaporizers, and anaesthetic ventilators (three theatres) 110,000
Laboratory equipment, assorted 120,000
Operating tables (one each for three operating theatre suites) 90,000
Operating lights (one each for three operating theatre suites) 50,000
Infant incubators (six) 40,000
Transport incubators (one) 15,000
Monitors (one each for three operating theatre suites) 60,000
Defibrillators (one) 20,000
Diathermy units (one each for three operating theatre suites) 45,000
Ultrasound scanner (one for maternity cases) 15,000
Beds (120) and hospital furniture 200,000
All other medium to low technology medical equipment and instruments 200,000
Plant
Autoclaves (two large units) 25,000
Laundry equipment (one small set) 165,000
Incinerator (one) 70,000
Kitchen equipment (one small set) 45,000
Air-conditioning (10 individual units) 25,000
Mortuary (nine-body capacity) 20,000
Refrigeration (eight individual units, one cold room) 10,000
Electrical generator (one small set covering the whole facility) 50,000
Electrode boiler (one small set) 45,000
Water storage and treatment tanks 20,000
All other various plant items such as geysers, pumps, compressors 100,000
Assorted
All other furniture and office equipment 250,000
Vehicles (three) 90,000
Communication equipment (telephones or radios) 10,000


Total 2,140,000
There will also be the buildings, and service installations such as the plumbing, sewage, and electrical
distribution routes.




57


3.3 Budget lines for equipment expenditures


3.3 BUDGET LINES FOR EQUIPMENT EXPENDITURES
If you want to plan the finances for your equipment correctly, you must have:
◆ a clear idea of what you currently spend, and
◆ a realistic estimate of what you need.
To do this, it is necessary to have expenditure records of sufficient detail to enable
you to identify equipment-related costs.
By introducing Budget Lines for Equipment Expenditures, you can record and
monitor the many different ways in which money is spent on equipment. This
planning tool means that you will be able to analyze the financing required adequately.
In many countries it is very difficult to identify what is spent on equipment, as there
are no specific equipment expenditure records. Nor is it possible to analyze in any
detail how funds are being spent, because of the ill-defined structure of health
budgets (both centrally and at facility level).


There are a variety of costs related to healthcare technology, and most of them are
hidden. This can be illustrated by using the image of an iceberg as shown in Figure 9.
An iceberg is known for only having a small portion of its bulk showing above water,
with the vast majority of its bulk hidden dangerously below the surface. All of these
expenses together are known as the ‘life-cycle costs’ for healthcare technology.


Country Experiences
Many countries face the following problems with analyzing their equipment expenditure:
◆ Running costs of equipment (i.e. consumable costs) cannot be identified as they fall


under a recurrent budget code covering all general and medical supplies.
◆ Maintenance costs for medical equipment cannot be identified as they fall under a


budget code which covers maintenance of everything – buildings, vehicles, office,
plant and general equipment.


◆ Planned development expenditure on plant and large installed items of medical
equipment (such as X-ray machines) cannot be identified as they are rolled into total
budget allocations for construction costs.


◆ Budgets for the replacement and maintenance of the buildings and plant of the
government health service are allocated to the Ministry of Works, but they cannot be
identified for the Ministry of Health as the budgets are not divided by facility or even by
client ministry.




Figure 9: The Iceberg Syndrome of Life-Cycle Costs for Healthcare Technology


Source: Damann, V. and H. Pfeiff (eds), 1986, ‘Hospital engineering in developing countries’,
GTZ, Eschborn, Germany


As we have illustrated, there are many different equipment-related costs, and it is
common for only the purchasing costs to be remembered and allocated. It is difficult
to plan if:
◆ the various spending allocations cannot be specifically identified or monitored


within a facility’s budget, and are lost among other expenditures
◆ central budgets do not show how these funds for equipment are allocated to


individual cost centres (facilities, districts or health service providers).
Therefore, it is important to have budget lines (or sub-divisions) for each type of
equipment expenditure, at each service level.


Different Types of Expenditure
It is important to recognize the different types of expenditure for equipment and
what they are used for:
◆ Capital Funds are required to cover large one-off expenses. They are normally


planned for annually. The sorts of expenses covered by capital funds depend on
the size of the task and whether it is linked to the purchase of new equipment.


58


Purchasing
costs


Operating
costs


Maintenance
costs


Transport and
installation
costs Cost of recordingand evaluating


data


Staff
costs


Training
costs


Costs of
Removal
from service


Administration
and Supply
costs


3.3 Budget lines for equipment expenditures




59


They usually include:
- replacing existing equipment
- buying additional equipment
- pre-installation work (site preparation and associated lifting and warehousing


expenses)
- support activities so you can start to use your purchases and donations
(installation, commissioning, and initial training)


- rehabilitation of equipment and the fabric of buildings which will be major works
and require large sums of money.


◆ Recurrent Funds are required to cover smaller regular expenses in order to keep
equipment functioning and running. They are normally planned for on a weekly or
monthly basis. The sorts of expenses covered by recurrent funds depend on the
size of the task and whether it takes place at times other than the purchase of new
equipment. They usually include:
- buying consumables for equipment operation
- buying spare parts and technical support for equipment maintenance, repair, and


minor works
- administrative expenses for equipment operation and maintenance services,


including energy costs
-training expenses for ongoing skill-development requirements.


In order to be able to monitor the different allocations and expenditures for these
equipment requirements, you will need to develop a variety of different budget
elements (or sub-divisions). These will need to be presented for each cost centre
(facility, region/district, or health service provider)


Tip • Whenever equipment is purchased it is essential to budget for its running costs.
Therefore, there must be a link between the budget lines for planned capital
expenditure and recurrent budget estimates for maintenance, consumable items,
and training.


We recognize that many poor countries find it difficult to set aside funds for
equipment needs from the small recurrent budgets available, as they are continually
re-allocated to meet other prioritized needs. This is especially the case if primary
healthcare is the priority of health services, and public health programmes take
precedence over institutional care services.


3.3 Budget lines for equipment expenditures




60


Who is Responsible for Creating Budget Lines?
Preference
Your health service provider should develop a budgetary system containing a variety of budget
elements for different equipment expenditures, which can be used across the whole of the
health service.


Tip • Your health service provider might not have developed a budgetary system with
various equipment-related budget elements. Do not let this prevent you from doing
so at your health facility or district level. You can encourage your health service
provider to do this centrally, but in the meantime you can start analyzing how you are
spending your money.


How to Create Budget Lines for Equipment Expenditure
It is possible to develop budget elements that will show how money is being spent
on the different equipment expenditures. Box 10 provides some strategies
necessary to do this.


3.3 Budget lines for equipment expenditures


Experience in Ghana
Seventy per cent of the capital budget for the Ministry of Health (MOH) is funded from
external sources, and these capital funds are more readily available than funds from the
recurrent budget. Thus the MOH has adopted a strategy that links more of the ‘life-cycle
cost’ of equipment (daily operation, maintenance, and administrative needs for running
the equipment) into the capital budget over a number of years.
It has achieved this by considering these running costs as part of the ‘total cost of
ownership’ (purchasing cost) of the equipment which can be covered by the capital
budget. In this way, Ghana ensures that the cost of using equipment is covered for a few
years after commissioning. In the meantime, the recipient facility accumulates enough
monies from their internally generated funds so that they can support the equipment after
this initial grace period is over.


Takes what action?
Develop the new budget lines.
Takes what action?
Can develop budget elements that will show
how money is being spent on the different
equipment expenditures.


Who?
Finance Officers
Which level?
Any level of the health
service (central,
region/district, facility)




61


3.3 Budget lines for equipment expenditures


BOX 10: Strategies for Developing Budget Lines for Equipment Expenditure


People Responsible Action
Establish different budget lines (sub-divisions) as itemized below:
a. capital funds to cover equipment replacement (depreciation)
b. capital funds to cover additional new equipment requirements
c. capital funds to cover support activities which ensure equipment


purchases can be used (installation, commissioning, and initial training)
d. capital funds to cover pre-installation work for equipment purchases
e. capital funds to cover major rehabilitation projects
f. recurrent funds to cover equipment maintenance costs, including


spare parts, service contracts, and minor works
g. recurrent funds to cover equipment operational costs, including


consumable items and worn out accessories
h. recurrent funds to cover equipment-related administration, including


energy requirements
i. recurrent funds to cover ongoing training requirements.
Start using these budget lines to analyze how money is allocated and
spent for equipment purposes.
Ensure that budgets are presented by cost centre so that it is clear what
allocations are made between central, region/district, and facility level. In
this way, you can see what money is spent on equipment activities at each
level of the health service.
Lobby other bodies involved (such as Ministry of Finance, Works) to also
show equipment expenditures by cost centre, so that you can see what is
allocated by other agencies for equipment activities in the health service.


Finance Officers, at all levels
of the health service (central,
region/district, facility)


HTM Working Groups


Health service providers


3.4 USAGE RATES FOR EQUIPMENT-RELATED
CONSUMABLE ITEMS
If equipment is to keep functioning, you must ensure that reasonable stocks of
consumable items are held at all times, and that these form part of recurrent
budgets. You therefore need to calculate the Usage Rates for Equipment-related
Consumable Items. By doing this, you can base your recurrent budgets on the
actual ‘lifetime costs’ (daily operational, maintenance and administrative
requirements) of the items in your Equipment Inventory.
Recurrent budgets covering equipment-related consumable items are required to ensure
that equipment continues to function. Equipment-related consumable items are:
◆ equipment consumables (for example, electrodes, gels, paper)
◆ replacement accessories (for example, handpieces, probes, lenses)
◆ spare parts (for example, filters, o-rings, bearings)




62


◆ maintenance materials (for example, lengths of pipe, paint, paper for the
record system)


◆ equipment cleaning materials (for example, cotton wool, detergents, disinfectants)
◆ safety materials (for example, protective clothing, refilling fire extinguishers,


calibrating test instruments)
◆ energy supplies (for example, fuel, oil, gas, electricity).


If recurrent budgets for equipment are too small, it will not be possible to use or
maintain many pieces of equipment because you will have run out of the necessary
consumable items.
It may be the case that, in the past, equipment-related consumable items have not
been ‘stockable’ items in the Stores system, in other words items which, when stocks
run low, are automatically replenished and therefore always ‘in stock’. (Details of
how to implement such a system are contained in Guides 4 and 5).
If this is the case, you are unlikely to have sufficient information available on which
to base estimates concerning requirements and rates of use of equipment-related
consumable items. To rectify this, you need to carry out assessments of their
requirements and rates of use. Based on these assessments, you can then estimate
adequate recurrent budgets for the operation and maintenance of equipment, and
calculate correct stock reordering times. This information is useful for:
◆ improving budget allocations
◆ planning the correct timing for the procurement of supplies
◆ providing feedback on the choice of equipment.


Who is Responsible for Determining Usage Rates?


3.4 Usage rates for equipment-related consumable items


Takes what action?
Is responsible for establishing usage rates


Takes what action?
Make these calculations, use the information for
planning and budgeting purposes, and share it with
higher administrative bodies within the health service.
Use the information to ensure more appropriate
budget allocations are provided to the facilities.


Who?
The HTM Working Group,
or a smaller stock sub-group
(Section 1.2)
Which level?
Facility level


District/regional and central
health authorities




63


How to Discover your Usage Rates
An initial exercise will be required to establish the usage rates and requirements of
equipment-related consumable items, as described in Figure 10.


Figure 10: Exercise to Establish your Usage Rates and Requirements for Equipment-related
Consumable Items


3.4 Usage rates for equipment-related consumable items


Process Activity


Undertakes an initial one-off
exercise to establish usage rates
and requirements for
equipment-related consumable
items


Identifies:
• the actual requirements (i.e. the
types of items, makes, sources,
and descriptive/identifying part
numbers)
• the rates of use for these
recurrent items by department
(e.g. quantities needed per day,
week, or month in order to
deliver the required health
service to the patients expected).


Makes use of the information
gathered for planning and
budgeting purposes.


Provides feedback to the Stores
Controller


Provides feedback to the
Specification Writing Group and
the Tender Committee


Investigate the actual annual requirements and rates of use
across the facility for:
• replacement accessories
• equipment consumables
• spare parts
• maintenance materials
• energy supplies
• equipment cleaning materials.


By:
• consulting with departments
• talking to equipment operators and maintainers
• referring to departmental statistics and records on patient
attendance
• referring to Stores records
• using information from suppliers.


To:
• calculate more realistic annual recurrent funding requirements
to cover consumable items
• supply the Health Management Team with sufficient
information to set more realistic budgets.


Supply the Stores Controller with sufficient data to:
• enter onto the Stores' Stock Cards (Bin Cards)
• calculate correct re-ordering quantities and times
• make equipment-related consumable items ‘stockable’ items
(see Guides 4 and 5).


Provide them with information for more appropriate selection of
models during procurement (see Guide 3).


Updates the information regularly. Undertake an annual review as part of your equipment management activities (Section 8.2)


The HTM Working Group (or its stock sub-group) at facility level:


Once you have undertaken the one-off exercises to establish the planning tools, as
described in this Section, you can use them to make your long-term plans (Section 7)
and to undertake annual planning (Section 8.1). You will also need to update the
tools. This is described in Section 8.2.




64


Section 3 summary


BOX 11: Summary of Procedures in Section 3 on Discovering your Starting Point


HTM Service
(at central level)


Facility and
District/
Regional
HTM Teams


HTM Working
Groups
(or pricing
sub-group)


Health
Management
Teams


Finance Officers
(at each level
of your
organization)


Health Service
Provider


HTM Working
Groups
(or stock
sub-group)
Health
Management
TeamsUs


ag
e


Ra
te


s



Bu


dg
et


L
in


es



S


to
ck


V
al


ue
s



I


nv
en


to
ry


◆ designs the inventory system, and the code-numbering system
◆ computerizes it
◆ gather inventory data, keep it, update it, and pass it onto the centre
◆ use the inventory code-numbering system


◆ develop a Reference Equipment Price List, and calculate the equipment stock values
◆ revise the prices regularly in order to ensure that an up-to-date database of current


equipment prices is available
◆ revise the stock values periodically
◆ use the information for planning and budgeting purposes


◆ establish a variety of different budget elements (see Box 10), so that it is possible
to see how money is allocated and spent for equipment purposes


◆ ensures that health allocations are presented for central, region/district, and facility
levels, clearly showing what is spent on equipment activities


◆ lobbies other bodies involved (such as Ministry of Finance, Works) to clearly show
what is allocated for equipment activities in the health service


◆ undertake an exercise to discover more realistic usage rates and requirements for all
equipment-related consumable items (see Figure 10)


◆ use the information for planning and budgeting purposes


Box 11 contains a summary of the issues covered in this Section.




65


4. How to discover where you are headed – planning tools II


4. HOW TO DISCOVER WHERE YOU ARE
HEADED – PLANNING TOOLS II


Why is This Important?
To manage your healthcare technology effectively, you need to have a clear
idea of your goals and targets, and the context in which you are operating.
It is very difficult to manage without knowing what you are trying to achieve.
Equipment, for example, should not be viewed in isolation – it is there for a
purpose, and must be managed according to set objectives.
To plan effectively, you require access to a wide range of information and
reference materials. You also need a clear vision of the direction your health
service is going in, plus a definition of what equipment is required to help you
achieve the health service goals.
To ensure any equipment purchasing is planned and rational, you will need to
have good policies and procedures in place. These will provide guidance on
the valid reasons for buying equipment, as well helping you to decide what
equipment to buy.


It is better to plan and budget with specific goals in mind. You therefore need to
gather information which will help you to understand the goals and objectives for
your equipment.
To help you analyze your future equipment needs, you need some further ‘planning
tools’. This Section covers five additional tools, and discusses how to discover the
direction you are going in, by:
◆ having access to information and reference materials (Section 4.1)
◆ developing a Vision for health service delivery (Section 4.2)
◆ translating that Vision into Model Equipment Lists (Section 4.3)
◆ agreeing what your equipment purchasing, donations, replacement, and disposal


policies are going to be (Section 4.4)
◆ writing Generic Equipment Specifications (Section 4.5).
Different health service providers will have reached different stages in deciding on
the direction to go in, depending on the amount of planning they have already
carried out. The direction you take will depend on:
◆ your country
◆ your health service provider
◆ which level of the health service you work at
◆ the degree of autonomy of your health facility.




66


This Section describes how to undertake one-off exercises to establish these tools.
Different activities are described for the different health service levels. This work
will help you to discover where you are headed.
The use of these tools in the planning and budgeting process is provided in Section 7,
and Section 8 discusses how to monitor and update the tools.


4.1 REFERENCE MATERIALS
To increase their skills in planning and budgeting for the equipment stock, health
service providers need to expand their information and knowledge base concerning
equipment and its management. Therefore it is useful to develop a library of
equipment literature, covering a broad range of types of documents. These are
known collectively as reference materials, and provide background advice for
equipment planning and budgeting.
To keep up-to-date, it may be useful to subscribe to regular equipment information
sources, such as hazard reports and monthly journals. Due to the cost, you may need
to ask for assistance from external support agencies. Information regarding the
sources of some useful literature is given in Annex 2.
It is advisable for some data to be kept in every health facility and maintenance
workshop, so that staff can be encouraged to read and learn from reference material
which is available close at hand.


Who is Responsible for Gathering Reference Material?
Preference
For information to be available at all levels of the health service.


4. How to discover where you are headed – planning tools II


Takes what action?
Organize the gathering of reference material
Takes what action?
Is in a much better position to finance subscriptions,
to ask for assistance from external support agencies,
and to share information around all levels of the
health service.
Should pursue strategies to gain more information,
and develop their own equipment libraries.


Who?
Health Management Teams
Which level?
The Central Health
Management Team


Health Management Teams
at individual facilities and
districts




67


How to Obtain Reference Materials
There are several ways of obtaining reference materials. Box 12 provides a variety of
strategies for trying to get hold of different types of data and expand your library.
Some data which costs a lot of money to obtain may only be collected by the central-
level HTM Team, and they should pursue the strategies listed for sharing this
information around the HTM Service network.


4.1 Reference materials


BOX 12: Strategies For Sourcing Useful Literature and Advice (see Annex 2),
and Expanding your Library


Strategy Type of Material/Information Action
Obtain literature which is
usually available free of
charge.


Obtain literature from
neighbours which, with
negotiation, may be
available for the cost of
photocopying and postage.


Obtain information
available internationally
which can be paid for as
one-off items, or by annual
subscription (depending
on the material type and
source). This material may
come as a hard copy or as
part of a software package.


For existing equipment, find as many
of these as possible.


Contact as many other health
facilities and health service provider
organizations in your country and
neighbouring countries as possible,
to obtain existing resources.


Try to get hold of these resources,
perhaps subscribe to them, and look
for help to pay for them.


◆ manufacturers’ brochures
(from manufacturers and their
representatives)


◆ procurement catalogues from
bulk suppliers


◆ lists of the manufacturers
registered nationally with the
central Ministry of Health.


◆ Model Equipment Lists
◆ equipment specifications
◆ copies of manufacturers’


operator and service manuals
for older machines


◆ lists of registered
manufacturers.


◆ text books on a variety of
subjects (including advice on
planning and budgeting)


◆ manufacturers’ operator and
service manuals


◆ Equipment Evaluation Reports
and Product Comparison data


◆ technology assessment
literature


◆ Equipment Hazard Reports
and safety literature


◆ journals
◆ internationally available advice


on equipment issues.


Continued overleaf




68


4.2 DEVELOPING THE VISION OF SERVICE
DELIVERY FOR EACH FACILITY TYPE
As Section 2.1 explains, the Vision for your health facility tells you the direction of
healthcare delivery (in terms of the interventions and procedures to be carried out).
By referring to the Vision, you can determine what type of equipment you require.
When developing the Vision for a certain level of health facility, it is very important
to be reasonable and realistic in your goals. As Section 2.2 explains, you need to be
aware of the cost implications associated with any of your proposed goals (such as
developing Essential Service Packages).


4.1 Reference materials


BOX 12: Strategies For Sourcing Useful Literature and Advice (see Annex 2), and Expanding
your Library (continued)


Strategy Type of Material/Information Action
Make sure you order
relevant literature when
purchasing all your new
equipment (see Guide 3).


Investigate other sources
for getting literature/
information which you do
not have.


If material is no longer
available on paper, find a
more accessible format.


Scan single copies of
printed documents into a
computer and keep them
as electronic copies.


◆ when the manuals arrive, store the
original copies in a safe place (such
as the HTMS library, the facility
library, the workshop library)


◆ make photocopies of the operator
manuals, and give one copy to the
relevant user department, and
one copy to the HTM Team or
relevant workshop


◆ make photocopies of the service
manuals, and give one copy to the
HTM Team or relevant workshop.


Make use of internet (world wide
web) contacts where possible, as this
method will become more and more
important in future.


Investigate these alternative sources
of information. Make copies and
print-outs of the material and make
it available to other facilities.
Scan these documents into your
computer system and make them
more easily available to maintenance
technicians at many locations.


◆ operator manual
◆ service manual.


◆ suppliers
◆ manufacturers’ local


representatives
◆ international agencies
◆ links with health facilities


abroad.
◆ CD-Rom
◆ video
◆ DVD.


◆ user manuals
◆ service manuals




69


For example, you might decide that decentralizing your services provides a fairer
level of access for the surrounding population. However, great care must be taken to
ensure that any such move is affordable. If not, you run the risk of putting funding
for existing services in danger.


Who is Responsible for Developing the Vision?
The body or organization responsible for developing the Vision will vary from country
to country. This will depend upon:
◆ your health service provider
◆ which level of the health service you work at
◆ the degree of autonomy of your health facility.


Preference
It is unhelpful to have lots of individual facilities pulling in different directions, and no
coordinated plan for the health service as a whole. It is easiest for all concerned if your health
service provider at central level considers what sort of healthcare will be provided at each
level of your health service. They should collaborate with the Ministry of Health and follow
MOH guidance.


Tip • Your health service provider at central level might not be undertaking a Vision
exercise. Do not let this prevent you from working on the Vision for your health
facility, as long as you stay within sensible goals for your level of the health service.


4.2 Developing the vision of service delivery for each facility type


Experience in South Asia
The Ministry of Health in a Southern Asian country felt pressured by manufacturers,
professional staff, and the example set by private health service providers to develop
public services in a certain direction. Such a development was dependent on the
purchase of sophisticated technologies, such as CT scanners, MRI scanners, cardiac-
angiography machines and video endoscopes.
However, in a recent survey they discovered that the utilization of these items is less
than 10 per cent due to the lack of available manpower and recurrent budgets. This
shows how important it is not to allow realistic decision-making to be undermined by
outside pressures.




70


4.2 Developing the vision of service delivery for each facility type


Takes what action?
Organize special meetings of different types of staff
at each level to discuss the Vision.
Advises the Health Management Team on all
technology issues during this process.
Takes what action?
Takes the first step and develops the overall Vision
for the direction of the health service as a whole.
Once this Vision has been completed or updated,
takes the second step and defines the services to
be provided by individual health facilities. By:
- studying the map of facilities for their area
- considering how their region/district varies from


the norm described by the centre.
Once the services have been defined for the district,
takes the third step and looks at the possibilities
they have for providing the defined services.


Who?
Health Management Teams
at each level
HTM Working Group
(Section 1.1)
Which level?
Central Level


Regional/District Level


Facility Level


How to Develop your Vision
The Health Management Team at each level should organize a series of meetings to
discuss the development of the Vision. These meetings should include a cross-
section of different types of staff from their level (facility, district/region, or service
as a whole). As well as involving staff, it is also important to ask questions of your
customers (as far as is possible), especially when they contribute to covering the cost
of the health service provided.
At these meetings you should discuss:
◆ the direction that the service should be taking
◆ the sort of care that should be provided now and in the future
◆ the sort of interventions and procedures that will be carried out; and
◆ the type of healthcare technology required.
These meetings should take into account:
◆ healthcare trends
◆ demographic data
◆ epidemiological profiles
◆ priority health problems
◆ the clinical and referral features of the target area
◆ the infrastructure, finances, and human resources available
◆ local strengths and weaknesses
◆ the support available from external support agencies.




To inform the technology part of the debate, the HTM Working Group (at each
level) should consider the equipment implications of the healthcare interventions
suggested, and then offer technical advice to their Health Management Team.
Box 13 shows some of the issues that the Central Level HTM Working Group
should consider.


71


BOX 13: Equipment Considerations for the Vision at Central Level
Issues Examples
What expansion of services
is necessary or feasible?


What are the implications
in terms of staff, skills,
resources, patient referral
networks?


Are desired expansions
financially affordable?


Do the services suggested
fit into the overall Health
Service in the country?


4.2 Developing the vision of service delivery for each facility type


◆ What should be the role of a hospital (central, referral, district, or rural), in
terms of the interventions and procedures to be carried out? What does
this mean in terms of equipment availability?


◆ What type of care can be offered by rural, district or town health centres?
Can any types of care be transferred over to them? What does this mean in
terms of equipment availability?


◆ It may be best to locate certain specialized services (such as intensive care
units) only at certain hospitals. Some specialized services, such as
radiotherapy, may only ever be offered at national/central level. With
pressures to reduce costs, improve efficiencies, and possibly to reduce
staff numbers, can service provision be rationalized? Is expansion based
only on needs that can be realistically met?


◆ Introducing a new service has knock-on implications for human, material,
and financial resources. Why buy eye instruments for a facility if there is
no eye surgeon, or prospects of one becoming available?


◆ If the referral system is such that dialysis is only undertaken and
supported at a central facility, think carefully before placing dialysis
machines at, for example, 10 further locations. Such a move would have
major and costly knock-on effects. For example, at each of the 10 locations
you would need to:
- recruit or train renal doctors and surgeons
- finance and supply dialysis machines, water treatment systems,


specialized laboratory services and equipment
- provide renal nurses and after care services
- provide regular supplies of consumables and maintenance support, as


well as recurrent budgets.
◆ Although many hospitals may ideally wish to have fluoroscopy facilities


(for example), at a cost of approximately $500,000 per suite is this a
feature each hospital can necessarily invest in?


◆ Is it possible to develop a Vision which fits in with the other health service
provider organizations?




72


4.2 Developing the vision of service delivery for each facility type


BOX 14: Equipment Considerations for the Vision at Regional/District/Diocesan Level
Issues Examples
Are some services
duplicated in facilities
near to each other and
therefore over-provided?


Are there alternative ways
to provide healthcare
interventions?


Do the services
suggested fit into the
overall health service in
the surrounding area?


◆ Each facility may wish to offer all services, but this may not be practicable.
In many cases, it may be necessary and important to share service
provision. Which healthcare interventions can be shared with other types
of facility in the neighbouring area (such as the referral hospital, the town
clinic, rural outreach services)? Can you reduce your equipment
requirements by sharing services?


◆ Are there neighbouring facilities or health services (such as a flying doctor
service) which are better able to offer certain interventions – for example
services for Ear Nose and Throat, eye specialists, sophisticated imaging? If
they are better equipped to provide such services, you might agree that
they will be the source of those services and limit your equipment
requirements in those areas.


◆ Are there other providers who could supply you with services you require,
such as hot meals, clean linen, incineration? If so, would the reduction in
equipment capital and recurrent costs outweigh the cost of buying in
those services?


◆ Is it possible to develop a Vision which fits in with the neighbouring
regions/districts and other health service provider organizations?


Box 14 shows some of the issues that the Regional/District Level HTM Working
Group should consider.




4.2 Developing the vision of service delivery for each facility type


73


Following these considerations, the Health Management Teams should:
◆ develop a reasonable and realistic Vision for the health service in terms of the


procedures and interventions to carry out, and produce it as a formal document; and
◆ ensure the approved written Vision is used as the basis of subsequent equipment


planning and budgeting decisions.


4.3 MODEL LISTS OF EQUIPMENT PER
INTERVENTION
Once the Vision for the direction of health service delivery for a facility has been
developed (Section 4.2), you will know the healthcare interventions and procedures
you will be offering. Based on this information, you can then develop Essential
Service Packages, which should translate the Vision into:
◆ human resource requirements, and training needs
◆ space requirements, and facility and service installation needs
◆ equipment requirements.


BOX 15: Equipment Considerations for the Vision at Facility Level
Issues Examples
Are some services
duplicated within
the facility itself?


Are there alternative
technology strategies
for providing the
services required?
Do the services suggested
fit into the overall
health service in the
surrounding area?


◆ Perhaps your facility was built with three operating theatres, but are they
all in use all of the time? Can the use of the theatres be rationalized and
operating times maximized, so that new theatre equipment does not need
to be purchased three times (in this example) for many separate theatres?


◆ Some countries have introduced fee-paying systems. This can result in a
difference between fee-paying (high cost) and non-fee-paying (low cost)
services, causing duplication of services. Can the difference between high
and low cost be based on factors such as more prompt service, more
experienced staff, better food? In this way, can you avoid two physically
separate sets of facilities which lead to duplication of expensive equipment,
especially in areas such as intensive care, labour, or dental units?


◆ Does your geographical area lend itself to different ways of providing
services which may be more cost-effective or reliable? For example, can you
use solar energy for your electricity, a biogas plant for your sewage system, a
borehole water supply, radio communication, oxygen concentrators?


◆ Is it possible to develop a Vision which fits in with the neighbouring
facilities and other health service provider organizations?


Box 15 shows some of the issues that Facility Level HTM Working Groups should
consider.




4.3 Model lists of equipment per intervention


74


This Section concentrates upon equipment requirements, and considers the process
of defining what equipment is needed for each healthcare intervention. The
planning ‘tool’ used to do this is the Model Equipment List.


What is a Model Equipment List?
A Model Equipment List is:
◆ a list of equipment typically required for each healthcare intervention (such as a


healthcare function, activity, or procedure). For example, health service providers
might list all equipment required for eye-testing, delivering twins, undertaking
fluoroscopic examinations, or for testing blood for malaria


◆ organized by activity space or room (such as reception area or treatment room),
and by department


◆ developed for every different level of healthcare delivery (such as district,
regional and central), since the equipment needs will differ depending on the
Vision for each level


◆ usually made up of everything including furniture, fittings and fixtures, in order
to be useful for planners, architects, engineers and purchasers


◆ a tool which allows you to see if your Vision is economically viable.
The Model Equipment List must reflect the level of technology of the equipment.
It should describe only technology that the facility can sustain (in other words,
equipment which can be operated and maintained by existing staff, and for which
there are adequate resources for its use). For example a department could have:
◆ an electric suction pump or a foot-operated one
◆ a hydraulic operating table or an electrically controlled one
◆ a computerized laundry system or electro-mechanical machines
◆ disposable syringes or re-usable/sterilizable ones.
As Section 2.2 explains, it is important that any equipment suggested:
◆ can fit into the rooms and space available. You should therefore refer to any


building norms which define room sizes, flow patterns, and requirements for
water, electricity, light levels and so on


◆ has the necessary utilities and associated plant (such as the power, water, waste
management systems) available for it on each site. If such utilities are not
available, it is pointless planning to invest in equipment which requires these
utilities in order to work


◆ can be operated and maintained by existing staff and skill-levels, or for which the
necessary training is available and affordable.


Due to these factors, Model Equipment Lists will vary from country to country.




Usefulness of the Model Equipment Lists
A Model Equipment List is an aid to the planning process. In order to plan what
equipment to purchase, you will need to be aware of any shortfall in equipment. To
determine such shortfalls, you will need to compare your Equipment Inventory
(Section 3.1) with your Model Equipment List. This will enable you to determine
whether any equipment is currently missing or needs to be purchased.
Thus, the Model Equipment List will help you determine what equipment is:
◆ necessary
◆ surplus
◆ extravagant
◆ missing
in relation to the Vision for your facility.


Who is Responsible for Developing Model Equipment Lists?
Who has responsibility for developing the Model Equipment Lists will vary from
country to country. It will depend on:
◆ your health service provider
◆ which level of the health service you work at
◆ the degree of autonomy of your health facility.
Although at district or hospital level there may be sufficient medics, often there are
limited economists and technical personnel with management skills for the facilities
and districts to complete the task of developing Model Equipment Lists alone
(Section 2.2). It is very important that this task is undertaken by a multi-
disciplinary team, so that decisions benefit from the skills and views of all
disciplines, not just one or two.


4.3 Model lists of equipment per intervention


75




4.3 Model lists of equipment per intervention


76


Preference
Your health service provider at central level should consider developing Model Equipment
Lists in collaboration with staff from each level of the service. It is not helpful to have lots of
individual facilities pulling in different directions, with no coordinated plan for the health
service as a whole.


Tip • Your health service provider at Central level might not be undertaking an equipment
list development exercise. Do not let this prevent you from working on the Model
Equipment List for your health facility, as long as you stay within sensible goals for
your level of the health service.


How to Create Model Equipment Lists
When each level works on the Model Equipment List, the HTM Working Group
should organize a consultation exercise for staff. The best way to do this is by
arranging a series of meetings. A cross-section of different types of staff should be
brought together, from across all the various levels the HTM Working Group is
responsible for (such as facility, district/region, or service as a whole). In these
meetings, each discipline needs to decide the types of equipment required to
provide the healthcare interventions described in the written Vision (Section 4.2).


Takes what action?
Organizes special meetings of different types of staff
to work on the Model Equipment List. Then reports
back to the Health Management Team.
Takes what action?
Takes the first step and runs specific exercises to
establish the Model Lists of Equipment for each
clinical and support area, at each operational level.
Takes the second step and adjusts the list on a
regional/district basis to cover local variations.
Takes the third step and assesses:
- how they can provide the healthcare interventions
- what numbers of equipment they require


depending on how they organize their work.
Organizational decisions influence the quantity of
equipment. For example, the timing of clinics can
reduce or increase the workload in the laboratory.
Before ordering new equipment, you will need to
assess its level of use. (For example, as a microscope
is used for a number of tests, the work pressure
upon it must first be established, before deciding
whether there is a need for additional microscopes).


Who?
HTM Working Group
at each level


Which level?
Central Level


Regional/District Level


Facility Level




4.3 Model lists of equipment per intervention


77


During these meetings, it is important not to simply look at the space available and
draw up a list of equipment to fill it. The idea is to consider:
◆ the disease burden that the facility faces
◆ the healthcare interventions that are required at that level of facility
◆ the equipment needed to provide those interventions and the technology level


that can be sustained
◆ the quantities of each type of equipment required. Factors to consider include:


- which interventions can share equipment (for instance, could several surgical
procedures share an operating table?)


- whether the location of activities requires duplication of equipment (for example,
the number of resuscitations per year may only call for one resuscitation bag, but
clinically it is safer to have a resuscitation bag available at several locations).


Tip • To begin with, the task of creating Model Equipment Lists may appear to be
overwhelming. A simple way to start might be to take a critical look through the
equipment lists of neighbouring countries. Disease patterns do not fluctuate that
much between neighbouring developing countries, and financial and technological
capacity are likely to be largely similar. (Further information on Model Equipment
Lists developed by a variety of agencies and countries is given in Annex 2). You
could simply adapt existing Model Equipment Lists for your own situation, if you do
not have the resources or central support for a full exercise


For HTM Working Groups at Regional/ District and Facility Level where there may
be limited management skills (Section 2.2), making comparisons with other
countries’ Model Equipment Lists may be the most effective way of working.
At Central level you may require some computer software to assist you when
undertaking the clinical, technical, and economic analysis. This would also be
beneficial if the centre is responsible for compiling and overseeing lists for the rest of
the health service. Annex 2 provides further information on how to computerize
your Model Equipment Lists, together with some equipment analysis software
products that are available.


Tip • The WHO recommends the use of the ‘Essential Healthcare Technology Package’
(EHTP) approach for determining equipment lists. Annex 2 provides details of
EHTP software which would usually be applied at central level.




4.3 Model lists of equipment per intervention


78


Box 16 describes an exercise for consulting staff that can be undertaken to develop Model
Equipment Lists.


Continued opposite


BOX 16: Exercise to Develop your Model Equipment Lists
People and Steps Example Activities
The HTM Working Group
gathers useful reference
materials from various
sources which can stimulate
discussions, and can be
modified according to
local needs.


The HTM Working Group
sets up a series of small
working groups of different
types of staff for different
working areas, until all
departments have
been covered.


Each working group
undertakes a series of tasks
so that they can develop an
Equipment List for their
working area.


◆ uses the Equipment Inventory as a starting point, in order to develop a list
for each department


◆ draws upon any existing Equipment Development Plan for the facility
(Section 7.1)


◆ uses Model Equipment Lists from neighbouring countries as a reference
point, which can be modified to suit the health service’s own working
practices (see Annex 2)


◆ seeks guidance from the central health service provider organization on
the Vision for the health service


◆ refers to any international guidance available
◆ uses any computer software programs available (if you have access to


them).
◆ surgeons, theatre nurses, CSSD staff, and medical equipment technicians


to discuss equipment required for theatre interventions
◆ different grades of laboratory staff, maintenance staff and doctors to


discuss the needs for laboratory services
◆ doctors, physiotherapy staff, maintenance personnel to discuss


physiotherapy needs
◆ the Support Services Manager, a range of kitchen staff, ward managers,


maintenance staff, and employee representatives to discuss kitchen and
canteen requirements,


and so on.
◆ considers the reference materials obtained
◆ discusses what equipment is required for each of the healthcare


interventions offered in the written Vision for the facility/service level, for
their department or area


◆ provides a realistic estimate of the type of equipment required to provide
the service to be offered, being careful not to create a wishlist which can
never be attained


◆ provides a realistic estimate of the level of technology which can be
sustained


◆ determines the numbers of each item required for the existing patient
throughput, staffing levels, and work organization


◆ considers all the items required to work effectively, including –
equipment, furniture, hardware (clocks, waste bins, kidney bowls),
instruments and utensils


◆ creates a departmental list of all items and their quantities, on an ‘activity
by activity’ and ‘room by room’ basis.




4.4 PURCHASING, DONATIONS, REPLACEMENT,
AND DISPOSAL POLICIES


4.4.1 General Issues
Having gone through a detailed planning and budgeting process, you will then be in a
position to acquire equipment, either through procurement or donations. In order to
ensure you obtain only what you need, you must undertake an acquisition process
which is both rational and planned.
Any new or additional equipment must be acquired according to good policies and
procedures. When planning, you should consider both the costs of replacement and
disposal of existing equipment, and also the costs of purchase and donation of
additional items. A useful planning tool is the Purchasing, Donations,
Replacement, and Disposal Policies. These are a series of policies which guide
you on the process of decision-making for new acquisitions and help you to
determine what equipment you should obtain.
Ideally the Ministry of Health will have developed a Healthcare Technology Policy
which other health service providers can use as guidance, or follow if regulated to do
so (Section 2). Central authorities of all health service providers should be actively
involved in expanding these details and developing policies of their own, which cover
all aspects of the life of equipment. The Purchasing, Donations, Replacement, and
Disposal Policies will thus form one part of a wider Healthcare Technology Policy.
Alongside the policies for internal use, health service providers also need to develop
donor regulations (see Guides 1 and 3) to ensure that all equipment received
through foreign aid and donations complies with existing standards and policies.
Guidance on developing and implementing such regulations is provided in Annex 2.


4.4 Purchasing, donations, replacement, and disposal policies


79


BOX 16: Exercise to Develop your Model Equipment Lists (continued)
People and Steps Example Activities
The HTM Working Group
prepares and reviews
the final list.


The Health Management
Team gives overall approval
for the proposals.


◆ compiles the clinical/support area lists
◆ determines quantities, by identifying where several interventions can


share an item of equipment, and highlights areas where the location of
activities means that duplication of equipment is necessary


◆ finalizes the Model Equipment List for that facility
◆ develops a mechanism for updating the lists over time.
◆ approves the Model Equipment List
◆ ensures it is used as the basis of equipment planning and budgeting


decisions.




4.4.1 General issues


80


Who is Responsible for Developing Purchasing/Replacement Policies?


Tip • Your health service provider may not have developed such policies. Do not let this
prevent you from doing so for your health facility.


4.4.2 Purchasing and Donations Policies
To make the best use of your finances, you should only acquire equipment according
to rational, reasonable arguments and not according to random or wild demands.
Therefore it is useful to develop policy statements for purchasing and donations of
equipment. These will fall into two parts:
i. when to purchase
ii. what to purchase.


When to Purchase
Each facility should acquire equipment for valid reasons only and according to an
order of priority, both of which should be defined. Box 17 provides an example of
suggested valid reasons and an order of priority.
If there is a shortage of funds, acquisition should then take place in the same order of
priority as shown in Box 17. This will:
◆ protect acquisitions which cover equipment as it fails at the end of its life; and
◆ ensure that, as a bare minimum, the existing status quo is maintained.
Otherwise, the existing health service provided will start to deteriorate.


Takes what action?
Approve the equipment policies


Takes what action?
Should develop Purchasing, Donations,
Replacement, and Disposal Policies for equipment,
and share them with each facility and district/region.
Can develop and implement policies.


Who?
Health Management
Teams, with advice from
their HTM Service on
technical issues.
Which level?
The central HTM Service


Any health service level
(central, region/district,
facility) with the help of
their HTM Service




4.4.2 Purchasing and donations policies


81


BOX 17: Example of Valid Reasons and Order of Priority for Purchasing and Donations of
Equipment


There are four reasons for procuring/donating equipment, each of which provides a different goal which will
dictate when to acquire equipment. These can be placed in the following order of priority:
1. To cover depreciation of equipment. Equipment is replaced as it reaches the end of its life and is taken


out of service. This is necessary in order for the level of healthcare you currently deliver to be sustained.
Note: This means that the size of your existing equipment stock remains the same, and does not imply


an expansion of the health service.
2. To obtain additional equipment items which are missing from the basic standard requirements.


Additional equipment may be required in order to provide a basic standard level of care.
Note: Missing items are identified by comparing the Equipment Inventory with the Model Equipment


List for the facility.
3. To obtain additional equipment items beyond the basic standard. This is done in order to upgrade


the level of health service provided by the hospital. For example, new equipment may be needed to
provide a new service, build a new special unit, or increase the level of care offered.


4. To obtain additional equipment items outside the facility’s own plans. This will only be applicable
if the additional items have been called for by directives from the central health service provider
organization or a national body and cannot be stopped/refused for political reasons, such as ‘out of the
ordinary’, high profile, or political projects.


Within each of the four categories shown, priorities will have to be set. The priorities can be based on
indicators which measure your progress with attaining the goals. These are discussed in Section 7.1 on
Equipment Development Planning.


Equipment acquisition should only occur under the umbrella of an Equipment
Development Planning Process, so that it is rational and planned (Section 7.1).
Any acquisition should also be guided by the priorities laid out in any annual
development plans (Section 8.1).


Experience in South Asia
The public health sector of a Southern Asian country does not have a Healthcare
Technology Policy or standards. It finds it difficult to control the purchase of equipment.
Ministry of Health officials face the following problems:
◆ Requests from influential clinicians or politicians to buy inappropriate equipment,


which need to be challenged.
◆ When funds are refused for such items, use of the mass media to override the official


decision and appeal to the public for donations.
◆ The high turnover rate of the Minister and Permanent Secretary of Health means the


new incumbents continually want to make gestures for their electorate of new and
sophisticated equipment projects.


◆ Often, the MOH may be forced to succumb to such public and political pressures and
fund such projects.




4.4.2 Purchasing and donations policies


82


What to Purchase
To help you to obtain only equipment which is appropriate to your needs, your
purchasing and donations policies should clearly specify the ‘good selection criteria’
to employ. All equipment should:
◆ be appropriate to your setting
◆ be of assured quality and safety
◆ be affordable and cost-effective
◆ be easily used and maintained
◆ conform to your existing policies, plans, and guidelines.


Tip • Only select equipment that is suited to your needs. For example:
There is little point in acquiring an expensive piece of equipment which:
- has capabilities that are hardly ever utilized
- is almost impossible to keep in running order
- is difficult to operate safely and effectively.
There is little point in acquiring a cheap or poor-quality piece of equipment which:
- does not have the capabilities that your staff require
- falls apart easily and must be replaced quickly
- is of poor design and cannot be operated safely.


The selection process is described in full in Guide 3 on procurement and
commissioning.
Box 18 summarizes good selection criteria.


BOX 18: Example of Good Selection Criteria for Purchasing and Donations of Equipment
Indicators of appropriateness Criteria
Appropriate to setting Equipment should be:


◆ suitable for the level of facility and service provided
◆ acceptable to staff and patients
◆ suitable for operator skills available
◆ suitable for the local maintenance support capabilities
◆ compatible with existing equipment and consumable supplies
◆ compatible with existing utilities and energy supplies
◆ suited to the local climate, geography and conditions
◆ able to be run economically with local resources.


Continued opposite




4.4.2 Purchasing and donations policies


83


BOX 18: Example of Good Selection Criteria for Purchasing and Donations of Equipment
(continued)


Indicators of appropriateness Criteria
Assured quality and safety


Affordable and cost-effective


Equipment should be:
◆ of sufficient quality to meet your requirements and last a


reasonable length of time
◆ made of materials that are durable and hard-wearing (for example,


aluminium bends easily compared to iron or stainless steel)
◆ made from material that can be easily cleaned, disinfected, or


sterilized without rusting (for example, a polymerized finish or an
epoxy coating)


◆ made of materials that do not easily break (for example,
polycarbonate rather than glass)


◆ manufactured to meet internationally recognized safety and
performance standards (see Guides 1 and 3)


◆ suitably packaged and labelled so that it is not damaged in transit
or during storage


◆ provided by reputable, reliable, licensed manufacturers, or
registered suppliers.


Equipment should be:
◆ available at a price that is cost-effective. Quality and cost often go


together (for example, the cheaper option may be of poor quality
and ultimately prove to be a false economy)


◆ affordable in terms of costs for freight, insurance, import tax, etc.
◆ affordable in terms of installation, commissioning, and training of


staff to use and maintain them
◆ affordable to run (for example, cover the costs of consumables,


accessories, spare parts and fuel over its life-time)
◆ affordable to maintain and service
◆ affordable to dispose of safely
◆ affordable in terms of the procurement process (for example the


cost of a procurement agent or foreign exchange)
◆ affordable in terms of staffing costs (for example, costs of any


additional staff or specialization training required).


Continued overleaf




4.4.2 Purchasing and donations policies


84


BOX 18: Example of Good Selection Criteria for Purchasing and Donations of Equipment
(continued)


Indicators of appropriateness Criteria
Ease of use and maintenance


Conforms to existing policies, plans
and guidelines


You should choose equipment:
◆ for which you have the necessary skills in terms of operating,


cleaning, and maintenance
◆ for which instructions and manuals are available to you in a


suitable language
◆ for which staff training is offered by the supplier
◆ for which local after-sales support is available with real technical


skills
◆ which offers the possibility of additional technical assistance


through service contracts
◆ which comes with a warranty/guarantee, covering a reasonable


length of time, for which you understand the terms. (For example,
does it cover parts, labour, travel, refunds or replacements?)


◆ which offers a supply route for equipment-related supplies (for
example, consumables, accessories, spare parts)


◆ which offers assured availability of these supplies for a reasonable
period (up to 10 years).


You should choose equipment:
◆ according to your purchasing and donations policy
◆ according to your standardization policy
◆ according to the technology level described in the Model


Equipment Lists and Generic Equipment Specifications
(Sections 4.3 and 4.5)


◆ which is deemed to be suitable, having studied available literature
and compared products (see Box 12 and Annex 2)


◆ which is deemed to be suitable, having received feedback
regarding previous purchases (Section 8.2).


If the equipment fails to meet these ‘good selection criteria’ (Box 18), you will have
to find ways around all the drawbacks that will arise. Alternatively, you could decide
not to acquire equipment which does not meet the selection criteria, and choose
another type, make, or model.
Introducing an element of standardization in the equipment purchased will help you
to limit the wide range of makes and models of equipment found in your stock
(Section 2.1). By introducing standardization, your technical, procedural and
training skills will increase, and your costs and logistical requirements will decrease
(see Guide 1). If procurement is carried out on an individual facility basis, you will
almost certainly be left with items of equipment which are uneconomic to maintain.
For this reason, it is extremely important to try to collaborate and procure
equipment at a central or regional level (Section 2.2).




4.4.3 Replacement and disposal policies


85


Tip • When you, or an external support agency, acquire equipment, it is important to
conform to any standardization policies or strategies that your health service
provider has introduced.


Equipment purchases and donations should be costed according to the principles
provided in Section 5.2 of this Guide, in order to determine which items can be
afforded over their life-cycles.


4.4.3 Replacement and Disposal Policies
The majority of equipment acquisitions should be carried out for the purpose of
replacing existing stocks as they reach the end of their lives (see the order of priority
for purchasing and donations in Box 17).
Replacement is necessary because all equipment has a finite life expectancy. This
lifespan will depend upon the type of equipment, and the types of technology
contained within it. For example, five years might be the typical life for an ECG
monitor, 10 years for a suction pump, 15 years for an operating table, and 20 years for
an electricity generator. Once the equipment reaches the end of its life no amount of
intervention (such as maintenance) will be effective, and the only option will be to
replace it. International guidance on equipment lifetimes is available in Annex 3.
If replacement of equipment is not planned for, the health service delivered to the
public will simply deteriorate. If you do not replace equipment at the end of its life,
there will be:
◆ an uneven standard of reliability among your equipment
◆ a general deterioration in:


- performance
- safety
- dependability
- availability for use.


Each facility should replace equipment for valid reasons only, which should be
defined. Box 19 provides an example of suggested valid reasons, and criteria for
condemning equipment.




4.4.3 Replacement and disposal policies


86


BOX 19: Example of Valid Reasons for Condemning and Replacing Equipment
Valid Replacement Criteria
i. Equipment will only be replaced when one of the following valid reasons has been fulfilled:


a. it is worn out beyond repair (has reached the end of its natural life)
b. it is damaged beyond repair
c. it is unreliable – faulty, old, unsafe
d. it is clinically or technically obsolete
e. spare parts are no longer available
f. it is no longer economical to repair.
and one of the following valid reasons has also been fulfilled:
g. utilization statistics are available to show that it is still required
h. a demonstrated clinical or operational need still exists.


ii. Equipment will not be replaced simply because:
◆ it is old
◆ staff do not like it
◆ a newer model has arrived on the market.


Judging When it is Time to Condemn Equipment
Senior maintenance staff need to study the equipment, and judge:
◆ whether the equipment fulfils any of the valid replacement criteria (see above)
◆ whether the equipment has outlived its (internationally/locally) advised typical ‘lifetime’ (see Annex 3)
◆ the equipment’s track record and state of health, as documented in its service history records (see Guide 5)
◆ whether it will be necessary to override the average expected lifespan and condemn the equipment early,


or even to extend the lifespan of the equipment.
For expensive equipment, it may be helpful to obtain an evaluation from the supplier.


Formal procedures must exist for condemning and disposal of equipment. Failure to
dispose of equipment properly could result in the following:
◆ graveyards of abandoned equipment piling up around health facilities
◆ departments, store rooms, cupboards, and workshops full of old equipment
◆ previously condemned equipment ending up back on the wards and being re-used.




4.4.3 Replacement and disposal policies


87


Once equipment has been condemned, you need a formal policy to oversee its
disposal. This should cover:
◆ how it should be disposed of safely
◆ how it can be disposed of as promptly as possible
◆ how it can be disposed of in an environmentally sound way according to your


‘Waste Management and Hygiene Plan’
◆ how you can strip off the useful spare parts before the equipment is disposed of.
These issues are discussed in Guide 4 on operation and safety.
The condemning and disposal of equipment should trigger the purchase of a
replacement piece of equipment. It is preferable to plan for replacements before
they are needed and, where possible, you should identify likely replacement needs
within your annual Equipment Inventory update and annual plans (Section 8.1).
These activities should be timed to take place ahead of the next procurement cycle,
which usually takes place annually (see Guide 3).
In summary, to replace and dispose of equipment it is necessary to have the following:
◆ technical skills to identify those items ready for replacement
◆ good procurement practices which enable you to finance and purchase


replacement items in good time
◆ courage and determination to take equipment out of service when necessary, even


if the users want to keep using it
◆ a formal method for condemning equipment
◆ a formal method for disposing of the equipment, safely and in an environmentally


sound way
◆ a formal method so that the disposal of equipment triggers the purchase of a


replacement item.
All these formal methods are described in Guide 4 of this Series.


4.5 GENERIC EQUIPMENT SPECIFICATIONS AND
TECHNICAL DATA
Having drawn up Model Equipment Lists (Section 4.3) and Purchase/Replacement
Policies (Section 4.4), you are ready to begin the process of acquisition. Whether you
are carrying out procurement on your own behalf, or have enlisted the help of an
external support agency to do it for you, purchase orders or requests for
tenders/quotations have to be prepared. All such purchase documents should include:
◆ Item information, describing what you want to purchase (equipment


specifications, quantities, technical and environmental data)
◆ Order information, describing the terms and conditions for supplying the goods


(qualification and evaluation criteria, delivery and payment terms, etc.)




4.5 Generic equipment specifications and technical data


88


The compilation and use of such purchase documents for acquiring your equipment
is described in Guide 3 on procurement and commissioning. However, establishing
the item information is a specialist technical task and requires advanced planning.
Ideally, you should write your own equipment specifications, so that whoever is
procuring/providing the goods can conform to your requirements. Useful planning
tools to help you are Generic Equipment Specifications and Technical Data.
These should be written by in-house technical staff, so that they can be used by
procurement staff from any organization.
The specifications provide the detailed technical description of each type of
equipment on your Model Equipment List. You may require specialist help with
writing such specifications.


What are Generic Equipment Specifications?
A clear specification includes:
◆ a detailed description of the equipment
◆ the ‘package of inputs’ needed to keep the equipment going through its lifetime


(including consumables, installation, training and after-sales support)
◆ the quantities required.
The specification is the most important document for both the purchaser and for
the potential supplier, since it sets out precisely what characteristics are required of
the products or services sought. Often, this is your only chance to detail your
selection criteria (see Box 18, Section 4.4.2), including requirements for certain
levels of technology, quality, safety, appropriateness, consumable inputs, training,
and technical support. This is especially the case if you are using a tendering process
(see Guide 3), when it is not legal to introduce additional terms and conditions after
the tender bids have been received. Therefore any preferences you have in these
areas must be highlighted within the initial specification.
When drawing up a product specification, it is best to describe equipment according
to its type or class – in other words to describe its function. The advantages of this
approach are:


◆ it describes exactly what the equipment will be required
to do


◆ it enables any supplier to offer any products which will
perform that function


◆ it does not limit the product only to one brand name or
make of product.


Although many variations exist, unfortunately many common problems arise as a
result of poor specification-writing. Some examples of this can be seen in the
‘Country Experiences’ box opposite.


Generic
means a ‘type’ of thing,


or a ‘class’ of item or object.




Properly written generic equipment specifications also enable you to conform to the
standards set by government, and to continue to meet the standardization policy of
your health service provider (Section 2.1).


Who Is Responsible for Developing Generic Equipment
Specifications and Technical Data?


In some countries, health service providers have already developed specifications
and technical data for equipment at most, if not all, levels of the health system. If no
such specifications and data exist, your HTM Working Group or a smaller
Specification Writing Group needs to develop specifications plus technical data for
equipment which is commonly used. Since this is a skilled technical task, staff may
require extra training or consultancy support.


4.5 Generic equipment specifications and technical data


89


Country Experiences
Examples of the kinds of problems which have arisen in various countries due to poor
specifications are:
Equipment that
is incompletely
procured


Equipment that
does not fit medical
and technical
requirements


Poor quality
equipment


Equipment that cannot
be installed


◆ Equipment arrives without the necessary accessories
◆ There is a lack of consumables such as chemicals or fuel
◆ Instruction manuals are not received or are written in a foreign


language
◆ No local after-sales support is available
◆ Equipment is technically and/or economically obsolete upon


arrival, or soon after its arrival
◆ Transport incubators are not transportable
◆ Generators have insufficient capacity to supply the hospital’s


power requirements
◆ Taps in the theatre scrub-up rooms are not elbow or foot operated
◆ Beds cannot be tilted
◆ Gas gauges are not compatible with local gas fittings
◆ There are items which no-one knows how to use
◆ Quality is so poor that a few years after commissioning, much


of the equipment falls apart and is hazardous
◆ Suction machines do not suck
◆ Heavy workload areas receive lightweight equipment
◆ Filing cabinets for X-ray film cannot bear the weight of films
◆ Trolleys are so narrow that the patients fall off them
◆ The site is not suitably built or provided with service supplies
◆ No expertise is available to install or commission the equipment
◆ Requirements and responsibilities for installation and


commissioning are not defined.




4.5 Generic equipment specifications and technical data


90


Did you know?
Many countries suffer from using poor equipment specifications. Common mistakes include:
◆ the product description is too short, providing an insufficient description of what is


required. For example, a specification which says: ‘Please supply one autoclave’ is useless. It
gives no details at all about the type of unit, what needs to be autoclaved, its size, or how it
will be powered (by electricity or kerosene). Many different sorts of autoclaves could be
supplied, most of which will be unsuitable.


◆ the product description is too rigid. If the description provided is not general enough, this can
be very limiting. For example, a specification which states: ‘Please supply one X-ray machine
like a Siemens model Unistat 11’ is so specific that most suppliers (other than Siemens) cannot
help. The only exception to this rule would be if you actually wanted to buy a particular make
and model of machine (for example, if you have standardized to it – Section 4.4).


◆ the product description reduces your options, by providing a description of particular
equipment rather than the function you require. For example, a specification which states:
‘Please supply one peristaltic pump for diffusion’ means that all you will be offered is
peristaltic pumps. If instead you say you want to undertake infusion with the best available
pump, you widen the choice of different available pumps that suppliers can offer.


Preference
To have a central library of generic equipment specifications that are used across the whole of
your health service organization. This is preferable to allowing each facility to write their own
specifications (though even this is better than having no specifications at all).


Tip • Your health service provider might not have developed generic equipment
specifications for all equipment types suitable for different health service levels.
Do not let this prevent you from developing the specifications you need at your
health facility for your own purchases and donations.


Takes what action?
Write the specifications and technical data and
develop a library of such resources.


Takes what action?
Ideally, develop generic equipment specifications
and technical data for the health service
organization as a whole. This is sensible, since the
Central Level is far more likely to have the
necessary technical skills, and access to technical
information and support.
Can develop generic specifications and technical
data suited to their own equipment levels.


Who?
HTM Working Groups
(or the smaller Specification
Writing Group)
Which level?
Central Level


Facility and
District/Regional Levels




How to Write Generic Equipment Specifications and Technical Data
Ideally, you should develop equipment specifications and technical data for all
equipment purchases. This will help ensure that you buy the right equipment for
your needs, and will minimize your risk of experiencing problems later on.


Tip • To begin with, the task of writing Generic Equipment Specifications may appear
overwhelming. A simple way to start might be to take a critical look through the
specifications of neighbouring countries. (Information on specifications
developed by a variety of agencies and countries is provided in Annex 2). You
could simply adapt existing specifications for your own country’s situation, if you
do not have the resources or central support for a full exercise.


For HTM Working Groups at Regional/ District and Facility Level where there may
be limited management skills (Section 2.2), making comparisons with other
specifications may be the simplest way forward.
At central level you may require some computer software to assist you in undertaking
the clinical and technical research and writing. If the centre is also compiling and
overseeing specifications for the whole health service, computers and software will
make the task easier. For further details on available software products, see Annex 2.
Contents of the Specification
The length of the specification will vary, depending on the item being purchased. For a
simple item, the specification may consist simply of a brief description, with few details.
For a more complex item, it will be necessary to itemize the product requirements, so
that the specification may run to several pages (see Annex 4 for an example).
When drawing up specifications, you will need to conform to the aims of your Model
Equipment List (Section 4.3). Take care not to specify a performance higher than
you need, (though you should also bear in mind any future medical developments
that may take place during the lifetime of the equipment). Equipment that is more
complex than actually required is needlessly expensive, more difficult to use, and
more costly to maintain. You can avoid the model being obsolete by asking the
manufacturer for the latest technology or latest model that meets your
specifications (be aware that simply asking for the latest model may provide you
with the most advanced model).
When writing the specification:
◆ Describe precisely and clearly what function you want the equipment to be able


to perform, together with its technical and operational criteria. You can then look
for suppliers who can provide equipment to meet your needs, at the most
attractive terms.


4.5 Generic equipment specifications and technical data


91




4.5 Generic equipment specifications and technical data


92


◆ Where possible, avoid limiting yourself only to the brand names you can
remember at the time. Often, other brands could be equally suitable.


◆ Occasionally, you may have a standardization policy that requires a particular make
or model to be provided (for example, you may decide that some of your machines
should be a particular model in order to save money on accessories or
consumables, or to ensure it can be used and maintained). In this case, you should
purposely describe the equipment by its make and model. Bear in mind, though,
this can present difficulties with some donor and funding agencies (see Guide 3).


Box 20 describes the sorts of information that you should include in your
specifications.


◆ Describe what the equipment should be used for.
◆ Describe what the equipment should do – its purpose, scope, function and


capabilities (that is, the output required).
◆ Describe the design and features you want, taking into account factors such as


performance to be achieved, and technical characteristics as follows:
- operational requirements
- versatility of the equipment
- safety requirements (in other words, the manufacturing standards equipment should


comply with). Where you cannot provide a standard, specify that the equipment
should match the authoritative standards appropriate to the country of origin (for
example, DIN – German Industrial Norms, BS – British Standard, or others)


- quality expected
- durability
- energy saving features
- physical characteristics (for example, construction/material requirements, colour


and finish, unit or pack size, power-type, whether or not it is portable).
◆ Describe what preferences you have when there are alternatives (for example,


whether you want wheels, handles, a drying cycle, extra facilities, whether it must
be made of plastic).


◆ Include any restrictions on country of origin.
◆ Include the expected performance or output, but do not necessarily define how


this should be achieved.
◆ Try to use common titles for equipment that are widely understood by various


countries. For example, the United States uses a United Medical Devices
Nomenclature System (UMDNS). Other manufacturing countries have developed
their own systems, and the European Commission is trying to combine these as a
Global Medical Devices Nomenclature (see Annex 2).


◆ If the goods you are purchasing are not whole pieces of equipment, but are simply
accessories, consumables, and spare parts for existing equipment, you must provide
technical details of each item. You must also specify the make, model and year of
manufacturer of the equipment that they are used with (see Guides 4 and 5).


BOX 20: Contents of a Typical Equipment Specification
Element Examples
Description of
the equipment,
and quantities


Continued opposite




4.5 Generic equipment specifications and technical data


93


The ‘package of inputs’ may include any or all of the following:
◆ Accessories (for example, shelves, mains lead, patient cables, hand-pieces). Outline


all the accessories you need to last a specified length of time (at least two years),
together with sizes, types and quantities. Usually, it will be necessary to purchase at
least three sets of accessories – one ‘in use’, one ‘being cleaned’, one ‘as spare’.


◆ Consumables (for example, electrodes, breathing circuits, gel). You will require a
stock to last a specified period of time (at least two years), although you should also
take into account expiry dates and short-life items. You must detail the exact type
and number of consumables. (It may be advisable to make them conform to the
types and sources of existing supplies, so that existing stocks can be rationalized).
Remember that, while some equipment uses standard supplies, other equipment
requires specific supplies and you will need to order accordingly.


◆ Spare parts (for example, bottles, switches, o-rings, gaskets). You will require a
stock to last a specified period of time (at least two years). You must detail your
requirements for both planned preventive maintenance and typical repairs. This
should be based on your experience, knowledge of the technology, and the
manufacturer’s recommended list.


◆ Manuals – you will require both Operator and Service Manuals including circuit
diagrams. It is advisable to obtain two copies of each.


◆ Warranty – you must specify that the guarantee should last for at least 12 months
from delivery or the end of commissioning, not 12 months from the shipping date
(since if the goods spend six months getting to you, you will have lost half the
guarantee period). If the equipment is not going to be used for some time after
delivery, special arrangements must be made with the supplier to re-define the
warranty period.


◆ Delivery – you must specify the freighting arrangements, by air, sea, or road. Also
include details for the packing and crating for freight, the destination, and the
delivery date or delivery period (number of weeks). Try to use common INCO
terms (for trade transportations). These can be found on the internet (world wide
web) with good explanations, and should be checked before use as they are
occasionally updated (see Guide 3).


◆ Insurance – you must specify whether you want the goods to be insured during the
delivery period. Some countries require all imports to be insured locally. Make sure
you specify any rules that apply.


◆ After-sales support (the supplier’s general capacity to deliver technical and
commercial know how after delivery) – specify whether you require this to be
available locally, and outline the sort of support required. In addition, ask for a price
for a maintenance contract (for reference, in case it is needed).


BOX 20: Contents of a Typical Equipment Specification (continued)
Element Examples
‘Package of inputs’
required, with
quantities.
This must cover
everything else
you need to use
the equipment
over its entire
lifetime.


Continued overleaf




4.5 Generic equipment specifications and technical data


94


◆ Site preparation details – you must ask for the technical instructions and details
from the suppliers so that you can plan for this work, either in-house or by
contracting out.


◆ Installation – you must ask for help with this if it is required.
◆ Commissioning – you must ask for help with this if it is required.
◆ Acceptance – you must clearly detail the responsibility of both the purchaser and


supplier with respect to testing and/or acceptance of the goods.
◆ Training of both users and technicians – you must ask for help with this if it is


required, and for written training resources.
◆ Maintenance contract (an important part of after-sales support) – you must ask


for one of these if it is required. It will be necessary to agree and stipulate the
duration and whether it should extend beyond the warranty period, the cost and
whether it includes the price of labour and spare parts, and the responsibilities of
the owner and supplier.


BOX 20: Contents of a Typical Equipment Specification (continued)
Element Examples
For some
equipment, such
as sophisticated
or imported items,
or equipment
which is new to
you, you may also
need to specify
the following
item lines:


Layout of the Specification
The layout of the specification is important, since details must be clear for the bidding
suppliers. Also, it should ensure that the manufacturer’s replies (his specification) can
easily be compared with your requirements (your specification). This helps when you
are evaluating bids (see Guide 3). The layout should ensure that:
◆ the specification is split into sections which describe different aspects of the item


to be purchased, and the different elements of the specification
◆ each section lists features of the equipment that the supplier must comply with.


Try to ensure that each feature is listed on a separate line
◆ equipment features are tabulated, together with columns where the supplier is


obliged to state whether their machine complies with each point, and the price of
each element


◆ the supplier is required to provide a breakdown of costs for each item/charge, as
well as a summary total cost for the overall bid.


Tip • When listing the ‘package of inputs’, it is important that you do not simply ask
the supplier to state whether or not they can supply the various services listed. If
so, you may just receive a ‘yes’ or ‘no’ answer. Instead, you must specify that they
should provide a quote for each of the services listed. This way, when it comes to
awarding the contract, you will be able to decide whether to omit certain services
if they are too costly.


An example of a layout for a long specification is shown in Annex 4.




Figure 11 provides advice on how to write your specifications, and how to update
them over time.


Figure 11: Steps for Writing Specifications


4.5 Generic equipment specifications and technical data


95


Steps Activities


Identifies needs by consulting
with potential users of the
equipment being considered


Identifies possible solutions by
referring to any available
information about equipment


Clarifies any queries by
contacting manufacturers and
suppliers


Compiles information and starts
writing the specification according
to an agreed layout


Improves the content of the
specification by studying existing
resources


• Discover the requirements of the users
• Inspect examples of equipment and the proposed sites for
new equipment
• Take advice from experts and consultants, if necessary


• Study equipment brochures, guides, manuals and catalogues.


• Ask for data and clarifications regarding available products.


Clarifies the types and quantities
of consumables, accessories,
and spare parts required


Finalizes the contents by
obtaining feedback from current
users and maintainers


Adds the specifications to the
library


Ensures the specifications are
used when equipment is
purchased


Revises and updates the
specifications periodically


The HTM Working Group or its Specific Writing Group:


• Look at other people’s generic equipment specifications and
your Model Equipment List (Section 4.3)


• For guidance refer to the ‘registers for new stocks’
(completed for newly purchased equipment on arrival –
see Guide 3)


• Check for drawbacks shown by the performance of existing
equipment and supplies (Section 8.2), and use this to revise
the specification.


• Write new specifications for new products and applications on
the market


• Provide the procurers with the specifications to include in the
purchase documents (see Guide 3)


• Regularly update existing specifications in response to
changes in technology and feedback on the performance of
equipment and supplies (Section 8.2)


• Look at the guidance on writing specifications provided in this
section


Technical and Environmental Information
As well as providing details of the types of equipment and support services required,
your purchase documents also need to include technical and environmental data. Such
data describes the types of environment and surroundings in which the equipment will
be used, and enables the supplier to offer the most suitable product for your needs.




There are a number of technical and environmental factors which you will need to
take into account. For example:
◆ If you have an unstable power supply, is your supplier able to offer technical


solutions (such as voltage stabilizers, uninterruptible power supply)?
◆ Will your geographical location (such as height above sea-level) affect the


operation of equipment (such as motors, pressure vessels)? If so, can the
manufacturer adjust the item for your particular needs?


◆ Extremes of temperature, humidity, and dust may adversely affect equipment
operation, and may require solutions provided by either you or the manufacturer,
such as air-conditioning, silica gel, polymerized coatings for printed circuit boards,
and filters.


You may include this information within the generic equipment specifications.
However, since much of the information is common to many pieces of equipment,
some health service providers have found it simpler to develop a separate summary
Technical and Environmental Data Sheet, which can be referred to in the
purchase documents. This data sheet can be distributed to all suppliers, interested
parties, trade delegations and other relevant bodies. Such a data sheet can be
provided regardless of the length of specification or the procurement method used,
ensuring that all parties are kept informed of prevailing national conditions which
could affect the operation of equipment.
When compiling a Technical and Environmental Data Sheet, you should include
details of:
◆ Electricity supply – mains or other supply, voltage and frequency values and


fluctuations
◆ Water supply – mains or other supply, quality and pressure
◆ Environment – height above sea-level


– mean temperature and fluctuations
– humidity
– dust level
– vermin problems


◆ Manufacturing quality – international or local standards required
◆ Language required – main and secondary
◆ Technology level required – manual, electro-mechanical or micro-processor


controlled.
You can develop a general data sheet for your country, or make more specific ones for
your region, or your health facility. A sample of a Technical and Environmental Data
Sheet is given in Annex 5, and its use is discussed further in Guide 3 on
procurement and commissioning.
Figure 12 provides advice on how to write your technical and environmental data
sheet, and update it over time.


4.5 Generic equipment specifications and technical data


96




Figure 12: Steps for Writing Technical and Environmental Data Sheets


Once you have gone through the one-off exercises to establish the planning tools, as
described in this Section, you can use them to make your long-term plans (Section 7)
and to undertake annual planning (Section 8.1). You will also need to update the
tools on a regular basis. This process is described in Section 8.2.
Box 21 contains a summary of the issues covered in this Section.


4.5 Generic equipment specifications and technical data


97


Steps Activities


Identifies the technical contents
required by consulting with users
and maintainers


Clarifies any queries by contacting
relevant national agencies


Compiles information and starts
writing the data sheet


Adds the data sheet to the library


Ensures the data sheets are used
when equipment is purchased


• Find out what the local conditions are
• Investigate the differences between sites if the data sheet
covers more than one facility
• Take advice from experts and consultants, if necessary.


• Ask for data and clarifications from bodies such as the
meteorological office, land survey office, water board,
electricity authority, etc.


• Look at the guidance on writing data sheets provided in this
section.


Revises and updates the data
sheets periodically


The HTM Working Group or its Specific Writing Group:


• Provide the procurers with the data sheets to include in the
purchase documents (see Guide 3)
• Supply other relevant bodies with the data sheets, such as
external funding agencies, trade delegations.


• Update existing data sheets if any factors or circumstances
change.


• Write new data sheets if products are purchased for facilities
not previously covered by existing data sheets.


BOX 21: Summary of Procedures in Section 4 on Discovering Where You are Headed


HTM Working
Groups
(at all levels)


Health
Management
TeamsR


es
ou


rc
es


◆ use the strategies in Box 12 to obtain as much literature as possible
◆ develop a reference library, and ensure the resource materials that staff require are


available
◆ investigate the cost of subscriptions, and other resources which must be purchased
◆ compile lists of resources to present to external support agencies for assistance
◆ use the reference materials for equipment planning and budgeting purposes


Continued overleaf




Section 4 summary


98


BOX 21: Summary of Procedures in Section 4 on Discovering Where You are Headed (continued)


Health Service
Provider
and Health
Management
Teams
HTM Working
Groups
(at every level)
Equipment
Users and
Section Heads
Health Service
Provider
and Health
Management
Teams
HTM Working
Groups
(at every level)
Equipment
Users and
Section Heads
Health Service
Provider
and Health
Management
Teams
HTM Working
Groups
(at each level)
and Section
Heads


HTM Working
Groups
(or Specification
Writing Groups)
Procurement
Officers (in the
health services,
and external
support agencies)S


pe
cs


a
nd


D
at


a
Bu


y/
Re


pl
ac


e
Po


lic
ie


s



M


od
el


L
ist


s









V


isi
on


◆ take responsibility for defining the Vision for the health services which are to be
provided


◆ use the Vision for equipment planning and budgeting purposes


◆ consider the technology implications of the Vision, and feed back to the Health
Management Team at your level, in order to inform the debate


◆ participate in a series of meetings held at each level to develop the Vision (see
Boxes 13–15)


◆ take responsibility for developing the Model Equipment Lists, and computerizing
them


◆ use the Model Equipment Lists for equipment planning and budgeting purposes


◆ organize a series of consultation meetings with staff from different disciplines, and
develop the Model Equipment Lists (see Box 16)


◆ participate in a series of meetings held at each level to develop the Model
Equipment Lists


◆ address the practical issues involved in implementing the equipment purchase,
donations, replacement, and disposal policies, and introduce them and their
implications to the Heads of Section


◆ ensure replacement equipment is purchased when equipment is condemned at the
end of its life (see Guide 4)


◆ use these policies for equipment planning and budgeting purposes


◆ take responsibility for developing generic equipment specifications (see Figure 11)
◆ take responsibility for developing technical and environmental data sheets (see


Figure 12)


◆ use generic equipment specifications and technical and environmental data sheets
during procurement negotiations with suppliers (see Guide 3).




5. How to make capital budget calculations – budgeting tools I


99


5. HOW TO MAKE CAPITAL BUDGET
CALCULATIONS – BUDGETING TOOLS I


Why is This Important?
Capital funds are required annually to cover large one-off expenses. These
may include such expenses as replacing existing equipment, buying additional
(new) equipment, getting new acquisitions to work, and undertaking major
equipment rehabilitation projects.
Failure to allocate sufficient funds for these items could result in insufficient
equipment for your needs, or new items which cannot be utilized for several
months because there is nobody to install or test them.
This Section provides advice on how you can learn to budget for all these costs.


The planning tools (Sections 3 and 4) will help you to identify what you want to
replace, purchase, or rehabilitate. However, you should only introduce changes if you
can afford them. This is determined by budgeting for equipment, according to the
principles and budget calculations outlined in this Section.
In this Section, we outline some ‘budgeting tools’, which will help you to understand
how to make various calculations for capital costs. Different calculations are
described for the different health service levels. These calculations can then be used
to make your plans and budgets, as described in Sections 7 and 8.1.
As Section 3.3 explains, one reason why capital expenditure is required each year is
to cover the need to purchase equipment. All capital allocations should be made in
accordance with the priorities given in your Purchasing and Donations Policy
(Section 4.4.2). In other words, funds should be spent on equipment for the
following reasons and in the following order of priority (see Box 17):
1. for replacement
2. to obtain a basic standard level of care
3. to upgrade the level of health service provided by the facility
4. to provide items outside your plan only if forced to because of directives from


higher authorities.
The capital funds must also cover:
◆ All other expenses that are associated with acquiring equipment, such as:


- pre-installation work
- support activities which ensure that you can use the equipment (installation,


commissioning and initial training).
◆ The cost of major equipment rehabilitation work which cannot be covered by your


usual annual recurrent allocation.




5. How to make capital budget calculations – budgeting tools I


100


Therefore, in order to be able to make adequate allocations, you need to be familiar
with various budgeting tools. This Section covers five budget calculations for capital
allocations:
◆ replacing equipment (Section 5.1)
◆ purchasing new equipment (Section 5.2)
◆ pre-installation work (Section 5.3)
◆ support activities so you can use your purchases (Section 5.4)
◆ large-scale major rehabilitation projects (Section 5.5).
In this Section, different ways of calculating budget elements are given. They are
used for different purposes, as follows:
a. Rough Estimations – used for long-term plans, business purposes, and


bulk purchasing
– most often used at central or regional levels


which cover the needs of many facilities and
cannot go into specific details.


b. Exact Detailed Estimates – used for annual requirements and specific single
purchases


– most often used at facility or district level.


Tip • Whenever new equipment is acquired, it is vital to budget for its running costs.
Therefore, there must be a link between planned capital expenditure and
recurrent budget estimates for things like maintenance and consumables. The
recurrent budget calculations are described in Section 6.


In many developing countries there is a recurring cycle:
◆ capital budgets are only allocated when funding is available from external support


agencies
◆ health facilities are often funded through foreign aid and constructed as turnkey


projects
◆ the useful lifetime of these facilities can be less than 10–15 years (if not well


maintained)
◆ rehabilitation thus becomes a huge burden on the health service provider.
As Figure 13 shows, such a cyclical approach to funding is costly and provides little
benefit to patients. If such an approach is followed, the quality of the health service
delivered will not be constant and will undergo frequent periods of deterioration.
It is important for budget estimates to reflect this danger. Therefore, you should
plan the replacement of your equipment and facilities in gradual stages, in order to
secure annual capital budget requirements.




Figure 13: The Danger of a Cyclical Approach to Funding Equipment


5.1 REPLACING EQUIPMENT
Budgeting for replacement is necessary, since all equipment has a life expectancy.
Once equipment has reached the end of its life, no amount of intervention will be
effective. Instead, you will simply have to replace the equipment if you want to carry
on delivering a quality health service.
Different types of equipment have varying life expectancies, depending on the type
of technology contained within them. For example, five years might be the typical
life for an oxygen tent, 10 years for a respiratory ventilator, 15 years for a dental chair,
and 20 years for a lift. It has been necessary to develop estimates for equipment
lifetimes, although it must be recognized that these lifetimes will vary for different
users. This will depend on a number of factors, such as:
◆ the rate of use of the equipment (how many tests per month, how many patients


per year, etc.)
◆ how many back-up units there are – whether a machine is used to its limit,


overworked or overloaded
◆ how the equipment is handled or whether it is abused
◆ how well the equipment is cared for and cleaned
◆ how well the equipment is maintained and how often
◆ the initial quality of the equipment
◆ the physical environment and climate that the equipment is used in.


5. How to make capital budget calculations – budgeting tools I


101


New
equipment


Rapid
deterioration


Slope A:
– inadequate maintenance
– lack of spare parts
– no planned replacements


Slope B:
– rehabilitation and restocking


Injection of
funds


Injection of
funds


Time


Functioning
stock of
equipment
for health
service
delivery


A B A AB




Annex 3 contains some typical lifetimes for equipment which have been developed
by various organizations. Over time, and based on your experiences, you can modify
these figures to suit your circumstances. But you need to start somewhere and these
figures provide a basis for planning purposes.
An annual replacement budget covers the needs of equipment likely to reach the
end of its life in any given year. This simply covers the normal demise/death of the
proportion of existing stock which reaches the end of its life in that year.
By providing the finance for this replacement equipment, the health service
provider is simply sustaining existing services and is not financing expansion.
For example, if a health facility wishes to continuously provide a dental service, the
dental drilling unit needs to be replaced at the end of its life so that the existing
service can continue. The purchase of a replacement drilling unit is not an expansion
in dental services, but is merely a continuation of the existing provision.


Thus replacement funds need to be provided routinely, and are required for
different reasons than funds allocated for the purchase of additions to the
equipment stock under facility expansions and upgrading projects.
Failure to replace equipment will result in soaring maintenance bills as the
equipment ages (see Figure 19 in Section 6.1). Also, if many years go by without an
annual replacement budget, your health service provider will face a critical reduction
in the healthcare they can deliver. You will accumulate an increasing backlog of
expired equipment. This means you will ultimately face the major capital
investment implications of having to undertake bulk replacement of equipment
stock all at once. This is not usually affordable or manageable.


5.1 Replacing equipment


102




5.1 Replacing equipment


103


What Budgeting for Replacement Implies
If replacement is not planned for, the health service delivered to the public will
simply deteriorate. As a quick estimate, you need to make the following calculation,
using the stock value estimates developed in Section 3.2:
equipment stock value in new (current) prices = replacement budget required


BOX 22: Principles Behind Replacement Cost Calculations
A. Basic Principle
Assuming – your equipment stock value (Section 3.2) is, for example, US$2,500,000 (Note: this is not


based on what you buy each year, but upon the value of all the items you already own)
And – all the equipment only had a ‘life’ of one year
Then – you would need $2,500,000 each year to replace your equipment!
B. Taking Equipment ‘Life’ Into Account
But – if the ‘life’ of the equipment is, in fact, five years
Assume – the equipment will not all reach the end of its life at the same time
Then – you can spread your replacement budget over the equipment lifetime, as follows:


replacement budget each year = value of stock
lifetime


For example: replacement budget per annum = 2,500,000 = $500,000 pa
5


C. Averaging Across All your Stock
In fact, your stock will actually be made up of different types of equipment with different lifetimes – some
five years, some 10, some 15, and some 20 years. Based on such lifetimes, an average lifetime is often taken
to be 10 years. Thus, a rough estimate of the replacement budget will need to be 10 per cent of the
equipment stock value each year:


replacement budget each year = total stock value
average lifetime


For example: replacement budget per annum = 2,500,000 = $250,000 pa
10


D. Averaging Across Types of Equipment
To make more exact estimates, it will be necessary be more specific and undertake calculations for each
different type of equipment that has a different lifetime (see Annex 3). For example, your stock of
equipment may be made up of:


$750,000 worth of stock with a ‘life’ of 15 years
$1,300,000 worth of stock with a ‘life’ of 10 years
$450,000 worth of stock with a ‘life’ of five years


Therefore, each year you will need a replacement budget of:
750,000 + 1,300,000 + 450,000 = 50,000 + 130,000 + 90,000 = $270,000 pa


15 10 5


equipment lifetime each year




5.1 Replacing equipment


104


In Box 22, Examples A and B explain the basic principles behind the calculations.
Such calculations can be undertaken for all types of equipment clumped together to
give an average estimate, as shown in Example C. Or calculations can be undertaken
for different groups of equipment with different lifetimes to provide a more accurate
estimate, as illustrated in Example D.


Tip • If we consider that typical equipment lifetimes range from approximately five to 20
years, an average equipment lifetime can be taken to be 10 years. Thus, as a rough
indicator, the replacement budget would need to be 10 per cent of the equipment
stock value each year. This has a significant implication for health finances.


It is very common for health service providers to undertake no regular planned
replacement budgeting, even though such a practice is commonly used in the
business community. We recognize that adequate replacement budgets may work
out to be a large percentage of the overall health budget. Thus replacement needs
are often not covered regularly but are left to fall under occasional development
projects, funded either by the health service provider or external support agencies.
Although it may be difficult to set aside the recommended amounts to cover all
replacement needs, your health service provider must start somewhere. They should
start with at least some percentage of the equipment stock value. If they do not,
they face the long-term cost implication of deteriorating facilities, lost ability to
function, and failure to deliver health services.


Who is Responsible for Replacement Budgeting?
Takes what action?
Need to learn how to budget for equipment
replacement.
Takes what action?
Can make equipment replacement budget
calculations.


Can use the rough estimations described here for
long-term forward plans and budget allocations


Can make more exact detailed estimates as
described in Section 5.2


Who?
HTM Working Groups
Finance Officers
Which level?
Any health facility that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its facility as a business.
Any service level that:
- covers the needs of many


facilities
- develops business plans
- wants a general idea of


needs
Any service level that makes
detailed estimates for:
- specific single purchases.
- annual requirements.




How to Budget for Replacement
When budgeting, you should aim to allocate sufficient funds for future needs. We
recommend that you actually put aside money in your budget each year, to cover
equipment replacement costs. This is not simply the book-keeping paper exercise of
depreciation accounting. (Depreciation accounting is when you write off part of the
value of your stock each year to show that your assets are worth less than they used
to, and to reflect the revised value of your business).


5.1 Replacing equipment


105


Figure 14: How To Make Rough Estimations of Replacement Costs for Forward Planning


Process Activity


Refer to existing documents


Calculate the annual
replacement equipment
budget requirements


Use the up-to-date
equipment stock values and
equipment reference price
lists (Section 3.2)


HTM Working Groups and/or Finance Officers:


Use one of the following
methods, depending on the
type of financial projections
you require in your
busininess plan:


Make allowance for the
assumptions made when
calculating the maintenance
budget (see Figure 20 in
Section 6.1)


Was your maintenance
budget based only on the
small proportion of current
equipment stock which can
be rehabilitated?


If you want an ideal
estimate for your
type of facility


Cost the Model Equipment List (Section 4.3)
for your type of facility. Then calculate 10
per cent of this ideal value, for the annual
equipment replacement requirement.


If you want a more
realistic estimate
based on your
current stock


Cost the existing Equipment Inventory
(Section 3.1) for your facility. Then calculate
10 per cent of this realistic value, for the
annual equipment replacement requirement.


If you are short of
money but want to
start somewhere


As a bare minimum, at least set aside some
percentage of the equipment stock value
(Section 3.2) each year.


If you want a more
pragmatic/practical
estimate for your
most urgent needs


Identify and cost only certain equipment
areas to concentrate on for replacement in
the current year. Then, calculate the
replacement costs for this pragmatic stock
value, according to the methods given in
Examples C or D (in Box 22) and their
expected life-times (see Annex 3).


As a bare minimum, at least set aside some
percentage of the equipment stock value
(Section 3.2) each year.
If so, i crease t replacement budget, in
order to return further proportion of the
equipment stock to a repairable condition.




A common mistake is to identify the supplier’s price for the goods required, and
assume that this is the total amount that you must budget for. In fact, there are many
other expenses involved when procuring equipment which need to be included in
order to identify what will be the total cost to you. You also need to take into account
the following expenses:
◆ the price of the equipment
◆ the cost of a ‘package of material inputs’ required for you to use the equipment.


This would include items such as accessories, manuals, stocks of consumables and
stocks of spare parts


5.2 Purchasing new equipment


106


When budgeting for replacement costs, you should make:
◆ rough estimations for long-term forward planning purposes, as shown in Figure 14.
Then, once you are in a position to make the actual purchase of the replacement
equipment, you can make:
◆ exact estimates for the specific equipment purchases, as shown in Box 23 or


Boxes 24 and 25 in Section 5.2.


5.2 PURCHASING NEW EQUIPMENT
Whenever you purchase equipment, you need to budget for more than just the cost
of the hardware. You must also budget for:
◆ the cost of the total ‘package of inputs’ (e.g. maintenance, training, consumables)


required to keep the equipment functioning
◆ the costs of getting the equipment to your facility in a working condition.




5.2 Purchasing new equipment


107


◆ the cost of a ‘package of support inputs’ required in order to get the equipment
going. This would include items such as assistance with installation,
commissioning and initial training


◆ the cost of freighting the goods to your facility (for example, crating, international
shipment by sea or air, insurance, import duties, customs clearance and onward
transport by road/rail to your facility)


◆ any procurement charges, if you are paying an agency to undertake the purchasing
for you.


Also, there may well be additional costs that are often forgotten, such as:
◆ the cost of pre-installation work, such as site preparation, additional equipment


needs (for example, air-conditioners or voltage stabilizers), hire of fork-lift trucks
and storage costs (Section 5.3)


◆ the annual maintenance contract required (Section 6.1)
◆ the cost of employing extra staff. This implication needs to be identified and


agreed in the planning stage, before the purchase goes ahead (Section 4).
All these costs will vary, depending on the purchase options you make (see Guide 3).
This will depend on factors such as:
◆ the type of technology you purchase
◆ whether you import the equipment
◆ whether you buy in bulk
◆ whether someone else is undertaking the procurement for you.
It is also important to look for savings, such as negotiated discounts. For example,
you may be able to lower your purchase costs by collaborating with other facilities or
service levels, and buying equipment together in bulk. Using this method will also
help you to standardize the makes and models purchased. Section 2.2 discusses such
issues of economies of scale.


Who is Responsible for Budgeting for Purchases?
Takes what action?
Need to learn how to budget for equipment
purchases.


Takes what action?
Can make equipment purchase calculations.


Who?
HTM Working Groups
Purchasing and Supplies
Officers
Which level?
Any facility or service level
that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its facility as a


business.




5.2 Purchasing new equipment


108


How to Cost New Equipment Purchases
If budgets are based solely upon the initial price of the equipment quoted by the
supplier, it is likely that they will be inadequate.
Thus, for real purchase costs, you can make:
◆ either rough estimations for long-term forward planning purposes and bulk


purchases, as shown in Box 23
◆ or exact estimates for specific or annual requirements, as shown in Boxes 24 and 25.


BOX 23: How To Make Rough Estimations of Equipment Purchase Costs for Forward
Planning and Bulk Purchasing


HTM Working Groups and/or Purchasing and Supplies Officers:
1. When buying a consignment of assorted items, aim to make an estimate averaged over the whole range of


the assorted equipment being purchased.
2. Start with the total bulk price of the equipment from the manufacturer (or see reference price lists in


Section 3.2).
3. Make the following calculations to estimate what the real cost might be:
Calculation Example
a. Take the (bulk) price of the equipment: US$ price = $20,000
b. Allow for the ‘package of material inputs’


by calculating: 110% of price = package value = $22,000
c. Allow for the ‘package of support inputs’


by calculating: 110% of package value = working value = $24,200
d. Allow for the freighting costs by calculating: 110% of working value = delivered value = $26,620
e. Allow for procurement charges by calculating: 110% of delivered value = Total Cost = $29,282
4. Consider whether any additional money is required for pre-installation work.


Make these calculations according to Box 26 in Section 5.3.


Takes what action?
Are more likely to make rough estimations for
long-term forward plans and budget allocations.


Are more likely to make more exact detailed
estimates.


Which level?
Central or regional service
levels that:
- cover the needs of many


facilities
- cannot go into specific


details.
Facility or district service
levels that make estimates
for:
- specific single purchases
- annual requirements.




5.2 Purchasing new equipment


109


BOX 24: How To Make Exact Estimates for Specific Equipment Purchases
HTM Working Groups and/or Purchasing and Supplies Officers:
1. When buying single items or types of item, aim to consider each piece of equipment or similar types of


equipment separately.
2. Contact the manufacturers or suppliers for the initial basic price of their available products (or see


reference price lists in Section 3.2).
3. Make the following calculations to estimate what the real cost might be:


◆ Imagine equipment falls into four categories which are dependent on how technically complicated it
is, and therefore how many skills and resources are required for it (as shown in Box 25).


◆ Choose the correct category for the equipment you are trying to purchase.
Then look up that category in Box 25 to find out the actual cost estimate required.


4. Use these total cost estimates (rather than the supplier’s initial price) when budgeting for specific
replacement and additional equipment purchases, which have been planned and agreed (Sections 7
and 8.1).


Box 25 helps you to see the impact of purchasing types of equipment of varying
complexity and technology levels.


BOX 25: Total Purchase Cost4 Estimates depending on Equipment Type
Price Category A: High technology sophisticated equipment requiring special spare parts. Most repair and
preventive maintenance is undertaken by specialists. Normally comprehensive training of clinical and
technical staff is required.
Price Category B: Medium technology equipment requiring special spare parts. Repair and preventive
maintenance can usually be undertaken by local staff. Training of clinical and technical staff is required.
Price Category C: Low technology equipment requiring easily obtainable spare parts. Repair can be
undertaken by local labour. Little or no training of staff is required.
Price Category D: Simple equipment and furniture requiring little or no spare parts. Repair can be
undertaken by local labour. No training of staff required.


COSTS A B C D
1. Net Procurement price Free-On-Board (i.e. at the port of exit


of the supplier’s country) 100%1 100% 100% 100%
2. Package of inputs (accessories, consumables, manuals, etc.)


for estimated one year of operation 7%2 5% 3% 2%
3. Installation, commissioning, plus initial training of


key personnel 15% 10% 5% 0%
4. Spare parts for estimated two years of normal operation 20%3 10% 2.5% 0.5%


Equipment Price Categories


Continued overleaf




BOX 25:Total Purchase Cost4 Estimates depending on Equipment Type (continued)


COSTS A B C D


5. Freight charges, dependent on whether coming from
neighbouring countries (eight per cent) or from overseas
(15 per cent) 8–15% 8–15% 8–15% 8–15%


6. Insurance 1.5% 1.5% 1.5% 1.5%


7. Contingency 3% 3% 3% 3%


8. TOTAL4 if freighting from neighbouring countries 154.5% 137.5% 123% 115%


TOTAL4 if freighting from overseas 161.5% 144.5% 130% 122%


Possible Additional Costs


9. Charges of a Procurement Agent 10% 7.5% 5% 5%


10. One year’s service support 7% 5% 1.5% 0.5%


11. Unloading/lifting equipment and warehousing5 – dependent on
size and weight; if small/light (nought per cent), if large/heavy
(one per cent) 0–1% 0–1% 0–1% 0–1%


12. Site preparation work5 – dependent on size and portability;
if small/portable (nought per cent), if large/fixed (10 per cent) 0–10% 0–10% 0–10% 0–10%


Notes:
1. The initial basic price for the equipment which you obtain from the manufacturer or supplier is the


amount to appear in the first row (100 per cent).
2. These percentages are calculated from the basic price provided by the supplier (in row 1).
3. For sophisticated equipment you may not hold the spares yourself, but will budget to pay the


manufacturer’s representative to obtain them or hold them for you.
4. The real total cost that you will have to budget for will be greater than 100 per cent of the initial price,


and will be the percentage shown in the Total row (row 8), with possibly the additional costs shown in
rows 9–12.


5. See Box 26 (in Section 5.3).


When negotiating with donors, it is very important to ensure that they finance this
full ‘package of inputs’. There are examples of good foreign aid projects where the
whole package has been planned for. Unfortunately, however, there are also many
examples of poorly planned projects, where equipment has failed to work from the
beginning, due to the lack of consideration of these inputs.


5.2 Purchasing new equipment


110


Equipment Price Categories




5.3 Pre-installation costs


111


5.3 PRE-INSTALLATION COSTS
Once equipment has been purchased, further work may be required, in order to
prepare the facility for the arrival and commissioning of the equipment. If you do not
allocate sufficient funds for this, your new equipment may sit for many months before
you are able to use it. It is best to build the extra expense of pre-installation work into
the capital allowance you set aside for equipment purchases, as this is when capital
funds are available. If you discover you need money for pre-installation work after the
equipment has arrived, it is then more difficult to find additional funds.
A variety of necessary work and tasks commonly fall under the category of ‘pre-
installation work’. These could include:
Site preparation tasks, such as:
◆ disposing of the existing obsolete item (disconnection, removal, cannibalizing for


parts, transport, decontamination and disposal)
◆ extending pipelines and supply connections to the site (from the existing


service installations)
◆ upgrading the type of supply (such as increasing the voltage, or the


pipeline diameter)
◆ providing new surfaces (such as laying concrete, or providing new worktops)
◆ creating the correct installation site (for example, digging trenches, building a


transformer house or a compressor housing).


Hiring lifting equipment (such as cranes, forklift trucks, stores trolleys, gangs of
labourers):
◆ to help with lifting equipment for unloading/moving purposes
◆ to help with lifting equipment for installation/positioning purposes.




Paying for warehouse space:
◆ if goods are stored by Customs because you have delayed their clearance or have


not paid the duty, then Customs will impose charges on you
◆ if equipment has to be stored when it arrives until you are ready to install it.
All of this ‘pre-installation work’ requires funding, if the equipment is to be usable
once it arrives. Often, this work requires substantial amounts of money.


Who is Responsible for Calculating Pre-Installation Costs?
Preference
Guide 3 of this Series covers in detail the activities involved during procurement and
commissioning of equipment. We suggest that the HTM Working Group, or a smaller
Commissioning Team (Section 1.2), is responsible for ensuring that pre-installation work is
organized, financed and implemented.


5.3 Pre-installation costs


112


Experience in a West African Country
A donor agency financed large amounts of new equipment but assumed the central
health service could finance the pre-installation work. However the cost of such work
was found to be so large it required external support funding of its own.


Takes what action?
Need to learn how to budget for pre-installation
work


Takes what action?
Can make pre-installation work calculations


Will find the calculations for exact estimates most
useful


Can use the calculations described for exact
estimates


Who?
HTM Working Group, or a
smaller Commissioning
Team (Section 1.2)
Which level?
Any health facility or service
level that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its service as a business.
A service level (such as
facility or district) that makes
detailed estimates for:
- specific single purchases
- annual requirements.
Any service level that
undertakes bulk purchasing,
needs an exercise to
estimate the pre-installation
requirements at the variety
of sites they purchase for.




How To Calculate the Pre-Installation Costs
You can make:
◆ either rough estimations for long-term forward planning purposes, by referring


to Box 26
◆ or exact estimates for specific equipment purchases, and investigate the needs


for your bulk purchases, as shown in Figure 15.
It is difficult to make global rough estimates for the cost of site preparation work
according to equipment price categories. However, Box 26 provides some
suggestions from various countries.


Box 26: Suggestions for Rough Estimations of Pre-installation Costs for Forward Planning
Different countries suggest a number of alternative approaches:
i. Advice can be obtained from:


◆ Manufacturers, who can usually provide information on site preparation and unloading/lifting needs.
These can then be used to make estimates of local costs.


◆ Local freight forwarding companies, customs, and warehousing facilities, who can provide information
on warehousing costs. Your commissioning team should be liaising with the freight forwarding
company and any installation company concerning delivery dates and expected delays, which can be
used to estimate warehousing needs (see Guide 3).


ii. Any estimates for site preparation depend on:
◆ the type of equipment involved
◆ whether site preparation involves new buildings or renovations/alterations of existing ones
◆ the state of the local construction industry
◆ local labour costs.


iii. Examples from Eastern and Southern African countries of site preparation costs are:
Equipment Price Site Preparation Needs Cost As percentage


(US$) (US$) of price
MRI unit 1 million new construction at US$1.500/sq.m 70,000 10%
Generating set
for a facility 50,000 cabling, concrete base, shed 2,500 5%
ECG recorder 3,000 none 0 0%
Water heater 200 brackets, tubing, switch, circuit breaker 20 10%


5.3 Pre-installation costs


113


Takes what action?
Only need to make rough estimations for their
long-term forward plans and budget allocations


Which level?
Service levels (such as
central or regional/district
levels) that:
- cover the needs of many facilities
- cannot go into specific details.


Continued overleaf




5.3 Pre-installation costs


114


Box 26: Suggestions for Rough Estimations of Pre-installation Costs for Forward Planning
(continued)


Thus the site preparation cost does not always depend on the equipment sophistication, or on price
category. Sometimes, it has more to do with:
◆ the size of the equipment
◆ whether it is portable
◆ whether it requires lots of service supply connections
◆ whether it requires a housing
Average costs as a percentage of equipment price are given in Box 25.


iv. Any estimates for unloading/lifting depend upon:
◆ the type of equipment involved
◆ its weight, size, and difficulty to handle
◆ local labour costs
◆ local hire costs for cranes and forklift trucks (for example, in parts of Southern Africa it costs


US$50/hour for hiring a crane)
◆ whether the freight forwarding company has the means for unloading/lifting the equipment.
Average costs as a percentage of equipment price are given in Box 25.


v. Any estimates for warehousing depend on:
◆ the weight and volume of the equipment
◆ the length of the storage period.
Average costs as a percentage of equipment price are given in Box 25.


To make exact estimates, you need to know more specific details about the site, as
shown in Figure 15.


Tip • The service level which makes these calculations will have to visit the site, or
know about the site, or have relevant site and engineering drawings.




Figure 15: How To Make Specific Estimates of Equipment Pre-installation Costs


5.3 Pre-installation costs


115


Step/Process Activity


Liaises with the supplier


Reviews administration needs and
costs


Reviews technical needs


Plans removal of existing
equipment


Plans any construction or building
alterations required


Whenever equipment is purchased, provide the supplier with
details of the proposed equipment site and services, and
officially request the necessary site preparation instructions and
the size and weight of the crated goods.


Identify the needs and arrangements required for warehousing,
hiring of lifting equipment, and safe disposal of existing items.
Cost the requirements.


Study the manufacturers’ site preparation instructions or, if these
are not available, use experience and common sense.


Plans the electrical requirements


1. The HTM Working Group or Commissioning Team:


• Is special construction required, such as a transformer
housing or lead screening?
• Is the room large enough to accommodate the equipment?
• Are any special modifications necessary, such as enlarging
the doorway, or building a worktop?
• Do any scrap or other items need to be removed from the
room?


• Does the new equipment require a new transformer?
• Do you need a generator, or does the existing one need
upgrading?
• Is a single phase or three-phase supply required at the site of
installation?
• Is a special circuit breaker needed?
• Is a special socket outlet required?
• Has the existing electrical circuit sufficient capacity?


Ensures the existing electricity
installation is safe


Organize an exercise to ensure that all relevant electrical
installations are properly grounded and tested, and determine
if any remedial works are required.


Plans the water and drainage
requirements


• Is the water pressure available adequate?
• Is water treatment required?
• Does the pipeline diameter need increasing?
• Is proper drainage provided?


Plans any steam supply
requirements


• Is the necessary steam supply available at the proposed site?
• Does the pipeline diameter need increasing?
• Can the boiler accommodate the increased load?


Plans the gas supply
requirements Are the necessary gas supplies available at the proposed site?


• What work is involved in removing the existing item and cutting
connections?
• What work is involved in cannibalizing the existing item for
parts?


2. HTM Manager:


Continued overleaf




5.3 Pre-installation costs


116


Figure 15: How To Make Specific Estimates of Equipment Pre-installation Costs (continued)


5.4 SUPPORT ACTIVITIES TO ENABLE YOU TO USE
YOUR PURCHASES AND DONATIONS


There are a number of activities which must take place before you can start using
equipment which has been purchased. These activities make up the official
‘Acceptance Process’ (see Guide 3) and include:
◆ receiving equipment on site
◆ unpacking
◆ installation (fixing equipment into place)
◆ commissioning (checking that equipment is performing correctly and safely)
◆ official acceptance
◆ initial training (for equipment users and maintainers)
◆ entering stocks into Stores and onto records
◆ payment
◆ complaints.


Plans any extra specific
requirements for installing the
equipment


Plans any additional equipment
needs


Liaises with the Health
Management Team


Consider the specific guidelines relevant to certain types of
equipment, as detailed and provided by the equipment supplier
(for example, placing bolts in the ceiling for attaching operating
lights in theatres, trenches for waste water for dental suites and
washing machines).


Consider whether associated items are required for the
equipment or installation, such as an air-conditioning unit, or an
uninterruptible power supply (UPS)


Estimates the materials required Draw up bills of quantities for the materials required for all the remedial works detailed above.


Calculates the costs required Prepare detailed costs of the work required (including any use of contractors if necessary).


Submit the total ‘pre-installation work’ costs to the Health
Management Team, so they can allocate budgets for such
requirements.


3. HTM Working Group or Commissioning Team:


Allocates the necessary budgets Decide which elements of the pre-installation work can be covered by the capital expenditure budget and which should
be covered by recurrent budgets.


4. Health Management Team or Finance Officer:




5.4 Support activities to enable you to use your purchases and donations


117


From this list of activities, health service staff must be responsible for receiving goods
on site, official acceptance, entering stocks and information into existing record
systems, and dealing with payment and complaints. These activities will not cost you
anything to undertake.
However, unpacking, installation, commissioning and initial training can be
undertaken either by health service staff or by paid external support. This ‘package
of support inputs’ will have a cost attached. How much it costs depends on the type
of technology and who undertakes the work.


Type of Technology
For common low-technology items of equipment that are simple to use, installation,
commissioning, and initial training are not major activities and will happen all at
once. For example, for a mobile examination lamp:
◆ installation is using a test meter to check the electricity supply of the socket


outlet, and then simply plugging in the lamp
◆ commissioning is using a test meter to check the electrical safety of the lamp so


that it will not give the operator an electric shock
◆ initial training is ensuring the operator knows where the on/off switch is, how to


handle the light bulb, and how to alter the angle of the head without pulling the
lamp over.


However for more complex items or for items you are not that familiar with installation,
commissioning, and initial training can become major tasks. Such activities must be
planned carefully if the equipment is to work properly from the start.


Who Should Undertake the Work?
Unpacking, installation, commissioning and initial training can be carried out either
by representatives from the supplier company, staff from your health service
provider, or another support organization.
The factors which help you to decide which type of personnel should be involved are:
◆ The level of complexity of the equipment. For example, the more complex an


item is, the more likely it is that you will need the help of the manufacturer or
his representative.


◆ Whether the HTM Teams have the necessary skills. For example, if your staff
cannot undertake the job it is useful to ask for assistance from a contractor.


◆ Whether you are buying one item or bulk buying. For example, if you are only
buying one item, it may not be worth the expense of getting the manufacturer’s
help and your HTM Team can manage with sufficient written guidance from
the manufacturer. But if you are buying large quantities of the same product it
will be worthwhile contracting the manufacturer to undertake the installation,
commissioning, and initial training at as many locations as necessary.




We recognize that for some equipment, installation, commissioning, and initial
training will happen all at once, will be undertaken by the same people, and can be
included in one quote. However, in the rest of this sub-section we consider the
needs for installation and commissioning separately from initial training, since
sometimes:
◆ you need installation and commissioning but no training
◆ you need initial training but minimal installation and commissioning work
◆ initial training takes place at a later date to installation and commissioning
◆ initial training is undertaken by different people than those doing the installation


and commissioning
◆ the organization of training has different requirements than installation and


commissioning.


5.4.1 Installation and Commissioning Costs


It is very important to ensure that new equipment is effectively installed and
commissioned if you want it to work correctly and safely right from the start of your
ownership. Even if the equipment is quite a common item, it is still necessary to
install and commission it well.


Tip • It is always best to address the need for installation and commissioning during the
purchase or donation negotiations.


Provision of installation and commissioning should be linked to the procurement
contract (see Guide 3 on procurement and commissioning). In other words, when
purchasing equipment from a company, you should request them to provide installation
and commissioning at the same time if you cannot undertake it yourself. Provision of
such support activities must be mentioned in your equipment specification (Section
4.5). If you are able to standardize your equipment and purchase in bulk in collaboration
with other health facilities, it is more likely that equipment suppliers will be willing to
travel to undertake this work, since they can cover several sites in one trip.


5.4 Support activities to enable you to use your purchases and donations


118




5.4.1 Installation and commissioning costs


119


People Involved
If you have the skills, installation and commissioning should be undertaken by a
combination of your HTM Team (or other teams from an appropriate level of the
HTM Service) for the technical work, and the Commissioning Team (Section 1.2)
for administrative work.
In the government system, plant may be installed and commissioned by staff from
the Ministry of Works. If you need help, you could ask for support from other bodies
such as another health service provider. However, for complex or unfamiliar items it is
recommended to ask for assistance from the supplier company or its representative.
If you are using external support, it is useful to arrange for some of your in-house
maintainers to accompany the external engineers for two reasons:
◆ to learn from watching the process
◆ to monitor that the work takes place (see Guide 5).


Requirements
Any outside contractor or organization assisting you will assume that you have made
the site ready before the date they are due to arrive (Section 5.3). They will also
expect you to provide a convenient nearby connection point on your service supply
installations (such as a suitable tap, circuit breaker or drain outlet) and will only
expect to provide materials to extend from the new equipment to this point. They
will budget for materials accordingly.
The contractors/organization will bring what are known as ‘start-up’ consumable items
with them – this is just enough to operate the equipment while checking that it is
performing correctly and safely. They will not bring stocks of operating consumables
for you to run the equipment with. You must ask for stocks of these in the
procurement contract/specification (Section 4.5).
You should provide a room for any visiting installation technician/engineer (whether
in-house or contracted staff) to use as an office, as a base to work from, and a safe
store for their materials and test equipment.
There will be a variety of other inputs required for the installation and
commissioning work (for example, accommodation, fees, travel arrangements) as
described in Figure 16.




Who is Responsible for Calculating Installation and Commissioning
Costs?
Preference
The HTM Working Group or its smaller Commissioning Team should be responsible for
identifying installation and commissioning needs, and negotiating with the suppliers of
equipment (see Guide 3).


5.4.1 Installation and commissioning costs


120


Country Experiences
Examples of the kinds of problems that have arisen with installation and commissioning
in many developing countries include:
No skills: new items of equipment left rotting in their crates at health facility sites


because there was no one with the skills to install it
Poor work: new equipment arrived on site but never worked properly, due to poor


installation and commissioning procedures
Poor planning: installation engineers were assured by health facilities that the site was


ready, but arrived to find that they could not start work, because there
was not the correct electricity/water/gas supply.


Takes what action?
Need to learn how to budget for installation and
commissioning
Takes what action?
Can make installation and commissioning
calculations


Will find the calculations here for exact estimates
most useful


Can use the calculations described here for exact
estimates


Who?
HTM Working Group or its
Commissioning Team
Which level?
Any health facility or service
level that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its service as a business.
A service level (such as
facility or district) that makes
detailed estimates for:
- specific single purchases
- annual requirements.
Any service level that
undertakes bulk purchasing,
needs an exercise to
estimate installation and
commissioning needs at
the variety of sites they
purchase for.




5.4.1 Installation and commissioning costs


121


How To Calculate the Installation and Commissioning Costs
You can make:
◆ either rough estimations for long-term forward planning purposes, by referring to


Boxes 23–25 (Section 5.2) and using a percentage estimate of the equipment
price to cover installation and commissioning as well as initial training (the
‘package of support inputs’)


◆ or exact estimates for specific equipment purchases, and investigate the needs for
your bulk purchases, as shown in Figure 16.


To make exact estimates, according to Figure 16, you need to know more specific
details about the site.


Tip • The service level responsible for making these calculations will have to visit the site,
or know about the site, or have access to relevant site and engineering drawings.


Figure 16: How To Make Specific Estimates of Installation and Commissioning Costs


Takes what action?
Only need to make rough estimations for their
long-term forward plans and budget allocations, and
can use the calculations in Section 5.2.


Which level?
Service levels (such as
central or regional/district
levels) that:
- cover the needs of many


facilities
- cannot go into specific


details


Process Activity


Identifies any arrangements made


Identifies who will undertake the
installation and commissioning


• What arrangements for installation and commissioning have
you negotiated in the procurement contracts/donation
agreements?
• Is installation and commissioning the responsibility of the
supplier or yourselves?


Will it be:
• staff from the equipment manufacturer?
• staff from the manufacturer's representative?
• maintenance staff from other teams, workshops, health
facilities, ministries, or health service providers who are
knowledgeable about the equipment?
• senior maintenance staff within your team, workshop, or health
facility who have experience of installing and commissioning
the equipment or have the necessary skills?
• partners in technical co-operation projects, or staff from
non-governmental organisations and charities?


The HTM Working Group or Commissioning Team:


Continued overleaf




Figure 16: How To Make Specific Estimates of Installation and Commissioning Costs
(continued)


5.4.1 Installation and commissioning costs


122


5.4.2 Initial Training Costs
It is very important to obtain some ‘initial’ training for operator and maintenance
staff on the new machines. Even if the type of equipment has been used before, staff
need to understand the operating requirements of a new make and model.


Tip • It is always best to address the need for application, operator, and maintenance
training packages during the purchase or donation negotiations.


The provision of training should be linked to the procurement contract (see Guide 3
on procurement and commissioning). In other words, when purchasing equipment
from a company, you should also ask them to provide training. Such support activities
must be mentioned in your equipment specification (Section 4.5). It is more likely
that equipment suppliers will be willing to offer training packages if your equipment
is standardized and purchased in bulk in collaboration with other health facilities.


The Needs
The cost of the training will depend upon whether you are buying single pieces of
equipment or buying in bulk. It also depends upon a number of other issues (see
Annex 2 for further guidance), as follows:


Liaises with any external installers


In order to:
• request quotes and information on how the installation and
commissioning will be provided
• discover any needs they have
• identify whether initial training costs will be included or extra
(see Figure 17).


Identifies the inputs required


Do you need:
• overnight accommodation for the installers?
• travel and subsistence for the installers (especially if from
abroad)?
• labour costs?
• material costs for installation (such as cable, plugs, piping)?
• material costs for checking operation (consumables used
whilst ensuring equipment is performing correctly)?


Calculates the costs Submit the total installation and commissioning costs to the Health Management Team.


Allocates the necessary budgets Decide which elements of the installation and commissioning costs can be covered by the capital expenditure budget and
which should be covered by recurrent budgets.


Health Management Team:




5.4.2 Initial training costs


123


Contractual Arrangements
As part of your procurement contract, you should negotiate who will pay for the
training and where it will take place. The training arrangements may be dependent
on the type and total cost of the equipment. If training is not provided by the
supplier, you can run the training sessions yourselves.
The Training Required
Training will be required for a variety of different types of staff (for example,
operators or maintenance staff), at different skill levels (such as doctors and nurses,
engineers and technicians), and will need to cover a variety of topics (such as
equipment operation, safety and maintenance).


The Trainers
The people who run the equipment training sessions can be representatives from
the equipment supplier company, or staff from your health service provider, or
another support organization. The cost of these trainers will vary, and you may have
to identify in-house staff to be trained as trainers first.
Training Sites
You must consider whether:
◆ your staff will travel to the trainer (perhaps the manufacturer’s factory, either


locally, in a neighbouring country, or abroad – which, if well organized, can be
useful for expensive equipment), or whether the trainers will come to you


◆ to repeat the training at many health facilities, or to bring the trainees to a central
location for training


◆ to bring the (portable) equipment to a suitable training room, or conduct the
training where the equipment is situated. For large items which are difficult to
move (such as operating tables, blood-bank fridge) and installed equipment
(dental suites, water still), the training sessions will have to be planned around
the equipment while trying to cause the minimum disruption to the services
provided by the department.




5.4.2 Initial training costs


124


The Numbers to be Trained
Different quantities of staff will attend the training depending on the type of
equipment and the department concerned. For example:
◆ for complex equipment in the theatre, the majority of theatre staff need to attend


the training
◆ for some general equipment used on the ward, only a few representatives from


each ward need to attend, who in turn should pass on their skills to the bulk of the
ward staff


◆ technical staff should be chosen from the relevant engineering discipline (such as
electrical or mechanical), and with varying skill levels (for example, engineer,
technician, and artisan)


◆ check if other staff, such as cleaners, need special orientation
◆ for the skills to be spread among the wider workforce who did not attend, you


must ensure you run extra courses so that the trained staff can teach their
colleagues.


Inputs
There will be a variety of different administrative and material inputs required for
running training sessions (for example, accommodation, fees, handouts) as
summarized in Figure 17 and detailed in Box 33 of Section 6.4.


Who is Responsible for Calculating Initial Training Costs?
Preference
Various people can be involved in identifying training needs. We suggest that the HTM
Working Group, or a smaller training sub-group (Section 1.2) should be responsible for
developing all training needs for the overall Equipment Training Plan (Section 7.2). In
addition, we suggest the Commissioning Team should be involved in negotiations with the
suppliers for new purchases, including the training of staff (see Guide 3).


Takes what action?
Need to learn how to budget for training which is
linked to purchases


Takes what action?
Can make training calculations for purchases


Who?
- HTM Working Group or a


smaller training sub-group
- Commissioning Team
Which level?
Any health facility or service
level that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its service as a business.




5.4.2 Initial training costs


125


How To Calculate the Initial Training Costs linked to Purchases
You can make:
◆ either rough estimations for long-term forward planning purposes, by referring


to Boxes 23–25 (Section 5.2) and using a percentage estimate of the equipment
price to cover initial training as well as installation and commissioning (the
‘package of support inputs’)


◆ or exact estimates for specific equipment purchases, and investigate the needs
for your bulk purchases, as shown in Figure 17.


To make exact estimates, according to Figure 17, you need to know more specific
details about the staffing situation.


Tip • The service level which makes these calculations will have to know about, or
obtain information about, the staffing and training requirements at each site.


Takes what action?
Will find the calculations here for exact estimates
most useful


Can use the calculations described here for exact
estimates


Only need to make rough estimations for their
long-term forward plans and budget allocations, and
can use the calculations in Section 5.2.


Which level?
A service level (such as
facility or district) that makes
detailed estimates for:
- specific single purchases
- annual requirements.
Any service level that
undertakes bulk purchasing,
needs an exercise to
estimate training
requirements at the variety
of sites they purchase for.
Service levels (such as
central or regional/district
levels) that:
- cover the needs of many


facilities
- cannot go into specific


details




5.4.2 Initial training costs


126


Figure 17: How To Make Specific Estimates of Costs for Initial Training Linked to Purchases


Process Activity


Identifies any arrangements made
• What arrangements for training have you negotiated in the
procurement contracts/donation agreements?
• Is training the responsibility of the supplier or yourselves?


Identifies the range of training
required


Do you need training on:
• good practice when handling equipment?
• basic ‘do’s and don’ts’?
• how to operate equipment?
• the correct application of equipment?
• care, cleaning, and decontamination?
• safety procedures?
• planned preventive maintenance (PPM) for users?
• PPM and repair for maintainers?


Identifies the trainees Which different types of staff should be taught the different skills described above?


Identifies who will be the trainers


Will they be:
• staff from the equipment manufacturer?
• staff from the manufacturer's representative?
• clinical or maintenance staff from other teams, workshops,
health facilities, and health service providers who are
knowledgeable about the equipment?
• senior clinical or maintenance staff within your team, workshop,
or health facility who were previously trained on the equipment
or have the necessary skills?
• partners in technical cooperation projects, or staff from
non-governmental organizations and charities?


Identifies the training site
Will it be:
• at the manufacturer's factory or their local representative's
workplace?
• at the health facility or a central location for training?
• in a special training room and/or around the equipment itself?


Identifies numbers to be trained • How many staff need training at each site?• How many times should the training sessions be run?


Identifies the resources required


Do you need:
• room hire?
• overnight accommodation for the trainees or trainers?
• travel and subsistence for the trainees or trainers (especially if
from abroad)?
• trainers’ fees?
• visual aids and teaching equipment?
• training materials (handouts) for the trainees?
• consumable inputs for the equipment demonstrations?


The HTM Working Group or its training sub-group:


Continued opposite




5.5 LARGE-SCALE MAJOR REHABILITATION
PROJECTS
You may have parts of your facility or pieces of equipment which have not been
functioning for a while, which you would like to bring back into working condition.
Such a task would involve more work and more inputs than a simple repair and, as
such, would require a specific rehabilitation (renovation) project. If such a job is
cheaper than replacing the broken items with new ones, then funds are required so
that you can get more of your stock working again.


Large-scale equipment rehabilitation projects may be too expensive to come out of
annual maintenance recurrent allocations, due to the amount of materials or size of
contracts required. These will have to be financed from the capital budget.


5.5 Large-scale major rehabilitation projects


127


Figure 17: How To Make Specific Estimates of Costs for Initial Training Linked to Purchases
(continued)


Liaises with the Commissioning
Team


In order to:
• notify any suppliers involved of the types of training required
• request quotes and information on how the training will be
provided
• identify whether the training will be part of the installation and
commissioning costs (see Figure 16) or extra.


Calculates the costs Submit the total training costs linked to purchases to the Health Management Team.


Allocates the necessary budgets Decide which elements of the training costs can be covered by the capital expenditure budget and which should be covered
by recurrent budgets.


Health Management Team:




5.5 Large-scale major rehabilitation projects


128


Who is Responsible for Calculating Rehabilitation Costs?
Takes what action?
Need to learn how to cost large-scale major
rehabilitation projects for equipment


Takes what action?
Can make calculations for rehabilitation work


Will find the calculations here for exact estimates
most useful


Can use the calculations described for exact
estimates


Only need to make the rough estimations
described here for their long-term forward plans and
budget allocations


Who?
HTM Managers with
technical skills (those
located at maintenance
workshops – Section 1.1)
Which level?
Any health facility or service
level that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its service as a business.
A service level (such as
facility or district) that makes
detailed estimates for:
- specific projects
- annual requirements.
Any service level that
undertakes many
rehabilitation projects and
needs an exercise to
estimate requirements at the
variety of sites they cover.
Service levels (such as
central or regional/district
levels) that:
- cover the needs of many


facilities
- cannot go into specific


details.


How To Calculate the Cost of Major Rehabilitation Work
You can make:
◆ either rough estimations for long-term forward planning purposes, as shown in


Box 27
◆ or exact estimates for specific rehabilitation projects, and investigate the needs


for a number of projects at various sites, as shown in Figure 18.
It is difficult to make global rough estimates for the cost of major rehabilitation
projects. However, Box 27 provides some suggestions from various countries.




5.5 Large-scale major rehabilitation projects


129


BOX 27: Suggestions for Rough Estimations of Large-scale Major Rehabilitation Costs for
Forward Planning


Different countries suggest alternative approaches to determine whether it is worth carrying out the
rehabilitation work:
i. The cost will depend upon the present status and condition of the equipment.


In order for rehabilitation work to be worthwhile, it must add an extra five years to the life of the equipment.
ii. The cost of rehabilitation obviously must be less than the price of replacing the equipment.


Some countries do not recommend continuing with rehabilitation if the cost will be more than 50 per
cent of the new equipment value.
Consider what is the maximum percentage of equipment value that you could spend that still makes the
rehabilitation worthwhile (ask your health economist, accountants, or finance officer).


iii. If you bought separately all the parts that made up a piece of equipment, it would cost you three to four
times the price of the equipment.
Therefore if five to ten per cent of the equipment parts need replacing, you would have to budget for at
least one-third of the new equipment value to buy the parts for the rehabilitation project.
Calculate the cost of the spare parts that you anticipate you will need and, if this is too large a proportion
of the new equipment value, then consider replacing the equipment rather than rehabilitating it.


To make exact estimates, according to Figure 18, you need to know more specific
details about the site.


Tip • The service level responsible for making these calculations will have to visit the
site, or must have sufficient knowledge or information about the equipment and
site to make informed calculations.




Figure 18: How To Make Specific Estimates of Large-scale Major Rehabilitation Project Costs


5.5 Large-scale major rehabilitation projects


130


Process Activity


Identify the needs
Identify any major rehabilitation projects agreed in the
Equipment Development Plan (Section 7.1) or the Annual
Rehabilitation Activities (Section 8.1).


Determine the work required


Using the process described in Figure 15 (for pre-installation
work), detail the work required for:
• construction or building alterations
• removal of existing equipment
• electrical requirements
• water and drainage
• steam supply
• gas supply
• other equipment-specific requirements
• additional associated equipment needs


Identify the inputs required
Evaluate:
• the spare parts and maintenance materials required to
undertake the planned rehabilitation activities.
• the requirements for work to be undertaken by sub-contractors
for the planned rehabilitation activities.


Cost the needs Prepare detailed costs of the work required (including the contracts).


HTM Managers at Workshops, and their Teams:


Identifies the sources of funds


Establish:
• which elements of the rehabilitation projects are too expensive
to fall under the annual maintenance budget and must be
covered by the capital expenditure budget.
• whether there is assistance available from external support
agencies.


Provides the finances Allocate sufficient funds from the budgets to cover such major equipment rehabilitation projects.


The Health Management Team or Finance Officer:




Section 5 summary


131


Once you have learnt how to undertake these capital budget calculations, as
described in this Section, you can use them to make your long-term Core
Equipment Expenditure Plan (Section 7.3) and to undertake annual budgeting
(Section 8.1). An example of a total capital budget plan is given in Section 7.3.
Box 28 contains a summary of the issues covered in this Section.


BOX 28: Summary of Procedures in Section 5 on Capital Budget Calculations


HTM Working
Groups and
Finance Officers


HTM Working
Groups, and
Purchasing and
Supplies Officers


HTM Working
Group, or its
Commissioning
Team


HTM Working
Group, or its
Commissioning
Team


HTM Managers
at Workshops


Re
ha


b


S
up


po
rt


Ac
tiv


iti
es


P
re


-in
st


al
l


P
ur


ch
as


es
R


ep
la


ce ◆ make rough estimations of replacement costs for long-term forward plans and budgetallocations, by using a percentage of the equipment stock value (see Figure 14)
◆ make exact estimates of replacement costs, by using detailed calculations for


purchases as described below (see Boxes 24–26)


◆ make rough estimations of equipment purchase costs for forward planning and bulk
purchasing, by using a percentage of the equipment price (see Box 23)


◆ make detailed estimates for single purchases and annual needs, by considering the
sophistication of the equipment and using a percentage of its price (see Boxes 24–26)


◆ makes rough estimations of pre-installation costs for forward planning and budget
allocations, by considering the suggestions relating to equipment weight, size,
portability, technology type, and price (see Boxes 25 and 26)


◆ makes detailed estimates for pre-installation work for single purchases, bulk
purchases, and annual needs, by costing specific requirements (see Figure 15)


◆ makes rough estimations for installation, commissioning, and initial training costs
for forward planning and budget allocations, by using a percentage of the
equipment price (see Boxes 23–25)


◆ makes detailed estimates for installation and commissioning costs for single
purchases, bulk purchases, and annual needs, by costing specific requirements (see
Figure 16)


◆ makes detailed estimates for initial training costs for single purchases, bulk
purchases, and annual needs, by costing specific requirements (see Figure 17)


◆ make rough estimations for costs of large-scale major rehabilitation projects for
forward planning and budget allocations, by considering the suggestions relating to a
percentage of the equipment price (see Box 27)


◆ make detailed estimates for costs of large-scale rehabilitation work for single
projects, multiple projects, and annual needs, by costing specific requirements (see
Figure 18).




132




6. How to make recurrent budget calculations – budgeting tools II


133


6. HOW TO MAKE RECURRENT BUDGET
CALCULATIONS – BUDGETING TOOLS II


Why is This Important?
Recurrent funds are required to cover regular expenses which are necessary
to keep equipment functioning and running. Such expenses could include
buying consumables, maintenance support, training, or stationery required for
record-keeping. These requirements can be planned for on a weekly, monthly,
or annual basis.
If you do not allocate sufficient funds for these expenses, you may not have
sufficient equipment that works, or you may wait for months before new items
can be utilized.
This Section provides advice on how you can learn to budget for all these costs.


Although the planning tools (Sections 3 and 4) will help you to identify what
equipment you want, you should only own those items that you can afford to keep
functioning. This is determined by budgeting for equipment running costs according
to the principles and budget calculations outlined in this Section.
This Section describes some further ‘budgeting tools’, which can help you to
understand how to make various calculations for recurrent costs. Different
calculations are described for the different health service levels. You can then use
these calculations when making your plans and budgets, as described in Sections 7
and 8.1.
As Section 3.3 explains, recurrent expenditure is required each year to enable you to
keep your equipment going. You should calculate your recurrent expenditure
allocations based on your existing stock of equipment. Please remember that
whenever new equipment is purchased (Section 5.2), it is necessary to budget for
its running costs. Therefore, there must be a link between planned capital
expenditure and recurrent budget allocations.
In order to make adequate allocations, you need further budgeting tools. This
Section covers four budget calculations for recurrent allocations:
◆ maintenance costs (Section 6.1)
◆ consumable operating costs (Section 6.2)
◆ administrative costs (Section 6.3)
◆ ongoing training costs (Section 6.4).




6. How to make recurrent budget calculations – budgeting tools II


134


In this Section, different ways of calculating recurrent budget elements are given.
They are used for different purposes, as follows:
a. Rough Estimations – used for long-term plans and business purposes


– most often used at central or regional levels
which cover the needs of many facilities and
cannot go into specific details.


b. Exact Detailed Estimates – used for annual requirements
– most often used at facility or district level.


It is important to remember that in many developing countries:
◆ equipment capital projects, often funded by external support agencies, can


introduce considerable recurrent budget burdens
◆ many donors are hesitant to assist with recurrent costs and leave the recipient


country to cope, even if they are not in a financial position to do so
◆ some donors provide maintenance contracts for a couple of years with the


equipment, but do not usually offer more sustainable solutions.
For these reasons, experts in this field are calling upon the donor community to show
more commitment by:
◆ assisting countries to develop adequate HTM systems
◆ contributing to recurrent expenditures for maintenance via a suitable national body
◆ setting aside 30 per cent of available project financing for recurrent needs.


6.1 MAINTENANCE COSTS
Equipment can only be used at its optimum performance level if it is regularly
maintained. Therefore it is necessary to plan for the annual cost of maintenance
and repair for the equipment stock, which will include any minor rehabilitation
work required.




135


6.1 Maintenance costs


Some of this Section may appear similar to the discussion regarding consumable
operating costs (Section 6.2). The key difference is that the calculations described
here are usually made by maintenance staff, or planners.
The objective of drawing up maintenance budgets is to estimate the money
required to maintain and repair the equipment, and thus ensure that the equipment
remains functional for as much of the year as possible. This is known as reducing the
‘mean-time between failures’ (MTBF). It is important to make an estimate which is
as realistic as possible, since:
◆ under-estimation will result in unsatisfactory maintenance for that year
◆ over-estimation will deprive other essential services in the facility of their


necessary resources.
For long-term planning, international experts provide estimates of the amount which
should be set aside each year. These amounts are expressed as a percentage of the
stock value (Section 3.2). These estimates are based on an average, so some equipment
in your stock will require much less money and some will require much more (the
precise amount required will depend on the equipment type and age). Experts
suggest that maintenance and repair costs ought to be approximately as follows:
◆ for medical equipment, each year five to six per cent of the ‘new’ stock value is


required
◆ for buildings, each year one to two per cent of the construction costs is required
◆ for service supplies and plant, each year three to four per cent of purchase and


installation costs is required.


Country Experience
Although the experts suggest five to six per cent of the new medical equipment stock
value each year for maintenance, countries have found different estimates work better for
them, depending on local conditions. For example:
◆ In East Africa, HTM managers found a budget of six to ten per cent of the medical


equipment stock value was more useful for covering maintenance needs and spare
parts, depending on local labour costs.


◆ In Sri Lanka, the Ministry of Health found the budget required for maintenance varied
with the age of equipment, as follows:
- one to four years old two to three per cent of stock value is needed
- five to six years old four to six per cent of stock value is needed
- seven to ten years old seven to eight per cent of stock value is needed.




136


Nevertheless, it is common for countries to have maintenance budgets as low as, or
even less than, one per cent of the equipment stock value, making it impossible to
keep the equipment functioning or safe. Also because maintenance funding over
many years has been generally so low, maintenance staff have automatically self-
limited their estimates and disregarded the need to return many items of equipment
stock to a working condition.


As a start, you will need to allocate at least some percentage of the equipment stock
value as your maintenance budget, if your situation is to start to improve. However,
you may have a large backlog of equipment waiting to be repaired. If so, this will have
a knock-on effect on your maintenance budgets, since the real value of annual
maintenance requirements will be much greater than your current planned
maintenance budget levels.


6.1 Maintenance costs


Country Experience
◆ Many health service providers have not calculated their equipment stock values, and


therefore they do not know what finances are required to sustain their stock.
◆ Many health service providers measure maintenance budgets as a percentage of the


health budget allocation (to a facility), rather than as a percentage of the equipment
stock value.


◆ Some countries are introducing new initiatives to try to increase maintenance
allocations by requiring health facilities to put aside a certain amount for maintenance.
For example:
- the Central Board of Health in Zambia requires hospital boards (semi-autonomous
facilities) to use 10 per cent of their recurrent budget allocations (net of salaries)
for maintenance


- the Ministry of Health in Kenya requires autonomous health facilities to use 25 per
cent of their generated income for maintenance.


◆ Such directives are welcomed, and are a step forward. However there is a danger that
they can be misleading, since the percentage allocated does not relate to the
equipment stock value and is not a measure of the well-being of the equipment.
For example:
- in the Zambian example given above, at the central teaching hospital the 10 per cent
directive translates into a figure that is only approximately 1.6 per cent of the
equipment stock value estimate.


◆ Other initiatives are being tried. For example:
- the Ministry of Works, Transport, and Communication in Namibia is selling off
government fixed property which is not in government use, and residential properties
(not in remote locations). The money raised will be invested to generate funds for
general maintenance of the remaining government facilities, and for building staff
housing in remote areas.




137


Maintenance costs are more than compensated by the gains obtained from extending
the useful life of equipment (Guides 1 and 5 provide examples as proof). Once you
have overcome any backlog of equipment that is waiting to be repaired, you should
ultimately find that maintenance will not generate costs, but save you money.
In some industrialized countries, there are laws in place which regulate that planned
preventive maintenance (PPM) must take place in order to ensure that equipment is
safe (see Guide 1). This is useful, as it means that funds for PPM must be allocated
by health service providers.
It is likely you will have a great deal of equipment within your facility which is very
old. Some of this equipment may be past the end of its lifetime and awaiting
replacement. Other items may be waiting to be repaired. However, it must be
recognized that it might be uneconomical to continue to try to repair such
equipment. Figure 19 illustrates how the cost of maintenance rises as equipment
gets older.


Figure 19: Traditional ‘Bath-tub’ Curve of Maintenance Costs over the Lifetime of Equipment


If a large proportion of your equipment is past rehabilitation, it may be necessary to
make maintenance calculations based on a smaller proportion of the stock which you
can keep working, while increasing the replacement budget (Section 5.1). The
longer you leave it to improve maintenance services, the greater your equipment
replacement bill will be.


6.1 Maintenance costs


Maintenance
costs


installation
& settling in useful life old age


Time (years)




138


Who is Responsible for Calculating Maintenance Costs?


How to Calculate Maintenance Costs
You can:
a. make rough estimations
b. make specific or annual estimates
c. determine monthly estimates within the annual allocation.
These three different approaches to calculating maintenance costs are described in
greater detail below.
a. Making Rough Estimations of Maintenance Costs
You can make a variety of rough estimations for long-term plans, depending on:
◆ the information available to you (refer to your Maintenance Management


Information System, such as your equipment service histories – see Guide 5)
◆ the sort of forward projections you are making
◆ how much of your equipment stock it is possible to return to a working condition,


and how much you can afford to rehabilitate.
Figure 20 describes these calculations.


6.1 Maintenance costs


Takes what action?
Need to learn how to budget for maintenance costs


Takes what action?
Can make maintenance calculations


Are more likely to make rough estimations for
long-term forward plans and budget allocations, and
business plans


Are more likely to make more exact detailed
estimates for annual requirements.


Who?
- HTM Managers with


technical skills
- HTM Working Groups
- Finance Officers
Which level?
Any health facility, workshop,
or service level that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its service as a business.
Central or regional service
levels that:
- cover the needs of many


facilities
- cannot go into specific


details.
Facility, workshop, or district
service levels




139


6.1 Maintenance costs


Figure 20: How To Make Rough Estimations of Maintenance Costs for Forward Planning


Process Activity


Refer to existing documents


Calculate adequate
maintenance budget
requirements


Use the up-to-date
equipment stock values and
equipment reference price
lists (Section 3.2)


HTM Working Groups and/or HTM Managers:


Use one of the following
methods depending on the
type of financial projections
you require in your
(business) plan:


If you want an ideal
estimate for your
type of facility


Cost the Model Equipment List (Section 4.3)
for your type of facility.
Then calculate:
• 5-6 per cent of the ideal stock value for
medical equipment, for its maintenance
each year;
• 1-2 per cent of the ideal construction
costs for buildings, for their maintenance
each year;
• 3-4 per cent of the ideal purchase and
installation costs for service supplies and
plant, for their maintenance each year.


If you want a more
realistic estimate
based on your
current stock


Cost the existing Equipment Inventory
(Section 3.1) for your facility.
Then calculate:
• 5-6 per cent of the realistic stock value for
medical equipment, for its maintenance
each year;
• 1-2 per cent of the realistic construction
costs for buildings, for their maintenance
each year;
• 3-4 per cent of the realistic purchase and
installation costs for service supplies and
plant, for their maintenance each year.


If you want a
reduced estimate
based on the current
stock it is possible
for you to rehabilitate


Cost the existing Equipment Inventory.
Then calculate:
• the percentage which is actually
repairable (for example, 20 per cent) to
obtain the value of the reduced stock of
items which are worth rehabilitating.
Then calculate:
• 5-6 per cent of the reduced stock value
for medical equipment, for its
maintenance each year;
• 1-2 per cent of the reduced construction
costs for buildings, for their maintenance
each year;
• 3-4 per cent of the reduced purchase and
installation costs for service supplies and
plant, for their maintenance each year.


Continued overleaf




140


6.1 Maintenance costs


b. Making Specific or Annual Estimates of Maintenance Costs
A different calculation is required when making specific or annual estimates. It
should be undertaken by HTM Managers with technical skills (such as those located
at a maintenance workshop – Section 1.1).
Annual maintenance budgets should be based on more exact estimates. They are
not always easy to predict, since breakdowns in most cases cannot be anticipated.
However, two types of budgeting can be identified (see Box 29, below). Generally
with experience, and where standardization of equipment is in place (Section 2.1),
the projection for equipment spare parts and maintenance materials becomes more
predictable.


Feed back the maintenance
assumptions made here, to
the replacement budget
calculations


Were reduced or pragmatic
maintenance amounts
calculated? (See last two
methods shown above)


If you want a more
pragmatic/practical
estimate for your
most urgent needs


Identify and cost only certain equipment
areas to concentrate on, which you want to
keep functioning over the next few years.
Then calculate:
• 5-6 per cent of the pragmatic stock value
for medical equipment, for its
maintenance each year;
• 1-2 per cent of the pragmatic construction
costs for buildings, for their maintenance
each year;
• 3-4 per cent of the pragmatic purchase
and installation costs for service supplies
and plant, for their maintenance each
year.


If so, increase the replacement budget so
that more of the facility's stock can be
returned to a working and repairable
condition (see Figure 14 in Section 5.1).


Figure 20: How To Make Rough Estimations of Maintenance Costs for Forward Planning
(continued)




141


BOX 29: Elements of Annual Maintenance Budgets
I. Planned Budgets:
These allocate funds for anticipated maintenance costs, which can be derived from the following main areas
of expenditure (see Figure 21 for strategies on how to calculate your requirements):
a) spare parts – which are required regularly, determined from previous experience and any planned


remedial work
b) spare parts – which are required according to planned preventive maintenance (PPM) schedules


and timetables
c) maintenance materials – which are required regularly, determined by previous experience and any


planned remedial work
d) maintenance materials – which are required according to PPM schedules and timetables
e) service contracts – required for any planned remedial work
f) service contracts – for breakdowns which are likely to be required, determined from previous experience
g) service contracts – required for PPM of complex equipment
h) calibration of workshop test equipment
i) replacement of tools at the end of their life
j) office material
k) any increased maintenance requirements brought about by planned new equipment purchases under the


capital expenditure budget.
Note: there will be other elements which may fall under other budgets. These could include:
◆ other administrative costs which are included in budgets held by other departments (Section 6.3)
◆ major repair works – in some cases the planned rehabilitation of equipment which requires major work


with the purchase of substantial amounts of materials or contracts. The large sums of money required for
such projects may have to fall under the capital budget (Section 5.5)


◆ pre-installation work (such as site-preparation). This often falls under capital funds as it is linked to
specific purchases (Section 5.3).


II. Contingency Budgets:
In addition to planned budgets, contingency budgets also exist. These allocate funds for unplanned
maintenance work, such as emergencies, or sudden breakdowns which could not be predicted.


Tip • When planning for spare parts and maintenance materials, it makes sense to:
- budget well in advance so that you have sufficient funds and do not run out of stocks
- buy in bulk so that you can make procurement savings
- only procure essential spares
- for perishable items, only buy quantities that you can use up before their shelf-life


expires.


6.1 Maintenance costs




142


No spare parts should be allowed to sit on shelves for too long as this ties up money
which could otherwise be used for other essential purchases. The only exception to
this is when buying equipment from abroad, when it makes sense to buy a stock of
spare parts at the same time as the equipment, because that is when the capital
funds are available, and you are in contact with the manufacturer (Section 5.2). If
you leave it until later, it becomes much more difficult to obtain the funding, the
foreign currency, and the spare parts from abroad. Details of how to stock up with
spare parts and maintenance materials are given in Guide 5.
Having purchased your initial stock with the equipment (Section 5.2), you must
review your recurrent stock needs. It is important to consider ‘economies of scales’ –
for example, you can get better prices and save on shipping costs if you buy in bulk.
Therefore it is a good idea to consider:
◆ buying for many locations (for example, to cover several health facilities


or workshops)
◆ buying stocks to cover an extended period (for example, stocks for one or two years).
Previously, equipment spare parts and maintenance materials have not always been
considered ‘stockable’ items in the Stores system. For this reason, there is often
insufficient information regarding their requirements and rates of use. Thus one of
your planning tools is an exercise to investigate their needs (Section 3.4).
Figure 21 shows the exact estimates you can make for specific or annual
requirements.


Figure 21: How to Make Specific or Annual Estimates of Maintenance Costs


6.1 Maintenance costs


Process Activity


Evaluate essential spare parts and
maintenance materials required


Using Box 29, consider the ‘Planned Budgets’ elements a – d.
For each different type of equipment, list the essential spare
parts and maintenance materials, using as guides:
• the Planned Preventative Maintenance (PPM) schedules and
timetables (see Guide 5)
• planned remedial work (such as actions in the ‘Annual
Rehabilitation Activities’ and ‘Annual Corrective Activities’ –
see Section 8.1)
• experience of typical problems, the parts typically used, and
the parts which typically run out (see planning tool exercise in
Section 3.4 for guidance)
• an allowance for any emergencies.


Cost the spare parts and
maintenance materials identified
above


Price the list of spare parts and maintenance materials for each
type of equipment (see above). Multiply the sum by the total
numbers of each equipment type involved.


HTM Managers at Workshops, and their Teams:


Continued opposite




143


6.1 Maintenance costs


Evaluate maintenance contracts
required for equipment


Using Box 29, consider the ‘Planned Budgets’ elements
e – g. List the requirements for maintenance contracts for
equipment, using as guides:
• those contracts which have already been drawn up
• experience of typical contracts which are likely to be required
• planned remedial work (such as actions in the ‘Annual
Rehabilitation Activities’ and ‘Annual Corrective Activities’ –
see Section 8.1)
• an allowance for any emergencies.


Cost the maintenance contracts
identified above


Estimate the total cost of the various maintenance contracts
identified above.


Cost the care and repair of
workshop test and measuring
instruments, and tools; also cost
the office materials


Using Box 29, consider the ‘Planned Budgets’ elements h – j,
and estimate the cost of:
• calibrating and servicing workshop test and measuring
instruments, and tools
• replacing old tools
• materials (stationery, ink, toner, etc) for running the office.


Identify any planned new
equipment purchases


For ‘Planned Budgets’ element k (in Box 29), liaise with the
Purchasing and Supplies Officer to identify any planned new
equipment purchases under the ‘Annual Purchase Activities’
(Section 8.1), which have been approved by the Tender
Committee for procurement from the capital expenditure budget.


Cost the maintenance needs for
new items identified above


Estimate the cost of the additional maintenance requirements
for new items (from above).


Activity


Review and prioritize all of the
costs estimated above


Review the total range of costs that have been estimated (from
all of the above), and:
• identify any major rehabilitation projects which will need to fall
under the capital expenditure budget (Section 5.5), and agree
this with the HTM Working Group;
• prioritize across the rest of the needs in order to come up with
a consolidated annual maintenance estimate.


Adjust the figures if you are short
of money


If the annual estimate is too big to be covered:
• ensure that a regular budget is set
• prioritize which work will be done.


Ensure other budgets are set
which affect maintenance services


Liaise with other budget holders (Section 6.3), and ensure that
sufficient estimates are placed in the administration budget to
cover the requirements of the maintenance service
(see Figure 23).


Figure 21: How to Make Specific or Annual Estimates of Maintenance Costs (continued)




144


6.1 Maintenance costs


c. Determining Monthly Maintenance Estimates within the Annual
Allocation


Within the annual maintenance allocation, the HTM Manager will have to
determine monthly requirements. As a rough estimate, the HTM Manager could
consider the monthly maintenance budget to be one-twelfth of the annual
maintenance allocation. However there may be seasonal variations which need to be
taken into account, for example workload may be heavier at certain times of the year
or weather conditions could affect the ability of equipment to function.
A more specific monthly maintenance budget can be derived from a combination of
the cost for both the planned preventive maintenance (PPM) work and the planned
remedial/repair work identified for that month. This would involve carrying out an
estimate of maintenance costs (using the process outlined in Figure 21) on a
monthly basis. If insufficient financial resources are available, the HTM Manager
will have to prioritize what work should be carried out.
Please note: In Section 6.1, we have only covered the general planning and
budgeting of maintenance work. For a more a detailed explanation of the daily
financial management required by HTM Teams, see Guide 6.
When undertaking planning and budgeting work, the HTM Teams will need to be
sure of their financial responsibility and financial accountability as they undertake
maintenance work, undertake other equipment management tasks, and run a
workshop. Guide 6 also discusses the possibility of charging for HTM Services.


6.2 CONSUMABLE OPERATING COSTS
Equipment can only be used daily if there are regular supplies of the accessories
and consumables it uses when working. Therefore, it is necessary to plan for the
annual cost of the consumable items required for operating the equipment stock.




145


6.2 Consumable operating costs


Some of the information in this Section may appear similar to the earlier discussion
regarding maintenance costs (Section 6.1). However, the key difference is that the
calculations described here are usually made by equipment operators, or planners.
You will need to estimate the money required to cover the accessories and
consumables used by the equipment, in order to ensure that equipment continues to
function for as much of the year as possible. It is important that the estimate should
be as realistic as possible, since:
◆ under-estimation will result in periods when the equipment cannot be used


during the year
◆ over-estimation will deprive other essential services in the facility of their


necessary resources.
For long-term planning, international experts acknowledge that the percentage of the
equipment stock value required each year for consumable items can vary widely:
◆ some equipment requires a great deal for consumable operating costs (10–20 per


cent of the equipment stock value), others require none
◆ the more sophisticated the equipment, the higher the consumable operating costs


– therefore the costs will vary according to the health service level
◆ depending on your inventory, if you estimate on a large scale the consumable


operating cost will average each year to 10 per cent of the equipment stock value.
Nevertheless, it is common for countries to have recurrent budgets for equipment
consumable items which are far too small. This makes it impossible to keep the
equipment functioning. In fact, many countries do not keep track of equipment
consumables as a separate budget element at all. As a result, it is impossible to
distinguish between expenditure on these items, and other general supplies (such as
food and blankets) and medical supplies (such as bandages and gauze). This causes
them to run out of essential items such as electrodes, ultrasound gel, batteries,
washing powder, paper, reagents, gas, spare patient leads, filters and developer.
Since accessories are often the link between the machine and the patient, they are
more vulnerable to daily wear and tear, and thus need to be replaced much more
frequently than the machine itself. It must be remembered that stocks of
consumables (especially single-use items) and accessories can be very expensive.




146


The lifetime of consumables and accessories will vary for different users depending
on a number of factors, such as:
◆ the rate of use of the equipment (how many tests per month, how many patients


per year, etc.)
◆ how many back-up accessories there are (for example, is an accessory used to its


limit? Is it overworked or overloaded? While one accessory is being sterilized or
repaired, is another one available for use?)


◆ how the accessory is handled or whether it is abused
◆ how well the accessory is cared for and cleaned, and what sterilizing techniques


are used
◆ how well the equipment is maintained and whether it is running efficiently or


using up too many consumable inputs
◆ the initial quality of the equipment, and its consumable items
◆ whether staff are knowledgeable about the items, or use them wastefully
◆ the physical environment and climate in which the items are used and stored.
The cost of consumable items will also vary, depending on where you buy them from
and their quality (see Guide 3 on procurement and commissioning).


6.2 Consumable operating costs


Country Experience
Planners often fail to realize that equipment operating costs can have a much greater
financial impact than the initial procurement cost, and can be anything from 5% to 100%
of the procurement cost per year. For example, health staff in Germany discovered that
an infusion pump which cost US$3,000 to buy, cost an additional US$24,000 to run over
its 10-year lifetime, mainly due to the cost of the continuous supply of infusion sets
required. However, many health service providers have not calculated and budgeted for
the real operating requirements of their equipment.




147


6.2 Consumable operating costs


Who is Responsible for Calculating Consumable Operating Costs?


Experience in Ghana
The Ministry of Health distinguishes between two different types of consumable items:
◆ Common types of consumable items which can be supplied from many different


sources are handled by stores and supplies departments.
◆ More specialized items which can only be supplied by specific equipment


manufacturers are handled by their equipment managers. These can be both ‘user
consumables’ needed to operate the equipment, and ‘technical consumables’
needed for PPM.


The Ministry of Health endeavours to:
◆ purchase an initial stock of these specialized items when buying new equipment, to


last a number of years (depending on their shelf-life)
◆ establish channels with the manufacturer for subsequent purchases.
Where equipment accessories are directly connected to patients, the Ministry of Health
always purchases a stock of additional items.


Takes what action?
Need to learn how to budget for consumable
operating costs


Takes what action?
Can make consumable operating calculations


Are more likely to make rough estimations for
long-term forward plans and budget allocations, and
business plans.


Are more likely to make more exact detailed
estimates for annual requirements.


Who?
- HTM Working Groups
- Heads of Department
- Finance Officers
Which level?
Any health facility service
level that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its service as a business.
Central or regional service
levels that:
- cover the needs of many


facilities
- cannot go into specific


details.
Facility or district service
levels




148


6.2 Consumable operating costs


How to Calculate Consumable Operating Costs
You can:
a. make rough estimations
b. make specific or annual estimates
c. determine monthly estimates within the annual allocation as follows:


a. Making Rough Estimations of Consumable Operating Costs
You can make a variety of rough estimations for long-term plans, depending on:
◆ the information available to you (refer to the Health Management Information


System – see Guide 1, for details such as your patient attendance statistics)
◆ the type of forward projections you are making
◆ how much of your equipment stock it is possible to keep functioning, and how


much you can afford to finance.
It is difficult to make global rough estimations of consumable operating costs as a
percentage of equipment stock values. However, Box 30 provides some suggestions
from various countries.


BOX 30: Suggestions for Rough Estimations of Consumable Operating Costs for
Forward Planning


Different countries suggest a number of alternative approaches:
i. Consumption depends on the type of equipment you use, the service you provide, and how many


patients you see.
Therefore, you can provide a rough estimation of consumable operating costs by evaluating past usage
rates/expenditures, and comparing these with expected patient loads and specific equipment usage rates
per intervention.


ii. If your equipment is part of a ‘closed’ purchasing system, the consumables are only made by one
manufacturer and you are limited to one supplier. This monopoly makes the consumable costs larger.
If your equipment is part of an ‘open’ purchasing system, anyone can supply the consumables and
different manufacturers’ consumables can fit your machine. This competition makes the consumable
costs lower.
You can keep costs down if you use items which can be sterilized/reused rather than disposable items
(see Guide 4).


iii. Consumable operating costs vary according to equipment type, and can be expressed as a percentage of
purchase cost or stock value, as shown by the examples opposite.
But as the majority of your equipment is likely to be technology that has low to medium consumable
costs, you could use averages of:
- three per cent of the stock value for equipment with low consumable usage rates, and


Continued opposite




149


BOX 30: Suggestions for Rough Estimations of Consumable Operating Costs for
Forward Planning (continued)


Description Consumable cost per year
relative to original purchase cost


Equipment with high consumable operating costs,
such as:
Haemodialysis machine
Automatic biochemical analyser
Automatic haematology analyser 70–120 per cent
Electrolyte analyser
Blood gas analyser
Equipment with medium consumable operating costs,
such as:
Conventional X-ray machine 30 per cent
Anaesthesia machine 20 per cent
ECG recorder, three channel
Ultrasound, medical/obstetric
Ventilator, ICU 15–25 per cent
Physiological monitor
EEG machine
Autoclave, steam 10–15 per cent
Incubator, baby, ICU 5–15 per cent
Equipment with low consumable operating costs,
such as:
Centrifuge, electrical 5 per cent
Suction pump 2–5 per cent
Delivery bed
Operating theatre lamp
Slit lamp 1–2 per cent
Operating microscope
Water bath


b. Making Specific or Annual Estimates of Consumable Operating Costs
A different calculation is required when making specific or annual estimates.
It should be undertaken by Heads of Equipment User Departments.


6.2 Consumable operating costs




150


6.2 Consumable operating costs


Annual operating budgets should be based on more exact estimates. These are not
always easy to predict since epidemics, outbreaks, or surges in workload cannot, in
most cases, be anticipated. However, two types of budgeting can be identified.
These are:
◆ planned budgets for anticipated work
◆ contingency budgets for unplanned work.
Generally with experience, and where standardization of equipment is in place
(Section 2.1), the projection for equipment consumables and spare accessories
becomes more predictable.


Tip • When planning for accessories and consumables, it makes sense to:
– budget well in advance so that you have sufficient funds and do not run out of stocks
– buy in bulk so that you can make procurement savings
– only procure essential items
– for perishable items, only buy quantities that you can use up before their


shelf-life expires.


No consumable items or spare accessories should be allowed to sit on shelves for too
long, as this ties up money which could otherwise be used for other essential
purchases. The only exception to this rule comes when buying equipment from
abroad, when it makes sense to buy a stock of accessories and consumables at the
same time as the equipment, while capital funds are available, and you are in contact
with the manufacturer (Section 5.2). If you leave it until later, it becomes much
more difficult to obtain the funding and the items. Details of how to stock up with
consumables and accessories are given in Guide 4 on operation and safety.
After the initial stock has been purchased with the equipment (Section 5.2), then
you must regularly buy your recurrent needs. It is important to consider ‘economies
of scale’ – you can get better prices and save on shipping costs if you buy in bulk. It
is therefore a good idea to consider:
◆ buying for many locations (for example to cover several health facilities)
◆ buying stocks to cover an extended period (for example, stocks for one or two years).
Equipment accessories and consumables have not necessarily been ‘stockable’ items
in the Stores system up to now, so there is often insufficient information regarding
the requirements and rates of use. So use the planning tool exercise in Section 3.4
to investigate your equipment accessory and consumable requirements.
Figure 22 shows the exact estimates you can make for specific or annual
requirements.
Box 31 provides some examples of how specific consumable operating costs can be
calculated.




151


6.2 Consumable operating costs


Figure 22: How to Make Specific or Annual Estimates of Consumable Operating Costs


Process Activity


Evaluate essential consumables
and spare accessories required


For each different type of equipment, list the consumables and
spare accessories required to operate the equipment in your
department, using as guides:-
• experience of typical requirements for expected workloads,
departmental patient statistics, data gathered regarding
departmental requirements and rates of use (see planning tool
exercise in Section 3.4 for guidance);
• any new requirements for items being brought back into a
working condition (as agreed in the ‘Annual Rehabilitation
Activities’ and ‘Annual Corrective Activities’– see Section 8.1);
• any additional requirements for planned new purchases of
equipment from the ‘Annual Purchase Activities’ (Section 8.1)
in the capital expenditure budget;
• the user planned preventative maintenance schedules and
timetables (see Guides 4 and 5);
• an allowance for any emergencies.


Cost the consumables and spare
accessories identified above


Price the list of consumables and spare accessories for each
type of equipment (from above), and multiply the sum by the
total numbers of each equipment type involved.


ri t li t f l r ri f r
t f i t (fr ), lti l t t
t t l r f i t t i l .


Review and prioritize the costs
estimated above


Review the total range of costs that have been estimated (from
above), and:
• prioritize the needs in order to come up with a consolidated
annual estimate of consumable operating needs.


Adjust the figures if you are short
of money


If the annual estimate is too big to be covered:
• ensure that a regular budget is set.


Ensure other budgets are set
which affect equipment operation


Liaise with other budget holders (Section 6.3), and ensure that
sufficient estimates are placed in the administration budget to
cover the requirements of your department (see Figure 23).


Heads of Department, with their teams:


BOX 31: Examples of Calculations for Consumable Operating Costs
Example 1: An electrocardiograph (ECG) recorder
Description


Recording paper


Electrodes (single
use, set)
Electrodes (reusable
type, set)


Rate of use
(average)
one roll of paper
per week
one set per day


two sets per year


Units needed
per year
52


365


2


Costs per set/unit
(US$)
23.00 per roll


10.00 per set


70.00 per set


Total per year =


Costs per year
(US$)
1,196


3,650


140


US$4,986


Continued overleaf




152


6.2 Consumable operating costs


Tip • When ordering consumable items, the lead-times (delivery times) can introduce
delays (see Guide 4), so staff may order larger quantities to avoid shortages.


c. Determining Monthly Consumable Estimates within the Annual
Allocation


Within the annual departmental allocation, the Heads of Department will have to
determine monthly requirements. As a rough estimate, they could consider the
monthly departmental budget for equipment-related consumables to be one-twelfth
of the annual allocation. However, there may be seasonal variations which need to be
taken into account, due to factors such as workload or weather conditions.
To calculate a more specific monthly departmental budget for equipment-related
consumables, you can work out a combination of the cost for the likely work for
each month, using a process similar to that described in Figure 22. The Head of
Department will have to prioritize what equipment-related consumables to order
if the required financial resources are not available.


Tip • The time between orders (frequency of ordering/supply period), will dictate
whether you can place orders every month (see Guide 4).


BOX 31: Examples of Calculations for Consumable Operating Costs (continued)
Example 2: A conventional X-ray machine:
Description


Cassettes and
screens


Films
Reagents


Rate of use
(average)
Set of five
different sizes of
cassette and five
different sizes of
screen (i.e. two
items per size).
Replace this set of
10 items every five
years.
50 films per day
five litres of
developer per
month and five
litres of fixing
agent per month


Units needed
per year
Each year replace
one fifth of the
set (in other
words, two items
out of a set of
10).


18,250
60 litres
and
60 litres


Costs per set/unit
(US$)
3,400.00 per set


1.40 per film
2.70 per litre


1.70 per litre


Total per year =


Costs per year
(US$)
680


25,550
162


102


US$26,494




153


6.3 ADMINISTRATIVE COSTS
There are several important elements of equipment operation and maintenance
which are classified as ‘administrative costs’, and fall under budgets that are not
under the control of the equipment operators and maintenance staff. If you do not
make sure that they are adequately financed, your equipment service can fail for
want of simple things like paper, a phone connection or fuel allocations.


The calculations described here are usually carried out by various staff members in
departments other than those with equipment operators and maintenance staff.
These are usually administrative staff.
Such administrative expenses are often hidden in sub-divisions of the administration
budget. Categories of expenditure which may fall under the budgets of departments
other than the equipment user or maintenance department could include:
For Equipment Use:
Equipment-related departmental operating costs (such as materials, literature, fuel)
which are necessary for work, safety and record-keeping activities to take place.
For Equipment Maintenance:
Departmental operating costs (such as materials, literature, fuel, utilities, staff costs)
which are necessary for work, safety, travel and record-keeping activities to take place.
Please note: This Section only covers the general planning and budgeting of the
administration side of maintenance work. In contrast, Guide 6 provides a full
explanation of the daily financial management required by HTM Teams so that they
can undertake maintenance work, undertake other equipment management tasks,
and run a workshop.


6.3 Administrative costs




154


6.3 Administrative costs


Who is Responsible for Calculating Administrative Costs?


How To Calculate Equipment-related Administrative Costs
You can make:
◆ either rough estimations for long-term forward planning purposes, as shown in


Box 32
◆ or exact estimates for annual requirements, as shown in Figure 23.
It is difficult to make global rough estimations for long-term plans, but Box 32
provides suggestions from various countries.


Takes what action?
Need to learn how to budget for administrative costs


Takes what action?
Can make calculations of administrative costs


Are more likely to make rough estimations for
long-term forward plans and budget allocations, and
business plans


Are more likely to make more exact detailed
estimates for annual requirements.


Who?
- HTM Working Groups
- Heads of Department
- HTM Managers
- Finance Officers
Which level?
Any health facility, workshop
or service level that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its service as a business
Central or regional service
levels that:
- cover the needs of many


facilities
- cannot go into specific


details
Facility, workshop or district
service levels




155


6.3 Administrative costs


Box 32: Suggestions for Rough Estimations of Equipment-related Administrative Costs for
Forward Planning


Different countries suggest alternative approaches:
i. Administrative costs are a small percentage of any operating budget, for example:


◆ the biggest percentage expense is for staff, taking 50–55 per cent
◆ supplies/spares take 35–45 per cent
◆ administration only takes 10–20 per cent
Thus an equipment-user department could use an average of 15 per cent of their total operating budget
for administrative costs.


ii. For HTM Teams and maintenance workshops, their administrative needs are not much higher than other
administrative units in health facilities.
Therefore, a reasonable estimate for the administrative costs for HTM Teams could be calculated by
taking 10–20 per cent of their total operating budget.


iii. A starting point is to use five per cent of the equipment stock value to cover equipment-related
administrative costs.


Figure 23 shows the exact estimates you can make for specific or annual
requirements.


Figure 23: How to Make Specific Estimates of Assorted Equipment-related Administrative
Costs Annually
Process Activity


Identify their needs


Evaluate their requirements for administrative costs, such as:
• salaries of the maintenance staff
• overheads of the workshops, such as electricity
• fuel allocations
• stationary, forms, records
• literature, written resources, and subscriptions
• communications - telephone bills
• protective clothing.


Ensure they are reflected in the
relevant budgets


Liaise with the relevant budget holders to ensure that they place
sufficient estimates in their budgets for expenditures affecting
equipment maintenance work and services.


HTM Managers:


Identify their needs


Evaluate their requirements for equipment-related administrative
costs, such as:
• stationery, forms, records
• literature, written resources, and subscriptions
• protective clothing
• fuel allocations.


Ensure they are reflected in the
relevant budgets


Liaise with the relevant budget holders to ensure that they place
sufficient estimates in their budgets for expenditures affecting
equipment operational services.


Heads of Equipment-User Departments:




156


6.4 Ongoing training costs


6.4 ONGOING TRAINING COSTS
In order to maximize your staff skills and make the best use of equipment, you will need
to draw up an annual training budget, covering ongoing equipment-related training.
Your HTM Working Group, or a smaller training sub-group (Section 1.2), should
develop an Equipment Training Plan to cover the rolling programme of refresher
training required by your staff (Section 7.2). This is needed in order to ensure adequate
skill development in all areas of equipment use, maintenance, and management.
Section 5.4.2 has covered the cost of initial training that is linked to the arrival of
equipment purchases. However, there will be other ongoing training needed
throughout the year to cover:
◆ induction training – when staff are newly placed in post, move to a new


department/facility, or move to a new location with different responsibilities
◆ refresher training – to update and renew skills throughout the working life of staff.
Equipment-related skills development will be required in the following areas (see
Guides 4 and 5):
◆ good practice when handling equipment – basic ‘dos and don’t’s’
◆ how to operate equipment
◆ the correct application of equipment
◆ care and cleaning
◆ safety procedures
◆ planned preventive maintenance (PPM) for users
◆ PPM and repair for maintainers
◆ assorted activities as applied specifically to equipment needs, such as


procurement, tender adjudication, stores management, financial management and
computing skills.


Experience from Mozambique
The Ministry of Health discovered the dangers of underestimating some aspects of the
equipment-related administrative costs. In Mozambique, the travel costs for maintenance
departments can be extremely expensive.
The travel expenses allocated per day work out to be equivalent to one-third of the
monthly salary of a technician. Thus a technician applying for three days travel effectively
doubles their monthly salary.
The provinces planned for two days per month of travel per technician. To achieve this, they
would have to budget for an additional 67 per cent of the technicians’ salaries each month.




157


6.4 Ongoing training costs


There are a wide range of options available for developing skills, using the training
provided by the following sources:
◆ equipment suppliers
◆ other health facilities, workshops, or health service providers
◆ academic or vocational training institutions
◆ on-the-job learning and practical experience
◆ self study and peer group support.
These are described in full in Box 40 in Section 7.2, and each facility will need to
use a combination of the strategies available.
You will require a variety of resources when training staff, whether someone else trains
them or you do it yourselves. These vary depending on the training source and skill-
development option you choose (see above and full description in Box 40). Box 33
shows the type of resources which you will usually have to organize and finance.


BOX 33: Resources Required when Training Staff
Resources Required if Sending Staff Away for Training:
Information about the training required (background and needs assessment) and the


training sources available (see Box 40 in Section 7.2).
Expenses overnight accommodation, travel and subsistence for the trainees,


trainers’ fees or course fees, plus any other likely costs.
Records a system for keeping a record of the specific training that a staff member


has received.
Recognition a formal way of ensuring that the additional skills attained by staff


are reflected in their promotion chances and job grades by the Human
Resource Department.


Additional Resources if Running the Training Courses Yourselves:
Training materials appropriate to the piece of equipment to be studied (see Guides 4 and 5).
Space suitable for carrying out the training in.
Equipment to be practised on during the training courses.
Test and calibration instruments in order to verify technical conditions and safety during training.
Spare parts and materials appropriate for maintenance training.
Supplies consumables, medical supplies, and cleaning materials for user training.
Manuals to refer to, such as manufacturers’ operator and service manuals.
Test method and certificate a formal way of testing trainees and issuing them with a certificate at the


end of the training course, as a quality control and motivating factor
(depending on the extent of the training).


Additional expenses possible room hire, overnight accommodation, travel and subsistence for
the trainers, trainers’ fees, visual aids/teaching equipment, etc.




158


6.4 Ongoing training costs


Who is Responsible for Calculating Ongoing Training Costs?


Tip • The service level which makes these calculations will have to know about, or obtain
information about, the staffing and training requirements at each site.


How To Calculate Ongoing Training Costs
You can make:
◆ either rough estimations for long-term forward planning purposes, as shown in


Box 34
◆ or exact estimates for annual requirements, as shown in Figure 24.
It is difficult to make global rough estimations for long-term plans, but Box 34
provides suggestions from various countries.


Takes what action?
Need to learn how to budget for ongoing training
needs


Takes what action?
Can make ongoing training calculations


Will find the calculations here most useful for exact
estimates


Only need to make rough estimates for their long-
term forward plans and budget allocations.


Who?
- HTM Working Group, or


smaller training sub-group
- Finance Officer
Which level?
Any health facility, workshop
or service level that:
- makes its own plans
- sets or requests its own


budget allocations
- runs its service as a business
A service level (such as facility
or district) that makes:
- detailed estimates for


annual requirements
Service levels (such as central
or regional/district levels)
that:
- cover the needs of many


facilities
- cannot go into specific


details




159


6.4 Ongoing training costs


Box 34: Suggestions for Rough Estimations of Equipment-related Ongoing Training Costs
for Forward Planning


Different countries suggest alternative approaches:
i. Plan and budget for ongoing training costs by using a percentage of staff costs (the salary budget).


Generally, ongoing training costs can be taken as two per cent of payroll costs.
ii. Plan and budget for ongoing training costs by using a percentage of the equipment stock value. As a


starting point, ongoing training costs can be taken as five per cent of the stock value.


Figure 24 describes how to make exact estimates for annual requirements.


Figure 24: How To Make Specific Estimates of Annual Equipment-related Ongoing
Training Costs
Process Activity


Annually, evaluates skill
development needs


Identify:
• activities in the Equipment Training Plan (Section 7.2) which
were not achieved in the previous year;
• requests for training interventions prompted by reports of
poor performance with equipment (see Guides 4 and 5), and
monitoring (Section 8.2).


Identifies the inputs required
Identify:
• the training sources to be used (see Box 40 in Section 7.2);
• the resources required to undertake the training (see Box 33).


Makes a plan for ongoing training Plan the requirements for the rolling programme of on-the-job training for the coming year.


Costs the plan Cost the training requirements for the coming year's activities, using the advice in Figure 17 (Section 5.4.2).


Obtains approval Submit the costs to the Health Management Team.


HTM Working Group (or its training sub-group):


Identifies the sources of funds
Consult the central health service provider to establish:
• which training activities can be financed from central activities
• what scholarships are available
• whether there is assistance available from external support
agencies.


Provides the finances Allocate sufficient funds from the budget to cover the in-house training programme for the year.


Health Management Team:




160


Section 6 summary


Once you have learnt how to undertake these recurrent budget calculations, as
described in this Section, you can use them to make your long-term Core Equipment
Expenditure Plan (Section 7.3) and to undertake annual budgeting (Section 8.1).
An example of a total recurrent budget plan is given in Section 7.3.
Box 35 contains a summary of the issues covered in this Section.


BOX 35: Summary of Procedures in Section 6 on Recurrent Budget Calculations


HTM Working
Group, HTM
Manager, Finance
Officer
HTM Managers
in Workshops
HTM Working
Groups


Heads of
Department
HTM Managers
and Heads of
Department


HTM Working
Group
(or Training
Sub-group)


Health
Management
Teams


Tr
ai


ni
ng


Ad
m


in



Op


er
at


e


M
ai


nt
ai


n


◆ make rough estimations of maintenance costs for long-term forward plans and budget
allocations, by using a percentage of the equipment stock value (see Figure 20)


◆ make specific or annual estimates of maintenance costs, by costing specific
requirements (see Box 29 and Figure 21)


◆ make rough estimations of consumable operating costs for long-term forward plans
and budget allocations, by considering the suggestions relating to a percentage of
the equipment price (see Box 30)


◆ make specific or annual estimates of consumable operating costs, by costing specific
requirements (see Figure 22)


◆ make rough estimations of administrative costs for long-term forward plans and
budget allocations, by considering the suggestions relating to a percentage of the
equipment stock value or departmental operating budgets (see Box 32)


◆ make specific or annual estimates of administrative costs, by costing specific
requirements (see Figure 23).


◆ make rough estimations of ongoing training costs for long-term forward plans and
budget allocations, by considering the suggestions relating to a percentage of the
equipment stock value or payroll costs (see Box 34)


◆ make annual estimates of ongoing training costs, by costing specific requirements
(see Figure 24)


◆ consult with the health service provider on central training plans, and scholarships
available


◆ lobby them for external resources for the training required.




161


7. HOW TO USE THE TOOLS TO MAKE
LONG-TERM EQUIPMENT PLANS AND
BUDGETS


Why is This Important?
If you have a large amount of equipment needs, you require a method of
prioritizing between them for your health facility or service level. An Equipment
Development Plan will help you to define which equipment you can afford to
concentrate on, in any given year.
The development of the equipment stock will help you to identify the range of
equipment-related training required by your staff. Therefore you need an
Equipment Training Plan to cover all aspects of equipment-related skill
development in an ongoing rolling programme.
To finance these plans, you need a Core Equipment Expenditure Plan which
ensures you allocate sufficient funds (both capital and recurrent) to provide
functioning healthcare technology over the long-term. You will also need a
Core Equipment Financing Plan which ensures you identify sufficient sources
of funds to cover your needs.


In this Section, we will show you how to apply the planning tools you have
established (Sections 3 and 4) and the budgeting tools you have previously learned
(Sections 5 and 6), for the purpose of making long-term plans and budgets.
Undertaking planning and budgeting together is important. Even if you have agreed
upon the type of equipment to buy (determined by planning), you can only purchase
what you can afford (determined by budgeting, prioritizing, and financing).
Facilities regularly identify equipment requirements. However they may have more
needs than they can afford, in which case they will need to prioritize them.
Currently, all facilities are faced with a number of unavoidable facts:
◆ They need a wide range of equipment if they are to provide the health services


they wish to offer.
◆ All equipment should be functioning, but many items are not working, thus


affecting the services that can be offered.
◆ Due to the age and shortfall of equipment, many different new items are required.
◆ Staff require a range of different equipment-related skills, but many staff have not


received the necessary training.
◆ Each year there are only limited funds available to address these issues.


7. How to use the tools to make long-term equipment plans and budgets




162


Therefore, it is very important that each facility, service level, and health service
provider is able to plan its response to this situation by undertaking an Equipment
Planning and Budgeting Process.
It is preferable to undertake forward planning and budgeting. This enables you to
plan ahead and determine your needs and actions in the near future (one to two
years) and the longer-term (three to five years). For this, you will have to:
◆ identify your equipment needs
◆ cost them
◆ identify sources of funds
◆ prioritize which activities you can afford and when they should take place.
In addition, your health service provider or the owner of your facility (such as a
Board) may wish to develop a strategic or business plan which is less detailed. This
enables you to make rough estimations of the long-term financial requirements for
the development of your health facility or service level, so that you can forecast the
need to raise money or recover costs.
This Section concentrates on the following long-term plans and budgets:
◆ an Equipment Development Plan (Section 7.1)
◆ an Equipment Training Plan (Section 7.2)
◆ your Equipment Budget – made up of a Core Equipment Expenditure Plan and a


Core Equipment Financing Plan (Section 7.3).
Once you have developed these long-term goals, you will need to undertake an
annual planning and budgeting process within these goals. Also, the long-term plans
will need to be updated to reflect your annual plans and changes in circumstance.
These issues are described in Section 8.1. The equipment rehabilitation, purchase,
and training goals which you set should be monitored each year to see if they have
been achieved (Section 8.2).


7.1 EQUIPMENT DEVELOPMENT PLAN (EDP)
Each facility and service level usually makes plans and sets itself targets which
prioritize its departmental work activities for the coming year (see Guides 4 and 5).
However, such annual action planning usually focuses on the improvements that can
be achieved with existing equipment, and specifically omits the major investments
required for additional equipment. Your Equipment Development Plan is the
means for the facility to set itself rehabilitation, replacement, purchase, and
corrective goals for its equipment stock.


7. How to use the tools to make long-term equipment plans and budgets




163


7.1 Equipment development plan (EDP)


If you have a large quantity of needs to improve your equipment stock, you require a
method of prioritizing between the needs across your facility or service level, since
you will not be able to buy everything at once. An Equipment Development Plan will
help you to do this, by defining which items of the equipment you need to
concentrate on in any given year.


Why Equipment Development Planning is Necessary
An Equipment Development Plan brings to your attention information about:
◆ the current stock of equipment (medical equipment, plant, service supply


installations, fabric of the building)
◆ the condition of the equipment
◆ the basic shortfalls in equipment
◆ the action required to rehabilitate, replace, purchase, or correct problems
◆ what should be attempted in both the short- and the long-term.
The Equipment Development Plan will be of help because it:
◆ identifies and forecasts your requirements in advance
◆ clarifies the direction of development
◆ allows cost estimates to be made for the actions required
◆ highlights where you need to allocate funds, and helps you to rationalize resources
◆ enables you to focus on the areas where fund-raising is required
◆ provides you with a time-frame for monitoring that the development is achieved.
The actions you must take are to:
◆ use the planning tools established (Sections 3 and 4)
◆ evaluate the current equipment stock and its needs
◆ evaluate your future requirements
◆ adhere to your purchasing, donations, replacement, and disposal policies
◆ present your decisions as the long-term Equipment Development Plan.


Tip • As can be seen from your purchase and donations policies (Section 4.4), the majority
of purchases are likely to be for replacing existing stocks as they reach the end of
their lives. Equipment should only be replaced for valid reasons as determined by
the criteria given in your replacement and disposal policies (Section 4.4).


• All your capital expenditure requirements should be covered by the Equipment
Development Plan. Thus all requests for replacement equipment, additional new
items, and major rehabilitation needs, should only be honoured if they are part of the
long-term goals detailed in the Equipment Development Plan.




164


Who is Responsible for Equipment Development Planning?
Preference
Equipment development planning should be undertaken by a multi-disciplinary team, so that
single types of staff (such as clinicians) do not have too much influence.


Tip • If you want to gain from standardization of equipment and economies of scale, it is
better to undertake needs assessment and procurement at a service level that covers
many health facilities (Section 2.2). Therefore try to collaborate in these tasks.


Principles Involved in Basic Equipment Development Planning
Figure 25 shows the basic process involved in equipment development planning.
However, to make the necessary decisions you should undertake some analysis of the
data you are studying. Box 36 illustrates the principles involved for the analysis, in
relation to the activities shown in Figure 25.


7.1 Equipment development plan (EDP)


Takes what action?
Is responsible for Equipment Development
Planning


Takes what action?
It is possible to undertake basic equipment
development planning
Require a bulk equipment development planning
process, most likely computerized, possibly with
specialist support


Who?
- HTM Working Group, or


smaller planning sub-group
- HTM Team (which


prepares background
technical information)


Which level?
At facility level


At service levels (such as
district, region, or centre) that
cover:
- the needs of many items of


equipment
- many different locations.




165


Figure 25: The Basic Equipment Development Planning Process


7.1 Equipment development plan (EDP)


Process Activity


Evaluates the current equipment
stock


• Analyze the up-to-date Equipment Inventory (Section 3.1):
- to discover the replacement, major rehabilitation,
maintenance, consumable, training, and administrative
requirements.
• Compare the Equipment Inventory with the Model Equipment
List (Section 4.3):
- to discover the shortfall of equipment that needs purchasing.
(If the Model Equipment List is not available, compare the
inventory to the urgent equipment needs drawn up by
departments).


Evaluates future requirements • Study the Vision for the facility: - to discover any new services planned.


Compiles the needs • List all these requirements


The HTM Manager and his/her HTM Team:


Prioritizes the actions to take, and
makes the Equipment
Development Plan


• Decide what to attempt:
- as short-term goals (in the coming year or two)
- as long-term goals (for example, within three to five years).


Prepares various Action Plans


• Create plans for:
- equipment replacement and new purchases, and any
associated support activities
- major rehabilitation projects
- corrective actions (maintenance, consumable needs, training,
administrative needs).


The HTM Working Group (or its planning sub-group):




166


7.1 Equipment development plan (EDP)


BOX 36: Analysis Required for the Equipment Development Planning Process (in Figure 25)
Analysis Method of Measurement
HTM Manager and his/her Team:
◆ When analyzing the up-to-date Equipment Inventory:
Discover the condition of the
equipment.


Discover:
- where the equipment is in its life-
cycle (refer to typical lifetimes in
Annex 3).
- whether the health service that can
be delivered is deteriorating.


Discover what hinders the use of
equipment


◆ When comparing the Equipment Inventory with the Model Equipment List:
Discover the shortfall of equipment
in the existing facility.


◆ When studying the Vision for the facility:
Discover any new services to be
offered by the facility in the
long-term.


a. Identify those items needing maintenance and repair (including
maintenance contracts).


b. Identify those items requiring major rehabilitation (including
maintenance contracts).


Note: It may be necessary to set priorities for renovating equipment
if you have a large backlog. A good indicator (way of measuring this)
is to monitor each year what percentage of your Equipment
Inventory has been returned to working order. Provide the HTM
Working Group with this percentage figure (see below).
c. Identify those items to be scrapped and not replaced, according


to the replacement and disposal policies (Section 4.4).
d. Identify those items needing replacement, according to the


replacement and disposal policies.
Note: It may be necessary to set priorities for replacing the
equipment if you have a large backlog. A good indicator of priorities
is to monitor what percentage of your Equipment Inventory is
beyond its expected lifespan. Provide the HTM Working Group with
this percentage figure (see below).
e. Identify where consumable and administrative inputs are


required.
f. Identify where training is required (this information will be used


when developing the Equipment Training Plan – Section 7.2).


g. Identify those items which are missing and must be purchased,
according to the purchasing and donations policies (Section 4.4).


Note: It may be necessary to set priorities for purchasing the missing
equipment. A good indicator of priorities is to monitor each year
what percentage of the Model List is covered by your Equipment
Inventory. Provide the HTM Working Group with this percentage
figure (see below).


h. Identify those new additional items of equipment which must be
purchased, according to the purchasing and donations policies.


Continued opposite




167


7.1 Equipment development plan (EDP)


BOX 36: Analysis Required for the Equipment Development Planning Process (in Figure 25)
(continued)


Analysis Method of Measurement
HTM Working Group (or its planning sub-group):
◆ When prioritizing which actions a–h (above) will be attempted:
Decide which actions will be
achieved:
- as short-term goals (in the coming
year or two)
- as long-term goals (for example,
within three to five years).


The first time you establish an Equipment Development Plan, you consider the
needs for a span of around five years. After that, you update and modify the
information annually (Section 8.1) to create a rolling programme of action plans.
To help you to review all the necessary actions and prepare the Equipment
Development Plan, you can use an Equipment Development Plan Record Sheet to
lay out the needs.


Layout of the Equipment Development Plan
A variety of layouts can be used for the Equipment Development Plan (EDP). Box 37
(overleaf) shows a possible layout of the Record Sheet used to capture the details,
which can then be used to help create your final EDP. Your equipment inventory will
be used as the first column on the Record Sheet. You can decide how best to sort your
inventory data (Section 3.1). In the example shown, the inventory is sorted by
location.
The EDP Record Sheet (Box 37) is ordered according to department (area, or
room), with each column providing different information and highlighting decisions
which need to be made. The activities recommended in these columns can form the
basis of your short- and long-term Action Plans. If you wish, you can add on extra
columns to record rough price estimates for the purchases and actions you propose.
This is useful, as you will need these estimates as the basis for your cost calculations
when preparing your Core Equipment Expenditure Plan (Section 7.3.1).


◆ Ensure the equipment remains in good working order – refer to
the indicator provided by the HTM Manager (see point b above).


◆ Ensure the health service delivered does not deteriorate – refer
to the indicator provided by the HTM Manager (see point d
above).


◆ Follow the principles in the purchase/replacement policies – refer
to the indicator provided by the HTM Manager (see point g
above).


◆ Conform to the available finances for the facility.
◆ Consider how important the equipment is for clinical operations


(see discussion of priorities in Section 8.1).




168


It is possible to mark up a printed copy of your Inventory, then type up the decisions
made in the column format of the EDP Record Sheet. However, creating an EDP is
easier if you have computerized records and know how to create spreadsheets. This
is discussed further in the next section on creating a bulk EDP.
Ultimately, it may be easier to work from a Summary EDP, rather than a large pile of
EDP record sheets. The summary combines the data and presents all the action
plans for the short term and long term in one place. Box 38 (overleaf) shows how
you might summarize the data from your EDP record sheets, and continues the
example started in Box 37. It assumes that the health facility concerned is large
enough to have an HTM workshop of its own and shows its needs. In smaller
facilities these requirements would be covered by the EDP for the district/regional
HTM Service.


How to Create a Basic Equipment Development Plan at Facility Level
At facility level you can go as far as you like. For example:
◆ you could simply follow the basic equipment development planning process


shown in Figure 25
◆ in addition, you could undertake the analysis described in Box 36
◆ you can make use of an EDP Record Sheet to assist you with laying out the


details, as shown in Box 37
◆ you can also develop a summary of your plans, as shown in Box 38.


How To Create a Bulk EDP at Service Levels which Cover Many
Facilities


Larger facilities (tertiary) and district, regional, or central health authority levels should
have drawn up equipment inventories on all assets. However, preparing an Equipment
Development Plan on the basis of analyzing each item would be an enormous amount of
work. You will therefore require strategies to make the task less of a burden.
If you only consider complex and large items of equipment, you risk omitting small
but important items. In many countries, it is common for the needs of major items to
be well addressed, but for smaller, essential items to be ignored due to the high level
of effort involved in calculating the numbers required. Since small equipment and
instruments are just as important and are used by many members of staff, planning
for this type of equipment should be done in a way which relieves the burden of the
administrative procedure.
Often, procurement may be triggered not by the size and complexity of equipment,
but by the price bracket. Since many small items used by many staff members can
add up to a large amount, they should not be forgotten. The same principles as those
described for basic equipment development planning are used, but instead you
consider the equipment in categories for a bulk EDP. Box 39 provides examples of
strategies that can help.


7.1 Equipment development plan (EDP)




169


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7.1 Equipment development plan (EDP)


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170


7.1 Equipment development plan (EDP)


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08




171


7.1 Equipment development plan (EDP)


Box 39: Ways of Categorizing Equipment for a Bulk EDP
Strategy Example
Consider major items of equipment
per department


Consider individually:
- those items of equipment above a certain value
- those items of equipment above a certain size


Lump together:
- small items which are used by many staff


so the large quantities required can be
purchased in bulk


- items which can be considered collectively
as larger ‘sets’


Use a computerized process to help with the
number-crunching


At a service level requiring a bulk EDP:
◆ use the strategies shown in Box 39 to categorize your equipment into groups
◆ follow the basic planning process shown in Figure 25
◆ undertake the analysis described in Box 36
◆ use an EDP Record Sheet to lay out the details, as shown in Box 37
◆ develop a summary of your plans, as shown in Box 38.
For a bulk EDP covering many items or many facilities, you could type up the
information but it is easiest if you have computerized your records. Then you simply
enter the data into the computer according to the EDP layout, and use trained
technical staff and secretarial or computing support to assist with data entry.


Include:
- medical equipment
- service provisions (such as electrical installations,


steam reticulation, sewage and water pipelines)
- elements of the fabric of the building (such as doors,


windows or roof)
For example:
- above US$500
- not handheld items (such as diagnostic sets), possibly


not portable items (such as resuscitators/ambu bags)
For example:
- stethoscopes and sphygmomanometers


- instrument sets, kitchen crockery and cutlery,
and toolkits


See Annex 2 for information on suitable software




172


With access to computers and spreadsheets, you could employ further columns in the
EDP record sheet or the summary EDP to hold additional useful data. For example,
you could programme the columns with codes for:
◆ the condition of equipment, and therefore its need for replacement or


maintenance
◆ the number of years left in the equipment’s lifetime, and therefore when it is


likely to need replacing
◆ how many additional pieces of equipment you need to meet the standard level set


in the Model Equipment List, and therefore the need for new purchases
◆ a running total of the possible rough costs involved
◆ your decisions on which actions to take in which year.


7.2 EQUIPMENT TRAINING PLAN (ETP)
Once you have drawn up an Equipment Development Plan (Section 7.1), you can
use this to tailor your training requirements.
If you want to maximize your use of equipment, a wide range of staff require training
in equipment-related skills throughout their careers. To ensure that healthcare
technology needs are not forgotten, the Equipment Training Plan (ETP) is an
essential planning tool.
The first time you establish an ETP, you will need to consider the equipment
training requirements over the long-term, for example for five years. After that, you
can simply update and modify the information annually (Section 8.1) to create an
ongoing programme of equipment-related skills development.


Skill Development Requirements


Types of Training
Healthcare technology is developing rapidly, with new models and makes of
equipment appearing almost every year. Health service providers need to be able to
cope with this wide range of rapidly changing products. Unfortunately, problems with
equipment often arise due to mishandling by users, or a failure to understand fully
how the equipment works. In order to be able to use and maintain the equipment
found in health facilities effectively, training must therefore be seriously addressed.


7.2 Equipment training plan (ETP)


on-the-job seminars going to college




173


7.2 Equipment training plan (ETP)


Throughout their careers, your staff will need both:
◆ basic training, and
◆ additional skill development opportunities.
The basic health training requirements for medical staff are generally covered by the
Human Resources Development Plan. However, it is common for health service
providers to forget:
◆ basic training and career development requirements for maintenance staff (for a


description of the needs, see Guide 1)
◆ specific training modules on equipment operation for medical and support staff


(see Guide 4)
◆ equipment-related training needs of general staff, such as purchase officers, stores


staff and finance officers (see Guides 3 to 6).
Major training needs (such as long courses, training abroad or specialization training)
may have to be covered by the capital budget.


Equipment-related skills development will be required in the following eight areas:
◆ good practice when handling equipment – basic ‘dos and don’ts’
◆ how to operate equipment
◆ the correct application of equipment
◆ care and cleaning
◆ safety procedures
◆ planned preventive maintenance (PPM) for users
◆ PPM and repair for maintainers
◆ assorted activities as applied specifically to equipment needs, such as


procurement, tender adjudication, stores management, financial management and
computing skills.


Experience from Southern Asia
The Human Resource Development Division of the Ministry of Health in one Southern
Asian country is responsible for training but has no specific budget for equipment or
facility-related training.
Their budget for training is small, and only gets used for clinical skills for new recruits
(such as nurses and laboratory technicians). None is used for maintenance technicians,
skills in equipment operation, or upgrading equipment knowledge.
Although they use the WHO country budget to get funds for assorted training needs, this
is not sufficient to keep up with new technical advancements.




174


7.2 Equipment training plan (ETP)


This range of training is required at varying times throughout a member of staff ’s
career. Key training stages include:
i. induction training – when staff are newly placed in post, move to a new


department/facility, or move to a new location with different responsibilities
(Section 6.4)


ii. training at the commissioning of equipment – when new equipment first arrives
(Section 5.4.2)


iii. refresher training – to update and renew skills throughout the working life of
staff (Section 6.4).


Monitoring how equipment works and how it is used will provide prompts that
training is required, which should be passed onto the Health Management Team
(Section 8.2). Figure 26 shows the likely prompts.


Figure 26: Example of Prompts Showing that Training is Required


Prompt Response


Staff newly arrived at a facility, or
transferred between departments


Staff admit that they need any type of
equipment-related training


Heads of Section see that staff are short
of particular equipment-related skills


Maintenance staff identify user-related
problems with equipment


New equipment arrives at the health
facility


An incident report is submitted
(see Guide 4)


Skill shortages are discovered during the
staff appraisal process (see Guide 4).


In-Service Training Co-ordinator organizes induction
training on equipment-related skills


They request it from their Head of Section


They request the necessary training from the
HTM Working Group (or its training sub-group)


They report this to the HTM Manager


The training sub-group/Commissioning Team
organizes this


The HTM Working Group, or its safety sub-groups,
decides if extra training is the appropriate solution


Managers agree with the individual which training
would be the best development strategy,
and request it from the Human Resource
Department/training sub-group




175


Sources of Training Available
There are a number of options available for developing skills, and each facility has to
use a combination of the strategies shown in Box 40.
Whichever options prove to be the most feasible, a skills development programme is
vital. The health service provider organization plays a significant role at central level,
such as:
◆ developing training plans
◆ organizing and providing training scholarships
◆ approaching donors to finance training programmes.
Therefore equipment training requirements at facility or district/regional level
should be submitted to the central body of your health service provider organization.


BOX 40: Strategies for Developing Equipment Skills
Strategy Advantage/Disadvantage
Send staff to factories that
manufacture equipment
(this may be appropriate
for high-cost equipment).


Invite engineers from
manufacturers to visit your
facility to conduct training
on their equipment.
Send staff to other locations
which have already developed
the skills required.


Link the provision of training
to the procurement process.


Run in-house (on-the-job)
training sessions


Make use of regular
clinical/professional meetings


7.2 Equipment training plan (ETP)


This can be good training but may be expensive as it often entails going
abroad and paying in foreign currency. However, the company may have a
local representative that has the skills to provide the training; this will be
a more affordable option. Dangers are that the manufacturer will offer a
course which is too simple (not much more than a factory tour), or
alternatively a very theoretical course. Good communication is required
to ensure that the training is appropriate to maximize the potential of
this equipment-specific training.
If you are facing financial constraints, it may not be possible to afford this
easily. However if the company’s local representative has sufficient skills
and can offer a well-organized plan for on-site training, this can be more
affordable.
Other facilities/workshops/teams may already have developed skills that
you need. Here your staff can either attend specific training courses, or
have a period of secondment in order to obtain skills through on-the-job
training, work experience, or work exchange visits.
When equipment is purchased from a company, you ask them to provide
training at the time of commissioning (see Guide 3). Who covers the cost
of the training and where it will take place is negotiated in the
procurement contract, and may be dependent on the type and total cost
of the equipment.
You can make use of local, national, or regional experts who are
maintenance and/or clinical staff. It may be necessary to send some staff
for training abroad so that they can become the local trainers/experts.
These can be used as a forum to introduce staff to particular equipment
concerns. They can be run at facility, district, central, or international levels.


Continued overleaf




176


7.2 Equipment training plan (ETP)


BOX 40: Strategies for Developing Equipment Skills (continued)
Strategy Advantage/Disadvantage
Make use of academic
courses at various levels
Approach local colleges to
develop, run, and accredit
new modules specifically
designed for your
equipment needs


Provide opportunities for
practical on-the-job
experience


Provide opportunities for
studying and teaching


Let the different types of staff
(both equipment operators
and maintainers) attend their
peer group meetings
Provide various training
materials for staff to refer to
(see Guides 4 and 5).
Provide work placements
for student maintainers in
your workshop


Resources Required
You will require a variety of inputs when undertaking training, and they will vary
depending on the training source and skill-development option chosen (as described
in Box 40). Box 33 (Section 6.4) shows the type of resources which you will
usually have to organize and finance.


These are useful for gaining additional specialist skills. They will be
available nationally, regionally, and overseas (see Annex 2).
- The Trade Testing Authority can develop trade tests suited to the


range of skills used by artisans/craftsmen who maintain healthcare
technology, so they can progress in their careers.


- The Polytechnic can combine a mixture of existing engineering
modules to create a certificate or diploma course suited to the range of
skills used by technicians who maintain healthcare technology, so you
can hire and train more suitably qualified staff.


- The health colleges (who provide basic training for nurses, doctors,
physiotherapists, and other health practitioners) can introduce new
modules aimed at developing equipment-related skills for equipment
users.


Practical experience, with or without supervision, provides excellent
training as long as it is at the right skill level. When a piece of equipment is
not in use, staff should be encouraged to familiarize themselves with the
equipment, and learn its principles and its different uses and problems.
Books, manuals, and articles from journals will give answers to many
questions on principles of operation and maintenance for different types
of equipment (see Annex 2). If staff are given opportunities to study,
with a little pressure/expectation to lecture to colleagues afterwards, the
benefits for individuals can be great.
This allows staff to share experiences regarding equipment, learn from
their colleagues, and develop a professional approach to work. The
meetings will be available nationally and internationally.


The materials, together with demonstrations, help staff to learn and
provide them with something to regularly refer to when uncertain. The
materials can be hand-outs, posters, OHP acetates, laminated cards, etc.
This will raise your profile and give you contacts with training
institutions. The students may also return to you for employment when
they graduate, and you will already have a good idea of their abilities.




177


Who is Responsible for Developing the Equipment Training Plan?


Tip • If you want to gain from economies of scale, it is better to undertake needs
assessment and organize training courses at a service level that covers many health
facilities (Section 2.2). Therefore try to collaborate in these tasks.


How to Create an Equipment Training Plan
The Equipment Training Plan should be an annually-updated rolling programme
of training covering many years. At service levels compiling and overseeing plans for
many facilities, the use of computers and spreadsheets will make the task easier.
Figure 27 shows how to create an Equipment Training Plan.
Box 41 provides an example of an Equipment Training Plan, and continues the
example from Box 38. It assumes that the health facility concerned is large enough
to have an HTM workshop of its own and shows its needs. For smaller health
facilities, these requirements would be covered by the Equipment Training Plan for
the district/regional HTM Service.
As Box 41 shows, if you wish you can have an optional column where you record
rough cost estimates of the training planned. This is useful as you will need to make
these calculations later anyway when preparing your Core Equipment Expenditure
Plan (Section 7.3.1).


7.2 Equipment training plan (ETP)


Takes what action?
Is responsible for establishing all training
requirements
Takes what action?
Needs to develop an overall Equipment Training
Plan to cover all aspects of equipment-related skill
development, and pass it on to higher levels.
Must include equipment training plans developed
at lower levels into their service-wide equipment
training plans.


Who?
HTM Working Group, or
smaller training sub-group
Which level?
Every level


Higher levels (such as district,
region, and central level)




178


7.2 Equipment training plan (ETP)


Figure 27: Making an Equipment Training Plan


Process Activity


Identifies existing needs


Refers to:
• any record the HTM Manager made when analyzing the
Equipment Inventory that training was required – see point f. in
Box 36 (Section 7.1)
• any prompts, triggers, or requests for training
reported/submitted.


Identifies new needs


Studies the Equipment Development Plan (EDP) and identifies
the training required to deal with:
• planned equipment replacements
• planned new equipment purchases/donations or additional
services
• problems with equipment operation, maintenance, or
management.


Determines the range of training
that will satisfy the needs


Considers:
• the eight different areas for equipment-related skill
development listed in this Section – basic handling, operation,
application, care and cleaning, safety, user PPM, PPM and
repair for maintainers, associated skills (procurement, stock
control, financial management, etc)
• the three types of training required at different times in the
working life of staff (induction, at commissioning, and
refresher training).


Determines the sources that will
provide the needs


Considers:
• the various sources of training (described in Box 40), which
provide the option for on-the-job or external courses
• any initiatives organized and provided by the central health
service provider organization and donor programmes.


Prioritizes across the needs Prioritizes the short- and long-term actions.


Prepares an overall Equipment
Training Plan


Covers all aspects listed above for equipment-related skill
development.


The HTM Working Group (or its training sub-group):


Abides by the plans made Only acts according to the agreed plans, unless emergencies arise (Section 8.2)


The Health Management Team:




179


7.2 Equipment training plan (ETP)


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180


7.3 EQUIPMENT BUDGET – FINANCIAL PLANS
Having drawn up a long-term Equipment Development Plan and Equipment
Training Plan, you need to identify and allocate the finances to cover your proposed
actions. To do this, you need an Equipment Budget. This ensures you have
sufficient funds (both capital and recurrent) to provide functioning healthcare
technology over a set period of time.
Any budget should have two parts to it:
◆ the income portion identifies the funds you have coming in, or must find
◆ the expenditure portion identifies how you wish to spend the money, and


therefore how to allocate the funds.
Thus you need a Core Equipment Financing Plan (CEFP) and a Core
Equipment Expenditure Plan (CEEP).
For government health facilities, your income usually consists of only the funds given
to you by government from its own finances, and the development funds provided by
external support agencies. However, if your health facility is more autonomous, it is
your responsibility to also identify various possible sources of income from fund-
raising and income-generating activities.
The financial planning process is circular:
◆ you need to know the income available before you can spend it
◆ however, you need to know what you plan to spend before you can raise funds.
It is necessary to start the discussion at some point in the cycle; therefore this
Section discusses:
◆ the Core Equipment Expenditure Plan in Section 7.3.1
◆ the Core Equipment Financing Plan in Section 7.3.2.


7.3.1 Core Equipment Expenditure Plan (CEEP)
The expenditure plan can be developed in two ways:
◆ A General CEEP for the Health Management Team, which displays the funds


required for the short- and long-term actions proposed in your Equipment
Development Plan (EDP) and Equipment Training Plan (ETP). This will form
the basis of your allocations and spending every year.


◆ A Strategic Business Plan for the health service provider (or Board/Trustees).
This makes use of rough estimations to provide a long-term financial overview so
that they can forecast the need for raising money or recovering costs.


7.3 Equipment budget – financial plans




181


The expenditure plan should be designed according to your budget lines (or sub-
divisions) for capital and recurrent costs. However, it is important to try and use the
planning tool developed in Section 3.3, so that the budget is laid out with sufficient
budget lines to show how money is allocated for different equipment requirements.
In this way, you can adequately monitor how the money is spent on equipment.


Tip • Part of financial planning is to ensure that you manage the allocations between
different expenditure requirements. Your aim is to obtain an effective balance
between capital and recurrent expenditure. For example, there must be a balance:
– between the amount spent on capital items, and sufficient allocations for the


recurrent costs required to keep the items functioning (including costs such as
consumables, maintenance and training)


– between the amount spent on staff salaries, and the amount spent to ensure there
is sufficient equipment for the staff to work with.


Who is Responsible for Developing Equipment Expenditure Plans?


How to Create a CEEP
If you have a large number of activities and requirements as part of your long-term
Equipment Development Plan and Equipment Training Plan, you must calculate
the expenditure required and balance the needs across the facility.
To do this, you simply use your ‘budgeting tools’ for rough estimations (Sections 5
and 6) to cost each element, with the strategic CEEP using the quickest roughest
estimates. Then you summarize the results and present them as the expenditure
portion of your budget. At service levels compiling and overseeing plans for many
facilities, the use of computers and spreadsheets will make the task easier.
Of course, you then need to ensure that the central financing body of your health
service provider accepts your plan and honours it. You will also need to identify a way
of financing your needs (Section 7.3.2).


7.3.1 Core equipment expenditure plan (CEEP)


Takes what action?
Is responsible for equipment expenditure planning


Takes what action?
Can prepare a general CEEP by budgeting for the
proposed actions in the Equipment Development
Plan and Equipment Training Plan
Can prepare rough estimations for a strategic
business plan


Who?
- HTM Working Group, or


smaller training sub-group
- Finance Officers
Which Level?
Any service level


Service levels such as
autonomous or donor-targeted
facilities, districts, regions, or
the centre




182


Fig
ure


28
: M


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ort


ac
tivi


tie
s f


rom
th


e t
wo



ca


lcu
lat


ion
s a


bo
ve


, g
ivin


g a
to


tal
fo


r a
ll e


qu
ipm


en
t re


pla
ce


me
nt


an
d n


ew
pu


rch
as


es
ac


co
rdi


ng
to


Bo
x 2


3 (
Se


cti
on


5.
2).


Ca
lcu


lat
e t


he
co


st
of


su
pp


ort


ac
tivi


tie
s f


or
pu


rch
as


es


Ca
lcu


lat
e a


pe
rce


nta
ge


of
th


e r
ep


lac
em


en
t a


nd
ne


w t
ota


ls
ab


ov
e,


us
ing


Bo
x 2


6 a
nd


25
fo


r g
uid


an
ce


(S
ec


tio
n 5


.2)
.


Us
e t


he
pr


ice
es


tim
ate


s f
rom


th
e E


DP
(S


ec
tio


n 7
.1)


, a
nd



ca


lcu
lat


ion
s f


rom
Bo


xes
26


an
d 2


5 (
Se


cti
on


5.
2).


Ca
lcu


lat
e t


he
co


st
of


pre
-in


sta
llat


ion
wo


rk


Us
e y


ou
r s


toc
k v


alu
es


or
pr


ice
es


tim
ate


s f
or


the
eq


uip
me


nt
co


nc
ern


ed
, a


nd
ca


lcu
lat


ion
s f


rom
Bo


x 2
7 (


Se
cti


on
5.


5)
Ca


lcu
lat


e t
he


co
st


of
ma


jor


reh
ab


ilita
tio


n p
roj


ec
ts


De
cid


e w
hic


h t
yp


e o
f C


EE
P t


o
pre


pa
re


Ch
oo


se
a


pe
rce


nta
ge


of
yo


ur
eq


uip
me


nt
sto


ck
th


at
yo


u c
an



aff


ord
to


re
tur


n t
o w


ork
ing


co
nd


itio
n.


Fo
r h


elp
se


e t
he


in
dic


ato
r


un
de


r p
oin


t b
. in


Bo
x 3


6 (
Se


cti
on


7.
1)


an
d t


he
se


co
nd


go
al


in
Bo


x 4
8 (


Se
cti


on
8.


2).


Us
e y


ou
r e


qu
ipm


en
t s


toc
k v


alu
e (


Fig
ure


8,
Se


cti
on


3.
2),


an
d


ca
lcu


lat
ion


s f
rom


Fi
gu


re
20


(S
ec


tio
n 6


.1)
. E


ns
ure


th
e a


mo
un


t is


gre
ate


r th
an


la
st


ye
ar,


to
co


ve
r c


orr
ec


tive
ac


tio
ns


pl
an


ne
d.







Ca
lcu


lat
e t


he
m


ain
ten


an
ce


co
sts


Us
e y


ou
r e


qu
ipm


en
t s


toc
k v


alu
e (


Fig
ure


8,
Se


cti
on


3.
2),


an
d


ca
lcu


lat
ion


s f
rom


Fi
gu


re
20


(S
ec


tio
n 6


.1)
. E


ns
ure


th
e a


mo
un


t is


gre
ate


r th
an


la
st


ye
ar,


to
co


ve
r c


orr
ec


tive
ac


tio
ns


pl
an


ne
d.


Co
nti


nu
ed


op
po


sit
e


7.3.1 Core equipment expenditure plan (CEEP)




183


7.3.1 Core equipment expenditure plan (CEEP)


Us
e y


ou
r e


qu
ipm


en
t s


toc
k v


alu
e (


Fig
ure


8,
Se


cti
on


3.
2),


an
d


ca
lcu


lat
ion


s f
rom


Bo
x 3


0 (
Se


cti
on


6.
2).


En
su


re
the


am
ou


nt
is


gre
ate


r th
an


la
st


ye
ar,


to
co


ve
r c


orr
ec


tive
ac


tio
ns


pl
an


ne
d.


Ca
lcu


lat
e t


he
co


ns
um


ab
le


co
sts


Us
e y


ou
r e


qu
ipm


en
t s


toc
k v


alu
e (


Fig
ure


8,
Se


cti
on


3.
2),


an
d


ca
lcu


lat
ion


s f
rom


Bo
x 3


0 (
Se


cti
on


6.
2).


En
su


re
the


am
ou


nt
is


gre
ate


r th
an


la
st


ye
ar,


to
co


ve
r c


orr
ec


tive
ac


tio
ns


pl
an


ne
d.


Us
e e


ith
er


the
re


lev
an


t o
pe


rat
ing


bu
dg


et
or


yo
ur


eq
uip


me
nt


sto
ck


va
lue


, a
nd


ca
lcu


lat
ion


s f
rom


Bo
x 3


2 (
Se


cti
on


6.
3).


En
su


re
the


am
ou


nt
is g


rea
ter


th
an


la
st


ye
ar,


to
co


ve
r c


orr
ec


tive
ac


tio
ns



pla


nn
ed


.


Us
e e


ith
er


the
re


lev
an


t o
pe


rat
ing


bu
dg


et
or


yo
ur


eq
uip


me
nt


sto
ck


va
lue


, a
nd


ca
lcu


lat
ion


s f
rom


Bo
x 3


2 (
Se


cti
on


6.
3).


En
su


re
the


am
ou


nt
is g


rea
ter


th
an


la
st


ye
ar,


to
co


ve
r c


orr
ec


tive
ac


tio
ns



pla


nn
ed


.
Ca


lcu
lat


e t
he


ad
mi


nis
tra


tive


co
sts


Us
e e


ith
er


yo
ur


sa
lar


y b
ud


ge
t o


r e
qu


ipm
en


t s
toc


k v
alu


e,
an


d
ca


lcu
lat


ion
s f


rom
Bo


x 3
4 (


Se
cti


on
6.


4).
En


su
re


the
am


ou
nt


is
gre


ate
r th


an
la


st
ye


ar,
to


co
ve


r c
orr


ec
tive


ac
tio


ns
pl


an
ne


d.
Us


e e
ith


er
yo


ur
sa


lar
y b


ud
ge


t o
r e


qu
ipm


en
t s


toc
k v


alu
e,


an
d


ca
lcu


lat
ion


s f
rom


Bo
x 3


4 (
Se


cti
on


6.
4).


En
su


re
the


am
ou


nt
is


gre
ate


r th
an


la
st


ye
ar,


to
co


ve
r c


orr
ec


tive
ac


tio
ns


pl
an


ne
d.


Ca
lcu


lat
e t


he
on


-go
ing


tra
inin


g
co


sts


Us
e t


he
di


ffe
ren


t b
ud


ge
t lin


es
(s


ub
-di


vis
ion


s)
a –


i,
de


ve
lop


ed


in
Bo


x 1
0 (


Se
cti


on
3.


3).
Us


e t
he


di
ffe


ren
t b


ud
ge


t lin
es


(s
ub


-di
vis


ion
s)


a –
i,


de
ve


lop
ed



in


Bo
x 1


0 (
Se


cti
on


3.
3).


La
y o


ut
the


se
ex


pe
nd


itu
re


req
uir


em
en


ts
in


a u
se


ful
wa


y


Eit
he


r b
y t


yp
ing


up
th


e d
ata


or
en


ter
ing


it
int


o t
he


co
mp


ute
r.


Tec
hn


ica
l st


aff
wh


o h
av


e b
ee


n t
rai


ne
d a


nd
se


cre
tar


ial/
co


mp
uti


ng
su


pp
ort


ca
n b


e u
se


d t
o a


ss
ist


wi
th


da
ta


en
try


.
Eit


he
r b


y t
yp


ing
up


th
e d


ata
or


en
ter


ing
it


int
o t


he
co


mp
ute


r.
Tec


hn
ica


l st
aff


wh
o h


av
e b


ee
n t


rai
ne


d a
nd


se
cre


tar
ial/


co
mp


uti
ng


su
pp


ort
ca


n b
e u


se
d t


o a
ss


ist
wi


th
da


ta
en


try
.


Co
mp


ile
the


Co
re


Eq
uip


me
nt


Ex
pe


nd
itu


re
Pla


n (
CE


EP
)


By
de


ve
lop


ing
th


e C
ore


Eq
uip


me
nt


Ex
pe


nd
itu


re
Pla


n a
s a


n
ac


tive
(re


gu
lar


ly u
pd


ate
d)


co
mp


ute
r fi


le,
as


we
ll a


s a
ha


rd
co


py
pr


int
-ou


t.
By


de
ve


lop
ing


th
e C


ore
Eq


uip
me


nt
Ex


pe
nd


itu
re


Pla
n a


s a
n


ac
tive


(re
gu


lar
ly u


pd
ate


d)
co


mp
ute


r fi
le,


as
we


ll a
s a


ha
rd


co
py


pr
int


-ou
t.


Ma
na


ge
th


e C
EE


P


To:


the
H


ea
lth


M
an


ag
em


en
t Te


am
fo


r a
pp


rov
al





th
e c


en
tra


l fin
an


cin
g b


od
y s


o t
he


y c
an


ho
no


ur
it.


To:


the
he


alt
h s


erv
ice


pr
ov


ide
r (o


r B
oa


rd,
Tr


us
tee


s,
etc


.)



fo


r a
pp


rov
al


an
d u


se



th


e c
en


tra
l fin


an
cin


g b
od


y f
or


fun
d r


ais
ing


pu
rpo


se
s.


Su
bm


it t
he


CE
EP


On
ly s


pe
nd


fu
nd


s o
n e


qu
ipm


en
t-re


lat
ed


ac
tivi


tie
s a


cc
ord


ing
to



the


de
tai


ls p
res


en
ted


in
th


e C
ore


Eq
uip


me
nt


Ex
pe


nd
itu


re
Pla


n.
Co


mb
ine


th
e C


EE
P w


ith
th


e C
ore


Eq
uip


me
nt


Fin
an


cin
g P


lan


(Se
cti


on
7.


3.2
) to


m
ak


e a
st


rat
eg


ic
bu


sin
es


s p
lan


to
pr


es
en


t to


po
ten


tia
l fu


nd
ing


so
urc


es
.


Ma
ke


us
e o


f th
e C


EE
P


Fo
llo


w t
he


pr
oc


ed
ure


s d
es


cri
be


d i
n S


ec
tio


n 8
.1


Fo
llo


w t
he


pr
oc


ed
ure


s d
es


cri
be


d i
n S


ec
tio


n 8
.1


Up
da


te
the


CE
EP


an
nu


ally


Fig
ure


28
: M


ak
ing


a
Co


re
Eq


uip
me


nt
Ex


pe
nd


itu
re


Pla
n (


co
nti


nu
ed


)




184


Bo
x 4


2:
Ex


am
ple


of
a


Co
re


Eq
uip


me
nt


Ex
pe


nd
itu


re
Pla


n


Ca
pit


al
Ex


pe
nd


itu
re


(U
S$


)


Re
pla


cem
en


t


To
tal


Sh
or


t-t
erm


Lo
ng


-te
rm


20
04


20
05


20
06


20
07


20
08


Ne
w


eq
uip


me
nt


Us
e c


alc
ula


tio
ns


for


rou
gh


est
im


ati
ons



fro


m
Sec


tio
n 5


(s
ee


No
te


bel
ow


)


Us
e c


alc
ula


tio
ns


for


rou
gh


est
im


ati
ons



fro


m
Sec


tio
n 6


(s
ee


No
te


bel
ow


)


NO
TE


: In
th


is e
xam


ple
of


a
gen


era
l C


ore
Eq


uip
me


nt
Exp


end
itu


re
Pla


n,
the


ro
ugh


pr
ice


s fr
om


th
e E


qui
pm


ent
De


vel
opm


ent
Pla


n
(Bo


x 3
8,


Sec
tio


n 7
.1)


an
d t


he
Eq


uip
me


nt
Tra


inin
g P


lan
(B


ox
41


,
Sec


tio
n 7


.2)
ha


ve
bee


n in
cre


ase
d b


y t
he


per
cen


tag
e r


equ
ire


d f
or


the
’p


ack
age


of
m


ate
ria


l in
put


s’ (
see


Bo
x 2


3,
Sec


tio
n 5


.2)
, a


nd
the



tot


al p
lac


ed
in t


he
yea


r c
olu


mn
.


NO
TE


: R
oug


h e
stim


ati
ons


of
th


ese
ca


pit
al c


ost
s h


ave
be


en
cal


cul
ate


d b
ase


d u
pon


th
e p


rice
s fr


om
th


e e
xam


ple
Eq


uip
me


nt
De


vel
opm


ent
Pla


n (
Bo


x 3
8,


Sec
tio


n 7
.1)


, a
nd


the
to


tal
s p


lac
ed


in t
he


yea
r c


olu
mn


.


No
te:


In
itia


lly,
ro


ugh
es


tim
ati


on
s a


re
use


d f
or


the
sh


ort
- a


nd
lo


ng-
ter


m
ov


erv
iew


w
he


n p
rep


ari
ng


thi
s C


ore
Eq


uip
me


nt
Ex


pe
nd


itu
re


Pla
n.


Du
rin


g a
nn


ual
pl


ann
ing






(


see
Se


cti
on


8.1
) th


e e
stim


ate
s a


re
rev


ise
d u


sin
g c


alc
ula


tio
ns


for
sp


eci
fic


req
uir


em
en


ts,
to


ob
tai


n y
ou


r A
nn


ual
Eq


uip
me


nt
Bu


dg
et.


Th
e e


xp
eri


en
ce


yo
u g


ain
fro


m



t


hat
an


nu
al r


evi
sio


n p
roc


ess
m


ay
me


an
tha


t y
ou


ha
ve


to
alt


er
the


lo
ng-


ter
m


est
im


ate
s in


th
is C


ore
Eq


uip
me


nt
Ex


pe
nd


itu
re


Pla
n,


so
tha


t th
ey


are
m


ore
re


alis
tic


.


48
,00


0


2,0
00


Su
pp


ort
ac


tiv
itie


s li
nk


ed
to



pu


rch
ase


s
Pre


-in
sta


llat
ion




Re
hab


ilita
tio


n


Su
b-T


ota
l


Re
cu


rre
nt


Ex
pe


nd
itu


re





(U
S $


)
Eq


uip
me


nt
ma


int
en


anc
e


Co
nsu


ma
ble


s


Ad
mi


nis
tra


tio
n


On
-go


ing
tra


inin
g


Su
b-T


ota
l


To
tal


Ex
pe


nd
itu


re


5,0
00


2,0
00


7,0
00


64
,00


0


25
,00


0


20
,00


0


6,0
00


15
,00


0


66
,00


0


13
0,0


00


NO
TE


: T
he


rou
gh


pri
ces


in
the


Eq
uip


me
nt


De
vel


opm
ent


Pla
n a


nd
the


Eq
uip


me
nt


Tra
inin


g P
lan


ar
e a


lre
ady


inc
lud


ed
in t


hes
e r


oug
h


est
im


ati
ons


of
ge


ner
al r


ecu
rre


nt
nee


ds
per


ye
ar.


7.3.1 Core equipment expenditure plan (CEEP)




185


7.3.1 Core equipment expenditure plan (CEEP)


Figure 28 (page 182) shows how to create a CEEP. This will help you to budget for
the finances required to achieve your health service delivery goals over a set period.
Box 42 shows a possible layout for a Core Equipment Expenditure Plan using the
various budget lines (subdivisions) discussed in Section 3.3. It continues the
example started in Boxes 38 and 41.


How to Create a Strategic Business Plan
The aim of this plan is to ensure that functioning healthcare technology will be
provided, at the level defined by the Model Equipment Lists (Section 4.3), by the
end of a specified period – possibly five or 10 years.
To create a strategic business plan, you simply combine your strategic CEEP with an
outline core equipment financing plan (Section 7.3.2). Depending on your type of
health service provider and your level of autonomy, you can then use this strategic
business plan to raise the necessary finances by approaching potential sources of
funding. You can also use it when planning how to recover costs.


7.3.2 Core Equipment Financing Plan (CEFP)
Having drawn up your Core Equipment Expenditure Plan (either general or
strategic), you need to identify funds from various sources to finance the equipment
expenses. These elements will be laid out in a Core Equipment Financing Plan,
which forms the ‘income’ portion of your Equipment Budget.
You then use the CEFP to allocate the necessary finances. Depending on your type
of health service provider and your level of autonomy, these finances may come from
a variety of different internal, national, or international sources.


Who is Responsible for Developing the Core Equipment
Financing Plan?


Takes what action?
Is responsible for developing the equipment
financing plan


Takes what action?
Can prepare a CEFP as the income portion of their
equipment budget
Are most likely to use the CEFP as part of their
strategic business plan for fund-raising purposes.


Who?
- HTM Working Group, or


smaller planning sub-group
- Finance Officers
Which level?
Any service level


Service levels such as
autonomous or donor-targeted
facilities, districts, regions, or
the centre




186


How to Create a Core Equipment Financing Plan (CEFP)
To create a CEFP, you simply consider your capital and recurrent needs per year from
your CEEP (see Box 42), and determine which type of funding source can finance
which element. Then the results are summarized and presented as the income
portion of your Budget.
Box 43 (overleaf) shows a possible layout for a Core Equipment Financing Plan, and
continues the example figures from Box 42. The layout uses a variety of entries
showing income sources that are either:
◆ internal (your own), such as patient fees, income generating projects
◆ national, such as government grants, sponsorship from local businesses/clubs; or
◆ international, such as grants and loans from external support agencies.
At service levels compiling and overseeing plans for many facilities, the use of
computers and spreadsheets will make the task easier.
Either yourself or the central financing body of your health service provider will need
to ensure that fund-raising activities are carried out and finances are obtained, so
that the planned expenditure (Section 7.3.1) can be allocated. By combining the
Core Equipment Financing Plan with your strategic business CEEP, you can draw up
a strategic business plan to present to potential funding agencies.
Figure 29 shows how to create a CEFP, and allocate sufficient funds to achieve your
health service delivery goals over a set period.
Once you have undertaken the one-off exercise to establish these long-term plans, as
described in this Section, you then update and modify the information during the
annual planning process (Section 8) to create a rolling programme of equipment plans.


7.3.2 Core equipment financing plan (CEFP)




187


7.3.2 Core equipment financing plan (CEFP)


Process Activity


Refers to the Core Equipment
Expenditure Plan (Section 7.3.1)


Considers available funding
sources


Identify expenditure requirements


The HTM Working Group (or its planning sub-group):


Identify:
• internal funds available from your own resources, such as your
budget, sales of equipment, fees, or income generating
projects
• national funds available from government or your health
service provider, such as grants, loans, donations, sponsorship
from local clubs, or promotional activities
• identify international funds available from external support
agencies, such as grants, loans, or donations.


Allocates finances against all
expenditure needs


Identify which sources can finance which expenditure
requirements.


Lays out the financing plan
according to the various funding
sources


Use the example of a Core Equipment Financing Plan in Box 43
to present the income according to internal, national, and
international sources.


Compiles the Core Equipment
Financing Plan (CEFP)


Either by typing up the data or entering it into the computer.
Trained technical staff and secretarial/computing support can
be used to assist with data entry.


Manages the CEFP By developing the CEFP as an active (regularly updated) computer file, as well as a hard copy print-out.


Submits the CEFP
To:
• the health service provider (or Board, Trustees, etc.) for
approval and use
• the central financing body for fund raising purposes.


Implements the CEFP


By:
• applying for grants, loans or donations, fund-raising, starting
income generating projects, and lobbying for finances
• combining the CEFP with the Core Equipment Expenditure
Plan to create a strategic business plan and presenting it
potential funding bodies.


Uses the CEFP when allocating
funds


Only allocate funds for equipment expenditures according to the
details presented in the Core Equipment Financing Plan.


Updates the CEFP annually Follow the procedures described in Section 8.1.


Figure 29: Making a Core Equipment Financing Plan




188


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189


Box 44 contains a summary of the issues covered in this Section.


Section 7 summary


BOX 44: Summary of Procedures in Section 7 on Making Plans and Budgets


HTM Working
Group
(or Planning
Sub-group)


Health
Management
Team
HTM Working
Group
(or Training
Sub-group)
Health
Management
Team


HTM Working
Group
(or Planning
Sub-group)


Health
Management
Team


Bu
dg


et















ET


P











ED
P


◆ uses the planning tools to establish an Equipment Development Plan for the short-
and long-term, either:
- a basic one at facility level (according to Figure 25), or
- a summarized one at higher service levels (using strategies in Box 39)


◆ updates the Equipment Development Plan annually (Section 8.1)
◆ implements the Equipment Development Plan


◆ uses the Equipment Development Plan and training requests to establish an
Equipment Training Plan as an ongoing rolling programme (according to Figure 27)


◆ updates the Equipment Training Plan annually (Section 8.1)


◆ consults with the health service provider organization in order to:
- identify the central training plans
- identify the scholarships available
- lobby for external resources for the training required


◆ implements the Equipment Training Plan.
◆ uses the Equipment Development Plan, Equipment Training Plan, and budgeting


tools to establish either a general or strategic Core Equipment Expenditure Plan
(CEEP) for the short- and long-term (according to Figure 28), as the expenditure
portion of the budget


◆ considers all possible funding sources to establish a short- and long-term Core
Equipment Financing Plan (CEFP) as the income portion of the budget (according
to Figure 29)


◆ updates the Core Equipment Expenditure Plan and the Core Equipment
Financing Plan annually (Section 8.1)


◆ combines the strategic CEEP and the CEFP to create a Strategic Business Plan to
present to potential funding sources when fund-raising.


◆ implements the Core Equipment Expenditure Plan
◆ implements the Core Equipment Financing Plan
◆ makes use of the strategic business plan.




190




191


8. HOW TO UNDERTAKE ANNUAL
PLANNING, BUDGETING, AND
MONITORING


Why is This Important?
Having drawn up your short- and long-term equipment plans and budgets,
you will need to carry out some annual planning and budgeting to find out
what activities you can attempt each year within these goals. This allows you
to revise the overall plans as time goes by.
Managing the activities described in this Guide will involve a cycle of actions.
You need to monitor your performance, and set yourself goals so that you can
improve. Then you monitor your progress, revise your goals, and review your
progress again – thus undertaking a continuous cycle of planning and review.
Such evaluation helps you to ensure the quality of your work. This is one
element of quality management – an important goal for managers.


The planning and review activities are interlinked in a cycle, as shown in Figure 30,
but it is necessary to start the discussion at some point in the cycle. This Section
discusses:
◆ the annual planning and budgeting process (setting goals) in Section 8.1
◆ the review process (monitoring progress) in Section 8.2.


Figure 30: The Planning and Review Cycle


8. How to undertake annual planning, budgeting and monitoring


Set/Revise
Goals Monitor Performance/Progress


action


feedback




192


All staff involved in equipment planning and budgeting should be involved in
planning and reviewing their progress with this work. Therefore, this Section is
relevant for all different types of personnel, including:
◆ staff from the equipment-user departments
◆ HTM Teams
◆ HTM Working Groups (managers, technicians, finance officers, health workers, etc.)
◆ their various sub-groups.
The main outcome of the planning and review process is that you are able to evaluate
your performance. This is important for ensuring the quality of your work (quality
assurance), which is an essential component of quality management.


Aims of Quality Management
◆ client satisfaction
◆ cost efficiency
◆ compliance with laws


We recommend that quality management is introduced into the health management
systems of all the decentralized levels of the health service. It can help to improve
staff attitudes and this, in turn, can help staff handle the challenges connected with
the many reforms and new management tasks they face (such as those described in
this Guide). Important elements of quality management are:
◆ a management team approach
◆ supervision and evaluation
◆ participative leadership
◆ methods for encouraging staff
◆ individual responsibility and initiative
◆ control measures such as performance measurements and impact analysis
◆ community participation.


8.1 ANNUAL EQUIPMENT PLANNING AND
BUDGETING (SETTING GOALS)
Each facility and service level needs to have goals and plans which set out their
priority activities. The goals and plans must be clearly defined so that they guide the
work of:
◆ health facilities
◆ service levels
◆ their staff
◆ the health service as a whole.


8. How to undertake annual planning, budgeting and monitoring




193


8.1 Annual equipment planning and budgeting (setting goals)


The goals and plans also enable staff and managers to monitor their own performance
and progress with regard to the planning and budgeting of equipment.
Every department or team can benefit from Annual Action Plans which contain
clear, specific goals relating to its key activities. An action planning process should
take place once a year, as standard practice. This is an opportunity for the teams to
agree the range of activities (initiatives and changes) they want to implement.
The annual action planning process for normal departmental activities is described
in Guides 4 and 5. However, there are boundaries and limitations to such
departmental planning, and the needs for major investments in equipment, staff,
and resources are normally discussed outside their annual process. In this Guide, we
outline the planning processes required for such major investments. For example:
◆ major equipment needs fall under the Equipment Development Plan (Section 7.1)
◆ skill development for equipment falls under the Equipment Training Plan


(Section 7.2), although hiring of staff and other skill development needs fall
outside the scope of this Guide


◆ resources for equipment fall under the Equipment Budget (Section 7.3),
although resources for other aspects of healthcare work also fall outside the scope
of this Guide.


Having drawn up short-term (one to two years) and longer-term (three to five
years) equipment plans and budgets, you will need to carry out the following
activities annually:
◆ review the activities planned for the year
◆ determine the activities you can pursue
◆ identify and allocate your funds for those purposes
◆ revise the long-term plans.
This is the annual planning and budgeting process, and involves:
◆ identifying needs
◆ costing them
◆ prioritizing which activities will occur in the coming year.
From the Equipment Development Plan you need to prioritize your requirements
annually according to available funds, and therefore determine the:
◆ Annual Purchase Activities (APA) for replacement and new equipment, including


all material inputs (stocks of accessories, consumables, spare parts) and associated
work (such as pre-installation, installation, commissioning, initial training)


◆ Annual Rehabilitation Activities (ARA) for major large-scale renovation projects
◆ Annual Corrective Activities (ACA), for undertaking repairs, introducing PPM,


increasing consumable inputs, and ensuring administrative inputs are available.




194


From the Equipment Training Plan you need to prioritize your requirements
annually according to available funds, and therefore determine the:
◆ Annual Training Activities (ATA).
These capital and recurrent requirements combined will determine the expenditure
and income portions of your Annual Equipment Budget (AEB).
All your long-term plans (and many of your planning tools) are active records. In other
words, they must be kept up-to-date if they are to be of any use. Data used for planning
and budgeting purposes is of little help if it is out of date. Identifying equipment needs
on an annual basis enables you to keep your plans and tools up-to-date.


Who is Responsible for Annual Planning and Budgeting?


How to Undertake Annual Planning and Budgeting
The timing of your actions is important. Your plan must be produced in time for your
health service provider’s deadline for submitting budget estimates. This will be
determined by the timing of the financial year, and the time required for the
negotiation process between your health service provider and the central financing
authority. Figure 31 shows a time-line in your annual calendar for the steps in your
planning and budgeting process, in relation to your health service provider’s deadlines.
As Figure 31 illustrates, the process of undertaking annual planning and budgeting
involves the following six steps:
Step 1 – Update your Equipment Inventory
Step 2 – Review your Equipment Development Plan to determine your annual needs
Step 3 – Review your Equipment Training Plan to determine your annual needs
Step 4 – Cost the annual needs
Step 5 – Review your Core Equipment Expenditure Plan and Core Equipment


Financing Plan, prioritize the needs, and prepare proposed annual plans
Step 6 – Update existing plans with final agreed Annual Plans and Budgets, once


funding has been approved.


8.1 Annual equipment planning and budgeting (setting goals)


Takes what action?
Are responsible for annual planning and budgeting


Takes what action?
Needs to undertake annual planning and budgeting


Who?
- HTM Working Group, or


its planning sub-group and
training sub-group


- HTM Team (which
prepares background
technical information)


Which level?
Every service level




195


8.1 Annual equipment planning and budgeting (setting goals)


Ste
p 1


An
nu


al
inv


en
tor


y
up


da
te


Ste
p 2


An
nu


al
rev


iew
of


Eq
uip


me
nt


De
ve


lop
me


nt
Pla


n (
ED


P)


Ste
p 3


An
nu


al
rev


iew
of


Eq
uip


me
nt


Tra
inin


g
Pla


n (
ET


P)


Ste
p 4


Co
st


the
ED


P a
nd


ET
P


Ste
p 5


Re
vie


w C
ore


Eq
uip


me
nt


Ex
pe


nd
itu


re
Pla


n (
CE


EP
) a


nd
Co


re
Eq


uip
me


nt
Fin


an
cin


g P
lan



(C


EF
P),


pr
ior


itiz
e f


un
ds


, a
nd



pro


po
se


an
nu


al
pla


ns
an


d
bu


dg
ets


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nu


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Pu


rch
as


e A
cti


viti
es


An
nu


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Re


ha
bil


ita
tio


n A
cti


viti
es


An
nu


al
Co


rre
cti


ve
Ac


tivi
tie


s
An


nu
al


Tra
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g A
cti


viti
es


An
nu


al
Eq


uip
me


nt
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dg
et


Ste
p 6


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g-t
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ns


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d


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dg


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an


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ina


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nu


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ac


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FP


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te


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t b


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he


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h


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rvi


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pro


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iss


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es


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fro


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h


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rvi


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ac


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TA
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D


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E


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ls
thr


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gh


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ea


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ure


31
: A


nn
ua


l C
ale


nd
ar


for
th


e P
lan


nin
g a


nd
Bu


dg
eti


ng
Pr


oc
es


s




196


The activities you need to undertake for each of these six steps are outlined over the
following pages.
Step 1 – Update your Equipment Inventory
Use the process shown in Figure 32.


Figure 32: Updating the Equipment Inventory as part of the Annual Planning Process


8.1 Annual equipment planning and budgeting (setting goals)


Ensures that the inventory
master/computer record
contains the updated
information gathered during
the year


Throughout the previous year, correct the existing record with
details on:
• new equipment arrivals
• service history details (see Guide 5) on equipment no longer
working
• equipment taken out of service


Identify:
• the training sources to be used (see Box 40 in Section 7.2);
• the resources required to undertake the training (see Box 33).


Prints out a hard copy of the
current Equipment Inventory
(Section 3.1).


To write notes on during the equipment inventory up-date
process.


Every year, prior to the Equipment Development Planning
process, and in time for the preparation/submission of budget
estimates (set at a time in the calendar determined by your
health service provider organization – see annual calendar in
Figure 31).


Sends an inventory team
(Section 3.1) to visit each
department


To:
• physically check equipment
• update the inventory records, using either the hard-copy print
out or some type of data-capture form (such as the one shown
in Box 5, Section 3.1).


Discusses the findings
To decide whether it is time to condemn a piece of equipment
according to the principles in the Replacement and Disposal
Policies (Section 4.4).


HTM Manager and his/her Team (from a workshop):


Organizes a formal inventory
update


When?


Why?


When?


Why?


Why?


Submits this report to the HTM
Working Groups (or its planning
sub-group)


In time for the annual review of the Equipment Development
Plan – Step 2 of the annual planning and budgeting process
(see Figure 33).


When?


Updates the inventory master/
computer record


Enter the notes from the marked-up print-out or the data-capture
forms onto the master record in order to update it.How?


Compiles a written report


Include:
• those items of equipment which present problems (and require
corrective actions – consumables, training, repairs, etc)
• those items requiring major rehabilitation
• those items condemned/written off
• those items requiring replacement, according to the
replacement and disposal policies (Section 4.4).
NOTE: Since the condemning and disposal of equipment is
meant to automatically trigger its replacement (Section 4.4), the
HTM Manager refers to his equipment disposal records (see
Guide 4) and ensures these items are included in the report.


How?




197


Step 2 – Review your Equipment Development Plan and determine your
needs for the coming year


Use the process shown in Figure 33.


Figure 33: Reviewing the Equipment Development Plan to Determine your Annual Needs


8.1 Annual equipment planning and budgeting (setting goals)


Ensures it updates the
Equipment Development Plan
(EDP) annually


After the Equipment Inventory update (Figure 32), and in time for
the preparation and submission of budget estimates
(see Figure 31)


Print out a hard copy of the
EDP (Section 7.1).


To determine which of last year's planned actions were not
completed and are still outstanding.


To study the current details on:
• problem equipment
• those items requiring corrective actions, such as maintenance,
consumables, administrative inputs, etc.
• those items requiring major rehabilitation
• those items already condemned
• those items requiring replacement


Talks to users and department
heads


To determine:
• their priorities
• urgent needs for absent equipment (items from the Model
Equipment List which are missing).


Reviews the intended plans for
the coming year from the
long-term EDP


To decide:
• if any changes should be made
• which actions should be attempted in the coming year


HTM Working Group (or its planning sub-group):


Considers the report submitted
by the HTM Manager following
the Equipment Inventory
update (see Step 1 – Figure 32)


When?


Why?


Why?


Why?


Why?


Draws up the equipment
development proposals for the
coming year


To be considered when all needs are prioritized – Step 5 of the
annual planning and budgeting process (see Figure 36).Why?


Passes the EDP proposals
onto the training sub-group


In time for the annual review of the Equipment Training Plan –
Step 3 of the annual planning and budgeting process
(see Figure 34).


When?


Updates the existing EDP with
the decisions for the coming
year and any implications for
the long-term.


After the plans are finalized – Step 6 of the annual planning and
budgeting process (see Figure 37).When?


Revises the existing EDP on file
according to its layout (see
Boxes 37 and 38, Section 7.1)


By:
• correcting any of the equipment particulars, as necessary
• making any alterations regarding the condition of the
equipment
• adding to the list any equipment required to provide new
services, which may have arisen from changes in the Vision
(Section 4.2).


How?




198


Step 3 – Review your Equipment Training Plan and determine your needs
for the coming year


Use the process shown in Figure 34.


Figure 34: Reviewing the Equipment Training Plan to Determine your Annual Needs


8.1 Annual equipment planning and budgeting (setting goals)


Ensures it updates the
Equipment Training Plan (ETP)
annually


After the review of the Equipment Development Plan (Figure 33),
and in time for the preparation and submission of budget
estimates (see Figure 31).


Print out a hard copy of the
ETP (Section 7.2).


To review:
• which of last year's planned actions were not completed and
are still outstanding (Section 8.1)
• the intended plans for the coming year from the long-term
Equipment Training Plan
• the requests for training interventions prompted by the
Equipment Development Plan (see Figure 33), reports of
performance with equipment (see Guides 4 and 5), and
monitoring (Section 8.2).


By considering:
• the staff and trainers to be trained in the coming year (see
Figure 17, Section 5.4.2)
• the training sources to be used (see Box 40, Section 7.2)
• the resources required to undertake the training (see Box 33,
Section 6.4).


Talks to users and department
heads about their priorities


Draws up the training
proposals for the coming year


To be considered when all needs are prioritized – Step 5 of the
annual planning and budgeting process (see Figure 36).


To decide:
• if any changes should be made to existing plans
• which actions should be attempted in the coming year


HTM Working Group (or its training sub-group):


Determines the relevant
training requirements


When?


Why?


How?


Why?


Why?


Passes the training proposals
onto the planning sub-group


In time for the costing of proposed plans – Step 4 of the annual
planning and budgeting process (see Figure 35).When?


Updates the existing ETP with
the decisions for the coming
year and any implications for
the long-term.


After the plans are finalized – Step 6 of the annual planning and
budgeting process (see Figure 37). When?




199


Step 4 – Cost the annual needs using the calculations for specific
(annual) estimates


Use the process shown in Figure 35.


Figure 35: Costing Your Annual Needs


8.1 Annual equipment planning and budgeting (setting goals)


Ensures it costs the proposed
annual plans


After the annual planning process (Figures 32 – 34), and in time
for the preparation and submission of budget estimates (see
Figure 31).


Refers to the proposed annual
equipment development and
training plans, and costs the
proposed actions using the
specific (annual) estimates


• use Boxes 24 & 25 (Section 5.2) to cost purchases of
replacement equipment and new items, together with their
‘packages’ of material and transport inputs
• use Figure 16 (Section 5.4.1) to cost any installation and
commissioning work
• use Figure 17 (Section 5.4.2) to cost any initial training linked
to the purchases
• use Figure 15 (Section 5.3) to cost any pre-installation work
• use Figure 18 (Section 5.5) to cost major rehabilitation work
(including maintenance contracts)
• use Box 29 & Figure 21 (Section 6.1) to cost maintenance
requirements (including maintenance contracts)
• use Figure 22 (Section 6.2) to cost any operating consumable
requirements.
• use Figure 23 (Section 6.3) to cost any administrative
requirements;
• use Figure 24 (Section 6.4) to cost any on-going training
requirements.


HTM Working Group (or its planning sub-group):


When?


Ensures there is a correct
balance between capital and
recurrent budgets


Remember:
• if you reduce the proposed amount of replacement items to
be purchased, you must increase the maintenance budget as
it will have to cover existing old equipment (Section 6.1);
• if you reduce the maintenance budget, you should increase
the amount of replacement items to be purchased so that more
of the facility's equipment stock can be returned to a working
and repairable condition (Section 5.1);
• if you plan to purchase new additional items of equipment,
you must increase the recurrent budgets for maintenance and
consumables as they will have to cover the running costs of a
larger stock of equipment (Section 3.3).


How?


Checks the totals to ensure the
estimates are of the right order
of size


For example:
* the maintenance estimate is a suitable percentage of the
equipment stock value (see Figure 20, Section 6.1)
* the replacement estimate is a suitable percentage of the
equipment stock value (see Figure 14, Section 5.1).


How?


Lays out these expenditure
requirements in a useful way


Use the different budget lines (sub-divisions a–i – see Box 10)
developed in Section 3.3.How?


Considers possible funding
sources for different elements
of expenditure


Use the different income elements of the Core Equipment
Financing Plan (internal, national, and international – see
Box 43) developed in Section 7.3.2.


How?


Uses these budget proposals
when prioritizing the annual
needs


Follow Step 5 of the annual planning and budgeting process
(see Figure 36).How?


How?




200


Step 5 – Review the Core Equipment Expenditure Plan and Core
Equipment Financing Plan, prioritize what you can do in the
coming year, and prepare various proposed Annual Plans


Use the process shown in Figure 36, having considered the following issues.
It is quite common to be faced with a wide range of tasks, so you will need to
prioritize between them. If money is short, you must choose to cut activities in such
a way as to minimize the effect on healthcare delivery. The tasks you attempt can be
chosen according to how important the equipment is for clinical operations. For
example, one suggestion is to concentrate on:
plant covering: medical equipment covering:
sterilization operating theatres (e.g. suction pumps)
electricity supply (including the generator) syringes
water supply anaesthetics
laundry basic laboratory (e.g. microscope)
refrigeration ultrasound (maternal/obstetric)
kitchen X-ray departments
steam for heating labour/delivery
sewage and sanitation installations basic diagnostics (e.g. BP machines)
cooling/air-conditioning (if climate is very hot)


Contrary to popular belief, sophisticated and electronic medical equipment are not
always the most important items to own and maintain. In terms of patient care and
comfort, items such as sufficient water, power generation for operating theatres,
effective sterilizers, and good beds are of greater importance than ECG or X-ray
machines. Box 45 shows a strategy used by some planners for working out which
equipment should be the first priority for purchase or corrective actions.


8.1 Annual equipment planning and budgeting (setting goals)




201


BOX 45: The VEN (or VED) System for Prioritizing Actions
Planners in several countries use a VEN (VED) system which helps to set priorities for taking actions on
equipment and deciding what to do first. Under this system, you do not simply consider the value or
complexity of the equipment or task, but you consider the effect on health service delivery if the equipment
is not available for use. Thus items are categorized as:
Vital – items that are crucial for providing basic health services and should be kept


functioning at all times (for example, electrical generator, operating theatre light,
suction pump in the theatre, mortuary refrigerator)


Essential – items that are important but are not absolutely crucial for providing basic health
services and a period when they are out of operation can be tolerated (for example,
suction pump in a ward, dental compressor, physiotherapy ultrasound)


Not so essential/ – items that are not absolutely crucial for providing basic health services. In other
words, it is possible to adapt and plan around their absence if they are out of
operation (for example, ECG recorder, lift, a back-up X-ray machine).


The same types of equipment can have various different classifications depending on their location. For
example, a microscope may be considered ‘vital’ in the main laboratory but only ‘not so essential/desirable’ in
the out-patients department (OPD).
If funds are limited, actions involving vital items should be given first priority, followed by those involving
essential items, and so on.


8.1 Annual equipment planning and budgeting (setting goals)


Desirable




202


Figure 36: Reviewing the Core Equipment Expenditure Plan and Core Equipment Financing
Plan, Prioritizing the Allocation of Funds, and Preparing Proposed Annual Plans
and Budgets.


8.1 Annual equipment planning and budgeting (setting goals)


Ensures it prioritizes and
prepares the annual plans
and budgets


After the annual costing process (Figure 35), and in time for the
submission of budget estimates (see Figure 31).


Prints out a hard copy of the
Core Equipment Expenditure
Plan (CEEP) and Core
Equipment Financing Plan
(CEFP) (Section 7.3)


HTM Working Group (or its planning sub-group):


When?


Studies the proposed costs
and incomes for the year,
made in Step 4 of this annual
process (see Figure 35)


To decide:
• if any changes should be made to the expenditure plans
• which actions can be covered by the financing plans.


To review:
• the expenditure and income intended for the coming year in
the long-term plans
• which of last year's planned expenditures were not spent
• which of last year's planned incomes did not materialize.


Why?


If the annual needs are too
great, prioritizes the
requirements across the
service level as a whole


According to:
• the overall goals in the long-term Equipment Development
Plan, Equipment Training Plan, and Core Equipment
Expenditure Plan
• the principles of the purchasing, donations, replacement
and disposal policies (Section 4.4);
• the available finances and goals of the Core Equipment
Financing Plan;
• how important the equipment is for clinical operations
(see Box 45).


How?


As a result of this prioritization
process, determines various
annual plans


• the proposed purchases for replacement and additional
equipment for the current year – the Annual Purchase Activities
(APA) for equipment;
• the proposed major rehabilitation projects for the current
year – the Annual Rehabilitation Activities (ARA) for equipment;
• the proposed corrective actions for the current year
(maintenance, consumables, administrative inputs, etc.) – the
Annual Corrective Activities (ACA) for equipment.
• the proposed training for the current year – the Annual Training
Activities (ATA) for equipment.


What?


As a result, develops the
overall equipment budget
which will be required in the
current year


• the income and expenditure portions of the Annual Equipment
Budget (AEB) which will cover all capital and recurrent costs
for equipment.


What?


Prints and distributes copies of
the proposed APA, ARA, ACA,
ATA, and AEB


For the Health Management Team (including all heads of
section) so they can study and comment on themWhy?


Updates the existing CEEP and
CEFP with the final decisions
for the coming year and any
implications for the long-term


After the plans are finalized – Step 6 of the annual planning and
budgeting process (see Figure 37).When?


Why?




203


8.1 Annual equipment planning and budgeting (setting goals)


Step 6 – Finally, when your budget has been approved by the central
health service provider, you update the EDP, ETP, CEEP, and
CEFP with the final agreed Annual Plans and Budgets


Use the process shown in Figure 37, having considered the following issues.
Of course, your health service provider may not have provided you with all the funds
requested. In this case, you will have to undertake another round of prioritization
using the principles discussed under Step 5. We recognize that there may also be
problems with the flow of money and the time it arrives at each health facility
(Section 8.2).


Figure 37: Updating All Long-term Plans and Budgets with the Final Agreed and Financed
Annual Actions


Ensures it remembers to
update all the long-term plans
when the final decisions for the
coming year are approved


After the Budget has been approved by the health service
provider at a time determined by them (see Annual Calendar in
Figure 31).


Studies the Budget provided
by the health service provider


HTM Working Group (or its various sub-groups):


When?


To determine:
• what changes or cuts have been imposed
• which actions can be financed in the coming year.


Why?


Revises the existing annual and
long-term plans


So that the annual and long-term plans can reflect the actions
and decisions made for the current year.Why?


Prints and distributes final
revised copies of the APA,
ARA, ACA, ATA, and AEB


For the Health Management Team (including all heads of
section) so they can act on them.Why?


Enters the final agreed
actions/decisions onto the
master (computer) records for
the annual and long-term plans


Update:
• the Annual Purchase Activities (APA), Annual Rehabilitation
Activities (ARA), Annual Corrective Activities (ACA), Annual
Training Activities (ATA), and Annual Equipment Budget
(AEB) – see Figure 36 – with the actions/decisions for the
coming year;
• the EDP, ETP, CEEP, and CEFP (see Figures 33, 34 and 36)
with the actions/decisions for the coming year and any
implications for the long term.


How?


If the annual needs have been
cut, prioritizes the requirements
across the service level as a
whole


According to:
• the overall goals in the long-term Equipment Development
Plan (EDP), Equipment Training Plan (ETP), and Core
Equipment Expenditure Plan (CEEP);
• the principles of the purchasing, donations, replacement, and
disposal policies (Section 4.4);
• the available finances and goals of the Core Equipment
Financing Plan (CEFP);
• how important the equipment is for clinical operations
(see Box 45).


How?




204


Once these plans are ready, other staff will need to implement the plans, as follows:
Finance Officer submits the budgetary requirements in the


Annual Equipment Budget to the central
financing body of the health service provider


Central Financing Body raises and allocates all (or part) of the funds
requested


Health Management Team on receipt of the funds:
◆ further prioritizes actions if funds are cut
◆ raises additional funds (if allowed and required to)
◆ allocates sufficient budgets to cover all the


annual work plans agreed.
Purchasing and Supplies Officer ◆ buys equipment only according to the agreed


Annual Purchase Activities
◆ liaises with the Specification Writing Group


regarding the necessary Generic Equipment
Specifications (Section 4.5), and purchase
contract details (see Guide 3)


◆ liaises with the relevant users to raise the
‘Purchase Order Requisitions’ and initiates the
normal process for purchasing (see Guide 3 for
more details on these procedures).


Box 46 provides an example of the annual action plan taken from the sample
Equipment Development Plan (see Box 38) and the sample Equipment Training
Plan (see Box 41). This assumes that the health facility concerned is large enough
to have an HTM workshop of its own and shows its needs. For smaller health
facilities, these requirements would be covered by the annual plan for the
district/regional HTM Service.
As the example shows, the actions have had to be altered because:
i. some activities will have been left over from the previous year which need


completing
ii. emergency activities may have arisen
iii. some activities can no longer be afforded.


8.1 Annual equipment planning and budgeting (setting goals)




205


BOX 46: Sample Annual Action Plans for Equipment (using examples for 2005 from Boxes 38 and 41)
Plan Actions (comments on changes from the EDP and ETP)
Annual Purchase
Activities (APA)


Annual Rehabilitation
Activities (ARA)


Annual Corrective
Activities (ACA)


Annual Training
Activities (ATA)


Box 47 provides an example of the annual equipment budget showing the
expenditure and financing plans taken from the sample Core Equipment Expenditure
Plan (see Box 42) and the sample Core Equipment Financing Plan (see Box 43). It
continues with the examples which were shown in Box 42 and Box 43. However, as
can be seen, the figures are altered because:
i. when you prepare your annual budget your calculations are more realistic than


the original long term estimates
ii. you must cut your planned expenditure to fit your likely income.


8.1 Annual equipment planning and budgeting (setting goals)


◆ replace the casualty ECG recorder
◆ replace one instrument set for the CSSD (number reduced from original EDP)
◆ replace the dental suite
◆ purchase two foetal heart detectors (number reduced from original EDP)
◆ purchase package of material inputs for these items, as necessary
◆ purchase package of support inputs for these items, as necessary
◆ undertake pre-installation work for these items, as necessary
◆ overhaul the generating set
◆ overhaul half the beds (left over from 2004)
◆ service the automatic film processor
◆ introduce PPM for electrical installations
◆ continue PPM for plumbing installations
◆ source and purchase red safe-light filters
◆ purchase correct X-ray developer and fixer
◆ purchase safety clothes for the maintenance workshop staff
◆ purchase maintenance report files for user department
◆ purchase maintenance record files for the workshop
◆ re-train clinical officers and nurses on ECG recorder use
◆ upgrade laundry staff skills in laundry procedures
◆ re-train technicians on photometer repairs
◆ PPM training for artisans on compressors
◆ upgrade artisans’ craft certificates (left over from 2004)




206


BOX 47: Sample Annual Equipment Budget (using examples for 2005 from Boxes 38 and 41)


Income [US$] Expenditure [US$]
(update figures with current more exact estimates) (use calculations for specific annual estimates)


Note:
i. If at the end of the year your expenditure is less than your income, you will have a retained surplus/profit for use


in the following year (if you are allowed to keep it and do not have to return it to the central financing body such as
the treasury).


ii. If towards the end of the year your expenditure looks as though it may exceed your income, you will have to cut
your expenditure in order not to be in debt.


8.1 Annual equipment planning and budgeting (setting goals)


Category


Own resources
Accumulated retained surplus
from previous year
Income from sale of equipment
Patient fees
Income generating projects
National resources
Government grants
Government loans
Donations
Local business sponsorship
International resources
External support agency grants
External support agency loans
Donations
Total Income


Budget
(comments on
changes from
example CEFP)


450 (less)
600 (more)
1,600 (less)
3,100 (more)


87,000 (less)
550 (less)
1,200 (more)
2,500 (more)


20,000
5,000
1,300 (more)
123,300 (less)


Category


Capital
Replacement
New equipment
Installation and commissioning


Initial training
Pre-installation
Rehabilitation
Recurrent
Equipment maintenance
Consumables
Administration
Ongoing training


Total Expenditure


Budget
(comments on
changes from
example CEFP)


44,500 (cut)
1,600 (cut)
3,000 (estimate too
high)
500
2,000
8,900 (need more)


25,600 (need more)
19,500 (need less)
5,500 (need less)
12,200 (estimate too
high)


123,300 (less)


8.2 MONITORING PROGRESS
An important part of the management of equipment-related activities is the
identification of problems and needs. All equipment-related activities should be
monitored and evaluated, and the performance of equipment, staff, and departments
should be supervised (this applies to all clinical, technical, and support
departments). The results of such monitoring are useful for providing feedback to:
◆ staff
◆ Health Management Teams
◆ the Healthcare Technology Management Service.




207


8.2 Monitoring progress


This feedback is beneficial as it enables you to learn from your actions, and
incorporate the lessons learned into the next round of planning and budgeting.
Each goal you set yourself must be easily measured, so that you can see if it has been
achieved or if progress is being made:
◆ You need a way of determining if you are moving towards your goal – this is called


an indicator. There will always be several possible indicators for each goal, and
more than one way of measuring them.


◆ You need to know where you are starting from, in other words, what the current
situation is – this is called the baseline data. The data chosen must be relevant
to the indicator.


Box 48 provides examples of different ways of measuring a goal using indicators and
baseline data. The examples use calculations that were mentioned during the
analysis part of the equipment development planning process (see Box 36 in
Section 7.1).


BOX 48: Examples of How to Measure Goals
Goal: Let’s ensure that the health service we deliver is not deteriorating
An indicator: Increase the number of equipment items on the inventory which are replaced at


the end of their useful life
Calculation required:
Percentage of items on your Equipment Inventory which are within their expected lifespans
= Number of equipment on inventory within its expected lifespan x 100 per cent


Total number of equipment on inventory
Baseline data: You have 150 pieces of equipment on your inventory. In August, you identify that


40 of these items are so old they need replacing. Therefore, there are 110 items
within their expected lifespan.
Therefore your baseline data is 73.3 per cent.
Your aim is to improve this situation and increase this percentage.


Goal: Let’s have as much equipment as possible in a working condition
An indicator: Increase the completion of outstanding equipment repairs and renovations
Calculation required:
Percentage of your Equipment Inventory which has been returned to working order
= Number of equipment on inventory in working order x 100 per cent


Total number of equipment on inventory which could be in working order
Baseline data: You have 150 pieces of equipment on your inventory. In August, you identify that


only 110 of these are within their expected lifespan and could be in working order.
However, you find only 75 in working order.
Therefore your baseline data is 68 per cent.
Your aim is to improve this situation and return an additional 10 items to working
order by the end of December.


Continued overleaf




208


BOX 48: Examples of How to Measure Goals (continued)
Goal: Let’s ensure we have enough equipment to offer basic health services
An indicator: Decrease the shortfall of equipment
Calculation required:
Percentage of your Model Equipment List available on your Equipment Inventory
= Number of items on Model Equipment List missing from your Inventory x 100 per cent


Number of equipment items on Model Equipment List
Baseline data: Your Model Equipment List contains 200 items. You find that 50 of these are not


on your Equipment Inventory.
Therefore, your baseline data is 25 per cent – i.e. a quarter of the model list is missing.
Your aim is to improve this situation and decrease this percentage.


It will be necessary to choose suitable indicators that are specific to all your annual
goals. There are many possible indicators for planning and budgeting, so HTM staff
and managers should look for the most important activities (or statistics and results)
to measure. Some examples of the types of indicators which can be used for
equipment planning and budgeting are those describing:
◆ the existing situation - numbers of generic equipment specifications available


- a vision available for each service level
- an equipment inventory established


◆ improved performance - the budget set meets the equipment needs
- income raised meets expenditure requirements


◆ cost-effectiveness - enough equipment is available so that it is possible to
manage/treat a significant number of patients
satisfactorily


- the right equipment is available to significantly reduce
other expenses such as length of hospital stay, need for
referrals to a more expensive higher level facility,
expensive personnel or expensive drugs


- equipment is specified which is not too dependent on
foreign skills for spare parts and maintenance.


The HTM Teams, HTM Working Groups, and Health Management Teams should
meet to agree on a few suitable indicators that can be measured easily and quickly (if
possible). Positive indicators are preferable as they motivate staff. Sometimes it is
useful to use common indicators for different teams, groups, and staff, so that their
progress can be compared.


8.2 Monitoring progress




209


Once the indicators have been agreed, they will need regular measuring and charting.
It is necessary for the relevant Health Management Team to decide:
◆ how records of these indicators will be kept (for example, whether in a register,


with a form, or on a chart)
◆ who will be responsible for keeping them
◆ how regularly the results will be summarized (for example, every quarter)
◆ what form of charts and displays will be used to show the quarterly summarized


results (so that it is easy for people to see how they are progressing).
Monitoring progress involves a number of different activities. In this Section, the
monitoring activities described are:
◆ monitoring progress with the activities in the annual equipment plans and


budgets which were set in Section 8.1 (Section 8.2.1)
◆ monitoring progress in general with your planning and budgeting activities


(Section 8.2.2).


Who is Responsible for Monitoring Progress?


8.2.1 How to Monitor Progress Against Annual Equipment
Plans and Budgets
Monitoring progress against goals is one of the best ways that staff, managers, and
the health service provider can judge their work performance. Thus, it is necessary to
follow up the goals set in the equipment plans and budgets (Section 8.1), in order to
ensure that they are put into practice. If this is not done and goals sit on a shelf
gathering dust, then all the time spent planning will have been wasted.
Several aspects of your plans and budgets need to be monitored, and are discussed in
this section. These include:
◆ which parts of the plans were implemented
◆ which incomes and expenditures were not properly forecast
◆ the deviations between planned expenditure and actual expenditure
◆ the consequences for future plans and budgets.


8.2 Monitoring progress


Takes what action?
Are responsible for monitoring progress with
equipment-related activities


Takes what action?
Needs to monitor progress


Who?
- Health Management Team
- HTM Working Group
- HTM Team
Which level?
Every service level




210


Also, we cover a number of issues which arise and indicate that planning can be
improved, such as:
◆ emergency purchases
◆ maintenance contingencies
◆ consumable contingencies.


Monitoring Implementation of Plans
Over the twelve months following planning and budgeting, the Health Management
Team and its HTM Working Group should ensure that:
◆ the finances requested in the Annual Equipment Budget are raised and allocated
◆ the equipment identified in the Annual Purchase Activities are purchased and


commissioned
◆ the major rehabilitation projects planned in the Annual Rehabilitation Activities


are completed
◆ the corrective actions listed in the Annual Corrective Activities are taken
◆ the training courses planned in the Annual Training Activities are implemented.
There are usually set times when facilities review budget allocations and can
purchase items. These may occur monthly, quarterly, or even annually for large
capital items. Thus:
◆ For equipment purchases and those equipment-related consumable items which


are not commonly used (in other words, ‘non-stockable’ items in the Stores
system – Section 3.4), the relevant Heads of Department/HTM Managers apply
for their needs according to the agreed plans by completing a ‘Supplies Order
Form’ (see Guides 4 and 5).


◆ For equipment-related consumable items which are commonly used (in other
words, ‘stockable’ items in the Stores system – Section 3.4), the Stores Controller
automatically applies for the departmental/workshop needs on their behalf.


◆ For expenditures which require assistance from external sources (such as
maintenance support or training courses), the relevant Department Head/HTM
Manager obtains quotes for the work according to the agreed plans.


The Purchasing and Supplies Officer will follow the normal procurement procedures
(see Guide 3) for:
◆ obtaining proforma invoices
◆ scheduling Tender Committee meetings
◆ choosing the suppliers to be used
◆ placing orders.


8.2.1 How to monitor progress against annual equipment plans and budgets




211


Occasionally, problems can arise if the central financing body incurs delays obtaining
foreign currency or with cash flow. In such cases, your service level may not always
get all the agreed elements of the budget requested, or may not receive funds on
time. You may therefore be forced to revise your budget (and plans) constantly
throughout the year.


Emergency Purchases
As Section 7.1 says, all capital expenditure should be covered by the Equipment
Development Plan (EDP), and the planned purchases should be procured according
to the normal procedures which are covered in Guide 3. However, in some cases
there may be emergency requirements that departments legitimately need outside
the planned Annual Purchase Activities (Section 8.1). These often arise during the
year due to circumstances that could not be foreseen.
Emergency purchases are not planned and lead to deviations between planned and
actual expenditures. If there are too many deviations of this kind, it indicates that
planning should be improved.
If emergency purchases are requested during the year, you need to take steps to alter
your annual plans and budgets, as shown in Box 49.


8.2.1 How to monitor progress against annual equipment plans and budgets


Experience in a Southern Asian Country
◆ The government treasury imposed a general embargo for all ministries (including


Health) on new construction and the purchase of office equipment for the first six
months of 2001.


◆ As their financial year runs from January to December, the tenders could not be
advertized and processed until the second half of the year.


◆ Thus unfortunately, by the time the tenders could be awarded, the financial allocations
for that year had already lapsed.




212


BOX 49: Procedures for Emergency Equipment Purchase Requirements
1. Heads of Department:
◆ When emergency equipment needs arise outside the planned Annual Purchase Activities (Section 8.1),


submit their requirements (details, estimated costs, and reasons) to the HTM Working Group.
2. HTM Working Group:
◆ Meets to:


- review the submissions
- discuss the implications of the proposals
- and either approve them, reject them, or return them for further information.


◆ Submits approved proposals to alter the Annual Purchase Activities to the Health Management Team,
who can grant approval if funds are available.


3. Heads of Department:
◆ If the changes are agreed, liaise with the Purchasing and Supplies Officer regarding ‘Purchase Order


Requisitions’ and the normal process for procurement (see further details in Guide 3).


Maintenance Contingencies
The HTM Team will have estimated their annual maintenance needs according to
Figure 21, as part of the Annual Corrective Activities (Section 8.1). In addition,
they will have determined monthly estimates within the annual plans (Section 6.1).
However, contingencies can arise over time which are difficult to plan for, such as
sudden crisis breakdowns of serviceable items.
Maintenance contingencies are not planned and lead to deviations between planned
and actual expenditures. If there are too many deviations of this kind, it indicates
that planning should be improved.
If maintenance contingencies arise, you need to take steps to alter your annual plans
and budgets, as shown in Box 50.


BOX 50: Procedures for Maintenance Contingencies
HTM Manager:
◆ When maintenance needs arise outside those planned:


Either – submits the contingency cost for inclusion in the following month’s maintenance budget
(Section 6.1)


Or – puts in a request for contingency funds outside of the existing maintenance budget.
Health Management Team:
◆ Considers proposals to alter the Annual Funding Plan and grants approval if the funds are available.
◆ If the changes are agreed, informs the Finance Officer and the HTM Manager.


8.2.1 How to monitor progress against annual equipment plans and budgets




213


Consumable Contingencies
The Heads of Department will have estimated their annual equipment-related
consumable needs according to Figure 22, as part of the ‘Annual Corrective Activities’
(Section 8.1). In addition, they will determine monthly estimates within the annual
plans (Section 6.2). However, contingencies can arise over time which were difficult
to plan for, such as unexpected surges in workload, outbreaks, and epidemics.
Consumable contingencies are not planned and lead to deviations between planned
and actual expenditures. If there are too many deviations of this kind, it indicates
that planning should be improved.
If consumable contingencies arise, you need to take steps to alter your annual plans
and budgets, as shown in Box 51.


BOX 51: Procedures for Consumable Contingencies
Heads of Department:
◆ When equipment-related consumable needs arise outside those planned:


Either – submits the contingency cost for inclusion in the following month’s departmental budget
(Section 6.2)


Or – requests for contingency funds outside the existing departmental budget.
Health Management Team:
◆ Considers proposals to alter the Annual Funding Plan and grants approval if the funds are available.
◆ If the changes are agreed, informs the Finance Officer and the Head of Department.


Monitoring Expenditure against Allocations
When funds are allocated, it is necessary to show how they are actually spent. This
requires you to monitor actual expenditure against allocation, and is often
undertaken on a monthly basis.
All Heads of Department and the HTM Manager have a role to play, together with
the Finance Officer. By monitoring expenditure against allocation, it is possible to
learn whether expenditures were properly forecast, thus enabling you to improve
upon your planning and budgeting the next time around.
Information concerning how allocated funds are actually spent should be available at
all levels, as feedback.
Box 52 shows you what steps to take.


8.2.1 How to monitor progress against annual equipment plans and budgets




214


BOX 52: Procedures for Monitoring Expenditure against Allocations
HTM Manager and Heads of Department:
◆ monitor their actual recurrent expenditure against their allocations on a monthly basis
◆ keep a record of how the current month’s allocation is being spent, according to the formal financial


reporting requirements
◆ follow all accounting guidelines (such as the submission of receipts to the Finance Officer on all


purchases arising from allocated funds)
◆ make estimates for the next month’s expenditure (Sections 6.1 and 6.2).
Finance Officer:
◆ compiles the data on expenditure against allocations and the next month’s estimates, for all of the


departments
◆ submits a written Financial Report to the Health Management Team for the monthly budget meeting
◆ provides the information on how funds allocated are actually spent as feedback to all levels.


Reaching Performance Targets
Each facility and service level should have goals and plans which set out their priority
activities for all health service work (Section 8.1). The normal departmental annual
action planning process (see Guides 4 and 5) will mean that goals are set for each
department regarding their daily work. They will also have indicators to measure
whether they reach their performance targets.
At the end of the year, it is essential to review and carefully analyze the results
achieved on all the departmental goals that have been set.
Once planning and financial systems are established, it might be possible to link
departmental annual planning to the process of setting their departmental budgets.
The achievement of proposed targets by a department could then play an important
part in justifying the budget allocations it requests from senior management.
For example, the Health Management Team can consider:
◆ the achievement by the HTM Team of its targets, when determining the budget


allocation for maintenance
◆ achievement by user departments of their targets, when determining their


recurrent budget allocations
◆ the achievement by the equipment training sub-group of their proposed training


targets, when justifying the budget allocations for training.


8.2.1 How to monitor progress against annual equipment plans and budgets




215


8.2.2 How To Monitor Progress in General
Regular monitoring of activities and services is also essential for improving the
quality of healthcare. Management need facts so that they can plan effectively, and
need to know how equipment-related activities are performed. Thus it is important
that you have some method of collecting information.
The people and groups involved in planning and budgeting need to gather
information regularly on the progress of their teams, and their work performance.
Such information will not only enable all those involved to manage their teams more
effectively, it also provides an important source of feedback for other people and
bodies who need to know how they are functioning.
Therefore health planners, finance officers, and HTM Working Groups and other
bodies involved in planning need to:
◆ monitor their progress with establishing the planning and budgeting ‘tools’
◆ ensure they keep active tools up-to-date
◆ ensure that the information generated by such tools is used to improve activities


such as stock control, training and procurement
◆ study the implications arising from planning and budgeting.


Establishing the Planning and Budgeting Tools
Box 53 shows the steps to take to ensure that planning and budgeting work is
implemented.


BOX 53: Monitoring the Establishment of Tools
Health Management Team and its HTM Working Group:
◆ Monitors progress with establishing the:


- Equipment Inventory (Section 3.1)
- equipment stock value estimates and a Reference Equipment Price List (Section 3.2)
- budget lines for equipment expenditures (Section 3.3)
- usage rates for equipment-related consumable items (Section 3.4)
- reference materials (Section 4.1)
- Vision (Section 4.2)
- Model Equipment List (Section 4.3)
- Purchasing, Donations, Replacement, and Disposal Policies (Section 4.4)
- Generic Equipment Specifications, and the environmental and technical data sheet (Section 4.5).


◆ Monitors that all the budgeting tools for capital and recurrent expenditure are understood and used
(Sections 5 and 6).


8.2.2 How to monitor progress in general




216


Keeping Tools Up-to-Date
The HTM Working Group (or its pricing sub-group) needs to:
◆ revise the Reference Equipment Price List regularly in order to ensure that an up-


to-date database of current equipment prices is available (Section 3.2)
◆ revise the equipment stock values periodically (see Figure 8)
◆ annually review the usage rates and requirements for equipment-related


consumable items (see Figure 10)
◆ annually update the library of reference materials and subscriptions (see Box 12).


Providing Feedback to Improve Procurement and Stock Control
The HTM Working Group (or its pricing sub-group) needs to use the data from the
Usage Rate planning tool (Section 3.4) to ensure that:
◆ correct information regarding the requirements and usage rates for equipment-


related consumable items is provided to the Stores Controller, for better
calculation of reordering quantities and times


◆ those items which are commonly used become ‘stockable’ items in the Stores system
◆ correct information regarding problems with equipment and its related supplies are


provided to the Specification Writing Group and Tender Committee (Section 1.2),
for more appropriate selection of models during procurement (see Guide 3).


Providing Feedback to Improve Training
During the planning process various prompts that training is required will emerge,
due to:
◆ the analysis of the equipment inventory, the Equipment Development Plan, and


the Equipment Training Plan
◆ the equipment purchases planned.
Figure 26 provides examples of the types of prompts. These should be passed onto
the Human Resources Department.


Implications of Planning and Budgeting
The (central level) Health Management Team needs to analyze the implications arising
out of planning and budgeting. For example, they could use the data to determine:
◆ life-cycle costs of equipment
◆ costs per intervention (unit costs), and whether the interventions are economic
◆ the percentage of expenditure used against different equipment budget lines.


8.2.2 How to monitor progress in general




217


The (central level) Health Management Team needs to monitor the planning and
budgeting process in order to identify any implications. For example, they could
monitor:
◆ the correct utilization of budget lines (for example, has money previously earmarked


for maintenance been moved and used for food, fuel or other commodities?)
◆ whether decentralized control of budgets is working (for example, do the


decentralized authorities leave vital activities unfinanced?).
Box 54 contains a summary of the issues covered in this Section.


Tip • Remember – if you have not been able to develop all the tools and plans because you
are short of management skills, Annex 6 contains bare minimum requirements for
equipment planning and budgeting for people who are just starting out.


Section 8 summary


BOX 54: Summary of Procedures in Section 8 on Setting Annual Goals and
Monitoring Progress


HTM Teams
HTM Working
Groups (or
their various
sub-groups)


Health
Management
Teams
HTM Working
Groups (or
their various
sub-groups)


Health
Management
Team


Mo
ni


to
r P


ro
gr


es
s











An
nu


al
P


la
ns


◆ update the Equipment Inventory according to Figure 32
◆ review the Equipment Development Plan and Equipment Training Plan for annual


needs according to Figures 33 and 34
◆ cost the proposals for the coming year according to Figure 35
◆ review the Core Equipment Expenditure Plan and Core Equipment Financing


Plan, prioritize the allocation of funds, and prepare proposals for:
- Annual Purchase Activities
- Annual Rehabilitation Activities
- Annual Corrective Activities
- Annual Training Activities
- Annual Equipment Budget, according to Figure 36.


◆ update all long-term plans and budgets with the final agreed and financed annual
actions, according to Figure 37.


◆ raise the funds required
◆ allocate sufficient funds for the action planned


◆ monitor progress with:
- implementing the annual plans
- expenditure against allocations according to Box 52
- establishing the ‘tools’, according to Box 53


◆ react to emergencies and contingencies outside of the plans, according to
Boxes 49–51


◆ keep the planning and budgeting tools up-to-date
◆ provide feedback to improve procurement, stock control, and training
◆ consider the achievement by departments and groups in reaching performance


targets, when determining their budget allocations
◆ consider the implications of the data arising out of planning and budgeting




218




ANNEX 1: GLOSSARY
Acceptance process: Activities undertaken when equipment arrives at an health facility, at


the end of which the equipment will be operational and officially belong
to the facility, such as receipt, unpacking, installing, commissioning,
initial training, entering into Stores and onto records, payment.


Accessories: For equipment, those items which connect the machine to the patient
(e.g. leads, probes), assist with the use of the machine (e.g. trays, foot-
switches), or adapt its performance (e.g. adaptors, lenses).


Acquisition: To obtain equipment through both procurement and donations.
Administrative level: See decentralized authorities.
Allocation: In financial terms, the funds distributed to a unit within an


organization to be spent for a particular purpose.
Assets: All resources owned by an organization, for example money,


equipment, land.
Autonomous: Self-governing or independent.
Budget: A written financial plan listing future, known, or estimated income


and expenditure covering a given period of time, such as a year
(annual budget).


Capital budget: Planned expenditure on capital items (such as buildings, equipment,
vehicles) that require substantial (possibly one-off) payments in a year,
and should not be included in the recurrent (or operational) budget.


Central level: Highest authority of your health service provider, such as Ministry of
Health or Board.


Commissioning: A series of tests and adjustments performed to check whether, and
ensure that, new equipment is functioning correctly and safely before
being used.


Communication equipment: Any equipment that is used for sending or receiving information, such
as telephones, two-way radios, nurse-call systems, paging systems.


Consumables: For equipment, those items which are used up during the operation of
equipment (e.g. film, reagents, gel).


Contingency: An event in the future that may happen but is not guaranteed to
happen; an amount set aside in the budget for contingencies is a
reserve for unexpected expenditure.


Cost centre: A unit of an organization that generates expenses but has no
responsibility for generating revenue (income); its goal is to adhere
to expense budgets, which are tailored to meet certain objectives
Which type of unit (health authority, facility, division, or department)
acts as a cost centre depends on whether it is at a level that has the
independence and responsibility to be allocated money, spend it, and
account for the expenditure.


Decentralized authorities: Local units of an organization that have had authority transferred to
them from the central level of the organization. For example, district,
regional, provincial or diocesan health authorities.


Annex1: Glossary


219




Decommission: Take out of service; dismantle and make safe; board. The process of
condemning or writing off equipment and disposing of it.


Depreciation: The amount by which the monetary value of an asset is reduced over a
period of time due to its everyday use (‘wear and tear’) or due to the
fact that it could not be sold second hand for as much as it originally
cost; the asset is said to depreciate in value.


Donor: See external support agency.
Energy sources: A source of energy or power, such as generating sets, solar panels


or transformers.
Equipment-related supplies: Items which are essential for equipment use, such as consumables,


accessories, spare parts, and maintenance materials used
with equipment.


Equipment users: All staff involved in use of equipment, such as clinical staff (e.g.
doctors and nurses), paramedical staff (such as radiographers and
physiotherapists) and support services' staff (such as laundry and
kitchen workers).


Essential service package: Definitions developed by health service providers of the basic service
packages to be offered at each level of healthcare delivery, in terms of
healthcare interventions. From these interventions, human resource,
space, and equipment requirements can be determined.


Expenditure: The amount of money spent (or due to be spent) by a unit within an
organization; payments made out of a financial allocation provided for
a particular purpose; money spent from your income.


External support agency: A body responsible for providing money, equipment, or technical
support to developing countries on various terms, such as
international donors, technical agencies of foreign governments,
non-governmental organizations, private institutions, financial
institutions, faith organizations.


External support agency staff: People working for external support agencies that health workers come
into contact with, such as a country representative, desk officer,
consultant, coordinating agency, director.


Fabric of the building: Items which are part of the integral structure or framework of a
building, such as doors, windows or roof.


Facility: See health facility.
Financial year: Period over which a set of accounts operate; the date up to which the


annual accounts of an organization are prepared (not necessarily the
calendar year).


Fire fighting equipment: Equipment used to put out fires, such as fire blankets, buckets,
extinguishers, hose and sprinkler systems.


Fixtures built into Items which are not part of the integral structure of a building but are
the building: installed into the fabric of the building, such as ceiling-mounted


operating theatre lights, scrub-up sinks and fume cupboards.
Head of section: Departmental manager, such as head of department, group leader,


officer in-charge, senior operator.


Annex1: Glossary


220




Health facility: Buildings where healthcare is delivered, ranging from small units
(clinics, health centres), and small hospitals (rural, district, diocesan),
to large hospitals (regional, referral).


Health facility furniture: Furniture with a specific clinical use in health facilities, such as beds,
cots, trolleys, infusion stands.


Health management team: Health management body, such as facility management committee,
district/regional/diocesan/central health management team, Board.


Health service provider: A provider of health services, such as Ministry of Health or Defence,
non-governmental organization, private institution, employer
organization or corporation (for example, mine), faith organization.


Health system: Comprises all organizations, institutions, and resources devoted to
health actions (defined as any effort, in personal or public health
services or through intersectoral action), whose primary purpose is to
improve people’s health (Source: WHO).


HTM Manager: Head of the HTM Team; ranging from a general member of health
staff with some management skills in the smallest HTM Teams, to an
engineering manager in the highest level of HTM Team.


HTMS: Healthcare Technology Management Service made up of a network of
HTM Teams and HTM Working Groups.


HTM Team: A body responsible for the management of equipment, such as,
equipment management team, maintenance management team,
physical assets management team; part of the HTM Service.


HTM Working Group: A working group, or standing committee responsible for making
decisions on healthcare technology management issues; part of the
HTM Service.


Income: Money received, usually generating from work done or investments
made; revenue.


In-house: Activities undertaken by staff already employed by the health service
provider organization (rather than using temporary hired labour or
external contractors).


Installation: The process of fixing equipment into place; can range from building
equipment into the fabric of a room, to simply plugging it into an
electrical socket.


Inventory: A systematic listing of stock (or assets) held. An annual inventory is
prepared at the end of each year following a physical inspection and
count of all items owned by an organization. The list gives details,
such as location, reference number, description, condition, cost, and
the date the inventory was taken.


Laundry and kitchen Equipment required for kitchen or laundry activities, such as cookers,
equipment: cold rooms, washing machines, hydro-extractors, roller-ironers.
Life-cycle costs: The recurrent cost required to keep equipment going throughout its


life (e.g. fuel, consumables, maintenance, training, disposal).
Lifetime: Lifespan, life expectancy. For equipment, the likely length of time


that an item will work effectively, dependent on the type of
technology and parts used in its manufacture.


Annex1: Glossary


221




Maintainers: See maintenance staff.
Maintenance materials: Those items used up during the maintenance of equipment, and


generally available from many sources (e.g. washers, oil, fuses, paint).
Maintenance staff: Staff responsible for maintenance of equipment, such as craftspeople,


artisans, technicians, technologists, engineers.
Manager: Any staff involved in the management of equipment-related activities.


This could include administrator, nurse-in-charge, medical
superintendent, chief executive, director, health secretary, medical
practitioner, maintenance manager, policy-maker.


Medical equipment: Equipment used for medical purposes, including X-ray units,
diathermy units, suction pumps, foetal doppler, scales, autoclaves,
infant incubators, centrifuges.


Model Equipment List: A list of the essential equipment for a health service level/facility type
(rural, district, regional, referral), determined by considering each
necessary healthcare intervention (function, activity, or procedure) for
example, equipment required for eye-testing, delivering twins,
undertaking fluoroscopic examinations, testing blood for malaria.


Office equipment: Equipment used in an office, such as computers, photocopiers,
calculators, record systems.


Office furniture: Furniture used in an office, such as desks, chairs or filing cabinets.
Plant, general: Machinery such as boilers, lifts, air-conditioners, water pumps


or compressors.
Pre-installation work: Activities required in preparation for the arrival and commissioning of


equipment, such as preparing the site at the health facility so the
equipment can be installed, hiring lifting equipment, organizing or
hiring warehousing space.


Profit centre: A unit of an organization that generates both revenue and expenses; its
goal is to have revenue exceed expenses.


Quality control: A system of maintaining standards; testing a sample
against specifications.


Recurrent budget: Planned expenditure on recurrent items for ongoing monthly needs,
such as drugs, materials, spare parts, food, fuel, which should not be
included in the capital budget.


Rehabilitate: Restore to a former state; renovate; undertake major repair work to
return an item to a working condition.


Service supply installations: Supply installations such as electrical installations, water and sewage
pipelines, gas supplies.


Spare parts: For equipment, those items which make up the machine, need
replacing as they wear out, and may be specific to a particular model
(e.g. bearings, bulbs, printed circuit boards).


Specifications: A detailed description of the design and materials used to make
something; a standard of workmanship, materials, etc. required to be
met in a piece of work. Generic specifications refer to a class or type
of thing and do not specifically mention a brand name.


Annex1: Glossary


222




Standard: A required or agreed level of quality attainment set by a recognized
authority, used as a measure, norm, or model for all aspects of health
services and healthcare technology.


Standardization: Rationalization, normalization, and harmonization. In other words,
reducing the range of makes and models of equipment available in
stock, by purchasing particular or named makes and models.


Stock: In stores, this is the goods held by an organization for its own use. The
‘equipment stock’ is all the equipment assets owned by an organization.


Supplier: Someone who provides equipment, such as a manufacturer,
manufacturer’s representative, wholesaler, salesman.


Support staff: Additional types of staff in the health service besides medical
personnel, such as planner, finance officer, procurement officer, stores
controller, human resource officer.


Training equipment: Equipment required when running training courses, such as overhead
and slide projectors, video and tape recorders.


Users: See equipment users.
Vehicles: Any conveyance used for transporting people, goods, or supplies in the


health service, such as ambulances, cold-chain motorbikes, mobile
workshops, lorries, buses.


Walking aids: Items used to aid mobility, such as wheelchairs, zimmer frames, crutches.
Waste treatment plant: Any plant used to treat waste, including incinerators, septic tanks or


biogas units.
Working group A group of people set up to be responsible for a particular subject area,


such as a standing committee, select committee, sub-committee.
Workshop equipment: Equipment used in a workshop, such as hand tools, bench tools or


test instruments.
Your organization: See health service provider.


BOX 54: WHO’s Definition of the Technology Management Hierarchy
Equipment support: undertaking maintenance and repair.
Equipment management: using the equipment database (inventory and maintenance history)


to help you make decisions for improving equipment support.
Asset management: including cost and utilization information (life-cycle cost analysis) in


the equipment database to help you make decisions on replacement
and acquisition.


Technology assessment: reviewing past, current, and future technologies to determine their
efficacy and effectiveness, and to help you make decisions for capital
planning and acquisition.


Technology management: using: equipment
equipment support
equipment management
asset management
technology assessment


to manage technology in health care from conception to retirement.
Source: Department of Health Service Provision, World Health Organization, 2000


Annex1: Glossary


223




ANNEX 2: REFERENCE MATERIAL AND CONTACTS
This Annex is in two parts, and provides information about:
Part i. Books, guidelines, databases, and websites
Part ii. Organizations, sources of publications in part i, resource and information centres.


i. Books, Guidelines, Databases, and Websites
The following books, guidelines, databases, and websites are listed in subject categories according to
the topics found in Sections of this Guide. For each publication, a brief description of the content and
the main source(s) are included. Contact details for the source organizations are included in Part ii.
Readers should note that many of the publications are available at low cost. In some countries it may
also be possible to obtain these publications from local bookstores, as publishers and distributors
increase efforts to ensure wider availability. Published prices may be flexible depending on the order
size, discounts available and distribution method.


Tip • Many books and documents cover a variety of topics that appear in several Sections of this Guide. The
first time they appear in this list they are described in full. For each subsequent entry only the basic
details are provided.


Healthcare Technology Management Framework Issues
This material covers issues in Sections 1 and 2, such as healthcare technology management
definitions, policy, regulations, guidance, and services, and in Section 4.4 on developing purchasing,
donations, replacement, and disposal policies. It is listed alphabetically by title.


Developing healthcare technology policy
Examples of Policies
A number of health service providers have already developed their own healthcare technology policies, as
well as implementation guidelines to go with them. For example, more information can be obtained from:
◆ Dr P Asman, Biomedical Engineering Unit, Ministry of Health (Room 33, MOH Building), PO


Box M-44, Accra, Ghana. Email: nchtm@africaonline.com.gh
◆ Ministry of Health, PO Box 7272, Kampala, Uganda. Email: info@health.go.ug, website:


www.health.go.ug/support_system.htm
◆ Dr N Forster, Under Secretary: Health and Social Welfare Policy, Ministry of Health and Social


Services, Private Bag 13198, Windhoek, Namibia. Email: nforster@mhss.gov.na
◆ Director of Health, Lusaka Urban District Health Board, PO Box 50827, Makishi Road, Lusaka,


Zambia. Email: msinkala@lycos.com
◆ Department of Hospital Services, Ministry of Health, 151-153 Kampuchea Krom Boulevard,


Phnom Penh, Kingdom of Cambodia. Email: procure.pcu@bigpond.com.kh, website:
www.moh.gov.kh


Annex 2: Reference materials and contacts


224




Health care technology management No.1: Health care technology policy framework
Kwankam Y, Heimann P, El-Nageh M, and M Belhocine (2001). WHO Regional Publications, Eastern
Mediterranean Series 24. ISBN: 92 9021 280 2
This booklet is the first in a series of four titles. It introduces the ideas of and behind health care
technology management, defines terms relating to and sets objectives for health care technology
management policy. It examines what should go in to such a policy, and the national policy framework
and organization. Capacity-building and human resources issues are considered, as well as economic
and financial implications. Attention is also given to legislation, safety issues, cooperation nationally
and between countries, implementation, monitoring, and evaluation. See Guide 1 for information on
the three further titles in this Series:
No.2: Eastern mediterranean regional strategy for appropriate health care technology
No.3: Health care technology policy formulation and implementation
No.4: Country situation analysis.
Available from: WHO
Interregional meeting on the maintenance and repair of health care equipment: Nicosia,
Cyprus, 24-28 November 1986
WHO (1987). WHO document WHO/SHS/NHP/87.5
This document provides a comprehensive discussion of the problem of non-functioning equipment
and of proposed solutions. The major policies, recommendations, and strategies proposed by the
conference on the issue of maintenance and repair of health care equipment are presented. It
includes four Working Papers which cover in detail: maintenance and management of equipment, the
proposed health care technical service, manpower development, and training.
Available from: WHO
Management of equipment
DHSS, UK (1982). Health Equipment Information No. 98
The aim of this booklet is to recommend a system of equipment management that, if fully
implemented, would ensure that all equipment used in the British National Health Service was
suitable for its purpose, was maintained in a safe and reliable condition, and was understood by its
users. Its recommendations and procedures are structured into sections on equipment selection,
acceptance procedures, training, servicing (maintenance, repair, and modification), and replacement
policy. It also covers the management of inventories, equipment on loan, servicing, long-term
commercial contracts, infection hazards.
Available from: Her Majesty’s Stationery Office (HMSO).
Medical equipment in sub-saharan Africa: A framework for policy formulation
Bloom, G and C Temple-Bird. (1988). IDS Research Report Rr19, and WHO publication
WHO/SHS/NHP/90.7. ISBN: 0 903354 79 9
This book provides a good overview of the situation of medical equipment in Africa. Its approach to
the analysis is to unpackage medical equipment technology into its component activities, such as
planning, allocating resources, procurement, commissioning, operation, maintenance, training, etc. It
provides good general policy formulation strategies to address the problems discussed.
Available from: WHO
Practical steps for developing health care technology policy: A manual for policy-makers
and health service managers in developing countries
Temple-Bird, C (2000). Institute of Development Studies, University of Sussex, UK. ISBN: 1 85864 291 4
This book is a practical step-by-step guide for developing health care technology policy. It can be used
by health service providers, regional and district health authorities, health facility managers, and
external support agencies. It describes a process for developing health care technology policy which is
collaborative, participatory, iterative, and involves community stakeholders. Guidance is provided on
underlying management concepts, undertaking a situation analysis, running a ideas workshop,
formulating policy, developing an implementation plan and procedures manual, as well as the
resources required to complete these tasks.
Available from: Ziken International Consultants Ltd


Annex 2: Reference materials and contacts


225




Strategic medical technology planning and policy development
Raab M (1999). Swiss Centre for International Health. August 1999.
This paper discusses the challenge of the fast expansion in technologies, and the choices that have to
be made to manage them. It looks at healthcare technology assessment, the elements and formulation
of a healthcare technology policy, and the strategic planning process required.
Available from: SCIH
See Guide 4 for resources that discuss policies for disposing of healthcare waste and the development
of a waste management plan.


Regulating relationships with external support agencies that provide equipment
Guidelines for health care equipment donations
WHO (1997). WHO document WHO/ARA/97.3
This document presents guidelines that aim to improve the quality of equipment donations, not to
hinder them. They are not an international regulation, but intended to serve as a basis for national or
institutional guidelines, to be reviewed, adapted and implemented by governments and organizations
dealing with health care equipment donations. They provide detailed guidance and checklists for
both the potential donor and recipient. The guidelines are based on extensive field experience and
consultations with many experts internationally. They also merge together several earlier documents,
including the one listed below.
Available from: WHO
Guidelines on medical equipment donations
Churches’ Action for Health (1994). World Council of Churches’ publication
This paper is a guide for those accepting and making donations, and is also useful for those planning
to buy equipment. It clearly lays out in point form the responsibilities of the recipient and the
responsibilities of the donor.
Available from: WCC


Understanding healthcare technology management
International seminar for hospital technicians/engineers: February 1998, Moshi, Tanzania
Clauss J (ed) (1998). FAKT
This document reports the results of intensive work by 38 national and international experts brought
together from faith, public, and private agencies to strengthen equipment management measures in
the health sector. It includes papers, with country examples, on healthcare technology management,
using cost-sharing to finance maintenance, networking, structures of health care technical services,
cash control for workshops, training, communication technologies, modification of medical and
hospital equipment, energy supply and photovoltaics. There are also lists of standardized equipment
for the Evangelical Lutheran Church of Tanzania and the Joint Medical Stores of Uganda, and a
description of how they were developed.
Available from: FAKT
International workshop on healthcare technology management: 2-6 October 2000,
Catholic Pastoral Centre, Bamenda, Cameroon
Clauss, J (compiler) (2000). FAKT
This document reports the results of intensive work by 35 national and international experts involved
in setting up and operating systems for the sustainable management of healthcare technology. It
includes papers, with country examples, on healthcare technology management, the role of
stakeholders, public/private partnerships for providing HTM, financial management of maintenance
organizations, and donations of healthcare technology.
Available from: FAKT


Annex 2: Reference materials and contacts


226




Medical equipment in Botswana: A framework for management development
Temple-Bird C L, Mhiti R, and G H Bloom (1995), WHO publication WHO/SHS/NHP/95.1
This book reports on the results of a study of the healthcare technology sector in Botswana, and the
lessons learnt are of relevance to many other countries. The study was undertaken by unpackaging the
sector into its component activities, such as planning, allocating resources, procurement,
commissioning, operation, maintenance, training, etc. In this way the book provides good general
healthcare technology management strategies to address the problems discussed. This book also
describes how technical staff obtain their basic technical qualifications either as artisans at local Trade
Testing Centres, or as technicians at the local Polytechnic, and provides an understanding of how such
systems and qualifications work.
Available from: WHO
Medical technology management
David Y, and T Judd. (1993) BioPhysical Measurement Series, SpaceLabs Medical Inc.
ISBN: 0 9627449 6 4
This book looks at the appropriate management tools needed to make technology’s role more
clinically effective and cost–effective (based on the healthcare delivery system in the USA). It focuses
on strategic technology planning principles, and how they contribute to improved patient outcomes.
It also looks at a process for technology assessment and life-cycle cost analysis. It defines many
common terms, and the role of useful committees, procedures, and forms.
Available from: SpaceLabs Medical Inc.
Physical assets management and maintenance in district health management
Halbwachs H (2000). GTZ document
This paper provides practical guidance to health workers involved in district health systems
concerning health technology - one of the critical areas in managing health service delivery at district
level. It presents the physical assets management approach, and elaborates on key strategies for
maintenance, financing, quality control, monitoring indicators, cost-benefit analysis calculations, and
a basic paper-based maintenance information system.
Available from: GTZ
The effective management of medical equipment in developing countries:
A series of five papers
Remmelzwaal B (1997). FAKT, Project Number 390
This document is aimed at the health workers, administrators, maintainers, and overseas aid workers
who are involved in medical equipment management in developing countries. It examines the
variation in performance with management of medical equipment in different countries, with the
objective of identifying successful approaches. It addresses some of the managerial issues related to
the conservation of equipment; allocation of human, financial and material resources; and acquisition
and use. It looks at the structure for the HTM Service, and the HTM cycle. It includes an example
spreadsheet layout to use as an inventory form, with various data collection codes.
Available from: FAKT
See Guide 1 for more information on further relevant issues, such as health service definitions, the
place of HTM in health systems, regulations, and standards.


Annex 2: Reference materials and contacts


227




Equipment Inventories and Price Information
This material covers issues in Section 3.1 on establishing and keeping an equipment inventory, and
an inventory code numbering system, and equipment price data needed for the stock value estimates
in Section 3.2 and the cost calculations in Sections 5 and 6. It is listed alphabetically by title.
Note on inventory software: Keeping an equipment inventory is an area where simple computer
software programs can be of assistance once you have mastered a manual paper system, have a large
enough stock (several hundred items of major equipment), and can obtain sufficient training of staff.
For example:
◆ at a district hospital, any common computer database software could be used such as a


commercially available product like Access (part of Microsoft Office) or a shareware program
available on the internet free or at competitive rates


◆ for larger stocks of equipment (for example at a teaching hospital, or a centralized inventory),
where analysis of the data is required with the possibility of sorting the data according to several
selection criteria in parallel, more sophisticated software programs can be used, such as the ECRI
and PLAMAHS products listed below


◆ more information on deciding when and how to computerize your records, see the GTZ book by
Halbwachs and Miethe listed below.


Clinical engineering service departments: Establishment, scope of work and organization
Raab M (1999). Swiss Centre for International Health, Basle, Switzerland
This paper discusses the issues that prompted the evolution of clinical equipment support services,
the resources and staff required when establishing clinical engineering service departments, and their
scope of work, including details of necessary documentation and reporting using inventories and other
recorded data.
Available from: SCIH
Computerizing maintenance for health care facilities in developing countries
Halbwachs H, and B Miethe (1994). GTZ, Eschborn, Germany
This book describes the documentation and analysis required if healthcare technology management is
to be undertaken effectively (such as inventory management, planned preventive maintenance
timetabling, costs analysis). It illustrates that for large stocks of equipment such work is made easier
with the aid of computers. The book goes on to describe when and how to computerize equipment and
maintenance records, including details of hardware and software requirements and products available.
It includes details of the sort of data to be collected for effective healthcare technology management.
Available from: GTZ
District laboratory practice in tropical countries (part 1)
Cheesbrough M (1998). Tropical Health Technology. ISBN:0 9507434 4 5
A valuable resource aimed at those responsible for the organization and management of district
laboratory services but can also be adapted for use by health centres. It covers selection and
procurement of laboratory equipment and supplies, including lists of requirements with brief
specifications and indicative (1997) prices. It covers parasitological tests, clinical tests and training of
personnel, as well as all types of safety issues for laboratories.
Available from: TALC, THT
District laboratory practice in tropical countries (part 2)
Cheesbrough M (2000) Tropical Health Technology. ISBN:0 9507434 5 3
Covers microbiological, haematological and blood transfusion techniques required at district level.
Available from: TALC, THT


Annex 2: Reference materials and contacts


228




Emergency Care Research Institute (ECRI, USA) products
This organization produces a variety of products on healthcare technology. They are available as hard
copy and as software regularly renewed by subscription, with special rates for developing countries.
The data is comprehensive and primarily written for the US audience, and the software is
sophisticated. The products cover various issues, such as:
◆ HECS 4 for Windows (includes inventory management software)
◆ Health devices source book (a directory of manufacturers and distributors for the US market,


their contact details, products, and typical price ranges)
◆ Healthcare product comparison system (a reference guide for selecting equipment)
◆ ECRI spec (a database of specifications, instructions to bidders, and terms and conditions, etc)
◆ Inspection and preventive maintenance system
◆ Health devices alerts database
◆ Health technology trends newsletter
Available from: ECRI
Healthcare equipment management
Halbwachs H. (1994). pp 14-20 in Health Estate Journal, December 1994, Portsmouth UK
This paper first discusses elements of an equipment management system including selection,
inventories, user training, and maintenance services, as well as issues concerning energy, waste, and
hygiene. It discusses establishing an HTM system including the organizational structure, personnel
requirements, and costs. It also covers typical maintenance running costs for various categories of
equipment, discusses budget implications of the backlog of repairs, and the financial balance between
preventive and repair activities.
Available from: GTZ
Hospital engineering in developing countries
Dammann V, and H Pfeiff (eds) (1986). GTZ, Eschborn, Germany. ISBN: 3 88085 293 6
This is a report of a symposium held in 1983 in Giessen. It covers the constraints in developing
countries, and requirements for establishing healthcare technical services. This includes discussions
on tasks, establishing an inventory, data collection, and training of maintenance and user staff.
Available from: GTZ
Management of equipment
DHSS, UK (1982). Health Equipment Information No. 98
Medical supplies and equipment for primary health care: A practical resource for
procurement and management.
Kaur M, and S Hall (2001). ECHO International Health Services Ltd. ISBN: 0 9541799 0 0
This book is intended for health workers and those responsible for the procurement and management
of medical supplies and equipment at primary healthcare level. It covers guiding principles for
selecting supplies and equipment, provides guidelines for ordering and procurement, storage and
stock control (with brief guidance on keeping an inventory), care and maintenance, and considers
decontamination and safe disposal of medical waste. The manual also discusses the use of standard
lists as a tool for encouraging good procurement practice and includes model lists and specifications
for medical supplies and equipment required for primary health care activities in both health facilities
in the community, and basic laboratory facilities.
Available from: TALC


Annex 2: Reference materials and contacts


229




Physical asset planning and management software (PLAMAHS)
HEART Consultancy
This software package holds information, and supports analysis, on: the equipment inventory,
equipment models and standards, existing and planned facilities, procurement support, and
maintenance support. The software holds various digital images, model equipment lists,
specifications, price and other financial data, and templates for forms, etc., and has a security system.
It has been designed especially with developing countries in mind and is available at special rates for
developing countries. It is being used in a number of countries, and HEART can assist with the set up
and initial training requirements.
Available from: HEART Consultancy
Practical laboratory manual for health centres in East Africa,
Carter J and Olema O (1998). AMREF.
Practical laboratory manual providing information necessary to establish, select and use laboratory
tests for patient management. Also includes material on implementation of safe working practices,
reporting and recording test results, keeping an inventory of supplies and equipment, ordering
supplies and maintaining equipment.
Available from: AMREF
Spare parts and working materials for the maintenance and repair of health care
equipment: Report of workshop held in Lübeck, August 1991
Halbwachs H, and C Temple-Bird (eds) (1991). GTZ, Eschborn, Germany
This book, mainly aimed at maintenance technicians, covers the maintenance requirements for
common items used at district level (anaesthesia equipment, infant incubators, X-ray equipment,
suction pumps, autoclaves and laundry equipment) including some advice on safety testing and test
instruments. It also includes information on workshops, stock control of parts, and an equipment
inventory code numbering system.
Available from: GTZ
The effective management of medical equipment in developing countries: A series of five papers
Remmelzwaal B (1997). FAKT, Project Number 390


Health Trends and a Vision for the Future
This material covers issues in Section 1.2 on trends in planning and expenditure for health and
healthcare technology, Section 2.2 on issues affecting service delivery in the future, and Section 4.2
on developing a vision of service delivery. The material also covers areas that may be new to some
health service providers, such as healthcare technology assessment, telemedicine, and energy
management. (For more information, refer to the section below on equipment needs). It is listed
alphabetically by title.
Addressing the future of healthcare technology management
Halbwachs H (2001). GTZ, Eschborn, Germany
This paper reminds healthcare technology management practitioners how HTM evolved, and warns
that it will not be successful unless it is integrated into the way health services are managed and
delivered on a daily basis. It lists the requirements for measuring and improving performance, and
undertaking a quality management approach. It suggests actions for all the different players involved
(countries, international organizations, donors).
Available from: GTZ


Annex 2: Reference materials and contacts


230




Better health in Africa: Experience and lessons learned
World Bank (1994). Development in Practice Series, World Bank, Washington, USA,
ISBN: 0 8213 2817 4
This book is aimed at policy-makers and sets forth a vision of health improvement that challenges
African countries and their external partners to rethink current health strategies. The report stresses
positive experiences in Sub-Saharan Africa and concludes that far greater progress in improving health is
possible than has been achieved in the past – even within existing resource constraints. It proposes that
a basic set of health services can be provided in low-income Africa at an annual cost of around US$ 13 per
person, presents the key reforms for achieving this, and illustrates the costs and benefits involved.
Available from: World Bank, major internet bookshops
Cost-effective aid for developing economies
Halbwachs H (1999). GTZ, Eschborn, Germany
This paper explains that as funds for aid are dwindling, there needs to be a more effective utilization
of resources. It presents strategies and criteria which would help aid used to supply equipment to be
more cost effective.
Available from: GTZ
Developing health technology assessment in Latin America and the Caribbean
PAHO (1998). PAHO. ISBN: 92 75 073777
This publication is aimed at policy-makers and health care professionals. The first part provides an
introduction to health technology assessment: why it is important, who does the evaluations, when
and how the evaluations are done. The second part looks at health technology in Latin America and
the Caribbean, and PAHO’s recommendations for promoting health technology assessment.
Available from: PAHO
District health care: Challenges for planning, organization and evaluation in
developing countries (2nd edition)
Amonoo-Larston R, Ebrahim G, Lovel H, and J Rankeen (1996). MacMillan. ISBN: 0 333 57349 8
This book contains practical support and advice intended for those in the planning, management and
evaluation of health services at district level. It covers a wide range of topics based on country
experience, including: district health needs, plans, organization and management; staff motivation,
teamwork, developing management skills, managing change, managing conflicts, and staff
development; managing finances; as well as monitoring and evaluation.
Available from: TALC
Draft final report of the informal consultation on physical infrastructure, technology and
sustainable health systems
WHO Health Systems Department (1998). WHO, Geneva, Switzerland
This paper looks at the issues surrounding physical infrastructure in health – it does not pretend to
provide the answers but prompts discussion. Using accumulated experience from different countries,
the paper defines the role of physical infrastructure in the development of sustainable health systems,
discusses the opportunities and challenges facing health systems in developing countries due to the
rapid developments in technology, identifies the constraints to progress with effective healthcare
technology management at national and international level, and identifies the current gaps in
knowledge which need to be filled.
Available from: WHO


Annex 2: Reference materials and contacts


231




Health and disease in developing countries
Lankinen, K et al (eds) (1994). MacMillan Press. ISBN: 0 333 58900 9
This comprehensive book covers health and disease from the wider perspective of development in
general. It is of particular interest to medical and other professionals working in developing countries
or for international cooperation agencies. It is a valuable resource for district medical officers, and
students taking courses in public health and tropical medicine. Besides sections on: society, economy
and health; infectious diseases; and challenges for health care, there is a section on health services to
meet the challenges. This section contains chapters relating to equipment and/or management such
as health systems management and financing, immunization services, essential laboratory services,
blood transfusion services, and medical equipment management.
Available from: major internet bookshops
Health in the commonwealth: Challenges and solutions 1998/1999
Commonwealth Secretariat (1999). Kensington Publications Ltd, London
This digest of articles covers a wide range of health issues, such as: resources and planning; equity of
access; medical technology and equipment; health promotion; mother and child health; community
health; communicable and non-communicable diseases, etc. The content is aimed at policy-makers
and planners. There is a range of technology articles on equipment management, telemedicine,
radiology, cardiac care, hospital design, sanitation, vector control, water and air supplies.
Available from: Commonwealth Secretariat
Healthcare technology management and health sector reform
Halbwachs H (2001). GTZ, Eschborn, Germany
This paper presents data and arguments for the need for healthcare technology management to be a
part of health sector reform. It explains how HTM can contribute to health sector reform, and what
needs to be done by the different players involved (countries, international organizations, donors).
Available from: GTZ
Health technology assessment: Methodologies for developing countries
PAHO (1989). PAHO. ISBN: 92 75 12023 4
This publication reviews the main concepts and methodologies involved in assessing the effectiveness,
safety, cost, and social impact of health technologies, and discusses the potential contributions of such
assessments to improving health care delivery in developing countries. It discusses how the
methodologies must be adapted for developing countries, using results from actual examples.
Available from: PAHO
Information technology in the health sector of Latin America and the Caribbean:
Challenges and opportunities for the international technical cooperation
PAHO (2001). Essential Drugs and Technology Program, Division of Health Systems and Services
Development, PAHO. ISBN: 92 75 12381 0.
This publication is aimed at policy-makers and reviews the challenges and opportunities for technical
cooperation in the area of information technology (IT) globally, with a status report from Latin
America and the Caribbean. The diffusion and impact of information technology in healthcare
services and organizations is reviewed. The publication also aims to start the process of defining
measurement indicators for the infrastructure, process, and impact of IT in the health sector.
Available from: PAHO, WHO
Medical technology management
David Y, and T Judd. (1993) BioPhysical Measurement Series, SpaceLabs Medical Inc.
ISBN: 0 9627449 6 4


Annex 2: Reference materials and contacts


232




Myths and realities about the decentralization of health systems
Kolehmainen-Aitken, R-L. (ed) (1999). Management Sciences for Health, Boston, USA,
ISBN: 0 913723 52 5
This book is aimed at managers and policy-makers, and provides a comprehensive look at the impact
of decentralization on health systems around he world. Decentralization can profoundly influence
both the content and quality of health services and the technical support areas necessary to deliver
the services equitably and efficiently, but there is little information on the challenges of introducing
new policies and services in a decentralized environment. So, this book presents lessons learned to
provide an understanding of the positive and negative consequences of decentralization, and offers
advice on anticipating and dealing with these issues based on experiences in numerous countries.
Available from: Management Sciences for Health
Strategic medical technology planning and policy development
Raab M (1999). Swiss Centre for International Health. August 1999.
Successful energy management of health facilities
Riha J (1994). In Halbwachs H, and R Schmitt (eds) La maintenance dans les systemes de santé/
Maintenance for health systems: 4th GTZ Workshop, Dakar, Senegal, September 1993. GTZ
This paper covers the principles of energy management and its importance for health facilities. It
discusses energy costs, strategies, and obstacles to overcome by the health team.
Available from: GTZ
Technology assessment in healthcare
Raab M (2000). Swiss Centre for International Health
This paper discusses and calls for the need to undertake health care technology assessment in
developing countries, in order to make the best use of new technologies. It presents some strategies
for starting this process.
Available from: SCIH
The world health report 2000: Health systems – Improving performance
WHO (2000). ISBN: 92 4 156198 X
This book is aimed at policy-makers. Drawing from a range of experiences and analytical tools, this
book traces the evolution of health systems, explores their diverse characteristics, and uncovers a
unifying framework of shared goals and functions. The book presents three fundamental goals for
health services, and shows that the achievement of these goals depends on the ability of each health
system to carry out four main functions. It aims to stimulate debate about better ways of measuring
health system performance and thus finding a successful new direction for health systems to follow.
Available from: WHO
World development report 1993: Investing in health
World Bank (1993). Oxford University Press, New York, USA. ISBN: 0 19 520889 7
This report examines the controversial questions surrounding health care and health policy, and
advocates a threefold approach for governments in developing countries and those in transition. First,
to foster an economic environment that will enable households to improve their own health. Second,
to redirect spending away from specialized care and toward low-cost and highly effective activities, by
adopting packages of public health measures and essential clinical care described in the report. Third,
to encourage greater diversity and competition in the provision of health services.
Available from: World Bank


Annex 2: Reference materials and contacts


233




Equipment Needs and Equipment Lists
This material covers issues in Section 4.3 on establishing model equipment lists and includes
resources that discuss equipment needs, provide lists of equipment, advise on design and layout
implications relating to the use of equipment, and standardization. It is listed alphabetically by title.
Anaesthesia at the district hospital (2nd edition)
Dobson MB (1988). Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
ISBN: 92 4 154527 5
A practical manual designed to help medical officers in small hospitals acquire competence in the use
of essential techniques for inducing anaesthesia for both elective surgery and emergency care of the
critically ill. Addressed to doctors having at least one year of postgraduate clinical experience, the book
concentrates on a selection of basic techniques, procedures, and equipment capable of producing good
anaesthesia despite the limited resources usually found in small hospitals. The manual was prepared in
collaboration with the World Federation of Societies of Anaesthesiologists.
Available from: WHO
Anaesthetic equipment: Physical principles and maintenance (2nd edition)
Ward C (1985). Baillière Tindall. ISBN: 0 7020 1008 1
This book provides a comprehensive and practical coverage of the wide range of equipment used in
anaesthetic practice. It allows the reader to understand the mode of operation and maintenance of
equipment, and how to cope with common causes of mechanical failure. Suitable for trainee and
established anaesthetists, intensive care specialists, anaesthetic nurses, and theatre and
maintenance technicians.
Available from: book suppliers
A pocket book for safer IV therapy (drugs, giving sets and infusion pumps)
M Pickstone (ed.) (1999). ISBN: 094 867232 3
This pocket book has been written to help clinical staff deliver safe IV therapy. It covers the
calculation of drug dose, the make-up of drug solutions and the selection of infusion devices and
associated equipment.
Available from: major internet bookshops
Approaches to planning and design of health care facilities in developing areas: Vol 3
Kleczkowski B, and R Pibouleau (eds) (1979). WHO Offset Publication No 45. ISBN: 92 4 170045 9
This volume addresses the issue of hospital design in terms of the building structure itself. It
discusses inpatient areas, outpatient department, surgery, radiology department, and mobile facilities.
Equipment issues are specifically covered in the sections discussing layout and flow, alternative ways
of undertaking procedures, the equipping process, and choosing a complete X-ray system for a rural
medical facility.
Available from: WHO
Approaches to planning and design of health care facilities in developing areas: Vol 4
Kleczkowski B, and R Pibouleau (eds) (1983). WHO Offset Publication No 72. ISBN: 924 170072 6
This volume addresses the issue of hospital design in terms of the building structure itself. The
design of a hospital is discussed in the context of geographic and demographic data, utilisation, costs
and available resources. It is a useful resource for planners, architects and administrators. This volume
covers small health care facilities, laboratory facilities, transport systems, local construction materials,
health service management, training, commissioning, and engineering and maintenance services.
Equipment issues are specifically covered in the sections discussing layout and flow, laboratory design,
commissioning, and engineering and maintenance services.
Available from: WHO


Annex 2: Reference materials and contacts


234




Design for medical buildings (4th edition)
Mein P, and T Jorgnesen (1988). University of Nairobi, Housing Research and Development Unit;
African Medical and Research Foundation
Construction guidelines for medical buildings with special reference to appropriate designs for
developing and tropical countries. Relationship diagrams, flow of patients, linkages between different
units and services.
Available from: WHO, AMREF
District health facilities: Guidelines for development and operation
WHO Regional Publications: Western Pacific Series No 22 (1998). ISBN: 92 9061 121 9
This revised and expanded book presents detailed, richly illustrated guidelines for the planning and
design of district hospitals including the efficient utilization of space and easy movement of people,
equipment, and supplies. It also provides extensive information on the selection and maintenance of
medical and laboratory equipment, including specifications for a basic radiological system and a
general–purpose ultrasound scanner. Additional material covers sanitation and waste management,
emergencies and disasters, the procurement of essential drugs, and test instruments.
Available from: WHO
District laboratory practice in tropical countries (part 1)
Cheesbrough M (1998). Tropical Health Technology. ISBN:0 9507434 4 5
District laboratory practice in tropical countries (part 2)
Cheesbrough M (2000) Tropical Health Technology. ISBN:0 9507434 5 3
Essential equipment for district health facilities in developing countries
Halbwachs H, and A Issakov (eds.) (1994). GTZ, Eschborn, Germany
This book describes the types of equipment required at different levels within the district health
services – at health post level (sub-health centre without beds), at health centre or small district
hospital level (with 1-75 beds), and at district or provincial hospital level (with 76-250 beds). It also
provides guidance on the maintenance skill levels required for each equipment type.
Available from: GTZ, WHO
Essential healthcare technology package (EHTP)
WHO Collaborating Centre for Essential Health Technologies, Medical Research Council, South Africa
The WHO and MRC-SA have developed a tool (concept, methodology, and software) which
systematically relates planning to essential health interventions, rather than relying on static
equipment lists. The software links all internationally classified diseases (ICD codes) to their
respective procedures (CPT codes), then to the technologies (medical devices, drugs, human
resources, facilities) required for their execution. The EHTP templates are modified through country
specific consultations and consensus. An in-built query and simulation capability ensures that
planners can see the implications and costs of their choices. The EHTP is being field tested and
modified in 20 – 25 countries. Various papers are available describing the software and the results of
pilot application studies, contact: heimannp@who.int, or issakova@who.int.
Available from: http://www.ehtp.info
Examples of model equipment lists
A number of health service providers have already developed their own model equipment lists. For
example, more information can be obtained from:
◆ Dr P Asman, Biomedical Engineering Unit, Ministry of Health (Room 33, MOH Building), PO


Box M-44, Accra, Ghana. Email: nchtm@africaonline.com.gh
◆ Ministry of Health, PO Box 7272, Kampala, Uganda. Email: info@health.go.ug, website:


www.health.go.ug/support_system.htm
◆ Dr N Forster, Under Secretary: Health and Social Welfare Policy, Ministry of Health and Social


Services, Private Bag 13198, Windhoek, Namibia. Email: nforster@mhss.gov.na
◆ Ministry of Public Health, Conakry, Guinea. In French. Contact: mboule.andre@hotmail.com
◆ Ministry of Health, Gaborone, Botswana. For district hospitals and primary hospitals. Contact:


Ziken International on info@ziken.co.uk


Annex 2: Reference materials and contacts


235




Furniture and equipment in relation to activities, personnel and architecture – Primary and
secondary health care in developing countries
Knebel P (1984). Club du Sahel, OECD
This book, based on experience in the Sahel region, contains lists of the minimum requirements for
furniture and equipment for health facilities. There are also sections on UNICEF ordering
procedures, inventory control, catchment areas, basic demographic assumptions and calculation of
manpower needs. Two additional sections cover, in more detail, i) advice on staffing levels by facility
and activity and, ii) proposed architectural layouts for facilities.
Available from: OECD, WHO
Future use of new imaging technologies in developing countries.
Report of WHO Scientific Group (1985). WHO Technical Report Series No.723. WHO,
Geneva, Switzerland
This document discusses the use of ultrasound and computed tomography and the specifications for
the required equipment.
Available from: WHO
General surgery at the district hospital
Cook J, Sabkaran B, and A Wasunna (eds) (1998). Dept. of Surgery, Eastern General Hospital,
Edinburgh, Scotland. ISBN: 92 4 154235 7
A richly illustrated guide to general surgical procedures suitable for use in small hospitals that are
subject to constraints on personnel, equipment, and drugs. The book presents an overview of basic
principles, and detailed information on simple but standard surgical techniques for the face and neck,
chest, abdomen, gastrointestinal tract, urogenital system, and paediatric surgery. Lists of essential
surgical instruments, equipment and supplies are included.
Available from: WHO
If not in use – switch off!: Guidelines and key recommendations for a sustainable and
cost-effective energy supply for health facilities in remote locations
Röttjes M (1995) FAKT, Stuttgart, Germany
This practical document aims to provide a variety of courses of action that medical and administrative
staff can pursue when health facilities are hit by energy problems. It covers sustainable and cost-
effective energy supplies, the different energy requirements, possible energy sources, and suggestions
for a hospital energy supply. It includes PPM schedules for air-cooled diesel power plants.
Available from: FAKT
Infusion systems
Medicines and Healthcare Regulatory Authority (1995). MDA Device Bulletin, No. DB 9503 (May 1995)
This publication addresses many aspects of the use and selection of infusion systems. Its purpose is to
raise awareness of the nature of infusion systems, their advantages and their potential risks, with a
view to reducing the number of adverse incidents that arise from their use. It describes the different
types of infusion devices, risks and applications, training programmes, safety recommendations,
purchasing, and management responsibilities.
Available from: MHRA
Instrumentation for the operating room: A photographic manual (5th edition)
Brooks Tighe S (1999). ISBN 0323003508
Colour photographic reference manual illustrating in detail a range of instruments for major surgical
procedures: endoscopic, neurosurgery, ophthalmic, orthopaedic, and oral, maxilla and facial surgery.
Also includes a section describing the care and handling of instruments from cleaning to sterilization,
inspection and testing.
Available from: major internet bookshops


Annex 2: Reference materials and contacts


236




International Centre for Eye Health (ICEH) standard lists of equipment
ICEH produces annual standard lists of equipment, instruments and optical supplies for eye care in
developing countries.
Available from: online at http://www.ucl.ac.uk/ioo
International seminar for hospital technicians/engineers: February 1998, Moshi, Tanzania
Clauss J (ed) (1998). FAKT
Medical administration for frontline doctors: A practical guide to the management of
district-level hospitals in the public service or in the private sector (2nd edition)
Pearson C (1990). FSG Communications Ltd, Cambridge, UK. ISBN: 1 871188 03 2
This book provides information for doctors who combine wide clinical responsibilities with
administration and support for primary health care services. It covers a wide range of topics, with
country examples, including: management structures; infrastructure and maintenance; buildings,
support services, and equipment; hospital supplies; training; outreach programmes; and wider
responsibilities in the district and above.
Available from: TALC
Medical supplies and equipment for primary health care: A practical resource for
procurement and management.
Kaur M, and S Hall (2001). ECHO International Health Services Ltd. ISBN: 0 9541799 0 0
Medicines and Healthcare Regulatory Agency (MHRA, UK) products
This agency of the UK government (formerly the Medical Device Agency) ensures medical devices
and equipment meet appropriate standards of safety, quality, performance, and effectiveness, are used
safely, and that they comply with relevant Directives of the European Union. The MHRA provides a
variety of publications, such as:
◆ Device evaluations (replacing former evaluation reports) which evaluate and compare different


makes and models of equipment
◆ Device bulletins (one of many types of safety warnings produced about specific types, makes and


models of equipment)
◆ Medical device alerts (replacing former hazard notices, safety notices, device alerts, advice


notices, etc.)
◆ Advice on a wide variety of safety topics (visit the website, click on contacts, then medical


devices, then search under a subject area such as decontamination, or laundry for example).
Available from: MHRA
Physical asset planning and management software (PLAMAHS)
HEART Consultancy
Provisional reference lists of equipment and supplies for peripheral health services
Torfs ME (1975). WHO, Geneva, Switzerland, WHO/SHS/75.2
The document begins with a discussion of the methodology used in drawing up the lists.
Recommended lists of furniture, equipment, supplies, disposables, and pharmaceuticals are provided
for: i) static facilities, ii) mobile facilities, and iii) kits and sets.
Available from: WHO
Selection of basic laboratory equipment for laboratories with limited resources
Johns ML and ME El-Nageh (2000). ISBN: 9290212454
This book provides a framework to help laboratory workers, supply officers and decision makers to
choose and buy laboratory equipment and consumables. Includes information on maintenance and
energy requirements for laboratory equipment, quick reference buyer’s guides and equipment data
specification sheets provide easy reference for equipment buyers. The framework can be adapted to
guide general equipment purchasing.
Available from: WHO


Annex 2: Reference materials and contacts


237




Surgery at the district hospital: Obstetrics, gynaecology, orthopaedics and traumatology
Cook J, Sabkaran B, and A Wasunna (eds) (1991). Dept. of Surgery, Eastern General Hospital,
Edinburgh, Scotland. ISBN: 92 4 154413 9
An illustrated guide to essential surgical procedures in small hospitals for treating the major
complications of pregnancy and childbirth, common gynaecological procedures, and managing
traumatic injuries, including fractures and burns. Emphasis is placed on standard surgical protocols
that represent the safest line of action in hospital settings where equipment may be primitive, drugs
limited, and specialist services sparse – these requirements are discussed.
Available from: WHO
Surgical instruments: A pocket guide (2nd edition)
Papanier Wells M, and M Bradley (1998). ISBN: 00721678017
A pocket guide listing and describing surgical instruments: sharps/dissectors, forceps, clamps,
retractors, suction tips, dilators, endoscopic instruments, internal stapling devices, and most
commonly used instrument sets for a variety of surgical procedures. Includes a picture of the
instrument with a brief description explaining the uses, varieties, and alternative names.
Available from: major internet bookshops
See Guide 4 for more literature that discusses equipment needs for particular disciplines but does not
contain lists of equipment, and for training videos.


Equipment Specifications and Appropriate Models
This material covers issues in Section 4.5 on developing generic equipment specifications and
technical data, as well as material that discusses appropriate design of equipment. It is listed
alphabetically by title.
Appropriate medical technology for developing countries: Report of IEE 1st seminar in
February 2000
IEE Medical Focus Group. Report 00/014
This document contains papers on appropriate products that have been designed for use in
developing countries, such as an anaesthetic machine, diagnostic instruments for primary health care,
laboratory equipment, and an incinerator. It also contains discussions on issues such as solar power,
repair and maintenance of equipment, selection and procurement options, and sustainability.
Available from: IEE
Appropriate medical technology for developing countries: Report of IEE 2nd seminar in
February 2002
IEE Healthcare Technologies Professional Network. Report 02/057
This document contains papers on appropriate products that have been designed for use in
developing countries, such as a healthcare technology management information system, laboratory
equipment, a growth monitor, observation of respiratory dysfunction, a virtual doctor system, solar
energy, ophthalmic examination and surgical equipment. It also contains discussions on issues such as
a global medical devices nomenclature, management systems, the use of Cobalt 60 teletherapy for
cancer, a call for a biomedical instrument development centre, and an update of the anaesthetic
machine, diagnostic tools for medical surveillance, and an incinerator
Available from: IEE
Appropriate medical technology for developing countries: Report of IEE 3rd seminar in
February 2004
IEE Healthcare Technologies Professional Network. UK ISSN: 0963 3308, reference no.: 03/10408
This document contains mainly scientific papers on research and design work being undertaken on
appropriate products and techniques for developing countries.
Available from: IEE


Annex 2: Reference materials and contacts


238




District health facilities: Guidelines for development and operation
WHO Regional Publications: Western Pacific Series No 22 (1998). ISBN: 92 9061 121 9
District laboratory practice in tropical countries (part 1)
Cheesbrough M (1998). Tropical Health Technology. ISBN:0 9507434 4 5
District laboratory practice in tropical countries (part 2)
Cheesbrough M (2000) Tropical Health Technology. ISBN:0 9507434 5 3
Emergency Care Research Institute (ECRI, USA) products
ECRI
Examples of equipment specifications and technical data
A number of health service providers have developed their own equipment specifications, package of
inputs to purchase, national technical data, and supply contracts. For example, more information can
be obtained from:
◆ Dr P Asman, Biomedical Engineering Unit, Ministry of Health (Room 33, MOH Building),


PO Box M-44, Accra, Ghana. Email: nchtm@africaonline.com.gh
◆ Ministry of Health, PO Box 7272, Kampala, Uganda. Email: info@health.go.ug,


website: www.health.go.ug/support_system.htm
◆ Dr N Forster, Under Secretary: Health and Social Welfare Policy, Ministry of Health and Social


Services, Private Bag 13198, Windhoek, Namibia. Email: nforster@mhss.gov.na
◆ Ziken International, contact: info@ziken.co.uk
Future use of new imaging technologies in developing countries.
Report of WHO Scientific Group (1985). WHO Technical Report Series No.723. WHO, Geneva,
Switzerland
Medical supplies and equipment for primary health care: A practical resource for
procurement and management.
Kaur M, and S Hall (2001). ECHO International Health Services Ltd. ISBN: 0 9541799 0 0
Physical asset planning and management software (PLAMAHS)
HEART Consultancy
UNICEF supply catalogue (formerly the UNIPAC catalogue)
UNICEF
This catalogue lists products with their specifications under categories such as: immunization and
cold chain; medical devices and kits; water, environment, sanitation and engineering; education,
communication; etc. View it online at www.supply.unicef.dk/Catalogue.
Available from: UNICEF Denmark


Cost and Budgeting Information
This material covers issues in Sections 5 and 6 such as resources that discuss the various costs
incurred when owning equipment and how to calculate them, how to make budget estimates, how to
make savings, how to undertake cost-benefit analysis. It is listed alphabetically by title.
A study into the costs of running X-ray equipment in a SCIH project in Egypt
Raab M, and G Hutton (2001). Swiss Centre for International Health, Basle, Switzerland
This paper investigates the cost and financing for a project in Egypt to provide X-ray machines. It
shows how the costs incurred during the life cycle of the equipment can be calculated, estimated and
summarized. The evaluation study classified costs as investment costs (money required at the start of
the project), recurrent costs (money required to make the project sustainable), and incremental costs
(additional costs to those covered by the Ministry of Health). The information on investment and
recurrent costs gave the decision makers a picture of (potential) impact on budgets, and how much
budgets should be adjusted to accommodate the project.
Available from: SCIH


Annex 2: Reference materials and contacts


239




Better health in Africa: Experience and lessons learned
World Bank (1994). Development in Practice Series, World Bank, Washington, USA,
ISBN: 0 8213 2817 4
Cost-benefit calculation models for optimizing technology management in
healthcare facilities
Raab M (1999). Swiss Centre for International Health
This paper presents a set of tools for evaluating the costs related to clinical engineering services
(whether in-house, externally contracted, or a mixture of both). These costs are balanced against the
benefits reaped by the health service provider. The method of analysis used has been tested in a
number of countries (mainly those in transition).
Available from: SCIH
Engineering and maintenance services in developing countries
Mehta, J.C. (1983) in Approaches to planning and design of health care facilities in developing
areas: Vol 4, B.M. Kleczkowski, R. Pibouleau. (eds), WHO Offset publication No 72
This document is based on over 8 years of experience of the maintenance system in a government
hospital in India. The document discusses maintenance for the hospital as a whole including
buildings, plant, and equipment. There are sections on maintenance management, activities of the
hospital engineering and maintenance department, planning the maintenance program, personnel,
services to offer, and tables of estimated costs of maintenance for different types of equipment as a
percentage of capital cost.
Available from: WHO
Estimated useful lives of depreciable hospital assets (revised 2004 edition)
American Society for Hospital Engineering (2004). American Hospital Association.
ISBN: 1 55648 319 8
One of the organizations which have tried to estimate typical equipment lifetimes for healthcare
technology. The AHA’s extensive list reflects how equipment lasts within the United States’ health
care system whether it was manufactured in the US or abroad. It covers buildings, estate, fixed
equipment, and individual items of movable equipment. The list was compiled after discussions with
manufacturers of healthcare equipment, discussions with various hospital department managers, and
analysis of actual retirement practices for actual hospital assets.
Available from: AHA
Healthcare equipment management
Halbwachs H. (1994). pp 14-20 in Health Estate Journal, December 1994, Portsmouth UK
Health economics for developing countries: A practical guide
Witter S et al (2000). Macmillan, UK, ISBN: 0 333 75205 8
This book is an introduction to health economics and finance for low-income countries, which is easy to
read and does not assume previous training in economics. It explains health economics in an accessible
lively way using material from, and relevant to, developing countries. The focus is on practical use
with worked examples and practice exercises. There are sections covering many topics, including
health and development, financing health care, the value of cost information for allocating resources,
organizational issues such as decentralization, public/private provision, and improving efficiency.
Available from: major internet bookshops
International seminar for hospital technicians/engineers: February 1998, Moshi, Tanzania
Clauss J (ed) (1998). FAKT


Annex 2: Reference materials and contacts


240




Maintenance and the life expectancy of healthcare equipment in developing economies
Hans Halbwachs, GTZ. In Health Estate Journal (March 2000) pp 26-31
This article comes from one of the organizations that have tried to estimate typical equipment
lifetimes for healthcare technology. The GTZ estimates are for 16 types of medical equipment and
plant, and tries to more closely reflect the realities in developing countries. The article describes the
Delphi survey used to obtain feedback from 23 experts from 16 different country backgrounds. Rather
than providing exact lifetimes, this approach provides a range for the lifetime that depends on the
quality of the initial equipment and how well it has been maintained.
Available from: GTZ
Medical equipment in developing countries: Two neglected issues – planning and financing
Berg H (1992). WHO Document WHO/SHS/CC/92.2
This document is aimed primarily at health planners. It describes planning problems, and outlines the
procedures that should occur before equipment is purchased in order to ensure that the implications
of ownership are known. It looks at the recurrent cost implications of equipment, and presents a
method for unit costing and shows the consequences through examples.
Available from: WHO
Medical technology management
David Y, and T Judd. (1993) BioPhysical Measurement Series, SpaceLabs Medical Inc.
ISBN: 0 9627449 6 4
Physical assets management and maintenance in district health management
Halbwachs H (2000). GTZ document
Reflections on the economy of maintenance: Presentation at the summit conference of the
African Federation for Technology in Healthcare, Harare, Zimbabwe, 1998
Riha J, Mangenot L, Halbwachs H, and G Attemené. (1998). GTZ
This paper aims to provide convenient quantitative guidelines for engineers, administrators and
decision makers on the cost implications of maintenance approaches. It explores how to define an
annual maintenance cost ceiling by relating maintenance cost to the expected increase in equipment
lifetime. This is achieved though the use of various equations with worked examples.
Available from: GTZ
The right equipment... in working order
Bloom GH et al (1989). Reprinted from World Health Forum, Vol 10, No. 1, pp 3 – 27. WHO,
Geneva, Switzerland
This document contains a series of papers that discuss planning and budgeting issues for healthcare
technology in developing countries. They contain cost estimates (as a percentage of the capital stock
value), financial planning implications, constraints and strategies.
Available from: WHO
The technical and financial impact of systematic maintenance and repair services within
health systems of developing economies or ‘How good is my maintenance service?’
Halbwachs H (1998).pp57-60 in Proceedings of the IFHE 15th International Congress, Edinburgh,
June 1998, International Federation of Hospital Engineering
This paper describes, with country examples, the consequences of a lack of maintenance and repair,
and how the introduction of planned preventive maintenance and repair services can benefit the
health service by providing a positive economic impact. It covers how to measure the quality of
maintenance services using process, impact, and cost indicators, including savings calculations. It
reports on the results of studies in three countries on the cost-effectiveness of maintenance services.
It also describes a suitable national body through which donors could provide financial contributions
to maintenance services.
Available from: GTZ, IFHE
World development report 1993: Investing in health
World Bank (1993). Oxford University Press, New York, USA. ISBN: 0 19 520889 7


Annex 2: Reference materials and contacts


241




See Guide 6 for more information and resources covering financial management, running Healthcare
Technology Management Services as businesses that can generate profits, and preparing budgets for
HTM Services.


Developing Skills and an Equipment Training Plan, and Managing Change
This material covers issues in Section 2.1 on managing change, and Section 7.2 on developing an
equipment training plan. It is listed alphabetically by title.
A book for midwives
Klein, S (1996). Hesperian Foundation. ISBN: 0 942364 23 6
This book provides practical information on antenatal care, labour, birth and post-partum care. It also
includes a section on making teaching materials and low-cost equipment.
Available from: TALC
District health care: Challenges for planning, organization and evaluation in developing
countries (2nd edition)
Amonoo-Larston R, Ebrahim G, Lovel H, and J Rankeen (1996). MacMillan. ISBN: 0 333 57349 8
Healthcare technology: Training skills for hospital technicians and engineers
FAKT (1999). FAKT Technical Library Data Sheet
This paper discusses the major objectives of training both on- and off-the-job. It then provides
practical guidance on how to undertake on-the-job training effectively by using the PESOS
procedures (prepare, explain, show, observe, supervise). It explains each step in detail. Although
written for maintenance staff, its advice is just as useful for any other types of staff.
Available from: FAKT
Hospital engineering in developing countries
Dammann V, and H Pfeiff (eds) (1986). GTZ, Eschborn, Germany. ISBN: 3 88085 293 6
Hospital technology: Communication – a vital skill for successful healthcare technical
service management
FAKT (1999). FAKT Technical Library Data Sheet
This paper discusses the importance of communication for both working in a team and working in an
organization/network. It provides advice on how to communicate effectively, its importance, the
barriers that exist, how to promote effective communication, the role of the head of department,
methods to use, and related reading. Although written for maintenance staff, its advice is just as
useful for any other types of staff.
Available from: FAKT
How to make and use visual aids
Harford, N and N Baird (1997). VSO. ISBN: 043592317X
This booklet describes a number of useful and practical methods for making visual aids quickly and
easily, using low cost materials.
Available from: TALC, VSO
Maintenance strategies for public health facilities in developing countries: Report of a
workshop held in March 1989 in Nairobi by GTZ
Halbwachs H, and R Korte (1990). WHO/SHS/NHP/90.2
This report presents the results of a workshop attended by 60 participants from 18 countries including
project staff and counterparts from GTZ projects in various countries, representatives of various donor
agencies, and resource persons. The papers included address the different types of personnel required
in maintenance services, the training they require, experiences of establishing national training courses
in hospital maintenance, and ways to monitor progress with maintenance and training.
Available from: GTZ, WHO


Annex 2: Reference materials and contacts


242




Management support for primary health care: A practical guide to management for health
centres and local projects
Johnstone, P, and J Ranken, (1994). FSG Communications Ltd, Cambridge, UK. ISBN: 1 87118 02 4
This practical user-friendly book gives support and guidance to leaders in health centres and other
local projects to help stimulate and maintain primary health care (PHC) in their surrounding
communities. Aid workers, and others unfamiliar with PHC and basic management techniques may
also benefit. Includes sections which will assist with staff motivation, such as teamwork and team
effectiveness; managing oneself, others and tasks; and managing change, as well as sections on
planning and monitoring progress.
Available from: TALC
Medical administration for frontline doctors: A practical guide to the management of
district-level hospitals in the public service or in the private sector (2nd edition)
Pearson C (1990). FSG Communications Ltd, Cambridge, UK. ISBN: 1 871188 03 2
Medical equipment in Botswana: A framework for management development
Temple-Bird C L, Mhiti R, and G H Bloom (1995), WHO publication WHO/SHS/NHP/95.1
On being in charge: A guide to management in primary health care (2nd edition)
McMahon R, Barton E, and M Piot (1992). ISBN: 9241544260
This practical guide aims to improve the managerial skills of middle level health workers. The text is
reinforced with practical examples, questionnaires and illustrations that help relate the information to
health workers’ own experiences. Topics include identifying health problems, assigning priorities to
their solution, planning and implementing programmes, and evaluating results. Also serves both as a
training and reference guide, covering all aspects of primary health care management including
equipment and drugs.
Available from: WHO
Setting up community health programmes: A practical manual for use in developing
countries (2nd edition)
Lankester, T. (2000). ISBN: 0333679334
A practical ‘how-to’ manual designed for a wide range of health workers working with community
health programmes. With revised and updated material on planning, management and evaluation of
health programmes ranging from choosing and training a team through the setting up of clinics and
advising village health workers. Includes new information on community-based approaches to safe
motherhood, immunisation, malaria and TB based on WHO guidelines.
Available from: TALC
Training health personnel to operate health-care equipment: How to plan, prepare and
conduct user training – A guide for planners and implementors
Halbwachs H, and R Werlein, (1993). GTZ, Eschborn
The aim of this book is to ensure that users are in a position to operate equipment and plant without
causing failure or malfunction. Part one addresses the planner/administrator developing user courses
and gives information about methods, course organization, finances, etc. Part two discusses
interesting issues for the implementers i.e. how to design a course, teaching methods and teaching
aids, conducting a course, etc. This practical guide provides sample checklists, questionnaires,
worksheets, tests, certificates, etc.
Available from: GTZ
Transfer of learning: A guide for strengthening the performance of health care workers
Intrah/PRIME II/JHPIEGO (March 2002)
This book is for health care workers involved in training and learning interventions and enables them
to transfer their newly acquired knowledge and skills to their jobs, resulting in a higher level of
performance and sustained improvement in the quality of services at their facilities.
Available from: free online at http://www.prime2.org/prime2/section/70.html


Annex 2: Reference materials and contacts


243




WHO Interregional meeting on manpower development and training for health care
equipment management, maintenance and repair: Campinas, Brazil, November 1989
WHO (1989). WHO document WHO/SHS/NHP/90.4
This document provides a comprehensive discussion of the complexities of manpower development
and training for healthcare technology maintenance and management, as well as proposed strategies.
It uses reports from countries, participating institutions and organizations regarding skill
development for healthcare technical services. It discusses the needs, professional development, use
of an equipment survey to determine manpower requirements, certification, and job descriptions.
Available from: WHO
See all other Guides in the Series for information on the training requirements specific to the topics
covered by each Guide.


Equipment Development Plans, Budgets, and Monitoring Progress
This material covers issues in Sections 7 and 8 on equipment development plans, income and
expenditure plans (budgets), and Section 8 on target-setting and monitoring progress. It is listed
alphabetically by title.
District health care: Challenges for planning, organization and evaluation in developing
countries (2nd edition)
Amonoo-Larston R, Ebrahim G, Lovel H, and J Rankeen (1996). MacMillan. ISBN: 0 333 57349 8
Maintenance strategies for public health facilities in developing countries: Report of a
workshop held in March 1989 in Nairobi by GTZ
Halbwachs H, and R Korte (1990). WHO/SHS/NHP/90.2
Management support for primary health care: A practical guide to management for health
centres and local projects
Johnstone, P, and J Ranken, (1994). FSG Communications Ltd, Cambridge, UK. ISBN: 1 87118 02 4
Medical technology management
David Y, and T Judd. (1993) BioPhysical Measurement Series, SpaceLabs Medical Inc.
ISBN: 0 9627449 6 4
On being in charge: A guide to management in primary health care (2nd edition)
McMahon R, Barton E, and M Piot (1992). ISBN: 9241544260
Planning and budgeting software
Preparation of equipment development plans, expenditure plans, and budgets is an area where simple
computer software programs can be of assistance once you have mastered a manual paper system, have
a large enough stock (several hundred items of major equipment), and can obtain sufficient training of
staff. The software should be a spreadsheet application, in which you can enter formulae to
manipulate the data in each column. There are a variety of products available with different
advantages, for example:
◆ OpenOffice software is free to download and use. It includes typical desktop applications: word


processor, spreadsheet, presentation manager, and drawing program. It works with a variety of file
formats and platforms, and various languages. It is run by a community of developers and end-
users. Website: www.openoffice.org, and look for the latest stable release to download.


◆ Any commercially available spreadsheet software can be purchased. Excel (the spreadsheet
application part of Microsoft Office) is readily available from any computer distributor, is
commonly available on health service provider’s computer systems, but is a more expensive option.
Website: www.microsoft.com/office/excel for information, viewing, and download possibilities.
Although many other products are available.


◆ Tailor-made budgeting software products have many features, however they are often more
complex and expensive than required, and than a straightforward spreadsheet. These products can
be found by searching for budgeting software on the internet.


Annex 2: Reference materials and contacts


244




◆ The ‘Health Manager’s Toolkit’ is a product produced by Management Sciences for Health that
includes spreadsheet templates, forms for gathering and analyzing data, checklists, guidelines for
improving organizational performance, and self-assessment tools that allow managers to evaluate
their organizations. Tools cover areas such as strategic planning, developing information systems,
cost and revenue analysis, and sustainability. Website: http://erc.msh.org/toolkit.


Setting up community health programmes: A practical manual for use in developing
countries (2nd edition)
Lankester, T. (2000). ISBN: 0333679334
Strategic medical technology planning and policy development
Raab M (1999). Swiss Centre for International Health. August 1999
The division for the supply of medical spare parts in the health system of Kenya
Paton J, Green B, and J Nyamu (1996). Ministry of Health, Nairobi/GTZ, Eschborn, Germany
This paper describes how a Division for the Supply of Medical Spare Parts was set up and is run in the
health system of Kenya, financed through the use of a revolving fund.
Available from: GTZ
The technical and financial impact of systematic maintenance and repair services within
health systems of developing economies or ‘How good is my maintenance service?’
Halbwachs H (1998). pp 57-60 in Proceedings of the IFHE 15th International Congress,
Edinburgh, June 1998, International Federation of Hospital Engineering


Accessing Information
These websites are sources of information concerning many aspects of health service delivery. They
are locations where there is, or may be, information about healthcare technology management and the
planning and budgeting requirements for equipment.
Africa online: Health website: http://bamako.africaonline.com/afol/index.php
Provides links to health information sites related to Africa. The links are organized into the following
categories: health information, health news, events, African organizations, international organizations,
schools and hospitals in Africa, projects, publications and health services
AFRO-NETS (African networks for health research and development)
website: www.afronets.org
Forum for exchanging health research information in and between East and Southern Africa.
AJOL (African journals online) website: www.inasp.org.uk/ajol
Offers free online access to tables of contents and abstracts of over 70 journals published in Africa.
British medical journal website: http://bmj.bmjjournals.com/
Free worldwide access to BMJ and the student BMJ and a wide range of specialist journals to users in
low-income countries.
Eurasia health knowledge network (EHKN) website: www.eurasiahealth.org
Specialises in the health information needs of the Former Soviet Union (FSU) and Central and
Eastern Europe (CEE). Site links to clinical practical guidelines, medical textbooks, and other
educational materials, many in Russian and other regional languages
FIN: Free international newsletters: www.healthlink.org.uk
Healthlink produces this publication that lists over 130 print and electronic health-related
newsletters and magazines which are available free to readers in developing countries.
Free medical journals website: www.freemedicaljournals.com
This site is a comprehensive, up to date list of medical journals available free on the internet.
GATE (German Appropriate Technology Exchange): www5.gtz.de/gate/
The GATE Information Service seeks to improve the technological knowledge of organizations and
individuals involved in poverty alleviation projects and to develop information and knowledge
management systems of organizations.


Annex 2: Reference materials and contacts


245




Global Medical Devices Nomenclature (GMDN) website: www.gmdn.org/index.xalter
The GMDN is a collection of internationally recognized terms used to accurately describe and
catalogue medical devices. It is a classification system developed to allow for the classification of all
medical devices put onto the market as defined by the European Standards body (CEN). It is intended
to replace the older national device nomenclatures such as UMDNS (USA), CNMD (Canada), NKKN
(Norway), JFMDA (Japan), in order to promote consistency in terminology around the world. The
system has been accepted by the International Organization for Standardization (ISO).
Health exchange website: www.healthcomms.org
Explores issues, ideas and practical approaches to health improvement in developing countries and
provides a forum for health workers and others to share viewpoints and experiences in this area.
HealthNet news website: www.healthnet.org/medpub
Weekly newsletter distributed to health professionals in Africa, Asia and Latin America. Features
current, practical, clinical and public health information.
HIF-net at WHO discussion group
Discussion list dedicated to issues of improving access to reliable health information in resource-poor
settings. To join, email your name, affiliation and professional interests to: health@inasp.info
HINARI (Health inter-network access to research initiative) website:
www.healthinternetwork.net
WHO initiative offering free/discounted access to journals from six leading publishers.
HNP flash website: www.worldbank.org/hnpflash
A free monthly electronic newsletter dedicated to sharing knowledge regarding the latest technical
developments in the fields of health, nutrition, population, and reproductive health.
ID21 health website: www.id21.org/health
An internet based development research reporting service for health policy makers and development
practitioners on global health issues. Latest research summaries are provided on a searchable website,
by email and in a quarterly publication.
IEC website: www.iec.ch
International Electrotechnical Committee, which sets standards for the safe manufacture of electrical
healthcare technology. There is a wide range of specific standards for medical electrical equipment
falling under the standard numbers IEC 60101–1,2, and 3.
IEE healthcare technologies professional network website: www.iee.org/pn/healthtech
The Institution of Electrical Engineers of the UK provides internet sites for a wide variety of
engineering professions, with the aim of enabling people to communicate with their peers around the
world and access the latest global industry news and key information sources. One of their professional
networks focuses on healthcare technologies. It has also hosted a series of seminars on Appropriate
medical technology for developing countries, and their reports can be obtained from the IEE.
INFRATECH discussion group
WHO forum for global exchange of information on infrastructure and health care technology issues
To subscribe send an email to LISTSERV@LISTSERV.PAHO.ORG enter in text: subscribe infratech
‘your full name’.
International health exchange website: www.ihe.org.uk
Provides training, information and advice to health workers in emergency aid and development
situations. This site also provides information about jobs and health development issues.


Annex 2: Reference materials and contacts


246




International journal of technology assessment in health care website:
www.cambridge.org/uk/journals/journal_catalogue.asp?historylinks=ALPHA&mnemonic=THC
This journal serves as a forum for professionals interested in the assessment of medical technology, its
consequences for patients, and its impact on society. It covers the generation, evaluation, diffusion,
and use of health care technology through essays, research notes, regular columns on technology
assessment reports, and sections devoted to particular topics. Sometimes there are articles with
particular relevance to developing countries. In 1994, the Cambridge University Press produced a
book of reprints called Technology assessment in health care for developing countries.
Email: journals-subscription@cambridge.org.
KAR (Knowledge and research programme on disability and healthcare technology) website:
www.kar-dht.org, and for the latest projects being funded use website: www.disabilitykar.net/
This is the Knowledge and Research Programme on disability and healthcare technology of the UK
governments’s Department for International Development (DFID). It supports a range of projects on
development and use of appropriate disability and healthcare technologies in developing countries.
The website also provides links to:
◆ Disability and healthcare technology newsletter produced every six months describing the


progress and findings of the projects funded;
◆ KaR global database on healthcare technology publications, organizations, manufacturers,


training institutions, etc.
NICE (National Institute of Clinical Excellence) website: www.nice.org.uk
Provides guidance to the UK National Health Service (NHS) on current best practice covering both
health technologies (from medicines to diagnostic techniques) and the clinical management of
specific conditions.
Programme for appropriate technology in health (PATH) website: www.path.org
PATH identifies, develops and applies appropriate technologies to public health problems in
developing countries.
Public health care laboratory website: www.phclab.com
Global forum of information exchange and resource centre for laboratory personnel and those
concerned with PHC laboratory services in developing countries.
TechNet (Technical network for strengthening immunisation services) website:
www.technet21.org
Forum focusing on improving management and operational logistics for health service delivery in
developing countries, in particular, immunisation services.
The manager’s electronic resource center website: http://erc.msh.org
The ERC website is an electronic information resource and communication service for health
managers, containing more than 150 ready-to-use management tools in various languages. A key
feature is The health manager’s toolkit – see the discussion on planning and budgeting software in
the section above.
WHO: Health technology and pharmaceuticals website: www. who.int/technology
This WHO site provides information on pharmaceutical and health technology developments with a
particular focus on developing countries. It includes links to blood transfusion safety and clinical
technology, essential drugs, medicines, vaccines and biologicals.
WHO: Management of health services (MAKER) website: www. who.int/management
This WHO site provides information, publications, and country experiences on all types of
management issues for health services, such as facility management, resource management, and
district management.
World Bank website: www.worldbank.org
This site should provide access to World Bank guidelines for equipping health facilities.


Annex 2: Reference materials and contacts


247




ii. Organizations, Sources of Publications in Part i, Resource and
Information Centres


For the following institutions we have included the name, address, contact details, a brief description
of the various services they offer, and additional contact details for further relevant activities.
AfriAfya
AMREF Building, PO Box 30125, Nairobi, Kenya
Tel: 254 2 609520, fax: 254 2 609518, email: info@afriafya.org, website: www.afriafya.org
Established by Kenya-based health agencies, AfriAfya provides community access to relevant and
appropriate health knowledge and information in an interactive manner. As well as a section on
HIV/AIDS there is a news centre, message board and discussion forum on their website.
Amazon Bookshop
PO Box 81226, Seattle, Washington 98108-1226, USA
Website: www.amazon.com or www.amazon.co.uk
Internet bookshop
American Hospital Association
Clinical Engineering Section, 840 North Lake Shore Drive, Chicago, Illinois 60611, USA
Website: http://aharc.library.net/
They produce a wide range of documents which are published by HealthForum, use
website:www.ahaonlinestore.com
AMREF International (African Medical and Research Foundation)
Resource Centre, AMREF Headquarters, Langata Road, PO Box 00506 – 27691, Nairobi, Kenya
Tel: 254 2 501301/2/3, fax: 254 2 609518, e-mail: amref.info@amref.org, website: www.amref.org
Publishes practical books, journals and other literature for health workers, and provides advice on
primary health care. Runs training courses and seminars.
BOND (British Overseas NGO’s for Development)
Website: www.bond.org.uk
A network of more than 260 UK based voluntary organisations working in international development and
development education. BOND works to promote the exchange of experience, ideas and information by
acting as a broker for a variety of relationships and by collating and distributing information.
Commonwealth Secretariat
Marlborough House, Pall Mall, London, SW1Y 5HX, UK
Tel: 44 207 747 6500, fax: 44 207 930 0827, website:
www.thecommonwealth.org/publications/html/contactus.asp
This website provides access to the publications produced by the Commonwealth Sectretariat.
De Montfort medical waste incinerators
Website: www.mw-incinerator.info/en/101_welcome.html
This website provides information on De Montfort University incinerators designed by Prof. DJ
Picken. It contains copies of drawings and instructions for the building, operation and maintenance of
various incinerator models. The range of DMU incinerators has been developed for use by rural PHC
facilities, and designed to be constructed on site using local materials. There may be a small charge to
cover the cost of printing and postage of the plans.
DFID (Department for international development)
Website: www.dfid.gov.uk
UK government’s department for international development assistance.


Annex 2: Reference materials and contacts


248




ECHO International Health Services Ltd
ECHO International Health Services is no longer trading as it used to. Its services can be accessed as
follows:
i. the charitable foundation can be contacted at:


ECHO, Ullswater Crescent, Coulsdon, Surrey, CR5 2HR, UK
Tel: 44 208 6602220, fax: 44 208 6680751, website: www.echohealth.org.uk/intro2.html


ii. the trading branch of the business (wholesale providers of medical supplies and equipment) is now:
Durbin PLC, 180 Northholt Road, South Harrow, Middlesex, HA2 0LT, UK
Tel: 44 208 8696500, fax: 44 208 8696565, email: cataloguesales@durbin.co.uk, website:
www.durbin.co.uk


iii. ECHO publications are still available from TALC (see below).
ECRI (Emergency Care Research Institute)
5200 Butler Pike, Plymouth Meeting, Pennslyvania 19462-1298, USA
Tel: 1 610 825 6000 ext 5368, fax: 1 610 834 1275, website: www.ecri.org
Offers guidance and advice on health care technology, planning, procurement and management; and
health technology assessment and assistance.
Elsevier Health Science
Elsevier Books Customer Services, Linacre House, Jordan Hill, Oxford, OX2 8DP, UK
Tel: 44 1865 474110, fax: 44 1865 474111, email: eurobkinfo@elsevier.com,
website: www.us.elsevierhealth.com
Books published by WB Saunders, Mosby, Churchill Livingstone, and Butterworth-Heinemann are
now all members of the Elsevier Science, Health Sciences Division.
European Union (EU)
http://europa.eu.int/comm/development/index_en.htm
EU site for international development and aid.
FAKT (Consultancy for Management, Training, and Technologies)
Gansheidestrasse 43, D-70184 Stuttgart, Germany
Tel: 49 711 21095/0, fax: 49 711 21095/55, email: fakt@fakt-consult.de, website: www.fakt-consult.de
Non-profit consultancy firm, that provides information on appropriate hospital and medical
equipment and training in healthcare technologies. FAKT is not a supply organisation.
Global Directory of Health Information Resource Centres.
Health Information for Development (HID) Project, PO Box 40, Petersfield, Hants, GU32 2YH, UK
Tel: 44 1730 301297, fax: 44 1730 265398, email: iwsp@payson.tulane.edu,
website: www.iwsp.org/directory.htm
This is a directory of health information resource centres that is arranged alphabetically by country.
Between January 2000 and May 2001, Health Information for Development (HID) compiled a Global
Directory of Health Information Resource Centres (HIRCs). This is available from their website. The
Directory is updated on an ongoing basis.
GTZ (Deutsche Gesellschaft für Technische Zusammenarbeit – German government technical
aid agency)
Division of Health and Education, PO Box 5180, D-6236, Eschborn, Germany
Tel: 49 6196 791265, fax: 49 6196 797104, email: Friedeger.Stierle@gtz.de
Website: http://www.gtz.de/de/4030.htm
Friedeger Stierle is the contact for the GTZ’s healthcare technology management programme, and
any articles or documents on HTM.
Healthlink Worldwide
Cityside, 40 Adler Street, London, E1 1EE, UK
Tel: 44 20 7539 1570, fax: 44 20 7539 1580, email: info@healthlink.org.uk, website:
www.healthlink.org.uk
Publishes a range of free and low-cost newsletters, resource lists, briefing papers and manuals about
health and disability. Publications include HIV testing: a practical approach which is a briefing
paper on HIV counselling and laboratory testing.


Annex 2: Reference materials and contacts


249




HEART Consultancy
Quadenoord 2, 6871 NG Renkum, The Netherlands
Tel: 31 317 450468, fax: 31 317 450469, email: jh@heartware.nl, website: http://www.heartware.nl
Consultancy firm working in all aspects of healthcare technology management in developing
countries. It also produces and supplies the PLAMAHS software package for managing the inventory,
model lists, maintenance, and procurement needs for your healthcare technology stock. HEART also
undertakes research and training, and produces publications on many aspects of sterilization for
developing countries. It has developed a basic testkit for performance testing of sterilizers, and can
identify suppliers that still manufacture basic sterilizers (manually operated/fuel heated).
HMSO (Her Majesty’s Stationery Office)
Website: www.hmso.gov.uk
Publishers of material produced by departments of the UK government.
Humanitarian Information for All
c/o Human Info NGO vzw and Humanity CD Ltd, Oosterveldlaan 196, B-2610 Antwerp, Belgium
Fax: 32 3 449 75 74, email: humanity@humaninfo.org, website:
http://media.payson.tulane.edu:8086/cgi-bin/gw?e=t1c11copyrigh-mhl-1-T.1.B.21.1-500-50-
00e&q=&a=p&p=home
The goal of this organization is to disseminate health care information free-of-charge in developing
countries. Thus, their Medical and Health Library makes publications available on the internet. Refer
to their homepage to find the large list of publications available.
Institution of Electrical Engineers (IEE)
Savoy Place, London, WC2R 0BL, UK
Tel: 44 207 240 1871, Fax: 44 207 240 7735, email: postmaster@iee.org, website: www.iee.org.uk
Largest professional engineering society in Europe with worldwide membership for those working in
electronics, electrical, manufacturing and IT professions. Produces a wide range of publications, is a
source of a wide range of information, and has a Healthcare Technologies Professional Network.
Copies of their publications are available from IEE Publication Sales Department, Michael Faraday
House, Six Mills Way, Stevenage, Herts, SG1 2AY, UK
Tel: 44 1438 767 328, fax: 44 1438 742 792, email: sales@iee.org.uk
Intermediate Technology Development Group (ITDG) and ITDG Publishing
The Schumacher Centre for Technology and Development, Bourton Hall, Bourton-on-Dunsmore,
Rugby, CV23 9QZ, UK
Tel: 44 1926 634400, fax: 44 1926 634401, email: enquiries@itdg.org.uk, website: www.itdg.org
The Development Group is a charity concerned with the research and development of ‘appropriate’
technologies for application in developing countries. It has worked on topics such as alternative
electrical supplies, access to water, disability aids, medical supplies. It also undertakes consultancies.
The Publication Division produces and disseminates books and journals covering aspects of health,
development, and appropriate technology. It can be contacted at:
Tel: 44 1926 634501, fax: 44 1926 634502, email: itpubs@itpubs.org.uk,
website: www.itdgpublishing.org.uk.
International Centre for Eye Health (ICEH)
International Resource Centre, Institute of Opthalmology, University College London, 11-43 Bath
Street, London, EC1V 9EL, UK
Tel: 44 20 7608 69 23/10/06, fax: 44 20 7250 3207, email: eyeresource@ucl.ac.uk, website:
www.ucl.ac.uk/ioo
Advises and publishes information on all aspects of eye care including prevention of blindness.
Produces the Community eye health journal distributed free to developing countries, an annual
standard list of medicines, equipment, instruments and optical supplies for eye care for developing
countries, and teaching slides/text sets and videos.


Annex 2: Reference materials and contacts


250




International Federation of Hospital Engineering (IFHE)
Website: http://home.enter.vg/ifhe/main.html
This body enables national engineering professional organizations to join in a world-wide federation.
It encourages and facilitates exchange of information and experience in the broad field of hospital and
healthcare facility design, construction, engineering, commissioning, maintenance, and estate
management. It arranges an International Congress every two years at different locations, in
conjunction with a healthcare trade exhibition. The reports of the papers presented at these
congresses are sources of information on the changing requirements for many topics, such as
sterilization, air flow control, waste management, equipment safety, etc. It publishes a newsletter.
International Society for Technology Assessment in Health Care (ISTAHC)
c/o Institute of Health Economics, 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada T5J 3N4
Tel: 780 448 4881, fax: 780 448 0018, email: info@HTAi.org, website: http://www.htai.org/
International non-profit body with regional branches, it researches and disseminates information
concerning health technology assessment. It produces the International Journal of Technology
Assessment in Health Care, and has a Special Interest Group on developing countries' issues:
International Society for Technology Assessment in Health Care – Special Interest Group
(ISTAHC-SPIG), Health Technology Research Group, Medical Research Council (MRC), PO Box
19070, Tygerberg 7505, Cape Town, South Africa. Tel: 27 21 938 04 13, fax: 27 21 938 03 85.
Management Sciences for Health (MSH)
Development Office, and/or Publications Office, 165 Allandale Road, Boston MA 02130-3400, USA
Tel: 1 617 524 7799, fax: 1 617 524 2825, email: development@msh.org, website: www.msh.org
MSH undertakes consultancies with health care policy-makers, managers, providers, and clients to
seek to increase the effectiveness, efficiency, and sustainability of health services by improving their
management. MSH also publishes and distributes practical, experience-based books and tools in
multiple languages for health and development professionals, managers and policy makers. Email:
bookstore@msh.org, website: www.msh.org/publications
Medical Research Council South Africa (MRC-SA)
PO Box 19070, 7505 Tygerberg, South Africa
Tel: 27 21 9380911, fax: 27 21 9380200, email:info@mrc.ac.za, website: www.mrc.ac.za
The MRC-SA’s mission is to improve the nation’s health status and quality of life through relevant
and excellent health research aimed at promoting equity and development. They have a WHO
Collaborating Centre for Essential Technologies in Health, at website:
www.mrc.ac.za/innovation/whocollaborating.htm
Medicines and Healthcare Regulatory Agency (MHRA)
Hannibal House, Elephant and Castle, London, SE1 6TQ, UK
Tel: 44 0207 972 8000, email: devices@mhra.gsi.gov.uk, website: www.mhra.gov.uk
Offers guidance, advice, and regulations on medical device quality, safety, performance, use,
and standards.
MSc Envirohealth Products
25 Reedbuck Crescent, Corporate Park, PO Box 506, 15 Randjesfontein, Midrand 683, South Africa
Tel: 27 11 314 7540, fax: 27 11 314 7535, email: scaine@mweb.co.za
Contact for further information about the Medcin 400 Gas Incinerator, a pre-assembled incinerator
designed for rural and small-scale health care waste management.
PAHO (Pan American Health Organization)
Pan American Sanitary Bureau, Regional Office of the World Health Organization, 525 Twenty-third
Street, N.W. Washington, D.C. 20037, USA
Tel: 1 202 974-3000, fax: 1 202 974-3663, website: www.paho.org/
The Pan American Health Organization (PAHO) is an international public health agency working to
improve health and living standards of the countries of the Americas. It also serves as the Regional
Office for the Americas of the World Health Organization.Antonio Hernandez is the contact for
healthcare technology issues, email: 1hernana@paho.org


Annex 2: Reference materials and contacts


251




Quality Assurance Research and Policy Development Group (QARPDG)
Philippine Health Insurance Corporation (PhilHealth), CityState Center, 709 Shaw Blvd., Brgy.
Oranbo, 1600 Pasig City, Philippines
Fax: 632 637 9693, emailmadz_valera@yahoo.com, contact: Dr. Madeleine Valera (Vice President)
PhilHealth is a government owned and controlled corporation that was the main organizer of the 3rd
Asian Regional Health Technology Assessment Conference in 2004, and is the source for the
conference proceedings.
RS Components Ltd.
Birchington Road, Corby, Northants, NN17 9RS, UK
Tel: 44 1536 201234, fax: 44 1536 405678, email: general@rs-components.com, website: rswww.com
Supplier of equipment, supplies, parts, and components for a wide range of engineering professions
such as electrical, electronic, mechanical, heating, ventilation, air-conditioning, plumbing, welding,
pneumatics, computing, automotive. Also a source of textbooks, technical data books, technical
literature, and training videos for all these engineering fields.
Source (International Information Support Centre)
The Wellcome Trust Building, Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK
Tel: 44 20 7242 9789 ext 8698, fax: 44 20 7404 2062, email: source@ich.ucl.ac.uk,
website: www.asksource.info
The Source Centre has a unique collection of over 20,000 health and disability related information
resources. These include books, manuals, reports, posters, videos, and CD-Roms. Many materials are
from developing countries and include both published and unpublished literature.
SpaceLabs Medical Inc
15220 N.E. 40th Street, Redmond, WA 98052, USA
Tel: 1 206 882 3700, website: www.spacelabs.com/
Spacelabs Medical is a leading global provider of patient monitoring and clinical information systems.
Their educational service produces a Biophysical Measurement Book Series for biomedical and
clinical professionals
Swiss Centre for Development Cooperation in Technology and Management (SKAT).
Website: www.skat.ch/dc/publ/publ.htm
SKAT works internationally in the areas of water and sanitation, architecture and building, transport
infrastructure, and urban development. They also publish the SKAT newsletter
Swiss Centre for International Health (SCIH)
Swiss Tropical Institute, Socinstrasse 57, PO Box, CH-4002 Basle, Switzerland
Tel: 41 61 284 82 79, fax: 41 61 271 86 54, email: martin.raab@unibas.ch,
website: www.sti.ch/francais/scih/scih.htm
Undertakes consultancies in healthcare technology management in developing countries and
countries in transition.
TALC (Teaching Aids at Low Cost)
PO Box 49, St. Albans, Herts, AL1 5TX, UK
Tel: 44 1727 853869, fax: 44 1727 846852, email: talc@talcuk.org website: www.talcuk.org/
UK registered non-profit charity specialising in supplying affordable books, slides and teaching aids on
health and community issues in developing countries, with a particular focus on materials for PHC
and district levels.
Third World Network
email: twnet@po.jaring.my, website: www.twnside.org.sg
The Third World Network is an independent non-profit international network of organizations and
individuals involved in development issues. Its website offers articles and position papers on a variety
of subjects related to developing countries, including trade, health, biotechnology and bio-safety.


Annex 2: Reference materials and contacts


252




Transaid (Transport for Life)
137 Euston Road, London, NW1 2AA, UK
Tel: 44 20 7387 8136, fax: 44 20 7287 2669, email: info@transaid.org website: www.transaid.org
A charity working in the field of international transport management. Thus unique organization works
with many sectors, including health, to ensure that transport resources are efficiently and effectively
used. Their aim is to develop local capacity in transport and logistics management. They produce a
newsletter Hub and spoke, and have developed the Transaid transport management handbook.
Tropical Health Technology (THT)
14 Bevills Close, Doddington, March, Cambridgeshire PE15 OTT, UK
Tel: 44 1354 740825, fax: 44 1354 740013, email: thtbooks@tht.ndirect.co.uk, website:
www.tht.ndirect.co.uk
Charity concerned with supporting and improving laboratory services in the developing world. Primary
focus is laboratory services, information and technology. Specializes in supply of laboratory equipment,
books, bench aids, slide sets and microscopes.
UNICEF (United Nations Children’s Fund)
UNICEF House, 3 UN Plaza, New York 10017, USA
Tel: 1 212 326 7000, fax: 1 212 887 7454, email: jando@unicef.org, website: www.unicef.org
It provides a wide range or resource materials, journals, books and videos, games and posters for
children’s programmes. Your regional or field office will offer advice on all aspects of child health care
and UNICEF materials – contact details are on the website. The goods contained in UNICEF’s
Supply catalogue are supplied by the UNICEF Supply Division, UNICEF Plads, Freeport, 2100
Copenhagen OE, Denmark. Tel: 45 3527 3527, fax: 45 3526 9421, email: supply@unicef.org.
World Bank (WB)
www.worldbank.org
One of the world’s largest sources of development assistance including health, nutrition and
population projects
World Council of Churches (WCC)
PO Box 2100, 1211 Geneva, Switzerland
Tel: 41 22 791 6111, fax: 41 22 791 0361, email: info@wcc-coe.org, website: www.wcc-coe.org
International fellowship of churches that produces publications and newsletters. Recent publications
include Guidelines on medical equipment donations.
World Health Organization (WHO)
20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Tel: 41 22 791 2476 or 2477, fax: 41 22 791 4857, website: www.who.int/en/
WHO offers advice, and undertakes programmes, on all aspects of health care. Contact your regional
or field office for advice on all aspects of health care and WHO materials - the addresses of the
regional offices worldwide are available on the website.
i. WHO has programmes and literature on many aspects of healthcare technology management.


Andrei Issakov, Coordinator of Health Technology and Facilities Planning and Management, is the
contact, and source of WHO literature on healthcare technology management that is not available
as published documents, email: issakova@who.int.


ii. WHO produces and distributes books, manuals, journals, practical guidelines and technical
documents, several include aspects of healthcare technology management. The Distribution and
Sales Office is the contact point for information on WHO publications, email:
publications@who.ch, website: www.who.int/publications/en/. To order WHO publications use
email: bookorders@who.int.


iii. WHO has a comprehensive library and information service on international public health
literature. Contact email: library@who.int. The WHO library catalogue has electronic access to
more than 4000 technical documents, use website: www.who.int/library.


iv. WHO produces many newsletters, for a list contact website:
www.who.int/library/reference/information/newsletters/index.en.shtml


Annex 2: Reference materials and contacts


253




Ziken International Consultants Ltd
Causeway House, 46 Malling Street, Lewes, E.Sussex, BN7 2RH, UK
Tel: 44 1273 477474, fax: 44 1273 478466, email: info@ziken.co.uk, website: www.ziken.co.uk
A consultancy organization working worldwide in many aspects of health care development, including
healthcare technology management.


See Guide 1 or 5 for information on training institutes and international professional bodies for
different aspects of clinical and hospital engineering. Also see all other Guides in the Series for
journals and training resources specific to the topics covered by each Guide.


Annex 2: Reference materials and contacts


254




ANNEX 3: TYPICAL EQUIPMENT LIFETIMES
Different organizations have tried to estimate typical equipment lifetimes for healthcare technology.
This annex contains the results from two different sources – the American Hospital Association, and
the GTZ (German Government Technical Aid Agency).


LIST 1: The American Hospital Association (AHA)
Source: American Hospital Asso.ciation, 1998, ‘Estimated Useful Lives of Depreciable Hospital Assets’, American Hospital


Association, Chicago, USA
The AHA’s extensive list reflects how equipment lasts within the United States’ healthcare system,
whether it was manufactured in the US or abroad.
Their list was compiled following:
◆ discussions with manufacturers of healthcare equipment
◆ discussions with various hospital department managers
◆ analysis of actual retirement practices for actual hospital assets.
Their list is made up of a series of tables of different categories of equipment determined by the
equipment’s role in the health facility.


Annex 3: Typical equipment lifetimes


255


Part One: Estimated Useful Lives of Land Improvements, Buildings, and
Fixed Equipment


Table 1: Land Improvements
Land improvements are assets of an above-ground or below-ground nature, found in the land area contiguous to
and designed for serving a health care facility. The asset cost would include a proportionate share of
architectural, consulting, and interest expense for newly constructed or renovated facilities.
Item Years Item Years
Bumpers 5
Culverts 18
Fencing


Brick or stone 25
Chain-link 15
Wire 5
Wood 8


Flagpole 20
Guard rails 15
Heated pavement 10
Landscaping 10
Lawn sprinkler system 15
Parking lot, open-wall 20
Parking lot gate/s 3
Parking lot striping 2
Paving (including roadways, walks,and parking)


Asphalt 8


Paving (including roadways, walks,
and parking) (continued)


Brick 20
Concrete 15
Gravel 5


Retaining wall 20
Shrubs and lawns 5
Signs, metal or electric 10
Snow-melting system 5
Trees 20
Turf, artificial 5
Underground utilities


Sewer lines 25
Water lines 25


Waste water treatment system 20
Water wells 25
Yard lighting 15




Annex 3: Typical equipment lifetimes


256


Table 2: Buildings
Buildings are structures consisting of building shell, exterior walls, interior framings, walls, floors, and ceilings.
The asset cost would include a proportionate share of architectural, consulting, and interest expense for newly
constructed or renovated facilities. In assigning the estimated useful lives in this table, the following factors
were considered: the type of construction, the functional utility of the structure, recent regulatory or
environmental changes, and the general volatility of the health care field.
Item Years Item Years
Boiler house 30
Garage


Masonry 25
Wood frame 15


Guardhouse 15
Masonry building, reinforced
concrete frame 40
Masonry building, steel frame
Fireproofed 40
Nonfireproofed 30
Masonry building, wood/metal frame 25


Table 3: Building Components
Building components are assets that are a part of the building shell or interior construction. The asset cost would
include a proportionate share of architectural, consulting, and interest expense.
Item Years Item Years
Canopies 15
Carpentry work 15
Caulking 5
Sealants 5
Ceiling finishes


Acoustical 8
Gypsum 10
Plaster 12


Computer flooring 10
Corner guards 10
Cubicle tracks 10
Designation signs 5
Doors and frames


Automatic 10
Hollow metal 20
Wood 15


Drapery tracks 10
Drilled piers 40
Floor finishes


Carpet 5
Ceramic 20
Concrete 20
Hardwood 10


Metal-clad building 20
Multilevel parking structure 25
Reinforced concrete building,
common design 40
Residence


Masonry 25
Wood frame 25


Storage building
Masonry 25
Metal garden-type 10
Wood frame 20


Floor finishes (continued)
Quarry 20
Sealer 5
Terrazzo 15
Vinyl 10


Folding partitions 10
Loading dock bumpers and levelers 10
Magnetic/MRI shielding 10
Millwork 15
Overhead doors 10
Partitions, interior 15
Partitions, toilet 15
Railings


Freestanding (exterior) 15
Handrails (interior) 15


Roof covering 10
Skylights 20
Storefront construction 20
Wall covering


Paint 5
Wallpaper 5


X-ray protection 10




Table 4: Fixed Equipment
Fixed equipment includes assets that are permanently affixed to the building structure and are not subject to
movement but have shorter useful lives than that of the building. The asset cost would include a proportionate
share of architectural, consulting, and interest expense.
Item Years Item Years
Benches, bins, cabinets, counters,
and shelving, built-in 15
Cabinet, biological safety 15
Canopy-ventilating for laundry ironer 15
Central dictation system 10
Coat rack 20
Conveyor system, laundry 10
Cooler, walk-in 15
Curtains and drapes 5
Emergency generator set 20
Generator controls 12
Hood, fume 15
Fire protection in hoods 10
ICU and CCU counters 15
Illuminator


Multifilm 10
Single 10


Table 5: Building Services Equipment (overleaf)
Building services equipment refers to mechanical components or systems designed for the building(s), including
air conditioning, electrical elevators, heating lighting plumbing sprinklers, and ventilating. The asset cost would
include a proportionate share of architectural, consulting and interest expense for newly constructed or
renovated facilities.


Annex 3: Typical equipment lifetimes


257


Laminar flow system 15
Lockers, built-in 15
Mailboxes, built-in 20
Medicine preparation station 15
Mirrors, traffic and/or wall mounted 10
Narcotics safe 20
Nurses’ counter, built-in 15
Pass-through boxes 15
Patients’ consoles 15
Patients’ wardrobes and vanities, built-in 15
Projection screens 10
Sink and drainboard 20
Sterilizer, built-in 15
Telephone enclosure 10




258


Item Years Item Years
Air-condition equipment


Centrifugal chiller 15
Compressor, air 15
Condensate tank 10
Condenser 15
Controls 10
Cooler and dehumidifier 10
Cooling tower, concrete 20
Wood 10
Duct work 20
Fan, air-handling and ventilating 20
Metal 20
Piping 20
Precipitator 10
Pump 10


Air-conditioning system
Large (over 20 tons) 10
Medium (5-20 tons) 10
Small (under 5 tons) 5


Air curtain 15
Antenna system 10
Boiler 20
Deaerator system 15
Boiler smokestack, metal 20
Clean-air equipment 15
Clock system, central 15
Co-generation plant, generator powered 15
Door alarm 10
Door-closing devices, for fire alarm system 15
Electric lighting and power


Composite 18
Conduit and wiring 20
Emergency lighting system 15
Feed wiring 20
Fixtures 10
Switch gear 15
Transformer 30


Elevator
Dumbwaiter 20
Freight 20
Passenger, high-speed automatic 20
Passenger, other 20


Emergency generator 20
Controls 12
Energy management system, computer based 10
Escalator 20
Fans, ceiling-mounted 10


Annex 3: Typical equipment lifetimes


Fire protection system
Fire alarm system 10
Fire pump 20
Smoke and heat detectors 10
Sprinkler system 25
Tank and tower 25


Furnace, domestic 15
Heating, ventilating, and air conditioning
(composite system) 15
Heat pump system 10
Humidifier 15
Incinerator, indoor 10
Insulation, pipe 15
Intercom system 10
Laboratory plumbing, piping 20
Magnetic door holders 10
Medical gas system (composite system) 15
Nurse call system 10
Oil storage tank 20
Oxygen, gas, and air piping 20
Paging system 20
Physicians’ in-and-out register, built-in 10
Plumbing, composite 20
Fixtures 20


Piping 25
Pump 15


Pneumatic tube system 15
Radiator


Cast-iron 25
Finned tube 15


Sewerage, composite 25
Piping 20
Sump pump and sewerage ejector 10


Solar heating equipment 10
Surge suppression system 15
Telephone system 10
Television antenna system 10
Television satellite dish 10
Temperature controls, computerised 10
Unit heater 10
Vacuum cleaning system 15
Water fountain 10
Water heater, commercial 10
Water purifier 10
Water softener 10
Water storage tank 20
Water wells 25




Annex 3: Typical equipment lifetimes


259


Part Two: Estimated Useful Lives of Major Movable Equipment
Major movable equipment is defined as assets that are generally assigned to a specific department within the
health care facility, but with the capacity of being relocated. The assets have a minimum useful life of at least
three years and a unit cost sufficiently large to justify the expense of maintaining an equipment ledger.
Note: Included within the departmental listings are assets that may be considered to be minor equipment (for
example, surgical instruments with a three-year life assignment). Minor equipment may be defined as assets
that are relatively small in size and unit cost and have high usage. They are generally found in the obstetrics,
surgery, and dietary departments.


Table 6: Administrative Departments
Administrative Departments consist of administration, barber shop, board room, admitting, business office,
communications, data processing, education, facilities management, finance, foundation, graphics, home health,
human resources infection control, library, lobby, marketing, medical education, medical records, medical staff
facilities, nursing administration, pastoral care, patient education, physician on-call rooms, public relations,
quality assessment and improvement, social services, and volunteer services departments.
Item Years Item Years
Beepers, paging 3
Bench, metal or wood 15
Binder, punch machine 10
Bookcase, metal or wood 20
Bulletin board 10
Cabinet file, metal or wood 15
Camera 5
Cathode-ray tube (CRT) 3
Chair


Arm 15
Conference 15
Executive 15
Folding 10
Guest 15
Side 15


Check signer 10
Clock 10
Collator, electric 10
Computer


Laptop 3
Large 5
Micro 5
Mini (personal) 3


Computer disk drive 5
Computer networking equipment


Controller 5
Hub 5
Modem 5
Mux unit 5
Server 5
Token ring 5


Computer printer 5
Computer software 3
Computer terminal 5
Credenza 15
Data printing unit 5
Data storage unit
Mechanical 10


Nonmechanical 15
Data tape processing unit (including
controller, drive, and tape deck) 5
Desk, metal or wood 20
Dictating equipment 5
Display cases 20
Duplicator 5
Facsimile transmitter 3
Files 15


Electric rotary 15
Legal 15
Regular 15


Filing system, portable 20
Imprinter


Address 5
Embossed plate 10


Integrator 10
Intercom 10
Label maker 10
Library furniture 20
Mailing machine 10
Microfilm unit 10


Continued overleaf




Table 6: Administrative Departments (continued)
Item Years Item Years
Microphone 5
Microprojector 10
Organ 10
Paper burster 8
Paper cutter 10
Paper shredder 5
Paper shredder 5
Partitions, movable office 10
Photocopier


Small 3
Large 5


Piano 20
Projector


Overhead 10
Slide 10
Video 5


Recorder, tape 5
Safe 20
Scale, postal 10
Screen, projector 10
Settee 12


Table 7: Nursing Departments
Nursing departments consist of cardiac care, chemical dependency, intensive care, medical/surgical care,
neonatal intensive care, nursery, pediatrics, pediatric developmental disabilities, and psychiatric units.
Item Years Item Years
Bassinet 15
Bath


Sitz 10
Whirlpool 10


Bed
Birthing 15
Electric 12
Flotation therapy 10
Hydraulic 15
Labor 15
Manual 15
Orthopedic 15


Bench, metal or wood 15
Bin, metal or wood 15
Blood pressure device, electronic 6
Bookcase, metal 20


Annex 3: Typical equipment lifetimes


260


Shelving, portable, steel 20
Sofa 12
Stamp Machine 10
Stapler, electric or air 10
Stencil machine 10
Stereo equipment 5
Table


Folding 10
Metal or wood 15


Television receiver 5
Time recording equipment 10
Transcribing equipment 5
Typewriter, electric 5
Valet, office 15
Video cassette recorder/player 5
Walkie-talkie 5
Water cooler, bottle 10
Word processor


Large 5
Small 5


Work station 10


Cabinet
Bedside 15
File 15
Instrument 15
Metal or wood 15
Pharmacy 15
Solution 15
X-ray 15


Central supply furniture 15
Chair


Blood drawing 10
Dental 15
Executive 15
Folding 10
Geriatric 10
Hydraulic, surgeon’s 15


Continued opposite




Operating stool 15
Ophthalmoscope 10
Osmometer 7
Otoscope 7
Ottoman 10
Patient monitoring equipment 10
Phototherapy unit 10
Physicians’ in-and-out register, portable 10
Physiological monitor 7
Pump, breast 10
Scale, baby 15
Settee 12
Shelving, portable, steel 20
Sofa 12
Stall Bars 15
Table


Anesthetic 15
Autopsy 20
Electrohydraulic tilt 10
Examining 15
Folding 10
Food preparation 15
Fracture 15
Instrument 15
Light 15
Metal 15
Obstetrical 20
Operating 15
Orthopedic 10
Overbed 15
Pool 10
Refrigerated 10
Therapy 15
Traction 10
Urological 15
Wood 15


Telemetry unit, cardiac 5
Thermometer, electric 5
Ultrasonic fetal heart monitor 7
Work station 10


Annex 3: Typical equipment lifetimes


261


Table 7: Nursing Departments (continued)
Item Years Item Years
Chair (continued


Kinetron 15
Podiatric 15
Shower/bath 10
Specialist’s 15


Chart rack 20
Chart recorder 10
Clothes locker
Fibreglass or metal 15
Liminate or wood 12
Computer, caridial output 5
Credenza 15
Crib 15
Croupette 10
Defibrillator 5
Desk, metal or wood 20
Doppler 5
Dresser 15
Food service furniture 15
Frame, turning 15
Housekeeping furniture 15
ICU and CCU furniture 15
Infant care center 10
In-service education furniture 15
Insufflator 5
Labor and delivery furniture 15
Laboratory furniture 15
Lamp


Bilirubin 10
Emergency 10


Lawn and patio furniture 5
Light


Delivery 15
Examining 10
Portable, emergency 10


Natural childbirth backrest 10
Nursing service furniture 15
Operating room furniture 15




Table 8: Diagnostic and Treatment Departments
Diagnostic and treatment departments consist of ambulatory surgery, anesthesia, cardiac rehabilitation,
catheterization laboratory, CT scan, ECT, EEG/EMG, emergency, employee health, enterostomal therapy, GI
laboratory, hemodialysis, hyperbaric medicine, in vitro medicine, IV therapy, inpatient pharmacy, laboratory,
lithotripsy, mobile air care, medical oncology, MRI, noninvasive cardiology, obstetrics, occupational therapy,
physical therapy, postanesthesia care unit, radiation therapy, radiology, respiratory therapy, speech therapy, and
surgery departments.
Item Years Item Years
Accelerator 7
Alternating pressure pad 10
Amino acid analyzer 7
Amplifier 10
Anaerobe chamber 15
Analyzer, haematology 7
Anatomical model 10
Anesthesia unit 7
Ankle exerciser 15
Apnea monitor 7
Apron, lead-lined 47
Arthroscope 5
Arthroscopy instrumentation 3
Aspirator 10
Audiometer 10
Autoclave 10
Autoscaler, ionic 10
Bacteriology analyzer 8
Baci incinerator 5
Balance


Analytical 10
Electronic 7
Precision mechanical 10


Basal metabolism unit 8
Bath


Fluidotherapy 7
Paraffin 7
Serological 7
Water 7


Biochemical analysis unit 7
Biochromatic analyzer 7
Biofeedback machine 8
Biomagnetometer 7
Bipolar coagulator 7
Blood cell counter 5
Blood chemistry analyzer, automated 5
Blood culture analyzer 8


Annex 3: Typical equipment lifetimes


262


Blood gas analyzer 5
Blood gas apparatus, volumetrics 8
Blood transfusion apparatus 6
Blood warmer 7
Blood warmer coil 7
Bone surgery apparatus 3
Breathing unit, positive-pressure 8
Bronchoscope


Flexible 3
Rigid 3


Carbon monoxide recorder/detector 10
Cardiac monitor 5
Cardioscope 8
Cart


Emergency-isolation 10
Medicine 10


Caspar ACF instrument and plate system 7
Cassette changer 8
Cautery unit


Dermatology 7
Gynecology 7


Cell freezer 7
Cell washer 5
Centrifuge 7
Centrifuge, refrigerated 5
Cerebral function monitor 7
Child immobilizer 15
Chloridiometer 10
Chromatograph, gas 7
Clinical analyzer 5
Clopay wrapping machine 10
Coagulation analyzer 5
Cold-pack unit, floor 10
Colonoscope 3
Colorimeter 7
Colposcope, with floor stand 8
Computer, clinical 5


Continued opposite




Table 8: Diagnostic and Treatment Departments (continued)
Item Years Item Years
Computer-assisted tomography (CT) scanner 5
Conductivity tester 5
CO-oximeter 10
Cryoopthalmic unit, with probes 7
Cryostat 7
Cryosurgical unit 10
Cyclotron 7
Cystic fibrosis treatment system 10
Cystometer 10
Cystometrogram unit 10
Cystoscope 3
Decalcifier 10
Deionized water system 7
Densitometer, recording 5
Dental drill, with syringe 3
Dermatome 10
Diagnostic set 10
Diathermy unit 10
Digital fluoroscopy unit 5
Digital radiography unit 5
Diluter 10
Dispenser, alcohol 10
Distilling apparatus 15
Doppler 5
Dose calibrator 5
Dryer, sonic 10
Duodenoscope 3
Echocardiograph system 5
Echoview system 5
Electrocardiograph 7
Electrocardioscanner
(Holter monitor scanner) 7
Electroencephalograph 7
Electrolyte analyzer 5
Electromyograph 7
Electrophoresis unit 7
Electrosurgical unit 7
Ergometer 10
Evacuator 10
Evoked potential unit 10
Exercise apparatus 15


Annex 3: Typical equipment lifetimes


263


Exercise equipment, outdoor 10
Exercise system, computer assisted 5
Exerciser, orthotron 10
Eye surgery equipment (phacoemulsifier) 7
Fiberoptic equipment 5
Fibrometer 7
Film changer 8
Film viewer 10
Flow cytometer 5
Fluid sample handler 5
Fluorimeter 10
Fluoroscope 8
Frame, turning 15
Furnace, laboratory 10
Gamma camera 5
Gamma counter 7
Gamma knife 10
Gamma well system 7
Gas analyzer 8
Gastroscope 3
Geiger counter 10
Generator 5
Gloves, lead-lined 3
Hand dynamometer 10
Heart-lung system 8
Heat sealer 5
Hemodialysis unit 5
Hemoglobinometer 7
Hemophotometer 10
High-density mobile film system 10
Holter


Electrocardiograph 7
Electroencephalograph 7


Homogenizer 10
Hood, exhaust or Bacti 10
Hydrocollator 10
Hydrotherapy equipment 15
Hyfrecator 10
Hyperbaric chamber 15
Hypothermia apparatus 10
Image analyzer 5


Continued overleaf




Table 8: Diagnostic and Treatment Departments (continued)
Item Years Item Years
Image intensifier 5
Immunodiffusion equipment 10
IMX analyzer 7
Incubator, laboratory 10
Inhalator 10
Intraarterial shaver 10
Iontophoresis unit 8
Isodensitometer 7
Isolation chamber 12
Isotope equipment 7
Isotope scanner 7
Kiln 10
K-pads 5
Kymograph 10
Lamp


Deep-therapy 10
Infrared 10
Mercury quartz 10
Slit 10


Laparoscope 3
Laryngoscope 3
Laser, coronary 2
Laser, surgical 5
Laser positioner 5
Laser smoke evacuator 5
Lifter, patient 10
Linac scalpel 5
Linear accelerator 7
Lithotripter, extracorporeal shock-wave (ESWL) 5
Magnetic resonance imaging (MRI) equipment 5
Mammography unit
Fixed 5
Mobile (van) 8
Marograph 7
Mass spectrophotometer 7
Microbiology analyzer 8
Microscope 7
Microtome 7
Microtron power system 7
Mirror, therapy 15
Muscle stimulator 10


Annex 3: Typical equipment lifetimes


264


Nebulizer
Pneumatic 10
Ultrasonic 10


Nephroscope 7
Neurological surgical table headrest 10
Neutron beam accelerator 8
Noninvasive CO2 monitor 7
Optical readers 5
Orthotron system 10
Orthourological instruments 10
Oscilloscope 7
Oven


Paraffin 10
Sterilizing 10


Oximeter 10
Oxygen analyzer 7
Oxygen tank, motor, and truck 8
Pacemaker, cardiac (external) 5
Pacing system analyzer 7
Panendoscope 10
Parallel bars 15
Pelviscope 7
Percussor 5
Perforator 10
Peripheral analyzer 10
pH gas analyzer 10
pH meter 10
Phonocardiograph 8
Photocoagulator 10
Photography apparatus, gross pathology 10
Photometer 8
Physioscope 10
Pipette, automatic 10
Plasma freezer 10
Platelet rotator 20
Positron emission tomography
(PET) scanner 5
Proctoscope 3
Prothrombin timer, automated 8
Proton beam accelerator 7
Pulmonary function analyzer 8


Continued opposite




Table 8: Diagnostic and Treatment Departments (continued)
Item Years Item Years
Pulmonary function equipment 8
Pulsed oxygen chamber 10
Pulse oxymeter 7
Pump


Infusion 10
Stomach 10
Suction 10
Surgical 10
Vacuum 10


Radiation meter 8
Radioactive source, cobalt 5
Radiographic duplicating printer 8
Radiographic-fluoroscopic combination 5
Radiographic head unit 5
Rate meter, dual 10
Refractometer 10
Refrigerator, blood bank 10
Resuscitator 10
Retractor 5
Rhinoscope 3
Rinser, sonic 10
Rotoosteotome unit 10
Saw


Autopsy 10
Neurosurgical 10
Surgical, electric 10


Scale
Bed 10
Chair 10
Clinical 10


Scale, metabolic 10
Scintillation scaler 8
Sensitometer 10
Seriograph, automatic 8
Shaking machine (vortexer) 8
Sharpener, microtome knife 10
Sigmoidoscope 3
Signal-averaged EKG 5
Simulator 5
Single-photon emission computed tomography
(SPECT) Scanner 5
Sinuscope 7
Skelton 10


Annex 3: Typical equipment lifetimes


265


Slide stainer, laboratory 7
Spectrophotometer 8
Spectroscope 10
Sphygmomanometer 10
Spirometer 8
Stand


Basin 15
Intravenous 15
Irrigating 15
Mayo 15


Steam-pack equipment 10
Stereo tactic frame 5
Sterilizer, movable 12
Steris sterilization system 7
Stethoscope 5
Stress tester 10
Stretcher 10


Hydraulic 7
Surgical shaver 5
Tank


Cleaning 10
Full-body 15
Hot-water 10
Therapy 15


TDX analyzer 7
Telemetry unit, cardiac 5
Telescope, microlens 10
Telescopic shoulder wheel 15
Telethermometer 10
Tent


Aerosol 8
Oxygen 8


Thyroid uptake system 5
Tissue-embedding center 8
Tissue processor 7
Titrator, automatic 10
Tonometer 10
Totalap 10
Tourniquet, automatic 10
Tourniquet system 7
Traction unit 10
Transcutaneous nerve stimulator system 5
Transesophageal transducer 5


Continued overleaf




Wheelchair 5
X-ray equipment


Developing tank 10
Film dryer 8
Film processor 8
Furniture 15
Image intensifier 5
Intensifying screens 5
Silver recovery unit 7


X-ray unit
Fluoroscopic 5
Mobile 5
Radiographic 5
Superficial therapy 5
Tomographic 5
Wiring 5


Cart
Food/tray, heated-refrigerated 10
Linen 10
Maid 10
Supply 10
Utility 10


Cash register 5
Central data processing unit 10
Clock 10
Coffee maker 5
Compactor, waste 10
Compressor, air 12
Conveyor, tray 10
Cooker, pressure, for food 10
Cooler, walk-in, freestanding 15
Cutter, cloth, electric 10
Cutter, food 10
Dish sterilizer 10
Dishwasher 10
Disinfector 15


Table 8: Diagnostic and Treatment Departments (continued)
Item Years Item Years
Treadmill, electric 8
Tube dryer 10
Tube tester 10
Ultrasound, diagnostic 5
Ultrasound unit, therapeutic 7
Vacuvette 10
Ventilator, respiratory 10
Vial filler 10
Vibrator 10
Video


Camera 5
Light source 5
Monitor 5
Printer 5


Table 9: Support Departments
Support departments consist of biomedical engineering, central sterile supply, dietary, engineering/maintenance,
housekeeping/environmental services, laundry, materials management, security, and staff facilities departments.
Item Years Item Years
Air conditioner, window 5
Ambulance 4
Automobile


Delivery 4
Passenger 4


Battery charger 5
Bedpan washer 15
Blanket dryer 15
Blanket warmer 15
Bottle washer 10
Broiler 10
Burnisher, silverware 15
Cage, animal 10
Camera, identification 5
Camera, surgical 5
Camera, television monitoring,
color or black-and-white 5
Camera, videotape, color or black-and-white 5
Can opener, electric 10
Capsule machine 10


Annex 3: Typical equipment lifetimes


266


Continued opposite




Annex 3: Typical equipment lifetimes


267


Table 9: Support Departments (continued)
Item Years Item Years
Dispenser
Butter, refrigerated 10
Milk or cream 10
Drill press 20
Dryer
Clothes 10
Hair 5
Drying oven, paint shop 10
Enlarger 10
Extractor, laundry 15
Floor-buffing and polishing machine 5
Floor-scrubbing machine 5
Floor-waxing machine 5
Folder, flatwork 15
Food chopper 10
Freezer, ultracold 10
Fryer, deep-fat 10
Garbage disposal, commercial 5
Glassware washer 8
Griddle 10
Grinder, food waste 10
Helicopter 4
Hoist, chain or cable 15
Hot-food box 15
Hotplate 5
Humidifier 8
Ice cream freezer 10
Ice cream (soft) machine 10
Ice cream storage cabinet 10
Ice cube-making equipment 10
Indicator, remote 10
Intercom 10
Ironer, flatwork 15
Kettle, steam-jacketed 15
Key machine 10
Laminator 10
Lathe 15
Lawn mower, power 3
Linen press 15
Linen table 15
Linen washer 15


Lint collector 15
Loom 15
Lowerator 10
Mannequin 10
Marking machine 10
Meat chopper 10
Mixer, commercial 10
Nourishment ice station 8
Oven


Baking 10
Microwave 5
Roasting 10


Packaging machine 10
Platform 12
Paint spray booth 15
Paint-spraying machine 10
Paper baler 15
Parking lot sweeper 5
Pipe cutter-threader 10
Planer and shaper, electric 10
Plate-bending press 10
Platemaker


Computerized 5
Noncomputerized 10


Popcorn machine 8
Power supply 10
Press, laundry 15
Printing press 10
Range, domestic 10
Refrigerator


Domestic 8
Commercial 10
Undercounter 10


Remote control receiver 10
Rotary tiller 10
Sanitizer 10
Saw
Band 10
Bench, electric 10
Meat-cutting 10
Scaffold 10
Scale, laundry
Movable 10
Platform 15


Continued overleaf




Table 9: Support Departments (continued)
Item Years Item Years
Sewing machine 15
Shears, squaring, floor 12
Shoulder wheel 20
Simulator 5
Slicer
Bread 10
Meat 10
Snowblower 5
Steamer, vegetable 10
Telephone, cordless 5
Telephone equipment for deaf 5
Telephone monitors 10
Telephone system 10
Television monitor 5
Television receiver 5
Toaster, commercial 10
Tractor 10
Truck (automotive)


Forklift 10
Multipurpose filling 15
Pickup 4
Van 4


Annex 3: Typical equipment lifetimes


268


Truck (hand)
Hot-food 10
Tray 12


Ultrasonic cleaner 10
Urn, coffee 10
Vacuum cleaner 8
Vegetable peeler, electric 10
Vending machine 10
Vise, large bench 20
Warmer


Dish 10
Food 10


Washing machine
Commercial, small 10
Domestic 10
Linen, large 15


Welder 10
Wire tightener-twister 10




LIST 2: The GTZ (German Government Technical Aid Agency)
Source: Halbwachs, H (GTZ), 2000, ‘Maintenance and the Life Expectancy of Healthcare Equipment in Developing


Economies’, in Health Estate Journal, March 2000, pp 26-31
The GTZ list contains estimates for fewer equipment items, but it more closely reflects the realities
in developing countries.
The GTZ used a particular research method (a Delphi survey – see source paper) to obtain and
analyze feedback from 23 experts from 16 different country backgrounds. The experts were made up
of hospital engineers, bio-medical engineers, a public health doctor/manager, health physicists, and a
health economist. Rather than providing exact lifetimes, this approach provides a range for the
lifetime that depends on the quality of the initial equipment and how well it has been maintained.
Reproduced here is a table containing a summary of their findings.


Table Summarizing GTZ’s Findings


Equipment type
Poorly Well Poorly Well


maintained maintained maintained maintained
Air-conditioner
(window type) 3 5 – 7 5 – 6 10 – 12
Anaesthetic machine
(Boyles) 2 – 5 5 – 10 5 – 10 10 – 15
Centrifuge 3 – 4 7 – 8 6 – 9 10 – 12
Generator (diesel) 3 – 6 9 – 10 10 – 12 18 – 20
Generator (petrol) 2 – 5 5 – 10 6 – 15 10 – 20
Microscope 3 – 6 5 – 10 6 – 10 10 – 20
Oven, hot air (laboratory) 2 – 6 5 – 8 6 – 10 10 – 15
Refrigerator (electrical) 3 – 5 5 – 8 5 – 8 10 – 15
Refrigerator (kerosene) 4 4 – 8 5 – 10 10 – 17
Sphygmomanometer
(aneroid) 1 – 3 2 – 3 2 – 5 5 – 10
Sphygmomanometer
(mercury) 1 – 2 3 – 5 3 - 5 8 – 10
Sterilizer, bench-top
(horizontal) 3 – 5 5 – 8 6 – 10 10 – 14
Sterilizer, floor-standing
(vertical) 3 – 6 5 – 12 8 14 – 15
Suction pump (electrical) 1 – 3 5 – 7 5 – 8 10 – 15
Truck, pick-up 2 – 4 3 – 6 4 – 8 7 – 12
Washing machine
(electrical) 2 – 4 5 6 8 – 11


Annex 3: Typical equipment lifetimes


269


Lifetime in years
Poor quality makes Good quality makes




Annex 4: Sample long generic equipment specification


270


ANNEX 4: SAMPLE LONG GENERIC EQUIPMENT
SPECIFICATION


This annex contains an example of a long generic specification. In Guide 3 there is an example of a
shorter one, for an operating table.


SPECIFICATION FOR AN INFANT INCUBATOR
1. APPLICABLE DOCUMENTS


The specification should be read in conjunction with the ‘Technical and Environmental Data Sheet’,
and all goods offered must conform to the details specified in it and be able to function in the
prevailing conditions described.


2. REQUIREMENTS
2.1 GENERAL DESCRIPTION


To supply: ONE x unit to provide a suitable environment conducive for nursing ill, premature, and
under weight babies.


2.2 OPERATIONAL REQUIREMENTS
Note: supplier to complete ‘Reply’ and ‘Remarks’ sections.


Reply Remarks
2.2.1 There shall be a trolley base with four swivel wheels,


at least two lockable.


2.2.2 The incubator shall fit securely onto the trolley.


2.2.3 The incubator base shall house the power
compartment, fan and humidifier tank.


2.2.4 The infant compartment shall have a base, mounted
above the humidifier tank and fan, which is large
enough to allow the unimpeded handling of the infant.
Base shall have smooth, easy to clean surfaces


2.2.5 The baby tray shall be mounted on the infant
compartment base and shall be tilt-able,
(Trendelenburg and reverse).


2.26 The baby tray shall be graduated along its length for
measuring the infant


2.2.7 The mattress will fit onto the baby tray, be
approximately 20mm thick, be not less than
64cm x 36cm and have a removable cover.


2.2.8 The infant compartment shall have a transparent
canopy that forms four sides and the roof.


Continued opposite




2.2.9 The canopy shall be hinged along one side so that it
can be swung up to provide free access to the bed.


2.2.10 The canopy shall be designed or secured so that it is
prevented from falling accidentally from the open
position


2.2.11 The canopy shall be sealed to the frame by means of
a non-porous rubber or plastic gasket.


2.2.12 The canopy shall be fitted with a drop down (or
swivel) access panel to allow the mattress to be
brought forward.


2.2.13 The canopy shall have five port doors, two on each
side and one at the front. They shall be hinged doors
or fitted with an iris-diaphragm type plastic cover. All
hand ports shall not be less than 127mm in diameter.


2.2.14 All openings with hinged doors shall have
closing latches.


2.2.15 The air shall be drawn into the incubator through an
easily removable bacteria filter capable of removing,
with an efficiency of 99%, particles of the size down
to 0.5 micron diameter


2.2.16 The air shall be circulated by means of a fan.
2.2.17 The circulated air shall maintain slight positive


pressure in the infant compartment such that enough
stale air escapes from the hood to prevent an
undesirable and dangerous carbon dioxide
accumulation inside blood.


2.2.18 The hood shall have inlet holes for access by oxygen
and feeding tubes.


2.2.19 The power compartment shall be of modular
construction and such that it can be withdrawn
for maintenance.


2.2.20 The power compartment will house a control panel
containing: -


On/off switch
Temperature display (digital)
Temperature display knob (manual)
High temperature alarm
Power failure alarm
Air flow alarm
Heat out-put indicator, "heat is on".


Annex 4: Sample long generic equipment specification


271


Continued overleaf


2.2 OPERATIONAL REQUIREMENTS (continued)




2.2.21 There will be an air temperature sensor mounted on
the inside of the canopy.


2.2.22 The incubator shall be equipped with heating
elements of the totally enclosed metal-clad type and
a thermostat capable of controlling the temperature
in the infant compartment over a specific
temperature range.


2.2.23 The incubator shall be equipped with a reliable pre-
set high temperature cut-out that operates
completely independently from the thermostat and
that disconnects the heating circuit from the
electricity supply if, as a result of heating from any
source (including direct sunlight or nearby heaters),
the temperature in the infant compartment exceeds
39 degrees Celsius. Any relay forming part of this
circuit shall be arranged to be fail-safe.


2.2.24 Temperature range of 34-39 degrees Celsius, in
increments of 0.1 degree.


2.2.25 At any setting of the thermostat, the temperature
overshoot during the warming-up period, relative to
the steady temperature reached, shall not exceed
1 degree Celsius.


2.2.26 The airflow alarm shall be activated if the airflow is
obstructed (due to fan failure or total air circulation
failure). The activation of the alarm shall cause a cut
off of the heating elements. It shall be mains
operated audible and visual.


2.2.27 The high temperature alarm shall be activated if air
temperature in the canopy exceeds 39 degrees
Celsius. It shall be mains operated audible and visual.


2.2.28 The power failure alarm shall give warning of any
interruption of the electric power supply to the
incubator. The alarm shall be operated from a battery
of the nickel cadmium type that is housed in the
power compartment and is continuously trickle
charged when the power is switched on. The alarm
shall be audible and visual.


2.2.29 Single phase power supply of 220-240 Vac, 50Hz.


2.2.30 To be able to withstand mains supply voltage
fluctuations of +/- 10%, and mains supply frequency
fluctuations of +/- 10%.


Annex 4: Sample long generic equipment specification


272


Continued opposite


2.2 OPERATIONAL REQUIREMENTS (continued)




2.2.31 The incubator shall be equipped with a 3 metre non-
kinking type flexible mains lead, fitted with a 3
(square) pin 13A plug. The mains connector to be
detachable locking type.


2.2.32 The humidifier tank will consist of a water reservoir,
water inlet port, and water outlet drain constructed
in such a way that once drained a residue puddle of
water cannot remain sitting in the reservoir.


2.3 PHYSICAL CHARACTERISTICS
Reply Remarks


2.3.1 The trolley to be of metallic tubular frame of such
dimensions and wall thickness as to give acceptable
strength and rigidity. It shall have a polyester powder
coating finish.


2.3.2 The casters will be of a minimum size of 100mm.


2.3.3 The incubator base shall be of metal construction
with a polyester powder coating finish.


2.3.4 The power compartment shall be of metal and so
designed that the mechanical and electrical
equipment within it is adequately protected against
mechanical damage and the ingress if water and
cleaning fluids.


2.3.5 There shall be an ignition proof barrier between the
infant compartment and the heating element and
other electrical components.


2.3.6 The canopy shall be of robust clear Perspex.


2.3.7 The bed tray and support shall be of corrosion
resistant material.


2.3.8 The mattress shall be of polyurethane (or other
acceptable) material.


2.3.9 Any metal attachments shall be chromium plated.


2.3.10 It should be possible to fully dismantle the
equipment for cleaning purposes; and all parts will be
easily cleaned.


Annex 4: Sample long generic equipment specification


273


2.2 OPERATIONAL REQUIREMENTS (continued)




2.4 SAFETY FEATURES
Reply Remarks


2.4.1 The unit must be manufactured to conform
to the IEC safety standard 60101 for medical
electrical equipment


2.4.2 Safety Classification: Type B


3. ACCESSORIES AND CONSUMABLES
Reply Remarks


3.1 The trolley base to contain a storage compartment
with latching doors.


3.2 An IV pole shall be attached to the trolley


3.3 An oxygen cylinder holder shall be attached to
the trolley


3.4 A shelf or holder will be attached to the trolley for
storage of baby feed.


3.5 A psychrometer will be attached to the canopy for
humidity measurement together with dry
thermometers and wet thermometers


3.6 Supply all necessaries for the unit to function
as described.


3.7 A list of each accessory and its cost must be stated.


3.8 State all consumables necessary for the unit to
function for two years.


3.9 A list of each consumable and its cost must be stated.


4. DOCUMENTATION
Reply Remarks


4.1 Supply an operating manual in English for
the machine.


4.2 Supply a service manual in English for the machine.


4.3 Supply a list of recommended spare parts required
for the maintenance of the machine, in English.


Annex 4: Sample long generic equipment specification


274




5. SPARE PARTS
Reply Remarks


5.1 Supply a set of only the recommended essential
spare parts for 24 months for maintenance and repair.


5.2 A list of each part and its price must be attached to
this bid.


6. DELIVERY
Reply Remarks


6.1 Package the machine with its accessories,
consumables, manuals and spare parts together in
one load.


6.2 Crate the goods for transport, and label it as follows:
1 x machine for health facility X.


6.3 • The cost of freighting the goods by sea and road
DDP to health facility X in country Y must
be stated.


• The cost of freighting the goods by air and road
DDP to health facility X in country Y must
be stated.


6.4 The cost of insuring the shipment for the full journey
must be stated.


7. INSTALLATION/COMMISSIONING/TRAINING
Reply Remarks


7.1 Full assembly and commissioning instructions must
be provided for assembly and commissioning by the
client, in a written format and as a video if available.


7.2 The cost of commissioning by the supplier or
representative must be stated.


7.3 State the cost of the supplier or representative
undertaking training and providing written
guidelines:
in operation – for users
in care and cleaning – for users
in PPM – for maintenance technicians
in repair – for maintenance technicians


7.4 Travel, accommodation and subsistence
requirements for undertaking the contract must
be stated.


Annex 4: Sample long generic equipment specification


275




8. WARRANTY
Reply Remarks


8.1 A guarantee period must be stated (a minimum of
12 months from the date of commissioning).


9. AFTER SALES SUPPORT
Reply Remarks


9.1 After sales support must be available in country Y or
in the region, with maintenance capabilities and
facilities, and spare parts stock holdings.


9.2 Details of the availability and location of spare parts
must be stated.


9.3 Details of the availability and location of
maintenance facilities must be stated.


9.4 The cost of the annual maintenance contract must
be stated, detailing the range/scope of such
maintenance work.


10. SUMMARY OF PRICES (detailed as follows:)
Reply Remarks


(total prices) (showing options
and alternatives)


1. Basic unit
2. Accessories as detailed
3. Optional accessories
4. Consumables
5. Documentation
6. Spare parts for maintenance and repair for 24 months
7.1 Crating
7.2 Delivery
7.3 Insurance
8.1 Commissioning
8.2 Training
9. Annual maintenance contract.


Note: supplier to attach to this summary:
◆ the lists of all accessories, consumables, spare parts, and manuals in the offer, showing their unit and total prices.
◆ the lists showing the breakdown of travel, accommodation, labour, subsistence, materials, and any other costs for


the installation/commissioning/training offered.
◆ the list showing the breakdown of the rates and costs of travel, accommodation, labour, subsistence, parts, and


any other items that apply to the maintenance contract during the warranty period, and post-warranty.
◆ the details describing after-sales support availability.


Annex 4: Sample long generic equipment specification


276




ANNEX 5: SAMPLE TECHNICAL AND ENVIRONMENTAL
DATA SHEET FOR SUPPLIERS


You can provide all tenderers, bidders, or suppliers with Technical and Environmental Information in
order to ensure that the equipment they are offering to supply conforms to the prevailing national or
local climate and conditions. The sample sheet in Box 56 contains examples of the sort of entries you
could include, which you can modify according to your own situation. Such a data sheet can be
developed for a country, a district, or a facility.


BOX 56: Sample Technical and Environmental Data Sheet for Suppliers
Example Entries for Health Facility X


Electricity Supply
Source: Mains / generating set / solar panels / none
Type: three-phase 550V, 50Hz / 380V, 50Hz


single phase 220V, 50Hz
etc


Fluctuation: There is some problem with:
a) mains fluctuation, approximately + 10 per cent in both the voltage and


frequency supplied
b) mains cut-off (black out)
c) spikes, not necessarily on the mains supply but when large plant items cut in such


as lift motors
d) power only available for 2 hours a day
etc.
Suppliers should check/modify their power supply units if necessary, or state if voltage
stabilisers or a UPS is required alongside their products.


Water Supply
Quality: Hard water (high mineral or salt content) / soft water / sediment in water/ etc


Suppliers should check/modify their equipment with filters, softeners, or descalers if
necessary, or state if such units will be required alongside their products.


Pressure: 48psi, mains supply close at hand / pressure unknown – borehole supply / pressure
unknown – mains supply to subterranean tank


Problems: ◆ water supplies are frequently cut-off, or the electricity supply to the water pumps
is cut off


◆ very low pressure, or machines suddenly being without any water at all.
Suppliers should state if a back-up water storage tank or water pump is required with
their products


Annex: 5 Sample technical and environmental data sheet for suppliers


277




Continued overleaf




BOX 56: Sample Technical and Environmental Data Sheet for Suppliers (continued)
Example Entries for Health Facility X


Environment
Height above 4,500 – 5,000 feet where the health facility is located.
sea-level: Suppliers should check whether this will affect motors, pressure vessels, etc.
Temperature: ◆ Average temperature in winter inside health facility 16oC


◆ Average temperature in summer inside health facility 32oC
◆ There is no air-conditioning, even in the operating theatres.
Suppliers should state if air-conditioning is essential for the correct operation of
their products.


Humidity: High at 80 per cent. / very low and arid
Suppliers should check their products and, if necessary, carry out the following actions:
◆ tropicalize their printed circuit boards (provide them with a polymerized coating)
◆ replace rubber components which will perish with metal ones
◆ enclose silica gel or use other drying strategies
◆ use cotton not plastic
◆ use stainless steel or epoxy-coated metals which will not rust
etc.


Dust: There are problems with:
◆ dust getting into equipment and clogging up filters.
Suppliers should consider checking/modifying their equipment with additional course
filter protection.


Vermin: There are problems with:
◆ rats chewing through wiring
Suppliers should consider checking/modifying their equipment with metal vermin guards.


Manufacturing Quality
Standards: Equipment to conform to the relevant International Standards (IEC, ISO), or


otherwise to the relevant National Standards, which relate to the safe manufacture of
quality medical and hospital equipment.


Language
Language: All documents and manuals to be in English / French / Spanish or appropriate language


All labels and markings on machines to be in English / French / Spanish or appropriate
language.


Level of Technology of Equipment
Preferences ◆ more manual, less automatic


◆ more electro-mechanical, and less micro-processor controlled
◆ easily used and maintained
◆ robust
◆ to withstand the climate and conditions described above
◆ with technically-skilled after sales support available locally
etc.


Annex: 5 Sample technical and environmental data sheet for suppliers


278




ANNEX 6: SHORT-CUT PLANNING AND BUDGETING
WHEN STARTING OUT


Perhaps you:
◆ have a small health facility
◆ are short of managers or management skills
◆ have limited or no technical staff
◆ cannot cope with this whole Guide yet.
If so, you may want to try a shortened version of planning and budgeting for equipment. Box 57 shows
the bare minimum requirements you need to put in place when you are first starting out.
It assumes you will not be undertaking long-term forward planning, but will initially concentrate on
planning and budgeting on a yearly basis. As you progress, you can add in the other elements for
forward planning.


BOX 57: Bare Minimum Planning and Budgeting Requirements
Planning and budgeting element If you are just starting out
◆ Equipment inventory (Section 3.1)
◆ Stock value estimates (Section 3.2)


◆ Budget lines for equipment expenditures
(Section 3.3)


◆ Usage rates for equipment-related
consumable items (Section 3.4)


◆ Reference materials (Section 4.1)
◆ Developing the Vision of service delivery


for each facility type (Section 4.2)
◆ Model Equipment Lists (Section 4.3)


◆ Purchasing, donations, replacement, and
disposal policies (Section 4.4)


◆ Generic equipment specifications and
technical data (Section 4.5)


◆ Capital budget calculations (Section 5)


◆ Recurrent budget calculations (Section 6)


◆ Equipment development plan (Section 7.1)


◆ Equipment training plan (Section 7.2)
◆ Core equipment expenditure plan


(Section 7.3.1)
◆ Core equipment financing plan


(Section 7.3.2)
◆ Annual equipment planning and budgeting


(Section 8.1)
◆ Monitoring progress (Section 8.2)


Annex 6: Short-cut planning and budgeting when starting out


279


◆ essential to have
◆ useful to carry out this exercise later on when you


need rough estimates for long-term forward planning
◆ this alteration to your budget layout can be done


later, but it will help with analysis
◆ useful to do this exercise as it helps you calculate


specific (annual) estimates
◆ these can be developed over time
◆ you should have an understanding of this, even if


you do not undertake a full exercise
◆ initially, use a list of urgent equipment needs drawn


up by departments. Later on, learn from other
people’s Model Equipment Lists


◆ essential to have


◆ initially learn from others. Later, develop your own


◆ initially learn how to make specific (annual)
estimates; only learn the rough estimation methods
when undertaking long-term planning


◆ initially learn how to make specific (annual)
estimates. Only learn the rough estimation methods
when undertaking long-term planning


◆ use the basic equipment development planning
process only, and only apply it to the short-term


◆ develop a straightforward one for the short-term
◆ initially only plan annually (see below)


◆ initially only plan annually (see below)


◆ create annual actions plans and an equipment budget
showing income and expenditure


◆ undertake the basic elements only – progress with
annual plans and tools, coping with emergencies,
providing feedback.




Figure 38 shows the suggested steps for a shortened version of planning and budgeting for equipment.
Figure 38: Shortened Version of Planning and Budgeting


Annex 6: Short-cut planning and budgeting when starting out


280


Establish your equipment
inventory HTM Team Use Box 7 (Section 3.1)


Undertake the exercise to
calculate your consumable
usage rates


HTM Working
Group
(HTMWG)


Use Figure 10 (Section 3.4)


Ensure you understand what
the vision is for your facility


Health
Management
Team


Write down your health delivery goals and your place in
the health service. For the technology implications of your
vision, ask yourself the questions in Box 15 (Section 4.2)


Use a substitute for a model
equipment list


Steps PeopleResponsible Activity


Gather departmental requests of urgent needs for
replacement and new equipment. In time, try to obtain
other peoples’ model equipment lists to learn from
(Section 4.3).


Develop your purchasing,
donations, replacement, and
disposal policies


HTMWG


Try to follow the advice in Boxes 17–19 (Section 4.4) and
apply them to the departmental requests for equipment


Try not to fall into the typical traps when specifying
equipment (Section 4.5). Learn from other people’s
specifications. Write simple specifications as you need
them (see Figure 11), and a simple technical data sheet
(see Figure 12).


Ensure you understand how to
make capital budget
calculations for specific
(annual) estimates.


HTMWG


HTMWG


See Boxes 24 and 25 (Section 5.2), Figures 15 – 18
(Sections 5.3 – 5.5)


Ensure you understand how to
make recurrent budget
calculations for specific
(annual) estimates.


HTMWG See Box 29 (Section 6.1) and Figures 21– 24 (Sections 6.1 – 6.4)


Use the basic equipment
development planning process,
for the short term


HTMWG Use Figure 25 (Section 7.1), but for the short-term only


Create a basic equipment
training plan, for the short term HTMWG Use Figure 27 (Section 7.2), but for the short-term only


Each year follow the annual
process HTMWG Use relevant parts of Figures 31 – 37 (Section 8.1)


Develop expenditure and
income requirements each year HTMWG Use Box 47 (Section 8.1)


Monitor progress HTMWG Use the basic elements of Section 8.2


Health
Management
Team


Develop basic generic
equipment specifications and
a technical data sheet




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284






‘How To Manage’ Series for Healthcare Technology
This Series of Guides helps you to get the most out of your investment in healthcare
technology. You need to manage your assets actively, ensuring that they are used optimally
and efficiently. This series shows you how.
Physical assets such as facilities and healthcare technology are the greatest capital
expenditure in any health sector. Thus it makes financial sense to manage these valuable
resources, and to ensure that health care technology:
◆ is selected appropriately
◆ is used correctly and to maximum capacity
◆ lasts as long as possible.
Such effective and appropriate management of healthcare technology will contribute to
improved efficiency within the health sector. This will result in improved and increased
health outcomes, and a more sustainable health service. This is the goal of healthcare
technology management – the subject of this Series of Guides.


The Guides
Guide 1: How to Organize a System of Healthcare Technology Management
Guide 2: How to Plan and Budget for your Healthcare Technology
Guide 3: How to Procure and Commission your Healthcare Technology
Guide 4: How to Operate your Healthcare Technology Effectively and Safely
Guide 5: How to Organize the Maintenance of your Healthcare Technology
Guide 6: How to Manage the Finances of your Healthcare Technology


Management Teams




Copyright 2016, Engineering World Health