Combining the Management and Maintenance of Medical Equipment and Cold Chain Equipment

I have attached a draft document on the Floating Assembly look at Cold Chain Equipment. This can be useful if we have a team that can help review it and provide additional ideas to the hospital equipment

Mazila Luka David

+2348024521764

Dear Mazila

The maintenance (management of assets) is a critical issue to have sustainability of the EPI cold chain and all efforts to improve it are ok. In Colombia is not possible to have a National Floating Assembly like your project, because each department (states in some countries), each clinic or hospital must maintain your equipments locally, so we focus more on training technicians. The list of tools and consumables are ok only include the Refrigerant Recovery machine, althogh for small masses of R600a is not practical to recover it, even for R134a in old equpments. The main cause of failure in our country is the poor power quality (transients and spikes in current and voltage) that damages electronic thermostats. To intervening the refrigeration system is rare.

Best regards

Using this opportunity, I would like to reflect few points with respect to integrated or combining management and O&M of medical equipment even though we do not have any thing to share. But, I believe this is one of the areas that ministry of health, doners, organizations as well as biomedical and supply experts need to advocate for creating capacity for integrated/ combined management and maintenance of different types of medical equipment such as cold chain equipment (CCE), Special Newborn Care Units (SNCU), oxygen concentrators, oxygen plants, blood storage units, systems for solarization of health facilities, healthcare waste management equipment and other essential medical equipment for primary health care throughout the health system. This ensures the optimum and sustainable utilization of expensive medical equipment. MOHs and organizations need to work towards:

• Holistic Integration: the integration should encompass all components of medical equipment management, including policy, workforce, operations, financing, guidelines, and business models for spare parts, operation, and maintenance.
• Tailored Strategies: it would be useful for Moh and organizations to understand better what are the possible different strategies, business models and approaches that can be followed by different country typologies. This includes understanding the options and then adopting solutions that are best fit, whether is through human capacity within the Government structures, utilizing local service providers, or combinations.
• Workforce Development: there are already examples of countries working with universities and technical colleges to ensure appropriate courses and degrees for biomedical engineers and technicians to ensure a pipeline of qualified professionals, Important to build on those examples.
• Building on existing capacity: The CCE maintenance is more advanced and clearly defined structures in most countries. This should be used as an entry point for integrating, whenever possible, capacities for management of other medical equipment.
• Creating center of excellent for expanding the concept: We need to work on selected regions or countries try to show how the integration will have an impact on improving the medical equipment management and move towards expanding this best experience.
• Documenting the current scenarios and forward strategies for the move to next steps: mapping what the current landscape is, analyze/understand better what the patterns are, document and facilitate sharing of best experiences and information, foster learning, create awareness about solutions that could fit different country typologies, facilitating community of practice, capacity development etc 
• Collaboration among immunization, supply and health program sections to enhance O&M approaches and human capacity to support all equipment that serves primary healthcare.

I am also eager to gain experience from countries that have successfully integrated the management and operation & maintenance (O&M) of medical equipment.

Fikreslassie Alemu

Combining the management and maintenance of medical (hospital) equipment with Cold Chain equipment,is much needed discussion & thanks for initiatiing..

As we know that,equipment life cycle management broadly categorised under four phases,i.e., Planning-Procurement-Lifetime- Decommissioning & Disposal. However,to have efficient,smoother & effective management,very first step is,there must be a clear policy for equipment maintainanace programme,i.e. whether to go for Inhouse mechanism or Outsourced mechanism or hybrid-combine the both (as happens in many countries)..The mechanism to be adopted,should be evaluated, on the basis of following

• Cost savings
• Staffing flexibility, expertise and work quality
• Service Reach
• Tool, equipment & technology
• Work focus
• Associated risk, i.e. Loss of control
• Staff turnover
• Redundancy in management roles
• Response time

The management aspects gets difffered based on the mechanism adopted,i.e.,

When it comes to inhouse management,capacity building of concern technical staff (Engineers/Technician) ,SOPs preparation,Planned Preventive Maintainance implementation,Spare Part inventory management,workshop & tool kit set up plays key role. However as far as the outsources mechanism is concerened contract management (AMCs/CMCs) requires more weightage.

In some countries,efforts are being made towards combining repair management for cold chain & medical equipment..It is being achieved to some extents,through capacity building,i.e train Bio Medical engineers on CCE repairs & train Cold Chain Engineers/Technicians on Medical Equipment repairs.However challanges still persists there in terms of

• No clear policy/guidelines in place
• Administrative Channels differs in its own way (Programmes are differant)
• Budget heads & Procurement strategy matters
• Expertise requirements in case of major repairs,
• Dependancy on OEM,especially for sophisticated equipment
• Absence of spare part management (inventory) & workshop space for undertaking the major sort of repairs

In concluding,despite of challanges involved,combining the management and maintenance of medical (hospital) equipment with Cold Chain equipment can be made possible,however there must be policy framework in place, for the maintainance model to be adopted ,covering the following 

• The scope and purpose;
• The need for a maintenance system;
• Roles and responsibilities…Potential partner & Stakeholders (MoH Officials/Clinical engineering & EPI cold chain team)
• High-level commitment to a participatory policy development approach.
• Quantification for the projected cost implications;
• Maintenance plans and secured budgets;
• How each equipment should be maintained and repaired, and by whom
• Officially recognized equipment maintenance organizations, and the private sector;
• MIS development & implementation
• Emergency Situations and Contingency Plans

Views upon  & ideas regarding are most welcome....

Thanks & Best Regards,

This is a topical discussion for me. 

I work as the product manager for immunization and cold chain at The mSupply Foundation and we are currently working on a CCE inventory software system (Open mSupply) with the view to expand out the capabilities of the system to handle a broader spectrum of equipment such as medical and waste management equipment (and other assets). 

Our CCE inventory system will initially handle the distribution, performance, maintenance and national analytical aspects of CCE. 

The system has been designed such that it can be tweaked to handle specialised subsets of equipment (such as integrated temperature management and cold storage volume capacity for CCE) whilst also supporting a more generic framework that can be used for other categories of equipment. 

In addition, the CCE inventory system is being designed to be part of a larger ERP that incorporates eLMIS, procurement and regulatory compliance functionality. 

Open mSupply has been specifically developed for low to middle income countries in alignment with the ISG's Target Software Standards.

Our aim is to grow the functionality of the system to keep pace with countries as their capacity and requirements advance, hence I was pleased to see discussion here about the future possibility of countries managing both their CCE and medical equipment in the one place. 

Please feel free to send me a direct message if you'd like to know more about our plans for the near future. 

Many thanks

Adam Dewey

Dear Yogesh Bhamare,

Thank you for sharing your experience and expertise regarding the integration of medical equipment management with Cold Chain equipment. If there are countries that have made efforts and progress in this area, I would love to hear about how they are managing this integrated approach. Additionally, who should advocate and lead for the development of a policy framework for this initiative to encourage countries to move towards integrated management? If there are countries that have successfully managed this integration, please share their experiences with us.

Regards,

Fikreslassie Alemu

Dear Fikreslassie Kibret and all

Thank you for the response to the document shared on the floating assembly.

The responses have helped in triggering discussions on tools and systems for integrating equipment maintenance and record-keeping at different units in Health facilities and healthcare service provider locations.

Currently, I have never come across any county or document that deliberates on integrated equipment maintenance and management.

However, I will suggest that we start to develop a structured document outlining the areas

First, in the integrated approach we need to develop a structure that will give us what we need,

Departments requirement.

Tools requirement.

Types of equipment for each unit within the hospital

Tools

Funding

Technicians

Also, we need to find out why expand program on immunization has different maintenance units and the reason for integrating the maintenance system.

We also need to draft a concept note showing what is the gap, the challenges also the benefits of integrating all maintenance under one roof. (floating assembly), How can WHO and Dons support,

Which country has a similar approach, or vendor?

If you can help and check or contact someone in India they have a similar approach but I don’t know the details of the structure covered in the maintenance unit.

Globally   Primary Health care has a tool for managing equipment inventory for expanded immunization calls (Inventory Replacement Plan IRP), the tool does a multiple projection in terms of equipment management related to vaccines.

This is because vaccines are continuous temperature activities while the hospital equipment is timely or periodic maintenance equipment, the first challenge is how can both be under one roof.

Currently, WHO has developed a tool called the inventory gap analysis tool; Both the inventory gap analysis tool and Inventory replacement Plan IRP can be modified to meet the requirement for additional equipment at different units of Primary Health care and hospitals that have to do inventory and maintenances depends on what is the need.

1. PHC under one roof
2. One functional PHC per district or ward

The floating Assembly will help in coming up with multiple ideas because is a center where staff training, testing of new equipment, and forecasting on innovation and partnering for invention through WHO and partners.

Most countries have one or more different challenges that globally need to start looking into through a forum where information and ideas related to equipment management need to be created.

Thank you

Engr Mazila Luka David

+2348024521764

Nigeria

Dear Fikreslassie Alemu,

Thanks for the response & acknowledgment...

There are some countries actively making efforts towards combining repair management for cold chain & medical equipment..India is one,who took initiative & made strategic planning of capacity building of Cold Chain Technicians (earlier who were looking repair & maintenance of CCEs only) for undertaking minor sort of repairs for Medical (Neonatal) Equipment,i.e. Radiant Heat Warmers,Phototherapy Units,Infant Ventillator, Oxygen Concentrator, Syringe Infusion Pump,Pulse Oximeter, Multi para monitor, CPAP unit etc)... The policy decision was made at MoH level & later implemented at state/province level..In other countries of South Asia region, i.e. Afghanistan,Maldives,Bhutan, Nepal, SriLanka this practices is started getting followed,but somewhat partially. In all these countries,Cold Chain Technicians are trained-involved in undertaking repairs of Medical (Neonatal) Equipment & Vice Versa Biomedical Engineers do undertake repairs of Cold Chain Equipment (CCE)

Even the countries in the East Africa region,i.e. Kenya, Rwanda, Tanzania, Uganda,etc Capacity building of Biomedical Engineers on Cold Chain Equipment Management is well going on. So not at the fullest,but to some extent many countries are trying & making efforts for combining Medical & Cold Chain equipment management,at least repair is concerned.

The policy formulation & release of guidelines should be at Secretariat/Commissionerate level based on the recommendation done by MoH level committee..Overall,this should be the High-level commitment to a participatory policy development approach.

Hope this will serve the purpose..

Best Regards,

Uganda's implementation of the Cold Chain Equipment Information System (CCIS) is a noteworthy example of how technology can improve CCE maintenance and management, although similarly the integration with other medical equipment is still a challenge as highlighted by Bastiaan Remmelzwaal and I quote "...differences in: (i) Specialized Requirements, e.g. Temperature Management (ii) Regulatory Compliance, (iii) Resource Allocation, and (iv) Maintenance Complexity". 

Key features of the CCIS:

• Built on the ODK-X platform, a step up from traditional ODK.
• Enables bidirectional data sync—both from devices to central servers and vice versa.
• Accessible via Android devices with robust offline functionality—sync when online.
• Interoperable with existing health information systems and tools (e.g., DHIS2, WHO IGAP).
• The CCIS dashboard is currently accessible via any internet-enabled device using a website and provides additional data analysis for any information that would have been collected through the ODK-X mobile app.

The ODK-App is primarily structured to capture CCE inventory data, temperature data, and maintenance records. The initial CCE data for refrigerators/cold rooms was derived from the CCEM tool, and health facilities data was obtained from the DHIS2 master list.

Impact of the CCIS:

• Enhanced CCE Functionality: continuously, the use of the CCIS regarding management of maintenance has enabled the country to achieve commendable functionality rates with a most recent rate of over 98% in November 2024. This is because of the increased use of the systems in matters regarding CCE maintenance.
• Data-Driven Decision Making: At the national level, staff from UNEPI and NMS now employ CCIS data for comprehensive cold chain inventory management, procurement decisions, and consistent reporting to critical TWGs such as the Vaccine Management Committee.
• Optimized Maintenance Activities: NMS personnel use the data to prioritize, strategize, and plan for CCE repair and maintenance tasks, ensuring a more responsive and agile system.
• Accountability & Warranty Management: Warranty data captured using the application enhanced accountability and laid down strong groundwork for spare part and repair warranty claims follow-ups.

How are other countries approaching the integration of medical equipment management? In Uganda, we are making gradual progress by involving biomedical engineers in cold chain management, particularly through initiatives like the ongoing HFSE project, which we are jointly implementing.