Telangana health department keeps an eye on high-end medical equipment

A modern cath lab at Nizam's Institute of Medical Sciences (NIMS) in Hyderabad.

Hyderabad: Maintenance of medical equipment in government hospitals has always frustrated patients and hospital authorities. Almost all the public health institutions in Telangana State have in the past struggled with non-functional high-end medical equipment.

Back in 2015-16, according to the estimates made by State Health and Medical Department, anywhere between 30 per cent and 60 per cent of medical equipment in government hospitals were non-functional.

Defunct medical equipment in government hospitals is known for dragging down the quality of healthcare. Non-availability of diagnostic tests causes a lot of heartburn among patients because they have to incur out of pocket expenditures for tests at private diagnostic clinics.

Considering the gravity of the situation, in the last 18 months, the State health authorities have put in place a system of checks and balances aimed at ensuring medical equipment is available in a working condition.

In the early part of 2017, the Health Department, based on Biomedical Equipment Management and Maintenance Program of National Health Mission (NHM) of Health Ministry, had framed guidelines that are vital for proper maintenance of medical equipment in State government hospitals.

By June, 2017, based on the guidelines, a tender was floated and an agency ‘Sindoori Faber’, a Malaysian-Indian agency specialising in such work, was identified to handle maintenance of medical equipment in government hospitals for a period of five years. Roughly, the State government will incur costs to the tune of Rs 20 crore every year to pay for the comprehensive annual maintenance contract.

“The aim is to ensure 95 per cent of the medical equipment in teaching and district hospitals are available round-the-clock and throughout the year. The private agency is providing comprehensive maintenance and facility management services,” says Executive Director, Telangana State Medical Services and Infrastructure Development Corporation (TSMSIDC), Dr. Mantha Srinivas.

Senior doctors familiar with the concept acknowledge that notwithstanding the initial hiccups, the new system of maintaining medical equipment in Government hospitals is a right move forward and will be a successful model in the long run.

Why PPP model?

Hyderabad: Almost all the State governments in the country tend to procure new medical equipment but after one or two years of usage, due to non-availability of spare parts and inability to conduct small repairs, the equipment is discarded and new equipment is procured.

Telangana health department keeps an eye on high-end medical equipment
Due to various reasons, medical equipment break down frequently.

This practice not only causes loss to the State exchequer but also leaves patients who visit State-run hospitals a frustrated lot. Like it or not, due to various reasons including rough geographic and climatic conditions, medical equipment do breakdown frequently. Like any other electronic gadgets, medical equipment too are prone to frequent breakdowns.

There are also difficulties in getting spare parts for such medical equipment and trained personnel who can actually take up repairs. Moreover, a majority of agencies involved in maintenance of equipment only offer to provide servicing the equipment and insist that the company should pay for the spare parts. An organisation like TSMSIDC would find it very difficult to procure spare parts frequently for repairs of medical equipment.

Considering such experiences, which are quite universal, the National Health Mission (NHM) in its guidelines had proposed for Public-Private Partnership (PPP) model for maintenance of medical equipment.

TS guidelines could set benchmark for NHM

While conducting a thorough study of guidelines and practices being followed in maintaining medical equipment in Maharashtra, Tripura, AP and other Indian States, the State health officials had stumbled upon several loopholes that were being leveraged by private agencies to make profits at the cost of the public exchequer.

According to health authorities, the conditions based on which the tenders for medical equipment maintenance were floated, are far superior to other States and could well become a benchmark for the National Health Mission (NHM).

Telangana health department keeps an eye on high-end medical equipment
There were several loopholes in the practices being followed in maintaining medical equipment.

According to officials, private maintenance agencies, without attempting to repair anything, tend to declare defunct medical equipment as  ‘condemned’, which paves the way to sell the equipment.

Later, the non-functional medical equipment is picked-up or bought by a sister agency, which then refurbishes the equipment and sells it to small and medium sized clinics and nursing homes who can’t afford to purchase original equipment.

Another glaring loophole that aided private agencies was that States were paying equipment maintenance to Original Equipment Manufacturer (OEM) as well as the private agency. Any new medical equipment comes with a three-year warranty, which means OEM will be responsible for its maintenance.

However, many States were paying money to private agencies also to maintain the same new medical equipment for three more years despite OEM maintaining the equipment for three years.

“It was strange that many States were paying twice for medical equipment maintenance. Once to OEMs while buying the equipment and second time to private maintenance agencies. We decided to stop this practice and brought about changes in the preconditions before floating tenders,” says ED, TSMSIDC, Dr. Mantha Srinivas.

Before directly calling for tenders, the health authorities here had first called for expression of interest six major maintenance agencies in India. The officials here took close to eight months in 2017 to convince private agencies to accept to the new terms.

How medical equipment will be repaired

Each State-run hospital will have an appointed nodal officer whose phone number will be linked to the online maintenance system. Just like requesting or booking a new gas cylinder, if a medical equipment is not working, the nodal officer will register a complaint in the special call centre, which is already set up by the private maintenance agency. The call centre will function round the clock to receive complaints from the nodal officers. The agency has to complete the repairs within the stipulated period of time.

Sick history to be recorded

The online maintenance system of TSMSIDC provides a unique feature that enables health authorities to track the sick history of medical equipment. Through data mining, authorities can now track the sick history of all expensive medical equipment, which will reflect the quality of the product. If a particular brand of medical equipment is failing and needs frequent repairs, the manufacturing company can be red-flagged during the next cycle of procurement.