Inventory management practices
This study assessed medical equipment inventory management practices in public health facilities in Homa Bay County, Kenya. Good inventory management practices enhance the performance of medical equipment, reduces costs in maintenance, motivates working personnel and reduces their downtime. All health facilities used a manual inventory register to manage medical equipment, which was more involving and complex to update. Inventory management was decentralised, where each department kept its inventory without coordination to collate with the central asset register. It was found out that most new equipment from donors and facility procurement were taken directly to the department without making entries into the central hospital inventory register.
A few health facilities had one comprehensive inventory containing all hospital medical equipment that needed updating. Some facilities had a biomedical department, that was tasked to maintain an aggregated inventory register for the entire institution. However, the administrative office maintained the register for those without a biomedical department. The finding shows that only some departments had complete records of equipment in their inventories(12) and manual inventories are difficult to update(13).
An inventory register should be standardised to enable users working in the same ministry to seamlessly utilise the document. Unfortunately, each department had different registers for same purpose. The findings pointed out that no standard form for the medical equipment inventory register (12). Where a standard inventory register was available, most sections were not filled making it incomplete and unsuitable for decision-making (13). WHO has provided the minimum information requirements that should be contained in the medical equipment inventory register (14).
The inventory register is supposed to echo the current status of medical equipment. Where the inventory registers was present, only 51% of them were up-to-date, indicating inadequate current information(4) Medical equipment registers contained obsolete medical equipment that had not been in use for years. Some of them had been sent to the biomedical engineering department and were yet to be returned. Regularly planned disposal mechanisms needed to be improved within the institutions, leading to the inventory register containing out-of-order medical equipment (15).
The questionnaire sought to find out what are the main uses of an equipment inventory register. Some of the common uses of the inventory were for planning procurement, maintenance scheduling, disposal of unusable medical equipment, replacement and other vital decisions regarding the equipment. However, the finding indicates that the inventory was mostly used to take stock of the available medical equipment. The other crucial decision that should be evidence-based was left to the discretion of individuals within the leadership.
The inventory ought to be an informative source on the current history and state of equipment. This history helps decision makers such as the medical equipment committee to recommend to the management what equipment requires replacement. Most institutions were not using the information in the register for replacing the equipment but rather the information from the top management and requests from the department.
Workload determination for all medical equipment facilitates understanding how efficiently the equipment has been used. This further facilitates the need to replace the equipment based on the wear and tear of the components. All the health facilities do not determine the workload of medical equipment, and similar findings were echoed by research conducted at educational hospitals in Isfahan (4).
Medical equipment procurement should be based on the needs of the community. This is conducted through a needs assessment that reveals the needs of the community and the strategic framework of the health sector. According to the Auditor General's Report (16), each healthcare provider was responsible for their own equipment procurement. The result of the findings show that the practice is different in that procurement is through the request placed by the department and by the top leadership locking out crucial decision makers. Similar findings were reported by the research conducted elsewhere (15). It was found that the procurement policies were not adhered to in Mandera referral hospital (17). This was also confirmed when none of the institutions had a needs assessment template, which is a vital document for determining the baselines and needs of the health facilities.
It is a good practice to have unusable medical equipment disposed of promptly while they still have value to help generate some income for the organisation. Such equipment may be of value to another organisation. Space is another factor to be considered in order to dispose of equipment timely. However, the result of the finding showed that none of the health organisations had disposed of their obsolete medical equipment. Obsolete equipment were dismantled and used as spare parts without decommissioning and deleting from the register (15).
The hospitals had a massive number of medical equipment that are costly and vital in the management of patients. The equipment needed to be properly maintained to avoid disruption of service and loss of life. None of the institutions had a medical equipment management committee. Two of the respondents acknowledged having one, but on further probing, they were found to be the health management committees that were used to deliberate the general planning of the entire hospital's functions. The committee is an important organ as it takes care of the welfare of medical equipment and recommends any action that should be taken on that equipment. It is this organ that constantly advises the hospital management on the status of the equipment. The lack of this committee subjected the institutional equipment to lacking better management, proper documentation, poor procurement practices and lack of disposal of unusable equipment.
Healthcare workers knowledge
Healthcare workers knowledge on the management of medical equipment enhances care of equipment. Inadequate training is attributed to higher costs in equipment management and lack of service provision to needy patients. Most health care workers revealed that they have never received training on managing medical equipment inventory. A similar scenario was witnessed in the study conducted in Nairobi and Central counties of Kenya (18).
The records of employees who have undergone the training were also not available. However, those who acknowledged having received the training focused on specific equipment under contractual management rather than comprehensive training on medical equipment inventory management, and these were a few laboratories and biomedical employees. This was also noted by the research conducted in major hospitals in Kenya (15). In the same departments, their inventory registers were also not standard according to WHO requirements but customised according to the vendors' requirements.