Essential Medical Supplies and Equipment

ln terms of selection and management, medical supplies and equipment are rarely given as much attention as drugs For some reason they are regarded as less important Yet they are as essential to patient care as drugs Their cost is considerable In most developing countries, the cost for medical supplies can be as much as 30 to 40 percent of the amount spent on drugs

Supplies

comprise mainly disposable items (such as cotton, dressings, disposable syringes) or items with relatively short life spans (such as reusable syringes or catheters)

Equipment
encompasses both capital equipment and recurrent equipment, the former being long-lasting, durable goods such as autoclave's, and the latter including goods with shorter life spans such as thermometers or sphygmomanometers. The distinction between supplies and equipment is not always clear, for example, thermometers are pieces of equipment, but they are purchased so frequently that they are sometimes referred to as supplies.

National Equipment and Medical Supplies Policy

Three main problems associated with medical supplies and equipment are lack of policies lack of standardization, and lack of quality assurance Consequence? wasteful and expensive over purchasing and overstocking

National Equipment and Medical Supplies Policy..

A sound national equipment policy with a list of essential medical supplies can be effective in simplifying supply issues reducing costs, and promoting efficient provision of health care The policy specifies what medical equipment and supplies should be used in which types of medical tests interventions and operations

National Equipment and Medical Supplies Policy

Since different medical procedures are carried out at different levels of health care, the policy defines the sets of supplies and equipment that will be needed at each of these levels.

Drawing Up the List

From this policy, lists of essential equipment and supplies can be drawn up according to level of care. These lists are useful to
define priority items and help ensure that the most essential items are available where needed; promote careful use of scarce financial resources; promote standardization, which simplifies supply management and reduces stock costs; provide the basis for training of staff and maintenance technicians.

Managing the Medical Supplies and Equipment List

The list of essential equipment and supplies should contain a complete and clear description of each items including stock number type standard pack size, and the most recent unit price VEN categories are useful to identify those items that should never be allowed to run out of stock.

Managing the Medical Supplies and Equipment List.

Without effective limits, a list of medical supplies tends to be long It is therefore important that the items be standardized as much as possible There is usually pressure to include more items on the list Doctors who were trained overseas may want to bring their treatment habits with them, or even impose them other health workers

Managing the Medical Supplies and Equipment List.

It is not easy to resist such pressure but a standardized list, drawn up by the committee and with procedures for regular updates, is probably the best solution.

Minimum Specifications
In addition to a catalog or list of essential items, a separate set of technical specifications for the items must be developed. These specifications must be prepared by technically qualified personnel and must be as accurate and precise as possible. They are essential to the procurement department or tender board to ensure the quality of the items. They are also needed for any claim if poor quality goods have been received.

Sample Product Specifications

Minimum Quality Requirements for Hydrophilic Absorbent Gauze
Raw material: 100 percent cotton, bleached Minimum number of warp and weft threads per inch: 19 x 15 Total of warp and weft threads per cm: 13 Net weight per square meter: 17 g Net weight per roll: 1,392 g Products comply with BP88 Packing details: Per piece in white polyethylene bag; 20 pieces in export carton

Selecting Medical Supplies

Many supply items, such as syringes, needles, and gloves, are available as either disposable or reusable items. The national policy on the use of disposable or reusable items may differ from one country to another.

Disposable and Reusable Items

In countries with limited funds for medical supplies, the main problem with using disposable syringes and needles is that they are expensive and sometimes out of stock; Because of this, they are often resterilized and used again. Two problems arise:
first, these disposables are not meant to be sterilized (resulting in air leakage and inadequate closing); second, the method of sterilizing is often inadequate

Disposable and Reusable Items

Boiling only disinfects and does not sterilize The same applies for soaking the disposables in a disinfectant solution Where stock outs are a problem, every health facility should probably keep a few reusable syringes and needles in reserve. This implies that a national policy for using only disposable or only reusable materials is not always practical.

Needles and Syringes

Injections are overused in many countries. In view of their cost and the risk of transmission of disease, this practice should be discouraged as much as possible. Nevertheless, every health facility should keep on hand enough syringes and needles to provide sterile items for each injection. In most hospitals or districts, the range of different syringes and needles can be simplified. It is not necessary to have all possible sizes available.

Sutures
At the primary care level, two kinds of sutures are usually sufficient: a resorbable chromic catgut suture with needle for deliveries, and a non resorbable monofilament or braided suture with needle for wound suturing and minor surgery. In district and specialist hospitals, some additional types of sutures are needed, but not the wide range that is usually found in stock, at considerable cost. There are round and cutting needles of different sizes, with catgut, nylon, silk, or Dexon threads in five to ten different thicknesses;

Gloves
Gloves are necessary for staff in dressing and delivery rooms, operating rooms, and laboratories where blood samples are handled. Gloves are used to protect personnel from infection by microorganisms from a patient's body fluids. In surgery, they are also used to protect the patient against infection with microorganisms from the surgeon's hands. The risk of HIV transmission has increased awareness and underscored the importance of using goodquality products with a low risk of pinholes and cuts.

Gloves..
There are many different types of gloves: thick rubber gloves used by cleaners and mortuary workers; thin, plastic non sterile disposable gloves to handle infected materials (dressings); plastic or rubber non sterile but reusable plastic gloves; sterile disposable surgeon's gloves; and reusable rubber surgeon's gloves, which can be sterilized several times, It important to match the correct gloves to the task.

Gloves..
Common errors are cleaners using rubber surgeon's gloves surgeons wearing resterilized disposable gloves (often patched with small pieces of rubber to repair the holes). Latex rubber gloves are preferred over plastic for procedures in which contact with a patient's body fluids is likely. Even wearing two or three layers of gloves does not reduce the risk of needle stick injury.

ESSENTIAL MEDICAL SUPPLIES AND EQUIPMENT

Nowadays the
When I worked in the operating room last year I hated it. The equipment never worked.

equipment is
very reliable

only because the medical director finally put nurses on the selection committee

Only because the medical director finally put nurses

Selecting Instruments and Equipment

Around the world, there are at least four different types of electrical plugs; two voltage systems, with 110 or 220 volts and 50 or 60 cycles per second; three different weight and volume measurement systems The obvious strategy for tackling this problem is to standardize equipment and instruments When the standard types and brands have been chosen, a list of standard equipment with specifications should be prepared to serve as a guideline for the procurement department.

Donated Supplies and Equipments

Responsibilities of Recipients Standardize equipment as much as possible. Involve technical departments in formulating a request for support. Clearly specify the items to accompany the equipment. Make a checklist of these three points for submission to the donor.

Responsibilities of Donors
Communicate with the recipient before donating equipment. Supply fully operational equipment. Supply all technical documents. Supply the requirements of consumables and spare parts for two years. Ensure proper packaging and shipping. Offer technical assistance in the training of end users and maintenance staff. Understand and respect important laws and regulations in the recipient country (for example, with regard to payment of customs duties).

Management of Medical Supplies

In principle, managing medical supplies and equipment is similar to managing drug supply.

Procurement
Procurement of medical supplies is not substantially different from drug procurement. There are a limited number of items that are responsible for a large proportion of the budget, and these can be identified by ABC analysis There will always be requests for the procurement of items that are not on the national list of essential supplies

Procurement.
For such items, for new items that have not yet beet included on the list, or for new items with an expected low turnover, the following questions should be asked before an order is placed: Is the item really necessary? Can and will it be use in the place for which it is being ordered? Is there a local alternative? Can spare parts or means of maintenance be consistently obtained?

Storage
Although most medical and surgical supplies are quite durable, some contain specific expiration dates, and others are subject to spoilage if left unused for too long Other items are sensitive to heat and humidity. Many sterile products, even if properly packed by the manufacture remain sterile only if stored correctly. Many have an expiry date and may lose sterility under tropical conditions.

Storage
Insufficient attention is frequently paid to the storage requirements of medical supplies. In some places, storage conditions are poor, with leaking roofs, dust, extreme heat, and rodents. Under such circumstances, the financial waste due to damaged supplies is considerable, and investing to upgrade the stores, particularly at the central and regional levels, is likely to be cost effective. In selecting supplies and in defining the specifications for them, one should consider the anticipated storage conditions. Guidelines for storage should he prepared and described in the list of essential supplies.

Distribution
Preprinted standard requisition lists of medical supplies, organized by level of health facility, are useful tools to simplify the distribution of supplies and promote the rational use of limited resources. Such lists indicate to the end user the range of items that are available within the system, with their specifications, pack sizes, and stock numbers. The lists can also include the current unit price. In addition, such lists facilitate checking procedures for ensuring that only approved items are ordered and supplied

Distribution.
The lists should specify the maximum amounts of all critical items to be kept in the health facility or hospital ward. Many medical supplies (gloves, catheters, and sutures) come in various sizes and materials. One of the most difficult aspects of stock management of medical supplies is to ensure that the specifications for the items (size, material, pack size) are all correct.

Consumption Monitoring
Regular monitoring of the consumption of medical supplies and equipment is useful to plan for future requirements, allocate supplies, and identify wards and facilities that have higherthanexpected consumption of particular items. Such a simple system can be an important deterrent to the misuse of supplies.

Consumption Monitoring
Consumption monitoring is not necessary for all items. Initially, it can be limited to those items that are most attractive, most prone to misuse, or most valuable. Monitoring reports can be produced quarterly. Each ward or unit should be listed separately.

Consumption Monitoring
Over time, usage indicators can be developed along the lines of those that already exist for drugs. An example of a usage indicator would be: number of rolls of cotton per month per 100 medical admissions. Such an indicator becomes a useful tool for comparing consumption among medical wards and for planning future requirements.

Supplies for Other Services

There are other medical services that need a certain number of "instruments, basic equipment, reagents, chemicals, and spare parts.

Laboratory Services
The extent of laboratory services may vary considerably from one country to another, and this situation has implications for the supply system. In most developing countries, laboratory services exist at the district hospital, and sometimes in facilities at lower levels, for collecting specimens and performing simple analyses. The selection of laboratory equipment, instruments, and supplies should be need driven and based on the range of tests required at each level.

Dental Services
The extent of dental services is often limited in developing countries, due to a lack of dentists and dental technicians. Comprehensive services are available only in dental clinics in the major towns or at the regional hospitals. The equipment and supplies needed for each level of health care should be listed on the basis of the available services.

Family Planning Services

Family planning services in many developing countries are largely donor supported. The donor provides contraceptive supplies and trains local health workers. Unfortunately, in many cases, the donor also decides which methods and brands are to be used. Procurement and distribution of supplies are often carried out separately from the regular governmental system.

Immunization Services
Immunization services are also largely donor supported in some countries. UNICFEF is the main donor of both equipment and services. The extent of cooperation between UNICFEF and the ministry of health may vary, and, as with family planning, the involvement of national staff on the managerial level may be limited.

 There is no reason that supplies and equipment for Laboratory, dental, family planning, and immunization services should not be part of medical supplies in general. However, the responsibility for such supplies may lie with different departments in the ministry of health. To ensure optima! management and a rational supply process, these units should play a consultative role in selecting items and estimating national needs In the same way that nurses and doctors are involved in the selection of drugs and general medical supplies.