Image of several lab technicians sitting at a large desk as one injects fluid into a test tube.

Building a Skilled Health Supply Chain Workforce for Haiti .

September 5, 2018

Haiti acquired in-country expertise needed to address the problem of donated medical and laboratory equipment maintenance, moving one more step closer to self-reliance and sustainability.

The World Health Organization estimates that 80 percent of medical equipment in developing countries is donated. Lack of funding to support recurrent costs, such as salaries for biomedical technicians or training on the use and maintenance of donated equipment, leads to a situation where life-saving medical donations are not utilized to the maximum extent, if not completely wasted.

Often, in under-resourced health facilities around the world, lifesaving laboratory and medical equipment does not serve its purpose, because these facilities do not have the expertise to install, operate, and maintain donated equipment. When international donors deliver new equipment, facilities do not always know how to install it. When the equipment breaks down, health technicians are not trained to troubleshoot. When spare parts are needed for maintenance, few facilities have the resources to procure them. When patients need vital tests and treatment, there are not enough trained specialists to operate sophisticated laboratory and medical machines.

For Haitians seeking medical care and the health workers serving them, such health facilities are not an exception. The devastating 2010 earthquake only worsened the situation, destroying 50 health-care centers as well as the Ministry of Health building. The influx of donated medical and laboratory equipment and supplies overwhelmed the remaining health centers, and an excessive amount of unused equipment — either new or in need of repair — cluttered the facilities. To make the situation even more complicated, staff did not know what kind of equipment (and in what quantities) was available because there was no management information system in place to track the donations.

Haiti’s health supply chain sector needed stronger local capacity to assess, operate, and repair laboratory and medical equipment. USAID’s Global Health Supply Chain (GHSC) – Technical Assistance (TA) Francophone Task Order (TO) took a holistic, data-driven approach to addressing this challenge.

Data for Decision-Making

An important starting point for improving Haiti’s health supply chain was monitoring the availability and condition of existing equipment. Over five months, the GHSC-TA Francophone TO conducted an inventory count and assessed medical and laboratory equipment in 153 sites supported by USAID through the President’s Emergency Plan for AIDS Relief. Project specialists and Ministry of Health biomedical technicians traveled to the most remote health centers on the islands of Hispaniola and Gonâve, collecting data ranging from the equipment’s serial number to its required power supply and functionality status. Through this inventory — the first of its kind in Haiti — thousands of pieces of equipment that were once unaccounted for became documented resources for the Ministry of Health to monitor.

The team recorded 3,640 items of equipment, 87 percent of which was for laboratory use and 13 percent of which was medical equipment. After assessing the equipment, the team found that 75 percent was functional, 17 percent was due for repair, 4 percent was not installed, and 4 percent was due for disposal. The project diligently compiled a list of spare parts needed to conduct repairs and initiated their procurement.

Two biomedical technicians from the Ministry of Health preparing to codify laboratory equipment at a USG-funded site.

With this valuable information, the Ministry of Health is now in a better position to assess available equipment and to estimate future needs.

From Baseline Assessments to Sustainable Management

The results of this comprehensive inventory and assessment marked a key turning point. The Ministry of Health now has up-to-date numbers on the availability of operational equipment. However, a new question arose: who will manage and maintain the equipment?

These two courses that I have participated in so far with the GHSC-TA Francophone TO are a real success! There are a lot of things I did not know at all, especially at the laboratory equipment level. Now I feel much more competent and more motivated than ever.

Ms. Gerda Brizé Delva, Biomedical Technician

The Directorate of Health Services Organization is the technical entity within the Ministry of Health responsible for laboratory and medical equipment. Due to a shortage of trained biomedical technicians who can oversee equipment management and maintenance, Haiti has been relying on representatives of foreign companies to perform these services. Recognizing the need to develop local capacity in routine equipment maintenance, the GHSC-TA Francophone TO developed training modules for laboratory and medical equipment maintenance and conducted theoretical and practical lessons for 21 Ministry of Health biomedical technicians. All participating biomedical technicians were tested pre- and post-training, and the majority demonstrated significant improvement in their knowledge and skills.

Ms. Patricia Rouzier, GHSC-TA Francophone TO specialist, teaching a course on laboratory equipment maintenance to Haitian biomedical technicians.

Gerda Brizé Delva, a biomedical technician from l’Hopital d’Arcachon in Port-au-Prince, is one of the beneficiaries of this activity. “I was really impressed with the training on the maintenance and repair of laboratory equipment. I learned a lot of new things and got to know about some machines that I did not know anything about. It was really rewarding, especially learning about the maintenance and repair of some of the medical equipment in our hospitals. These two courses that I have participated in so far with the GHSC-TA Francophone TO are a real success! There are a lot of things I did not know at all, especially at the laboratory equipment level. Now I feel much more competent and more motivated than ever.”

Ms. Delva and her colleagues from the Ministry of Health will not be leading one-off repairs; instead, they will be part of a sustainable management system responsible for conducting training sessions at the central level and at health centers, installing new equipment, and disposing of obsolete items.

With robust documentation of its laboratory and medical equipment and a clear plan for maintaining the equipment, Haiti’s public health sector is taking great strides toward establishing an effective, organized, and sustainable biomedical maintenance program. This will ensure ongoing delivery of high-quality laboratory and medical services needed to improve the health of Haitian citizens.