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Health Service Physical Infrastructure and Technology in Latin America and the Caribbean In Latin American and the Caribbean, during the1960s and 1970s there was a process of expansion, and modernization of the healthcare facilities infrastructure in the public sector accompanied by a massive incorporation of the latest clinical and hospital technologies. Despite the high investments made by governments, this process was not accompanied with strategies and mechanisms to ensure the uninterrupted and safe operation and maintenance of the facilities.
At the First Meeting of Ministers of Health of the Andean Area held in Lima, Peru in December 1971, It was expressed the need for developing and implementing policies and strategies for guaranteeing the adequate operation and maintenance of the health facilities, protecting the investment made and ensure the provision of health services to the population. At the Third Special Meeting of Ministers of Health of the Americas held in Santiago, Chile, in October 1972, the subject was addressed from a regional perspective. As a result, during the XXI Meeting of the Directing Council of PAHO held in Washington D.C. that same year, resolution CD21.R10 was adopted, which recommended that the Director of PAHO support the countries in the organization and strengthening of national engineering and maintenance programs and Health Technology Management (HTM) strategies.
National centers and programs were organized in several countries like Argentina, Brazil, Colombia, Cuba, Costa Rica, Mexico, Ecuador, El Salvador, Peru and Venezuela, some of them with the support of Pan American Health Organization / American Region of the World Health Organization (PAHO/AMRO) and with United Nations Developing Programs (UNDP) grants. However, these programs were focused only in the Ministry of Health (MoH) hospitals and in some cases with the Social Security healthcare facilities. The countries’ engineering academia and professional societies were not part of this process, resulting in the national centers not being able provide adequate HTM training. The engineers and technicians received equipment maintenance hands-on training, but there was limited management training that would allow them to adjust to ongoing improvements in medical device technology, its complex support requirements and the required managerial skills. In general, national HTM policies were not implemented and resources were not allocated as required to develop and strengthen the programs for planning and management of the physical infrastructure and associated healthcare technology. Due to several factors - the dearth of policies and programs, academia not involved in the education of the professionals and technicians required in these new areas of work, and to shortfalls in budgets allocated - the physical infrastructure and equipment deteriorated at a rapid pace. This process that was also exacerbated by the economic crisis of the 1980s that led to a crisis in public healthcare facilities and drove them to the brink of collapse. During this period, PAHO/AMRO was actively working in several countries and sub regions, like Central America and the Andean Countries, for institutional capacity building on engineering and maintenance. Recognizing that some universities in the Region had been working on biomedical engineering for almost 20 years but with no link to the health sector, PAHO/AMRO started to approach academia to get assistance in HTM training.
Studies conducted in the late 1980s in the hospitals of the MoH and Social Security in Central America and MoH in the Andean Group revealed a severely deteriorated and aging physical infrastructure. As an average, 50% of the clinical and hospital equipment was out of service or not in use. Donations were one of the reasons linked to this figure. Assessments conducted in different countries have shown that this situation was similar, and was continuing to worsen. In summary, during this time period, health technology had been incorporated at a faster rate than the capacity of the health sectors of the countries to adapt their resources and physical infrastructure to ensure their continuous and safe operation and maintenance.
In the 1990s, Health Sector Reform began to highlight the steering role of the MoH in the health sector. Three gaps became clear for MoH leaders - the lack of use of evidence based information for decision making in technology selection, the lack of required medical device regulation, and the economic crisis faced by public hospitals. The National Maintenance Centers owned and operated by governments, started to disappear. Health authorities with the collaboration of PAHO/AMRO began attracting donors to work on HTM projects and seek the collaboration of the ECRI Institute, WHO Collaborating Center on Health Technology to provide information and training on medical devices planning, acquisition and evaluation. In 1991 PAHO/AMRO, in partnership with the American College of Clinical Engineering (ACCE), started a series of Advanced Clinical Engineering (ACEW) and HTM Workshops to build technical capacity, to assist health leaders in addressing the gaps identified, to provide information on the best practices on HTM, to organized Clinical Engineering Departments in Hospitals, to motivate the academic sector to implement necessary undergraduate and graduate programs in Clinical and Biomedical Engineering and to promote the organization of professional societies in biomedical and clinical engineering and their incorporation into the global engineering societies. Currently this activity has expanded worldwide and 32 out of the 42 ACEW have been conducted in the Region of the Americas.
In the 21st PAHO’s Planning and Programming Subcommittee in 1993, the topic of “Hospital Equipment Maintenance” was presented. As a result, the “regional plan for the planning, regulation, and management of the physical and technological infrastructure of health services” was developed. The plan presented a taxonomy, trends in health technology, and articulated different Health Technology components: Health Technology Assessment (HTA); Medical Devices Regulation; Heath Technology Management; Healthcare Facilities Development; Hospital and Clinical Engineering; Maintenance of Medical and Hospital Equipment; and the convergence of Technologies of Information and Communications in the growing Telemedicine and e-Health field. In the 42nd PAHO’s Directing Council, the Resolution CD42.R10 on Medical Devices was adopted and encouraged countries to make it a priority to develop capacity for the regulation of medical devices. In the new millennium, several countries are renovating and modernizing their physical infrastructure and technology. New national centers – such as CENETEC from Mexico, CENGETS from Peru, and the Institute of Biomedical Engineering from Brazil - have been organized to better respond to the countries demand on HTM, HTA, and medical device regulation.
For more than four decades, PAHO/AMRO has accompanied and participated in the evolution of HT and in particular HTM in the region and has served as a repository for the institutional memory of this process. It has also been deeply involved with the countries’ healthcare improvement efforts, by supporting the organization of HTM programs and human resource education. The technical cooperation of PAHO/AMRO has been oriented to collaborate with the Member States in foster National Development and Institutional Capacity Building on Healthcare Technology and Physical Infrastructure. |
