E-drug: Needs of district hospitals (cont'd)
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In response to the discussion on standard equipment schedules we
can add that we have been involved in the compilation of equipment
schedules for hospitals since the early nineties, and it seems as
though there has always been a lack of a standard list of equipment
for district hospitals. Strange, since the concept of district health
services is one of the most defined models in health care.
The references made to the various WHO publications are helpful but
usually only cover a limited part of the total hospital services. The
document "Essential Equipment for a District Hospital" as mentioned
in a previous postings is not that valid anymore since it was only a
draft, and as far as we believe, never finalised. Unfortunately the
document still contains many gaps and for example does not include
the WHO standardised radiology equipment for a district hospital.
Another problem with the present documents is that they only
concentrate on the medical equipment and not on other parts of the
hospital like the laundry, kitchen and medical furniture.
Over the years we have developed several standard lists for district
hospitals in Africa and Asia however these have tended to be adapted
to the local conditions, so have not always been applicable to all
countries. The question is indeed why the concept of the essential
drugs list has never been applied to hospital equipment by
international organisations. In our view, the right approach would be
to define the essential health care package that has to be provided on
any given level and base a standard list on the packages. Only with
this information can suitable sets of instruments and equipment be
defined. This process was undertaken for laboratory services in
Malawi, where standardization of laboratory procedures at district
level resulted in a 50% reduction in the equipment list. Since 1996,
WHO together with the African Medical Research Council (MRC) in
Cape Town have been developing the Essential Healthcare
Technology Package (EHTP), which includes essential equipment as
well http://www.hab2001.sld.cu/arrepdf/00460.pdf. Recently we were
informed that UNICEF in Copenhagen have also started working on a
standard list for district hospitals.
So it would seem that many initiatives have and are being undertaken
but that perhaps these need to be coordinated by a central
organisation, whom, perhaps WHO? We would be most interested to
contribute to any initiatives taken to develop a standard list according
to the "essential drugs" process. If any more information is needed
please contact us by email.
Wim PG Heesbeen
Health Technology Management Advisor
The Netherlands
wim@heesbeen.net
www.heesbeen.net
Val Remedios
Euro Health Group A/S
Denmark
vremedios@ehg.dk
www.ehg.dk
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