Clinical engineering support is critical in ensuring the hospital equipment work as required.

1. BIOMEDICAL ENGINEERING
CAPACITY BUILDING IN THE
REPUBLIC OF PALAU
Nehal Kapadia,
SSCSiP Biomedical Engineering Coordinator, CMNHS, Fiji National University, Suva, FIJI
Alben Adelbai,
Belau National Hospital, Koror, 96940 Republic of Palau
Sanjeev Hiremath,
Australian Volunteers International, Fitzroy VIC 3065 Australia

2. REPUBLIC OF PALAU
• Republic of Palau is a remote island nation in the northern Pacific.
Population of 20,000 served by - Public Health Bureau and Belau National Hospital
• One major hospital many health centers around the islands.
• Belau National Hospital
• 100 Bedded hospital with
• 2-operating rooms,
• Radiology with CT Scanner, Mammography,
• Renal Dialysis, Orthopedics and Behavioral health
• Tele-radiology and Tele-ophthalmology facilities,
• Maternity and Neonatal care facilities

3. BIOMEDICAL ENGINEERING
SITUATION
As of April 2013, the Ministry of Health had following biomedical engineering
capacity:
• One workshop at Belau National Hospital with minimum test equipment and tools
• 3 Biomedical Engineering technicians and 1 Medical Equipment Specialist
• They catered for about 1000 pieces of medical equipment mostly situated in the
national hospital and few in the health centers
• Very little formal training and continuing professional development available

4. SITUATIONAL ANALYSIS
• A situational analysis was carried out in the Pacific Island Countries by
AusAID supported biomedical engineers.
• The method used involved obtaining responses to a questionnaire designed
by the biomedical engineers from the host country hospital staff.
• The results were compiled by collating the scored responses and tabulating
them country-wise.
• The questions were designed to minimize the effects of population variation

5. Results from Questionnaire on Biomedical Services for Pacific
situational analysis
Number Question Palau Score Regional maximum score (best or worst indicator)
3.1 Preventive maintenance 0 3
3.2 Safety & function checks 0 4
3.3 Safety checks after repair 1 4
3.4 Check due date marked 0 4
3.5 Work documentation 4 4
3.6 Documentation
manual/PC 2 4
3.7 Equipment details on
delivery 3 4
3.8 Equipment Inventory
number 794 11000
3.9 Eqpt. Inventory Value $US 3 million 88 million
3.10 Waiting Fault Diagnosis
today 1 18
3.11 Waiting spare parts today 10 117
3.12 Waiting disposal today 10 54
3.13 Service manuals available 2 4
3.14 Specialised test eqpt 1 4
Weighted Total Score
(maximum 98) 32 75

6. PACTAM – BIOMEDICAL ENGINEERING ASSITANCE
Australian overseas aid program – PACTAM
The Pacific Technical Assistance Mechanism (PACTAM) provides
skilled international deployees to work with Pacific Island nations.
PACTAM deployees:
• Offer experience that may not be available locally
• Help you respond to unexpected or emerging issues
• Develop the skills and capacity of your current staff team
• Work with you in a respectful and culturally appropriate manner

7. PACTAM Biomedical Engineer deployment
to the Republic of Palau (2013-15)
Australian Volunteers International (AVI) managed deployment began in
April 2013.
This 24 months deployment is planned to be aligned to local needs of the
host country.
Follows Lean Six Sigma (LSS) methodology in capacity building:
The LSS based ‘5 – S’ steps follow:
1. Sort
2. Set-up
3. Shine
4. Standardize
5. Sustain

8. SORT
This is the first step of aligning the elements of the existing
system so as to reduce the wasteful activities and processes.
TIMWOOD – 7 cardinal forms of ‘Waste’ in business processes:
T – Transport
I – Inventory
M- Motion
W – Waiting
O – Over-processing
O – Over production
D – Defective work

9. Transportation of spare-parts, workers and
equipment for repairs/maintenance in the
region is extremely time consuming and
wasteful.
KEY: MINIMIZE THE POTENTIAL TRANSPORT
This was addressed by rationalizing the
equipment inventory and work-schedules so
that maximum utilization of workers time and
minimum down time were achieved.
UNNECSSARY TRANSPORTATION REMOVED

10. Inventory management
Poor Inventory Management is the single most costly cause of
biomedical equipment unavailability in the hospitals.
It is compounded by the fact that good hospital inventory
management systems are unaffordable for many small hospitals.
KEY : WHO PAYS and WHO CARES???
All the processes and systems used for managing the inventory in the
hospital including equipment procurement, maintenance and
disposal were reviewed by the biomedical engineer with the senior
management.
A simplified and direct system of responsible inventory management
system is being evolved.

11. PALAU:
Current Scores on the same scale
Number Question Palau Score
3.1 Preventive maintenance 2
3.2 Safety & function checks 3
3.3 Safety checks after repair 3
3.4 Check due date marked 2
3.5 Work documentation 4
3.6 Documentation manual/PC 3
3.7 Equipment details on delivery 3
3.8 Equipment Inventory number 893
3.9 Eqpt. Inventory Value $US 3 million
3.10 Waiting Fault Diagnosis today 3
3.11 Waiting spare parts today 4
3.12 Waiting disposal today 1
3.13 Service manuals available 4
3.14 Specialised test equipment. 4
Weighted Total Score (maximum 98) 78

12. We are getting there….
…………………… Thank you.