Healthcare Facilites and Medical Equipment whole of Life Cost Modeling Tool supporting policy makers - eswatini case

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Claudio Meirovich Montrull
Meirovich Consulting SL, Madrid, Spain
Healthcare Facilities and Medical Equipment
Whole-of-Life Cost Modelling Tool
supporting policy makers - a Swaziland
experience

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The Kingdom of eSwatini

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In case you need to leave…
0
1,000
2,000
3,000
4,000
5,000
6,000
Year 0 Year 1 Year 2 Year 3 Year 4 Year 5
THOUSANDS
Option 2 (Inhouse) Option 3 (Mix)
Option 4 (Outsourced) Option 5 (PPP)

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Maintenance Cost Centers
Buildings
Equipment
Infrastructure MEP + ICT

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Maintenance Cost Centers
Equipment
Infrastructure MEP + ICT

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Maintenance Cost Main Questions
?
or ?

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Maintenance Cost Calculation Options
% of
+
+ + +

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What do we need to know?
Value of Assets
Detailed Inventory of Assets
Type of works
required
Skills required
Training needed
Materials
Spare Parts
Qty
Purchase price
Date of Purchase
Condition of
Assets

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What to do if we don’t have the procurement cost?
Use of Ratios
• $/m2
• $/bed
• Building Cost Comp
• Typical Eq PM frecs
• Avg Spare Parts Prices
• Avg Work Efficiency
• others
Use prev exp

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Options for Maintenance of Healthcare
Infrastructure and Equipment in the Kingdom of eSwatini
(PPP)

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Static Financial Analysis vs. Cashflows Analysis
% ≃ ∑!
"
𝑎"
≃

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Situation Analysis:
Infrastructure and Equipment Challenges
No specialized staff for
building maintenance
No Inventories for
Facilities
No renovation
in buildings
No clear budget
facility maintenance
Budget Equipment
Maintenance
2.3 million USD
1 biomedical engineer
20 biomedical technicians
8 artisans
>50% equipment
condemned / bad
Equipment Value:20 million USD
No Policies
185.000 m2
117 facilities

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Variables and Parameters:
Number and Type (level) of Healthcare facilities

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Variables and Parameters:
Other Variables

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Results obtained with our tool
Comparison Table Between Options
Source: Meirovich Consulting

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0
1,000
2,000
3,000
4,000
5,000
6,000
Year 0 Year 1 Year 2 Year 3 Year 4 Year 5
THOUSANDS
Option 2 (Inhouse) Option 3 (Mix)
Option 4 (Outsourced) Option 5 (PPP)
Five years total cost comparison for
different maintenance options
Source: Author’s own Analysis
Total 5-years cost comparison (USD)

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Preliminary Conclusions
• The tool allowed to compare the cash flows required to do maintenance
over a period of five years including infrastructure and equipment.
• While the static analysis would not allow a clear understanding of the
differences between different implementation approached our tools
makes it evident
• The cheapest option was in our case to do full in-house maintenance
while the most expensive one is the PPP.
• Our results ONLY apply to the initial hypothesis considered for OUR case.
Different results may be obtained with different starting conditions

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Final Conclusion
• The use of simulation tools allow a better understanding on the real
costs underlying the maintenance of any healthcare facility
• Today, developing or implementing a simulation tool is at everybody’s
hands, and therefore simulation tools like the one presented today
should be considered mandatory before deciding any major investment
plan.

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Claudio Meirovich Montrull
Meirovich Consulting SL, Madrid, Spain
claudio@meirovichconsulting.com
+34 675973332
Healthcare Facilities and Medical Equipment Whole-
of-Life Cost Modelling Tool supporting policy makers -
a Swaziland experience
You may contact me for any comments or questions you may have
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