Professional Documents
Culture Documents
(1) Current conditions of CMSD (Central Medical Stores Depot)and maintenance support in the
hospital
So far the role of each party for medical equipment maintenance is not clear and end-users such as
Physicians, nurses and co-medicals have to maintain medical equipment and they check the
equipment daily before using it and confirm if they can use the equipment safely. In addition they
manage the replacement parts and consumables such as a breathing circuit for ventilator or infusion
set. In regard to the malfunction with medical equipment CMSD or local agent was asked to repair
it through Medical Superintendent (hereinafter referred to as MS) if malfunction occurs. There is
no Annual Maintenance Contract concluded between the hospital and local agent. Hospital
administrative officers well recognize the importance of maintenance contract for the medical
equipment which requires the advanced maintenance, however it seems that they do not have
enough knowledge about how to decide the scope of services and requirements.
According to the information obtained in July 2016 three new engineers (civil engineer, electrical
engineer and hydro engineer) have been assigned to MgGH from Ministry of Health and Sports and
they are working in full-time and supposed to be in charge of maintenance of the facility and medical
equipment. However they do not have enough experience, as they just graduated from engineering
university.
There are 6 staffs working in CMSD among them chief engineer, assistant engineer and electrical
engineers. In Myanmar CMSD was playing key role in medical equipment maintenance. Before
2012 there was only equipment easy to handle even in top referral hospitals. Thus, technical level
of CMSD was not so high and they could only cope with not so serious malfunction with essential
equipment, such as oxygen concentrator, oxygen central piping, high pressure steam sterilizer and
suction machine. Furthermore there was no management tool for medical equipment, they could act
only after they received request to repair from the hospital.
Ministry of Health and Sports is procuring medical equipment on a large scale since 2012 and
MRI or CT scanner has been introduced to state level hospitals including MgGH. The manufacturers
of these kinds of advanced medical equipment allow only engineers who was trained by
manufacturers themselves (hereinafter referred to “qualified engineer”) to provide maintenance
services such as periodical check or repair according to PL law(Product Liability law)in the country
where head quarter of the manufacturer exists. Engineers from CMSD are not qualified, so they
cannot cope with serious problems and cannot conduct periodical check.
CMSD, as a medical service department managing and providing comprehensive service of
procurement and maintenance, is required to enhance the ability of integrated management of each
equipment status (working or not working) and plan the replacement of the equipment in which
many cases of malfunction occurs and whose repair cost is high in accordance with people
concerned in the hospital so that the equipment can be used in good condition for long time. They
are also required to provide preventive maintenance services more actively even from a distance
based on the procured equipment management database. Furthermore hospital administrative
officers need to learn more about the scope and requirements of Annual Maintenance Contract in
order to conclude it in proper manner.
3 Medical equipment maintenance contract will be engaged between hospital and local agent after
applying necessary budget to Ministry of Health and Sports. There are two kinds of contract. One
is Comprehensive Maintenance Contract includes cost of spare parts, and another is Annual
Maintenance Contract including only repair service.
Medical staffs in MgGH have enough experience to operate and utilize the existing equipment and
enough clinical experience in using each equipment.
Therefore they can operate the equipment very well, however they do not well understand the
preventive maintenance to find out the malfunction of the equipment due to aging through daily
check and to take necessary preventive measures. In the Wards of each clinical department,
Operation Theater Complex and Delivery Unit medical staffs check the equipment by appearance
daily, however they do not have a regular maintenance check sheet to record the status. Thus, the
method of check and the items to be checked are different from staff to staff and it cannot be said
that they check the equipment in a standardized way. Moreover they inform next shift staff of the
status of the equipment only verbally that makes it difficult to share the information exactly. There
is no periodical check support by the qualified engineers from the local agent, so preventive
maintenance services are not provided well and necessary parts are not replaced periodically.
The initial operation guidance for the equipment provided under the grant aid project will be
conducted by the supplier or the manufacturer. However the duration of the guidance is only for 20
to 60 minutes and main contents of the guidance is about its operation, so it is difficult for every
end-users to learn the method of daily check and trouble-shooting in detail. It is important to support
further the preventive maintenance activity such as daily check and trouble-shooting that is not
covered by the initial operation guidance so that the supplied equipment can be used in good
condition for long time.
① It takes time to get to know about the malfunction of each equipment, as CMSD and hospital
administrative officers (MS or Deputy MS) do not manage the status of equipment.
② Annual Maintenance Contract is not concluded as CMSD in charge of maintenance do not
have enough knowledge to conclude the contract and as the budget for the contract is not
ensured in the hospital, which leads to interruption of medical services due to equipment
malfunction.
③ Preventive maintenance such as daily check or periodical check is not conducted in a regular
way, which makes the malfunction of the equipment worse and the life time of the equipment
shorter.
Expected attendees are hospital administrative officers (MS or Deputy MS), end-users of provided
equipment (physicians, nurses, co-medicals) the person in charge of medical equipment maintenance
and his maintenance team. Engineers from CMSD, who are in charge of medical equipment
maintenance in MgGH, are also expected to join the Program .The program will be held in MgGH
The plan of implementation is shown in Table 2. The photos and movies of the practical training of
the program held in MgGH will be taken and shoot and they will be presented to staffs in CMSD head
office so the contents of the program can be ingrained for them as a technical knowledge.
○ ○
The frequency and contents
of periodical check for each
equipment
Currently CMSD is in charge of procurement and delivery of medical equipment for each medical
facility. CMSD procures replacement parts and consumables together with main unit of the equipment,
however they do not know how many replacement parts and consumables are used and how many of
them are left as a stock. This situation causes the each hospital not to be able to plan their procurement
in proper manner. CMSD has to inform each hospital of the price and supplier of replacement parts or
consumables so that each hospital can plan the budget for them. CMSD is expected to understand the
process of equipment maintenance, develop the maintenance system and well manage it, so the
training shown above in Table-2 item 3.3 and 3.4 is critically important for CMSD.
Local medical staffs do not communicate in English well except physicians, thus the interpreter
from English to Burmese will be employed in order to enhance their understanding.
7. Implementation Plan of Soft Component (Technical Assistance) Program
It takes 13.7 months to complete whole Soft Component Program including preparation.
1st Session
Preparation Report
14 Mobidity and Morality data by department Soft Copy Magway General Hospital
Pump Well TW No.1 Pumping Started 6:00 AM Project Ground Water Survey
Well Diameter 6" Duration for Q 6 seconds Location Magway General Hospital,Magway
Drilled Depth 250 feet Discharge Rate 13638.27 L/h (or) 327.27 m3/d Performed by Zaw Min Than
Screen Depth 40' Pump Type (Submersible Pump) Date 9.04.16
Static Water Level 13.07 m Pumping Stopped 8:00 AM
Top of Casing 2 inch Tank 5 gallon
Pumped Well
Form Pumping For Recovery
Time since Depth to water level from Time since Depth to water level from Depth to water level from
Time since
pump started t,(min) reference point (m) pump started t,(min) reference point (m) reference point (m)
pump stopped t,(min)
0 13.07 0 16.57
1 14.37 1 15.11
2 15.52 2 13.99
3 15 8
15.8 3 13 35
13.35
4 15.83 4 13.27
5 16.08 6 13.2
10 16.4 8 13.16
15 16.55 10 13.11
20 16.57 15 13.11
25 16.57 20 13.1
30 16.57 25 13.1
35 16.57 30 13.09
40 16.57 40 13.09
50 16.57 50 13.09
60 16.57 60 13.09
80 16.57 80 13.08
100 16.57 100 13.07
120 16.57 120 13.07
150 150
180 180
210 210
240 240
270 270
300 300
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7-3-1 Groundwater Survey for Magway General Hospital
7-3-1 Groundwater Survey for Magway General Hospital
7-3-1 Groundwater Survey for Magway General Hospital
7-3-1 Groundwater Survey for Magway General Hospital
7-4 EQUIPMENT LIST FOR MAGWAY GENERAL HOSPITAL
No. of Equipment
Operation Theater
Gynecology Ward
Sterilization Unit
Obstetrics Ward
Emergency Unit
(Existing bldg.)
Neonatal Unit
Delivery Unit
Laboratory
ID
Total No.
Complex
Name
ICU
No.
6 Ceiling lamp A 1 1
8 Central Monitor 3 1 1 1
9 CPAP unit 4 4
11 Defibrillator 4 1 1 1 1
12 Delivery bed 4 4
13 Diagnostic set 15 3 2 10
14 ECG machine 4 2 2
15 Electrosurgical unit 3 3
16 ELISA machine 1 1
17 Emergency trolley 5 2 1 2
18 Examination bed 2 2
19 Examination lamp 5 3 2
20 Fetal Doppler 3 1 2
24 ICU bed 4 4
25 Infant incubator 6 6
26 Infant warmer 6 6
27 Infusion pump 36 4 8 3 18 3
28 Infusion stand 43 3 36 4
29 Instrument cabinet 6 3 2 1
30 Instrument cart 6 2 4
31 Instrument trolley 3 3
32 Labor bed 6 6
34 Linen cart 3 3
No. of Equipment
Operation Theater
Gynecology Ward
Sterilization Unit
Obstetrics Ward
Emergency Unit
(Existing bldg.)
Neonatal Unit
Delivery Unit
Laboratory
ID
Total No.
Complex
Name
ICU
No.
36 Medicine cabinet 3 1 1 1
37 Medicine rack 1 1
38 Medicine trolley 2 2
41 Operation table A 2 2
42 Operation table B 1 1
43 Oxygen concentrator 2 1 1
46 Patient monitor A 32 11 4 5 10 2
47 Patient monitor B 1 1
48 Patient monitor C 4 4
49 Pharmaceutical refrigerator 4 1 3
52 Recovery bed 15 7 3 5
53 Stretcher 7 6 1
54 Suction machine 29 3 2 3 18 3
55 Syringe pump 17 4 10 3
57 Ultrasonic nebulizer 3 3
58 Ultrasound scanner 1 1
60 Vein finder 3 3
61 Ventilator 5 1 4
62 Wheel chair 4 1 2 1
63 UPS (1.0kVA) 3 1 1 1
64 UPS (2.0KVA) 2 1 1