title: Assessment of the availability of technology for trauma care in India.
abstract: BACKGROUND
  We sought to assess the status of availability of technology for trauma care in a state in India and to identify factors contributing to both adequate levels of availability and to deficiencies. We also sought to identify potential solutions to deficiencies in terms of health system management and product development.
  
  
  METHODS
  Thirty-two technology-related items were selected from the World Health Organization's Guidelines for Essential Trauma Care. The status of these items was assessed at 43 small and large hospitals in Gujarat State. Site visits utilized direct inspection and interviews with administrative, clinical, and bioengineering staff.
  
  
  RESULTS
  Many specific individual items could be better supplied, including many that were very low cost (e.g., chest tubes). Many deficiencies arose because of mismatch of resources, such as availability of equipment in the absence of personnel trained to use it. Several locally manufactured items were fairly well supplied: pulse oximetry, image intensification, and X-ray machines. Ventilators were often deficient because of inadequate numbers of units and frequent breakdowns.
  
  
  CONCLUSIONS
  Availability of a range of lower-cost items could be improved by better organization and planning, such as: better procurement and stock management; eliminating mismatch of resources, including optimizing training for use of existing resources; and by strengthening service contracts and in-house repair capabilities. From a product development viewpoint, there is a need for lower cost, more durable, and easier to repair ventilators. Promoting increased capacity for local manufacturing should also be considered as a potential method to decrease cost and increase availability of a range of equipment.
authors.affiliation: Smt. NHL Municipal Medical College, Ahmedabad, India, mihir.28290@gmail.com.
authors.forename: Mihir Tejanshu
authors.initials: MT
authors.lastname: Shah
authors.forename: Manjul
authors.initials: M
authors.lastname: Joshipura
authors.forename: Jered
authors.initials: J
authors.lastname: Singleton
authors.forename: Paul
authors.initials: P
authors.lastname: LaBarre
authors.forename: Hem
authors.initials: H
authors.lastname: Desai
authors.forename: Eliza
authors.initials: E
authors.lastname: Sharma
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
mesh_terms: D003151:Community Health Centers; D019049:Developed Countries; D004865:Equipment and Supplies, Hospital / Q000600:supply & distribution*; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008283:Maintenance; D010092:Oximetry / Q000295:instrumentation; D010564:Personnel, Hospital / Q000193:education; D011204:Poverty Areas; D017410:Practice Guidelines as Topic; D011859:Radiography / Q000295:instrumentation; D062606:Tertiary Care Centers; D012122:Ventilators, Mechanical / Q000600:supply & distribution; D000078329:Workforce; D014944:World Health Organization; D014947:Wounds and Injuries / Q000628:therapy*