title: Assessment of the availability of technology for trauma care in Nepal.
abstract: BACKGROUND
  We sought to assess the availability of technology-related equipment for trauma care in Nepal and to identify factors leading to optimal availability as well as deficiencies. We also sought to identify potential solutions addressing the deficits in terms of health systems management and product development.
  
  
  METHODS
  Thirty-two items for large hospitals and sixteen items for small hospitals related to the technological aspect of trauma care were selected from the World Health Organization's Guidelines for Essential Trauma Care for the current study. Fifty-six small and 29 large hospitals were assessed for availability of these items in the study area. Site visits included direct inspection and interviews with administrative, clinical, and bioengineering staff.
  
  
  RESULTS
  Deficiencies of many specific items were noted, including many that were inexpensive and which could have been easily supplied. Shortage of electricity was identified as a major infrastructural deficiency present in all parts of the country. Deficiencies of pulse oximetry and ventilators were observed in most hospitals, attributed in most part to frequent breakdowns and long downtimes because of lack of vendor-based service contracts or in-house maintenance staff. Sub-optimal oxygen supply was identified as a major and frequent deficiency contributing to disruption of services. All equipment was imported except for a small percent of suction machines and haemoglobinometers.
  
  
  CONCLUSIONS
  The study identified a range of items which were deficient and whose availability could be improved cost-effectively and sustainably by better planning and organisation. The electricity deficit has been dealt with successfully in a few hospitals via direct feeder lines and installation of solar panels; wider implementation of these methods would help solve a large portion of the technological deficiencies. From a health systems management view-point, strengthening procurement and stocking of low cost items especially in remote parts of the country is needed. From a product development view-point, there is a need for robust pulse-oximeters and ventilators that are lower cost and which have longer durability and less need for repairs. Increasing capabilities for local manufacture is another potential method to increase availability of a range of equipment and spare parts.
authors.affiliation: Academy of Traumatology (India), Ahmedabad, India; Smt NHL Municipal Medical College, Ahmedabad, India. Electronic address: mihir.28290@gmail.com.
authors.forename: Mihir Tejanshu
authors.initials: MT
authors.lastname: Shah
authors.affiliation: B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Suraj
authors.initials: S
authors.lastname: Bhattarai
authors.affiliation: Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: Norman
authors.initials: N
authors.lastname: Lamichhane
authors.affiliation: Smt NHL Municipal Medical College, Ahmedabad, India.
authors.forename: Arpita
authors.initials: A
authors.lastname: Joshi
authors.affiliation: PATH, Seattle, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: LaBarre
authors.affiliation: Academy of Traumatology (India), Ahmedabad, India.
authors.forename: Manjul
authors.initials: M
authors.lastname: Joshipura
authors.affiliation: Department of Surgery, University of Washington, Seattle, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
mesh_terms: D003362:Cost-Benefit Analysis; D004865:Equipment and Supplies, Hospital / Q000600:supply & distribution*; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D009390:Nepal; D011204:Poverty Areas; D017410:Practice Guidelines as Topic; D011634:Public Health; D014193:Trauma Centers / Q000706:statistics & numerical data*; D012122:Ventilators, Mechanical / Q000600:supply & distribution; D014944:World Health Organization; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: Essential trauma care; Essential-surgery; Healthcare equipment; Low income country; Nepal; South east Asia healthcare; Trauma care; Trauma technology