The number of BioMed working in each of the 10 medical equipment maintenance workshops varied in numbers, level of education and qualification. The access to maintenance service provided to health facilities from each maintenance workshops were variables obtained as high as 87 and as low as one, with 27 health facilities on average. Twenty-five percent of the activities asked about the preventive maintenance (PM) and 40% on the corrective maintenance (CM) activities were practiced in the regional maintenance workshops. Thirteen percent of the questions related to the training activities were practiced in the maintenance workshops. The management structure of the maintenance workshops was varying, and they lacked basic materials and a budget to provide training and maintenance services.
Number of BioMed
Each of the 10 medical equipment maintenance workshops had a different number of BioMed staff members working there, as well as different educational backgrounds, certifications, and employers. Six biomedical technicians and three biomedical engineers, two biomedical engineers and seven biomedical technicians, one biomedical engineer and two biomedical technicians, two biomedical engineers and two biomedical technicians, and one biomedical engineer and three biomedical technicians, respectively, are employed by the hospitals and the regional health bureau in Dire-Dawa, Harari, Gambela, Nekemte, and Assosa maintenance workshops. Five biomedical engineers and one biomedical technician, one biomedical engineer and two biomedical technicians, and three biomedical engineers and two biomedical technicians, respectively, are employed by the hospitals' maintenance workshops in Adama, Debrebrihan, and Yirgalem. The Samara and Jijiga maintenance workshops have one biomedical engineer & two biomedical technicians, one biomedical engineer & one biomedical technician respectively, were all employed by regional health bureaus (Fig. 1).
Service coverage
The number of health facilities receiving maintenance services from each maintenance workshop was higher up to 87 and as low to 1 with 27 health facilities in average. Dire-Dawa, Samara, Assosa, Jijiga, Harar, Gambela and Nekemte maintenance workshops served some health facilities in their regions as shown in Fig. 2. Adama, Debrebrihan and Yirgalem maintenance workshops serve Adama, Debrebrihan Yirgalem hospitals, respectively. Yirgalem maintenance workshop tends to support some health facilities around the workshop, but it is not taken as its routine activities because all the BioMed were the employ of the Yirgalem hospital. Samara maintenance workshop assume to serve all health facilities in the Afar region and Nekemte maintenance workshop also assume to serve the health facilities in the zone but, the service was not provided as needed due to limitation in manpower and allocated resources. Currently, a total of 41 regional hospitals and 232 health centers which serve about 10.25 million population are getting medical equipment management service from these regional maintenance workshops.
Preventive Maintenance (PM)
Each maintenance workshop was assessed for four PM-related questions. Only five (50%) responded that SOP on practice of formal periodic equipment cleaning, and inspection system to identify potential problems on equipment before malfunctions. Three (30%) reviewed their PM procedure when frequent breakdown occurs to adjusted as necessary to prevent the problem from reoccurring. One (10%) reviewed and updated their preventive maintenance procedures when equipment or practices changed, and they have a measurement in place to monitor the performance and the results of the preventive maintenance process (Fig. 3).
This increases equipment downtime, and the maintenance cost of medical equipment as preventive maintenance can reduce the cost of repairs by 45 to 50 percent [11].
Corrective maintenance
Three (30%) of the maintenance workshops support the concept of planned and scheduled maintenance as the most efficient, effective way of performing maintenance and involves all BioMed working in the workshop in planning, scheduling, and coordinating of maintenance work. Four (40%) of the maintenance workshop have a work order system in place to allow effective management of maintenance, use the previous routine maintenance work orders document as an information source and have standard procedures for planning routine maintenance work. Only one (10%) has a plan for more than 80% of non-emergency work orders and nine (90%) have documentation, spare parts lists, manuals, drawings, etc. readily available, and used for the maintenance activities (Fig. 4).
Although all the maintenance workshops were performing medical equipment corrective maintenance (CM), they were lacking in practicing work ordering and scheduling of non-emergency maintenance activities. Overall, only 40% of the issues asked for CM activities were practiced in the regional maintenance workshops.
Training
One (10%) of the maintenance workshop has a list of training needed by operators, mechanisms to regularly provide maintenance training for the end users, maintenance skills taught to operators and maintenance personnel and system to transfer knowledge and skill for the newly recruited BioMed. None of the maintenance workshops has a formal list of maintenance training required for maintenance personnel or BioMed and a participatory skill requirement reviewing system. Three (30%) of the maintenance workshops were adopted and reviewed a standard operator procedure to be followed during maintenance activities and two (20%) have operational skills training for the maintenance personnel and operators which were implemented (Fig. 5).
Totally 13.3% of the questions related to the training activities were practiced in the regional maintenance workshops.
Management structure
A different management structure was observed among the maintenance workshops, some are organized with the hospital management, and the others are with regional and zonal health bureau. Adama ,Debrebrihan and Yirgalem medical equipment maintenance workshops are organized under the hospital management. Dire-Dawa, Harari,Gambela, Nekemte and Assosa maintenance workshops are used both by hospitals and regional health bureaus. Samara and Jijiga maintenance workshops are organized under the regional health bureau.
Materials availability
It was observed that the maintenance workshops were lacking in maintenance workbenches, electrical maintenance toolkits, refrigeration maintenance toolkits and office furniture which are important for the maintenance and training activities. In addition, some maintenance workshops, particularly those found in warm areas, need air conditioners.