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Purpose: This study measures the impact of implementation of the Improved Decentralized Maintenance Model on the functionality and availability of medical equipment in Burundi's resource constrained health care system with hypothesis that the model has a measurable impact. Methods: The initial model was tested in 2 provinces before being improved and extended to the provinces of Bujumbura and Rumonge. It is composed by 4 interrelated main axes (Maintenance management, Human, Financial and Material resources,). This study analyses the effects of this implementation between October 2020 and February 2022. Results: The rate of medical equipment functional in service has increased substantially, respectively +8% in the province of Bujumbura and 2% in the province of Rumonge, and the rate of medical equipment requiring maintenance has fallen by 9.7% (Bujumbura) and 2% (Rumonge). The provinces implementing the model have convincing results in terms of functionality with scores of at least 80%, while the national average is 64%. Conclusions: There is a notable positive change between 2020 and 2022 in the functionality of medical equipment and a decrease in equipment awaiting maintenance, and therefore in its availability. This study proves that a sustainable implementation of a decentralized maintenance model is feasible and highly useful in low-resource settings due to its affordability. The context of a low-resource country is a challenge in itself, but the model developed shows that by tackling the low-resource levels of preventive maintenance, we can have some impact on the functionality of the equipment and therefore on the quality of care. [ABSTRACT FROM AUTHOR]

This study documents the setup and roll-out of a Computerized Maintenance Management System (CMMS) in Burundi's resource constrained health care system between 1/04/2017 and 31/03/2020. First, in 2017 a biomedical assets ontology was created, tailored to the local health system and progressively mapped on international GMDN (Global Medical Devices Nomenclature) and ICMD (International Classification and Nomenclature of Medical Devices) classifications. This ontology was the cornerstone of a web-based CMMS, deployed in the Kirundo and Muramvya provinces (6 health districts, 4 hospitals and 73 health centers). During the study period, the total number of biomedical maintenance interventions increased from 4 to 350 per month, average corrective maintenance delays were reduced from 106 to 26 days and the proportion of functional medical assets grew from 88 to 91%. This study proves that a sustainable implementation of a CMMS is feasible and highly useful in low resource settings, if (i) the implementation is done in a conducive technical environment with correct workshops and maintenance equipment, (ii) the active cooperation of the administrative authorities is ensured, (iii) sufficient training efforts are made, (iv) necessary hardware and internet connectivity is available and (v) adequate local technical support can be provided. [ABSTRACT FROM AUTHOR]