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 hemoglobinometers.
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 organization. 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 pulseoximeters
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.