Chapter YY: Infrastructure and asset Management

February 2024
Outline of presentation

• Objective
• Introduction
• Operational standards
• Implementation guidance
• Summery
 Objectives

 By the end of this session the participants will be able

to :-
 To describe the hospital’s infrastructure and asset
management operational standards

 To address the hospital’s infrastructure and asset

management implementation guidance

 To signpost hospital infrastructure and asset management

indicators and monitoring tools
 1. Introduction

 FAM is a systematic approach to the governance & realization of

all values for which a group or entity is responsible.

 FAM is applied to both tangible and to intangible assets to

achieved the most cost-effective Assets management.

 Tangible assets management includes (physical objects such as complex

processes or manufacturing plants, infrastructure, buildings, or equipment)

 Intangible assets management includes intellectual property and goodwill

such as a systematic process of developing, operating, maintaining,
upgrading, and disposing of assets in the most cost-effective manner
 1. Introduction … (2)

 Adequate FAM has several advantages such as:

 Improving patient care and safety;

 Allowing staff to quickly and and increase staff efficiency;

 Safety disposes of medical waste,

 Create efficient use of physical space, organization and

storage.

 oversee cleaning, transportation, landscape gardening &

security service,
 2. Operational standards
1. The hospital has a functional Basic Service and Asset Management
Executive office to plan, execute, coordinate, and monitor hospital
infrastructure and Asset Management activities.

2. The hospital complies with relevant laws, regulations, Guidelines,

SOPs

3. The hospital grounds are regularly inspected maintained, for their basic
services and ensured cleanliness for safety of patients, visitors & staff.

4. The hospital has included its infrastructure, asset procurement, and

maintenance plan in its long-term and annual plans
 2. Operational standards… (2)
5. The hospital has a maintenance workshop with technical
personnel, sufficient space, and adequate ventilation.

6. The hospital has a transport policy for using and accessing

hospital vehicles.

7. The hospital has a safety and security policy.

8. The hospital has a plan for responding to likely incidences in

the hospital and other disasters.
 2. Operational standards… (3)

9. The hospital stock management system is in place, and

disposal is done in compliance with the relevant laws and
guidelines.

10. The hospital conducts an annual inventory.

11. The hospital has allocated a budget for procuring and

maintaining medical and non-medical devices, buildings,
vehicles &utilities from retained revenue.
 3. Implementation guidance

3.1. Organization of Hospital Infrastructure and Asset

Management Services

 Each hospital should have a fictional Basic Services and Asset

Management Executive office.

 The executive office should have assigned full-time workers.

 The Basic Services and Asset Management Executive office is responsible

for hospital infrastructure and assets facilities

 The hospital must have an asset management policy and strategy

 The hospital should employ evidence-based planning and budgeting for

facilities and assets facilities.
 3. Implementation guidance … (2)
3.1.2. hospital Buildings layout
 The buildings are the most fundamental component of a any hospitals,

 Hospital building layout and design are significantly contributed to the

smooth operation of patient services.

 The purpose building layout is to minimize the travel distance between care
teams/units and allow patients to be easily visible to staff.

 The hospital should be organized in a manner that services are easily

accessible and located nearby to the Emergency, OPD and central triages.
 3. Implementation guidance … (3)

3.1.3. Hospital site map

 The hospital map should be displayed at all entry points to
provide straightforward, easy navigation for patients, visitors and
guests.

 All hospital buildings should be clearly labeled,

 Arrow Signs should be used to guide patients or visitors to each

hospital service areas.
 3. Implementation guidance … (4)
3.1.4. Building maintenance
 Buildings should be well-maintained to prolong their lifespan and minimize
the need for expensive repairs.

 Inspections of buildings should be conducted regularly to ensure that

facilities are in good condition by certified and skilled professional staff
(masons, painters, carpenters, etc.)

 The facility management staff should access to appropriate tools, equipment,

and machinery.

 Preventive maintenance & repairs should be undertaken whenever necessary.

 The hospital should ensure reasonable stocks for building maintenance

materials with adequate budget allocation.
 3. Implementation guidance … (5)
 A construction plan and civil engineering drawings, should be
available and be updated whenever modified.

 The hospital should have a maintenance workshop with skilled

personnel and essential equipment.

 A hospital could have library with adequate reference materials.

 The maintenance team should have a tool inventory, either paper-

based or computerized,

 Tool usage should be monitored by keeping a tool ledger in which

each item is 'signed out' and 'signed in' when used by a technician.
 3. Implementation guidance … (6)

 Damage fault reporting and work orders procedures should be

in place, for staff, patients, or visitors.
 The work request should be submitted in written form to
enable tracking of service requests.
 To accommodate changes in services or patient load, it may
need to undertake significant renovation, construct new
buildings, and/or redesign the layout of the hospital.
 New constructions must be carefully planned and performed
by dedicated committee, with various backgrounds members.
 3. Implementation guidance … (7)
3.1.3. Landscape and Garden
 Patient and community and staff satisfaction can be
enhanced by clean, safe and pleasant hospital grounds.

 Buildings should be linked by covered and paved

walkways.

 Recreation areas should be established, including areas for

sitting and for walking.

 Grounds keeping staff should have access to all necessary

tools, equipment, and machinery
 3. Implementation guidance … (8)
3.2. Asset Management
 The hospital should establish a robust Asset Management (AM) system

 Assets management should ensure the availability, efficient use, and

replacement of asset sets.

 Assets Procurement must comply with the country's public procurement law.

 The hospital should establish a database for fixed assets that details the
history of the asset sets,

 The history of the fixed asset, includes the name of the asset set, its
manufacturing time, lifespan, and actual or estimated cost.

 The hospital must compile with the rules and protocols of the government to
dispose of any significant hospital asset.
 3. Implementation guidance … (9)

3.3. Utilities and Sewerage (Electricity)

 A reliable source of electricity is essential for every hospital.

 Every hospital facility must have a backup system, including functional

diesel generator with sufficient supply of diesel and solar.

 Hospitals should have access to a professionally qualified technician with

appropriate training, tools, and equipment.

 Up-to-date plans, manuals and a reasonable stock of spare parts should

be kept by each facility to ensure easy access when troubleshooting.
 3. Implementation guidance … (10)

3.3. Utilities and Sewerage (Water supply)

 All hospitals should have access to a safe and reliable water supply.

 Hospital Water must be Free of disease-causing organisms,

hazardous substances, Transparent, colorless, odorless, tasteless,
and minerals.

 Regular microbiological checks should be conducted at least every

6 months on the water supply.

 A backup water supply such as water tanks, a reservoir, or a

dedicated well should be available if the main supply is interrupted.
 3. Implementation guidance … (11)
 Backup supplies should be cleaned regularly and checked to
ensure the quality and safety of the water.

 Water should be available in all toilets and clinical areas (IPD,

treatment rooms, OPD, emergency room, laboratory, pharmacy..)

 All staff should have access to hand washing facilities near their
workstation.
 Drinking water should be available to patients and staff at all
times.
 3. Implementation guidance … (12)

3.3. Utilities and Sewerage (Sewerage)

 Proper sewage facilities are essential to any hospital facility
to ensure hospital cleanliness.
 Flushing toilets should be available wherever possible and
when adequate water is available.
 Covered walkways should be used to link hospital buildings
to any external toilet facilities.
 Flushable toilets should be inspected regularly to ensure
functionality.
 3. Implementation guidance … (14)

3.3. Utilities and Sewerage (Plumbing)

 Hospital plumbing should checked regularly to ensue functionality

 Water pumps should be regularly checked and maintained per the

manufacturer’s recommendations.
 Hazards include flooding, slippery floors, and water damage.

 Hospitals should have access to a professionally qualified plumber with

appropriate training, tools, and equipment.

 The hospital must ensure that reasonable stocks of plumbing maintenance

materials
 3. Implementation guidance … (15)

3.3. Utilities and Sewerage (Boiler)

 Boilers should be constantly supervised by a dedicated boiler
technician.

 Regular inspections should be performed to ensure its

functionality.

 The boiler technician should be qualified and have access to

appropriate tools and equipment.

 The hospital must ensure that reasonable stocks of boiler and

steam plumbing and piping maintenance materials.
 3. Implementation guidance … (16)

3.4. Heating, ventilation, and air conditioning

 Hospitals in Ethiopia generally do not require heating systems

 Adequate ventilation is essential in a hospital environment to

prevent the spread of infections, health risks and pollutants.

 Hospitals should have access to qualified HVAC technician

with appropriate training, tools, and equipment.

 The hospital must ensure that reasonable stocks of HVAC

maintenance materials are always held.
 3. Implementation guidance … (17)

3.5. Energy efficiency

 Hospitals should maximize energy efficiency to
minimize costs and environmental pollution by:
 The use of natural ventilation:
 Provide reflective materials on windows to redirect the sun
rays,
 Plant trees to provide shade to buildings, especially outside
windows, in hot climate areas,
 Use solar panels for heating water, powering lights, etc.,
 3. Implementation guidance … (18)

3.6. Pet, pest, and rodent control

 Rodents and insects can spread disease and
cause damage to buildings and equipment.
 Pests and rodents can be minimized by
keeping the facility clean and free from waste
materials.
 Pets and rodents should eliminated by using
different methods indicated in EHSIG.
 3. Implementation guidance … (19)
3.7. Vehicle Management
 Hospital vehicles should be organized within a transport
department of drivers and department heads.

 Vehicles should be equipped with at least one spare tire, and

these should be checked regularly

 All vehicles should be fitted with functioning seat belts in

both front and back seats,

 Routine services should be undertaken for each vehicle only

by a qualified mechanic as per their transport policy.
 3. Implementation guidance … (20)

3.8. Hospital Security

 Hospital should have Security personnel for staff, patients, property.
 Security personnel play a vital role in welcoming, accessible and a
safe environment for patients, visitors, and staff.

 Security personnel need a thorough knowledge of the premises to

protect buildings and valuable equipment.

 The security department should provide 24-hour coverage, with

security officers stationed at all hospital entry & exit points.
 3. Implementation guidance … (21)

3.9. Hospital Safety

 Exposure to hazardous chemicals can produce a wide range of
adverse health effects.
 The occurrence and severity of an adverse health effect is
dependent on the toxicity of the chemical, the route of exposure
and extent of exposure to that substance.
 Material safety data sheets (MSDSs) information should be
available for all chemicals found at the hospital.
 The hospital should ensure reasonable stocks of personal
protective equipment's.
 3. Implementation guidance … (22)
3.10. Fire safety
 A fire safety plan that addresses the prevention and response.
 A Fire prevention safety measures includes (Electrical safety,
Flammable storage, Smoking/open flame restrictions and Fire
inspections)
 A Response is action taken in response to a fire to minimize
injury and the damage caused to buildings and equipment.

 Fire response measures should include (Fire warning system,

Emergency notification, Firefighting equipment, Water sources,
Access to the building, Evacuation and Referrals)
 3. Implementation guidance … (23)

3.11. Major Incident Planning and Management

 A major incident is any event whose impact cannot be handled
within routine service arrangements.

 An incident poses a serious threat to the health of the community;

or is potential for the hospital itself to suffer severe internal
disruption.

 Hospital should have major incident plan that aims to ensure that
the hospital can respond to major incidents
 4. Summary
 Appropriate facility and assets management has critical for smooth
operation of clinical services

 Facility and assets related problems can be prevented by detailed

plan and timely response for identified problems.

 The hospital senior management should establish monitoring

system for smooth and sustainable infrastructure and assets
management.
Thanks!!!