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SEGURAN AN A EM SA SA DE CURSO E OFICINA DE TRABALHO SOBRE GERENCIAMENTO DE RISCO E SEGUR

Sao Paulo - SP, Brazil Nov. 5 7, 2007

Risk Management PAHO Perspective


Antonio Antonio Hernandez Hernandez Regional Regional Advisor Advisor on on Physical Physical Infrastructure Infrastructure & & Technology Technology Pan Pan American American Health Health Organization Organization // World World Health Health Organization Organization

Outline
The Pan American Health Organization PAHO Risk Management (RM) Concepts Health Technology Taxonomy & Trends Physical Infrastructure & Technology - RM Perspective Challenges & Opportunities
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ORGANIZATIONS LEADERSHIP
Director: Dr. Mirta Roses Periago Deputy Director: Dr. Cristina V. Beato Assistant Director: Dr. Carissa Etienne Director of Administration: Mr. Michael Boorstein

ORGANIZATIONS HISTORY
1902 1902 International Sanitary Bureau (ISB) is formed by the First General

International Sanitary Convention of American States

1923 1923 ISB renamed Pan American Sanitary Bureau 1924 1924

Adoption of the Pan American Sanitary Code which continues in force today
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ORGANIZATIONS HISTORY
1936 1936 1946 1946 1947 1947

1948 1948 1949 1949 1950 1950 1958 1958

Ratification of the Pan American Sanitary Code by all the American Republics. International Health Conference drafts the Constitution for a World Health Organization. Pan American Sanitary Conference reorganizes the Bureau and its Governing Bodies, and gives a new name to the organization: the Pan American Sanitary Organization (PASO). Establishment of the World Health Organization (WHO). PASO also becomes the WHO Regional Office for the Americas (AMRO). PASO becomes the specialized agency for health for the InterAmerican System. Pan American Sanitary Organization is renamed Pan American Health Organization (PAHO).

Regional Structure
EURO EURO Copenhagen, Copenhagen, Denmark Denmark

HQ HQ Geneva, Geneva, Switzerland Switzerland

AMRO AMRO Washington, Washington, DC DC USA USA AFRO AFRO Brazzaville, Brazzaville, Rep. Rep. Du Du Congo Congo

WPRO WPRO Manila, Manila, Philippines Philippines EMRO EMRO Alexandria, Alexandria, SEARO Egypt SEARO Egypt New New Delhi, Delhi, India India

PRESENCE OF PAHO IN THE REGION

CFNI CFNI INCAP INCAP CAREC CAREC

CEPIS CEPIS Headquarters Headquarters Country Country Offices Offices Centers Centers PANAFTOSA PANAFTOSA BIREME BIREME CLAP CLAP

PAHO MEMBER STATES


Antigua Antigua and and Barbuda Barbuda Argentina Argentina Bahamas Bahamas Barbados Barbados Belize Belize Bolivia Bolivia Brazil Brazil Canada Canada Chile Chile Colombia Colombia Costa Costa Rica Rica Cuba Cuba Dominica Dominica Dominican Dominican Republic Republic Ecuador Ecuador El El Salvador Salvador Grenada Grenada Guatemala Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago United States Uruguay Venezuela Participating States France Kingdom of the Netherlands United Kingdom of Great Britain and Northern Ireland Associate Member Puerto Rico Observer States Spain Portugal

PAHO - Specialized Agency on Health


Organization of American States Specialized Agency

Inter American Systems

PAHO
Regional Office of the World Health Organization

United Nations System

Risk Management
Risk Management is a Process to Make Decision that will Eliminate or Minimize the Consequences of a Accidental Losses The Process: Objective Efficient Pragmatic

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Risk Management Program Purpose

Protect the Organization/Institution Against Loss


Property Loss Net Income Loss Liability Loss Personnel Losses

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Risk Management Program Components


Risk Identification Risk Analysis Loss Prevention Claims Management Disaster Preparedness

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HEALTH TECHNOLOGIES
Health Information System
People's Health Environmental Health

Epidemiological Information
Community Health Services Protection Technologies Prevention Technologies Promotion Technologies Clinical Technologies

Clinical Information
Individual Health Services Support Technologies

Electronic Medical Record Organization


Pharmaceutical Medical and Other Equipment Products and Devices Clinical Procedures Information Infrastructure and Equipment

e-Health Tele-Health - TELEMEDICINE


13 Source: Developing Health Technology Assessment in Latin America and the Caribbean - PAHO/WHO

Health Technologies
Assessment
Safe, and Cost-effective Interventions ...

Regulation
Efficacy, Safety and Quality Devices

Management
Planning, Acquisition, Use, Maintenance, Evaluation & Discharge

Technical Support Service


Training, Information, Maintenance
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Health Technologies
Convergence
Moving to Uniformity

Integration
Process of Incorporated as Equals

Development
Accelerated

Interoperability
Exchange Information Among Them
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HEALTH SERVICES PHYSICAL AND TECHNOLOGICAL INFRASTRUCTURE


E-Health Tele-Health Telemedicine

MEDICAL DEVICES REGULATION


DEVICES

MEDICAL MED ICAL DEVICE REGULATION PROGR PROGRAM AM


Define & Classify DEVICE" Classif y "MEDICAL "MEDICAL DEVICE" PrePre -Market Approval Approva l Po stPost -Market Vigilance Audit Manufacturer & Audit & Distributo Distributor r Apply PreApply Pre-Market Market Assessm Assessment ent Controls Cont rols Harmo nize Reg Regulatory Harmonize ulatory Requirements Requirements

EQUIPMENT TECHNOLOGY MANAGEMENT


MEDICAL INDUSTRIAL

EQUIPMENT EQUIPMENT TEC TECHNOLOGY HNOLOGY MANA MANAGEMENT GEMENT


PLANNING PLANNIN G PR OCU REMENT PROCUREMENT MANA MAN AGEMENT GEMENT ASSESSMEN T ASSESSMENT DISPOSAL REPLA CEMENT R EPLACEMEN T
TH S/ E VAHH

ARCHITECTURE AND ENGINEERING

HEALTHCARE FACILITY DEVELOPMENT PLANT OPERATION


HEALTH HEALTH CARE CARE FACILITIES FACILITIES ENGINEERING PROGRAMS PROGRAMS
MAINTENANCE MANAGEMENT SAFETY AND BIO-SAFETY E NERGY MANAGE MENT DISASTER PREPAREDNESS ENVIRONMENTAL MANAGEMENT
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T HS/ E V-AH H

HEALTH HEALTH CARE FACILITY FACILITY DEVELOPMENT

PLANNING FUNCTIONAL PROGRAMMING EQUIPMENT DESIGN CONSTRUCTION INSTALLATION ACEPTANCE TEST OPERATION AND MAINTENANCE
T HS/ E V -AHH

CLINICAL ENGINEERING

HOSPITAL ENGINEERING

MAINTENANCE

MAINTENANCE SERVICES

HEALTHCARE TECHNOLOGY ASSESSMENT


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Paradigm Shift in Healthcare


Old Paradigm : Service-Centered Care
Primary Health Care (Alma Ata) Hospital without Walls Reaching the Community

New Paradigm: Patient-Centered Care


Point-of-Care Technologies Personal Monitoring Devices Telemedicine

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PAHO Technical Cooperation on Health Services Physical Infrastructure & Technology To Collaborate with the Member States in National Development and Institutional Capacity Building on Healthcare Technology
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Challenges in LA&C
Technology Dependant Countries Lack of National Policy for Science & Technology in Health Few Medical Device Regulatory Programs Limited use of Evidence-Based Information for Decision-Making Limited or No Use of Norms, Standards and Codes Average 50% of Equipment Out of Service or Not in Use Obsolete Buildings and Highly Deteriorated (50%) Shortage of Professional and Technical Staff Few Universities & Technical School with Programs on BE, CE, Lack of Physical Infrastructure Planning Programs Deficient Maintenance Programs & After Sale Support Service Low Budget Allocation for Maintenance Lack of Equipment Inventories and Control Systems Continuous Acquisition of Technology
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Opportunities
National Strategic Alliances (Public-Private) Coordination with Academic Sector Interaction with Scientific and Professional Societies Work with PAHO/WHO Collaborating Centers Institutional Capacity Building on Technology Management Networks of
9 9 Experts Experts 9 9 Institutions Institutions

Links to Global Initiatives


9 9 9 9 9 9 9 9 9 9 9 9 International International Standards Standards for for Healthcare Healthcare Technology Technology (OMS/ISO/IEC/ITU) (OMS/ISO/IEC/ITU) Health Health Technology Technology Assessment Assessment (HTAi) (HTAi) Medical Medical Devices Devices Regulation Regulation (GHTF/PAHO) (GHTF/PAHO) Global Global Alliance Alliance for for Patient Patient Safety Safety (WHO) (WHO) e-Health/Telemedicine e-Health/Telemedicine (PAHO/WHO) (PAHO/WHO) Integrating Integrating Healthcare Healthcare Enterprise Enterprise (IHE)(IHE)- Patient Patient Care Care Domain Domain (HIMSS/ACCE) (HIMSS/ACCE)
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Risk Management Program is a Enabler Factor for Quality, Safety, Equity and Cost-Effectiveness on Health Services Delivery

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