The evolution of engineering management in Latin America and the Caribbean.

Abstract

The Latin American and Caribbean regions are undergoing significant social transformation, including changes aimed at the expansion of coverage and the improvement of the quality of health services. These changes are expected to result in more equitable access to quality health care, particularly for the most needy segments of the population. All countries in the region are engaged in this transformation but are at different stages in the reform process. To provide a comprehensive overview about the way engineering management has evolved in the Latin American and Caribbean regions, it is helpful to examine some facts related to: • the way health services and health care facilities have evolved during the past 4 decades, • the use of technology in countries with inadequate public utility infrastructure, • the lack of national norms and regulations, • the economic constraints that limit maintenance activities, • the way planning and acquisition of equipment for health care facilities is conducted at the central level (Ministry of Health), • the way engineers and technicians have been trained to manage and maintain the physical infrastructure and equipment at health care facilities, • the minimal after-sale technical support provided by local importers of technology, • the current status and trends in engineering management and, particularly, in clinical engineering management, and • the international work of organizations such as the American College of Clinical Engineering (ACCE). Although there is no single model followed by all countries, the most important characteristic of the health sector reform process is the decentralization of health care facilities. The trend has been to transfer responsibility for the management and operation of public hospitals and other care facilities from the central level (Ministry of Health) to local governments or municipalities.1 The 1960s and part of the 1970s were characterized by an expansion, renovation, and modernization of the physical infrastructure of the region’s public health services, with an emphasis on hospitals. These decades were also characterized by important technological developments in the medical field that were incorporated into health care facilities. The implementation of these new technologies, however, was in most cases not accompanied by a similar organization of maintenance programs and the implementation of continuing education programs to prepare the human resources needed to manage and provide technical support for the newly deployed resources.2