RADIATION PROTECTION IN HEALTH FACILITIES 2018-SARPA CONFERENCE/AGM Misty Hills S BAKHANE Director: Health Technology Policy National Department of Health 21 AUGUST 2018

VISION AND MISSION FOR HT 9/5/2019 Vision Appropriate, safe and cost effective health technology available at the point of need. Mission To position HT as a key enabler of quality and affordable health service delivery by: creating a national health technology system; facilitating safe and appropriate utilization of health technology ; promoting the optimal distribution of the limited HT resources to facilitate equity in access.

Quality Sustainability Efficiency Access & equity Adverse event monitoring Licensing, testing Appropriateness Affordability Safety Availability at a point of need Adequacy Risk Management Performance of HT Sustainability PPP HTA Appropriateness Affordability CMMS Cost Of ownership Self Sufficiency Local Industry Strategic Sourcing Reduction R&D Efficiency Maintenance Reduce Downtime Improving HT Extended Lifetime HTA Efficient Use HT Availability Gaps Analysis HT availability Access & equity audits distribution Essential Equipment Lists Appropriate

CURRENT CHALLENGES 9/5/2019 The following challenges were identified as outlined in National HT Strategy: A fragmented approach to planning and procurement of Medical Equipment and/or lack of systematic replacement strategy Inconsistencies in prices between private and public sector and between provinces for health technology items The rapid rate of technological influx and lack of a scientific mechanism to decide on appropriate technologies(HTA). Mismatch between the need and available technologies Poor maintenance practices /Quality Assurance with a high percentage of equipment that is not fully functional and high levels of maintenance backlogs coupled with low user training levels. Also - lesser control and monitoring capability, not realizing benefits from leveraging on economies of scale, poor inventory management.

RADIOLOGICAL EQUIPMENT/TECHNOLOGIES 9/5/2019 The use of ionizing radiation in medicine is well established, and has resulted in tremendous benefit to humankind in diagnosing and treating diseases. While the medical benefits are unquestionable, there has been growing evidence of unintended and unnecessary use of radiation in medicine, creating the need for radiation protection principles. Radiation Protection in Medicine Conference(IAEA) 2017.This was a follow up conference to 2012 “Bonn call for action” The aims of the “Bonn Call for Action” conference of 2012 are: (a) to strengthen the radiation protection of patients and health workers overall; (b) to attain the highest benefit with the least possible risk to all patients by the appropriate use of ionizing radiation medicine; (c) to aid the full integration of radiation protection into health care systems; (d) to help improve the benefit–risk dialogue with patients and the public; and (e) to enhance the safety of technical operations in medicine.

RADIOLOGICAL EQUIPMENT/TECHNOLOGIES... 9/5/2019 Radiological Equipment: One of the Key Priorities in the NHI White paper, the recently developed National Cancer Plan and Joint work with National Treasury(OCPO). Radiology: X-rays, CT, Mammography, Dental Biggest use within our Health care institutions Quality assurance critical(SANAS Accredited service providers) Infrastructure: Shielding critical, Equipment: PPE, Dosimeters Key professionals: Radiologists, Radiographers & medical Physicists Interventional Radiology: Fluoroscopy, Cathlabs Cardiologists, Radiologists, Nurses & other Medical specialists Infrastructure& Equipment: Theatre, PPE, Dosimeter Nuclear Medicine: PET/SPECT NM Physician, NM radiographers, Medical Physicists, Radiation protection Specialist, Nursing

RADIOLOGICAL EQUIPMENT/TECHNOLOGIES... 9/5/2019 Combination Technologies: PET/ CT/MRI Use within Regional/Private Health care institutions Quality assurance critical(SANAS Accredited service providers) Infrastructure: Shielding critical NM Physicians, NM radiographers, Medical Physicists, Radiation protection Specialists, Nursing, Diagnostic Radiographers External Beam Radiation Therapy: Linear accelerators, Cobalt Units Quality assurance critical(Regulatory compliance) Radiation Oncologists, Radiotherapists, Radiobiologists, Other Medical Specialists, Radiation protection Specialist, Nursing, Diagnostic Radiographers

RADIOLOGICAL EQUIPMENT/TECHNOLOGIES... 9/5/2019 Particle therapy: Neutron /Proton Infrastructure, Equipment: PPE, Dosimeters Isotope Therapies: gamma/Beta source NM Specialists, Radiation Oncologists, Urologist &other specialists, Medical Physicists, Radiobiologists Infrastructure: Patient isolation Rooms, Equipment: PPE , dosimeters

SUMMARY OF CHALLENGES RECOMMENDATIONS 9/5/2019 Critical shortage of RP staff at Medical Centers Creation of RP posts at Institutions/Strategic Partnerships Training Needs(Continuing Education etc)(Competency) Academic Institution, PPP Shortage of Appropriate Equipment Need for standardized Specification(appropriateness, quality) Lack of skill on Quality Assurance/Management Train personnel on QA and improve budgets for service Improve regulatory Enforcements Obsolete equipment Put in place proper replacement plan and improve budgets Frequent confusion on Disposal of Radiological waste

9/5/2019 THANK YOU