Repair as a circular strategy for increasing resource availability and health system resilience during a crisis

Cobra, Raphael and Moroni, Iara Tonissi and Picanço Rodrigues, Vinicius and Fradinho, Jorge M.S. and Mascarenhas, Janaina (2023) Repair as a circular strategy for increasing resource availability and health system resilience during a crisis. Health Policy and Technology, 12 (3). p. 100778. 100778. ISSN 2211-8837 (https://doi.org/10.1016/j.hlpt.2023.100778)

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Abstract

Background Healthcare is a complex socio-technical system where nations regularly struggle with the misalignment between public needs and available resources. The advent of COVID-19 further exacerbated shortcomings, as evidenced by the global panic to find ventilators and beyond. However, the pandemic catalysed a successful Brazilian public-private voluntary partnership that united key industry players, industrial training centres and several volunteers, who, in the absence of a supportive government, could repair ventilators in record time, giving the health system means to succeed. Objectives Characterise how a voluntary public-private partnership came into existence and codify recommendations on how it effectively used repair as a circular strategy to increase ventilator availability and bolster health system resilience. Methods Case study using multiple data sources collected over 10 months, including national data, semi-structured interviews, daily reports, and internal communications. Sampling, research instruments, and subsequent qualitative data analysis and theory development grounded in repair strategy, resilience, and supply chain literature. Results A successful public-private voluntary partnership delivered 2,514 repaired ventilators, approximately 3% of the total ventilators in use in Brazil and impacting around 24,700 lives. Furthermore, effectively functioned as a first-responder bringing to hospitals approximately 500 repaired units as early as April 2020, surpassing the government's procurement and doing so just-in-time for Brazil's COVID 1st wave. More than 70 institutions and 700 professionals helped hospitals in 25 out of 27 Brazilian states. This case documents how the initiative persevered through adversity, including inadequate policies representing a widespread difficulty in enforcing the “right to repair”. Public interest summary In Brazil, automakers, the National Industrial Training Service and other organisations formed a voluntary and temporary alliance to repair broken ventilators that had accumulated in hospitals. This initiative took place at the beginning of the COVID-19 pandemic and returned 2,514 ventilators to hospitals, supporting patient care and partially alleviating the shortage of ventilators. This repair depended on the training of technical staff who had never worked with health equipment before. In addition to training, there was a need to share information and manuals, calibrate repaired equipment, procure spare parts, organise logistics and find funding, amongst other activities, meaning that it was a wide scale operation involving several organisations - both within and outside the health system. This research demonstrates the role of ventilator repair in making a health system more resilient in the event of a health emergency, and the urgent need to develop strategies to make repair an everyday commitment.

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