Management of medical equipment in the Brazilian public health system (SUS), historical situation and the context of the pandemic COVID-19: a cut for lung ventilators.

Purpose: The main objective of this paper is to analyze the Brazilian Ministry of Health (MoH) efforts in the management of medical equipment, with a specific approach for lung ventilators in the pandemic scenario of COVID-19. Methods: The methodology included a review of the normative framework and literature on technological management and research on the database of the Ministry of Health. Results: As a promoter for acquiring medical equipment, the MoH role is highlighted and added to this competence; its function as the coordinator of the National Policy on Health Technology Management (PNGTS). According to the PNGTS the MoH has to support health managers in the implementing, monitoring, and maintaining health technologies. The scenario of lung ventilators in the pandemic was discussed, with research to verify demands, offers, installed capacity, and investments. In less than one year, the Ministry of Health acquired several pulmonary ventilators, 8.55 times greater than the annual averages of equipment acquired from 2016 to 2019. So far, there is still no maintenance plans or strategy of management for that equipment, especially in a post-pandemic scenario. Conclusion: It is possible to conclude that the Ministry of Health needs to improve health technology management systems. On the scale of the Policy, it is necessary to commit to permanent and long-term actions to ensure sustainability and reduce the technological vulnerabilities of the SUS.

Optimization methods for large-scale vaccine supply chains: a rapid review.

Global vaccine revenues are projected at $59.2 billion, yet large-scale vaccine distribution remains challenging for many diseases in countries around the world. Poor management of the vaccine supply chain can lead to a disease outbreak, or at worst, a pandemic. Fortunately, a large number of those challenges, such as decision-making for optimal allocation of resources, vaccination strategy, inventory management, among others, can be improved through optimization approaches. This work aims to understand how optimization has been applied to vaccine supply chain and logistics. To achieve this, we conducted a rapid review and searched for peer-reviewed journal articles, published between 2009 and March 2020, in four scientific databases. The search resulted in 345 articles, of which 25 unique studies met our inclusion criteria. Our analysis focused on the identification of article characteristics such as research objectives, vaccine supply chain stage addressed, the optimization method used, whether outbreak scenarios were considered, among others. Approximately 64% of the studies dealt with vaccination strategy, and the remainder dealt with logistics and inventory management. Only one addressed market competition (4%). There were 14 different types of optimization methods used, but control theory, linear programming, mathematical model and mixed integer programming were the most common (12% each). Uncertainties were considered in the models of 44% of the studies. One resulting observation was the lack of studies using optimization for vaccine inventory management and logistics. The results provide an understanding of how optimization models have been used to address challenges in large-scale vaccine supply chains.