Inappropriate and poorly maintained equipment have been indicated as key factors in increasing the already high levels of patient mortality and morbidity in Uganda. Much of the equipment donated from abroad is not appropriate or cannot be used due to the lack of user training, unavailable or overly expensive consumables or lacking repair skills. Through this project, K4C’s professional volunteers have improved the skills of hospital technicians and biomedical engineers in areas such as the procurement, maintenance and disposal of medical equipment. The initial project began in 2013 and has received £228,000 funding from the Tropical Health Education Trust.
The Ugandan Blood Transfusion Service (UBTS) reports serious deficiencies in blood supply; this reflects inadequate donations; inappropriate use of blood but also serious problems in the efficiency of blood collection and production processes. 2017 saw the start of a project focused on improving equipment management in UBTS.
The biomedical engineering project has directly supported over 60 technicians in 12 different health facilities across Uganda including: Mulago National Referral Hospital; Mbarara, Hoima, Mbale, Fort Portal and Gulu Regional Referral Hospitals; Mengo, Virika and Kisiizi Church of Uganda Hospitals; and Kawempe, Kisenyi, Kasangati and Kabubbu Health centres. Each technician has been provided with comprehensive formal and ‘on-the-job’ training, including access courses for beginners and specialist modules for advanced practitioners. Additionally, over 400 clinical staff have received equipment user training to assist with basic maintenance, reduce accidental damage and improve operation and breakdown feedback mechanisms. Each health facility has been equipped with appropriate sets of high-quality tools and equipment required for maintenance.
K4C has also supported the training of degree level Biomedical Engineering students at Makerere University; the first of their kind in the whole of East Africa. We have supported curriculum development, delivery and evaluation as well as providing ongoing training, mentoring and continuous professional development for graduates.
Several conferences and workshops have been organised to stimulate networking and cooperation between technicians and engineers from across East Africa. A National Conference was held in Kampala in January 2017 (supported by the Ministry of Health, UNAMHE and NACME) to raise awareness, share findings from the project and disseminate the benefits of having well-structured training programmes, policies and guidelines and effective management structures. A number of hospital technicians have travelled to the UK for training, supported by British Commonwealth fellowships.
The UBTS project, funded by the Tropical Health and Education Trust, focused on providing training and mentorship for the first dedicated bio-medical engineer to be employed by UBTS and for technicians using equipment in 7 Regional Blood Banks.
The project has also strongly influenced the addition of Biomedical Engineering to the government healthcare delivery structure within Uganda through meetings with key stakeholders such as hospital and Ministry of Health officials.
The UBTS project reported a significant improvement in the amount of equipment in good working order and active use in the Regional Blood Banks.
The project has successfully organised structured training programmes incorporating both local and international volunteers as trainers. A peer to peer mentorship and training scheme has also been established, with the technicians that joined the team earlier training their newer counterparts for sustainability. The technicians also visit each other in their peers’ hospitals that have been highlighted as outstanding in a particular field, for example workshop management, to learn new techniques.
The technicians have greatly improved their way of reporting, their techniques and their approach to work. The project has been instrumental in changing the work ethic of the technicians; it has improved their way of reporting, their techniques and their approach to work, as well as building their confidence and knowing how and when to seek assistance through consulting and sharing information with colleagues. The technicians are now more passionate in their work, sharing and solving problems together, and are more involved in the planning and procurement processes within their facilities.
There is still a long way to go with regard to presence of full time biomedical engineering staff at the hospitals; only the referral hospitals have been assigned biomedical engineers when their services are required right down to the level of small rural community health centres. Many of these facilities have large amounts of life-saving equipment lying idle until one of our project staff are able to visit to rectify often simple faults. This is made more challenging by the absence budgets for equipment maintenance within many facilities.
The Ugandan regulatory bodies are strained by the large amount of equipment being brought into the country from abroad, exaggerated by the absence of quality control, warranties and calibration centres. Donated equipment is often problematic due to the lack of clear guidelines and structures for needs assessment, importation, quality testing and regulation of the devices. Though they are much needed, they come with a plethora of burdens which may include faults on the machines, absent parts and lack of spare parts, inaccessible consumables, lack of manuals and the absence of staff who can actually use, maintain and repair it.
More information about our biomedical engineering project can be found using the links below or by contacting us:
SSekitoleko, S. Hoyle, S. Daglish, L. Ackers; A Novel Approach to Biomedical Technicians Training in Ugandan Hospitals; Paper No 0017; Appropriate Healthcare Technologies for Low Resource Settings - AHT2014
Oshabaheebwa, S., Ssekitoleko, R.T., Namuli, L.K., Tusable, M., Nantume, J., Ackers, H.L. (2020) ‘Enhancing the utilization of medical laboratory equipment in low resource settings through training’ Health Policy and Technology