Barriers to Availability of Surgical Equipment in Kenya: A Surgical Equipment Journey Approach
Main Article Content
Keywords
Surgery, Surgical equipment, Sub-Saharan Africa, Kenya, Biomedical Equipment Technicians (BMETs), Maintenance
Abstract
Background & Objective: The need for surgery is currently not met in Sub-Saharan Africa, requiring both extra workforce and surgical equipment. Currently, there is a gap in the availability of surgical equipment which, among others, limits the provision of safe surgery. To design strategies to increase availability, the use of surgical equipment in this context needs to be understood. This study aims to: 1) identify the different phases surgical equipment goes through during its lifespan (i.e. the surgical equipment journey) in Kenya, and to 2) identify barriers that are perceived by biomedical equipment technicians (BMETs).
Material & Methods: Seven semi-structured in-depth interview sessions were conducted with a total of 17 BMETs working in Kenya. Participants worked in six different hospitals (four public, one private and one mission). Interviews were conducted between December 2016 and December 2018. Participants were asked to describe or draw the surgical equipment journey and describe the perceived barriers during this journey.
Results: The surgical equipment journey consists of three phases: procurement, usage, and disposal. Stakeholders involved in the surgical equipment journey are users, BMETs, procurement officers, local distributors and in case of donations, donation agencies. Bureaucracy during procurement, difficulties to obtain consumables and spare parts (especially for donated equipment), cleaning with heavy chemicals, and usage in challenging environments were identified as barriers during the surgical equipment journey.
Conclusion: Sustainable interventions at multiple organisational levels are required to optimize the surgical equipment journey in hospitals in Kenya. Different strategies that can be applied in parallel to increase availability of surgical equipment in Kenya were identified by the participants in this study: policies on donations, procurement of durable equipment, more well-trained BMETs and university-trained biomedical engineers, and designs and business models that fit the local use in Kenya and presumably other countries in Sub-Saharan Africa.
Downloads
Abstract 1576 | PDF Downloads 568
References
2.Henry JA, Windapo O, Kushner AL, Groen RS, Nwomeh BC. A survey of surgical capacity in rural southern Nigeria: opportunities for change. World J Surgery 2012;36(12):2811–8.
3.Kouo-Ngamby M, Dissak-Delon FN, Feldhaus I, et al. J A cross-sectional survey of emergency and essential surgical care capacity among hospitals with high trauma burden in a Central African country. BMC Health Serv Res 2015;15(1):478.
4.Wong EG, Gupta S, Deckelbaum DL, et al. The International Assessment of Capacity for Trauma (INTACT): an index for trauma capacity in low-income countries. J Surg Res 2014;190(2):522–7.
5.Elkheir N, Sharma A, Cherian M, et al. A cross-sectional survey of essential surgical capacity in Somalia. BMJ Open 2014;4(5):e004360.
6.Chao TE, Burdic M, Ganjawalla K, et al. Survey of surgery and anesthesia infrastructure in Ethiopia. World J Surg 2012;36(11):2545–53.
7.Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015;386(9993):569–24.
8.Perry L, Malkin R. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world? Med Biolog Engineer Comput 2011;49(7):719–22.
9.World Health Organization. Medical Devices: Managing The Mismatch: An Outcome Of The Priority Medical Devices Project: Geneva: Author; 2010.
10.Howie SR, Hill SE, Peel D, et al. Beyond good intentions: lessons on equipment donation from an African hospital. Bull World Health Org 2008;86(1):52–6.
11.Malkin RA. Design of health care technologies for the developing world. Annu Rev Biomed Eng 2007;9:567–87.
12.Emmerling D, Dahinten A, Malkin RA. Problems with systems of medical equipment provision: an evaluation in Honduras, Rwanda and Cambodia identifies opportunities to strengthen healthcare systems. Health Technol 2017:1–7.
13.Neighbour R, Eltringham R. The design of medical equipment for low income countries: dual standards or common sense. 7th International Conference on Appropriate Healthcare Technologies for Developing Countries; 2012.
14.Republic of Kenya. Ministry of Health. Kenya Health Policy 2014-2030 2014. Available at: https://www.afidep.org/?wpfb_dl=80. Accessed on April 1st , 2019
15.Diaconu K, Chen Y-F, Cummins C, et al. Methods for medical device and equipment procurement and prioritization within low-and middle-income countries: findings of a systematic literature review. Globaliz Health 2017;13(1):59.
16.Ogembo-Kachieng'a M, Ogara W. Strategic management of technology in public health sector in Kenya and South Africa. East African Med J 2004;81(6):279-86.
17.Republic of Kenya. Ministry of Health. Demystifying the Managed Equipment Services (MES) project in Kenya. Available at: http://publications.universalhealth2030.org/uploads/MES-BROCHURE.pdf. Accessed on April 1st, 2019
18.The World Bank. World Development Indicators. Washington, DC: Author. Accessed on April 1st, 2019
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Author(s) must obtain all parties consent [co-author(s), others if applicable] and submit the acceptance of Copyright Agreement with their paper. Written permission must be obtained by the author for material that has been published in copyrighted material; this includes tables, figures, and quoted text that exceeds 150 words. A copy of all permissions must accompany the manuscript when published in copyrighted material. The author(s) hereby represents and warrants that the paper is original and that he/she is the author of the paper, except for material that is clearly identified as to its original source, with permission notices from the copyright owners where required. Author(s) must clearly indicate that approval for publication has been received in cases of institutional ownership.
In all submitted material authors retain all copyrights; however, the GlobalCE Journal reserve the right to reprint all or portions of the article and to post all or part of the article online. GlobalCE Journal reserves the right to edit manuscripts as required to publish in the journal. Authors are responsible for obtaining any and all clearances as appropriate. Unless stated otherwise, all articles are open-access and distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and original work (e.g. first published in the Global Clinical Engineering Journal) is properly cited with the original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on www.Globalce.org well as the copyright and license information must be included. No use, distribution or reproduction is permitted which does not comply with these terms.
