By COLLEEN SCHRAPPEN
For more than 15 years, Bruce Compton has been working to ensure that medical equipment donated by the United States to low-income countries is usable, helpful and sustainable. His commitment stems from firsthand experience while living and working in Haiti for a nonprofit clinic that did public health outreach.
"When we unloaded containers of donations," Compton said, "it was almost embarrassing to see what was donated and what they couldn't use." Unusable devices often just pile up, because facilities can't afford to dispose of them.
When Compton returned to the U.S., he founded and ran Hospital Sisters Mission Outreach, to manage donations of medical devices from the Hospital Sisters Health System. He did research on what benefited or hindered facilities on the receiving end of donations. "It's not as simple as 'they don't have this, I can give it to them,'" he said.
For example, a facility might be lacking an MRI machine, but even if it's donated, the machine can't be used unless someone knows how to install it, it has a continuous power source and there are trained personnel to operate it.
Compton became CHA's first senior director of international outreach in 2010 determined to advance best practices in international health activities for the developing world including medical device donations. "CHA has done research on the issue, but there is still a lot to be understood," he said. In 2016, he suggested to his fellow members of the National Academies' Forum on Public-Private Partnerships for Global Health and Safety that the dilemma of ineffective donations of medical equipment affects all organizations involved in global health. The Global Health and Safety forum comprises private firms, nongovernmental organizations, government agencies and academia.
Rachel Taylor, the forum's director, said, "What was immediately apparent is that the impact cut across all members of the forum."
Interested members formed a work group to write a perspectives paper, with Compton as lead author. Their work product, "Access to Medical Devices in Low-Income Countries: Addressing Sustainability Challenges in Medical Device Donations," was published online by the National Academy of Medicine on July 16. It is available at https://nam.edu/access-to-medical-devices-in-low-income-countries-addressing-sustainability-challenges-in-medical-device-donations/#NAMPerspectives.
"One of our primary reasons for producing the paper is it's such an underappreciated issue," said Taylor. "The impact on the recipient side is not always understood on the donor side. It's an opportunity to raise awareness by putting the paper out there."
The paper cites data from the MedSurplus Alliance, an agency based in Georgia, that as much as 80 percent of medical devices used in some low-income countries are donated, but an estimated 40 percent of donated equipment is out of service.
The nine authors use an example of an X-ray machine donated to a facility in Uganda to illustrate how the "mismatch between intentions and usability results from breakdowns that can occur at many points in the complex system of donations." The X-ray machine fails during a procedure, but a replacement part can't be ordered because no manual was sent with the machine. The part itself is more expensive than the hospital can afford anyway, and there would be no trained technicians to install it, so the machine is unusable.
The paper focuses on three factors that are needed to make medical device donations more effective: the quality and appropriateness of the donations, sustainability and transparency about how donations are made globally.
The authors of the paper cite previous guidelines on best practices from organizations including CHA, the World Health Organization and the MedSurplus Alliance.
"There are more people aware of this issue than ever before," said Compton. "There's been tons and tons of progress, but at the same time, we see people suffering, and they don't have access to the most basic medical devices."
Compton described the need for a switch from a top-down model where donors give regardless of usability or need, to a bottom-up model where recipients provide feedback on what is needed without fear they will lose donations altogether. Donors want this information but aren't always able to get it because of breakdowns in communication.
According to the paper, "empowering recipients to have a voice and take action to benefit the populations they serve is an important part of the process." Another recommendation involves the use of data to track whether donations are being put to use, evaluate the cost of making and receiving donations, and determine the economic and environmental impact of failed donations. This data can also identify gaps in health care.
The data collection would be part of increased communication efforts between donors and recipient countries, allowing for better accommodation of countries' policies and processes and reduction of waste and inefficiencies.
"Mapping the supply and demand of donations can shed light on the types of donations that are most prevalent and those that are scarce. This visibility can be useful in managing and optimizing the flow of donations," according to the paper. "A whole systems approach recognizes that different stakeholders manage different components of the donations system, but each component affects and influences the others."
For Compton, the next steps in improving access to sustainable medical equipment in low-income countries include continued conversations between all stakeholders, funding research on each country's needs and increasing training so staff can manage donations.
"From a Catholic social teaching perspective, we treat everyone equally. If it's not usable here because of safety or quality concerns, it shouldn't be used somewhere else," he said.
Copyright © 2018 by the Catholic Health Association
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