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An Initiative to support more EQUAL access to health services

By Mindo - 19th Jul 2022


The EQUALS Initiative, a collaboration between the RCPI and the HSE, is continuing with its work to support healthcare and medical training in Zambia.

The EQUALS Initiative, a partnership between the RCPI and the HSE, started with one ultrasound machine shipped from Ireland to Zambia to address a significant resource shortage almost 10 years ago. The programme has now seen 13 40- foot containers of reusable medical equipment sent to the Zambian Ministry of Health and has evolved into a vehicle for nationwide medical training and supply. 

Prof Frank Murray

Prof Frank Murray, past President of the College, received a request in 2013 from an Irish doctor in Zambia asking if he could help source an ultrasound machine for Monze Mission Hospital. 

It quickly became apparent that there was no official mechanism in place to facilitate the donation of reusable medical equipment from Ireland to developing countries. Together, the RCPI and the HSE established the EQUALS Initiative to address some of the global inequalities in health through reciprocal, local partnerships. 

EQUALS contributes to healthcare development in Zambia in three ways: By sourcing good quality equipment when it becomes available in Irish hospitals and donating it to hospitals in Zambia in response to local need; by supporting the training of biomedical engineers; and by supporting the development of postgraduate medical training for specialist physicians. 

In addition to the aforementioned reusable medical equipment, the EQUALS Initiative has also shipped 10 new clinical engineering test kits to the Zambian Ministry of Health. Multiple clinical engineering trips have also been carried out to conduct needs assessments, to decant and test equipment shipped, and to support local training of clinical engineers. 

Over the past 10 years, the Initiative has evolved from a primarily equipment-centred model of support to a much more holistic approach, supporting both equipping and training needs at a national level in Zambia. 

The vision is for people in Zambia to have access to quality health services, which will improve health and save lives 

The EQUALS Initiative has directly supported the development of postgraduate medical training in Zambia and the eventual establishment of the Zambian College of Medicine and Surgery (ZACOMS) by sending delegates to conduct needs assessments and engage with key stakeholders. Two ‘train the trainer’ workshops have been provided to the new ZACOMS Faculty to date, with more planned for the future. ZACOMS final year trainees have one year of access to RCPI online courses with this agreement expected to be renewed annually. 

Why Zambia? 

The Ireland-Zambia connection dates to the early 20th Century when Irish missionaries travelled to Zambia and established a relationship of friendship, trust, and solidarity that still endures to this day. 

Zambia is a landlocked country in southern Africa with a population of approximately 19.2 million. It is around 10 times the size of Ireland and although it is an emerging and fast-growing economy, it remains one of the world’s poorest countries with a poor infrastructure of roads, telecommunications, electricity, and water. Medical facilities in Zambia are spread over vast distances, which are out of reach to many. 

According to Habitat for Humanity, over 60 per cent of the population live below the poverty line and poverty is particularly high amongst the rural population, especially those in the most remote districts. A shortage of drugs, blood products and medical supplies is an ongoing challenge facing the Zambian health sector. 

The World Health Organisation (WHO) estimates that at least 50 per cent of medical equipment in developing countries is out of use. There are many factors contributing to this including poor planning, inappropriate donations, inadequate budgeting, lack of training, and limited maintenance capacity. 

Life expectancy in Zambia (57) is shorter than it is in Ireland (82) by as much as 25 years, while a baby born in Zambia today is almost 20 times more likely to die in the first five years of its life. 

Women are 30 times more likely to die as a result of pregnancy and childbirth and 12 per cent of adults between 15 and 49 years of age have HIV. Without access to treatment, this is inevitably a death sentence. 

Despite having much greater health needs, Zambia spends only 2.5 per cent of what Ireland spends on healthcare each year. For Prof Murray, the vision of the EQUALS Initiative is simple. 

“The vision is for people in Zambia to have access to quality health services, which will improve health and save lives,” according to Prof Murray. 

“The combined approach of equipment donation and specialist medical training will improve access to quality care through better services at the central and provincial hospitals across the country. 

“The Irish arm has benefited from a huge contribution by clinical engineers, especially Karl Bergin and Eoghan Hayden, and their colleagues nationwide, who have gathered the healthcare equipment, serviced it and prepared it for shipment. They have followed up with setting up equipment in Zambia and have helped with clinical engineering training on the ground. 

“Our partnership has stimulated postgraduate medical training in Zambia and we have made measurable progress, with a promise of more to come. 

“I want to recognise especially Dr David Weakliam, Prof Diarmuid O’Donovan, and Prof Victor Mukonka in Lusaka for their continuing work.” 

Today, the EQUALS Initiative is entering an exciting period of growth and change, which will likely see an expansion on existing activities and partnerships, as well as the introduction of new ones. 

Committee structure and support 

The EQUALS Initiative committee membership is made up of clinical specialists, clinical engineers and administrative staff from both RCPI and the HSE, with Co-Chairs elected from both organisations. The Chair position is currently held by Dr Weakliam, Global Health Programme Director, HSE, and Prof Murray. 

RCPI provides managerial and administrative support to the Initiative through the business development function and is the primary contributor of funding (RCPI’s annual contribution to the EQUALS initiative has grown from €5,000 in 2013 to €55,000 in 2022). Additional, ad hoc, funding is sourced through donations made on behalf of individuals or organisations, as well as grant aid sourced through the likes of ESTHER Ireland. 

The HSE provides clinical engineering support through two very dedicated clinical engineers, Mr Karl Bergin and Mr Eoghan Hayden, respective Heads of Clinical Engineering in the Coombe and Holles St maternity hospitals. All donated equipment is assessed for suitability ahead of acceptance by the clinical engineers and fully tested ahead of shipment. Where possible, the clinical engineers travel to Zambia to decant and re-test the equipment on arrival. The HSE also provides warehouse space for storage of equipment ahead of shipment. 

A formal memorandum of understanding between the RCPI and the HSE, originally signed in 2016, is currently due for renewal. 

Future plans 

Over the next three-to-five years, the EQUALS Initiative aims to strengthen all aspects of the programme to achieve greater impact in low- and middle-income countries through a number of objectives. 

There is a plan to increase medium-term funding through sources other than RCPI (eg, HSE, Irish Aid) and to establish criteria for identification and formation of new partnerships with countries in Africa other than Zambia. 

Increasing donations of reusable medical equipment from the Irish health service is another priority and the aim is to triple donations of decommissioned reusable equipment through greater integration of the Initiative into the national equipment replacement programme. 

This article was produced by the RCPI.

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