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The tools of the trade

The arrival of much-needed hospital equipment in Zambia is a milestone and Uganda will be the next African country to benefit, Dr David Weakliam, Lead of the HSE Global Health Programme and Chair of Irish Forum for Global Health, tells the Medical Independent (MI).

The Irish equipment has been replaced or updated and will not be used again here. But it is still of good quality and has a good working life left, making it worthwhile to donate overseas. The programme, dubbed the EQUALS initiative, is a collaboration between the RCPI and the HSE to improve the quality of healthcare in developing countries.

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RCPI President Prof Frank Murray (right) with Dr David Weakliam checking hopsital equipment bound for Zambia

The equipment was collected from Irish hospitals around the country and was shipped to Zambia in a 40ft container from Shannon, where it had been stored at a donated facility.

“The equipment was dispatched in October and arrived at the end of November in Monze for the district hospital there. The equipment was also sent to three other hospitals and a biomedical engineering training institution,” Dr Weakliam explains. The other hospitals that will get the equipment are in the capital Lusaka, for use in the university teaching hospital there, the central hospital in Ndola and a hospital in a rural area in Livingstone.

“We are now in the process of distributing the equipment,” Dr Weakliam adds. “It includes a range of minor and fairly major medical equipment. The larger items include ultrasound machines and a number of different types of endoscopes and there are smaller items like oxygen concentrators, blood pressure monitors, defibrillators and other commonly-used equipment.

“It was a very substantial amount of equipment. It doesn’t have a commercial value, of course, but you’re talking about tens of thousands of euro in value that this equipment would have for those hospitals in Zambia.”

The equipment was tested and prepared for shipping by engineers working in the health service who volunteered their time to get the equipment ready

Dr Weakliam outlines the logistics involved in the enterprise. “The first step was the collection of equipment from hospitals in Ireland. That equipment was then transported to a warehouse in Shannon that had been donated to the initiative by Westpark Shannon, and DHL provided reduced rates to transport it from the hospitals to Shannon. A number of medical companies also donated equipment. The equipment was tested and prepared for shipping by engineers working in the health service who volunteered their time to get the equipment ready.

“Then, in consultation with doctors in Zambia and different institutions, we identified how much equipment would be allocated to which institution. This was done in conjunction with an Irish obstetrician, Dr Michael Breen, who has been working in Monze for a number of years.

Training is critical

“We are also working with the Ministry of Health in Lusaka and with the other hospitals. Our desire is to develop strong relations with a number of hospitals and to collect and send out equipment that matches their needs.

“Training is also critical. We need to ensure there is the means of training in the hospitals to service and maintain the equipment over time. That is why one of the institutions in Zambia we are supporting is the new NORTEC biomedical training institution in Ndola. If we can support them, then we will be helping to increase the number of trained biomedical engineers who can work in different hospitals and manage the equipment.

“In the coming months, we plan for equipment engineers from the HSE to go out to Zambia and to help provide training for the local engineers. Details are still being worked out but they would go to Monze, and potentially the other hospitals, to offer training. We would be interested in providing support for training at the biomedical college as well, but that has to be explored further to ascertain the needs of the college and what we can offer in terms of training,” Dr Weakliam explains.

“In addition to providing equipment, we will be seeking other ways to improve the quality of care. It’s also important that the hospitals have physicians who are well trained and we are working with the Ministry of Health now to support postgraduate medical training for their doctors.”

Zambia is now producing more medical graduates and the number will increase over the next few years to 200 a year, Dr Weakliam says, but there are limited opportunities for those doctors for postgraduate medical training and career development in Zambia.

Formal collaboration

“Under the leadership of its President, Prof Frank Murray, the RCPI, as part of the EQUALS initiative, is developing a formal collaboration with the Ministry of Health to support them to develop their own training body. This would be authorised and responsible for all postgraduate medical training in Zambia.

“The RCPI would guide development in areas like training of trainers, accreditation of training sites, developing specialist trainers and trainee posts — those are the kinds of components that over the years we in Ireland have developed to quite a high degree and we’re in a position to support another country to go through a similar process.”

Enhanced training at home would also help Zambia to staunch the flow of its doctors abroad, Dr Weakliam points out. “It’s very important for Zambia that it doesn’t lose its doctors. These doctors often go overseas in order to get their postgraduate medical training and sometimes they don’t come back. So it’s really important for such countries to be able to develop their own training programme so doctors can develop their specialist careers at home.”

It’s very important for Zambia that it doesn’t lose its doctors. These doctors often go overseas in order to get their postgraduate medical training and sometimes they don’t come back

The EQUALS initiative is also involved in donating healthcare equipment to Uganda. “That is in response to contact we had with an Irish priest, Fr Tom Smith, who has been working with the local diocese and Ministry of Health to develop a new maternity unit and outpatient facility in Ngoma, Uganda. Fr Smith had been in touch with a number of the maternity hospitals in Ireland in order to gather equipment. As we were engaged in a similar initiative, we have supported him in his efforts to get the equipment and that has been collected and is being stored in Shannon, with a view to being transported to Uganda,” Dr Weakliam says.

Responding to needs

In addition to Zambia and Uganda, responding to the needs of other developing countries is also being explored, Dr Weakliam says. But he stresses the importance of sending equipment that matches the needs of hospitals. “Our whole approach is that we would be responding to needs identified in the hospitals overseas. They would share their particular needs with us and then we would try to respond to that by sending out the right equipment.

“A lot of equipment sent to developing countries doesn’t get used well because it’s not the right kind of equipment or is not easy to maintain and manage in the conditions that it’s sent to.”

In many ways, Zambia has become a model for how the initiative works. “As we send out the equipment, we are learning how to manage the process in the best way so that the next time we do it, it becomes easier,” Dr Weakliam tells MI.

But the programme also faces some challenges. One of principal challenges is the need for funding. Shipping the 40ft container to Zambia, for example, cost about €13,000.

Dr Weakliam sums up the challenge in this way: “This equipment itself doesn’t cost us a thing; the cost is really transport and shipping. So the first challenge is raising the money we need to ship the equipment because it’s very valuable equipment and yet if we can’t deliver it to where it’s needed, we can’t progress. So far we’ve raised a small amount of money and the RCPI has made a contribution, but that was sufficient only for the container that went out in October.

Funding

“If we are going to continue sending out equipment we need to raise funds. So we are currently looking at how we would do that and are hoping to engage with interested parties — hopefully some of the other medical colleges in Ireland, and we may also approach some donors who might support the initiative.”

Between 15 and 20 hospitals to date have donated equipment for the initiative, and donations have also been made by some private companies, Dr Weakliam says. He is very pleased with the progress made so far and believes the future looks even brighter now that the initiative has got off the ground successfully with the Zambian delivery.

“We are very pleased to have delivered one container because we had spent a lot of time planning it and now that we have done it, we are in a stronger position to go out and garner more support. When something gets to the stage where it is achieving benefits, it’s much easier to get more support for it and to grow the initiative. So getting the first container out was quite a milestone for us. We want to build on that.”

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Dr Victor Mukonka

By all accounts, it was a milestone too for Zambia. Dr Victor Mukonka from the School of Medicine at Ndola Central Hospital tells the Medical Independent that the Irish equipment will be a key factor in helping to improve his country’s healthcare system.

“The equipment is key to the provision of quality health services to the Zambian people. The country is going through very hard times to meet the health needs of the population, particularly with the rise in poverty levels, disease burden, both communicable and non-communicable diseases.”

Zambia has made significant progress in terms of political and socio-economic development since its independence from Britain in 1964, the WHO says in its 2013 annual report. But, like Dr Mukonka, it cites the high burden of communicable diseases and an increasing burden of non-communicable diseases facing the country.

Disease burden

“HIV and AIDS, TB and malaria are the major drivers of the disease burden. Maternal and child mortality remain unacceptably high. Malnutrition is also a major threat to child survival. Apart from a high disease burden, the Zambian health sector is affected by various challenges and constraints that have made it difficult to adequately improve health service delivery to desired levels. The poor social-economic situation and high poverty levels remain a threat to health,” the WHO warns.

It says the major challenges include a critical shortage of qualified health workers; limited funding to the health sector; the country’s large geographical area and diverse epidemiological disease patterns; and the erratic supply of essential drugs and medical supplies.

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Dr Mukonka addressing WHO assembly in 2011

The country also has challenges related to the poor state of health infrastructure, equipment and transport systems, and inequities in the distribution of resources between urban and rural areas, according to the WHO.

In this context, the Irish equipment is bound to have a major impact and Dr Mukonka, who is Senior Lecturer at Coppperbelt University in the Zambian city of Kitwe, tells MI that the equipment is also playing a major role in helping Zambia’s medical training.

High-impact assistance

“The equipment is needed in our training institutions as we address the health workforce crises by expanding training sites for health professionals, and Ireland has been our strategic partner to help build capacity in the country. It’s coming at the right time and will touch many lives in our healing mission. It’s a very practical, high-impact assistance from the Irish people,” Dr Mukonka tells MI.

“Zambia is experiencing very high maternal and child mortality. Apart from that, we have a high burden of communicable diseases like malaria, HIV/AIDS, TB, cholera and typhoid outbreaks. Now we are also seeing a rise in non-communicable diseases like hypertension, diabetes, cancers, accidents and injuries and strokes. Most of our hospitals have obsolete equipment, making it hard for the few health professionals to provide quality health services, so the donation of equipment will make a major difference and impact.”

Indeed, the Irish equipment can ultimately make the difference between life and death for some patients in Zambia. “Zambian people value the programme because it’s responding to our requests and needs. The equipment is put to immediate use in life-saving,” Dr Mukonka emphasises.

“There is consultation and dialogue in terms of what is needed and appropriate and there is capacity-building in how to maintain and service the equipment.

“This is unique and very helpful.”

Zambia: Key statistics

  1. Zambia is a land-locked country, with an area of 752,612 square kilometres.
  2. It shares borders with eight countries, namely the Democratic Republic of Congo, Angola, Botswana, Namibia, Zimbabwe, Malawi, Mozambique and Tanzania.
  3. The population of Zambia is over 14 million. Out of the total population, 51 per cent is female and 49 per cent is male. The population is relatively young, with 45 per cent below 15 years.
  4. Out of the total population, 60.5 per cent reside in rural areas, while 39.5 per cent live in urban areas, making Zambia one of the most urbanised countries in Africa.

Although the population is relatively small, it is geographically scattered, making delivery of equitable health services close to the people a major challenge.

Source: WHO/Global Health Observatory)

Total population (2013)

14,539,000

Gross national income per capita (PPP international $, 2013)

$3,070

Life expectancy at birth m/f (years, 2012)

55/58

Probability of dying under five years old (per 1,000 live births, 0)

Not available

Probability of dying between 15 and 60 years m/f (per 1,000 population, 2012)

398/353

Total expenditure on health per capita (Intl $, 2012)

$112

Total expenditure on health as % of GDP (2012)

$6.5

 

WHO sees progress and achievement in Zambia

“Significant achievements were made in a number of healthcare programmes during 2013. Notable among these was the introduction of four new and under-utilised vaccines in the national immunisation system, which included the pneumococcal conjugate vaccine (PCV), measles second dose, human papillomavirus (HPV) vaccine, and the rotavirus vaccine. The national cold chain storage capacity for vaccines was also expanded from 3,580 litres in 2012, to 50,000 litres in 2013.

Positive developments were also recorded in the male circumcision programme. The number of males circumcised increased significantly, from 173,922 in 2012, to 266,476 in 2013. WHO provided normative guidance, technical leadership, advocacy and co-ordination for the scale-up of the male circumcision programme.

In 2007, the WHO made a recommendation that voluntary medical male circumcision (VMMC) be included as an additional HIV prevention strategy. This followed evidence from three large, randomised, controlled trials that indicated that adult Voluntary Medical Male Circumcision reduces men’s risk of HIV acquisition by at least 60 per cent. Reaching, and then maintaining, 80 per cent prevalence of male circumcision among men 15-to-49 years old could prevent 340,000 [globally] HIV infections by 2025, saving an estimated US$2.4 billion in lifetime HIV treatment costs.

The year 2013 was the mid-point for the implementation of the National Health Strategic Plan 2011-2015 and other programme-specific strategic plans. WHO provided technical and financial support to the Ministry of Health for the mid-term review of the NHSP, the National Malaria Strategic Plan 2011-2015, the National TB Strategic Plan 2011-2015 and the National AIDS Strategic Framework (NASF) 2011-2015.

One of the notable events in 2013 was the classification of Zambia by WHO as at low risk of yellow fever. WHO provided the necessary leadership, technical and financial assistance to the Ministry of Health to conduct a survey to determine whether or not there was the presence of yellow fever in the country. The survey was instrumental in helping the country to confirm or refute the yellow fever classification.

Another notable event in 2013 was the commencement of the national 2013 Tuberculosis (TB) Prevalence Survey.

Notwithstanding these achievements, much needs to be done in the country to improve health indicators. The work of WHO in Zambia in the 2014-2015 biennium will continue to support priorities in the NHSP.

The major focus will continue to be that of reducing the disease burden, strengthening health systems, improving human resources for health and ensuring consistent and adequate supply of quality essential medicines. In order to address the rising burden of Non-Communicable Diseases in the Country, WHO supported the development of the National Non-Communicable Diseases (NCDs) Strategic Plan 2012-2016, which is reflective of strategies outlined in the WHO Global Non-Communicable Diseases Action Plan 2013-2020.

The implementation of this plan will (continue to) receive support from WHO and the WHO Country Office will also work within the framework of WHO’s 12th Global Programme of Work in order to help the country achieve national, regional and global health targets and goals.

It is gratifying to note that stakeholders value WHO’s role, leadership, work and contribution globally, as was indicated by results of a WHO global perception survey. Zambia is one of the countries that participated in this survey. The survey provided useful findings on areas WHO needs to pay attention to further improve the organisation’s work. At country level, the findings will be incorporated into the general communications strategy as part of the WHO reforms and will form part of the ongoing efforts aimed at improving the visibility of the organisation.”

(Extracts from WHO Annual Report 2013)

  1. FABIAN KABULUBULU on February 25, 2015 at 10:25 am

    This is good initiative and I would like to participate

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