Zambia’s Equipment Graveyards

Funded by the UK Department for International Development and the Millennium Development Goal Initiative, the project was sponsored by the European Union (EU) and funds were managed by UNICEF Zambia. The aim of this project was to understand and evaluate the impact of a well-equipped Biomedical Engineering Technologist (BMET) on the status of medical equipment within each health facility.

Established in 2011, Chongwe District Hospital is a first level hospital located 45km east of Lusaka. With a 100-bed capacity, the hospital serves a population of more than 182,000. Patients are referred here from 34 surrounding health centers and can access a range of services, including paediatrics, surgical care and dental care. Due to health service demands across the district, when the hospital was initially upgraded from a primary health facility , it was provided with equipment acquired from other health facilities, some of which was old and needed frequent servicing and repair. The lack of user training among health workers led to equipment breaking down and unfortunately, the hospital did not have a BMET on-site to conduct preventative or corrective maintenance. This meant that medical equipment had to be repaired by provincial level staff which often led to significant delays for vital repairs.

At the start of THET’s medical equipment up-time pilot project, the hospital had approximately 120 pieces of medical equipment with an equipment uptime of 73% (100% uptime equates to all medical equipment in a particular facility being functional). Following THET’s introduction of a BMET, Anderson Phiri, a biomedical workshop was set up at the hospital where broken-down equipment could be repaired without being sent to the Provincial Health Office, which is much quicker and more cost effective. Through the workshop and Anderson’s full-time placement in the hospital, the medical equipment status rose significantly, reaching 96% in the tenth, and final, month of the project. Major improvements were made in specific departments, such as a 60% increase in physiotherapy equipment up-time, meaning health workers could provide vital services for patients recovering from surgery or injury to enable them to get back on their feet, and a 51% increase in up-time in the X-ray department, allowing health workers to diagnose life threatening injuries and conditions. With staff able to access the equipment they needed to treat patients, quality health care services could be provided across the hospital.

In 2019, Anderson returned to the hospital to undertake research on the status of the medical equipment one year after his ten-month THET funded placement at Chongwe. Disappointingly, overall equipment up-time had returned to the level it had been when he started his placement (73%), with significant losses in specific wards, for example, down 30% in the operating theatre. Broken-down equipment in need of repair was found across the wards and in the storeroom. The limited remaining equipment, such as suction machines and oxygen concentrators, was shared amongst the departments dependent on need, a practice which is clinically unsafe and puts patients at risk as it increases the risk of spreading infections from department to department and means that life-saving equipment is often not available for patients when they need it most.

From the data Anderson collected, he found that 35% of the hospital’s equipment required regular preventative or corrective maintenance to run efficiently. Without a BMET on-site to repair the equipment, this has significant consequences for the hospital’s staff and patients, both financially and in terms of quality of care. For patients, service provision is badly affected, and, in many cases, patients must be referred to another health facility for care which can be costly for both the hospital and individual. It can also lead to delays in accessing life-saving treatment, such as women having to wait to be transferred for an emergency caesarean section which puts them, and their child’s lives at risk. For staff, malfunctioning equipment prevents them from being able to do their jobs effectively, which can be both demotivating and hazardous. If, for example, a malfunctioning oxygen concentrator continues to be used, it becomes very difficult to ensure that a patient is getting enough oxygen.  For the hospital, hiring an external BMET incurs a relatively high cost and waiting for an engineer to arrive from the Provincial Health Office can take a number of weeks, limiting the hospital’s ability to provide quality care and meet patient needs.

This project has made clear just how vital BMETs are to a well-functioning hospital. The presence of a well-trained, well-equipped BMET can significantly improve the status of medical equipment, but this progress is only sustainable with continued on-site servicing and repair. When no BMET is present, the equipment status can revert to the original baseline in as little as one year and patient care will inevitably suffer.