Availability and Utilization of Medical Devices in Jimma Zone Hospitals, Southwest Ethiopia: a Case Study Beyene Wondafrash Ademe1*, Bosena Tebeje2 and Ashagre Molla3
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Ademe et al. BMC Health Services Research (2016) 16:287 DOI 10.1186/s12913-016-1523-2 RESEARCH ARTICLE Open Access Availability and utilization of medical devices in Jimma zone hospitals, Southwest Ethiopia: a case study Beyene Wondafrash Ademe1*, Bosena Tebeje2 and Ashagre Molla3 Abstract Background: Health systems throughout the world, whether in developed or developing countries, are struggling with the challenge of how to manage health-care delivery in conditions of resource constraint. The availability and utilization of various health care equipments at all levels of the health care system has been emphasized for effective and efficient service delivery. In Ethiopia lack of proper management of medical equipment limited the capacity of health institutions to deliver adequate health care. The main objective of this study was to assess availability and utilization of medical devices and identify reported reasons that affect availability and utilization of medical devices among hospitals in Jimma Zone. Methods: A cross-sectional multiple case-study using mixed quantitative and qualitative methods was used. Three hospitals of Jimma Zone were included in the study. Adapted and pre-tested structured English version checklist for availability and utilization of medical equipment and document review as well as interview guide for in-depth interview were used for data collection. Data were collected by observation of availability of the devices, interviewing selected professionals and document review of health care services using devices in the study hospitals. Data were analyzed using SPSS 16.0 statistical software. Descriptive analysis was made to determine the availability and functional status of medical devices. For qualitative part responses were transcribed, categorized and thematically analyzed. Results: Observation and interview using checklist showed that 299 medical devices were available in the three hospitals among which, 196 (65.6 %) of them were available in Jimma University Specialized Hospital whereas, 57 (19.0 %) and 46 (15.4 %) were available in Limu Genet hospital and Shenen Gibe hospital respectively. Among 196 available medical devices in JUSH, 127 (64.8 %) were functional and the rest; 63 (32.1 %) and 6 (3.1 %) were not functional and not in use respectively. Similarly, 28 (60.9 %) and 30 (52.6 %) of the devices in Shenen Gibe hospital and LGH respectively were functional. Conclusion: More than a third of medical devices in the three study hospitals were not functional. Purchasing devices with bids and preference for cheap price, lack of training on how to operate devices, less sense of accountability, power interruption, staff work overload and lack of maintenance experts, and inappropriate referral system were among the reported reasons for influencing availability and utilization of medical devices. Keywords: Medical devices, Availability, Utilization, Functionality, Southwest Ethiopia * Correspondence: [email protected] 1College of Health Sciences(CHS), Population and family Health Departement, Jimma University, Jimma, Ethiopia Full list of author information is available at the end of the article © 2016 Ademe et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Ademe et al. BMC Health Services Research (2016) 16:287 Page 2 of 10 Background state, Southwest part of Ethiopia. Based on the 2007 cen- Eventhough medical devices are indispensible for all as- sus, the Zone has a total population of 2,486,155. The pects of healthcare many appropriate technologies are three hospitals in Jimma Zone are Jimma University inaccessible to the majority of people who need them, Specialized Hospital (JUSH), Shenen Gibe Hospital (SGH) particularly in low and middle-income countries [1]. and Limu-Genet Hospital (LGH) [9]. Many people in developing countries do not have access JUSH and SGH are found in Jimma town which is to health technologies, even basic ones. These technolo- located 350 km southwest of Addis Ababa. JUSH is the gies include life-saving medicines, such as antiretroviral only teaching and referral hospital in southwest part of for HIV/AIDS, as well as life-enhancing medicines, such the country. JUSH has bed capacity of 450 and a total of as antiasthma medications that help stop asthma attacks more than 750 staffs of both supportive and professional. and improve breathing. It provides services for approximately 9000 inpatient and Essential medical products must be available at all times 80,000 outpatient attendances a year, coming from the at the appropriate level within the health-care system. [2]. catchment population of about 15 million people. SGH is Improvements in the health of much population are asso- newly established hospital located on other end of the city ciated with the improved ability to predict, prevent, diag- and serves communities of the city and surrounding areas. nose and cure many illnesses, and to alleviate functioning LGH is a district hospital found in Limu-Genet town that problems using treatments and technologies [3]. A well- is located 80 km south of Jimma town. functioning health system ensures equitable access to es- Cross-sectional case study with mixed methods in- sential medical products, vaccines and technologies of cluding in-depth interview, observation and document assured quality, safety, efficacy and cost-effectiveness, and review was conducted. Observation of devices at 16 units, their scientifically sound and cost-effective use [4]. document review; and nine in-depth interviews were con- Health systems throughout the world whether in devel- ducted. Adapted structured English version checklist for oped or developing countries, are struggling with the chal- availability and utilization of medical equipments from the lenge of how to manage health-care delivery in conditions report by Indian Employee’s state insurance corporation of resource constraint [5]. Lack of working equipment has [10] document review, and interview guide for in-depth a devastating effect on healthcare in resource-poor set- interview were used for data collection. The checklist was tings. It is often said that most of the medical equipment adapted to be suited for district and referral hospitals. This in the developing world is broken with estimates ranging was done by considering the services available at referral up to 96 % out of service. More than 50 % of the labora- and district hospital in Ethiopia. Some of the medical de- tory and medical equipments in resource-poor settings vices from the list were omitted to study district hospitals are not in service [6]. since those medical devices were not available due to In Ethiopia, lack of proper management of medical the unavailability of a particular service in the hospital equipment has limited the capacity of health institutions e.g. major devices used for ICU were not included since to deliver adequate health care. It is estimated that only the ICU service is not available in district hospitals. about 61 % of medical equipments found in Ethiopian The checklist include medical device lists which should public hospitals and other health facilities are functional be present in typical district or referral hospital and num- at any one time. Medical equipment management de- ber of available devices with level of functionality and fines organization and coordination of activities that en- frequency of monitoring. The availability of the medical de- sure the successful management of equipment related to vices was checked by observation of different units using patient care in a health facility [7, 8]. the checklist. The units where observation conducted were However, there is limited evidence in availability and radiology, ophthalmology, laboratory, Operation Theater utilization of medical devises and technologies in Ethiopian and Central sterilization, maternity and newborn care, and hospitals in general, and in hospitals of Jimma zone in par- Intensive care unit (ICU). ICU observation was conducted ticular. Therefore, this study was designed to identify the only on the specialized teaching hospital since the service reported reasons that contributed to availability as well as is available in JUSH among the study hospitals. Patients’ utilization of medical devices in the respective hospitals. registration books and procedure registration books were This will help hospital administrators and other stake- reviewed. Functional status of the equipments were deter- holders to create awareness as a means of resolving prob- mined as “functional” if it was on use during data collec- lems through communication and to take informed actions tion, “not functional” if it stopped functioning and “not in for better health care delivery. use” if it was not ever used since the device were procured or donated. Methods Data were collected from different departments of the The study was conducted from August 6–30, 2013 in all study hospitals by using observation checklist, interview three hospitals found in Jimma Zone,