Beyond Good Intentions: Lessons on Equipment Donation from an African hospital/Au-Dela Des Bonnes Intentions : Lecons Tirees D'un Don D'equipements a Un Hopital africain/Las Buenas Intenciones No Bastan: Lecciones De Un Hospital Africano Sobre Las Donaciones De Equipo

Introduction Health services in developing countries often struggle to meet the demands of a high burden of illness in their communities. (1) Health facilities conspicuously lack technology and it is not surprising when medical equipment becomes a focus for well-meaning donors and hard-pressed recipients. In 2000, the Royal Victoria Teaching Hospital (RVTH), the Gambia's tertiary referral centre, received a donation of more than 20 oxygen concentrators, a relatively simple technology that filters nitrogen from atmospheric air to produce oxygen. Oxygen is an essential treatment for several life-threatening conditions including pneumonia, the single biggest cause of death in children less than five years of age. (2) A private group of North American philanthropists had visited RVTH and asked how they might assist the hospital. The chief executive made the request, being conscious of the hospital's oxygen shortage and aware of the advantages of concentrators. The concentrators were received, and a small number of units were put to use initially. Nursing staff reported immediate problems: units typically worked for about 30 minutes before stopping. After an interval a unit would be able to be restarted only to stop again in a recurring cycle. The problem was reported to the donors, who sent a technical assistant to help. Nevertheless, within weeks none of the concentrators remained in use. Local technicians were unable to fix the machines and they were put in storage. They were shown to a paediatrician (SRH) in the context of discussions among staff concerning oxygen supplies. With the support of the senior hospital management, a case study was initiated to explore the reasons for this failure and to learn lessons that could be applied to the development of locally appropriate oxygen delivery solutions and enhance the success of future equipment donations. Methods An assessment of the concentrators was conducted by a qualified biomedical engineer with particular expertise in oxygen concentrators (DP) with the aim of identifying important technical problems. Semi-structured interviews were undertaken with eight key informants (a nurse, a technician, a clinical manager, a hospital accountant, a central government health official, a local health-sector nongovernmental organization director, a visiting engineer trainer and a clinician) selected by stratified purposeful sampling to access a range of perspectives. The informants (designated A to H in no particular order) were asked a series of open-ended questions exploring what they knew of the donated concentrators and their understanding of the reasons why the concentrators did not remain in use. All interviews were recorded and transcribed by the interviewer (SEH) apart from one, which was undertaken by e-mail using written versions of the questions normally asked in person. Interviews were analysed using content analysis and inductive approaches, based on grounded theory methodology, to construct the history of the units and the reasons for the failure. (3,4) Interviews were undertaken between May and December 2004. The project was approved by the Gambia Government--MRC Laboratories Joint Ethics Committee (L2004.E15). Results The informants All informants approached agreed to participate and gave written informed consent for interview. Six of eight had direct knowledge of the concentrators, shown in Fig. 1, and all had knowledge of the local context. Six informants were Gambian and two were non-Gambian. What caused them to fail? An account of the episode is presented in the introduction, and is consistent with the reports of the six informants with direct knowledge of what happened. Reflecting on the episode, informants identified three causes for the failure of this venture: technical problems with the concentrators, limited capacity in the health service to appropriately use and maintain the concentrators, and problems with donations. …