80% of healthcare devices and technologies in Africa come from donations. Here are the conditions for an effective, lasting and useful donation.
Goodwill and best intentions are not enough: the donation of biomedical technologies to poor countries, to be effective, must be transparent, sustainable in the medium to long term, well managed. In practice: it is useless to give a tac if there is not enough electricity to make it work.
With the presentation – which took place during the recent XVIII National Conference – of the Guidelines on the donation of medical technologies in developing countries, the Italian Association of Clinical Engineers thus wanted to start new concrete health paths. “From 40 to 70% of the donated devices”, explained Antonietta Perrone, one of the authors of the Aiic Guidelines and coordinator of the specific area of activity within the Association, “unfortunately it is not usable: it is broken or is in infrastructural contexts deficient or inadequate.
Donating an inefficient device becomes a problem and a waste, which instead of contributing to an improvement in welfare activities then ends up in open landfills ». Yet the disused, but still efficient, equipment could make a difference especially in African countries where medical personnel is only 3% and state health coverage reaches 4% of the population.
“In Ethiopia”, Perrone gave as an example, “A recent form of public-private partnership has given life to a service that, thanks to the use of some ultrasound scanners during pregnancy, has helped to reduce postpartum mortality: fortunately there are many examples of this type”. A thirty-year-old woman in these countries may have already given birth to ten children. The loss of elasticity of the uterus exposes these mothers to a high risk of fatal bleeding after giving birth.
“The prenatal ultrasound in these areas is an opportunity to do prevention by identifying women at risk and to train for pregnant women and midwives, otherwise at the mercy of local gurus, unprepared for such situations”, continued the engineer.
The AIIC has made an estimate: 80% of the advanced technology devices and equipment in developing countries come from donations.
“Over 50% of the medical technology that is decommissioned at the hospital level could be donated with both economic and environmental benefits,” said Francesco Ribolzi of the BiomAID Onlus association. Faced with maintenance of the device, often supported by third parties such as non-profit organizations, the hospital would avoid storage and disposal costs.
“Every thousand euros invested in donations generates 7,800 euros of income in developing countries and 1,300 euros of savings for the hospital”, observed Maria Teresa Baldini who dealt with these aspects for the Lombardy Region. and precise rules, however, all these opportunities sometimes become a waste.
Here then is the meaning of the Guidelines developed by the AIIC as a tool to make donor and recipient dialogue and make every single donation activity useful and effective. «These first guidelines» observes Antonietta Perone, «put in line the main steps that must be taken to be of help and not create more problems».
In Aiic best practices, a pre-donation phase is envisaged which includes a series of checks that involve donors and recipients in identifying the health needs and local technical-infrastructural capabilities, since it is “useful to have ten electrosurgical units and no oximeter” , explained Perrone, exemplifying the problem.
Next step: the disused instrumentation in Western countries, to be donated must be evaluated not only for its correct functioning, but also based on the presence of suitable environments to be placed, availability of energy resources and on-site availability of spare parts.
A fundamental aspect highlighted by the Guidelines is then staff training: “Instead of ten mammographs that no one knows how to use, better to donate five and provide for the presence of a medical trainer and a maintenance technician in the field for an adequate period”, observed the expert. of the AIIC, which also underlined the importance of a follow-up, that is, a verification of the result obtained with the technological devices implemented, to optimize and adapt the donation to the needs of the population.
“The Aiic guidelines are a beginning, a first step towards a conscious, correct and effective confrontation of these issues”, concluded Antonietta Perrone.