There are 270 Pima machines currently in Uganda (see earlier post for an explanation of what a Pima machine is and the purpose of it) that need to be rolled out to health centers and introduced with the training package I helped design. We've been supporting the Ministry of Health in figuring out the logistics of the rollout, budgets, where the machines should be allocated, etc.
Working on the rollout has expanded my stores of patience and made me realize or reminded me of a few things (some extremely obvious):
Working on the rollout has expanded my stores of patience and made me realize or reminded me of a few things (some extremely obvious):
- In this context, it's vastly better for something to be done right than done quickly. If the machines are placed within the next week at sites that won't be able to use them fully or don't have proper training in their use and integration, the amount of money wasted will be in the millions. It's scary that this is a real risk that we are trying to work to prevent because there is political pressure to move quickly.
- The allocation of resources toward health (and so many other things) does not get enough strategic consideration. The country purchased these machines at a huge expense, yet funding for training to introduce the machines has been an afterthought and we are now scrambling to help find this funding. Some of the machines may be placed at sites that really don't need them (for example because they have only 10 HIV+ patients) because of political reasons (this is assuming that I don't win the arguments I'm currently having!). The Ministry could have procured fewer machines and spent the remaining money on training for the machines.
- The introduction of new technologies, while hugely valuable, is also a major challenge in this context. Uganda made a big investment in this technology, but within a year or two, there is likely to be an even better machine on the market. Over the past few years, dozens of CD4 machines (each costing upwards of $20,000) have been purchased for health centers that would be better served by a Pima machine (for about $4-5,000) because of their low-medium patient volumes and intermittent access to electricity. Managing the technology transitions and deciding when to invest is a much bigger issue than I had imagined.
Despite the challenges, this is a really exciting project to be working on and one that I hope will have real impact in improving both monitoring of patients' condition and turnaround time to when they can access correct care.
At the CHAI/MOH Christmas party with two of my key partners in the Ministry.... the first outdoor Christmas party I have ever been to!
