Title:
Sustained Use of Ultrasound Equipment in Uganda: an Evaluation
Authors:
Groot, Wilma de
Place:
Amsterdam, The Netherlands
Publisher:
KIT - Royal Tropical Institute [etc.]
Year:
2013
PAGE:
ix, 68
Language:
En
Subject:
Value Chains for Development
Keywords:
sustainability, theory based evaluation, theory of change, institutionalization, donor-funded programs, quantitative research, Africa, Uganda
Abstract:
Background Sustainability continues to be a major concern of many externally- and locally funded healthcare projects in developing countries. In literature on sustainability usually five dimensions are distinguished: economic, social, environmental, institutional and technical sustainability. Main objectives and methods This thesis evaluates the technical sustainability of an externally funded health infrastructure development project in Uganda. Focus of the evaluation was on the continued use and maintenance of ultrasound equipment and on continued availability of competent staff. A ‘Theory Based Evaluation” Weiss (1972) approach was used. To this end a Theory of Change for the technical sustainability of the project was constructed, consisting of 3 pillars: materials, maintenance and training. Information was gathered from 32 out of 52 facilities that had benefitted from the project through a paper-based questionnaire and interviews. In addition a number of key stakeholders were interviewed. Findings The research found that only 60% of the equipment which had been delivered through the project was fully operational. Identified direct reasons for equipment not being used were: no maintenance done (56%), battery down (28%), high voltage malfunctioning (12%), and repairs too expensive for facility (4%). Indirect reasons contributing to equipment not being used were found in the health workforce: transfers of staff (74%), retirement (5%), gone for further studies (11%), not interested (5%) and staff passed away (5%). Poor local adherence to maintenance procedures and lack of trained engineers was found to hamper a good maintenance management structure. The project had a positive impact on the reputation of the local training institute in the country and the rest of East-Africa. The local training institute managed to continue good quality training in ultrasound after the end of the project. Conclusions The fact that only 60% of the delivered equipment were found fully operational, suggests that the issue of sustainability in projects like these need more attention. The research found that the following are important conditions for technical sustainability: (1) establishment of local supportive systems (like health workforce management, budget allocation for districts, maintenance management structure, supply chain), and (2) institutionalisation of training. Research on factors influencing sustainability remains a challenge. The nature and set-up of projects vary tremendously, so generalization of findings is not always possible. Careful consideration must also be given to interactions among the five dimensions of sustainability.
Organization:
KIT - Royal Tropical Institute
,
VU - Vrije Universiteit Amsterdam
Institute:
KIT (Royal Tropical Institute)
Department:
Development, Policy and Practice
Country:
The Netherlands
Region:
Amsterdam
Training:
Master of Public Health
Category:
research
Right:
© 2013 Groot
Document type:
Thesis/dissertation
File:
uYQJay31Go_20171119121733336.pdf