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Duke T, Hwaihwanje I, Kaupa M, Karubi J, Panauwe D, Sa'avu M, Pulsan F, Prasad P, Maru F, Tenambo H, Kwaramb A, Neal E, Graham H, Izadnegahdar R. Solar powered oxygen systems in remote health centers in Papua New Guinea: a large scale implementation effectiveness trial. J Glob Health 2018; 7:010411. [PMID: 28567280 PMCID: PMC5441450 DOI: 10.7189/jogh.07.010411] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pneumonia is the largest cause of child deaths in Papua New Guinea (PNG), and hypoxaemia is the major complication causing death in childhood pneumonia, and hypoxaemia is a major factor in deaths from many other common conditions, including bronchiolitis, asthma, sepsis, malaria, trauma, perinatal problems, and obstetric emergencies. A reliable source of oxygen therapy can reduce mortality from pneumonia by up to 35%. However, in low and middle income countries throughout the world, improved oxygen systems have not been implemented at large scale in remote, difficult to access health care settings, and oxygen is often unavailable at smaller rural hospitals or district health centers which serve as the first point of referral for childhood illnesses. These hospitals are hampered by lack of reliable power, staff training and other basic services. METHODS We report the methodology of a large implementation effectiveness trial involving sustainable and renewable oxygen and power systems in 36 health facilities in remote rural areas of PNG. The methodology is a before-and after evaluation involving continuous quality improvement, and a health systems approach. We describe this model of implementation as the considerations and steps involved have wider implications in health systems in other countries. RESULTS The implementation steps include: defining the criteria for where such an intervention is appropriate, assessment of power supplies and power requirements, the optimal design of a solar power system, specifications for oxygen concentrators and other oxygen equipment that will function in remote environments, installation logistics in remote settings, the role of oxygen analyzers in monitoring oxygen concentrator performance, the engineering capacity required to sustain a program at scale, clinical guidelines and training on oxygen equipment and the treatment of children with severe respiratory infection and other critical illnesses, program costs, and measurement of processes and outcomes to support continuous quality improvement. CONCLUSIONS This study will evaluate the feasibility and sustainability issues in improving oxygen systems and providing reliable power on a large scale in remote rural settings in PNG, and the impact of this on child mortality from pneumonia over 3 years post-intervention. Taking a continuous quality improvement approach can be transformational for remote health services.
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Affiliation(s)
- Trevor Duke
- Center for International Child Health, University of Melbourne and MCRI, Melbourne, Australia.,School of Medicine and Health Sciences, University of PNG, Taurama Campus, NCD, Papua New Guinea
| | - Ilomo Hwaihwanje
- Goroka General Hospital, Eastern Highlands Province, Goroka, Papua New Guinea
| | - Magdalynn Kaupa
- Mt Hagen General Hospital, Western Highlands, Mount Hagen, Papua New Guinea
| | - Jonah Karubi
- Mt Hagen General Hospital, Western Highlands, Mount Hagen, Papua New Guinea
| | | | - Martin Sa'avu
- Mendi Hospital, Southern Highlands Province, Mendi, Papua New Guinea
| | - Francis Pulsan
- School of Medicine and Health Sciences, University of PNG, Taurama Campus, NCD, Papua New Guinea
| | | | - Freddy Maru
- AusTrade Pacific, Port Moresby, Papua New Guinea
| | - Henry Tenambo
- Health Facilities Branch, National Department of Health, Papua New Guinea
| | - Ambrose Kwaramb
- Health Facilities Branch, National Department of Health, Papua New Guinea
| | - Eleanor Neal
- Center for International Child Health, University of Melbourne and MCRI, Melbourne, Australia
| | - Hamish Graham
- Center for International Child Health, University of Melbourne and MCRI, Melbourne, Australia
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