Early signs of impact in rural health facilities in Zambia: Energy-efficient solar-charged medical appliances

Tokozile N. Ngwenya

The Frontier Technologies Programme, which is funded by the Foreign, Commonwealth and Development Office has partnered with SolarAid and successfully distributed solar-powered non-contact infrared thermometers, pulse oximeters, foetal dopplers and digital blood pressure monitors to offer safe assistance with medical care to rural health facilities in December 2020.

Through SolarAid’s work with our collaborating partner Churches Health Association of Zambia (CHAZ) and local communities, we learned there were three rural health clinics in Lusaka and Central Provinces of Zambia that were in need of solar lights as well as energy-efficient medical appliances. We reached out to the rural clinics and asked whether they would benefit from medical equipment to support their diagnosis of patients. With the on-going COVID-19 pandemic, these communities find themselves in precarious situations.

This is the first sprint of a pilot- read our introductory Medium post here, in which SolarAid will scale up to an additional seven (7) rural health clinics in the Eastern, Southern and North-Western part of Zambia. All ten (10) will obtain the latest plug-and-pay, PAYG solar systems accompanied by energy-efficient medical appliances.

Zambia Helpers Society Rural Health Clinic

“The BP (blood pressure) machine is working and has helped us on days when we have antiretroviral therapy (ART), the screening process for other clients is not disrupted.” — Sister Odilia Chilombo of Zambia Helpers Society Rural Health Centre.

Sister Grace Mukupa, St Paul’s Mulungushi Mission Rural Health Centre In-charge attending to a patient. Photo credit: SolarAid/Jason J Mulikita

This health facility based in Lusaka Province under Chilanga district serves a catchment population of 1,786 people. Prior to the deployment of the medical equipment, the facility only had one blood pressure machine and one infrared thermometer. With access to new medical equipment, the way that medical attendants are now conducting their work has been greatly improved. Because of the lack of equipment, the clinic was previously unable to screen oxygen levels. With the introduction of a pulse oximeter, this element can now be included when obtaining vitals from the patients.

The foetal doppler has also been an important tool at the maternity ward. Mercy Namwinga of Zambia Helpers Society Rural Health Centre states, “The foetal doppler is more accurate as compared to foetal scope. The foetal scope can only be used after a certain time (when the pregnancy has advanced). The advantage of the foetal doppler is that it can be used even when the foetus is young.” Mercy continues, “It has improved our work, the foetal doppler is faster and louder, you are able to get the foetal heart rate clearer.”

The overall feeling among the staff at the clinic is that the medical equipment has reduced the patient waiting time, as there are more instruments to use, such as the blood pressure monitor. This means that several patients can be attended to at the same time. In addition, diagnosis of temperature using the non-contact infrared thermometer is timely, considering the COVID- 19 restrictions and guidelines that need to be followed. A non-contact infrared thermometer can measure within 1–15 centimetres, it is safer as it allows for a distance between the patient and medical staff.

Chipembi Mission Rural Health Centre

Chipembi Health Facility is located around 100 km from the capital Lusaka under Chisamba District of Central province. The facility caters for a population of 11,976 individuals. Before deployment of the medical devices, the facility had a blood pressure monitor that was functioning, however, all infrared thermometers had broken. The staff welcomed the digital blood pressure monitor, infrared thermometer, foetal doppler and pulse oximeter.

The nurse in-charge explains how the medical attendants are now able to detect patient’s oxygen levels which are low, below 90. During the month of January this year, the clinic had run out of COVID-19 rapid kits. However, as a result of a low reading of oxygen, screened with the new pulse oximeter, the facility was able to refer it’s first case of COVID-19. Upon observing the low reading of oxygen in addition to other symptoms presented, the patient was referred to Kabwe General Hospital for further testing. There, the patient tested positive for COVID-19. This would not have been possible without the use of the pulse oximeter.

Pulse oximeter diagnosing a patient’s oxygen level. Photo credit:SolarAid/Jason J Mulikita

A pulse oximeter is a non-invasive and painless instrument that measures oxygen levels in the blood. It can quickly identify small changes in how efficiently oxygen is being carried to furthest parts of the heart, as well as the legs and the arms.

“The pulse oximeter helps us know which cases to refer, for example, we do not have oxygen services at our clinic. When we have a serious case of COVID-19, it helps us ascertain who needs to go to the next level.” — Esther Sakala of Chipembi Mission Rural Health Centre.

The workers at the facility say they feel better equipped and prepared to handle the diagnosis of COVID-19 cases even when their supply of rapid COVID-19 kits is unavailable.

St. Paul’s Mulungushi Mission Rural Health Centre

“This is my second pregnancy, during my first pregnancy, the medical attendant used a foetal scope, however during this current pregnancy a foetal doppler was used. I prefer the foetal doppler because with the foetal scope I was unable to hear if my baby was breathing.” — Olivia Chivita, patient at St. Paul’s Mulungushi Mission Rural Health Centre.

A foetal doppler is a handheld ultrasound instrument used to identify the foetal heartbeat of a foetus. It uses the doppler effect to provide an audible replication of the heartbeat. One advantage of the foetal doppler over a foetal scope is its ability to produce an electronic audio output, which allows people other than the physician to hear the heartbeat.

Mercy Namwinga, Zambia Helpers Society Health Centre Registered Nurse attending to a patient. Photo credit: SolarAid/Jason J Mulikita

St. Paul’s mission is located under 200kilometres from Lusaka under Kapiri Mposhi District of Central Province. The facility has a catchment population of 13,211. The medical devices were distributed at an opportune time when the facility only had one blood pressure machine and had never received any of the other medical appliances designated for the health facility.

Early Impact

So far everything has been going smoothly with the solar systems. Across all three facilities, the early impact that has been observed since the delivery of medical appliances is an increase in satisfaction from both medical staff and patients. The solar system has improved the way that the health facilities operate, now they have a backup that ensures that they are able to continue their work without disruption. Previously the laboratory would close and night nurses on duty would wait until daylight to conduct screening. The foetal doppler allows for closer interaction with the mother and her unborn child, as the mothers are now able to hear for themselves the foetal heartbeat, rather than waiting for the medical attendant to complete the diagnosis and relay the status of the foetus. The proximity between the patient and the medical attendant allows for a good distance, bearing in mind the Covid-19 guidelines and measures being implemented. The infrared thermometers were offered at an appropriate time where Covid-19 measures are being observed. Temperature can now be observed without physical contact as is done with the traditional thermometers. The infrared thermometers are also faster and provide a reading that the patient is able to clearly read for themselves, thus increasing a sense of comfort.

The largest impact has been the increased number of working hours to attend and care for patients.

Our initial key assumptions included our belief that:

• The plug and play solar systems would increase the range and quality of health services available
• Medical staff would find value in using new medical equipment
• Plug and play solar would increase patient satisfaction
• Solar power generated would be enough to charge medical equipment provided
• Clinical equipment would be easy to use and meet the demands of the clinic

The findings from the facilities have validated our initial assumptions and given confidence to the team as we scale up to the additional seven (7) rural health clinics.

Learnings

From this initial assessment we offer the following learning advice:

• We found that it was helpful to conduct a baseline assessment at the clinic prior to installing the solar systems to determine the specific needs which would inform the installation process, as opposed to conducting both activities simultaneously
• Consulting with the clinic staff on the rooms to install the solar lights that would have the greatest impact. The wards selected often included the maternity, labour ward, In-charge’s office, children’s ward and the screening room, additionally, this fostered a feeling of ownership among the staff

In conclusion, this was a successful first sprint that confirmed our assumptions of the need for solar lighting and energy-efficient solar-charged medical equipment. Going forward we will develop criteria to assess one rural health facility that will receive a solar fridge in the second sprint that will potentially have the most impact on the patients and medical staff of the selected clinic.