Paper short abstract:

The application of complexity science is critical to the effective delivery of health services. This study assessed the status, leadership dynamics and bottle necks and proposed changes needed to create adaptive systems for health care equipment management across 100 laboratories in Uganda.

Paper long abstract:

Equipment is a critical input for health service delivery, enabling health service providers to diagnose, treat, monitor, rehabilitate and identify emerging diseases. Equipment procuring, maintenance, reagents, training and disposal requires a complex array of institutions which many countries lack. This study conducted a health equipment audit across 100 health facilities in Uganda to identify systems constraints and leverage points across procuring, maintenance, reagents, health worker training and decommissioning of obsolete equipment. The study found more than 70% high grade equipment in a state of dysfunction due to the lack of policies on procurement, lack of reagents, lack of maintenance and obsolescence. Equipment was procured through multiple channels including donations, government purchases and research without maintenance plans or orientation training for health workers. There was under utility of functional equipment which could ideally cover a spectrum of investigations but was only used to diagnose and monitor HIV and Tuberculosis, neglecting core diseases like malaria and syphilis. Despite the rise in non communicable diseases, equipment for diagnosing these was only found in 45% facilities. In 85% facilities, there were no schedules for maintenance of equipment or for disposal of obsolete items. We found that in 76% facilities which should be able to run tests on available equipment ended up referring these tests with financial, health and equity consequences for their clients.By applying complexity science towards the harmonisation of equipment management in Uganda, this paper proposes a strategy for harmonising equipment management in Uganda to ensure universal health coverage towards meeting SDGs.