By Jonathan Howard-Brand, Supply Specialist (Innovation)
From 29 March to 2 April 2016, Bissie and I travelled to beautiful Bolivia to work with the Country Office on how to field trial the ARIDA devices (Acute Respiratory Infection Diagnostic Aid.)
Carmen Lucas, the Programme Officer who is our focal point, coordinated the project from the country office and is a great host. She has over 19 years’ experience and dedication to UNICEF Bolivia and therefore a lot of experience working with the ministry, both at national and regional levels.
Bolivia is different from some countries in that its health system is decentralized, meaning each region is responsible for its health system, including procurement. UNICEF supports the health system in two of the nine regions: Potosi and Cochabamba. PAHO (Pan American Health Organization) supports the other seven regions. This means that we need to keep PAHO in the loop throughout our field trials as any scale-up will need to be done in collaboration with them.
Whilst in La Paz, we met with the national level Ministry of Health who were very positive about the field trial. They advised that we work closely with the regional ministries in Potosi and Cochabamba to agree to the specific sites for the 300 healthcare workers and health facility workers to field trial the ARIDA devices. Through the meetings with the ministries they confirmed our assumptions that ARIDA will aid the health workers in the hardest part of their diagnosis – the counting of breaths. They admitted that some health workers do not even do the respiratory rate count. This is because of the challenges involved with counting respiratory rates using wrist watches as the aid to count time (wrist watches are used in Bolivia instead of the ARI timers). Instead of counting breaths, the health workers look for other vital signs and then give out Amoxicillin.
In Potosi we visited two health centers. Both were ‘quiet’ — they are relatively close to the local hospital so local people visit the hospital in Potosi rather than the local health center. This is one aspect we have to think about for all of our field trials in order to get significant users and therefore data to analyze the use of the ARIDA devices.
During our visit to one health centre we showed the “ARI timer” which is used in most countries to aid in defining the respiratory rate of the child. Some of the older health workers recognised the ARI timer, but explained that in Bolivia they use a simple wrist watch to time the 60 seconds in which the breaths are counted. From here the health workers went on to explain some of the challenges using the wrist watches, and one particular challenge was watching the child’s chest, and watching the watch at the same time. No one we spoke to knew why the ARI timer was not ‘scaled’ compared to the watches, but felt that the automated ARIDA device would overcome many of the challenges associated with breath counting.
- The Request for Proposals for Services (RFPS) has closed for the field trial and protocol development. We now have to conduct the technical and commercial evaluation in order to get this work going.
- The Specifications for the devices has been created and we will be launching this tender soon.
- We will be going into detailed planning with countries in order to make the field trials happen.
- We need to conclude the choice of the next countries within the following regions – ESARO, WCARO, ROSA and EAPRO.