A health systems engineering approach to meeting the demand for skilled foetal ultrasound services in the Boland/Overberg public health district

Uys, Nina (2010-10)

Final year project, 2010

Technical Report

ENGLISH ABSTRACT: In its Millennium Development Goals, the United Nations prioritizes the improvement of maternal health in developing countries. The World Health Organization argues that this can be done through improving the accessibility and quality of basic maternal health care, which includes ultrasound services. In South Africa, many clinics and hospitals have ultrasound machines, but there is a lack of skilled personnel to operate them and to provide safe and meaningful service. The purpose of this project was to find an optimal combination of technology and business processes to meet the sonography skills shortage in South Africa in a sustainable way. Alternative solutions to educating a nurse or midwife at a rural clinic in sonogram acquisitioning and interpretation were investigated. The technological requirements for each were identified. An information and communications technology audit was then done to determine if these solutions are technologically feasible. All of the systems were deemed feasible. These solutions were then tested for their economic feasibility through an analytic hierarchy process. From these two feasibility studies, the most feasible solution was an asynchronous tele-ultrasound system. This system was developed by the Biomedical Engineering Research Group and the Department of Obstetrics and Gynaecology (OB/GYN) at the University of Stellenbosch, in collaboration with the Department of Bioengineering at the University of Washington. The system is composed of a portable ultrasound machine, a laptop and a server. It was evaluated in 2008 by a midwife in South Africa and three OB/GYN specialists in the United States of America. The midwife had low-level pre-existing ultrasound knowledge and interpretation skills. The legal requirements for the implementation of the system in a Boland/Overberg public health district clinic were evaluated. Next, through process reengineering, the new system was designed to be incorporated in a typical consultation between a nurse and pregnant patient. Finally, the scheduling requirements to ensure the success evaluation and safety of the system were done. It was found that overall this system is feasible within the Boland/Overberg health district. Further studies were recommended for the further implementation of the system.

AFRIKAANSE OPSOMMING: In hul Millennium Ontwikkelingsdoelwitte, prioritiseer die Verenigde Nasies die verbetering van gesondheid tydens swangerskap in ontwikkelende lande. Die Wêreld Gesondheidsorganisasie beweer dat dit bereik kan word deur die toeganklikheid en gehalte van basiese gesondheidsdienste tydens swangerskap te verbeter. Dit sluit ultraklankdienste in. In Suid-Afrika het klinieke en hospitale meestal ultraklankmasjiene – maar daar is ’n tekort aan vaardige gesondheidswerkers wat dié masjiene kan gebruik om veilige en betekenisvolle dienste te lewer. Die doel van hierdie projek was om die optimale kombinasie van tegnologie en besigheidsprossese te vind, om sodoende die tekort aan sonogramvaardighede in Suid Afrika op ’n volhoubare manier aan te spreek. Alternatiewe oplossings is ondersoek om deur opleiding die sonogramvaardighede van ’n suster of vroedvrou by ’n landelike kliniek te verbeter. Die tegnologiese behoeftes vir elke oplossing is geïdentifiseer. ’n Informasie- en kommunikasietegnologie-oudit is toe gedoen om te bepaal of die oplossings tegnologies haalbaar is. Die oudit het gewys dat al die oplossings wel haalbaar is. Deur ’n analitiese hiërargieproses te gebruik, is die oplossings toe getoets vir hul ekonomiese haalbaarheid. Vanaf die twee haalbaarheidstudies is die mees haalbare oplossing gevind, naamlik ’n asinchrone tele-ultraklank sisteem. Dit is ’n sisteem wat in 2008 ontwikkel is deur die Biomediese Ingenieurswese Navorsingsgroep en die Departement van Verloskunde en Ginekologie van die Universiteit Stellenbosch, in samewerking met die Departement van Bio-Ingenieurswese van die Universiteit Washington. Die sisteem bestaan uit ’n draagbare ultraklankmasjien, ’n skootrekenaar en ’n bediener. Dit is geëvalueer deur ’n vroedvrou in Suid Afrika asook drie verloskunde- en ginekologie-spesialiste in die Verenigde State van Amerika. Die vroedvrou het bestaande basiese kennis van ultraklank- en interpretasie-vaardighede gehad. Die wetlike vereistes vir die implementering van die sisteem in ’n openbare kliniek in die Boland/Overberg-gesondheidsdistrik is toe geëvalueer. Daarna is proses- herbewerking gebruik om die nuwe sisteem in ‘n tipiese konsultasie tussen ‘n suster en ‘n pasiënt te inkorporeer. Om te verseker dat die skeduleringshaalbaarheid verseker is, is die vereistes vir sisteem-evaluasie en -veiligheid bewerkstellig.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/18205
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