If one-third of donated medical equipment is not being utilized or is inoperable, perhaps its time to focus on the “who” vs. the “what” on medical donation model.
Last week, ReaMedica founder and VisionLink consultant Michael Seo and myself presented at the Fulbright Association’s 38th Annual Conference, Creating Pathways to Peace: Global Health & Education, in Atlanta. We were honored to participate because the conference only accepts presenters who are past Fulbright scholarship recipients and as we are not, they made an exception in including us in the program. It was also an honor to be part of a program that included 2014 Nobel Peace Laureate Kailash Satyarthi, Louis Sullivan, MD, former secretary of Health and Human Services and other dynamic thought leaders. We were also honored to have our work shared with the Fulbright Alumni community who, through Fulbright programs and individually, are creating and implementing global health initiatives around the world. Here is brief conversation describing our work and the presentation.
Michael: In developing countries surplus medical equipment donations are playing an ever-larger role in health systems strengthening. The World Health Organization (WHO) reports that in some developing countries up to 80% of all the medical equipment in the health system has been donated or financed externally. Yet somewhat counter intuitively they also report that up to 70% of the equipment is not operable due to disrepair or inappropriate equipment being donated. On a macro level it is indisputable that the MSRO model needs to be improved.
Lori: The scale of inappropriate donations is discouraging, yet it is also clear that donations benefit millions of people around the world. Lives are improved and saved when in-country and visiting healthcare workers are equipped with the materials they need to diagnose and treat patients. Our presentation had two goals, to share the MedSurplus Alliance model for improving donation outcomes for patients by through standards, accountability, collaboration, capacity building and education. I shared the new MedSurplus Alliance website and encouraged the participants to check out the Code of Conduct and Toolkit.
It was exciting to have two of the session participants ask for help with current projects!
(Pictured: Lori Warrens)
The second goal was to share a for improving medical equipment donations that Michael developed as part of his Masters studies at McGill University. Michael studied the potential impact of introducing and analyzing the possible contributions of a different set of beneficiaries (recipients of a medical equipment donation) such as Social Enterprises and Health Entrepreneur Businesses.To help accomplish this, Michael has developed a Beneficiary Profile-Institutional Change Map that he shared with the participants.
Michael: The map was developed specifically in the context of medical equipment surplus repurposing better known ad donations and does not include pharmaceuticals. Much of the medical equipment recovery dialogue focus on what: what do we have, what do they want and what should we send. It’s a donor bias. In a system where estimates calculate one-third of equipment not being utilized or inoperable perhaps the question should focus on “who”. Focusing on “who” is not discarding “what” rather it is a different point of analysis. We are still asking the same questions of why so much donated medical equipment is unused or unusable, but if we are seeking radical improvement it is unlikely to occur when the actors an behaviors remain constant.
I believe that introducing a new set of actors such as Social Entrepreneurs and Health Entrepreneur Businesses will accelerate the improvement of efforts and require the development of new skills sets and a rethinking across the medical equipment donations sector. The Beneficiary Profile-Institutional Change Map diagrams this hypothesis.
Lori: The MedSurplus Alliance will host a stakeholder webinar to review the map and discuss how the Alliance can help test the hypothesis and incorporate what we learn in to our work.
To sign up for the webinar or for more information about the presentation, please email us a firstname.lastname@example.org.
AN ALLIANCE FORMS During a mid-July 2012 meeting, about 70 leaders of medical surplus recovery organizations took early steps toward creating a formal network aimed at increasing the efficiency, professionalism and supply chain systems expertise of the sector. They met in Atlanta at a conference sponsored by the Partnership for Quality Medical Donations and funded by a Gerard Health Foundation grant to CHA.
The meeting’s goals were to:
• Understand the current status and impact of medical surplus recovery in the United States, globally and in developing countries
• Understand the issues and drivers affecting medical surplus recovery
• Understand the opportunities and strategies to improve outcomes for recipients
• Discuss options for collaboration and partnerships • Determine readiness to lead or participate
• Identify next steps
Lori Warrens is VisonLink’s senior director of community solutions. She also is former Executive Director at the Partnership for Quality Medical Donations, which initially volunteered to work with the medical surplus recovery organizations. Warrens is a driving force for the MedSurplus Alliance’s advancement, and she participated in a Q and A to bring us up to date.
Health Progress: How is this work organized?
Lori Warrens: There are three main groups or components of this project:
• The MedSurplus Alliance, whose current participants are the MedSurplus Network and VisionLink, which is providing leadership and administrative support.
• MedSurplus Stakeholder Group, which will be the driving force behind the work. Currently under development, the stakeholder group will be made up of high-level individuals from the nonprofit, private and public sectors and international organizations. The group will provide thought leadership and influence that drive medical surplus recovery organization performance and accountability to a higher level. The stakeholder group also will oversee an accreditation program. Proposed members include: the World Health Organization/Pan American Health Organization, CHA and other hospital associations, InterAction, medical product manufacturers, academic and research institutions, logistics and technology companies.
• MedSurplus Network, a formal, incorporated association of medical surplus recovery organizations that is governed by a board of directors and association bylaws. Its goal is to develop and support a learning and practice network dedicated to improving medical surplus recovery standards and outcomes. Current resources and activities include: a website, code of conduct, toolkit, networking and annual conference. Members include: medical surplus recovery organizations, mission trip organizations and other stakeholders.
HP: What are the current projects?
Warrens: The network is exploring and piloting new business models designed to improve donation outcomes and explore opportunities for medical surplus recovery organizations to work on joint projects. Two pilot projects were launched in 2013:
• Zambia — A joint project with Catholic Relief Services and Churches Health Association of Zambia. The project is exploring strategic supply of commonly used consumable products to eliminate stock outages of those products and supplement supply budgets.
• Mozambique — A project with an in-country team of business, nonprofit, academic and health leaders. The goal is to support the development of an occupational health and safety clinic to meet the needs of workers in the extractive, or mining, industries. The clinic will provide fee-based and free services.
HP: Why is this important to Catholic health care organizations? What’s in it for them?
Warrens: Health care organizations turn to professional associations and accrediting bodies to provide leadership and guidance that shape their operations and practices. Now, for the first time, there is an association committed to helping health care organizations to be effective stewards of their excess products and product donation programs.
The MedSurplus Alliance also can help to communicate good news about health care organizations’ commitment to improving the health of people around the world and minimizing waste.
HP: You are investigating certification for medical surplus recovery organizations. Why? What could it mean for the issue of broken, unneeded or inappropriate donations?
Warrens: Medical surplus recovery organizations have well-documented histories of poor quality donations, sloppy practices and negative outcomes for recipient non-government organizations. The steering committee recognized early in the process of developing the Medical Surplus Recovery Code of Conduct that it needed to take additional steps to professionalize practices and improve outcomes. Creating an association, providing a learning and practice network and hosting education events were recognized as important first steps. However, real change in practice and reputation requires implementing a process to document that medical surplus recovery organizations are adhering to a higher standard.
The impact on broken, unneeded and inappropriate donations is threefold. Building awareness of the problem can sensitize donors, medical surplus recovery organizations and recipients to the harm that inappropriate donations cause and mobilize them to take action to improve practices. Creating voluntary standards is the most common way for an industry to regulate itself and raise the level of practice. It provides a method for identifying professional and high quality organizations. These standards also can provide a framework for regulations that provide additional safeguards to prevent inappropriate donations. Donors benefit by working with nongovernmental organization partners that are committed to quality practices.
HP: What are some of the pros and cons of certification, for both medical surplus recovery organizations and for health care organizations?
Warrens: My thoughts include these pros:
• Certification provides a clear indication that an organization is committed to quality by undergoing a voluntary evaluation.
• By undergoing regular reviews by an impartial and respected body, certification encourages donor and recipient confidence in medical surplus recovery organizations.
• Certification enhances donor satisfaction with medical surplus recovery organizations and their clients.
• Regular assessment of system effectiveness, efficiency and competence promotes continual improvement for the medical surplus recovery organizations and their clients.
• Certification provides a competitive advantage to medical surplus recovery organizations and creates added value for donors that want to be sure their donations are used appropriately.
Among the cons:
• There are additional operating costs associated with accreditation. They include application fees and site visit expenses. There also may be expenses associated with building capacity to meet the code of conduct expectations.
• The code of conduct and certification create awareness of poor practices — initially, that may have a negative impact on some medical surplus recovery organizations.
HP: What is the ultimate goal of the network and alliance, and how will it bring help and hope to low-income countries?
HP: From your perspective, is the tide turning on current destructive practices?
Warrens: We can learn from the experience of pharmaceutical donations. It took international nongovernmental organizations and the World Health Organization working together to raise awareness of inappropriate pharmaceutical donations, set standards and work to advance quality practices. Today, thanks to that work and the efforts of the Partnership for Quality Medical Donations, strides have been made in eliminating expired and poor quality product donations.
Now, for the first time, there is an organization that is taking ownership in the fight to eliminate inappropriate medical consumable, equipment and device product donations. We are building on the work that improved pharma donations, and we are expanding our strategies to build awareness of the problem and offer practical tools and solutions.
The volume of donations and the range of donors are immense. It will take years to create real change. What we need to do now is determine how to measure impact and set goals to guide our work.
BRUCE COMPTON is a Senior Director of International Outreach at Catholic Health Association, St. Louis.