Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 12 Issue 1 2023 12 01 Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study 1 11 4512 10.34172/ijhpm.2023.7385 EN Angeli Rawat UNICEF Supply Division Innovation Unit, Copenhagen, Denmark School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada 0000-0002-1313-2796 Agazi Ameha UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia 0000-0002-5796-0972 Jonas Karlström UNICEF Supply Division Innovation Unit, Copenhagen, Denmark Global Programmes and Research, SingHealth Duke-NUS Global Health Institute, Duke-NUS, Singapore, Singapore 0000-0002-7279-428X Lisanu Taddesse Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia Elias Legesse Negeri Frontieri Consult, Addis Ababa, Ethiopia Anne Detjen Child and Community Health Unit, Health Programme Group, UNICEF, New York City, NY, USA 0000-0002-9807-4045 Kristoffer Gandrup-Marino UNICEF Supply Division, Copenhagen, Denmark Noah Mataruse UNICEF Supply Division, Copenhagen, Denmark 0000-0001-8441-163X Karin Källander Digital Health and Health Information Systems Unit, Health Programme Group, UNICEF, New York City, NY, USA Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden 0000-0002-5778-5780 Abraham Tariku Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia Journal Article 2022 05 13 Background In Ethiopia, childhood pneumonia is diagnosed in primary healthcare settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children’s Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA). Methods Key informant interviews (KIIs) were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, district management, and key decision-makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis. Results All participants recommended scaling up the ARIDA initiative nationally as part of Integrated Management of Newborn and Childhood Illness (IMNCI) in primary healthcare. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement was recommended. Conclusion Automatic RR counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.

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