Establishment of a high-dependency unit in Malawi

Area of Science:

• Critical Care Medicine
• Global Health
• Health Systems Strengthening

Background:

• Adults with critical illness in sub-Saharan Africa face high morbidity and mortality due to limited resources.
• Increasing life expectancy leads to more complex patient demographics and healthcare needs, requiring integrated critical care approaches.
• Enhanced critical care provision, including standardized delivery, specialist staff, and organ support, can improve patient outcomes.

Purpose of the Study:

• To describe a participatory approach for designing and implementing a sustainable high-dependency unit (HDU) in a low-income, sub-Saharan African setting.
• To address the specific needs of patients and healthcare providers in Malawi's critical care services.
• To outline the key components and considerations for establishing such a unit.

Main Methods:

• A participatory design process involving managers, clinicians, nurses, and patients.
• Alignment with existing healthcare services and refurbishment of a dedicated physical space.
• Recruitment and training of specialist nurses, development of context-specific standard operating procedures, procurement of appropriate equipment, and creation of digital clinical information systems.

Main Results:

• Successful establishment of a new high-dependency unit at Queen Elizabeth Central Hospital, Malawi.
• The unit was designed collaboratively to meet local needs and ensure sustainability.
• The unit's opening was accelerated due to the COVID-19 pandemic, and it effectively responded to increased demand.

Conclusions:

• A participatory, context-sensitive approach can successfully establish a sustainable high-dependency unit in resource-limited sub-Saharan African settings.
• The developed model provides a framework for improving critical care infrastructure and services in similar regions.
• The unit demonstrated its value and adaptability, particularly during the COVID-19 pandemic.