Strengthening Indonesia’s capacity to use mechanical ventilators for COVID-19 treatment and mitigation: Field monitoring report

The LINKAGES Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) Project was contracted to strengthen Indonesia's capacity to utilize the mechanical ventilators for COVID-19 care and treatment. Meditrans Indonesia handled ventilator distribution, set up, and support for machine maintenance. Approximately 905 ventilators were distributed by Meditrans, and 1,572 health care workers across 458 facilities in 211 districts and 13 provinces received ventilator capacity development by the LINKAGES project. A field monitoring visit was conducted at 44 COVID-19 treatment hospitals across 13 provinces in October-November 2021 to assess the condition of donated ventilators, understand their utilization, identify challenges, and issue recommendations. The assessment found that the majority of ventilators arrived at the designated facility in good working order, with 97.5% of 123 Vyaire ventilators arriving in good condition. Ninety-seven facilities performed a ventilator check, and 76 sites sent the results to Meditrans Indonesia. Ventilator training and capacity development were provided by Meditrans Indonesia and the LINKAGES project, with 122 health care workers participating in Meditrans-facilitated training sessions and 84 persons participating in LINKAGES' capacity development sessions. Facilities employed their US-donated ventilators in ICU wards, with nine facilities adding that Vyaire ventilators were used in emergency rooms and seven sites highlighting ventilator utilization during patient transport. Approximately 1,042 COVID-19 patients received mechanical ventilation using US-donated ventilators since installation at the assessment facilities. The number of ventilated patients increased significantly after receiving Vyaire ventilators, with 42 reporting facilities providing mechanical ventilation to 1,120 patients, an increase of 8.9 patients per month per facility. Participants in the assessments described the need for additional training and mentoring support to increase their confidence and skills in ventilator maintenance and utilization. Face-to-face capacity development was highlighted as a priority, and some facilities suggested the need for training of trainers (TOT) sessions to cascade capacity development for new staff. Recommendations were made to facilitate continued ventilator utilization following the end of US Government support, including providing additional training and mentoring support, conducting TOT sessions, and developing training materials for independent training sessions.