Scale-up of the CRADLE Vital Signs Alert intervention to improve maternity triage in Sierra Leone: a mixed methods evaluation of device repair and maintenance

Background Scale-up of the CRADLE intervention, a simple and accurate blood pressure and pulse device and focused training package, across all government maternity care facilities in Sierra Leone was completed in June 2023. Device maintenance must be prioritised to achieve sustainability. We evaluated device functionality 3 years after implementation to ensure sustainability. Methods Non-functioning devices were collected and evaluated across five districts. Semi-structured interviews conducted with staff explored barriers and facilitators to maintenance and sustainability. Results 21% (261/1257) of devices were reported as non-functioning and collected. 10% (26/261) of these devices had been damaged in storage and excluded from analysis. 75% (176/235) of non-functional devices needed a new cuff, 43% (100/235) a new inflation bulb and 18% (43/235) a new machine. Therefore, 3 years after scale-up, 82% of devices collected (192/235) and 96.5% of total devices distributed (1188/1231) could be functional after simple measures conducted within the healthcare facility. 100% (18/18) of healthcare workers who use the device regularly were able to identify these specific problems and solutions. Barriers to repair included transportation and logistical challenges communicating the need for repairs. A novel training video in the local language was co-produced. Conclusion The CRADLE device is robust and repair solutions are low cost but require logistical support at local and national levels. The majority can be fixed at the healthcare facility with minimal training if spare parts are available. The importance of implementation strategies to mitigate logistical challenges should be considered when scaling up technological innovations in similar low-resource settings.