Building Critical Care Capacity in a Low-Resource Setting: Lessons Learned from Establishing an ICU in Uganda

Background

Access to intensive care unit (ICU) services remains severely limited in many low- and middle-income countries (LMICs). Although conceptual frameworks and policy-level recommendations for critical care development exist, real-world experiences describing the practical challenges of starting an ICU in a low-resource setting are scarce.

Methods

This mixed-methods descriptive study was conducted at a rural hospital in Uganda. A six- bed ICU was established with capabilities for mechanical ventilation, inotropic support, continuous monitoring, point-of-care blood gas analysis, and piped oxygen. Quantitative data including demographics, diagnoses, and interventions were collected. In addition, qualitative data were collected through structured group discussions to identify key challenges and lessons learned.

Results

A total of 45 patients were admitted during the first three months. Key challenges identified included an unstable power supply, procurement delays for essential medications, limited baseline critical care knowledge, cultural barriers to assertive communication, and financial constraints. Continuous training, standardized protocols, and continuous patient monitoring were critical components of successful ICU operation.

Conclusions

Establishing a functional ICU in a low-resource setting is possible, but requires extensive planning, continuous training, and robust infrastructure. Simple and affordable interventions, such as continuous monitoring, improved nurse-to-patient ratios, and reliable oxygen supply, had a substantial impact on patient safety. This study provides practical insights that complement existing policy frameworks and inform similar initiatives that strengthen critical care in LMICs.

Key Points

Question

What practical challenges and lessons are encountered when establishing and initiating a six-bed intensive care unit in a rural, low-resource setting?

Findings

In this mixed-methods descriptive study of the first 3 months of a newly established ICU in rural Uganda, 45 patients were admitted, while stakeholder discussions identified unstable power supply, procurement delays, limited critical care knowledge, communication barriers, and financial constraints as key implementation challenges. Continuous training, standardized protocols, and continuous patient monitoring were identified as important components of successful ICU operation.

Meaning

Establishing critical care capacity in a rural low-resource setting is feasible but requires structured planning, reliable infrastructure, continuous workforce training, and adaptation of ICU systems to local circumstances.