User-Centered Design: Developing the RELI Delivery System – a Low-Cost, Non-Electric, Pneumatic Infusion Pump

Elizabeth Abu-Haydar,1 David Katuntu2 ,†James Bauer,1 Alec Wollen,1 Mike Eisenstein,1 Jill Sherman-Konkle,1 Anthony Roche,3 Michael Ruffo1 1PATH, Programs and Innovation Division, Medical Devices and Health Technologies, Seattle, WA, USA; 2PATH, Uganda Country Program, Kampala, Uganda; 3Department of Global Health, University of Washington, Seattle, WA, USA†David Katuntu passed away on September 1, 2020.Correspondence: Elizabeth Abu-HaydarPATH, Programs and Innovation Division, Medical Devices and Health Technologies, 2201 Westlake Ave, Seattle, WA, 98121, USATel +1 206 285-3500Email eabuhaydar@path.orgPurpose: Infusion pumps are the preferred method for intravenous delivery of drugs and fluids, and an essential tool in health facilities. Their high cost, complexity and reliance on electricity pose serious challenges to wide-spread use, availability and access in low- and middle-income countries. PATH developed the RELI Delivery System (RELI), a low cost, non-electric infusion pump to address these challenges. Input collected from fifty-nine newborn and maternal care providers and from seven national level decision makers in Uganda was used to guide product development, further informing product design requirements, and optimal design features to best serve their needs.Methods: A formative evaluation following a mixed methods approach including focus group discussions (FGDs), stakeholder interviews, and observations was used to collect data from end users.Results: Stakeholders provided critical input on the RELI prototype design features, safety criteria, and contexts of use of infusion pumps, as well as recommendations for design refinements. Infusion systems are greatly needed but not readily available and their use is limited to well-resourced higher level facilities, even though the need is high in non-tertiary care hospital where patient volume is high, resources are scarce, power is inconsistent, and facilities are understaffed and overcrowded. Users expressed a need for an affordable and simple device with an intuitive user interface, clear instructions for use, and basic safety features.Conclusion: The study provided important guidance for further design refinements based on input from respondents and confirmed the need for robust, affordable, infusion pumps that meet the requirements for use in low-resource settings.Keywords: infusion pumps, low- and middle-income countries, user-centered design, product development, Uganda