Background The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called “imaging enterprise” is important. The aim was to analyse a provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. Results Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km2). Rural imaging facilities by population are double the metropolitan (20 vs 11/106 people). Metropolitan imaging personnel by population (112 vs 53/106 people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/103 people), with mammography (24 vs 5 studies/103 woman > 40 years) and CT (21 vs 6/103 people) recording the highest, and plain radiography (203 vs 171/103 people) the lowest differences. Conclusion Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses that define progress towards the goal.

No abstract

Background There are marked disparities in radiological resources globally, particularly between metropolitan and rural populations. The World Health Organization (WHO) suggests that 90% of low- and middle-income country (LMIC) imaging needs can be addressed by one X-ray and ultrasound machine for every 50000 people. However, this figure is untested, as limited work on radiological resources and service utilization patterns globally, particularly in LMICs exists. The aim was to analyze provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province (WCP) of South Africa (SA) for 2017, utilizing databases of the WCP Department of Health and Stats SA. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the province, metropolitan and rural areas. Results Metropolitan population density exceeds rural (1682 vs 19 people/km 2 ; 89:1). Rural imaging facilities by population are double the metropolitan (19 vs 11/10 6 people). Provincially, there are 36 X-ray and 18 ultrasound units/10 6 people. Rural X-ray (39.3 vs 33.6/10 6 people), ultrasound (24.7 vs 14.5/10 6 people) and mammography (14 vs 5 units/10 6 women > 40 years) resources exceed metropolitan by 17, 70 and 180 percent, respectively. Metropolitan personnel resources by population (n = 112 vs 53/10 6 people) and equipment unit (1.7 vs 0.7/10 6 people) are double the rural. Provincial imaging studies totalled 1.2778 million, averaging 262 examinations/10 3 people and 1.3 investigations/patient. Radiography (n=935607,73%) and ultrasound (n=202639,16%) together constituted 89% (n=1138246) of studies. Population-based utilization of imaging services was 30% higher in the metropole (279 vs 214 studies/10 3 people), with mammography (24 vs 5 studies/10 3 woman >40 years; 517%) and CT (21 vs 6/10 3 people; 380%) recording the highest differentials and plain radiography (203 vs 171/10 3 people; 19%) the lowest. Conclusion Our findings support the WHO contention that approximately ninety percent of a population’s diagnostic imaging needs can be met by plain radiography and ultrasound and underscore the complexity of achieving equitable utilization of services between rural and metropolitan areas.