Optimizing integrated imaging service delivery by tier in low-resource health systems

Abstract

Access to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved.

Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems

“…Furthermore, relevant imaging specialists, such as radiologists, are frequently not consulted in the purchasing process of imaging technology that must be appropriate and tailored to the local needs. 58 This partly explains the high failure rate of donated equipment in LMICs. 59 , 60 Device failure is a common issue as repair works are often carried out by specialist companies covering a large geographical area, which can incur substantial delays.…”

“…In addition, it was noted that the mean outpatient waiting time for a CMR scan in London was 28 vs. 40.7 days for the Midlands. 58 Local staffing and the expertise needed to report scans may be a reason for the disparity. This can be improved by pooling resources, offering support and proctorship for low-volume centres as encouraged by the national imaging board of the UK, the British Society of Cardiac MRI, outlined in their CMR imaging standards.…”

Health professionals’ technology readiness on the acceptance of teleradiology in the Amhara regional state public hospitals, northwest Ethiopia: Using technology readiness acceptance model (TRAM)

“…Imaging holds immense importance within healthcare systems due to its critical role in patient treatment through image-based interventions and diagnoses [ 1 ]. Currently, numerous online platforms offer imaging services [ 2 ].…”

“…Implementing teleradiology has numerous advantages, such as enabling healthcare providers to provide timely diagnosis, to avoid patient travel, to reduce out-of-pocket travel expenses, to decrease radiology report waiting time, to avail the service at all the times (24/7/365) [ 7 ], and to reduce patient transfer [ 7 , 8 ]. However, its adoption is limited, particularly for low‑income countries (LICs) [ 1 , 5 ] because of socio-political systems [ 5 ], low penetration of information technology (IT) in the healthcare industry compared to non-health sectors [ 9 ], lack of adequate infrastructure, high initial costs [ 10 ], lack of technical experts, and system simplicity [ 11 ].…”

Institutionalization of limited obstetric ultrasound leading to increased antenatal, skilled delivery, and postnatal service utilization in three regions of Ethiopia: A pre-post study

“…These conditions all rely on offering at least one ultrasound scanning service for every pregnant woman before the 24 th week of gestation for confirming the diagnoses [ 6 ]. However, access to ultrasound services is limited in low-resource settings due to human resource constraints and lack of availability of the required technology [ 10 ]. Optimizing the capacity of existing human resources and distribution of tasks and responsibilities among various health professionals will improve access to, and quality and equity of health services [ 11 ].…”