Training for rural radiology and imaging in sub-saharan Africa: addressing the mismatch between services and population.
The objectives of this review are to outline the needs, challenges, and training interventions for rural radiology (RR) training in Sub-Saharan Africa (SSA). Rural radiology may be defined as imaging requirements of the rural communities. In SSA, over 80% of the population is rural. The literature was reviewed to determine the need for imaging in rural Africa, the challenges, and training interventions. Up to 50% of the patients in the rural health facilities in Uganda may require imaging, largely ultrasound and plain radiography. In Uganda, imaging is performed, on an average, in 50% of the deserving patients in the urban areas, compared to 10-13 % in the rural areas. Imaging has been shown to increase the utilization of facility-based rural health services and to impact management decisions. The challenges in the rural areas are different from those in the urban areas. These are related to disease spectrum, human resource, and socio-economic, socio-cultural, infrastructural, and academic disparities. Countries in Sub-Saharan Africa, for which information on training intervention was available, included: Uganda, Kenya, Tanzania, Rwanda, Zambia, Ghana, Malawi, and Sudan. Favorable national policies had been instrumental in implementing these interventions. The interventions had been made by public, private-for-profit (PFP), private-not-for profit (PNFP), local, and international academic institutions, personal initiatives, and professional societies. Ultrasound and plain radiography were the main focus. Despite these efforts, there were still gross disparities in the RR services for SSA. In conclusion, there have been training interventions targeted toward RR in Africa. However, gross disparities in RR provision persist, requiring an effective policy, plus a more organized, focused, and sustainable approach, by the stakeholders.
Department of Radiology, Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda.
Michael G
MG
Kawooya