Towards equity : a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
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 ne progress towards the goal.
Description
CITATION: Van Zyl, B. C., et al. 2021. Towards equity : a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017. BMC Health Services Research, 21:991, doi:10.1186/s12913-021-06997-x.
The original publication is available at https://bmchealthservres.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
The original publication is available at https://bmchealthservres.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
Keywords
Urban hospitals -- Radiological services -- Western Cape (South Africa), Rural hospitals -- Radiological services -- Western Cape (South Africa), Health services accessibility -- Western Cape (South Africa)
Citation
Van Zyl, B. C., et al. 2021. Towards equity : a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017. BMC Health Services Research, 21:991, doi:10.1186/s12913-021-06997-x