The status OF clinical diagnostic imaging services in Uganda’s regional referral hospitals.

Abstract

Background: Clinical imaging is an essential component of health care which supports and improves the effectiveness of clinical decision-making. Quality care saves lives and resources of both the patient and the health system. However, many developing countries have neglected diagnostics, especially clinical imaging. Non-use of or poor imaging services lead to wrong diagnosis and treatment, unnecessary health expenditures, and poor health outcomes. Regional Referral Hospitals should have good diagnostic imaging services to provide expert care and bridge the continuum of care by stemming the flow of uncomplicated cases from general hospitals to National Referral Hospitals. Aim: To determine the situation of diagnostic imaging services at regional referral hospitals in Uganda. Methods: A descriptive cross-sectional survey of all the nine Regional Referral Hospitals of Uganda was done in 2007. Environmental inspection of the imaging units, process observation and exit interviews with 156 patients present on the day of the visit were done to assess their satisfaction with the imaging services. Staff were also interviewed. However, quality validation of the imaging outputs was not done. Selected health facilities in the capital Kampala were visited to obtain data on patients referred from upcountry. Five-year hospital records were reviewed for outputs. Results: The premises were of poor quality and staff and patients were not safe from radiation exposure. No radiosurveillance measures were operational. The output of imaging services was generally very low, (mean: 16 procedures per day, range: 6 - 22) due to lack of consumable inputs. Only 37% (range: 14 – 64) of approved staff positions were filled. Nurses were insufficient and some cadres lacked altogether. Stock-outs of key consumable inputs were prolonged (ultrasound gel: 90 days) and patients were required to buy their own. Many patients were referred to private services but not recorded. Central level supervision by the Ministry of Health was lacking. Conclusion and recommendation: The quality of imaging services was poor, and could be improved through higher prioritization of imaging services in hospital planning, better financing, better support supervision and establishment of an active radio surveillance mechanism.