Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Francie van Zijl, Avenue, Tygerberg, Cape Town, 7505, South Africa.
Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, 1st Floor North Block, Bellville Health Park, c/o Mike Pienaar Boulevard & Frans Conradie Drive, Bellville, Cape Town, 7500, South Africa.
BMC Health Serv Res. 2021 Sep 20;21(1):991. doi: 10.1186/s12913-021-06997-x.
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.
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.
Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km). Rural imaging facilities by population are double the metropolitan (20 vs 11/10 people). Metropolitan imaging personnel by population (112 vs 53/10 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/10 people), with mammography (24 vs 5 studies/10 woman > 40 years) and CT (21 vs 6/10 people) recording the highest, and plain radiography (203 vs 171/10 people) the lowest differences.
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.
减少不平等是联合国 2030 年可持续发展目标（世卫组织，卫生人力资源：全民健康覆盖和 2015 年后发展议程的基础，2014 年；改变我们的世界：可持续发展目标 2030 年议程：可持续发展知识平台，2020 年）的关键。尽管全球放射服务存在明显差异，特别是在中低收入国家的城市和农村人口之间，但在任何环境中，关于成像资源和利用模式的工作都很少（改变我们的世界：可持续发展目标 2030 年议程：可持续发展知识平台，2020 年；世卫组织，本地生产和技术转让以增加医疗器械的获取：2019 年；欧洲放射学会（ESR），洞察成像 6：573-7，2015 年；Maboreke 等人，对津巴布韦许可放射学设备资源的审计，作为医疗保健获取和公平性的衡量标准，2020 年；Kabongo 等人，泛非医学杂志 22，2015 年；Skedgel 等人，医学决策 35：94-105，2015 年；Mollura 等人，美国放射学杂志 913-9，2014 年；Culp 等人，美国放射学杂志 12：475-80，2015 年；Mbewe 等人，对赞比亚许可诊断成像设备和人员的审计，2020 年）。为了实现公平，更好地了解所谓的“成像企业”的基本组成部分非常重要。目的是分析中等收入国家的省级放射服务。
对 2017 年南非西开普省公共医疗部门的放射学数据进行机构审查委员会批准的回顾性审计，利用省级数据库。我们对全省、大都市和农村地区的成像设备、人员和服务利用数据进行了基于人群的分析。
城市人口密度是农村人口密度的 90 倍（1682 比 19 人/公里）。按人口计算，农村的成像设施是城市的两倍（20 比 11/10 人）。按人口计算，城市的成像人员（112 比 53/10 人）和设备数量（1.7 比 0.7/单位）是农村的两倍多。大都市的整体人口成像服务利用率高出 30%（289 比 214 项研究/10 人），其中乳腺 X 线摄影（24 比 5 项研究/10 岁以上女性）和 CT（21 比 6/10 人）记录的差异最大，而普通 X 线摄影（203 比 171/10 人）的差异最小。
尽管通过在农村地区提供更多的设施/每百万人来尝试实现成像公平，但利用模式的差异仍然存在。必须将公平的实现视为一个涉及逐步改进和迭代分析的过程，以确定实现目标的进展。
