Medical Imaging: The Missing Element of National Health Plans

Devanshi R Shah,Susan Horton,Eline Van De Broek-Altenburg,Abimbola Leslie,Bernice Dahn,Kristen Destigter

doi:10.7191/jgr.2021.1158

Abstract

Purpose: Radiology global outreach programs have increased in recent years but progressed more slowly than other specialties. Establishing radiology services is increasingly recognized as a priority in resource-limited settings. Myanmar has a tremendous disease burden that is treatable with interventional radiology (IR) techniques, and aims to grow and effectively integrate this service into its public healthcare sector. Through collaborations between Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and Myanmar Radiological Society (MRS), the field of IR has grown exponentially over recent years. This study aims to provide a Myanmar national IR report on the current trends and future challenges. Methods and materials: Descriptive variables across five domains (facility and equipment, workforce, supplies, infrastructure, and casemix) from the four public sector hospitals with IR capability were obtained between 2016-2019. The four hospitals were Yangon General Hospital (YGH), Yangon Specialty Hospital (YSH), Mandalay General Hospital (MGH), and Defense Services General Hospital (DSGH). Data were analyzed to demonstrate progress in IR and the differing casemix. Results: There are currently four IR-capable hospitals and nine interventional radiologists across Myanmar’s public healthcare sector. IR case volumes tripled from 514 cases in 2016 to more than 1,500 cases in 2019. The three most common procedures performed were trans-arterial chemoembolization (TACE, 63%), bronchial arterial embolization (BAE, 7.7%), and drainages (7.7%). Significant challenges to the growth and adoption of IR services span the domains of infrastructure, equipment and supplies, workforce, and IR awareness, among other clinical specialties. Conclusion: Myanmar’s healthcare priorities, coupled with international radiological outreach programs, have led to rapid growth of IR. The exponential growth in case volumes is promising for Myanmar and other developing countries. But to widen the scope of practice and integrate the service within local clinical workflows, a holistic effort that addresses multiple domains is needed in the future.

Highlights

Lack of availability and access to diagnostic imaging in low- and lower middle-income countries (LLMICs), and in low-income countries (LICs), contributes to an increase in global disease burden and mortality [1]
This study aims to examine the extent to which national health services strategic plans (NHSSPs) recognize medical imaging and laboratory medicine in the areas of workforce, technology/equipment/infrastructure, financing, and key performance indicators in their considerations of the Universal Health Coverage by 2030 (UHC2030) initiative [4]
Medical imaging was underrepresented, with deficiencies identified in the inclusion of laboratory medicine

Summary

Introduction

Lack of availability and access to diagnostic imaging in low- and lower middle-income countries (LLMICs), and in low-income countries (LICs), contributes to an increase in global disease burden and mortality [1]. NHSSPs are country-specific frameworks to describe how health priorities and issues will be managed, including those related to political benchmarks [10]. They serve as the gateway to establish and strengthen Universal Health Coverage (UHC) at a country level [10]. Items included in these plans are more likely to be operationalized [11]

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Methods

Results

Discussion

Conclusion