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Introduction: the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world’s population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services. Methods: utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province. Results: of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66; 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22,33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service. Conclusion: in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.
The study was conducted in Zimbabwe, a landlocked Southern African country with a total land area of 390757 square kilometres, a population of 13.06 million people and 10 administrative provinces [15]. Zimbabwe’s Primary Healthcare System includes primary level care provided at clinics and rural health centres, secondary care at district hospitals, tertiary care at general and provincial hospitals, and quaternary care at central teaching hospitals. Mission hospitals are accessible to all, make a substantial contribution to rural secondary-level services, may be considered equivalent to district hospitals, and were thus included in this analysis of public sector services. In 2015, maternal mortality was 651/105 live births, while under-five mortality was 69/103 live births. The HIV prevalence rate for the population 15-49 years was 13.8 percent [15]. In 2015, Zimbabwe’s national per capita healthcare expenditure was 25 USD. While lower than the WHO recommendation of 86USD per capita, more than half the annual national health funding (56%) is from external donors [11]. Approximately ten percent of the population has access to private healthcare. The Zimbabwean Ministry of Health and Child Care (MHCC), and the University of Zimbabwe’s Department of Medical Physics and Imaging Sciences were key collaborators in this work. Since no formal government policy exists with respect to the provision of sonar services, phase 1 of the project involved contacting the ten provincial health authorities for an overview of sonar services at provincial level, and identification of all provincial facilities with sonar equipment. Phase 2 involved interrogation of the MHCC database for the contact details of all facilities identified in Phase 1 as having sonar equipment. In phase 3, the managers of all facilities with sonar equipment cooperated in a telephonic survey on their institution’s ultrasound equipment, staff complement, staff expertise and services. Survey data were captured on a customised spreadsheet and analysed for the whole country, and by province. Descriptive statistics defined resources per 1000 square kilometres and per million people. The study was approved by the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences of Stellenbosch University, Cape Town, South Africa and by the MHCC of Zimbabwe through the Medical Research Council of Zimbabwe.
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