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Diffusion and utilization of computed tomography scanners in Africa: The Case study of Malawi
Other Title
Diffusion and Utilization of Computed Tomography Scanners in Africa: The Case study of Malawi
Type
thesis
Date Issued
2013-06-20
Author(s)
Dominic Zaliro Samu Moyo
Advisor
Peter Wushou Chang
Subjects
系所名稱：全球衛生暨發展碩士學位學程
Description
學位別：碩士
語文別：英文
指導教授：Peter Wushou Chang
共同指導教授：
口試委員：Chung-Yeh Deng;Ya-Wen Chiu
中文關鍵字：Barriers, Computed Tomography, Diffusion, Utilization
語文別：英文
指導教授：Peter Wushou Chang
共同指導教授：
口試委員：Chung-Yeh Deng;Ya-Wen Chiu
中文關鍵字：Barriers, Computed Tomography, Diffusion, Utilization
Abstract
Abstract
Background and objectives
Computed Tomography scanners (CT scanner) is a high-tech medical imaging machine that uses computer-processed X-rays to produce tomographic cross-sectional images of the specific area of the body being imaged. The demand for the CT scanner on the market has grown globally, both in developed and developing countries. Since its innovation, the use of CT in medical care has grown rapidly for diagnostic and therapeutic purposes because of its superior image display which allows visualization of structures previously not seen with conventional radiography. The growing burden of non communicable diseases has been one of the factors driving this increased use thus given the current epidemiological paradigm shift in developing countries like Malawi where non communicable diseases are equally becoming a public health concern, health institutions are more likely to seek ways to improve patients care through adoption of more complex medical technology like CT scanners.
Research in diffusion of medical technology has predominantly been done in developed countries. Factors such as countries net worth as presented by its Gross Domestic Product (GDP) and Total Expenditure on Health have been shown to positively influence its diffusion. CT scanner is a capital intensive advanced medical imaging technology which has greatly revolutionalised the field of medicine since its innovation close to 3 decades ago. There is paucity of evidence in developing countries with regards to diffusion of CT scanners. This study attempts to fill that gap by giving a descriptive analysis of the current status of diffusion and utilization of CT scanners in Malawi, an Africa country located in the Eastern part of Africa. It focuses mainly on the barriers to the adoption of CT scanners as well as its utilization at institutional level.
Methods
A case study was conducted using email based; self reported questionnaires administered to hospital directors and heads of radiology departments in six facilities in Malawi,
currently owning CT scanners. Content analysis of the data was done and the results are presented in four thematic components namely: 1) Human Resources, 2) Availability of CT scanners, 3) Access to CT scanner services and 4) Quality control and maintenance.
Results
There are six facilities in Malawi offering services to a population of 15 million people representing a CT scanner density of 0.4 per million people compared to 15.4 per million in developed countries and an overall of 0.29 per million in all the developing countries. There is mal-distribution of services as the scanners are all located in urban areas and access is highly selective. There is lack of capital investment in Malawian health care institutions to acquire and install CT scanners such that almost two thirds of the machines currently available were donated either as second hand or brand new first hand from private donors or foreign governments.
The cost of access to its services in private sector is very high such that it provides a big obstacle to its utilization by the population most of whom are living on less than a US Dollar per day. Service in government facilities is free of charge but access limited because the institutions serve a lot of people resulting into long waiting lines and interruptions due to frequent breakdowns.
Conclusion
This study has established that the availability of CT scanners in Malawi, defined by the number of scanners per million population is almost the same with other developing countries but a great mismatch exist when compared to developed countries. However of note is that most of the currently available machines were acquired through donations from private donors and foreign governments. Access is limited to urban areas and mostly in private sector where not many people in Malawi can afford. Institutions in Malawi lack financial power to finance the purchase and maintenance of the machines. The study further demonstrates that there are health system factors, demand side factors and supply side factors, specifically the innovation itself which are the main barriers to diffusion and utilization of CT scanners at institutional level in Malawi
Key words: Malawi, Computed Tomography, Diffusion, Barriers
Background and objectives
Computed Tomography scanners (CT scanner) is a high-tech medical imaging machine that uses computer-processed X-rays to produce tomographic cross-sectional images of the specific area of the body being imaged. The demand for the CT scanner on the market has grown globally, both in developed and developing countries. Since its innovation, the use of CT in medical care has grown rapidly for diagnostic and therapeutic purposes because of its superior image display which allows visualization of structures previously not seen with conventional radiography. The growing burden of non communicable diseases has been one of the factors driving this increased use thus given the current epidemiological paradigm shift in developing countries like Malawi where non communicable diseases are equally becoming a public health concern, health institutions are more likely to seek ways to improve patients care through adoption of more complex medical technology like CT scanners.
Research in diffusion of medical technology has predominantly been done in developed countries. Factors such as countries net worth as presented by its Gross Domestic Product (GDP) and Total Expenditure on Health have been shown to positively influence its diffusion. CT scanner is a capital intensive advanced medical imaging technology which has greatly revolutionalised the field of medicine since its innovation close to 3 decades ago. There is paucity of evidence in developing countries with regards to diffusion of CT scanners. This study attempts to fill that gap by giving a descriptive analysis of the current status of diffusion and utilization of CT scanners in Malawi, an Africa country located in the Eastern part of Africa. It focuses mainly on the barriers to the adoption of CT scanners as well as its utilization at institutional level.
Methods
A case study was conducted using email based; self reported questionnaires administered to hospital directors and heads of radiology departments in six facilities in Malawi,
currently owning CT scanners. Content analysis of the data was done and the results are presented in four thematic components namely: 1) Human Resources, 2) Availability of CT scanners, 3) Access to CT scanner services and 4) Quality control and maintenance.
Results
There are six facilities in Malawi offering services to a population of 15 million people representing a CT scanner density of 0.4 per million people compared to 15.4 per million in developed countries and an overall of 0.29 per million in all the developing countries. There is mal-distribution of services as the scanners are all located in urban areas and access is highly selective. There is lack of capital investment in Malawian health care institutions to acquire and install CT scanners such that almost two thirds of the machines currently available were donated either as second hand or brand new first hand from private donors or foreign governments.
The cost of access to its services in private sector is very high such that it provides a big obstacle to its utilization by the population most of whom are living on less than a US Dollar per day. Service in government facilities is free of charge but access limited because the institutions serve a lot of people resulting into long waiting lines and interruptions due to frequent breakdowns.
Conclusion
This study has established that the availability of CT scanners in Malawi, defined by the number of scanners per million population is almost the same with other developing countries but a great mismatch exist when compared to developed countries. However of note is that most of the currently available machines were acquired through donations from private donors and foreign governments. Access is limited to urban areas and mostly in private sector where not many people in Malawi can afford. Institutions in Malawi lack financial power to finance the purchase and maintenance of the machines. The study further demonstrates that there are health system factors, demand side factors and supply side factors, specifically the innovation itself which are the main barriers to diffusion and utilization of CT scanners at institutional level in Malawi
Key words: Malawi, Computed Tomography, Diffusion, Barriers