Audit of the accessibility, state and cost of computed tomography service: A national audit in a middle-income resource setting

Background

Computed Tomography (CT) scanners are described as the workhouse of the radiology department. However, their geographical distribution, operationality, availability of skilled personnel and cost of the service may restrict their service to only a few people in some jurisdictions.

Objective

This study audited CT scanners in Ghana to determine their geographical distribution, factors affecting their state and service accessibility to provide data for informed decision-making.

Methods

A survey involving 45 CT centres was conducted between May and August 2021 using a 3-part semi-structured questionnaire. Data collected included equipment characteristics, maintenance support and scheme, CT personnel and examinations. Responses were analysed using Microsoft Excel 2019 and SPSS v. 21. Comparative analyses were made using ANOVA. Downtimes (DT) of CT equipment and corresponding revenue loss were computed. Logistic regression analysis was carried out to determine the odds radio of power control devices (PCD), maintenance support and scheme on downtime. At CI 95 % p < 0.05 was considered statistically significant.

Results

There was a ratio of 1.55 CT scanners to a million population, with only 3 CT centres not included in the survey. Six out of the 16 administrative regions, with 17 % (5 million) of the population had no CT scanners. 22 % of the scanners were non-functioning at the time of the study. 53 % of the centres used PCD and showed a statistically significant relationship with the work setting. There was a cumulative 4356 days DT as at the year 2020 corresponding to an estimated revenue loss of GHc 11,978,692 (USD 2090281.86).

Conclusion

Findings have important policy implications on CT equipment distribution, maintenance and revenue loss due to unplanned downtime. There was low density and disproportionate distribution of the equipment, with more than 1/5 of them non-functioning at the time of the study. The majority of their maintenance was outsourced with 1/3 of the centres employing corrective maintenance policy. While the estimated revenue loss due to unplanned DT was very significant, paradoxically, the service appeared to be unaffordable to many, when the living standards were considered.

Implications for practice

The distribution of CT scanners should be improved and the efficiency of maintenance management systems in CT scanners should be ensured.