Diagnostic radiology capacity and demand in Zimbabwe : trends and forecast

Abstract

The aim of this study was to provide evidence basedforecast for radiology demand in Zimbabwe that would support policies aimed at optimising radiology resource allocation and utilisation. This was upon the realisation that the Ministry of Health and Childcare required such forecast in order to ensure equitable, accessible and quality health services as prescribed in the 2009-2015 National Health Strategy as well as in Section 29 and 76 of the Zimbabwean constitution. On the international perspective, many researchers have reported stable high demand for radiology services giving rise to long waiting lists and backlogs. In the United Kingdom’s National Health Services (NHS), there is general consensus that these waiting lists are caused by variation mismatches between capacity and demand for radiology services. Elsewhere, it has been reported that skill mix, role changes, dynamic nature of radiography teaching and learning, technology diffusion, service transaction time, overutilisation, and unjustified exposures are key drivers of high demand for radiology services. It has long been established that demand for radiology services is stochastic in nature, and therefore planning of future investments in radiology must be guided by an understanding of how these variables interact to model the criterion variable. However, there is paucity of information pertaining to key aspects of legitimate radiology demand forecasts. Formulation of these fundamental concepts formed the impetus of this study. A document review, interviews and non-participatory observations revealed that justification of radiology examinations, dynamic nature of radiography teaching and learning, diffusion of extended roles and technology, equipment and personnel capacity, and most importantly service transaction time all had an impact on the demand for radiology services in Zimbabwe. Limited diffusion of extended roles and technology had increased over a ten year period. Observed role changes were informal additions to the procedures normally carried out by radiographers and these were not supported by formal education. Consistent with global concerns, over utilisation and unjustified requests were a national concern. In situations where capacity outweighed demand, there was evidence that internal management of radiology departments was responsible for most variation mismatches which then gave rise to long waiting times.