CHALLENGE

Two thirds of the world’s population lack access to efficient diagnostic imaging. At least one ultrasound scan before 24 weeks of gestation for a pregnant woman is recommended for gestational age estimation, to improve detection of foetal anomalies and multiple pregnancies, and to improve a woman’s pregnancy experience (WHO 2016).

However, due to the inadequacy of human resources for health in low-income countries (radiologists, sonographers, technologists) and the infrastructure required for imaging systems, most rural pregnant mothers cannot access ultra sound services. Patients often need to travel long distances to access these services at district hospitals or urban centres, where imaging centres are often located.

Imaging the world thus ensures that rural pregnant women can access low cost obstetric ultra sound imaging at lower level health facilities, for birth planning and to rule out pregnancy complications.

INTERVENTION

The programme involves training identified nurses and midwives in selected lower level health facilities (HC III) to make ultrasound sweeps between specific land marks of the abdomen, to capture multiple clips that are compressed to a size of a still photo and uploaded over cell phone network to a secure system.

An accredited external reviewer (who may be in the country or abroad) receives the images for interpretation and a short report of the findings is sent via Short Message Service to the nurse/midwife’s cell phone.

The ultra sound cost is much lower than what is charged in the private health facilities. The pregnant women contribute 5,000 Shs, which is approximately five times lower than what would be paid in a private health facility. This is used to pay for consumables necessary for the ultrasound process like gel, electricity, and internet costs. The health facility staff are trained for 2 months, examined and supervised by expert radiologists.

Over 200,000 scans have been performed over a period of 6 years, increasing antenatal visits by 70% in health centres employing the Imaging the World model. Twenty-three (23%) of the scans have identified pregnancy complications, which have resulted in specialized care that pregnant women might otherwise not have received.

There has been an increase in people seeking diagnostic care due to the closeness of the service to the communities and due to the low cost of the imaging services provided. There has also been an increase in male involvement in antenatal care for their wives due to the opportunity to see the foetus in the uterus.

CASE INSIGHTS

It is possible to provide affordable ultra sound services in rural areas through task shifting, where lower level health worker cardres like nurses and midwives (who are often closest to pregnant women), are trained to take images and even interpret results. This can save the cost of hiring a sonographer in a low-resource setting. Integration of e-health in low-resource health care settings is feasible and it provides an opportunity to improve quality of care in these areas.