Introduction: Diagnostic radiology services are severely lacking in many rural settings and the implementation of these services poses complex challenges. The purpose of this paper is to describe the implementation of diagnostic radiology services at a district-level hospital in Achham, a rural district in Nepal.
Methods and Materials: We conducted a retrospective review of the implementation of diagnostic radiology services. We compiled a list of implementation challenges and proposed solutions based on an internal review of historical data, hospital records, and the experiences of hospital staff members. We used a seven-domain analytic framework to structure our discussion of these challenges.
Results: We documented the first five years of challenges faced and lessons learned by the non-profit organization Possible while implementing and providing diagnostic radiology services for the first time in a remote location. Additionally, we documented the uptake of these services through the first five years of operations. During this time, the number of X-rays performed increased 271%, while ultrasounds increased 258%. The main challenges included educating the community about the appropriate use of these services, recruiting trained providers, and coordinating referral care and consultations for higher-level diagnostics and treatment. Finally, investments in training providers and technicians, as well as investments in infrastructure, primarily the installation of solar panels to maintain a power supply, were critical to sustaining services.
Discussion: This experience demonstrates that reliable and sustained services can be deployed even in extremely remote areas and identifies challenges that other implementers may face in similar program implementation.
diagnostic imaging, radiology, Nepal, global health, implementation science
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This work is licensed under a Creative Commons Attribution 4.0 License.
Acknowledgements: The authors would like to express our appreciation to the entire staff of Possible in Achham who dedicate themselves to providing excellent healthcare to the patients of Achham; to Dr. Borgny Ween at Oslo and Akershus University College of Applied Sciences for her valuable assistance in preparing this manuscript, for her contributions to developing Bayalpata Hospital’s radiology program, and for her guidance in developing clinical programs at Bayalpata Hospital; and to the Ministry of Health and Population of Nepal for their continued commitment to strengthening Nepal’s public-sector healthcare system in rural Nepal.
Filkins M, Halliday S, Daniels B, Bista R, Thapa S, Schwarz R, Schwarz D, Gauchan B, Maru D. Implementing Diagnostic Imaging Services in a Rural Setting of Extreme Poverty: Five Years of X-ray and Ultrasound Service Delivery in Achham, Nepal. Journal of Global Radiology 2015;1(1):1001. https://doi.org/10.7191/jgr.2015.1001. Retrieved from https://escholarship.umassmed.edu/jgr/vol1/iss1/2
Figure 1. Time series of number of X-rays and ultrasounds with arrows indicating key events
Figure2.jpg (33 kB)
Figure 2. Time series of fracture diagnoses, and cholecystitis diagnoses
Figure 3. Solutions leading to improved diagnostic radiology services.tif (813 kB)
Figure 3. Solutions leading to improved diagnostic radiology services