Chidubem Ugwueze (Oregon Health & Science University, Portland, USA) provides an update on the current state of play concerning interventional radiology (IR) equipment and training in low and middle-income countries (LMICs).
Developing an equitable supply chain for IR equipment is essential for training and encouraging interventional radiologists in LMICs, especially in Sub-Saharan Africa. The need for IR training programmes in LMICs has long been acknowledged. Over the past five to ten years, various training initiatives have emerged to address this need. Despite the nascent growth of IR training programmes in the region, local manufacturing of IR devices is clearly non-existent, and direct supply chains are scarce. The graduates of these programmes then find themselves in settings where they cannot fully utilise the range of skills which they have acquired from their training. This is particularly true for clinicians returning to their practice in the public teaching hospitals following completion of their training. One such programme is the two-year IR fellowship in Lagos, Nigeria.
Established through a tripartite partnership between RAD-AID International, University College Hospital (UCH) in Ibadan, and IRDOCNIGERIA, this programme aims to leverage the growing clinical IR practice in the private sector and to transfer this clinical expertise to clinicians in public teaching hospitals. IRDOCNIGERIA, led by Hammed Ninalowo, is a private IR practice in Lagos offering interventional and neurointerventional services.
In addition to excellent clinical training, further honed by working as an IR attending at a tertiary hospital system in the USA, Ninalowo’s success in creating a clinical service which is suitable as a training programme is based on creation of a reliable supply chain for necessary consumables to utilise the capital imaging equipment instalments already made by hospitals in the private sector. This strategic approach, detailed in an Journal of the American College of Radiology (JACR) article titled ‘Developing a supply chain for interventional radiology consumable equipment in a lower middle-income country: A strategic approach’, includes leveraging clinical expertise, focusing initially on elective cases, adopting a ‘just in case’ bulk procurement model, fostering self-sustaining investment, and collaborating with multiple hospitals.
The wide range of clinical services offered by IRDOCNIGERIA made the practice an ideal partner for an in-country IR fellowship programme, which aims to train senior registrars or junior consultants from teaching hospitals who pledge to return to their teaching hospitals to build IR practice and train residents. The first trainee, Peter Adenigba from UCH in Ibadan, completed his fellowship in June 2024, having performed up to 936 interventions on 821 patients. He now faces the daunting challenge of securing consumables for his new clinical practice. This is not a problem unique to Adenigba. There is a new generation of IR trainees across LMICs who have put in the hard work to become trained, with the goal of training future generations, only to find themselves struggling to obtain the required support to achieve this.
Possible avenues of support include national governmental investment in the capital equipment required to grow an IR practice in public institutions and the support of industry to make consumable devices more easily accessible to these burgeoning IR pioneers like Adenigba. The aim of this article is to add to the voices advocating for industry investment in device registration, partnership with local distributors, and eventual local manufacturing of equipment in LMICs. This is an investment that is bound to be mutually beneficial for industry and the growing practice of IR in LMICs.
Chidubem Ugwueze is an associate professor of interventional radiology at the Dotter Institute of Oregon Health and Sciences University in Portland, USA.
