Malawi Radiology Collaboration Project

The Malawi Radiology Collaboration Project brings together four organisations with a shared interest in improving access to diagnostic imaging tests for patients in Malawi.

Our contribution focuses on building health workforce capacity and supporting research initiatives. Aligning our solutions in a collaborative fashion with those implemented by government and partner Institutions.

We believe that investing in a strong and high quality cohort of Malawian imaging experts will enable them to drive the national diagnostic imaging agenda more effectively and sustainably, with the required in-depth knowledge of the wider Malawian healthcare context. It will also optimise the use of exisiting infrastructure and resources.

We are growing a collaborative network of Malawian radiology staff and international expert volunteers, so that many more students and health workers can be trained in all aspects of diagnostic imaging, more scans and X-rays can be performed and expertly reported and wider radiology education and research can flourish.

Malawi Liverpool Wellcome Clinical Research Programme

Collaborating with Collective Minds Radiology (CMRAD) to provide teleradiology support

Together with CMRAD, we provide a secure, low cost tele-radiology platform to assist departments across borders with their image interpretation and education.

This allows a wide group of volunteer experts to participate in our work. For radiologists working in Malawi this remote support provides an opportunity to discuss cases with colleagues and can help with reduction in workload, freeing up time for activities such as education and research.

It can also provide access to a specialist radiologist opinion for those situations where there is no local expert available.

Limited access to diagnostic imaging in Malawi

In Malawi, access to diagnostic imaging tests is severely limited for most patients. This can make it very difficult for them and the healthcare workers looking after them to get a correct and timely diagnosis when they become ill. Yet, without a clear diagnosis it may be impossible to offer the right treatment and care in a timely manner, leading to unnecessarily poor health outcomes or even loss of life.

In rural areas this barrier to accessing imaging tests is especially high. Infectious diseases like Tuberculosis, pneumonia and HIV remain commonplace in Malawi. Not only this, but increasing numbers are suffering from non-communicable diseases, such as strokes and cancer. While deaths related to pregnancy and childbirth are decreasing, they still remain much higher
than in well-resourced health systems. Major injuries from road accidents are the number one cause of death for young adults. All these patients need access to imaging tests for accurate diagnosis and treatment.

Chest x ray being performed by a doctor in Malawi

Scan being reviewed by a medical team in Malawi

Resource constraints and skill shortages

The causes of this problem are manyfold. Malawi is one of the financially least well-resourced countries in the world. Difficult decisions need to be made about how to prioritise funds within the health system and imaging services are relatively costly and complex to implement and scale up.

As a result, there is a severe shortage of functional equipment, radiographers, sonographers, maintenance engineers and radiologists. Health workers outside Radiology often have to interpret X-rays or perform bedside ultrasound themselves to try and fill this gap, without having access to specialist support or training.

There is an urgent need to increase health worker knowledge and skills capacity within radiology and to provide quality training and support to those outside radiology, filling the gaps and focussing on solutions that are affordable, easier to implement and scaleable.

Education

In collaboration with KUHES and MLW, we provide an international network of expert teachers to deliver the post-graduate Radiology training programme. This programme started in September 2022 and the first cohort of nationally trained Radiologists will graduate in 2026. Without additional teaching capacity, it would not be possible for the few Specialist Radiologists in Malawi to deliver this programme.

We are one of the two key international partner organisations enabling the new post-graduate radiology programme funded by NORHED to thrive.

Radiographers and technical staff have received training in optimisinig utilisation of the CT scanner at QECH, improving quality assurance processes for Chest X-rays for research, and obtaining new skills in ultrasound assessment of kidneys.

The project currently offers 12 International Imaging experts a structured opportunity to volunteer their knowledge and skills and to learn about imaging needs in settings like Malawi.

All radiology staff at QECH and KUHES have ongoing access to an international network of peers and experts. This offers a unique opportunity for day to day problem solving and mutual learning, in addition to planned educational activities.

Medical team in Malawi reviewing an x ray

Clinical Support

In collaboration with QECH and MLW, we provide additional reporting capacity for the Radiology department, through an international network of voluntary teleradiologists. This reduces long waiting times for reports and offers access to sub-speciality expert opinions, not yet available in Malawi.

As a result of our teleradiology support, CT scan backlogs have reduced and complex cases can now be sent to volunteers with the relevant specialist expertise. Approximately 380 scans were reported in 2023. An increase of 50% is anticipated for 2024. Impact on patient outcomes has not yet been evaluated, but benefits have been reported consistently in feedback from radiology staff and senior hospital management. Reporters also learn about disease presentation and treatments in Malawi.

Having an expert Gynecological Radiologist in the MDT will enhance clinical decision making and treatment for women with gynecological cancers, impacting an estimated 300 women per year.

Research

At MLW, we contribute radiologist expertise to the Diagnostic Imaging Steering Committee which guides all delivery and development of research in Imaging.

Through our co-leadership committee, researchers at MLW have access to imaging facilities at QECH that meet international research standards, as well as access to imaging experts for study design, practical support and image analysis.

Radiology staff from KUHES and QECH also have opportunities to engage in research projects.

Bringing national radiology stakeholders together annually facilitates alignment of research, educational and clinical service activities and fosters collaboration. For example for the complex implementation and evaluation of the volunteer led teleradiology service.

All partners collaborate on a range of clinical research projects, including in lung health, cancer, infectious diseases and radiology service improvement.