Arthur Arroye^1*, Timb Timb Fils ², Ahuka Longombe Lambert³, Nwedjiwe Nana Narcisse⁴, ARROYE Fabrice ⁵, Juliette-Amelie Mengue⁴, Aziz Ndam⁵, Biongol Draha⁶, Manka’a Wankie⁴, Aristide SOUSSOU⁷, Mawe Deffo Aurelie Laure⁸, Wandji Arnaud⁹, Hamidou Alioum⁹ and Vincent Vidal²

¹Radiology Department, Martinique University Hospital, 97232 Le Lamentin, Martinique

²Radiology Department, Timone Hospital, 264 Saint-Pierre Street, 13005 Marseille, France

³University Clinics of Kisangani, Kisangani, Democratic Republic of the Congo

⁴Douala General Hospital, Cameroon

⁵Laquintini Hospital of Douala, Cameroon

⁶Maroua Regional Hospital, Cameroon

⁷Radiology Department, Amath Dansokho regional Hospital, Kedougou, Senegal

⁸Mvogada District Hospital

⁹Varese Hospital, University of Insubria (Italy), Department of Anesthesia and Intensive Care

¹⁰Garoua General Hospital, Cameroon

^*Corresponding Author: Arthur Arroye, Radiologist, Radiology Department, Martinique University Hospital, Email: cyrillearroye@yahoo.fr

Received: 30 June 2025; Accepted: 30 July 2025; Published: 05 September 2025

Article Information

Citation: Arthur Arroye, Timb Timb Fils, Ahuka Longombe Lambert, Nwedjiwe Nana Narcisse, Timb Timb Fils, Arroye Fabrice, Juliette-Amelie Mengue, Aziz Ndam, Biongol Draha, Manka’a Wankie, Aristide Soussou, Mawe Deffo Aurelie Laure, Wandji Arnaud and Vincent Vidal. Challenges in Establishing an Interventional Radiology Unit in Cameroon. Journal of Radiology and Clinical Imaging. 8 (2025): 100-106.

DOI: 10.26502/jrci.2809115

Abstract

Article Details

1. Introduction

Interventional radiology (IR) is a branch of radiology that utilizes medical imaging techniques (ultrasound, CT scan, angiography, or MRI) to guide minimally invasive diagnostic and therapeutic procedures [1]. Among its key innovations are tumor embolization, targeted thrombolysis for stroke treatment, vascular stent placement, and precision-guided biopsies, which enable precise treatment of many chronic diseases. For instance, in the management of liver cancer, embolization and percutaneous ablation offer less invasive and more targeted solutions than traditional surgery [2]. Similarly, for peripheral arterial diseases, angioplasty with stent placement significantly reduces the risk of amputation [3,4].

In developed countries, interventional radiology is routinely used and has led to a significant reduction in the prevalence, incidence, and mortality of various chronic diseases, particularly oncological and cardiovascular conditions [5]. However, in Africa, particularly in sub-Saharan Africa, the burden of these chronic diseases continues to rise. Despite the availability of conventional therapeutic solutions (surgery, medication), interventional radiology remains underutilized, even though it could serve as an innovative and suitable therapeutic option, reducing complications and hospital stays [6]. In Cameroon, as in many countries in the region, IR implementation rates are very low, and the factors explaining this underutilization remain poorly documented.

Given this context, it is crucial to identify and understand the specific challenges that hinder the establishment of interventional radiology units in Cameroon. Therefore, the primary objective of this study was to comprehensively assess the financial, technical, logistical, human resource, regulatory, and political challenges encountered in setting up an IRU and to propose possible solutions to improve chronic disease management in the country.

2. Materials and Methods

2.1. Study Design

To understand the challenges of establishing an IRU in public and private healthcare facilities in Cameroon, we conducted a cross-sectional study from November 2024 to January 2025, involving a rigorous survey among healthcare (specialist doctors, radiologists, general practitioners, radiology technicians) and administrative personnel from these facilities in regional capitals of Cameroon. The study sites were selected based on accessibility and infrastructural predisposition for IRU implementation.

2.2. Study Population and Data Collection Procedure

The study included healthcare and administrative personnel from public and private healthcare facilities in these regional capitals who met the inclusion criteria (accessibility and infrastructural predisposition). Following ethical approval from the University of Douala Ethics Committee and authorization from regional health delegations, data collection was conducted using a structured, pre-tested questionnaire validated by the research team. The questionnaire primarily collected demographic information, well-being and financial satisfaction of medical and administrative staff, as well as technical, infrastructural, financial, human resource, regulatory, and political challenges, along with proposed solutions. Data collection was conducted both in person and online via a Google Forms survey (https://forms.gle/VYRsAsjgDuwnYr8Q8 ) to address time and accessibility constraints.

2.3. Statistical Analysis

The data were recorded in an Excel 2013 spreadsheet and analyzed using R software version 4.4.2 for Windows Professional. Variables were presented as frequencies (N, n) and percentages (%). Pearson’s Chi-squared test was performed to compare the proportions of various challenges between healthcare personnel categories and healthcare facility types. For this test, the null hypothesis (H₀), which stated that there was equality between these proportions, was set at a 95% confidence interval with a 5% margin of error. The p-value was considered statistically significant when less than 0.05.

3. Results

3.1. General Information on Respondents and Their Healthcare Facilities

The majority of healthcare facilities were referral hospitals (27%) and private clinics (26%), while company medical-social centers were the least represented (1.9%). Regarding angiography equipment, 72% of facilities lacked it. Among the surveyed personnel, specialist doctors (29%) and general practitioners (28%) were the most numerous, followed by radiologists (23%) and radiology technicians (10%). Administrators, ENT doctors, and pharmacists represented smaller proportions (4.4%, 3.0%, and 2.4%, respectively). In terms of experience, 40% of respondents had 1 to 5 years of practice, while 28% had less than a year of experience, and only 7.9% had over 10 years of experience (Table 1).

Table 1: General Information on Respondents and Their Healthcare Facilities.

3.2. Impact of Financial Satisfaction and Professional Aspirations on Healthcare Personnel’s Involvement in the Establishment of an Interventional Radiology Unit

Financial satisfaction varied significantly across professional categories (p < 0.001): 52% of respondents found it unsatisfactory, while only 5% considered it highly satisfactory. Financial aspirations also differed significantly (p < 0.001), with the majority demanding a salary increase (61%), while 25% were seeking more lucrative career opportunities. A lack of motivation due to insufficient remuneration significantly influenced respondents' involvement in setting up an interventional radiology unit (p < 0.001), with 69% stating that it would be a hindrance. Similarly, the perceived impact of better financial well-being on the success of the project was significant (p < 0.001), with 56% of participants believing it would play a major role. The perception of interventional radiology’s effect on income growth also varied significantly (p< 0.001), with 33% believing it would have no impact, while 30% saw it as having a significant effect. Finally, almost all respondents agreed that this specialty would improve patient care (p < 0.001), with 71% considering its impact to be highly significant (Table 2).

Table 2: Impact of Financial Satisfaction and Professional Aspirations on Healthcare Personnel’s Involvement in the Establishment of an Interventional Radiology Unit.

3.3. Technical and Infrastructural Challenges in Establishing an Interventional Radiology Unit

The analysis of technical and infrastructural challenges in establishing an interventional radiology unit revealed significant differences between private and public healthcare facilities (p < 0.001). Overall, 50% of facilities considered their infrastructure moderately adequate, with a higher proportion in the public sector (30%) compared to the private sector (21%). Infrastructure adequacy was more frequently reported in public facilities (23% vs. 2% in private facilities). The main technical shortcoming identified was the availability of equipment (60%), which affected public facilities (47%) more than private ones (13%). Issues related to adequate physical space (17%) and equipment maintenance (15%) were also more common in the public sector. Regarding equipment availability, public facilities had more ultrasound machines (21% vs. 12% in private facilities) and CT scanners (24% vs. 2.4% in private facilities). However, equipment such as angiography machines, MRI scanners, and X-ray machines were less accessible, particularly in the private sector, where some equipment, such as mammography and standard X-ray machines, was completely absent (Table 3).

Table 3: Technical and Infrastructural Challenges in Establishing an Interventional Radiology Unit.

3.4. Financial, Logistical, Human, Regulatory, and Political Constraints in Establishing an Interventional Radiology Unit

The study highlighted financial, logistical, human resource, regulatory, and political challenges in establishing an interventional radiology unit, with significant differences between private and public healthcare facilities (p < 0.001). The main financial barrier was the cost of acquiring equipment (56%), which affected public facilities (43%) more than private ones (14%). Logistical constraints were primarily related to equipment transportation and installation (46%) and the supply of medical consumables (43%), with a greater impact in the public sector. The availability of trained personnel was deemed inadequate in 57% of cases, with initial staff training identified as the most critical training need (54%). The lack of qualified candidates (50%) and working conditions (33%) were the main recruitment challenges. On the regulatory level, authorization procedures (45%) and safety standards (28%) were the primary barriers. Finally, political support was perceived as neutral (37%) or unfavorable (25%) by a large proportion of respondents, with a complete absence of "very favorable" support in private facilities (Table 4).

Table 4: Financial, Logistical, Human, Regulatory, and Political Constraints in Establishing an Interventional Radiology Unit.

3.5. The proposed solutions

To overcome technical and infrastructural challenges primarily included improving equipment maintenance (35%), purchasing modern equipment (34%), and expanding infrastructure (31%). To enhance staff skills, training programs in collaboration with international institutions were the most recommended (46%), followed by local seminars and workshops (42%), while online training (9.4%) and on-site internal training (2.4%) were less favored. Regarding strategies to overcome financial and logistical obstacles, the most supported measure was increasing public funding (55%), followed by public-private partnerships (31%) and international subsidies (13%) (Table 5).

Table 5: Solutions.

4. Discussion

Our study reveals several key factors that hinder the establishment of an interventional radiology unit (IRU) in Cameroon. First, the typology of healthcare facilities, primarily composed of referral hospitals (27%) and private clinics (26%), highlights the diversity of the local healthcare system. However, the high proportion of facilities lacking angiography equipment (72%) reflects a severe material deficit, limiting access to interventional care [6]. This shortage of specialized equipment may be linked to budgetary constraints and insufficient investment planning in healthcare, as previously noted by Brock et al. (2023) in other African contexts [2].

Financial satisfaction emerged as an important determinant of staff involvement, with 52% of respondents dissatisfied (p < 0.001) and 69% stating that insufficient remuneration hindered their engagement in setting up an IRU. Several studies suggest that better remuneration and a motivating work environment are essential to attracting and retaining highly qualified professionals in advanced specialties like interventional radiology [1,2]. The low level of salary satisfaction could thus contribute to migration towards the private sector or other countries offering more attractive conditions, further exacerbating the shortage of trained personnel in this field.

Financial constraints appear to be the primary obstacle (56%, p < 0.001) to IRU implementation, reflecting the high costs associated with acquiring and maintaining high-tech equipment. In this regard, equipment transportation and installation (46%, p < 0.001), as well as the supply of medical consumables (43%, p < 0.001), add to the already substantial logistical burden for healthcare facilities [5]. Furthermore, the lack of qualified personnel (57%, p < 0.001) highlights the absence of institutionalized training pathways in interventional radiology. According to the European Society of Radiology [7], training and continuous education are crucial for the development and sustainability of this specialty, particularly in countries with a low density of specialists.

Regulatory barriers and lack of political support (37% neutral and 25% unfavorable, p < 0.001) further complicate the situation. Lengthy or complex authorization procedures, along with the absence of targeted health policies, may discourage both public and private initiatives [8]. Policymakers, often faced with competing health priorities, do not always allocate sufficient attention to the development of interventional radiology, a specialty perceived as costly and demanding in highly qualified human resources [9].

To address these challenges, our study proposes concrete solutions. On one hand, improving equipment maintenance (35%) and acquiring new equipment (34%) aim to resolve technical deficiencies. On the other hand, expanding infrastructure (31%, p < 0.001) and establishing training programs through international collaborations (46%, p < 0.001) and local seminars (42%, p < 0.001) could help enhance staff competencies.

This combination of actions, supported by increased public funding (55%), public-private partnerships (31%), and international subsidies (13%, p < 0.001), is also recommended by the World Health Organization in its strategy to strengthen healthcare systems in sub-Saharan Africa. The experience of some emerging countries shows that mixed funding models and resource pooling can accelerate the implementation of interventional radiology units [10].

5. Conclusion

Financial, logistical, human resource, and regulatory barriers—particularly the high cost of equipment, limited availability of trained personnel, and insufficient political support—currently hinder the establishment of interventional radiology units in Cameroon. However, targeted strategies combining infrastructure upgrades, improved maintenance, specialized training through international and local programs, and diversified financing (increased public funding, public–private partnerships, and international subsidies) could enable rapid and sustainable development of interventional radiology services and improve patient care.

6. Conflicts of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

7. Funding

The authors state that the research was conducted in the absence of any external funding.

8. References

1. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization, 2013.
2. Brock KK, Chen SR, Sheth RA, Siewerdsen JH. Imaging in interventional radiology: 2043 and beyond. Radiology 308.1 (2023): e230146.
3. Suchy H. Living in lead: the evolution of interventional radiology. 2023.
4. Zealley IA, Chakraverty S. The role of interventional radiology in trauma. BMJ 340 (2010).
5. Miranda-Schaeubinger M, Noor A, Leitão CA, Otero HJ, Dako F. Radiology for thoracic conditions in low- and middle-income countries. Thorac Surg Clin 32 (2022): 289-298.
6. Ministry of Public Health, Cameroon. National Health Development Plan 2021–2025. [Internet] Yaoundé: MINSANTE.
7. England RW, Anand J, Yanoshak E, Sidloski M, Muruka J, Maina FW, Mollura D, Dixon R, Shah TI, Anton K. Expanding global IR outreach to address postpartum hemorrhage in Kenya using geospatial analytic mapping. J Vasc Interv Radiol 36 (2025): 1067–1075.e1.
8. De Filippo M, Brunese L, Reginelli A. Advances in diagnostic and interventional radiology. Acta Biomed 90-S (2019): 5-8.
9. Weiss CR, Hafezi-Nejad N. Interventional radiology: past, present, and future. Radiology 308 (2023): e230809.
10. European Society of Radiology (ESR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Interventional radiology in European radiology departments: a joint survey. Insights Imaging 10 (2019): 16.