Neuroimaging Inequities in Africa: Health system readiness, diagnostic capacity, and an embedded case study of portable ultra-low-field MRI implementation in Ethiopia

Neurological conditions in Africa are an increasingly significant public health burden. Conditions such as stroke, dementia, and central nervous system infections impose a disproportionate burden in resource-constrained regions, highlighting the need to strengthen diagnostic capacity. Magnetic Resonance Imaging (MRI) and computed tomography (CT) are essential technologies for the diagnosis and management of these conditions. However, the availability and affordability of these advanced diagnostic technologies remain limited across the continent. A low-cost, portable ULF-MRI system may help expand access to neuroimaging services across diverse settings by overcoming some of the infrastructural and affordability challenges. The aim of this study was to assess the diagnostic imaging capacity and health system readiness for advanced neurological services in Africa and to examine the feasibility of integrating portable ULF-MRI into routine clinical care in a low-resource setting, specifically in Ethiopia. Quantitative data on MRI and CT capacity and selected health system infrastructure indicators were obtained from the World Health Organization Global Health Observatory Database. The qualitative case study was based on a recently deployed 0.064T ULF-MRI Hyperfine Swoop system at a regional specialized hospital in Ethiopia for clinical use. The results showed substantial gaps in diagnostic imaging capacity, workforce availability, and supporting infrastructure across Africa. MRI and CT density in Africa stood at 0.11 MRI and 0.42 CT scanners per million population, respectively. The Ethiopian case study suggested that ULF-MRI may be a promising approach to expanding neuroimaging access because it can be integrated into routine clinical practice with relatively modest infrastructure and personnel requirements. These findings underscore major diagnostic inequities across African health systems and suggest that portable ULF-MRI may offer a feasible approach to expanding access to neuroimaging services in resource-constrained settings.