Towards the scale and menace of unregulated sonography practice in Ghana

Abstract

# Background There is a high demand for medical sonographers, mainly due to high antenatal and other ultrasound examinations. Ghana has 334 registered radiographers and sonographers for a population of 30 million. The non-existence of strict enforcement of mandatory credentialization and licensure for the practice of ultrasonography has made the proliferation by quacks very pervasive in Ghana. However, there is inadequate knowledge about the activities of these unlicensed sonographers. This paper looks at the scale, creation, proliferation, and patronage of unlicensed Sonographers and discusses the impact on Ghana's health care delivery. # Methods The study was a qualitative study using well-structured pretested questionnaires administered to unlicensed sonographers – multiple techniques were used in data collection. Sonographic reports emanating from unlicensed sonographers brought by referred patients to a tertiary hospital were also collated and analyzed. # Results A total of 207 unlicensed sonographers were recruited for the survey. The results showed 90% (186) response rates out of which 128 (69%) were males and 58 (31%) were females. All participants were above 25 years. 46.8% of unlicensed sonographers had senior high school (SHS) or tertiary (41.4%) education. Four pathways identified for their proliferation, 32.8% trained by attending sonography short courses, 32.2% by Peer-to-peer hands-on training, 32.2% by unaccredited training schools, 3.8% attended sonography workshop, and 1.0% had no form of training. Radiologists 33%, Licensed Sonographers 29%, Medical Doctors 20%, unlicensed sonographer 16%, and midwives 2% were responsible for their training. The majority (67.2%) worked in hospitals, and 29.6% in diagnostic centers. The facilities' ownership structure showed 66.7% privately owned, 15.8% government-owned, 14.2% owned by the Christian Health Association of Ghana (CHAG), faith-based health facilities, and 3.3% of respondents set up their personal ultrasound scan center. The majority (82.2%) of respondents believed sonography practice must be rigorously regulated. The overwhelming majority (95.5%) wanted practicing unlicensed sonographers to be allowed to upgrade at accredited ultrasonography schools leading up to their appropriate licensing. # Conclusions Regulators must stringently implement guidelines regulating the practice of ultrasound to safeguard patients. However, the 334 licensed sonographers in Ghana is woefully inadequate; therefore, unlicensed sonographers must be persuaded and supported to upgrade. Policy direction is to increase accredited ultrasonography training institutions to facilitate the training of more medical sonographers.