Stranded Potential: Early Digital Pathology Investments in Ethiopia and The Challenge of Sustainable Utilization

Research Article

Stranded Potential: Early Digital Pathology Investments in Ethiopia and The Challenge of Sustainable Utilization

Giorgis Yeabyo ^1*
Mesfin Nigussie ²
Addisu Alemu ³
Wubshet Assefa ⁴
Meron Demelash ⁵
Elizabeth Chilpala ⁶
Dan Milner ⁷
Dana Razzano ⁸

1ABiTi Consultancy Services (ACS), Addis Ababa, Ethiopia.

2International Clinical Laboratories (ICL), Addis Ababa, Ethiopia.

3Harmaya University, Harar, Ethiopia.

4Swiss Diagnostic Ethiopia (SDE), Addis Ababa, Ethiopia.

5Ethiopian Society of Pathologists (ESP), Addis Ababa, Ethiopia.

6Premier Laboratories LLC, Colorado, USA.

7Liberagem Consulting LLC, USA.

8Department of Research, Institute for Systems Biology, Seattle, Washington, USA.

*Corresponding Author: Giorgis Yeabyo, ABiTi Consultancy Services (ACS), Addis Ababa, Ethiopia.

Citation: Yeabyo G, Nigussie M, Alemu A, Assefa W, Demelash M, et al. (2026). Stranded Potential: Early Digital Pathology Investments in Ethiopia and The Challenge of Sustainable Utilization, International Journal of Clinical and Surgical Pathology, BioRes Scientia Publishers. 3(1):1-3. DOI: 10.59657/3067-0462.brs.26.016

Copyright: © 2026 Giorgis Yeabyo, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: January 26, 2026 | Accepted: June 12, 2026 | Published: June 24, 2026

Abstract

Background: Digital pathology offers potential to improve diagnostic accuracy and accessibility in Ethiopia, a country with critical shortages in pathology infrastructure (188 pathologists, 18 laboratories).

Objective: To explore digital pathology adoption post-procurement in low-resource settings by assessing scanner utilization relative to capacity and identifying implementation barriers including power instability, internet connectivity, technical support absence, staff training gaps, and storage limitations.

Materials and Methods: A multi-site case study was conducted involving purposive sampling of three Ethiopian institutions with known digital pathology scanner acquisition. Structured interviews were conducted with 7 key informants (department heads and practicing pathologists) across sites between June and July 2025. Quantitative operational metrics (annual scanned slides, scanner uptime) were collected via interview and institutional records where available. Qualitative data were analyzed thematically based on pre-specified domains including infrastructure, workflow integration, and human resources.

Results: Scanner capacities ranged from 46 to 60 slides/hour with optimal annual capacities of 69,000 to 90,000 slides (calculated assuming 5 hours/day operation over 300 working days). Actual annual scanned slides were substantially lower: 1,097 (HU), 300 (SDE), and 10 (ICL). Only HU integrated digital pathology for primary diagnostics and research, while SDE used scanners for research and occasional consults, and ICL’s scanner was non-functional with ad hoc use. Key barriers included unstable power and connectivity, absence of technical support, and variable training. Verification protocols referred to user competency checks and quality control measures, present in HU and ICL but absent in SDE.

Conclusion: Despite clear clinical need and high-capacity scanners, digital pathology systems remain underutilized due to infrastructural, technical, and workflow challenges. Sustainable adoption requires coordinated governance, infrastructure investment, dedicated support, and comprehensive training programs tailored to low-resource contexts.

Keywords: digital pathology; whole slide scanner; infrastructure; workflow integration; Ethiopia

Introduction

Digital pathology facilitates remote diagnostics, workflow management, research, and education, offering scalable solutions to address personnel shortages and geographic disparities in resource-limited settings (Pantanowitz et al., 2013; Hanna et al., 2020). Ethiopia, with a population exceeding 120 million, faces a critical shortage of pathology resources: only 188 pathologists and 18 pathology laboratories nationwide (WHO, 2025; Berhane et al., 2022). This gap underscores the urgent need for scalable diagnostic technologies.

Despite increasing investments in digital pathology scanners, there is limited understanding of post-procurement adoption, utilization, and sustainability in such settings. This study employs a multi-site case study approach to assess operational status, scanner utilization, and implementation barriers in three Ethiopian institutions, thereby informing strategies to optimize digital pathology integration.

Materials and Methods

A multi-site case study design was used, with purposive sampling of three Ethiopian institutions known to have acquired digital pathology scanners. Data collection occurred June-July 2025. Seven key informants (department heads and practicing pathologists) were interviewed using a structured guide covering digital and human resource infrastructure, workflow integration, scanner usage, and operational challenges. Quantitative data on scanner utilization (annual scanned slides, uptime) were obtained from institutional records when available or estimated through interviews. Qualitative data were thematically analyzed based on pre-specified domains: infrastructure, technical support, workflow integration, training, and verification protocols.

Results

Table 1: Scanner Capacity vs. Actual Slides Scanned [X*5hr*300 working days/year=Z (Leica Biosystem].

Institution	Ownership	Location	Established (Year)	Scanner Type	Capacity (Slide/Hour) (X)	Scanned slides since implemented and per year (Y)	Optimal number of scanned slides/year (Z)
HU	Public	East Ethiopia	2018	Aperio CS2	46	7679 (1097/year)	69000
SDE	Public	Addis Ababa	2022	3DHistech	60	600 (300/year)	90000
ICL	Public	Addis Ababa	2015	Aperio CS2	46	100 (10/year)	69000

Optimal number of scanned slides/years is calculated as: scanner capacity × 5 hours/day × 300 working days/year.

HU integrated digital pathology into routine primary diagnostics and research workflows. SDE used digital pathology primarily for research and occasional external consultations; routine clinical use was not active. ICL’s scanner was non-functional at the time of study, with limited ad hoc scanning.

Reported Barriers

All institutions reported very low connectivity and power instability. None had access to technical support, and only two had trained personnel. Verification protocols were present in two institutions, and storage solutions varied in reliability.

Barrier	HU	SDE	ICL
Poor Connectivity	Yes	Yes	Yes
Power Outage	Yes	Yes	Yes
Tech Support	No	No	No
Trained HR	Yes	No	Yes
Verification	Yes	No	Yes
Storage (Cloud/Server)	Cloud	Server	Server
Workflow-Integration	N/A	Disrupted	Integrated

Discussion

This study highlights a significant gap between digital pathology investments and sustainable utilization in Ethiopia. Despite high scanner capacities and clinical demand, actual usage remains minimal, with only one institution fully integrating digital pathology into routine workflows. Barriers such as unstable power supply, poor internet connectivity, lack of technical support, and inconsistent training undermine system functionality.

The term "verification protocols" refers to user competency assessments and quality control measures ensuring diagnostic reliability. Their absence at SDE may contribute to limited clinical adoption. Workflow integration varies: HU applies digital pathology for routine primary diagnostics and research; SDE limits usage to research and sporadic consults; ICL’s scanner is non-operational, restricting use.

These findings reflect systemic challenges common in low-resource settings, where technology acquisition often outpaces readiness for operational integration (Pantanowitz et al., 2013; Williams et al., 2018). Strategic, coordinated governance, infrastructure investment, and comprehensive training are essential to unlock digital pathology’s potential and avoid stranded capacity.

Conclusion

Digital pathology adoption in Ethiopia remains nascent, with significant underutilization despite clear clinical need and available technology. Addressing infrastructural and operational barriers is critical to prevent resource wastage and enhance diagnostic capacity.

Recommendations

National-level centralized governance should standardize digital pathology implementation, ensuring interoperability and equitable resource allocation. Investments must focus on robust infrastructure stable power, high-speed internet, cloud/server storage and dedicated technical support teams capable of real-time troubleshooting. Comprehensive training programs, AI-assisted verification protocols, and vendor service agreements are vital for maintaining diagnostic accuracy and system reliability across healthcare tiers.

Declarations

Conflict of Interest

The authors declare no conflicts of interest.

Funding

This work received no funding from governmental, non-governmental, or private organizations.

References

Pantanowitz L, Sinard JH, Henricks WH, et al. (2013). Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med. 137(12):1710-1722.
Publisher | Google Scholor
Hanna MG, Reuter VE, Ardon O, et al. (2020). Validation of a digital pathology system including remote review during the COVID-19 pandemic. Mod Pathol. 33(11):2115-2127.
Publisher | Google Scholor
Williams BJ, Hanby A, Millican-Slater R, et al. (2018). Digital pathology for the primary diagnosis of breast histopathology: a validation study. Histopathology. 72(4):662-671.
Publisher | Google Scholor
WHO. (2025). Global Health Observatory data repository: density of pathologists. World Health Organization.
Publisher | Google Scholor
Berhane Y, Worku A, Teka T, et al. (2022). Health system challenges in Ethiopia: a review of diagnostic capacity and laboratory infrastructure. Ethiop J Health Dev. 36(Suppl 1):45-52.
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Leica Biosystems. (2019). Introducing the Aperio GT 450 Whole Slide Scanner [brochure].
Publisher | Google Scholor

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