Medical imaging serves as a foundational pillar of modern healthcare by enabling early disease detection and precise treatment planning. Sub-Saharan Africa faces a complex, dual burden of high infectious disease rates alongside rising cases of non-communicable conditions. This reality makes diagnostic services increasingly vital. However, severe barriers limit patient access to these critical tools. This narrative review assesses the current landscape of medical imaging in the region. It aims to identify the primary technological and organizational challenges hindering diagnostic access and to explore low-cost, innovative solutions. A literature search of peer-reviewed articles published largely between 2015 and 2026 was conducted using PubMed and PubMed Central. Findings indicate that hospitals struggle constantly with broken equipment, poor maintenance networks, unreliable power grids, and digital infrastructure limitations. Organizationally, severe shortages of radiologists and radiographers are compounded by migration, limited training, and high out-of-pocket costs for patients. Despite these hurdles, frugal innovations provide viable paths forward. Point-of-care ultrasound enables non-physician healthcare workers to perform basic scans in rural settings. Artificial intelligence assists in interpreting chest X-rays, reducing specialist workloads. Lowfield magnetic resonance imaging, solar-powered systems, and teleradiology networks are successfully circumventing traditional infrastructure gaps. Sustaining these innovations requires governments to invest in local biomedical engineering, update regulatory frameworks, and improve health financing mechanisms.