A beefing up of diagnostics

India needs to build momentum similar to that generated for Covid-19, for other diseases

n 50% of patients not getting treated for six tracer conditions, i.e., diabetes, hypertension, HIV, hepatitis, malaria and tuberculosis.
n 50% of patients not getting treated for six tracer conditions, i.e., diabetes, hypertension, HIV, hepatitis, malaria and tuberculosis.

By Kamini Walia

Historically, diagnostics never received too much attention from policy makers and health administrators—that is, before Covid-19 pandemic. It would have been impossible to manage the pandemic without expedited development, manufacturing and expanded delivery of the relevant diagnostics. Poor accessibility of diagnostics, especially in low- and middle-income countries, is not a new phenomenon, but not much has been done globally to address this challenge. The lack of these has been recognised as a major challenge impeding the expansion of universal health coverage, addressing the challenge of antimicrobial resistance and general progress on pandemic preparedness. Last month, the Lancet Commission on Diagnostics released a detailed report on what’s ailing the diagnostics systems across the globe, especially in low- and middle-income countries, and what should be done at national and international level to prioritise diagnosis in health care.

The report highlights the diagnosis as the single-most important step in the cascade of care, with poor accessibility resulting in 50% of patients not getting treated for six tracer conditions, i.e., diabetes, hypertension, HIV, hepatitis, malaria and tuberculosis. Narrowing the diagnostic gap for these six conditions would reduce the annual number of premature deaths in LMICs by 1·1 million, and the annual DALY losses by 38·5 million. The largest absolute effect was for hypertension, followed by HIV and tuberculosis which are also health priorities for India.

Going by the current availability of diagnostics by level of health are facility, geography, and socioeconomic group, as per the report, the gap is most severe at the level of primary health care, in which only about 19% of populations in low-income and lower-middle-income countries have access to the simplest of diagnostic tests (other than those for HIV and malaria). Even in hospitals, this figure only rises to 60–70%. People who are poor, marginalised, young, or less educated have the least access to diagnostics. Diagnostic imaging is essentially absent outside of hospitals and concentrated in urban settings. Various surveys conducted in India have highlighted the problem of lack of tests for malaria, HIV, hepatitis and other key diagnostics like glucometer and electrocardiogram machines and point-of-care test supplies such as blood glucose estimation strips, needles and urinary protein strips needed for the management of noncommunicable diseases at primary health facilities.

Lack of microbiology laboratories outside the tertiary care sector has resulted in syndromic use of antimicrobials, thus adding fuel to the ever-increasing problem of antimicrobial resistance in the country. Non-availability of diagnostic tests at different levels of health care results in a thriving private sector where some players deliver expensive and sometimes irrelevant and poor quality tests, with many patients spending out of pocket for having a diagnostic test conducted. Of the overall out-of-pocket expenses on health care, the current expense of Indian patients on diagnostics is estimated to be around 10%. As a part of its nationwide effort on Health for All, the Union government, under the National Health Mission, launched the Free Drugs Service and Free Diagnostics Service initiative aimed at reducing out-of-pocket expenses on diagnostics by providing free, high-quality diagnostics services at all levels of healthcare. The initiative and the states make annual investments to meet the costs of conducting tests, maintaining equipment and consumables. India also created a nationwide network of 3,000 laboratories, both in public and private sector, for Covid-19 testing. This success now needs to spillover to improve diagnostics for other disease conditions as well.

The Lancet Commission on Diagnostics is the second major effort to bring focus on diagnostics after the release of the WHO Essential Diagnostics List in 2018 which recommended list of minimum essential tests which should be available at all levels of healthcare. India remains first country, and indeed, the only so far, to release a National Essential Diagnostics List (NEDL) in 2019. India has also taken series of steps like introducing creating an ecosystem for funding innovation in new diagnostic development. Yet, to augment the availability and accessibility of diagnostics, what is required is improvement at multiple levels; for instance, having supportive infrastructure, trained human resources, availability of quality diagnostics and well-functioning supply chains supported by relevant policy, regulatory and adequate funding mechanisms and sustained commitment. Overwhelmed by the extent of problem and investment required for improvement of diagnostic systems, syndromic management is seen as a more economical alternative.

Taking cognisance of the enormity of the challenge and realising that there is no single effective means (eg, technology) to address the multiplicity of challenges in improving the access to diagnostics, the Commission proposes ten recommendations which if implemented can be transformative. In addition to the ongoing initiatives, implementing the Lancet Diagnostics Commission’s recommendations will enhance India’s preparedness for any future pandemics, and help achieve health-related sustainable development goals.

The author is Program officer AMR, division of epidemiology and communicable diseases, Indian Council of Medical Research

Get live Stock Prices from BSE, NSE, US Market and latest NAV, portfolio of Mutual Funds, Check out latest IPO News, Best Performing IPOs, calculate your tax by Income Tax Calculator, know market’s Top Gainers, Top Losers & Best Equity Funds. Like us on Facebook and follow us on Twitter.

Financial Express Telegram Financial Express is now on Telegram. Click here to join our channel and stay updated with the latest Biz news and updates.