The COVID-19 pandemic has shown that access to timely, accurate diagnostics is fundamental to effective healthcare. Yet today, almost half the world’s population has little or no access to even the simplest of tests. The problems are most severe and acute in primary and community care – in low- and middle-income countries, basic tests are available in just 1% of primary care clinics. The result is not only blindness to current and emerging health threats, it also puts achievement of the global goal of universal health coverage (UHC) in jeopardy.
Addressing shortfalls in diagnostic testing must be an urgent priority. While deficiencies impact the whole care cascade – affecting medical workforces, education, research, physical infrastructure, supply chain, data collection, and management – the root causes are more straightforward. Lack of political prioritization, resource allocation and finance, and lack of effective regulation for governance and quality are stymying efforts to build sustainable, resilient health systems that can deliver health for all.
A two-pronged approach, focused on both policy and implementation, is critical, and must be underpinned by long-term (>20 year) commitments and funding. Solutions fall into several categories, all of which are aimed at optimizing scant resources.
Establish national diagnostics strategies to support National Health Plans, including the development and implementation of national Essential Diagnostics Lists. Diagnostic testing must be acknowledged as a key enabler for health, and supported by adequate funding, for example through national financing strategies for diagnostics, and coverage of diagnostics for key conditions in UHC benefits packages.
- Make key basic diagnostic tests available at primary health centres, as a key step towards UHC. This includes the availability of accurate, reliable point-of-care tests that are linked to radiology and pathology and laboratory medicine (PaLM) systems to provide “see and treat” at one visit, ensure seamless handover between health facilities and tiers, and enable appropriate patient follow up. Digital tools can also support community health workers with tasks that may previously have been restricted to specialized clinics.
- Invest in an expanded workforce with the skilling and upgrading needed to support advances in diagnostics. Training programmes are needed to increase the number of technicians, scientists and pathologists to a base level, and enable task shifting that can reduce both the time and cost of training fully qualified specialists. Regional/transnational networks should be activated to optimize both training and capacity of staff. Technology such as artificial intelligence and digital decision support tools can also support tasks such as image interpretation at lower levels of the health system.
- Commit to enabling policy and regulatory frameworks for diagnostics in Africa. Context-appropriate, simple accreditation processes are needed to ensure affordable, high-quality tests can be made available where they are needed as quickly as possible.
- Improve infrastructure, including supporting the expansion of local and regional manufacturing capacity. This must include initiatives to streamline supply chains, equipment purchase and maintenance, IT and mobile developments to improve data flow and communications, alongside development of robust, affordable and context-appropriate Laboratory Information and Management Systems.
Open Zoom
