Summary
About half (47%) of the world’s population still lack access to basic diagnostics which are fundamental to quality healthcare.
1·1 million premature deaths in LMICs (low and middle-income countries) could be avoided annually by reducing the diagnostic gap for six priority conditions: diabetes, hypertension, HIV, and tuberculosis in the overall population, and hepatitis B virus infection and syphilis for pregnant women
It pays off to invest in diagnostics in the LMICs. According to a report published by the Lancet Commission on Diagnostics, the median benefit–cost exceeds one for five of the six priority conditions in middle-income countries, and exceeds one for four of the six priority conditions in low-income countries, with a range of 1·4:1 to 24:1.
The Unmet Need for Diagnostics in LMICs.
Diagnostics are central for guiding medical treatments. Despite this, about half (47%) of the world’s population still lack access to basic diagnostics which are fundamental to quality healthcare.
These findings were part of a report entitled The Lancet Commission on Diagnostics : Transforming Access to Diagnostics published in Oct 2021. It highlighted the unmet need for diagnostics in LMICs in Africa (e.g. Kenya, Senegal, Malawi, Haiti etc.) and South Asia (Bangladesh and Nepal) and potential steps forward.
Using 6 conditions as a benchmark (diabetes, hypertension, tuberculosis, HIV, Hep B, malaria, maternal and newborn care), the study found that the diagnostic gap in LMICs ranges from 35% to 62%, indicating that, on average, about half of all people with these conditions are undiagnosed.
The cascade of care shows that hypertension and Hep B have the lowest percentage of patients with treatment completed or condition controlled.
Overall, narrowing the diagnostic gap for these six conditions would reduce the annual number of premature deaths in LMICs by 1.1 million (2·5% of total annual deaths from all conditions in LMICs).
Availabilities of diagnostics are lowest in basic primary health-care facilities, with the greatest availability being for malaria at 40%, but only around 15% for urine glucose and urine protein, and 5% for ultrasound
The availability of diagnostics is somewhat correlated with country income, particularly at the level of primary care.
At the advanced level of primary health care, HIV and malaria were the most readily available tests (65% and 62% availability, respectively).
Investigations included as part of WHO recommendations for antenatal care had variable, but low, availability—namely, syphilis testing (49%), urine dipsticks (52%), haemoglobin testing (37%), blood glucose testing (32%), and ultrasound (12%).
Without essential diagnostics, clinical misdiagnosis can easily occur with fatal consequences. For example, a 2017 study in Angola found that the error rate for diagnosing malaria was as high as 84.3%, which led to unnecessary deaths and morbidity.
In terms of challenges for patients, generally, they must travel to hospitals for investigations such as a complete blood count, blood chemistry, basic bacteriology, and any form of imaging. But even if they travel there on foot, availability of the diagnostic is not guaranteed.
Funding is usually an issue contributing to the lack of diagnostics. However, it pays off to invest in diagnostics. The median benefit–cost exceeds one (i.e. benefits outweigh costs), for 5 of the 6 priority conditions in middle-income countries. Benefits also outweigh costs for four of the six priority conditions in low-income countries, with a range of 1.4:1 to 24:1.
Median cost benefit ratio of investing in diagnostics in LMICs in specific disease areas., according to the Lancet Commission on Diagnostics research.
Call to action
The Lancet Commission on Diagnostics was set up to overcome these pressing gaps. It includes 25 commissioners from 16 countries, with experts from laboratory medicine, surgery, diagnostic imaging etc. After studying the issue, they made 10 recommendations including:
Developing a costed national diagnostics strategy, based on an integrated and tiered network, including an evidence-based essential diagnostics list (EDL), with a prioritised subset for universal health coverage
Expanding the health workforce and upskilling for contemporary diagnostic skills
Developing governance and regulatory frameworks to support and oversee diagnostic quality and safety
Building a national financing strategy to provide sufficient, long-term financing to plan and implement diagnostics, including infrastructure
Advocating at all levels to ensure that diagnostics receive appropriate recognition and funding
Establishing an International Diagnostics Alliance to support and monitor the effort in transforming diagnostics
Countries like India, which have established a National Diagnostics List and a Free Diagnostics Services Initiative to ensure access to basic diagnostics, show that progress is possible but requires substantial stakeholder cooperation.
With coordinated efforts involving the global health community, governments and industry, Centivis looks forward to progress for diagnostics in the LMICs.
For more about the Lancet Commission on Diagnostics, see here
Want to know more about diagnostics? Contact us at info@centivis.com