Availability of essential diagnostics in primary care in India
2018; Elsevier BV; Volume: 18; Issue: 10 Linguagem: Inglês
10.1016/s1473-3099(18)30539-5
ISSN1474-4457
AutoresMikashmi Kohli, Kāmini Walia, Sumit Mazumdar, Catharina Boehme, Zachary Katz, Madhukar Pai,
Tópico(s)Pharmaceutical Economics and Policy
ResumoThis year, WHO published the first essential diagnostics list1WHOWorld Health Organization model list of essential in vitro diagnostics, first edition.http://www.who.int/medical_devices/diagnostics/WHO_EDL_2018.pdfDate: May 16, 2018Date accessed: August 7, 2018Date accessed: August 4, 2018Google Scholar and declared its commitment to making diagnostics as important as essential medicines in universal health coverage.2Berumen AV Garner S Hill SR Swaminathan S Making diagnostic tests as essential as medicines.BMJ Global Health. 2018; 3: e001033PubMed Google Scholar The essential diagnostics list includes 113 tests, grouped by two broad levels: diagnostics for primary care settings with no or basic laboratories, and diagnostics for facilities with clinical laboratories.1WHOWorld Health Organization model list of essential in vitro diagnostics, first edition.http://www.who.int/medical_devices/diagnostics/WHO_EDL_2018.pdfDate: May 16, 2018Date accessed: August 7, 2018Date accessed: August 4, 2018Google Scholar At the primary care level, general tests in the list include urine dipstick, complete blood count, haemoglobin, glucose, and microscopy, and disease-specific tests include tests for HIV, tuberculosis, malaria, syphilis, and hepatitis B and C.2Berumen AV Garner S Hill SR Swaminathan S Making diagnostic tests as essential as medicines.BMJ Global Health. 2018; 3: e001033PubMed Google Scholar The essential diagnostics list offers countries a benchmark they can use to measure and improve diagnostic services. We used the list to assess availability of essential tests at the primary care level in the Indian public sector. For this pilot facility survey, we chose three districts in three states of India, in north, south, and central zones (figure). Within each district, with permissions from district health authorities, we randomly selected 20% of the all primary health centres. Each primary health centre was visited by a researcher (MK) with a checklist, to assess availability of diagnostics. Between Dec 13, 2017, and March 22, 2018, we assessed 21 primary health centres in Tumkur (Karnatka), 13 in Fatehpur (Uttar Pradesh), and six in Wardha (Maharashtra). No participant data were collected and ethics approval was deemed unnecessary. Our results show that all three districts had major gaps in test availability, and there were large variations across the districts, with Wardha faring relatively better, and Fatehpur faring worst (appendix). Some of the tests listed in the essential diagnostics list were not available in any district, such as blood lactate, hepatitis B e-antigen, anti-hepatitis C virus antibody, malaria rapid diagnostic tests, sputum tuberculosis loop-mediated isothermal amplification test, anti-HIV/p 24 rapid test, and a combined test for syphilis and HIV. With regard to the other tests, availability varied widely. For example, primary health centres in both Tumkur and Fatehpur had limited or no availability of blood counts and glycated haemoglobin A1c tests, whereas these tests were available in Wardha district. Of note, Wardha district used a public–private partnership model, in which diagnostic testing was outsourced to a private laboratory. For infections, the hepatitis (HBsAg) rapid test was available in 76% of the facilities in Tumkur, 38% of the facilities in Fatehpur, and 100% of the facilities in Wardha. For HIV and syphilis, only 38% of facilities in Fatehpur had these tests, whereas all facilities in Wardha provided the tests. Microscopy for tuberculosis and malaria was available in some, but not all, primary health centres. Our pilot survey revealed gaps in the availability of essential tests. Such gaps can limit the ability of health workers to manage common diseases, and the ability of the health systems to respond to threats such as outbreaks or antimicrobial resistance.3Schroeder LF Pai M A list to cement the rightful place of diagnostics in healthcare.J Clin Microbiol. 2018; (published online July 25.)DOI:10.1128/JCM.01137-18Crossref PubMed Scopus (4) Google Scholar To confirm our findings, larger, nationally representative sample surveys are necessary, and should cover both public and private sectors. Surveys must cover all key dimensions of access—availability, use, and quality—to generate a comprehensive diagnostics access scorecard. India has recently launched a free diagnostics service initiative under the National Health Mission to make some tests freely available.4Ministry of Health and Family WelfareNational Health mission: free diagnostics service initiative. Ministry of Health and Family Welfare, Government of India, New Delhi2016Google Scholar India is also developing a national essential diagnostics list.5Raghavan P India to create new essential list to improve access to life-saving diagnostic tests.https://economictimes.indiatimes.com/industry/healthcare/biotech/pharmaceuticals/india-to-create-new-essential-list-to-improve-access-to-life-saving-diagnostic-tests/articleshow/63272757.cmsDate accessed: August 14, 2018Google Scholar Both initiatives should improve access to essential tests, and the national essential diagnostics list could become the standard for benchmarking access, since it will better reflect national needs and disease burden. This project was supported in part by FIND, Geneva, and Canadian Institutes of Health Research. KW and MP served on the WHO SAGE IVD Group that developed the first edition of the WHO Essential Diagnostics List. KW, SM, CCB, and ZK declare no competing interests. We are grateful to district health officials of Tumkur, Fatehpur, and Wardha districts in India for their support. We are also grateful to Vijayashree Yellappa, Gurram Krishnamurthy Sanathkumar, Ashwini Kalantri, and Sunitha Varghese for their encouragement and support in organising field visits. Download .pdf (.7 MB) Help with pdf files Supplementary appendix
Referência(s)