What WHO’s essential diagnostic list means for India
India must boost its laboratory infrastructure to offer comprehensive diagnostic services that cover a wider range of conditions, including antimicrobial resistance and non-communicable diseases to help the country move away from a syndrome-based approach to targeted therapy approach.
Diagnostics provide information needed by service providers to make informed decisions about patient care and public health actions. The limited availability and access to quality laboratory and radiology services contribute to delayed or inappropriate responses to disease control and management. It also leads to continued reliance on empirical patient care or irrational diagnostic prescription, which are practices that not only waste scarce resources but are often also ineffective and harmful.
The World Health Organization’s (WHO)’s first Essential Diagnostics List (EDL) released last week comprises a list of tests needed to diagnose the most common conditions and global priority diseases. Essential diagnostics are defined as diagnostics that satisfy the priority health-care needs of the population and are selected keeping in mind the disease burden and public health relevance, evidence of efficacy and accuracy and comparative cost-effectiveness.
The first EDL, compiled by a WHO expert advisory group on in-vitro diagnostics, contains 113 tests of which 58 are basic tests (haemoglobin, blood glucose, complete blood count, urine dipstick etc). The remaining 55 tests are designed for the detection, diagnosis and monitoring of “priority” infections such as HIV, TB, malaria, hepatitis B and C, human papillomavirus (HPV) and syphilis.
The EDL will facilitate improving patient care, helping detect outbreaks, increasing affordability of tests, reducing out-of-pocket expenses for tests, reducing antibiotic abuse, improving regulation and quality of diagnostic tests, strengthening accreditation and quality of laboratories, improving supply chain and guiding the R&D of new diagnostic tools.
India is in the process of rolling out its Free Diagnostics Service Initiative in 29 states with a goal at ensure the availability of a minimum set of diagnostics appropriate to the level of care to reduce out-of-pocket expenditure on diagnostics and encourage appropriate treatment based on accurate diagnosis. It includes tests required at various levels of the health system, ranging from peripheral health facilities to reference hospital and laboratories.
Technological advancements has led to the diagnostic sector growing and evolving very rapidly. India must grab the opportunity to use this resource to its advantage and strengthen the diagnostics component in the health care system and make it available at affordable prices to improve outcomes.
The release of the WHO list could not have been more timely. India must boost its laboratory infrastructure to offer comprehensive diagnostic services that cover a wider range of conditions, including antimicrobial resistance and non-communicable diseases to help the country move away from a syndrome-based approach to targeted therapy approach. National efforts with ICMR in the lead are being initiated to develop an India-specific essential diagnostics list in the foreseeable future.
Kamini Walia is a senior scientist, ICMR, and Rajesh Bhatia, is a former adviser, communicable diseases, WHO SEARO, who were on the WHO expert panel that drafted the list.
The views expressed are personal.