Quality (309) Lancet Global Health: Availability of essential diagnostics in ten LMICs

10 November, 2021

As we have noted previously on HIFA, it is impossible to deliver high-quality health care unless the basic needs of health workers are met. These needs, described by HIFA with the acronym SEISMIC, include Equipment and diagnostic tests. This paper finds that 'Major gaps in diagnostic availability exist in many low-income and middle-income countries, particularly in primary care facilities'. The authors concede in the full text that even where diagnostic tests are available, this does not mean they are appropriately utilised.

CITATION: Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys

Harika Yadav et al.

Lancet Global Health; Articles| volume 9, issue 11, e1553-e1560, november 01, 2021

SUMMARY

Background: Pathology and laboratory medicine diagnostics and diagnostic imaging are crucial to achieving universal health coverage. We analysed Service Provision Assessments (SPAs) from ten low-income and middle-income countries to benchmark diagnostic availability.

Methods: Diagnostic availabilities were determined for Bangladesh, Haiti, Malawi, Namibia, Nepal, Kenya, Rwanda, Senegal, Tanzania, and Uganda, with multiple timepoints for Haiti, Kenya, Senegal, and Tanzania. A smaller set of diagnostics were included in the analysis for primary care facilities compared with those expected at hospitals, with 16 evaluated in total. Surveys spanned 2004–18, including 8512 surveyed facilities. Country-specific facility types were mapped to basic primary care, advanced primary care, or hospital tiers. We calculated percentages of facilities offering each diagnostic, accounting for facility weights, stratifying by tier, and for some analyses, region. The tier-level estimate of diagnostic availability was defined as the median of all diagnostic-specific availabilities at each tier, and country-level estimates were the median of all diagnostic-specific availabilities of each of the tiers. Associations of country-level diagnostic availability with country income as well as (within-country) region-level availability with region-specific population densities were determined by multivariable linear regression, controlling for appropriate covariates including tier.

Findings: Median availability of diagnostics was 19·1% in basic primary care facilities, 49·2% in advanced primary care facilities, and 68·4% in hospitals. Availability varied considerably between diagnostics, ranging from 1·2% (ultrasound) to 76·7% (malaria) in primary care (basic and advanced) and from 6·1% (CT scan) to 91·6% (malaria) in hospitals. Availability also varied between countries, from 14·9% (Bangladesh) to 89·6% (Namibia). Availability correlated positively with log(income) at both primary care tiers but not the hospital tier, and positively with region-specific population density at the basic primary care tier only.

Interpretation: Major gaps in diagnostic availability exist in many low-income and middle-income countries, particularly in primary care facilities. These results can serve as a benchmark to gauge progress towards implementing guidelines such as the WHO Essential Diagnostics List and Priority Medical Devices initiatives.

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org