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Half of World’s Population Lacks Access to Basic Diagnostics for Common Diseases: Lancet

The diagnostic gap is greatest in primary care, where only about 19% of populations in low- and lower-middle income countries have access to the simplest diagnostic tests.

Representational use only.

Washington: Nearly half of the global population lacks access to basic diagnostics for many common diseases such as diabetes, hypertension, HIV, and tuberculosis, according to an analysis led by The Lancet Commission on Diagnostics.

The Commission brought together 25 experts from 16 countries who noted that without access to accurate, high-quality, and affordable diagnostics, many people will be over-treated, under-treated or not treated at all.

The Commission highlights the centrality of diagnostics for any functioning health care system and calls on policy makers to close the diagnostic gap, improve access, and expand the development of diagnostics beyond high-income countries.

The authors of the report noted that an early lesson of the COVID-19 pandemic was the crucial importance of timely, accurate diagnosis.

In high-income countries, the ability to use existing public health laboratories, in addition to the private sector, was critical in ramping up testing capacity, they said.

However, many low and middle-income countries without access to this infrastructure were disadvantaged and left unable to reach full testing capacity.

"In much of the world, patients are treated for diseases in the absence of access to key diagnostic tests and services,” said Kenneth Fleming, Commission Chair, from the University of Oxford in the UK.

"This is the equivalent of practicing medicine blind. Not only is this potentially harmful to patients, but it is also a significant waste of scarce medical resources," Fleming said.

The analysis shows the shocking scale of the challenges, and the report offers recommendations on how the gap can be closed, the authors said.

They noted that COVID-19 pandemic has put testing at the top of the political and global health agenda, and it must be a turning point in ensuring diagnostics for all diseases.

Diagnostics include a collection of key tests and services that are essential to understand a patient's health.

These might include blood, tissue, or urine samples collected and analysed at the bedside or in a laboratory, or diagnostic imaging such as X-rays, ultrasound, MRI, CT, or nuclear medicine.

The authors reviewed the best available data on access to World Health Organization (WHO) recommended tests for antenatal care to provide a global estimate on access to basic diagnostics.

These tests, including syphilis testing, urine dipsticks, haemoglobin testing, blood glucose testing, and ultrasounds, represent essential diagnostic tests and should be available within a two-hour travel time of the patient.

Diagnostics are fundamental to quality health care, but as the Commission states, this notion is under-recognised, leading to underfunding and inadequate resources at all levels.

Globally, they estimate that nearly half (47%) of the population lack access to diagnostics.

The diagnostic gap is greatest in primary care, where only about 19% of populations in low and lower-middle income countries have access to the simplest diagnostic tests.

The authors call for urgent investment and training to improve access to testing in primary care, especially point-of-care testing.

 At a global level, narrowing the diagnostic gap for just six conditions -- diabetes, hypertension, HIV, and tuberculosis, plus hepatitis B and syphilis for pregnant women -- from 35-62% to 10% would reduce the annual number of premature deaths in low-income and middle-income countries by 1.1 million, they said.

Key to closing the diagnostic gap is the availability of trained staff, and the Commission estimates a global shortfall of up to one million diagnostics staff, which must be addressed through training and education.

"Without a skilled workforce that can use its education and training to the fullest extent, countries will not be able to provide access to diagnostics that are appropriate for each level of care and achieve Universal Health Coverage," said Professor Michael Wilson, Deputy co-Chair of the Commission, Denver Health and Hospital Authority, US.

The Commission further recommends that countries urgently develop national diagnostics strategies based on providing populations with access to a set of essential diagnostics that are appropriate for the local health care needs.

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