Half of the world’s population lacks access to basic diagnostics for common illnesses (Lancet)

Nearly half of the world’s population does not have access to basic diagnostics for many common diseases such as diabetes, hypertension, HIV and tuberculosis, according to an analysis conducted 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 stresses the centrality of diagnostics to 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.

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The authors of the report noted that a first lesson from the Covid-19 pandemic was the critical importance of an accurate and timely diagnosis.

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

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

“In much of the world, patients are being treated for illnesses without access to key diagnostic tests and services,” said Kenneth Fleming, Chairman of the Commission, University of Oxford in the United Kingdom. -United. “It is the equivalent of practicing blind medicine. Not only is it 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 to close the gap, the authors said.

They noted that the Covid-19 pandemic has placed testing at the top of the political and global health agenda, and that it must be a turning point to ensure diagnosis of all diseases.

Diagnostics include a set of key tests and services that are essential to understanding a patient’s health.

These may include samples of blood, tissue, or urine collected and analyzed at the bedside or in a laboratory, or diagnostic imaging such as x-rays, ultrasound, MRI, CT or CT scan. nuclear medicine.

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The authors reviewed the best available data on access to tests recommended by the World Health Organization (WHO) for antenatal care to provide an overall estimate of access to baseline diagnostics.

These tests, including syphilis tests, urine dipsticks, hemoglobin tests, blood sugar tests, and ultrasounds, are essential diagnostic tests and should be available within two hours of the patient’s journey.

Diagnostics are fundamental to quality health care, but as the Commission argues, this notion is underestimated, resulting in underfunding and inadequate resources at all levels.

Globally, they estimate that nearly half (47%) of the population does not have 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.

Globally, reduce the diagnostic gap for just six conditions – diabetes, hypertension, HIV and tuberculosis, as well as hepatitis B and syphilis for pregnant women – from 35-62% to 10% would reduce the annual toll of 1.1 million premature deaths in low- and middle-income countries, they said.

The key to closing the diagnostic gap is the availability of qualified personnel, and the Commission estimates that there is an overall shortage of one million diagnostic personnel, which needs to be addressed through training and education.

“Without a skilled workforce who can take full advantage of their education and training, countries will not be able to provide access to appropriate diagnostics for each level of care and achieve universal health coverage. Said Professor Michael Wilson, Co-Assistant. Chairman of the Commission, Denver Health and Hospital Authority, USA.

The Commission further recommends that countries urgently develop national diagnostic strategies based on people’s access to a set of essential diagnostics tailored to local health care needs.

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