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Study reveals gaping gaps in the availability of diagnostics test in India’s primary health centres

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Diabetes, a chronic condition, is the fastest growing disease in India, affecting about 49% of our population. Yet, one may not be able to get a simple glycated haemoglobin A1c test, which tells you the average level of blood sugar over 2-3 months, done in a primary health care centre, reveals a new study. Conducted by researchers from the McGill University, Canada, Indian Council of Medical Research, New Delhi, University of York, UK, FIND, Switzerland and the Manipal Academy of Higher Education, India the results of the study were published in the journal The Lancet Infectious Diseases.

The survey study was conducted in three districts in three states of India—Tumakuru in Karnataka, Fatehpur in Uttar Pradesh, and Wardha in Maharashtra. In each of these districts, the researchers randomly selected 20% of the health care centres to check the facilities available. Between Dec 13, 2017, and March 22, 2018, the researchers surveyed 40 health care centres in total.

The researchers compared these with the essential diagnostics list published by the World Health Organisation (WHO). This list contains 113 tests, grouped by two broad levels—diagnostics for primary care centres with no or basic laboratories, and diagnostics for facilities with clinical laboratories. The WHO also urges considering these diagnostics as important as essential medicines in universal health coverage.

Some of the diagnostic  tests in the WHO’s list include urine dipstick used for routine urine check-up, complete blood count to measure the cells in the blood, haemoglobin test, glucose test and microscopy, and disease-specific tests for HIV, tuberculosis, malaria, syphilis, and hepatitis B and C. The list also has a benchmark that can be used to measure and improve the current services.

The results showed that all the three districts included in the pilot survey fared badly and had significant gaps in the availability of the above tests. While the facilities in Wardha district were relatively better, Fatehpur in UP was the worst. The researchers observed that none of the districts had diagnostics available for measuring blood lactate—a test to determine conditions that result in inefficient clearing of lactate in blood, hepatitis B e-antigen to detect Hepatitis B infection, 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.

There were gaps in the availability of other tests too. In Tumakuru and Fatehpur, primary health centres had limited or no availability of blood counts and glycated haemoglobin A1c tests. For infections, the hepatitis (HBsAg) rapid test was available in 76% of the facilities in Tumakuru, 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”, say the researchers, talking about their findings.

The researchers also note that more extensive, nationally representative sample surveys that cover both public and private sectors are necessary and these should also assess the availability, use, and quality to get a better understanding of the access to comprehensive diagnostics.

The findings of the pilot survey have a few pointers to the recently launched free diagnostics service initiative under the National Health Mission to make some tests freely available and improve access to essential tests.