Diagnostics and disease management

In a harrowing picture of Lady Reading Hospital’s neonatology ward published recently (in an article by Zeenat Khan), five newborn babies were crammed in a single, and not so clean, baby bed. Squeezed together, they seem flustered and bewildered. There should have been only one baby in that incubator. These babies were in need of care, attention and needed to be separate from their newly-arrived members of the human race to avoid infection. Such state of care is not just a reflection of Lady Reading Hospital. Population burden is only one part of the problem. The systematic degradation of equipment and tools that are in a state of disrepair and neglect contributes equally to the dismal state of our newborn health and well-being. The most fundamental tools of diagnosis and management are often absent, poorly used and lack a coherent government support programme for investment and support. These issues need urgent attention if we are to create a healthy society that works for all.

Earlier this month, the WHO in a landmark move issued a list of “Essential Diagnostics”. This first-ever list is modelled after the essential medicines list (of 1977), with the hope of providing a list of essential tools needed to every health system in the world for diagnosis of most common conditions and high priority global diseases. There are 113 diagnostics on the list at the moment, 58 are for most common tests ranging from blood and urine tests of various kinds, and the remaining 55 are for high impact global diseases, including HIV, TB, malaria, etc.

However, this list is incomplete in design. Each country ought to add additional tests based on the system and its unique health challenges. As Dr Madhukar Pai, of McGill University, and one of the main drivers behind the effort to create an essential diagnostics list recently noted in an interview “ I’m very aware that publishing a list in Geneva will not magically make malaria test kits available in Vietnam. Each country has to make its own list to give the idea teeth”.

While the list has generated activity in several countries, including India, that aims to issue its own essential diagnostics list by the end of the year, the federal and provincial health departments in Pakistan have not shown any interest, or activity, in creating a list and a policy framework for diagnostics. The DRAP effort for medical device regulation, that has been talked about for a couple of years, still remains mired in confusion and controversy and is focused largely on registration and pricing, not on access and quality of diagnostics specifically.

Diagnosis and disease management is not just a fundamental right, it is also good economics. Better diagnosis not only improves the efficacy of care, it also saves others from infection and risk. The proper and rational use of medicines is inherently connected to an accurate diagnosis. Improper use has landed us right in the middle of the global antibiotic resistance crisis.

In a country like Pakistan, where the burden of diseases and the disparity across socio-economic and geographic spectrum are high, a rigorous, thorough and urgent effort is needed to create a national essential diagnostics list. At the same time, emphasis should be laid on access and quality, lest those who are vulnerable suffer the same fate as they often do due to poor quality medicines. A national level effort on diagnostics will not only improve health outcomes, but will also involve local industry and innovators, who are often on the sidelines of the health innovation market. A robust effort and policy will increase access to diagnostics with a positive impact on the disease management market, so that Lady Reading Hospital and countless others can provide the new arrivals to this world a warm, comforting and safer welcome.

Published in The Express Tribune, May 29^th, 2018.

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