By: Dr Allan Pamba – Executive Vice President, Diagnostics, Africa, at Roche Diagnostics
In May this year, the Resolution on strengthening diagnostic capacities was officially adopted by the World Health Organization (WHO) At World Health Assembly. This has significant implications for the healthcare landscape in Africa. The official resolution document describes it as follows: “Recognizing that diagnostic services are essential for the prevention, diagnosis, case management, surveillance and treatment of communicable, non-communicable, neglected, tropical and rare diseases, injuries and disabilities. » This is an unprecedented recognition of the value of diagnostics in solving public health problems and the start of a long – but definitely promising – road ahead.1
Africa is home to 23 countries classified as LMICs (low- and middle-income countries) that experience a double burden of communicable and non-communicable diseases. These countries are experiencing rapid urbanization, with significant numbers of people flocking to the NCD risk group each year. In 2021, only about half of African citizens (around 615 million people) had access to essential healthcare.2,3,4
On the occasion of World Heart Day, it is worth mentioning that Africa, with its population of over a billion, contributes significantly to the global burden of cardiovascular diseases (CVD). In 2019 alone, more than 1 million deaths occurred due to cardiovascular disease in sub-Saharan Africa. This represents 5.4% of all cardiovascular disease-related deaths globally and 13% of all deaths in Africa.5
Imagine a patient – let’s call her Jane – a 45-year-old Kenyan farmer who tends her small plot of land to provide for her family. Jane begins to experience shortness of breath, fatigue and swelling in her legs. At first, she brushes off the symptoms, attributing them to her demanding daily tasks.
However, as the symptoms persist, Jane decides to visit the local clinic for medical advice. To do this, she takes a Matatu (a minibus taxi), which takes up a lot of time from her working day and is costly on her modest income.
The clinic has limited resources, but it is the closest health facility to her village, about 15 km away. The doctor at the clinic examines her and suspects that she is suffering from heart failure. But he can’t know for sure.
Jane will need further diagnostic tests, which can only be done at a tertiary level hospital in the city. Jane faces uncertainty over whether she will be able to get a proper diagnosis. The costs add up and if she needs treatment, those costs may also be prohibitive.
Suffering from a life-threatening illness, Jane is trapped in a cycle of poverty and lack of access to proper health care. Stories like Jane’s are all too common in many African countries. Heart failure is a growing problem in sub-Saharan Africa. But diagnosing heart failure can pose significant challenges across the continent due to lack of access to appropriate diagnostics.6
In Africa, cardiovascular diseases are the leading cause of the burden of noncommunicable diseases. In sub-Saharan Africa, heart failure typically affects younger age groups, often presenting in advanced stages with an exceptionally high mortality rate.7
Prioritizing early diagnosis is key to achieving better outcomes for patients like Jane – a mother, breadwinner and economically active member of her community. Healthy populations are more economically active. There is no doubt that effective health care delivery can have a direct impact on gross domestic product. Now let’s imagine, in the context of the WHO resolution on diagnostics, how we might change Jane’s health journey.
Few countries have a national diagnostic strategic plan, hampering access for patients like Jane. The value of diagnosis is underestimated, leading to underfunding, inadequate diagnostic services, delayed diagnosis of serious illnesses and inevitably higher mortality rates and higher treatment costs. Establishing a national diagnostic strategy and adopting lists of essential diagnostics will simultaneously increase access to diagnostics and reduce overall costs to the health system.1
With a national plan in place, the clinic Jane visits – her main point of care – has access to essential diagnostic lists and a functioning laboratory on site, ensuring she receives the necessary tests quickly. Having been trained to do so, the healthcare provider provides appropriate education and support, helping them understand the implications of their diagnosis and necessary lifestyle changes or directing them toward timely treatment.
In this enhanced scenario, Jane’s health journey takes a significant turn for the better. Prioritizing diagnoses at their first point of care allows them to have early knowledge of their condition and facilitates rapid interventions. To achieve this type of outcome for more patients, it is essential to strengthen laboratory systems and maximize current infrastructure. Poor laboratory infrastructure, limited human resources, lack of equipment and poor quality assurance programs significantly limit access to diagnostics.8
The next pillar is investing in sustainable capacity building and workforce training. Strengthening laboratory systems goes hand in hand with investing in laboratory professionals. There is a shortage of laboratory personnel in high-income and low-middle-income countries. This creates a barrier to diagnostic services. Additionally, approximately two-thirds of laboratory errors occur outside the facility, typically during the pre-analytical phase, such as at the point of collection of test samples. This is often the result of poor quality sample transport or incorrect sampling.9
Laboratory professionals need to be trained and empowered so that patients like Jane can be empowered. Policies to equip professionals with laboratory expertise or train new laboratory staff could significantly ease the burden on health systems.
Finally, adopt a regulatory framework that accelerates access is essential to create synergy between the public and private sectors. Smart regulatory frameworks can accelerate access to safe and effective diagnostics while preserving valuable regulatory resources. Unfortunately, smart regulations are not implemented consistently across jurisdictions, particularly in LMICs. Convergence towards best regulatory practices and internationally recognized standards (IMDRF) is crucial to improve access to innovation.
We need to do now what patients need next, which is our strategy at Roche Diagnostics. It is a strategy to mobilize collaboration, essential to realizing the full potential of diagnostics in Africa. We must work together to develop sustainable solutions, strengthen research and development capacities and foster innovation in the African healthcare landscape. By amplifying the role of the private sector, we can inspire others to act and drive transformative change.
Now that the resolution has been adopted, the private sector should encourage more African governments to adopt policies that support the optimization of diagnostic strategies and obtaining adequate financial allocation for essential healthcare to meet the national and regional commitments.12
The resolution on strengthening diagnostic capacity is a phenomenal start. It is a signal to rethink the preparedness and resilience of African health systems, drawing on successful responses to diseases like HIV/AIDS. By investing in infrastructure development, localizing health solutions and maximizing public-private partnerships, we can build a resilient health ecosystem that effectively responds to Africa’s present and future challenges.
- https://futures.issafrica.org/geographic/ Income-groups/lower-middle-Income-Africa/#:~:text=According%20to%20the%20World%20Bank,and%20Pr%C3%ADncipe%2C% 20Senegal%2C%20Eswatini%2C