Innovation in diagnostics is key to facilitating the accuracy and timeliness of information, which ultimately improves patients’ journeys and their treatment outcomes. Progress in technology, artificial intelligence and big data is creating new opportunities for informing, personalising and improving treatment management and care. But innovation in diagnostics is more than technical solutions and equipment. Procuring and providing access to the latest technologies is also an important part of the picture.
Universal access to diagnostics is not yet a reality for society. Even in high-income countries with robust healthcare systems, and generally good access to diagnostics, there are pockets of inequity. This is caused by variations in the capacity and funding of local health services and gaps in family income across these countries and regions. Access to the latest diagnostics technologies is particularly prevalent in low and middle-income countries due to health system strength and limited resources, which gives rise to more extreme health inequities1.
Despite these challenges, innovation in diagnostics, such as information technology and point-of-care testing, have tremendous potential to improve countries’ capacity – for managing infectious and non-communicable diseases, and strengthening primary healthcare2. Nevertheless, these innovations can only deliver positive patient outcomes if local socio-economic, political, and epidemiological environments are appropriately considered. This is why understanding the ecosystem where a technology is introduced is highlighted as a key practice in the World Health Organisation’s ( WHO) recommendations on digital interventions for health system strengthening. At the same time, the WHO recommends designing technologies with and for the user, designing for scale and building for sustainability, while being collaborative3.
As previously highlighted, there are still many ‘equity gaps’ in accessing diagnostics between the world’s higher income countries and their lower income counterparts, where vast population groups still do not have equal access to these tools.
As diagnostics gain recognition as an essential component of effective health systems, the challenge for health policy makers in low and middle-income countries is how to offer their populations
‘Diagnostics delivery partnerships’ are demonstrating useful solutions for people in lower income countries, for example:
Building capacity among laboratory teams
Community disease awareness programmes on the value of diagnostics for early detection, for confirming a diagnosis and for managing a disease
Training of healthcare professionals
Advice to improve laboratory efficiency and access to digital diagnostic tools
Continuous innovation to make diagnostic tools economically effective and easier to use and transfer to labs.
Here, the objective is to support countries to develop a culture of diagnostic practice and a robust national programme that links screening and testing for people living with various conditions. For example, programmes in progress today are helping countries to access diagnostics technologies as a frontline defence to strengthen their healthcare services’ ability to provide better quality management for people living with HIV/AIDs, tuberculosis, hepatitis B and C, human papillomavirus/cervical cancer and COVID-19.
When COVID-19 hit Southern Africa, leaders of Zambia’s healthcare services knew they
Yoram Siame, Head of Advocacy Planning and Development, at the Churches Health Association in Zambia, explains that the Global Fund to Fight AIDS, Tuberculosis and Malaria was among the first to recognise the need for flexibility – and supported the country to refocus some of the testing programmes and platforms to fight COVID-19. This was an important step, he says, as failure to tackle COVID-19 head-on when it emerged risked eroding the gains made over the past decade by African countries in fighting TB, malaria and HIV.
He says that the Global Fund’s past decade of investment in AIDS, TB and malaria was focused on strengthening partner countries’ health systems. “This experience meant that our health system was better prepared to respond to COVID-19, and to put into action diagnostics and management for the disease. Our health services quickly refocused some of the HIV testing services and infrastructure to address the pandemic.”
A similar approach was applied across other African countries, resulting in COVID-19 testing of more than 26 million people by December 2020.
In February 2020, the WHO and the Foundation for Innovative New Diagnostics (FIND) signed a five-year strategic collaboration to strengthen diagnosis in low and middle-income countries by addressing diagnostic gaps at country level and strengthening disease surveillance5. This partnership contributes significantly to informing public health initiatives and improving outbreak preparedness and response.
The initiative increases access to essential diagnostics, develops national Essential Diagnostics Lists and collects data to drive universal access to essential diagnostics. It also takes the first steps in creating a country-led diagnostics alliance for long-term support and a continuous focus on improving access to diagnostics at the global level.
What are the best strategies to encourage ‘diagnostic thinking’ in society, to make sure that all people have equal access to the latest diagnostic technologies and services?
More than 463 million people around the world live with diabetes6. To maintain their health, people living with diabetes have to keep in mind hundreds of data points to make dozens of decisions every day. It’s a lot of responsibility. And pressure. To give people with diabetes the tools and confidence to navigate the complexity of their daily therapy routine, a young Austrian digital health company launched the first version of its
Today, the app is used by some four million registered users in 80 countries7. With this tool, patients collect all their key therapy data in one place. It also connects with devices – including glucose meters, smart insulin pens and health apps – so users can track their condition on an hourly basis, or share data with healthcare providers if desired.
For someone with HIV, testing does not end with diagnosis. It is key that once a person discovers their HIV status, regular viral load monitoring of the virus is performed. However, in Sub-Saharan Africa and other countries with limited resources this can be a real challenge. Patients must often travel long distances to get their test results, which can lead to losing a day’s wages or having to make different childcare arrangements.
To address this issue that is faced by people across the region, Roche has partnered with patients, healthcare professionals, Ministries of Health, research universities and laboratories in Sub-Saharan Africa, to develop a mobile app that works even on basic smartphones. Through the app, patients can now quickly receive their test results for HIV viral load monitoring. The tool also gives patients alerts for medication and appointment reminders, targeted educational content and progress tracking. By giving people easily and useful access to data, this app empowers patients to take an active role in managing their health.