Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action

• Published in: The Lancet (British edition) Vol. 391; no. 10133; pp. 1953 - 1964
• Main Authors: Horton, Susan, Sullivan, Richard, Flanigan, John, Fleming, Kenneth A, Kuti, Modupe A, Looi, Lai Meng, Pai, Sanjay A, Lawler, Mark
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 12-05-2018; Elsevier B.V; Elsevier Limited
• Subjects: Analysis; Clinical Laboratory Services - legislation & jurisprudence; Clinical Laboratory Services - standards; Cost benefit analysis; Developing Countries; Diagnostic tests; Embedding; Expenditures; Financing; Funding; Health; Health Education; Health Expenditures; Health Policy; Health Services Needs and Demand - legislation & jurisprudence; Hospitals; Humans; Income; Infectious diseases; International cooperation; Laboratories; LDCs; Leadership; Low income groups; Medical care, Cost of; Medicine; Molecular chains; National health insurance; New technology; Palm; Pathologists; Pathology; Point-of-Care Systems - economics; Poverty; Public Health; Quality of Health Care - legislation & jurisprudence; Quality of Health Care - standards; Ratings & rankings; Sustainable development; World health; United Kingdom; Malaysia; United Kingdom > UK; Kenya; United States > US; India
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(18)30460-4

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.