Expanding diagnostics for LMICs – Authors' reply

We thank Stuart Gilmour and colleagues for their Correspondence, and we are grateful for the opportunity to further address two important topics. In our Commission,1Fleming KA Horton S Wilson ML et al.The Lancet Commission on diagnostics: transforming access to diagnostics.Lancet. 2021; 398: 1997-2050Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar we noted that the absence of reliable internet connection and insufficient, inadequate information systems are important barriers to accessing quality diagnostics. In the tiered model we presented of the national essential diagnostics list, the ability to do send-out tests (an approach used in the Indian national essential diagnostics list) requires strong health-information systems at each level of the health system. In our Commission, we noted that adequate and sufficient information systems are becoming increasingly important due to the need for data sharing between the tiers of an integrated diagnostic network; the increasing use of digital technology in diagnostic imaging and pathology and laboratory medicine; a need to move from paper-based systems; and the increasing use of mobile technologies in health care. In addition, robust information technology systems enable data collection that facilitates better management systems, disease tracking and reporting, and development of quality metrics used to assess the performance of health systems. Gilmour and colleagues are correct that much more could be written about this issue. Word count constraints meant that we could not fully do justice to other important topics, including the supply chain for diagnostics. Supply-chain constraints have been at the forefront of news during the COVID-19 pandemic because of their impact on populations around the world; and they have been recognised as a long-standing barrier to providing access to laboratory diagnostics and diagnostic imaging in many countries.2Wilson ML Fleming KA Kuti MA Looi LM Lago N Ru K Access to pathology and laboratory medicine services: a crucial gap.Lancet. 2018; 391: 1927-1938Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar, 3De Stigter K Horton S Atalabi OM et al.Equipment in the global radiology environment: why we fail, how we could succeed.J Glob Radiol. 2019; 5: 3Google Scholar Supply-chain governance is particularly difficult in low-income and middle-income countries, which often lack the necessary financial resources to provide effective regulatory oversight.1Fleming KA Horton S Wilson ML et al.The Lancet Commission on diagnostics: transforming access to diagnostics.Lancet. 2021; 398: 1997-2050Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar Although there has been substantial research on supply-chain issues for medicines and vaccines, and international organisations have devoted considerable effort to policy improvements, Gilmour and colleagues highlight that more work on this topic is needed for diagnostics. Health-information systems and the supply chain are important and emblematic of the broader issues of providing access to diagnostic services globally, such as inadequate health systems, poor infrastructure, and insufficient financing. Addressing the issues of health-information systems and supply-chain governance will depend on countries addressing these broader issues first.1Fleming KA Horton S Wilson ML et al.The Lancet Commission on diagnostics: transforming access to diagnostics.Lancet. 2021; 398: 1997-2050Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 4Sayed S Cherniak W Lawler M et al.Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions.Lancet. 2018; 391: 1939-1952Summary Full Text Full Text PDF PubMed Scopus (80) Google Scholar We declare no competing interests The Lancet Commission on diagnostics: transforming access to diagnosticsAt the end of 2019, the first reports of a new respiratory virus appeared in China. The subsequent COVID-19 pandemic has affected every person, in every country, in the world. One early lesson was the crucial importance of timely accurate diagnosis. A second lesson was the widespread scarcity of such diagnostic capacity and capability. Full-Text PDF Expanding diagnostics for LMICsKenneth Fleming and colleagues' Commission on diagnostics1 represents a worthy first step in improving access to diagnostics in low-income and middle-income countries (LMICs), but its recommendations are insufficient in two important areas: medical-record keeping and supply-chain governance. Full-Text PDF