Addressing diagnostic disparities in low-resource settings

The Covid-19 pandemic served as a stark reminder of a critical vulnerability in India’s healthcare system – the lack of robust and high-quality diagnostic services in Tier-II and Tier-III towns. These regions, with limited infrastructure, struggled immensely under the unprecedented demand for testing. This exposed the existing gap in diagnostic capabilities, highlighting the need to address this disparity.

One significant challenge lies in the current structure of the industry. The market is marked by a high degree of fragmentation. As per a Praxis Global Alliance study, standalone diagnostic centers account for nearly half (46%) of the industry, followed by hospital-based labs (28%). Large diagnostic chains, with their potential for standardization and wider reach, currently hold a small share (6%) of the market. While it creates challenges but also presents exciting opportunities.

Fortunately, positive trends are emerging. The Indian diagnostics market is projected for significant growth due to rising health awareness and disposable incomes. This growth emphasizes the critical role of diagnostics and high-quality testing, influencing roughly 70 percent of healthcare decisions. Fuelled by a rising burden of chronic diseases, and a growing middle class with more disposable income, the Indian diagnostics market is booming. Increased insurance penetration and technological advancements like telemedicine are further driving growth by making advanced tests more affordable and accessible. Doctors and patients alike are recognizing the value of diagnostics, leading to more testing and a focus on preventive healthcare.

India’s growing disease burden
India faces a dual burden of communicable and non-communicable diseases. While infectious diseases like tuberculosis and malaria remain prevalent, non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, and cancer are on the rise. This significant disease burden highlights the need for robust diagnostic services to enable early and effective detection.

Expansion into Tier-III towns and beyond
Robust diagnostic services are critical for addressing India’s healthcare challenges. However, a significant knowledge gap exists. This lack of awareness often leads to people foregoing diagnostic services, delaying disease detection.

The study done by Praxis Global Alliance suggests that Tier-I cities in India boast 399 diagnostic labs per million people, while Tier-II and Tier-III+ cities lag far behind at 245 and 205, respectively. This stark disparity highlights unequal access to essential diagnostic services. Expanding healthcare infrastructure to Tier-II and Tier-III towns and rural areas is crucial. The Ayushman Bharat scheme, promoting comprehensive healthcare coverage and establishing health and wellness centers (HWCs) nationwide, represents a positive step in the right direction.

While these initiatives are commendable, further efforts are needed to strengthen diagnostic services. Government policies should incentivize private sector participation in rural healthcare and encourage public-private partnerships. Furthermore, educating communities and promoting the benefits of early diagnosis and preventive healthcare can bridge the gap in public understanding and utilization of diagnostic services.

Human resource challenges in smaller towns
As diagnostic technologies rapidly evolve, partnerships between diagnostic firms and academic institutions can play a vital role in addressing this need. This is particularly important considering a significant barrier to improving healthcare in smaller towns – the shortage of skilled professionals. Specialists like radiologists, pathologists, and lab technicians often find rural and remote areas unattractive. Limitations in infrastructure, professional development opportunities, and living conditions contribute to this challenge.

According to a study presented at the annual meeting of United States and Canadian Academy of Pathology 2022, India has roughly 3 lakh medical diagnostic laboratories but only 5500 qualified pathologists, falling far short of the global benchmark. To address this workforce gap, increased investment is necessary to build a stronger diagnostic workforce. Ongoing training is crucial to keep skills current, but funding and resources are often lacking. Programs to address this gap are essential. Financial incentives, opportunities for career advancement, and improved working and living conditions can make rural postings more appealing. Integrating telemedicine and telepathology can further bridge the gap by allowing specialists in urban centers to support remote areas, ultimately enhancing the quality of care.

The role of technology in improving access to healthcare services
Mobile health (mHealth). Mobile health applications enable remote diagnostics and monitoring, particularly for chronic diseases, allowing healthcare workers to collect and transmit patient data to specialists for timely care without extensive travel.

Point-of-care testing (POCT). Portable POCT devices provide immediate results for conditions like diabetes, HIV, and malaria, reducing turnaround time for diagnosis and improving patient outcomes.

Telemedicine and telepathology. Telemedicine platforms offer remote consultations, while telepathology allows pathologists to provide proper diagnoses, address specialists’ shortage in rural areas, and reduce travel cost.

Artificial intelligence (AI) and machine learning (ML). AI and ML enhance diagnostics by improving the accuracy and efficiency of disease detection.

Blockchain technology. Blockchain enhances the security, integrity, and traceability of medical data, facilitating secure data sharing across providers.

India’s booming diagnostics market holds promise for underserved regions. Companies delivering affordable, high-quality tests in smaller cities and rural areas can unlock growth and contribute to universal healthcare, improving health outcomes for all.