I do not grudge the millionaire his mansion, but it is my earnest request to them, to do something to bridge the gulf that separates them from the peasants- as spoken by the Father of our nation Mahatma Gandhi, sums up the ever existing and as yet unresolved challenge of inequitable distribution and provision of laboratory services in the rural and semi-rural areas vis-a-vis the urbanized sectors of our country.
A developed country may very naturally opt for the most state-of the-art and advanced technology, as affordability is hardly a matter of concern for them, owning to no paucity of funding sources. However, for majority of third world countries the first and foremost criterion is achievement of higher technology at its most affordable cost.
The major challenge here is that all areas of our country do not enjoy the same socio economic status. The metropolitan cities can boast of huge hospital-based or stand alone labs, which caters to approximately 3000-5000 patient samples per day. For them the best set up is total lab automation with integrated automated systems with every step usually being taken to ultimately reduce the turnaround time (TAT) of tests.
In contrast, while setting up a lab in rural and suburban areas, which usually cater to a population of around 100-200 patient samples a day, the main orientation would be to provide good quality reports at very affordable rates. Hence such labs need to keep in mind, not only cost of instrument but also other crucial factors namely, reagent pack size or annual maintenance charge of instruments, all of which might run into considerably high figures.
A small to medium lab often finds it extremely difficult to utilize a big pack of reagent containing 960 tests, especially in light of the fact that on an average, annual tests done by such a lab amounts to merely 500. Hence for these sorts of set-ups, small pack availability is a vital issue while choosing an instrument. In most cases they prefer to opt for an open system analyser instead of a closed system as freedom of choice is also a significant point for them.
It also needs to be kept in mind that generation of a genuinely dependable report does not always need to be dictated by a very advanced technology. On the contrary, understanding and ensuring quality assurance (QA) is of far greater importance for establishing a robust and good quality lab, irrespective of its economical and throughput status. The concept of quality control (QC) and accreditation has to be decentralised and disseminated among all sections.
A recent trend has developed in rural and semi-urban areas are to do basic testing somehow and outsource the costly and high end tests to big urban based chain labs. We need to understand that 70 percent of errors that occur in lab are of the pre analytical genre. Clearly, if the point from where the sample originated is not maintaining quality then it is unfair to expect the end-point to shoulder the entire responsibility of ensuring quality. Under such circumstances, even the highest technology employed by the chain lab to which the sample has been outsourced, will not be able to achieve the desired level of quality.
Another key area that often raises quality concerns in downstream sample analysis and reporting of test results is transportation. Very frequently, the process of transport of samples from point of origin to the chain lab (point of testing), is not undertaken with the desired quantum of stringency. Careless handling of samples in transit, delay in transit, lack of maintenance of cold chain constitute some of the areas that can ultimately compromise analysis and reporting and consequently quality.
As an NABL assessor I have witnessed a suburban small lab in one of the remotest corners of India beautifully maintaining an adorable quality of work whereas a big urban chain lab despite of possessing the highest-end equipment continues to be plagued by compromised quality. The basic differences between the two were nothing but the quality policy adopted and sincerity of the manpower behind the machine. Hence my take is that development of a good quality lab is not dependent on technology rather on will and education.
From lowest to highest end, achievement and sustained maintenance of quality is the cornerstone for establishing a reliable and robust lab set-up. There may be differences in the extent of adoption of advanced technologies, but this basic tenet needs to remain the same.