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Beyond diagnostics: The WHO essential list

Beyond diagnostics: The WHO essential list

Earlier this month, the WHO released its first list of essential diagnostic tests to provide a reference for countries. The list is a way of directing countries with limited resources to focus on developing certain tests to diagnose common conditions and priority diseases. Major problems globally are lack of access to diagnostic services, which results in people either being treated blindly or not at all, and incorrect diagnoses from wrong tests. This means conditions are diagnosed late, which can lead to spread of disease and can also affect the success of treatment.

The essential diagnostic test list concentrates on in vitro tests – tests of human specimens such as blood and urine. The list contains 113 tests – 58 to diagnose and monitor non-communicable and communicable disease in primary care settings, and 55 to detect, diagnose and monitor priority diseases such as Malaria, Hepatitis B and C, Human Papilloma Virus, Tuberculosis, HIV and Syphilis. The list will be updated on a regular basis and adapted to local contexts.

The 113 tests are extensive and will be incredibly useful, particularly for pregnant women and reproductive health. In most countries, antenatal care guidance requires a lot of the tests in the essential list to be performed. However, for countries that are struggling to provide antenatal care, these tests, if performed in primary care would be very useful – for e.g. checking hemoglobin is necessary to detect anemia during pregnancy. Specialized tests such as those that detect HIV or Hepatitis are vital to reduce the risk of maternal-fetal transmission of disease. Tests that diagnose malaria are important, as the disease places extra stress on women’s bodies in multiple ways during pregnancy. This allows physicians to then individualize care and categorize women according to risk. Detecting viral diseases that can infect the fetus can guide physicians as to mode of delivery.

Although this list provides guidance, there are still concerns as to its implementation. In order to carry out some of these tests, functioning laboratories and technicians are required, as well as a functioning health system. They also require patients to actually present to physicians in a timely manner, which is dependent on various social and economic factors. This is a major rate limiting step to early diagnosis, not just inaccessible diagnostics. Women in particular are more likely to be affected by socioeconomic factors and cultural influences, impacting when they present to a physician. Another issue is the availability of treatments. There is no point testing unless there are treatments that are accessible and affordable. The WHO essential drug list has worked towards this for the last forty years. However, many countries are still struggling to provide basic treatment to patients.

The hope is that the essential diagnostic test list will encourage countries to build the infrastructure required to perform these tests. The list creates an internationally recognized standard. By increasing the demand for these diagnostic tests, the diagnostics industry will most likely compete to manufacture them, and so prices should eventually fall. However, investments in health systems and workforce, as well as addressing socioeconomic barriers are required in order for this list to be used to its full potential.

By Shreya Patel

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Flag of the WHO 

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