Moving closer to community level diagnostics

FIND has taken significant steps in recent months towards its ambition of being able to deliver rapid diagnostic tests at community level. The closer a diagnostic intervention can be made to where the person lives, the more value it will have in arresting illness at an early stage. The technological hurdles are within sight of being overcome and delivering the promise of equitable access is within reach. This has been a process of strategic evolution over several years.

Paradigm shift

However, delivery is only one part of the equation. At this time, most countries do not yet include the community level in their national laboratory policies. So there needs to be a formal structure which links community level services, which are often resource starved and poorly controlled, to the national health or laboratory system. This integrated laboratory network can be defined as one that can provide all needed primary diagnostic services for care and treatment of patients without requiring them to go to different laboratory facilities for specific tests.

Community health care workers will have to be trained to make the basic diagnostic tests, and community health posts – even quite basic ones – will have to be equipped for this task. Much of the responsibility for this rests with national governments, but not alone. Support provided by international funding institutions is proving to be crucial in this process. A recent example of developments for the community level is the Community Laboratory Initiative. This aims to create a new model for clinical laboratories at the health center or health post level. It will come as a complement to existing community level structures in primary health care and seek to leverage the advantages of using modern technology in rural settings – mHealth, eHealth and mobile telephony.

The advantages of being able to diagnose at village or community level include getting patients into treatment earlier and avoiding self-medication, thereby contribution to lowering of healthcare costs. This vision requires a critical appraisal of current practices and a rethinking of diagnostic and laboratory methods. Institutionally integrated into the district, regional and national laboratory structure, this community level diagnostic capacity is ultimately expected to provide a solid base for continuing efforts to address the key health targets of the Millennium Development Goals.

So today, FIND is undergoing nothing less than a paradigm shift in its strategic evolution from a patient-centred approach to a more people-centred one at community level.

We look forward to the day when community health workers will confidently be able to perform simple diagnostic tests for more than one disease at a time and deliver the result within minutes. That’s what our vision is all about!