Away from the attention on the TB Summit in Delhi this week, another crucial discussion was taking place in the Capital to draw up a list of essential diagnostics. And significantly, India has been first off the blocks in getting this process started.
The World Health Organisation is starting the process to prepare guidelines on an Essential Diagnostics List (EDL), with the first meeting to be held this April in Geneva, says Dr Kamini Walia, a senior scientist with the Indian Council of Medical Research (ICMR).
Although India effects revisions of its list of essential medicines from time to time, this is the first time there is a concrete initiative on diagnostics, she notes. And the expectation is to have a diagnostics list ready in about a year’s time.
Accurate and affordable diagnostics form the backbone for treatment, says Walia. And this becomes particularly crucial at a time when the world battles against drug resistance, where, in some cases, antibiotics have ceased to have curative value due to irrational consumption or exposure to such drugs.
“The diagnostics list will be crafted along the lines of the National List of Essential Medicines, (and) is expected to influence government policies towards price controls on key diagnostic tests,” says Walia. Diagnostics are the weakest link in the chain of tackling communicable diseases, for example, and the proposed list will look at tuberculosis, HIV, malaria and hepatitis B, among others. ICMR organised the first meeting along with WHO India and McGill University. It saw the participation of experts, including former ICMR chief Dr Soumya Swaminathan, currently Deputy Director-General of WHO.
A ‘defining’ moment
Defining “essential” or “life-saving” in healthcare is a difficult task. For instance, a paracetamol could be life-saving for someone with extraordinarily high fever.
The proposed EDL expects to address this at two levels, at the primary care level and at the stage where a person is very sick and is in the Intensive Care Unit, explains Walia. At the primary level, it’s about diagnosing the illness and treating it; at the other end of the spectrum, staff should be able to monitor for infection, for example, she explains.
The list would include tests for haemoglobin (which is linked to nutrition concerns, also a national issue) and other non-communicable illnesses as well. There is a massive task ahead, she says, indicating that the deliberations would have to look at illnesses, the stage at which they are diagnosed, and so on.
Procurement and price control
The EDL list will help streamline procurement of essential diagnostics required at a primary healthcare centre, besides encouraging local manufacturers to focus on making these products and ensuring quality supplies. On the drugs side, the NLEM has been at the heart of bringing medicines under price control. And Dr Walia expects a similar exercise with diagnostics as well. She cites dengue as a case in point, where different labs priced the tests differently when there was an outbreak.
Besides, there are anomalies: sometimes the diagnostic test is more expensive than the medicine to treat it, leading again to erratic diagnosis and treatment.
But Rajiv Nath, with the Association of Indian Medical Device Industry, says the EDL should focus on making diagnostics and devices accessible and affordable. Bringing them under price control should be the next level of intervention, if required, says Nath, who had also participated in the diagnostics discussions.
The proposed list will also look to incorporate learnings from States that provide free diagnostics, says Dr Walia. The exercise at WHO to create an EDL comes more than 40 years after the first Essential Medicines List (EML) in 1977. India published its first EML in 1996. But as it spearheads discussions on the EDL, the initiative is being seen as a “game-changer” for public health.