| Child Health | Diagnostics | Hospitals | Maternal & Rep. Health | Pharmacy | Primary Care | Public Health | Traditional Healer Definition Procedures that are used to determine the cause of an illness or disorder. Top Status of Diagnostic Services Diagnostic services provide health care practitioners with information about the presence, severity, and cause of diseases in patients. Subsequently, health care providers deliver the appropriate treatment to their patients, reducing the patients' mortality and morbidity levels. There are generally three levels to diagnostic services. At the basic level, diagnostic procedures observe symptoms or use a simple microscope. At the next level, diagnostic services require equipment such as X-rays or culture facilities. At the more complex level, diagnostic services demand sophisticated equipment such as endoscopes and CT scan machines. In developing countries, many of the diagnostic tools target diseases that impose a high burden on the population. For example, there are tools such as Dipsticks and IC Strip Tests that attempt to identify the presence of HIV, TB, and Hepatitis B. Top Issues in Diagnostic Services Several systematic factors undermine the quality of diagnostic services in developing countries. Inadequate human capital, lack of standardized procedures, and resource/input constraints are some of these factors. WHO: Diagnostic Imaging and Laboratory discusses these problems. Human Capital-- If health care personnel have inadequate skills in utilizing diagnostic and laboratory tools, the reliability and validity of test results can be poor. Such a problem is further aggravated by new and expanding technology combined with insufficient training. Standardized Procedures-- If there is a lack of standardized laboratory procedures, diagnostic test results can be of poor quality and reliability. Resource/Input constraints-- If there are import barriers or other supply constraints (financial, logistical), it can lead to inadequate supply and low quality diagnostic services. Other systematic factors include the lack of coordination between diagnostic providers and health care providers, the tendency for diagnostic providers to engage in self-referral, and the inclination for such providers to perform excess diagnostic tests. The latter two result from the dual role of providers or from 'kick-backs.' In addition, utilization of outdated technology mitigates the quality of diagnostic services. If diagnostic service organizations are using prosaic technology, it negatively affects the sensitivity of the tests. Also, if old technology tends to produce results that take longer than a day, they may not reach the patients.  Foulds (1998) found that in low-income nations, the method of identifying smear-positive tuberculosis cases was not adequate since it was laborious and insensitive.
PATH notes that tests where results are available in minutes, or at the most an hour or two, are best. Yet the quality of diagnostic services does not suffer from information asymmetry as compared to other health services. This is because health providers are generally more knowledgeable than regular health consumers about the product they are purchasing. Thus, diagnostic services quality is more likely to be helped by competition. Top Trends in Diagnostic Services In order to improve diagnostic services, policy makers have proposed strengthening laboratory procedures and enhancing human capital. WHO: Diagnostic Imaging and Laboratory supports such approaches: Laboratory procedures-- This strategy to standardize laboratory procedures consists of administrative, management, and training efforts that extend beyond the establishment of international reference materials. Human Capital-- This strategy focuses on training, developing manuals, and recruiting staff or departments so that public diagnostic service organizations can produce more reliable results in a timely manner. Furthermore, another strategy is the replacement of obsolete or unreliable technology with technically feasible and rapid technology. WHO and PATH are some of the agencies that have promoted such a strategy. While diagnostic services are often the responsibility of the public sector in many countries, the public sector lacks the resources to purchase and update diagnostic equipment. Consequently, many public providers rely on the private sector, which can mobilize resources more easily in order to maximize its profit. Quality of diagnostic services under such a situation has the opportunity to improve due to competition. Top Key References World Bank To be added in the near future... Top External - Foulds, J. and R. O'Brien (1998). "New tools for the diagnosis of tuberculosis: the perspective of developing countries." Int J Tuberc Lung Dis, 2(10): 778-83.
Discusses the need to replace or facilitate acid-fast bacilli (AFB) microscopy for the identification of smear-positive tuberculosis cases in developing countries. Advocates for the development of a product that has increased sensitivity, speed, ease of use, and safety.
Top Resource People To be added in the near future... Top Useful Websites - WHO: Diagnostic Imaging and Laboratory Technology
Provides guideline for diagnosis, and offers educational program. Includes several publications. - PATH: Health Tech
Presents diagnostic tools for major diseases such as HIV, TB, and Hepatitis A. Also discusses the importance of developing rapid diagnostic tests while maintaining accuracy since many people fail to return for results that take longer than a day.
Additional References To be added in the near future... Top |
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