ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2018) 15 13.7 | DOI: 10.1530/ey.15.13.7

ESPEYB15 13 Global Health for the Paediatric Endocrinologist How does paediatric endocrinology and diabetes fit in the global initiatives? (7 abstracts)

13.7 Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action

Horton S , Sullivan R , Flanigan J , Fleming KA , Kuti MA , Looi LM , Pai SA & Lawler M


School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada


To read the full abstract: Lancet 2018; 391(10133):1953-1964

[Comment on 13.5, 13.6 & 13.7] Published just a week before the World Health Organization put out their first Essential Diagnostics List (http://www.who.int/medical_devices/diagnostics/WHO_EDL_2018.pdf), this series of 3 papers highlights the previously often unrecognized but important role of pathology and laboratory medicine (PALM) services in low- and middle-income countries (LMIC). Increasingly, modern medicine relies on diagnostic testing to confirm clinical diagnoses, including through in vitro diagnostics, devices, pathology and radiology procedures – often avoiding morbidity, mortality and a negative economic impact from a wrong diagnosis. Endocrine conditions such as diabetes and lipid metabolism disorders are prime examples that can be difficult to diagnose, classify, treat and monitor based on clinical grounds, especially in their asymptomatic stages. While in high-income countries PALM are used for 2 out of 3 health conditions, LMICs continue to have limited access to PALM services despite bearing a disproportionate share of the global burden of disease with much scarcer access to resources.

The first paper (13.5) outlines key barriers to setting up PALM in LMICs, including a shortage of human resources and workforce capacity, a lack of continuing medical education, an inadequate infrastructure for laboratory services, and absence of standards for rational use of resources, quality, and accreditation. In the second paper (13.6), the case is made for a universal health coverage supported laboratory and health system that is aligned with the Sustainable Development Goals. Avoiding the mistakes of vertical, siloed programs, successes from programs such as PEPFAR should be incorporated, including investment into an improved infrastructure, a solid health care workforce, the wise use of task shifting and task sharing with community health workers, and the value and cost-effectiveness of high quality care along the care delivery cascade. The delivery package proposed aligns with needs for non-communicable disease programs in LMICs (including those suitable for pediatric endocrine services), suggesting evidence based, innovative, locally adapted health care delivery services that incorporate PALM and are integrated into a national health system strategy, conceptualized by local leaders with support from international organizations and stakeholders. The third paper (13.7) takes on a political, systems, advocacy and financing perspective to establishing sustainable high-quality PALM services in LMICs. Actionable recommendations are outlined and should be understood as an attempt at not only holding local and international stakeholders responsible for implementing the required services, but also at assuming responsibility among the PALM professionals to take leadership and advocate.

The challenges, potential solutions and proposed political and advocacy strategies for PALM services are fully relevant for global pediatric endocrinology and diabetes. Many parallels exist and several of the outlined suggestions for PALM are immediately applicable to establishing pediatric endocrine services in LMICs. Further, as capacity for pediatric endocrinology in LMICs is increasing through subspecialty training programs such as the Pediatric Endocrinology Training Center for Africa (PETCA) and the Pediatric Endocrinology Education Program for Haiti (PEEP-H), graduates seeking to establish their endocrine practices in their countries will need available, affordable and accessible PALM services to effectively deliver their care. Global efforts to achieve the Sustainable Development Goals need to be leveraged to align national and international stakeholders, move towards universal health coverage, and develop national strategic health care plans that are appropriately resourced to facilitate locally adapted, quality, cost-effective and equitable care – including in subspecialties like endocrinology.

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