Diagnostics are an essential part of an effcient healthcare system. A Diagnostic system is required to confirm diseases, determine drug resistance, guide, and monitor treatment, and for the surveillance of outbreaks. Universal Health Coverage cannot be achieved without ensuring people have timely access to quality diagnostic services at all levels of the health system, without experiencing fnancial hardships.

Thee word ‘Diagnosis’ has not received much attention and acclaim as it has during the pandemic period, when detection and timely treatment has emerged as the need of the hour.

Diagnosis helps in improving patient care, contributes to protecting patient’s health and in some cases, even helps limit healthcare spending. A diagnostic test detects a possible condition or confirms the lack of one. Sometimes diseases need to be studied repeatedly for not just their nature, but also their stage or degree of development. Diagnostic tests form the framework with which healthcare professionals can better assess the effectiveness of the chosen treatment in stopping the progression of the disease and achieve the desired population health outcomes as stated under UHC and SDG.

The Sustainable Development Goal (SDG) 3.8 sets the following target for 2030: achieve universal health coverage (UHC), including fnancial risk protection, access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines for all. Our nation is now aiming for UHC which essentially means removing barriers to seeking and receiving required care, like reducing out-of-pocket expenditures, distance to health care facilities and under-equipped facilities with poorly skilled health workers. Improving access to free-of-cost diagnostic tests needs to be a key component of this initiative.

The Free Diagnostic Service Initiative (FDSI) was launched in 2015 to ensure a broader range of diagnostic and imaging services delivered free-of-cost. It was further strengthened through Comprehensive Primary Health Care (CPHC) rolled-out through Ayushman Aarogya Mandirs (erstwhile Ayushman Bharat- Health and Wellness Centres, 2018) to provide an expanded range of free diagnostic services at primary healthcare facilities. This has enabled states to become better positioned to provide an assured package of free diagnostic services and point-of-care testing at primary healthcare facilities, along with conventional in-house diagnostic services at secondary level of healthcare facilities like Community Health Centres, Civil Hospitals and District Hospitals.

The challenge of establishing a network of diagnostic testing and imaging services across health facilities with real time reporting and quick turnaround time (TAT), has been the need of the hour. The lessons learned during COVID-19 pandemic have been a clear example of effcient diagnostic testing, reporting, clinical diagnosis, and adherence to treatment protocols, followed by reduction in hospitalization days and out-of-pocket expenditure. These experiences and evidence paved the way for establishing two models of diagnostic testing and one model of imaging services, based on outsourcedin public private partnerships.

The ‘Wet Lease’ diagnostic testing model is housed in all district hospitals and selected high load Civil Hospitals, providing a wide range of, free-of-cost 132 types of diagnostic tests, including haematology, biochemistry, and microbiology. The adoption of the PPP model has also enabled the expansion of test numbers from 48 to 132, along with deployment of advanced testing equipment by the vendors. Under the service delivery, the average TAT is 24-48 hours with the provision of SMS based report delivery to the patients, 24×7 lab operationalization, bar-coded vials, and seamless data transfer to Lab Information Management System (LIMS). Currently, this PPP based diagnostic testing is conducting more than 36,000 tests and is being availed by 10,000+ patients per day.

On the other hand, the Hub and Spoke Model housed at selected 324 Civil Hospitals/Community Health Centres is functional as hub and is receiving samples from 1610 Primary Healthcare Centres (both urban and rural) as spokes. Under this model, the provision of the number of tests has been expanded from 16 to 80 tests, conducted through advanced diagnostic equipment and bar-coded vials. The average TAT is 24-48 hours with the provision of SMS based report delivery to the patients, and seamless data transfer to LIMS. Currently, this PPP based diagnostic testing is conducting more than 32,000 tests being availed by 7200+ patients per day.

The state is also developing Integrated Public Health Labs (IPHLs) at District Hospital level and Block Public Health Units (BPHUs) at block level, under the aegis of GOI’s flagship scheme Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PMABHIM). These IPHL will integrate all the diagnostic testing services under one roof with specialists like Pathologist, Microbiologist, Biochemist, and trained lab technicians. These IPHL and BPHU will establish a diagnostic network linked with LIMS for better understanding of disease surveillance and timely response. The linkages with Animal Husbandry facilities will also help in capturing newer disease patterns and outbreaks in a particular geography.

One of the most important and critical interventions in these models is the provision of digital interface through the LIMS. The sample collection in bar-coded vials, patient registration and reporting followed by recording the LIMS provides numerous data sets and insights, not only for clinical diagnosis, but for understanding the disease pattern, gender specificity, rural and urban pattern, region specificity and epidemiological transition. For this very purpose, the Department of Public Health and Family Welfare, MP, developed an integrated dashboard. This integrated dashboard gives quick comparative analytics of different scenarios, district and block level comparison, yearly and monthly comparison dynamic charts like graph, line, column, bar; data triangulation, based on information based on facility level taken to the last granularity of data.

Through the integrated dashboard the department is now attempting crosscutting analysis of different diseases, their patterns and geographical spread in order to initiate better preventive strategies. In recent times, with epidemiological transitions and the onset of newer diseases and change in seasonality of existing diseases, it has become imperative to study the health data and use it for better preparedness of public health systems. Madhya Pradesh has in this direction created the integrated dashboard which receives information from public health facilities via the LMIS about the different tests and it is now correlated with information from Integrated Disease Surveillance Programme to formulate better on-held preventive measures. Cross-cutting data of different tests like diabetes is fetched from LMIS and is now being used for screening and eye-checkup of the concerned patients for diabetic retinopathy, thereby ensuring better health service delivery. Similarly, data of LMIS and the dashboard is used to check abnormal values for Chronic Kidney Diseases (creatinine values) and then use it to initiate dialysis services. This way, leveraging technology has enabled the state to promote preventive health and improve delivery of curative health.

Post implementation of PPP based projects and development of integrated dashboard, the department can understand the disease pattern and trends in multiple parameters. For example, under Haemoglobin testing, Khargone has maximum patients under 9g/dl to 11g/dl range whereas, Barwani has maximum patients below 9g/dl range including severe anaemic cases. Similarly, under diabetes confirmatory test HBA1c, Bhopal reported maximum patients with HBA1c value more than 7% with prevalence of 16.5% during April-December 2023. Under Dengue testing, the top three districts reporting dengue cases are Bhopal, Gwalior and Morena. In addition to this, the analytics also shows that the number of dengue cases rises during September-December and monthly cases falls in 2023 during the same period as compared to 2022, which makes a point towards prior public health functions like planning and monitoring at state and district level.

Similarly, the PPP based CT Scan Imaging services are operational in 50 District Hospitals and 3 selected high load Civil Hospitals where US FDA/ European CE/BIS approved, 16 slice CT scan machines are installed. Under this model, the vendor is responsible for the provision of Human Resources like Radiologists, Anesthesiologists, staff nurses and Radiation Safety Officer. Also, the patients receive reports in 2 hours through soft and hard copy along with SMS for EHR registration and report collection. The availability of CT scans helps in early detections of diseases, optimizing care pathways along with creation of effective treatment plans based on the findings. This initiative has successfully averted 5.78 Lakh cases between Aug-22 to Aug-23, from private to government health facilities. Also, there has been an increase of 20,140 cases between the same period showing a significant rise of 57%. On average, more than 1450 CT scans are being conducted in a single day across the state.

Under CT scan integrated dashboard, the number of scans is maximum in Sehore whereas lesser in Indore and Bhopal, which shows that patients of Indore and Bhopal are migrating towards private centres for CT scan. The age wise pie-chart also shows that the age group of 31-50 years patients have maximum CT scans. The case type analysis shows that the top three case types are CT head, CT Brain and whole abdomen CT scan. Using the data analytics feature of the dashboard, the department is doing a deep dive into patient profile, age cohort, demography details and other statistics to design future preventive strategies.

The introduction of digital interfaces in data triangulation and clinical diagnosis based on health metrics, has supported policy formulation, decision making, planning for better interventions based on gap analysis and development of comprehensive clinical standard treatment protocols. The integrated dashboard also provides specific alerts if any specific parameters or KPIs is performing within defened range. There are various programmatic indicators which are dependent on these KPIs, can also be tethered and generate required analysis for monitoring optimum performance of national health programs at district, block, or facility level.

The Department of Public Health and Family Welfare has taken cognizance of Universal Health Coverage and developed a solution for better, effcient, and integrated monitoring of performance indicators. The vision of availability of free diagnostic services at facility-level has been elevated through LIMS and integrated dashboard. The PPP based models have benefitted the public enormously through lesser rate and maximum outcome and reach because of KPI linked payment to vendors. The success of these diagnostics and imaging services has been evident from the increase in the footfall for availing these free of cost services. Recurrent efforts are being made to integrate the diagnostic network at facility levels with the HMIS and ABHA ID for effective penetration of data, interconnection of disease profile and clinical history, along with real time alerts.

The health department of Madhya Pradesh has ensured accessible, affordable, and quality diagnostic and imaging services at public health facilities and has significantly reduced the out-of-pocket expenditure.

Views expressed by: Ms. Priyanka Das, Mission Director, National Health Mission, Govt. of Madhya Pradesh

Be a part of Elets Collaborative Initiatives. Join Us for Upcoming Events and explore business opportunities. Like us on Facebook , connect with us on LinkedIn and follow us on Twitter , Instagram.

Related Article