[Answered] Universal healthcare requires accessible diagnostics, but challenges remain in technical capacity. Evaluate the policy and governance reforms needed to address equipment supply and skill deficits for effective public health delivery.

Introduction

Universal Health Coverage (UHC), enshrined in India’s National Health Policy (2017) and the UN Sustainable Development Goals (SDGs), demands timely, accurate, and affordable diagnostics. While recent advances in equipment supply have improved access, deficits in technical capacity and system integration hinder effective public health delivery.

Importance of Diagnostics in UHC

1. Foundation of treatment: Accurate diagnosis precedes effective therapy, reducing mistreatment and costs.
2. Public health impact: Early detection of TB, malaria, NCDs like diabetes and cardiovascular diseases, improves health outcomes and reduces disease burden.
3. Economic benefit: Outpatient care (60%+ of out-of-pocket expenditure) is driven by diagnostics, drugs, and transport. Strengthening local diagnostics reduces catastrophic health expenditure.

Recent Policy Initiatives

1. National List of Essential Diagnostics (NLED): Updated by ICMR (2019, 2025) to reflect changing disease profiles.
2. Ayushman Aarogya Mandirs: Integrating sub-centres and PHCs with point-of-care testing for NCDs, infectious diseases, and maternal health.
3. Molecular diagnostics expansion: RT-PCR networks from COVID-19 now adapted for TB, dengue, and other infections.
4. Tele-diagnostics: Tele-radiology, tele-pathology, and tele-dermatology bridging rural-urban expertise gaps.

 Persistent Challenges

1. Equipment gaps: Uneven distribution; many PHCs lack functioning analyzers, imaging facilities, or cold-chain systems.
2. Technical skill deficits: Shortage of trained lab technicians and poor training in interpretation of results.
3. Maintenance and supply chains: Delays in repair, lack of reagents, and weak logistics networks.
4. Diagnostic literacy: Limited understanding among healthcare providers of test sensitivity, specificity, and predictive values.

Policy and Governance Reforms Needed

1. Equipment Supply and Infrastructure: Public procurement reform and shift from ad hoc purchases to life-cycle contracts covering supply, calibration, maintenance. Decentralized logistics hubs and regional diagnostic warehouses for reagents and spare parts to reduce downtime. Tiered diagnostic network with clearly defined tests at sub-centre, PHC, CHC, and district hospital levels with referral protocols.
2. Human Resource Capacity: A National Diagnostic Training Mission modeled on the National Skill Development Mission, targeting lab technicians, radiographers, and PHC staff. Task shifting and authorize trained community health officers for basic point-of-care testing. Continuous professional development to integrate AI-assisted learning for interpretation of results.
3. Governance and Integration: Evidence-based diagnostic algorithms which should be led by ICMR to standardize test selection, sequencing, and interpretation. Public-private partnerships (PPPs) and outsource specialized tests where in-house capacity is limited, ensuring affordability. Digital health integration to link test results to National Digital Health Mission (NDHM) for continuity of care.
4. Financing and Incentives: Inclusion in insurance schemes to extend Ayushman Bharat coverage to outpatient diagnostics. Performance-linked grants to fund states based on improvements in diagnostic coverage and turnaround time.

Global Best Practices Relevant to India

1. Thailand’s UHC model: Fully integrates diagnostics into primary care financing.
2. Rwanda’s drone-based logistics: Cuts sample transport times, relevant for India’s remote areas.
3. Brazil’s Family Health Teams: Combine diagnostics with community outreach for holistic care.

Conclusion

Accessible diagnostics form the backbone of universal healthcare. Strengthening supply chains, building skilled human capital, and integrating diagnostics into public health governance will make India’s UHC goals a practical reality.