Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions

Shahin Sayed, William Cherniak, Mark Lawler, Soo Yong Tan, Wafaa El Sadr, Nicholas Wolf, Shannon Silkensen, Nathan Brand, Lai Meng Looi, Sanjay A Pai, Michael L Wilson, Danny Milner, John Flanigan, Kenneth A Fleming

Research output: Contribution to journalReview article

31 Citations (Scopus)

Abstract

Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.

Original languageEnglish
Pages (from-to)1939-1952
JournalLancet
Volume391
Issue number10133
DOIs
Publication statusEarly online date - 14 Mar 2018

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Medicine
Pathology
Telepathology
Clinical Laboratory Information Systems
Public-Private Sector Partnerships
Laboratory Personnel
Education
Mentors
Accreditation
Technology
Delivery of Health Care

Keywords

  • Journal Article
  • Review

Cite this

Sayed, S., Cherniak, W., Lawler, M., Tan, S. Y., El Sadr, W., Wolf, N., ... Fleming, K. A. (2018). Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions. Lancet, 391(10133), 1939-1952. https://doi.org/10.1016/S0140-6736(18)30459-8
Sayed, Shahin ; Cherniak, William ; Lawler, Mark ; Tan, Soo Yong ; El Sadr, Wafaa ; Wolf, Nicholas ; Silkensen, Shannon ; Brand, Nathan ; Looi, Lai Meng ; Pai, Sanjay A ; Wilson, Michael L ; Milner, Danny ; Flanigan, John ; Fleming, Kenneth A. / Improving pathology and laboratory medicine in low-income and middle-income countries : roadmap to solutions. In: Lancet. 2018 ; Vol. 391, No. 10133. pp. 1939-1952.
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abstract = "Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.",
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Sayed, S, Cherniak, W, Lawler, M, Tan, SY, El Sadr, W, Wolf, N, Silkensen, S, Brand, N, Looi, LM, Pai, SA, Wilson, ML, Milner, D, Flanigan, J & Fleming, KA 2018, 'Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions', Lancet, vol. 391, no. 10133, pp. 1939-1952. https://doi.org/10.1016/S0140-6736(18)30459-8

Improving pathology and laboratory medicine in low-income and middle-income countries : roadmap to solutions. / Sayed, Shahin; Cherniak, William; Lawler, Mark; Tan, Soo Yong; El Sadr, Wafaa; Wolf, Nicholas; Silkensen, Shannon; Brand, Nathan; Looi, Lai Meng; Pai, Sanjay A; Wilson, Michael L; Milner, Danny; Flanigan, John; Fleming, Kenneth A.

In: Lancet, Vol. 391, No. 10133, 14.03.2018, p. 1939-1952.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Improving pathology and laboratory medicine in low-income and middle-income countries

T2 - roadmap to solutions

AU - Sayed, Shahin

AU - Cherniak, William

AU - Lawler, Mark

AU - Tan, Soo Yong

AU - El Sadr, Wafaa

AU - Wolf, Nicholas

AU - Silkensen, Shannon

AU - Brand, Nathan

AU - Looi, Lai Meng

AU - Pai, Sanjay A

AU - Wilson, Michael L

AU - Milner, Danny

AU - Flanigan, John

AU - Fleming, Kenneth A

N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.

PY - 2018/3/14

Y1 - 2018/3/14

N2 - Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.

AB - Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.

KW - Journal Article

KW - Review

U2 - 10.1016/S0140-6736(18)30459-8

DO - 10.1016/S0140-6736(18)30459-8

M3 - Review article

C2 - 29550027

VL - 391

SP - 1939

EP - 1952

JO - Lancet

JF - Lancet

SN - 0140-6736

IS - 10133

ER -