Pathology and laboratory services in low to middle income countries: Challenges and Opportunities for Growth

Successful healthcare systems rely on strong, efficient and reliable pathology and laboratory services. In developed countries like the United States, the role of pathology and the lab in service delivery cannot be overemphasized. Through multidisciplinary tumor board conferences, the central role of pathologists in patient management has become more critical. This reality was further emphasized for me during a tumor board conference, where an oncologist wanted clarification on the difference between invasive ductal carcinoma with mucinous differentiation vs. mucinous carcinoma of the breast. I later learned that the distinction was necessary because of different prognosis and treatment. As pathologists, we work in concert with treating physicians which makes for more efficient and reliable patient care.

However, the situation is not the same in low to middle income countries (LMIC) where the pathology and laboratory workforce is currently suboptimal. One reason that has been attributed to this situation is a lack of awareness of the central role of pathology and lab medicine in developing countries with fragile health care systems. This has led to ineffective policy decisions and inadequate budgetary allocations to the lab, with the attendant catastrophic effects on patient care and outcomes.1

West Africa for example has seen a steady decline in healthcare delivery standards, even though diseases such as Burkitt lymphoma were first described in Africa, followed by the growth of the first human lymphoma/leukemia cell line (the Raji cell line).2 In addition, ‘Cancer in Five Continents’, a publication of the International Agency on Cancer Research, used data from Ibadan-Nigeria and Uganda cancer registries in its early years of publication. Unfortunately, during the years the countries in these regions have not been able to keep up with technologic advances that have since reshaped healthcare service delivery and research.3 Several barriers to sustainable pathology and laboratory services in LMIC have been identified including an inadequate workforce, substandard infrastructure, inadequate education and training, and quality assurance problems.1


Photo by National Cancer Institute on Unsplash

Despite these challenges, there are opportunities to improve healthcare delivery systems in LMIC through effective laboratory and pathology services. One area that needs to be prioritized is the education and training of qualified pathology and laboratory personnel. This can be achieved through cross-cultural competency training and the building of collaborative networks through short term visitor exchange programs. In addition, continuing medical education (CME) opportunities should be made available to training institutions in these countries so they can keep up with modern day standards.

Another opportunity for growth in pathology and lab services in LMIC is through the implementation of accreditation and regulatory programs. These accreditation services should set standards by which lab services operate in these countries to ensure reliable and consistent operations. Such efforts may improve health service deliveries and ultimately improve patient outcomes.

One factor that has been a huge problem in disease prevention in LMIC is lack of adequate screening programs for chronic diseases, including several cancers. In many countries, misplaced priorities, in addition to lack of adequate personnel has been the bane of the healthcare systems. Therefore, policies that promote screening programs in LMIC should be prioritized. This strategy if implemented properly could lead to significant improvements in the healthcare systems, which would ultimately have an impact on patient care.

Furthermore, collaborative healthcare should be prioritized. The care and management of patients should be done collaboratively through clinicians across different specialties with proper communication channels in place. There have been instances where a clinician treating a patient may not have access to laboratory results requested by another clinician, which ultimately impacts the outcome of patients.

The role of efficient and functional laboratory and pathology services in healthcare systems cannot be overemphasized. Systems which lack these services experience catastrophic patient outcomes and until local and international governments prioritize the labs in these low-resource settings, patient outcomes will continue to remain suboptimal.

References

  1. 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. Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions. Lancet. 2018 May 12;391(10133):1939-1952. doi: 10.1016/S0140-6736(18)30459-8. Epub 2018 Mar 15. PMID: 29550027.
  2. Pulvertaft JV. Cytology of Burkitt’s Tumour (African Lymphoma). Lancet. 1964 Feb 1;1(7327):238-40. doi: 10.1016/s0140-6736(64)92345-1. PMID: 14086209.
  3. Adeyi OA. Pathology services in developing countries-the West African experience. Arch Pathol Lab Med. 2011 Feb;135(2):183-6. doi: 10.1043/2008-0432-CCR.1. PMID: 21284434.

-Evi Abada, MD, MS is a Resident Physician in anatomic and clinical pathology at the Wayne State University School of Medicine/Detroit Medical Center in Michigan. She earned her Masters of Science in International Health Policy and Management from Brandeis University in Massachusetts, and is a global health advocate. Dr. Abada has been appointed to serve on the ASCP’s Resident’s Council and was named one of ASCP’S 40 under Forty honorees for the year 2020. You can follow her on twitter @EviAbadaMD.

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