Communities in Madagascar face numerous barriers in accessing diagnostics services. Working with communities there, we anecdotally learned of these barriers, including high costs of diagnostics, communities needing to travel far to access testing facilities, and poor communication of results and follow-up of patients. In an effort to document these realities, we embarked on a rapid diagnostics assessment exercise, interviewing 43 individuals (including 4 health care workers) living in rural and semi-rural communities in Madagascar.
This rapid assessment found a complex diagnostics environment marked by high out-of-pocket spending for diagnostics relative to income, relatively long distances to get to primary healthcare centres, doctors prescribing antibiotics with incomplete diagnostics regimens or no diagnostics at all, poor clinical practices on diagnostics (such as use of inaccurate terminology), and insufficient data about stockouts. We noted that because rapid malaria tests are provided for free, doctors offer these more regularly, but upon a negative result are unable to recommend additional tests because of the cost barrier. We also found that rural communities overwhelmingly wanted more accessible and affordable testing – and perceived that people they knew were dying from ‘unknown diseases’.
Urgent reforms are needed. Based on our research, we proposed the following:
- Universal health coverage for diagnostics | Tests that are fully funded by the state, and made available in all public health facilities.
- Better clinical practice around diagnostics | Including accurate and respectful communication of confirmed diagnoses to patients and avoiding prescription of antibiotics if diagnostics regimens are incomplete.
- Trained & salaried community health workers bringing rapid tests to communities | Poor road infrastructure means that a 5.5km trek to the nearest primary healthcare centre is a deterrent for access to tests.
- Facilities with point-of-care testing closer to rural communities | As aforementioned, there is poor road infrastructure and travelling to healthcare centres often takes an entire day, with many taking time off from informal jobs and losing a days’ income.