Leveraging Existing Laboratory Capacity towards Universal Health Coverage: A Case of Zambian Laboratory Services
Background: The provision of quality health care is influenced by the availability and capacity of the support systems such as the laboratory. The Service Availability and Readiness Assessment (SARA) by the Ministry of Health with support from WHO Zambia aimed to establish the availability levels of basic amenities required for quality health care including selected diagnostic tests that normally should be conducted at general hospitals and most health facilities. Adequately equipped clinical laboratories should provide early warning signals of health risks. The Assessment categorized the laboratories at three levels relating to the type of facility, these being hospital, health center and health post. This study used results from the SARA to determine the ability to make timely diagnosis, towards the Universal Health Coverage goals.
Methods: The general service readiness, the service specific readiness and diagnostic capacity were measured to determine overall capacity, ability of facilities to offer specific services and the mean availability of 8 basic lab tests respectively according to the guidelines in the SARA reference manual, version 2.1. Single stage stratified random sampling method was used to select facilities. A total of 234 health facilities were randomly sampled from 86 districts with 231 visited for assessment. In each stratum, a proportionate of health facilities was selected. Sample was weighted against all facilities. Analysis of data was done using STATA version 13.0. Descriptive analysis was done and data presented as percentages.
Results: A total of 231 (99%) out of 234 health facilities took part in the study. Most health facilities had the capacity to diagnose malaria (99%) and HIV (94%). A third (33%) of the facilities had capacity to diagnose blood glucose. The mean of tracer items was 66%. Compared across provinces, the Central (71%), Luapula (73%), and Southern (74%) provinces had higher mean availability of diagnostic capacity tracer items (ADCTI), while North-western province (48%) had the least mean ADCTI. Among the health type, hospitals had the highest mean ADCTI (87%); followed by health centres (70%) and health posts (46%). Private health facilities had a mean ADCTI of 76% compared to those of public health facilities of 63%. With regard to residence, the mean ADCTI for facilities in urban areas was 71% compared to that of facilities in rural areas of 63%. Overall, 12% of the facilities reported all the 8 tracer items for diagnosis.
Discussion: Although the mean availability of tracer items was found to be 66%, very few facilities (12%) had full diagnostic capacity. This status limits the ability to carry out the objective of Universal Health Coverage which is aimed at providing basic services for all at minimal cost. Only about a third of facilities had the capacity to diagnose blood glucose and yet Zambia has a high prevalence of diabetes. The capacity for health facilities to conduct essential tests in Zambia is low. Laboratory support is urgently needed to enhance service delivery in the country especially with regards to timely diagnosis of diseases of public health significance.
Conclusion: Although Zambia has not attained the ideal height of providing the basic diagnostic services to all as per aim of the Universal Health coverage, the capacity according to the SARA 2015 report has improved from 45% in 2010 to 66% in 2015.