Human cost of poor-quality testing in India

Hindustan Times

08-06-2025

Ramesh, a 32-year-old construction worker, first visited his local clinic when he was having persistent cough and it refused to go away. For over two months, he had been suffering from coughing, recurring fever, and unexplained weight loss. The classic symptoms that should have raised red flags for tuberculosis (TB). But due to limited infrastructure and inadequate diagnostic support, his condition was misread as simple bronchitis. The technician, lacking proper training and resources, failed to spot early signs of TB. The doctor, relying on this flawed report, prescribed a general course of antibiotics and sent Ramesh home. Two more painful months passed. Ramesh's condition worsened. His cough began producing blood, and severe fatigue left him unable to work.
This story reflects a deeper systemic failure of our country. Low-quality diagnostic services, often driven by under-resourced facilities, lack of quality checks, and poor training, lead to misdiagnosis, delayed treatment, worsening health, and higher health care costs.
In situations like Ramesh's, the need is not for centralised, high-end laboratories but for accessible, quality-assured diagnostics at the point of care, especially for conditions like respiratory infections, diarrhoeal diseases, sexually transmitted infections (STDs), and chronic diseases like diabetes and kidney dysfunction. Many of these tests do not require the National Accreditation Board for Testing and Calibration Laboratories (NABL) accreditation. What's crucial is to ensure standardised quality control for every batch of diagnostics and robust supply chains so that tests are accurate, affordable, and always available where they are needed most. Most of the syndrome-based approaches such as fever, STDs where the diagnostic should be available at a point of care with a quality check. The cervical cancer diagnostics should be provided with appropriate quality checks, the same is with glucose levels, HB levels as well as basic diagnostics for lipids, kidney, liver tests. Point-of-care diagnostics for respiratory tract infections and diarrhoeal diseases must be made widely available, given the high mortality associated with these conditions. Just like medicines, every batch of diagnostic kits should undergo stringent quality checks and be supported by robust supply chain and storage systems.
Currently, many government hospitals and public health facilities function without NABL accreditation. This underscores the need to build a parallel grassroots-level accreditation system, modeled along the lines of National Accreditation Board for Hospitals & Healthcare Providers (NABH), but adapted to rural realities. Such a system would ensure minimum quality benchmarks, especially for programme-related diagnostics and should be integrated into national health schemes including those under the Ayushman Bharat PM-JAY.
The lack of structured quality control has allowed an influx of unreliable diagnostic tools in both public and private sectors. Each diagnostic batch, like medicines, must undergo quality verification before deployment. This is especially critical for widespread conditions like cervical cancer, glucose imbalance, anaemia (Hb levels), and liver/kidney dysfunction, where inaccurate results can lead to incorrect treatment or no treatment at all. To ensure sustained quality, regular training and upskilling of lab technicians must be mandated. Training should focus not only on basic test operations but also on ethical diagnostic practices, quality assurance, storage standards, and the correct use of surveillance tools, which should never be substituted for clinical diagnostics.
According to the National Health Profile 2023, only 12% of primary health centers (PHCs) have diagnostic labs and many of those do not meet even basic standards. The result is a massive diagnostic gap in rural India, pushing patients toward unregulated, low-quality private labs. The consequences are severe: delayed or missed diagnoses, prolonged disease burden, high out-of-pocket costs, and ultimately, preventable deaths.
While decentralised diagnostics are essential, India must also invest in national reference labs to support complex testing and surveillance. Establishing 50 NABL-accredited reference labs, each serving approximately 25 million people, would ensure comprehensive national coverage. These hubs should be equipped with Artificial Intelligence (AI)-assisted digital microscopy, real-time PCR machines, and cloud-based data systems for seamless health care integration.
Public-private partnerships can be leveraged to train lab personnel at these reference centers, ensuring they are equipped with both theoretical knowledge and hands-on skills. Curriculum should emphasise AI tools, quality protocols, and patient-centric diagnostic delivery.
Diagnostics are not just support tools; they are central to effective healthcare delivery. Without timely, accurate testing, even the best clinical decisions can fail. As India aspires toward Universal Health Coverage and a $ 5 trillion economy, strengthening diagnostic services, particularly at the last mile, is not optional. It's an urgent public health imperative.
This article is authored NK Ganguly, former director general, Indian Council of Medical Research (ICMR).