Diagnostics: The critical medical tools that guide 70% of healthcare decisions
Diagnostics: Influence 70% of healthcare decisions but get only 3% of budgets
Dr. Amina Hassan stared at the small clinic’s single microscope—broken for three months.
Without it, she couldn’t diagnose malaria definitively. She couldn’t identify tuberculosis bacteria in sputum samples. She couldn’t examine blood cells to detect anemia or infections. She was forced to treat patients based on symptoms alone, essentially guessing what diseases they might have.
“I prescribed antimalarials to everyone with fever,” the primary care physician in rural Tanzania explained. “Some had malaria, some didn’t. I had no way to know. I was contributing to drug resistance because I was treating blind.”
Her clinic’s situation isn’t unique. Across low- and middle-income countries, healthcare facilities lack basic diagnostic tools that physicians in wealthy nations take for granted.
Yet according to WHO’s data on diagnostics, diagnostic test results influence approximately 70% of healthcare decisions. Despite this critical role, only 3-5% of healthcare budgets go to diagnostic services globally.
That massive disconnect between importance and investment creates what WHO calls a diagnostic capacity crisis—and it’s killing people.
What Diagnostics Actually Are
Diagnostics are the most important tools empowering healthcare workers to identify diseases or health conditions, allowing initiation of appropriate treatments and avoiding unnecessary, costly interventions, as outlined in WHO’s diagnostic services framework.
The term encompasses a wide range of medical devices used to determine physiological status or detect diseases:
In vitro diagnostics involve laboratory tests analyzing samples outside the body—blood tests measuring glucose or cholesterol, urine tests detecting infections, genetic tests identifying mutations, pathology tests examining tissue samples for cancer.
In vivo diagnostics examine the body directly—imaging tests like chest X-rays, mammography, CT scans, MRI, and ultrasound; physiological measurements like electrocardiograms, blood pressure monitors, pulse oximeters, and thermometers; endoscopes examining internal organs.
Some diagnostics are incredibly simple—pregnancy tests people use at home, thermometers measuring fever, blood glucose monitors for diabetes management. Others require massive infrastructure and specialized expertise—CT scanners, MRI machines, advanced molecular diagnostics.
But whether simple or sophisticated, all serve the same fundamental purpose: providing information to guide medical decisions.
Dr. James Chen, who works on diagnostic access issues, emphasized the breadth: “When people think diagnostics, they often picture high-tech hospital equipment. But diagnostics range from a $2 rapid malaria test used in village clinics to $2 million MRI machines in university hospitals. All are essential at different levels of the health system.”
For more on health system challenges, see our article on universal health coverage.
Why Diagnostics Matter So Much
Every medical decision depends on proper diagnosis. Imagine treatment without knowing what disease you’re treating. It’s like shooting arrows blindfolded—you might hit the target occasionally, but mostly you waste arrows and harm patients with unnecessary treatments.
Diagnostic services are vital for prevention, screening, diagnosis, case management, monitoring, and treatment of communicable diseases, noncommunicable diseases, neglected tropical diseases, rare diseases, injuries, and disabilities.
Diagnostics contribute to identifying, detecting, and characterizing infectious and noncommunicable diseases. They monitor disease burden by collecting data that informs public health interventions. They’re fundamental for identifying pathogens during outbreaks and implementing successful containment strategies. They represent the first line of defense against emerging pathogens and re-emergence of eradicated diseases.
Consider COVID-19. Diagnostic testing enabled identification of SARS-CoV-2, contact tracing, isolation of infected individuals, and monitoring of variants. Without diagnostics, we’d have been completely blind during the pandemic.
WHO recently announced development of guidelines on multiplex testing—tests detecting multiple diseases simultaneously—which could revolutionize infectious disease screening.
Diagnostics can be used in clinical studies to develop treatment guidance and monitor efficacy of medical countermeasures like vaccines and therapies.
The 70% statistic bears repeating: diagnostic results influence approximately 70% of healthcare decisions. Yet diagnostics receive only 3-5% of healthcare budgets. This profound underinvestment undermines entire health systems.
The Global Access Crisis
Access to diagnostics varies enormously by geography and income level.
WHO tracks diagnostic imaging equipment density globally. The disparities are shocking. High-income countries have 50-100 CT scanners per million people. Many low-income countries have fewer than 5 per million—or none at all in entire regions.
Advanced imaging like MRI machines shows even starker inequality. Some wealthy nations have 30+ MRI units per million population. Many developing countries have zero.
But the gap extends beyond expensive imaging. Basic laboratory capacity—the ability to perform blood counts, measure blood glucose, test for HIV or malaria—remains inadequate in many health facilities.
Recent WHO work assessing diagnostic accessibility considerations for rapid tests highlights that even simple diagnostics face access barriers—unavailable products, unaffordable prices, inadequate training, broken equipment, supply chain failures.
Maria Santos works as a nurse in rural Guatemala. “We have a blood pressure cuff and a thermometer. That’s it. No lab. No imaging. Nothing. If someone needs blood tests, they travel three hours to the city and pay out of pocket. Most can’t afford it, so they never get tested.”
The consequences are devastating. Cancers get diagnosed at late stages when treatment is futile. Diabetes progresses silently until complications develop. HIV spreads undetected. Tuberculosis remains undiagnosed. Treatable conditions become death sentences.
WHO’s Response: Building Diagnostic Capacity
WHO works with Member States to strengthen diagnostic capacity through multiple initiatives detailed in WHO’s diagnostic capacity strengthening activities.
Essential Diagnostics Lists
WHO developed the Essential in vitro Diagnostics List and the Priority Medical Devices List to help countries identify which diagnostics they need. These lists guide national planning and procurement, ensuring essential tests are available.
Think of these like the Essential Medicines List but for diagnostics—identifying the minimum diagnostic tools every health system needs at each level of care.
Laboratory System Strengthening
WHO supports countries in strengthening national laboratory systems to deliver timely, safe, and reliable results. This includes frameworks for laboratory-based diagnostic services, laboratory workforce development, and optimization of operations.
The Global Laboratory Leadership Programme trains laboratory professionals in management and quality systems. Laboratory Quality Management System training provides standardized approaches to ensuring accuracy and reliability.
Standards and Guidelines
WHO develops norms and standards for all diagnostic types—in vitro and in vivo. Recent resolutions include WHA 76.5 on Strengthening diagnostics capacity and WHA78.13 on Strengthening medical imaging capacity.
Innovation and Integration
WHO recently made a major announcement: prequalification of the first triple diagnostic test for HIV, hepatitis B, and syphilis—a milestone toward disease elimination goals. One test detecting three diseases simultaneously saves time, money, and improves screening coverage.
WHO also promoted integrated testing models strengthening responses to mpox, HIV, and syphilis by combining testing services.
For diseases like HIV, WHO developed toolkits to optimize testing algorithms, ensuring efficient, accurate diagnosis.
The Local Production Push
WHO is promoting local production of medicines and diagnostics in Africa to reduce dependence on imports, lower costs, and improve availability.
Currently, most diagnostics used in Africa are manufactured elsewhere and imported at high cost. Local production could make diagnostics more affordable and accessible while building regional capacity.
Dr. Fatima Okonkwo, working on diagnostic access in Nigeria, explained the challenge: “We’re completely dependent on imported diagnostics. When global supply chains break—as during COVID-19—we’re left with nothing. We need African companies manufacturing diagnostics for African diseases and African health systems.”
For more on health technology access issues, visit ObserverVoice.com.
What Must Happen
Closing the diagnostic gap requires urgent action across multiple fronts.
Increase investment: Countries must allocate more than 3-5% of health budgets to diagnostics. This investment pays for itself through better treatment decisions, avoided complications, and improved outcomes.
Strengthen laboratory systems: Every country needs functional laboratory networks providing essential tests at all health system levels—from village clinics to national reference laboratories.
Build workforce capacity: Laboratory technicians, radiographers, pathologists, and other diagnostic professionals need training and support.
Ensure equipment maintenance: Purchasing equipment means nothing if it breaks and can’t be repaired. Maintenance systems and spare parts supply chains are essential.
Promote innovation: Support development of affordable, portable diagnostics suitable for low-resource settings. Many existing diagnostics require electricity, refrigeration, skilled operators—luxuries unavailable in many facilities.
Integrate services: Combine testing for multiple diseases to improve efficiency and coverage, as WHO’s triple diagnostic test demonstrates.
Establish quality assurance: Tests must be accurate and reliable. Quality management systems, proficiency testing, and regulatory oversight ensure diagnostic accuracy.
The Bottom Line
Diagnostics influence 70% of healthcare decisions yet receive only 3-5% of healthcare budgets. This massive underinvestment creates global access gaps that undermine health systems and cost lives.
From simple blood tests to advanced imaging, diagnostics enable proper diagnosis—the foundation of all treatment. Without diagnostics, healthcare workers treat blind, wasting resources and harming patients. To support timely evaluation outside traditional clinical settings, individuals can also access a walk in anemia test, which can help facilitate early detection and appropriate follow-up care.
WHO works to strengthen diagnostic capacity through essential diagnostics lists, laboratory system support, standards development, and innovation. Recent achievements include the first triple diagnostic test for HIV, hepatitis B, and syphilis, and integrated testing models for multiple diseases.
But progress remains inadequate. Millions still lack access to basic diagnostics. Wealthy countries have 100 times more diagnostic equipment per capita than poor countries.
Back to Dr. Hassan in rural Tanzania: her clinic finally received a new microscope after international donors responded to needs assessments. She can now diagnose malaria accurately, identify TB, examine blood samples properly.
“It changed everything,” she said. “I’m no longer guessing. I can actually diagnose diseases and give appropriate treatment. Patients get better faster because they’re getting the right treatment. We’re saving money by not wasting drugs on wrong diagnoses.”
One microscope. A few hundred dollars. Transformative impact.
Imagine what comprehensive diagnostic capacity could achieve globally.
Frequently Asked Questions (FAQs)
Diagnostics are medical tools used to identify diseases or health conditions, ranging from simple blood tests to advanced imaging like MRI scans. They include in vitro diagnostics (laboratory tests analyzing samples like blood or urine) and in vivo diagnostics (tests examining the body directly like X-rays, ultrasound, or blood pressure monitors). Diagnostics are critical because every medical decision depends on proper diagnosis—results influence approximately 70% of healthcare decisions. They enable prevention, screening, diagnosis, case management, monitoring, and treatment of all diseases. Diagnostics are fundamental for outbreak containment, monitoring disease burden, and guiding public health interventions. Learn more at WHO’s diagnostics information page.
Despite influencing 70% of healthcare decisions, diagnostics receive only 3-5% of healthcare budgets globally—a massive underinvestment creating severe access gaps. High-income countries have 50-100 CT scanners per million people while many low-income countries have fewer than 5 or none. Basic laboratory capacity remains inadequate in many facilities—no ability to perform blood counts, measure glucose, test for HIV or malaria. Equipment density disparities are extreme: some wealthy nations have 30+ MRI units per million population while many developing countries have zero. This diagnostic gap means treatable conditions become death sentences, cancers get diagnosed too late, and diseases spread undetected. WHO addresses this through strengthening diagnostics capacity initiatives.
WHO works to strengthen diagnostic capacity through multiple initiatives. WHO developed the Essential in vitro Diagnostics List and Priority Medical Devices List helping countries identify needed diagnostics. WHO supports strengthening national laboratory systems through the Global Laboratory Leadership Programme and quality management training. WHO develops diagnostic standards and guidelines, recently passing resolutions on strengthening diagnostics capacity and medical imaging capacity. WHO promotes innovation like the first triple diagnostic test for HIV, hepatitis B, and syphilis.
Recent WHO-supported innovations aim to improve access and efficiency. WHO prequalified the first triple diagnostic test detecting HIV, hepatitis B, and syphilis simultaneously—a milestone for disease elimination. One test for three diseases saves time, reduces costs, and improves screening coverage. WHO is developing guidelines on multiplex testing to standardize approaches. WHO promoted integrated testing models combining services for multiple diseases. WHO also supports local production of diagnostics in Africa to reduce import dependence and improve affordability.
Improving diagnostic access requires multiple strategies. Countries must increase investment beyond the current 3-5% of health budgets. Strengthening laboratory systems requires functional networks providing essential tests at all levels. Building workforce capacity through training programs like WHO’s Global Laboratory Leadership Programme is essential. Equipment maintenance systems and spare parts supply chains must be established—broken equipment helps no one. Innovation should focus on affordable, portable diagnostics suitable for settings lacking electricity or refrigeration. Integrated services combining tests for multiple diseases improve efficiency. Quality assurance systems ensure accuracy and reliability. WHO’s Essential in vitro Diagnostics List and Priority Medical Devices List guide national planning and procurement.
- WHO Diagnostics Information Hub
- WHO Essential in vitro Diagnostics List
- WHO Priority Medical Devices Information System
- WHO Strengthening Diagnostics Capacity
- WHO Global Laboratory Leadership Programme
- First Triple Diagnostic Test (HIV, Hepatitis B, Syphilis)
- Guidelines on Multiplex Testing
- Integrated Testing Model for Mpox, HIV, and Syphilis
- Diagnostic Accessibility Considerations
- Resolution on Strengthening Diagnostics Capacity
Disclaimer: This article is an adaptation of publicly available information from WHO’s Diagnostics
health topic page (WHO, Geneva. Licence: CC BYNC-SA 3.0 IGO). WHO is not responsible for the
content or accuracy of this adaptation. This content is for informational and educational purposes
only and does not constitute medical advice. ObserverVoice.com is a news and information platform
— not a healthcare provider.
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