Basic Diagnostics Laboratory for Community Health Centers in Madagascar
Clinicians throughout Madagascar rely mainly on symptomatic methods (algorithms) for disease diagnosis; this is due to the lack of laboratory services throughout the country. In the absence of laboratory support, the clinician is “blind” and misdiagnosis is common. Inaccurate diagnosis can lead to a number of negative outcomes: 1) inappropriate treatment resulting in prolonged illness, 2) an increase in health care expenditure for patients and their families, 3) lack of understanding of disease prevalence, which leads to the inability to design appropriate preventative interventions, and 4) unnecessary treatment that could lead to drug resistant pathogens.
Accurate disease diagnosis provides decision makers with valuable information to assist them in understanding the determinants of health and the nature and extent of community needs for improving their health status. The provision of laboratory services is a cost effective means of improving disease diagnostics and reduces the overall health care expense of the patients.
Over the past year, TAPFIRE Madagascar has been operating and managing a basic diagnostic laboratory in the Community Health Center of Ankarobato, a peri-urban municipality of capital city of Antananarivo. The Ankarobato lab offers the following tests on a fee-for-service basis:
Procedure / Sample Type |
For detection/diagnosis of |
Peripheral Blood Smear |
Malaria, filariasis |
Stool Exam |
Ova and cysts |
Urine Exam |
Schistosomiasis, calcium and phosphate crystals, yeast, RBCs, bilirubin levels, ph, leukocytes, |
Urethral / Vaginal Exudates |
Gram neg, Gram pos bacteria, yeast, |
Rapid Diagnostic Tests |
HIV, Syphilis, Malaria, Pregnancy |
The objective of this intervention was to create a replicable model for an economically viable and sustainable system for laboratory services, leading to improved accuracy of diagnoses and overall quality of healthcare in Madagascar.
Results to date suggest that the service is an economically sustainable and viable service. Both, patient and doctor believe that laboratory diagnosis is an import element of ‘quality of health care’. Community members understand the benefits of laboratory diagnostics, and value the accuracy and are willing and able to pay for these services.
TAPFIRE seeks funding to replicate this successful model and expand to other communities. Funding will provide the capital startup costs of the following:
- Microscope and other lab equipment.
- 3-month supply of consumable goods.
- 1-year subsidy of the lab technicians’ salary, supervision and administration costs.
After 1-year of operation the lab will become self-sufficient, earning enough revenues to continue to provide lab services.