An Essential Pathology Package for Low- and Middle-Income Countries

Authors: Kenneth Fleming, Mahendra Naidoo, Michael Wilson, John Flanigan, Susan Horton, Modupe Kuti, Lai Meng Looi, Christopher Price, Kun Ru, Abdul Ghafur, Jianxiang Wang, Nestor Lago


Objectives: We review the current status of pathology services in low- and middle-income countries and propose an “essential pathology package” along with estimated costs. The purpose is to provide guidance to policy makers as countries move toward universal health care systems.

Methods: Five key themes were reviewed using existing literature (role of leadership; education, training, and continuing professional development; technology; accreditation, management, and quality standards; and reimbursement systems). A tiered system is described, building on existing proposals. The economic analysis draws on the very limited published studies, combined with expert opinion.

Results: Countries have underinvested in pathology services, with detrimental effects on health care. The equipment needs for a tier 1 laboratory in a primary health facility are modest ($2-$5,000), compared with $150,000 to $200,000 in a district hospital, and higher in a referral hospital (depending on tests undertaken). Access to a national (or regional) specialized laboratory undertaking disease surveillance and registry is important. Recurrent costs of appropriate laboratories in district and referral hospitals are around 6% of the hospital budget in midsized hospitals and likely decline in the largest hospitals. Primary health facilities rely largely on single-use tests.

Conclusions: Pathology is an essential component of good universal health care.


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Kenneth A. Fleming; Mahendra Naidoo; Michael Wilson; John Flanigan; Susan Horton; Modupe Kuti; Lai Meng Looi; Chris Price; Kun Ru; Abdul Ghafur; Jianxiang Wang; Nestor Lago. 2016. "An Essential Pathology Package for Low- and Middle-Income Countries." American Journal of Clinical Pathology.  doi: 10.1093/ajcp/aqw143