Expanding Access to Diagnostics is the Cornerstone for Extending Universal Health Coverage in Africa

This article was co-authored by Africa Health Business and Nigeria Health Watch as part of our advocacy efforts to raise awareness and drive action on Universal Health Coverage.

About five years ago as COVID-19 intensified , the continent of Africa—like other regions of the world—witnessed the critical role of diagnostics in global health security, proving that timely and widespread testing was essential not only for controlling outbreaks, but also for sustaining routine healthcare services.

As the continent strives towards achieving Universal Health Coverage (UHC), the significance of diagnostics cannot be overstated. Diagnostics are more than tools for identifying diseases, they are the gateway to effective treatment, the roadmap for prevention, and the backbone of public health strategies.

However, nearly 47% of the global population has limited or no access to diagnostics, with low-and middle-income countries (LMICs) in the World Health Organization (WHO) Africa Region facing the greatest challenges. To achieve equitable health systems that include everyone, this gap must be addressed.

By facilitating early detection, diagnostic tools empower healthcare providers to diagnose and prevent diseases, deliver timely and effective treatments, and curb the spread of illnesses. This not only minimises their impact but also significantly enhances health outcomes for individuals and communities.

Diagnostics also drive cost efficiency in health systems by streamlining resource allocation, reducing the need for unnecessary treatments or hospitalisations, and placing greater emphasis on preventive care, a strategy that benefits both patients and the public health system.

Current challenges in diagnostic access in Africa

Despite the critical role of diagnostics in healthcare, only 30% of health facilities in Africa have the necessary equipment or reagents to perform basic tests.

Nigeria offers a striking example of both progress and persistent gaps in diagnostic access. While its diagnostic market is projected to reach USD 665 million by 2026, systemic challenges—such as infrastructure deficits and workforce shortages—continue to hinder optimisation of its laboratory services.

These challenges mirror those faced across the continent, where barriers to accessing diagnostics are complex and multifaceted, encompassing several critical challenges:

1. Inadequate Infrastructure: Many healthcare facilities lack essential laboratories, equipment, and supplies required for even the most basic diagnostic tests. Existing laboratories are often under-resourced, with outdated or insufficient equipment and low-quality materials, resulting in limited capacity to deliver accurate and timely results.
2. Workforce Shortages: The scarcity of trained personnel to operate diagnostic equipment and analyse test results is a significant bottleneck. This gap in expertise further hampers the delivery of effective diagnostic services, especially in underserved areas.
3. Financial Constraints: The high cost of diagnostic tools and consumables places these services beyond the reach of many individuals. In a region where healthcare often relies on out-of-pocket payments, the financial burden discourages people from seeking diagnostics, leading to delayed or missed diagnoses and untreated diseases. Furthermore, laboratories dependent on unstable or irregular funding face operational disruptions, preventing them from consistently delivering accurate and timely services.
4. Weak Regulatory and Governance Frameworks: The availability of affordable and high-quality diagnostic products is hindered by weak regulatory systems, inconsistent policies, and insufficient governance. These systemic issues undermine efforts to ensure equitable access to diagnostics across the continent.
5. Geographical Disparities: Diagnostic services are disproportionately concentrated in urban areas, leaving rural populations with limited or no access. Patients in remote regions often face the burden of traveling long distances to access diagnostics, which can be time-consuming and costly. For many, this deters them from seeking care altogether, exacerbating health inequities.

?The pathway to change

Over the years, numerous declarations and resolutions have highlighted the critical need to strengthen diagnostic systems in Africa, including the 2008 Maputo Declaration on Strengthening Laboratory Systems; the WHO Resolution on enhancing public health laboratories in the African Region; and, more recently, the adoption of Resolution WHA 76.5 at the World Health Assembly, which emphasises strengthening diagnostic capacity.

While these commitments mark progress and are aligned with Africa’s New Public Health Order which emphasises regional manufacturing capacity, expanding access to diagnostics requires a multifaceted approach, one that directly addresses key barriers through innovation, strategic investments, and collaborative efforts. Only by prioritising these pillars can we ensure diagnostics are accessible, affordable, and impactful for all.

Innovative Technologies

Harnessing innovative technologies such as point-of-care testing, portable diagnostic devices, and mobile diagnostics has the potential to revolutionise healthcare by bringing critical diagnostic services directly to underserved communities. These advancements enable rapid and accurate results, facilitating immediate diagnosis and treatment where it is needed most. Notable examples include point-of-care HIV tests, COVID-19 rapid antigen kits, Essential Diagnostics Lists (EDLs) and a range of other diagnostics for both infectious and non-infectious diseases. By delivering accessible, timely, and effective diagnostic solutions, these technologies are breaking down barriers to care and improving health outcomes in even the most remote areas.

Policy and Financing

Governments and development partners must prioritise diagnostics as a core component of national health strategies. By increasing funding and implementing cost-reduction measures such as subsidies and bulk purchasing, diagnostic tools can become more affordable and widely accessible. Collaboration with regulatory bodies, industry leaders, and international organisations is also essential to establish standardised guidelines and streamline processes.

Strengthening Networks

Beyond funding and regulatory improvements, strengthening interconnected diagnostic networks is crucial for maximising resources and ensuring rapid disease response. The COVID-19 pandemic demonstrated the value of regional collaboration in disease surveillance, as countries referred samples to sequencing laboratories in Senegal, Nigeria, and South Africa. At the national level, the Nigeria Centre for Disease Control and Prevention (NCDC) has successfully coordinated a network of seven Lassa fever testing laboratories across the country, ensuring a decentralised but unified approach to diagnostics. This presents a model for integrating robust national laboratory networks into a broader regional diagnostic ecosystem to optimise resources and enhance cross-border collaboration.

Additionally, building interconnected diagnostic networks can foster cross-border collaboration, facilitate shared learning, and optimize resources. These efforts will ensure that Africa's unique healthcare contexts are fully integrated into global health initiatives, strengthening the continent's capacity to contribute meaningfully to international health efforts and advancing equity in diagnostics worldwide.

Capacity Building

Capacity building of healthcare workers, laboratory staff, and other professionals is also essential to unlocking the full potential of technological innovations in diagnostics. Advanced tools alone are insufficient without adequately trained personnel to operate and manage them effectively. Comprehensive training programmes are critical to ensure these innovations are utilised to their fullest potential. Additionally, establishing robust data collection systems and integrating laboratories into healthcare frameworks form the backbone of effective diagnostic capabilities.

Public-Private Partnerships

Collaborative action among key stakeholders across the public, private, and development sectors is essential to driving innovation and expanding access to diagnostics. By aligning efforts, leveraging successful practices, and focusing on shared priorities, countries and partners can not only strengthen laboratory systems but also amplify their impact on healthcare outcomes. Unified partnerships foster the exchange of knowledge, optimise resources, and create scalable solutions that address the diverse challenges in diagnostic access, ultimately contributing to stronger and more equitable health systems.

Diagnostics for All

Expanding access to diagnostics is not just a choice—it is a moral imperative and a critical step toward building equitable and resilient healthcare systems. The time for decisive action is now. Governments, the private sector, international organisations, and civil society must come together to develop diagnostic systems that are accessible, affordable, and transformative.

By prioritising collaboration, innovation, and investment, Africa can accelerate progress toward achieving UHC while safeguarding the fundamental right to health for all. A healthier and more equitable future is not a distant goal—it is within Africa’s grasp, however, realising it demands bold, unified action from all of us, starting today.

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