7 Barriers to Point of Care Testing in India and South Africa
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diagnosis, and visions of an ideal test. The focus group discussions focused exclusively on challenges experienced when diagnosing. Interview and focus group discussion guides were piloted and revised during the fieldwork to improve the clarity
of questions. All interviews and discussions were held in English (except some of
them in Kannada in India) and digitally recorded, and the notetaker wrote down
main points raised, nonverbal communication, and setting characteristics. Data analysis was done thematically (Eisenhardt and Graebner 2007), using Nvivo 9 (QSR
International).
7.1.2 Ethics Approval
The ethics review board of the University of Cape Town, South Africa and McGill
University Health Centre (MUHC), Montreal, Canada approved this study. Approvals
for interviews and discussions conducted at public primary healthcare facilities were
sought from the Provincial Department of Health authorities as necessary. All participants were provided with information sheets explaining the objectives of the study
and all signed informed consent forms prior to participation.
7.2 Results
In the following, we review selected results per country. This highlights the very
different diagnostic eco-systems (see Figs. 7.1 and 7.2) and the distinct set of challenges to diagnosing at POC, as well as the strategies actors employ to overcome
these.
7.2.1 India
India has a highly fragmented and largely unregulated diagnostic landscape.
Laboratory-based testing takes place across a multitude of providers ranging from
small, ill-equipped one-room laboratories in public clinics to large hospital laboratories, from small private neighborhood laboratories with limited testing equipment
to medium-sized facilities and state-of-the-art laboratory chains. Patients carry the
main responsibility for ensuring a POC continuum. Patients in India are the carriers
of samples, reports, and communication between the providers. If they are asked
to obtain a diagnostic test in any of the settings, they need to go to the laboratory
themselves, provide a sample there, pick up results once available, and return them
to the doctor. The system thus relies heavily on patients’ initiative to ensure successful POC testing. Oftentimes, these journeys start in the private sector (for rich and
poor patients alike) and if patients are not diagnosed and treated successfully, these
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diagnosis, and visions of an ideal test. The focus group discussions focused exclusively on challenges experienced when diagnosing. Interview and focus group discussion guides were piloted and revised during the fieldwork to improve the clarity
of questions. All interviews and discussions were held in English (except some of
them in Kannada in India) and digitally recorded, and the notetaker wrote down
main points raised, nonverbal communication, and setting characteristics. Data analysis was done thematically (Eisenhardt and Graebner 2007), using Nvivo 9 (QSR
International).
7.1.2 Ethics Approval
The ethics review board of the University of Cape Town, South Africa and McGill
University Health Centre (MUHC), Montreal, Canada approved this study. Approvals
for interviews and discussions conducted at public primary healthcare facilities were
sought from the Provincial Department of Health authorities as necessary. All participants were provided with information sheets explaining the objectives of the study
and all signed informed consent forms prior to participation.
7.2 Results
In the following, we review selected results per country. This highlights the very
different diagnostic eco-systems (see Figs. 7.1 and 7.2) and the distinct set of challenges to diagnosing at POC, as well as the strategies actors employ to overcome
these.
7.2.1 India
India has a highly fragmented and largely unregulated diagnostic landscape.
Laboratory-based testing takes place across a multitude of providers ranging from
small, ill-equipped one-room laboratories in public clinics to large hospital laboratories, from small private neighborhood laboratories with limited testing equipment
to medium-sized facilities and state-of-the-art laboratory chains. Patients carry the
main responsibility for ensuring a POC continuum. Patients in India are the carriers
of samples, reports, and communication between the providers. If they are asked
to obtain a diagnostic test in any of the settings, they need to go to the laboratory
themselves, provide a sample there, pick up results once available, and return them
to the doctor. The system thus relies heavily on patients’ initiative to ensure successful POC testing. Oftentimes, these journeys start in the private sector (for rich and
poor patients alike) and if patients are not diagnosed and treated successfully, these