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



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.



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.



Pathology is an essential component of good universal health care.
From the Centre for Global Health, National Cancer Institute, Washington, DC.|Green Templeton College.
Kenneth A
KA
Fleming
From the Centre for Global Health, National Cancer Institute, Washington, DC.
Mahendra
M
Naidoo
Department of Pathology, University of Colorado School of Medicine.|Department of Pathology & Laboratory Services, Denver Health, Denver, CO.
Michael
M
Wilson
From the Centre for Global Health, National Cancer Institute, Washington, DC.
John
J
Flanigan
Global Health Economics, University of Waterloo, Waterloo, Canada.
Susan
S
Horton
Department of Chemical Pathology, College of Medicine, University of Ibadan & University College Hospital, Ibadan, Nigeria.
Modupe
M
Kuti
Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Lai Meng
LM
Looi
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Chris
C
Price
Department of Pathology and Lab Medicine.
Kun
K
Ru
Apollo Hospital, Chennai, India.
Abdul
A
Ghafur
Institute of Hematology, Chinese Academy of Medical Sciences, Beijing, China.
Jianxiang
J
Wang
Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina.
Nestor
N
Lago
D003906:Developing Countries; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics*; D010336:Pathology / Q000191:economics* / Q000193:education