ICMR recommends tests for TB, hepatitis at PHCs: How will this improve public health?

Indian Express

2 days ago

From rapid diagnostic tests for Hepatitis B, point-of-care tests for thalassaemia and sickle cell disease, to sample collection for molecular testing for tuberculosis (TB) at the sub-centre level — the Indian Council of Medical Research (ICMR), has updated its National List of Essential Diagnostics with the aim of bringing clinical testing closer to people.
The National List of Essential Diagnostics — first released in 2019 — is a list of all the tests that must be available at different levels of health facilities, such as sub-centres, primary health centres or district hospitals. One of the key changes in the second iteration of the list is the inclusion of several rapid diagnostic and biochemical tests at lower levels of health centres, keeping in mind the expanding infrastructure over the years.
The government's healthcare delivery mechanism provides primary care through sub-centres, primary healthcare centres (PHCs) and community healthcare centres (CHCs), secondary care through sub-district hospitals, tertiary care through district hospitals and super-speciality care through medical colleges.
Why was the list revised?
'In the six years since the first list was released, there have been significant changes. Take, for example, the government investing in semi-auto analyzers at the PHC level. This means the tests can be performed at the PHC itself, instead of the samples being sent to a higher centre for analysis in a hub-and-spoke model,' said Dr Kamini Walia, senior scientist at ICMR, who was behind the compilation of the list. 'There have also been changes to the Indian Public Health Standards and the Integrated Public Health Laboratory Standards, so it was a good idea to revisit the list,' she added
What are the new tests in the 2025 list compared to the one released six years ago?
Several rapid diagnostic tests that have been added include those for sickle cell anaemia, thalassaemia, Hepatitis B and syphilis at the sub-centre level. Many of these are priority diseases for the government.
The new list also recommends collecting samples for dengue testing at the sub-centre level. Over the years, the spread of the mosquito-borne disease has expanded to all states of the country, making it a bigger public health challenge.
Many of the blood tests — such as those to check for blood glucose levels, liver enzymes, and cholesterol — which could not be performed at the primary health centre level earlier, are now recommended at that level, with semi-auto analyzers (machines for conducting chemical and biological analysis of samples with minimal human intervention) becoming available.
What do the new tests mean for public health?
The updated list, once implemented, will have significant public health implications. Experts point out that the list has been updated keeping in view the ambitious targets set for specific diseases. For instance, the government runs a national mission aimed at eliminating sickle cell anaemia by 2047 by screening people and making them aware of whether they are carriers of the faulty gene. The mission also focusses on quick and accurate diagnosis of the disease and providing quality care to patients. The government runs the National Viral Hepatitis Control Programme, which focusses on reducing cases and deaths due to the various hepatitis infections.
How this is likely to enhance sample collection for critical diseases at the sub-centre level
The 2025 list recommends collecting samples for molecular TB testing right from the sub-centre level. For sub-centres and primary health centres, it recommends collecting sputum samples and sending them to a higher centre. From the community health centre level onwards, it recommends performing these tests in-house.
This has been made possible due to the penetration of cost-effective molecular testing machines even in smaller centres during the pandemic. The country's National TB Elimination Programme recommends that molecular diagnosis become the first line of testing, instead of the less sensitive microscopy. The burden of the pathogen has to be much higher for it to test positive using microscopy, meaning the use of molecular tests can detect many more cases, including asymptomatic ones. It can also determine if a person is resistant to commonly used medicines.
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The list calls for samples for sophisticated tests — such as HbA1c, which shows average blood glucose levels over a period of three months — to be collected at the PHC level and sent to a higher centre. The government has been focusing on controlling and caring for people with lifestyle diseases such as diabetes, hypertension and cancer.
At the CHC level, the new list has also added tests such as the TB skin test, which can detect the presence of the pathogen even in people who do not have an active infection. Dental X-rays have now been added at the CHC level. This is important, considering the government's goal of ensuring these tests are available at its centres.
'This list is important because it is implemented in the health centres under the Free Diagnostics Service Initiative, which ensures that these tests are available at all health centres and, in turn, reduces people's out-of-pocket expenditure on healthcare,' said Dr Walia.
In addition, the 2025 list has also merged the diagnostic lists for sub-district hospitals and district hospitals. This is because sub-district hospitals are being upgraded to district hospitals, while district hospitals are being upgraded to the level of medical colleges across the country, Dr Walia explained.