Strategic partnerships to increase access to quality diagnostics towards the achievement of universal health coverage in Africa.
The need
Universal Health Coverage is a priority for African countries to attain inclusive and sustainable growth. However, many diseases remain undiagnosed due to poor diagnostic capacity in most African countries. The limited access to essential tests and slow introduction of innovative technologies result in insufficient disease case finding and hampers access to and monitoring of treatment. Barriers to diagnostics prevent the African continent from becoming free of epidemic-prone diseases and compromise the achievement of the health agenda of the African Union .

Over the last 10-15 years, significant investments have been made by national governments, NGOs, partners, and donors to address the technical, health system and financial roots of diagnostics gaps in Africa. These efforts have however been fragmented, uncoordinated and lack the synergy to generate impactful reductions of mortality and effective prevention and control of epidemic outbreaks. Other challenges include:

• Slow uptake of useful technology innovations
• Inadequate acquisition and utilization of diagnostic data for patient and program benefit
• Inefficient development of laboratory networks, resulting in sub-optimal coverage, testing capacity and quality of service delivery
• High cost and inefficiency of diagnostic testing, and inadequate leverage to negotiate better pricing and terms
• Lost opportunities to leverage investments in HIV, TB and malaria diagnostics to enable better access to diagnosis of other priority diseases in the African region.

The Initiative
Recognizing the urgent need to address existing barriers towards advancing the diagnostic agenda in Africa, the Africa Centres for Disease Control and Prevention (Africa CDC), in partnership with the African Society for Laboratory Medicine, Institut de Recherche, de Surveillance Epidémiologique et de Formation, WHO-AFRO, Clinton Health Access Initiative, African Field Epidemiology Network, UNITAID, and other partners have launched the Africa Collaborative Initiative to Advance Diagnostics (AFCAD), to promote the diagnostic agenda in the African region through better coordinated and synergized efforts that align with the priorities of Ministries of Health.
The role of AFCAD
The role of AFCAD is to support efforts that will enable all Member States to achieve equitable access of up to 80 percent coverage to the essential package of health including essential diagnostics as defined by WHO , taking advantage of technological innovations delivered through optimized integrated laboratory networks. This is expected to support achievement of the Sustainable Development Goals as well as improved adherence to International Health Regulations (2015).

More specifically, AFCAD will support activities towards achieving the following goals:

• Eliminating or eradicating diseases prioritized by global health normative agencies such as ending HIV epidemics including elimination of mother-child transmission (eMTCT), multi-resistant tuberculosis, malaria, viral hepatitis, cervical cancer and other STIs (Syphilis, Gonorrhea, Chlamydia) and neglected tropical diseases.
• Early detection and prevention of antimicrobial resistance, to protect the effectiveness of antimicrobials for human and animal health and support the overall global development.
• Reducing the barriers to early detection, prevention and management of non-communicable diseases such as cardiovascular diseases, diabetes and cancers.
• Preventing disease outbreaks and reducing their human, economic and social cost by instituting early warning systems and ensuring timely detection and diagnosis of epidemic-prone diseases.

The approach
AFCAD will prioritize approaches that address critical gaps and unmet needs of laboratory diagnostics such as:

• Accelerating regulation to facilitate timely and wide access to essential diagnostics
• Market interventions towards increased affordability of diagnostic testing and reduction of user-fees
• Communication and dissemination of data supporting evidence-based improvement of diagnostic services and the smart investment of resources
• Advocacy for appropriate investment in diagnostics.

AFCAD aims to address diagnostic gaps holistically. The initiative will share information and compare various investments made across the disease areas. The identification of complementarities, overlaps and gaps will provide clarity about whether end-to-end solutions exist and are being implemented.