It is also known that many of these laboratoriesmay not even meet normal and expected Quality standards and many may not even have qualified lab technicians. “If the labs need due recognition then they must register with the Quality Council of India and develop minimum or essential standards. As on date, all over the country, most of the labs do not have a official recognition,” opines Dr Venkatesh Thuppil, of National Referral Centre for Lead Poisoning in India, at St John Hospital, Bengaluru.

Popularly known as “Lead Man” for his pioneering work in detecting lead poisoning, Dr Thuppil is critical of the fact that the country lacks a sufficient number of super-speciality laboratories. The medical profession has progressed enormousl while the progress on the laboratory front has remained nearstatic. Dr Thuppil is of the view that “at this juncture we need more super speciality laboratory facilities in the government sector in the diagnosis and prognosis of complicated diseases”.

Diagnostic and prognostic pathology investigationsare mostly conducted in good private hospitals, which at any time, are beyond the reach of ordinary citizens who are dependent on government hospitals. But it is unfortunate that even large government hospitals lack skilled technicians to carry out many of the diagnostic and prognostic tests. “I do not share this view. In my hospital I have an elaborate laboratory managed by competent and dedicated doctors and technicians who have acquitted themselves well. There are doctors conducting research here,” points out Dr K K Kalra, Medical Superintendent, Chacha Nehru Bal Chikitsalaya (CNBC), the country’s foremost paediatric hospital.

CNBC is an exception as Dr A K Agarwal, Dean of Mualana Azad Medical College, points out. “We cannot hide from the fact that, in general, we lack good and Quality pathology laboratories in the country,” he says and adds, “it is an important aspect of the medical profession and yet very few opt for laboratory work.” Dr Thuppil oncurs and emphasises that “there are not enough competent professionals and technicians to run a laboratory”.

Blood Bank accreditation programme Quality assurance in Blood Bank/Blood Centre and Transfusion Services cannot be ignored as it affects the safety of patients. Concerns were often raised on theQuality of blood and blood components. It was a long felt need to have an accreditation programme in this area due to a number of constraints:  Accessibility and affordability of safeblood  Highly fragmented Blood Transfusion Service  Absence of a nation-wide network of bloodbanks.  Different levels of Quality standards.  Absence of a system for the continuousmonitoring and evaluation of the service The National Accreditation Board for Hospitals and Healthcare Providers (NABH), constituent board of Quality Council of India took up the challenge and in October 2006 the board approved the new programme and the Technical Committee to prepare the accreditation standard. The Technical Committee (comprising Dr Nabajyoti Choudhury, Prathama Blood Centre, Ahmebabad; Prof K Selvarajan, Govt General Hospital, Chennai; Dr Md Saukat, NACO, New Delhi; Dr Prashant Agarwal, SGPGI, Lucknow;

There are a few renowned laboratories across the country - though they are few and far between. One such laboratory of repute is the 60-year-old Dr Lal PathLabs in Delhi. “Medicine is a faith and trust business and it has taken us 60 years to achieve this  faith and trust and deliver services to patients who are highly dependent on good pathology reports. As you know 70 per cent of medical decisions are based on pathology tests,” affirms Dr Arvind Lal, Chairman and Managing Director of Dr LalPathLabs.

There are not many Dr LalPathLabs kind of laboratories in the country. “Over the years we have developed a maximum number of tests, test technologies, instrumentation and even non-medical instrumentation with latest IT systems. We have introduced customised software which till now no laboratories in the country have it,” mentions Dr Lal. He had to order a special server system, from Sun Microsystems, to run that software. “We have had that kind of
innovative legacy, pioneering spirit if you call it that way, to be able to serve people better,” admits Dr Lal.

This, perhaps, is the reason why Dr Lal PathLabs has the largest test menu, 1650 kinds of tests to be precise and similar facilities areavailable in all their 30 laboratories spread across the country. They collect samples from 600 collection centres and over 1,500 pickup points. “Apollo Hospital or Escorts Heart Institute is our pickup points since we do not run their pathology services. Every day there is a sample to be tested by us since it cannot be conducted there of which some of the high-ended tests are what we call esoteric tests,” avers Dr Lal.

Such laboratories are islands of excellence and there is a need for many more such islands. When questioned whether it is the cost factor that inhibits us from having Quality laboratories, Dr Thuppil says, “That is not true. Unfortunately, there is lack of good Quality lab governance. Quality costs but lack of Quality cost even more. If the Quality is not improved, it will not be long before MNCs enter the Indian health sector.”

Dr Lal, however, has a contradictory view. “Though we are doing pioneering service, I needed affirmation from a third party to assess our capability. We invited National Accreditation Board for testing and calibration of Laboratories (NABL) to assess our capability as well as the College of American Pathologists. Now we get samples from the US for testing. It is not that easy for an MNC to walk in andset-up a laboratory. It has taken us 60 years to build confidence and trust among people,” mentions Dr Lal.

We are in the era of a public-private partnership (PPP) and this model is picking up but the pace is slow. The crunch here is the lack of qualified personnel; in fact, there is an acute shortage of skilled people to work in the laboratories, laments Dr Thuppil. Irrespective of whether it is private, public or PPP model, the problem at the end remains the same: skilled manpower — or rather the lack of it. Aware of the situation, Dr Lal is planning to set-up a college for laboratory technicians. “We are planning to start our own college and I have already contacted the Quality Council of India for the module. In conjunction with that I am planning a laboratory, which could be described as Asia’s largest, in WestDelhi. It will be on similar lines of a medical college attached to a hospital,” mentions Dr Lal.

Another trend that is emerging is thesetting up of laboratories as a business venture but the doctors Quality India meet termed it as bad ethics. “If we cannot provide Quality service it is morally, medically and ethically wrong. We have to uphold people’s trust and confidence,” says Dr Lal.

So, what option do we have? One is short term and the second, long term. In the short term, Dr Thuppil believes that the existing laboratories should upgrade the facilities by registering with The Quality Council of India and assessment through the National Accreditation Board for testing and calibration of Laboratories (NABL). The problem is registration and accreditation is voluntary and not mandatory. “Laboratories can demonstrate their Quality and competence as per the requirement ofI SO 15189-2007 whereas NABL accreditation has global acceptance. It is the stamp of Quality,” saysDr Thuppil.

Today, we look for Quality healthcare. Why not insist on Quality pathology tests, too? “It is up to the people to demand, like they do healthcare, for pathology tests as well. It is the people who would force laboratories to acquire the stamp of Quality and this would force many to change their ways. In the end it would benefit the health industry,” avers Dr Lal.

Even government hospitals known for its lackadaisical laboratory management are opting for NABL accreditation. States like Gujarat and Tamil Nadu are in the forefront to acquire accreditation, or in short, the, stamp of Quality. Six government medical college hospitals are getting ready for National Accreditation Board for Hospitals & Healthcare Providers (NABH) accreditation with the help and guidance from the Quality Council of India. “It is for the first time in the country that the government medical college laboratories going in for NABL accreditation and again first time in the country that the government medical college hospitals getting ready for NABH accreditation,” points out Dr Thuppil. Likewise, Tamil Nadu is preparing 12 hospitals for NABH accreditation while in the next phase it is going to be laboratories.