India’s diagnostic gap leaves many tropical diseases undetected

India carries a large share of the world’s neglected tropical disease (NTD) burden, but until now it has been unclear whether basic tests are available where they are most needed. To answer that question, a team led by Zeeshan Mustafa carried out a cross-sectional survey of 332 public health facilities across seven states and one union territory. The facilities included sub-centers, primary health centers, community health centers, and district hospitals—the different tiers of India’s public system where people typically first seek care. The researchers used the ICMR National Essential Diagnostics List (2019) as a benchmark and created a Diagnostic Readiness Index (DRI) to measure how prepared facilities, districts, and states are to diagnose major NTDs. The study also notes that diseases often discussed as the “big three” — tuberculosis, malaria, and HIV — now receive more attention and funding, but their overlap with classic NTDs creates a dual burden for vulnerable communities. By comparing diagnostic readiness with reported disease burden, the team aimed to show whether testing resources match local needs.

The study evaluated diagnostic availability for malaria, dengue, Japanese encephalitis, chikungunya, lymphatic Filariasis, Leishmaniasis, helminthic infections, and HIV across the sampled facilities. Using the ICMR National Essential Diagnostics List (2019) as a standard, the authors calculated a Diagnostic Readiness Index (DRI) at facility, district, and state levels to quantify how well places were equipped to test for these conditions. Readiness generally rose at higher levels of care: district hospitals were better prepared than sub-centers and primary health centers. However, availability did not consistently match where disease was reported. Malaria diagnostics were widely available (mean district DRI: 84.34%), reflecting sustained programmatic prioritization. By contrast, diagnostics were much less available for dengue (40.36%), lymphatic Filariasis (29.22%), helminthic infections (25.30%), Japanese encephalitis (8.13%), and Leishmaniasis (5.72%). The largest mismatches between burden and diagnostic availability were at peripheral sites—sub-centers and primary health centers—while district hospitals showed a more favorable alignment.

These results indicate that essential diagnostic deployment for NTDs in India is uneven and often not responsive to where disease is concentrated. That gap matters because sub-centers and primary health centers are frequently the first point of contact for underserved populations; if these sites lack simple tests, cases may be missed, treatment delayed, and surveillance data rendered less accurate. The study emphasizes the need for burden-informed, decentralized access to point-of-care diagnostics so that testing capacity follows epidemiological need rather than only existing program priorities. Strengthening diagnostics at peripheral and primary care levels could improve early case detection, give public health authorities clearer surveillance signals, and accelerate progress toward national NTD control and elimination targets. The findings provide policy-relevant evidence to guide health system strengthening and more equitable diagnostic access in NTD-endemic regions.