Medical Diagnostic Services
Medical Diagnostic Services
Business Model Description
Put up medical diagnostic facilities and specialized equipment that includes incubators, microscopes and spectrometers, to provide private and public sector molecular diagnostic and pathology services to individual and institutional patients.
Expected Impact
Provide basis for detection, prevention and treatment of diseases for better health outcomes, sustainable human development, and productive workforce and economic growth.
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Lesotho: Maseru District
- Lesotho: Quthing District
- Lesotho: Mafeteng Dstrict
- Lesotho: Mohale's Hoek District
Sector Classification
Health Care
Development need
Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is also extremely low, but has been so particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021 (3).
Policy priority
The National Health Strategic Plan 2017 – 2022 prioritizes efficient delivery of health services through strengthening of supervision and quality assurance, as well as the health outreach services for an inclusive national health care and partnering with the private sector (2).
Gender inequalities and marginalization issues
As a result of their culturally constructed lower status in the society and their special role in reproductive health, pregnancy and childbirth, women are mostly affected by lack of access and poor services in the health sector, and particularly because of shortages of essential infrastructure in the rural areas ( 2).
Investment opportunities introduction
Ministry of Health has a long-standing Public-Private Partnership (PPP) arrangement that covers service delivery, supply chain and hospitality services, but the coverage is still limited and provides an opportunity for expanding PPPs, including direct private investment in the health sector (2).
Key bottlenecks introduction
Low numbers of nurses and doctors per capita, the third-highest HIV/AIDS rates worldwide, a short life expectancy and lack of facilities for all needed treatments in Lesotho undermine the efforts to improve and strengthen the health sector (10).
Medical Technology
Development need
Lesotho's main barriers to tuberculosis diagnosis, testing and treatment completion are at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement in search of jobs (3, 5).
Policy priority
Lesotho National Health Policy 2011 notes that the most urgent services are the clinical, diagnostic and nursing services in the health sector, and plans to provide quality, effective and efficient clinical, diagnostic and nursing services for prevention, and treatment of diseases, with involvement of the private sector (4).
Gender inequalities and marginalization issues
Lack of decentralized diagnostic services exclude many local communities, especially the poor households and rural population, particularly women who may actually need the services more than men (5).
Investment opportunities introduction
Lesotho National Health Strategy recognises the value of investment in health and the linkage to overall economic development, with NSDP II identifying investment opportunities in the sector (2).
Key bottlenecks introduction
In view of the growing cancer burden, there are inadequate facilities and specialists to respond to the actual demand for cancer diagnosis and treatment in Lesotho (2).
Medical Equipment and Supplies
Pipeline Opportunity
Medical Diagnostic Services
Put up medical diagnostic facilities and specialized equipment that includes incubators, microscopes and spectrometers, to provide private and public sector molecular diagnostic and pathology services to individual and institutional patients.
Business Case
Market Size and Environment
< USD 50 million
75% of all premature Non-Communicable Disease deaths occur in low- and middle-income countries (31). Main causes are Cancer, Cardio-Vascular Diseases, Chronic Respiratory Diseases and diabetes (23). In Lesotho, gaps exist in linking people with positive tuberculosis symptom screens to testing and closing this gap would require extra 11,000 tests per year (32).
Market survey of molecular and pathology laboratory indicates 1,000-2,000 tests per month (2000*12*M 500 = M 12 million) (USD 666,666), with referrals from private doctors (70%) being a key pillar of demand (17).Other tests are full blood count, urea, electrolytes, creatinine and liver count (12).
Market survey of molecular and pathology laboratory of 24,000 / year tests plus the tuberculosis gap of 11,000 / year provides a minimum market of 35,000 * M 500 = M 17.5 million (USD 972,222) (12, 32).
Indicative Return
> 25%
Chronic illnesses need for regular medical examinations, and COVID-19 pandemic have contributed to Liselo Labs (an African research and development company dealing in disease, pest, and environmental management) record of ROI of >25% during its 3 years of operation (17).
Investment Timeframe
Short Term (0–5 years)
Increasing prevalence of chronic diseases and heightened health awareness is surging demand for the services, and COVID-19 contribute to Liselo Labs achieving returns with 3 years of operation (17).
Ticket Size
USD 500,000 - USD 1 million
Market Risks & Scale Obstacles
Market - Highly Regulated
Capital - CapEx Intensive
Market - High Level of Competition
Impact Case
Sustainable Development Need
In Lesotho, data quality and completeness, under-reporting of diseases, is a challenge amid poor health outcomes: one-third of children under 5 are stunted; 52% of 15-year-olds survive to age 60; HIV/AIDS prevalence (25.6%), tuberculosis incidences (611 / 100,000) are among the highest globally (2, 5, 23).
Lesotho's Research and Development (R&D) expenditure as a share of GDP is only 0.1% compared to the regional average of 0.5%, which deprives it of real time information on health matters and the ability to effectively manage diseases (1).
Gender & Marginalisation
Women and children, particularly in the rural areas, are negatively impacted by lack of health services, including diagnostic services to support women with their role in reproductive health, pregnancy and childbirth (1, 5).
Expected Development Outcome
Medical diagnostic services have the potential to widen health services and improve access to health services for early detection, prevention and treatment of diseases, including improving data quality, under-reporting of diseases and reported national health outcomes (18).
Medical diagnostic services have the potential to influence and support R&D and inform policy and innovation, and help the country to better manage its health sector, resulting in improvements of the outcomes.
Gender & Marginalisation
Diagnostic health services can help develop appropriate technologies, like point of care (POC) diagnostic tools in the rural areas to address Lesotho's specific topography and help improve access in the remote rural areas. (6).
Primary SDGs addressed
3.3.2 Tuberculosis incidence per 100,000 population
3.1.1 Maternal mortality ratio
TB incidence (611/100,000) as at 2021 (5).
Maternal mortality rate (per 100,000 live births) 566.2 as at 2020 (27).
Reduce by 25% to (460/100,00) in 2024 (7).
Government plans to reduce maternal mortality to 300 / 100,000 in the medium term (2).
9.5.1 Research and development expenditure as a proportion of GDP
0.1% of GDP (1).
According to the Rapid Private Sector Assessment Report (2022) recommendation, the expenditure should reach the regional average of 0.3% of research and development expenditure as a proportion of GDP, in the medium-term, if Lesotho is to address its health care challenges and be competitive (26).
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Planet
Corporates
Public sector
Indirectly impacted stakeholders
People
Gender inequality and/or marginalization
Planet
Corporates
Outcome Risks
Once embedded in the national health care system, the diagnostic services may need subsidy like the rest of the other public health services (2), and funding may not be available and sustainable.
Lack of decentralized diagnostic services, food insecurity and high patient movement in search of jobs, including ineffective data management systems may undermine the outcome of the services (3).
Impact Risks
Households with low or no incomes could still not afford the cost of the diagnostic services, resulting in sustained inequalities and untreated diseases.
If technologies to develop the point of care (POC) diagnostic tools are not well designed, the services may fail to garner the confidence and support of the rural market.
Impact Classification
What
Diagnostic services contribute to better health management and improves access to health care services, including optimization of early disease detection, prevention and treatment.
Who
Patients, nurses and doctors are empowered to better manage diseases, including prevention and treatment.
Risk
Households with low or no incomes, and inappropriate design of point of care (POC) diagnostic tools, may make the investment unaffordable and fail to garner support, respectfully.
Contribution
Diagnostic services contribute to access to health care and better health outcomes, which in turn contribute to a healthy and productive workforce.
How Much
Given that health affects everyone, the impact of diagnosis services cuts across the entire population.
Impact Thesis
Provide basis for detection, prevention and treatment of diseases for better health outcomes, sustainable human development, and productive workforce and economic growth.
Enabling Environment
Policy Environment
National Health Strategic Plan 2017 – 2022 prioritizes efficient delivery of health services through strengthening of supervision and quality assurance, as well as the outreach services, which provides an enabling environment for investment in the sector (2).
National Health Policy notes prioritizes clinical, diagnostic and nursing services in the sector, and plans to provide quality, effective and efficient clinical, diagnostic and nursing services for prevention, and treatment of diseases, to improve health outcomes (4).
National Strategic Development Plan II (2019/19 - 2022/23) commits to improving health sectoral coordination, monitoring and evaluation and systems strengthening, and build human resource capabilities to create a supportive cross-sectoral environment (11).
Budget Speech 2023/24 proposes a forward looking and dynamic and futuristic development of industries that are driven by innovation and technology development, such as, health care predictive analytics, digital education, fintech, nanotechnology and others (13).
Financial Environment
Financial incentives: World Bank's incentives for health staff to expand health services and improve their quality by linking facility payments to service delivery and indicators, enhance efficiency and delivery, and by extension participation and collaboration of the private sector (12, 22).
Fiscal incentives: Government adopted free user fee policy for primary health and subsided secondary and tertiary for access to services, and encourage participation of the private sector. Per capita health spending is USD 7 and registration is USD 1 to 2.5, making a subsidy of 64% (14, 24, 25).
Other incentives: Although Lesotho is yet to develop policy and strategy guiding the PPPs in the health system, there is a PPP Unit in the Ministry of Health, coordinating PPP activities, including an arrangement of case-by-case negotiations resulting in an MOU, where there is agreement on specific incentives (2, 23, 29).
Other incentives: Liselo uses partnerships and collaboration as part of its operational/financing model, and with universities and other research institutions around the world, it has been able to develop a test kit platform, resulting in the ongoing development of a number of rapid point-of-care diagnostics. The work of Liselo Labs in Lesotho is also partially funded by South African Grant from the Department of Trade and Industry (30).
Regulatory Environment
Under the Medical, Dental and Pharmacy Order No. 13 of 1970, Lesotho Medical, Dental and Pharmacy Council (LMDPC) promotes the health of the population, determines standards of professional education and training, and sets and maintains fair standards of professional practice (15).
Medicines and Medical Devices Control Authority Act 2023 helps provide guidance and standards of the health services and supplies (20).
Marketplace Participants
Private Sector
Christian Health Association of Lesotho, Path Care, Elite Labs, Husteds Pharmacy, Metropolitan Lesotho, Scott Hospital, Seboche Hospital, Willis Hospital, St Joseph Hospital, Maluti Hospital.
Government
Ministry of Health, Ministry of Finance and Development Planning, National Health Training Center, Queen ’Mamohato Memorial Hospital, Food and Nutrition Coordination Office, National University of Lesotho.
Multilaterals
World Health Organization, United Nations Development Programme, United Nations Childrens Development Fund, African Development Bank, World Bank, The President's Emergency Plan For AIDS Relief (PEPFAR).
Non-Profit
Village Health Workers, Care Lesotho, World Vision, Lesotho Council of No-Governmental Organization, Catholic Relief Services, Partners in Health.
Public-Private Partnership
The Ministry of Health has a Public-Private Partnership (PPP) arrangement with Christian Health Association of Lesotho (CHAL) that covers service delivery, supply chain and hospitality services (2).
Target Locations
Lesotho: Maseru District
Lesotho: Quthing District
Lesotho: Mafeteng Dstrict
Lesotho: Mohale's Hoek District
References
- (1) World Bank, Sustainable Development Report 2022
- (2) Government of Lesotho, National Health Strategic Plan 2017 – 2022
- (3) Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho, 2023 - PLOS Digital Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174523/
- (4) Government of Lesotho, Lesotho National Health Policy, 2011
- (5) World Bank, Systematic Country Diagnostic Update: Bridging Implementation Gaps to Accelerated Development, 2021
- (6) Diagnostics barriers and innovations in rural areas: insights from junior medical doctors on the frontlines of rural care in Peru. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1114-7
- (7) Center for Diseas Control and Prevention, Lesotho Country Profile, 2021. https://www.cdc.gov/globalhivtb/where-we-work/lesotho/lesotho.html
- (8) Damon Francis, et al, ,How healthcare can help heal communities and the planet, 2019. https://www.bmj.com/content/365/bmj.l2398
- (9) Soumya Swaminathan, et al, Bridging the gender gap around diagnostic testing to embrace health equity. https://www.finddx.org/publications-and-statements/opinion-piece/bridging-the-gender-gap-around-diagnostic-testing-to-embrace-health-equity/
- (10) Wold Bank, Lesotho - Health sector reform program phase (English). https://documents.worldbank.org/en/publication/documents-reports/documentdetail/987171467991050641/lesotho-health-sector-reform-program-phase#:~:text=Lesotho%27s%20challenges%20in%20the%20healthcare,provide%20vital%20health%20care%20services.
- (11) Government of Lesotho, National Strategic Development Plan II, 2018/19 - 2022/23
- (12) World Bank, Lesotho Public Health Sector Expenditure Review 2019
- (13) Government of Lesotho, Budget Speech, 2023/24
- (14) Public Expenditure Tracking Survey and Service Delivery in the Health Sector, 2017
- (15) Lesotho Medical, Dental and Pharmacy Council. http://www.lmc.org.ls/About.aspx
- (16) Investing in Health for Africa 2011 - Harmonzing for Africa
- (17) SDG Investor Map Liselo Labs Stakeholder Consultations, June 2023
- (18) Zara Ziad, Data quality in healthcare – Benefits, challenges, and steps for improvement, 2022. https://dataladder.com/data-quality-in-healthcare-data-systems/
- (19) SDG Investor Map Investment Opportunity Areas Shortlist Report 2023
- (20) Government of Lesotho,Medicines and Medical Devices Control Authority Act 2023
- (21) ElitePath Laboratory. https://www.elitepath.co.ls/about
- (22) World Bank Group, Improving Effective Coverage in Health, 2022
- (23) Governmet of Lesotho, National Multi-Sectoral Integrated Strategic Plan for the Prevention and Control of Non-Communicable Diseases, 2014-2020
- (24) Statista, Health Financing - Lesotho, 2023. https://fr.statista.com/outlook/co/health-indicators/health-financing/lesotho#:~:text=In%202023%2C%20the%20estimated%20spending,be%20%E2%82%AC5.85%20by%202023.
- (25) Mesfin G. Zbelo, et al, Assessing Lesotho's Financial Burden of Household Payments and Access to Healthcare, 2022. https://assets.researchsquare.com/files/rs-2043986/v1/ded957c2-cc76-49a5-a85d-148d87797001.pdf?c=1665400474
- (26) Government of Lesotho, Rapid Private Sector Assessment Report, 2022
- (27) United Nations, Sustainable Development Report 2023 - Lesotho Score Card
- (28) Government of Lesotho, The Lesotho Population-Based HIV Impact Assessment, December, 2018. https://phia.icap.columbia.edu/wp-content/uploads/2019/03/3407%E2%80%A2Lesotho-SS_NEW_v29.pdf
- (29) SDG Investor Map Ministry of Health Stakeholder Consultations, July and November, 2023
- (30) Liselo Labs, Antibody-based diagnostics and therapeutics, 2023. https://liselo.com/research-projects/
- (31) SolidarMed, 2020. https://www.solidarmed.ch/en/news/non-communicable-diseases-lesotho-combacal
- (32) Heidi Albert, et al., Designing an optimized diagnostic network to improve access to TB diagnosis and treatment in Lesotho, 2020. https://journals.plos.org/plosone/article/file?type=printable&id=10.1371/journal.pone.0233620