Assessing Essential Diagnostic Availability for Neglected Tropical Diseases in India: A Burden-Informed Analysis

India bears a substantial burden of neglected tropical diseases (NTDs), yet the availability of essential diagnostic services across public health facilities may not adequately reflect local epidemiological needs. This study aimed to assess the availability of diagnostics for major NTDs and examine their alignment with disease burden across different levels of the public health system.

A cross-sectional assessment was conducted in 332 public health facilities across seven states and one union territory in India, including sub-centres, primary health centres, community health centres, and district hospitals. Diagnostic availability for malaria, dengue, Japanese encephalitis, chikungunya, lymphatic filariasis, leishmaniasis, helminthic infections, and HIV was evaluated based on the Indian Council of Medical Research National Essential Diagnostics List (2019). A Diagnostic Readiness Index (DRI) was calculated at facility, district, and state levels to measure diagnostic capacity.

Diagnostic readiness increased with higher levels of healthcare facilities but showed limited concordance with reported disease burden. Malaria diagnostics demonstrated the highest availability across all tiers of care (mean district DRI: 84.34%), reflecting sustained national programmatic prioritization. In contrast, diagnostic availability for dengue (40.36%), lymphatic filariasis (29.22%), helminthic infections (25.30%), Japanese encephalitis (8.13%), and leishmaniasis (5.72%) remained limited, even in districts reporting considerable disease burden. The most pronounced gaps between disease burden and diagnostic availability were observed at sub-centres and primary health centres, while district hospitals showed relatively better alignment.

These findings highlight a persistent mismatch between NTD burden and diagnostic readiness within India’s public health system. Strengthening decentralized, burden-informed deployment of point-of-care diagnostics—particularly at peripheral and primary care levels—will be critical to improve early case detection, enhance surveillance accuracy, and accelerate progress toward national NTD control and elimination goals.