Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action.

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.

The value of European immigration for high-level UK research and clinical care: cross-sectional study.

OBJECTIVE: The UK's impending departure ('Brexit') from the European Union may lead to restrictions on the immigration of scientists and medical personnel to the UK. We examined how many senior scientists and clinicians were from other countries, particularly from Europe, in two time periods. DESIGN: Cross-sectional study. SETTING: United Kingdom. PARTICIPANTS: Individuals who had been elected as Fellows of the Royal Society or of the Academy of Medical Sciences, and UK medical doctors currently practising and listed in the Medical Register for 2015. MAIN OUTCOME MEASURES: Percentages of Fellows of the Royal Society, Fellows of the Academy of Medical Sciences and UK medical doctors by nationality (UK and Irish: UKI, European: EUR and rest of world: RoW) over time. Fellows of the Royal Society and the Academy of Medical Sciences proportions were assessed for two time periods, and doctors over decades of qualification (<1960s to 2010s). RESULTS: Percentages of European Fellows of the Royal Society increased from 0.8% (1952-1992) (the year the UK signed the Maastricht treaty) to 4.3% (1993-2015). For Fellows of the Academy of Medical Sciences, percentages increased from 2.6% (pre-1992) to 8.9% (post-1992) (for both, p < 0.001). In the 1970s, only 6% of doctors were trained in the EU; the proportion increased to 11% in the last two decades (also p < 0.001). Europeans replaced South Asians as the main immigrant group. Among these, doctors from the Czech Republic, Greece, Poland and Romania made the largest contribution. CONCLUSIONS: Any post-Brexit restriction on the ability of the UK to attract European researchers and medical doctors may have serious implications for the UK's science leadership globally and healthcare provision locally.