Patient Pathways and Diagnostic Value in Sierra Leone

What is the value of a diagnostic test? Most obviously for primary healthcare settings, laboratory tests can inform clinical decision making about treatment and patient management. Their predominant in this context therefore medical. But what when that setting chronically under-resourced, workers (including workers) are underpaid, government supply chains fail to deliver basic supplies? In contribution Field Notes section, we describe Community Health Centre (CHC) Sierra Leone where such conditions have given rise quasi-private service within public health facility. Through detailed ethnographic description patients’ pathways through facility, examine assess impact on care medical economic diverge.