When a physician prescribes treatment, almost every clinical decision depends on one fundamental assumption—that the laboratory report is accurate. An incorrect laboratory result can lead to misdiagnosis, inappropriate treatment, delayed intervention, unnecessary healthcare costs, and even preventable deaths. Modern healthcare, therefore, relies on laboratory medicine not merely as a support service but as the foundation of safe and effective clinical decision-making.
In Bangladesh, the institution entrusted with the responsibility of ensuring the accuracy, reliability and consistency of laboratory results is the National Institute of Laboratory Medicine and Referral Centre (NILMRC). It is the country’s apex reference laboratory under the Ministry of Health and Family Welfare. Comprising specialised departments including haematology, pathology, biochemistry, microbiology, virology, molecular biology, and radiology, NILMRC was established not simply to provide diagnostic services but to become Bangladesh’s national authority for laboratory quality assurance, research, training, and accreditation. Yet despite impressive achievements, it has not been empowered to fulfil this broader mandate.
Approved by ECNEC in 2010 and becoming operational in 2020, NILMRC was envisioned around four strategic pillars: advanced diagnostics, postgraduate training, biomedical research, and laboratory accreditation. Its mandate extended beyond patient testing to developing a national laboratory network, establishing Bangladesh-specific laboratory reference values, introducing internationally recognised quality assurance systems, conducting advanced biomedical research, and serving as the national reference laboratory for both public and private sectors. Few health institutions in Bangladesh have been assigned such a comprehensive responsibility.
Despite severe institutional constraints, NILMRC has demonstrated remarkable technical capability. It now provides sophisticated diagnostic services using modern automated technologies across multiple laboratory disciplines. During the pandemic, it performed more than 15 lakh RT-PCR tests. It has also emerged as one of the country’s major dope-testing centres, conducting over 178,000 tests for government recruitment and transport authorities. More than 500 patients, including people from distant districts, seek services at the institute every day because of its reputation for reliable and affordable diagnostics.
Beyond clinical diagnostics, NILMRC has contributed to antimicrobial resistance surveillance, genome sequencing of multidrug-resistant organisms, thalassaemia research, newborn screening, and collaborative international research. These accomplishments demonstrate that the institute possesses the scientific expertise and technical capacity to lead Bangladesh’s laboratory system.
However, diagnostics alone were never intended to define NILMRC’s role. Its founding vision was to become the country’s national laboratory reference and accreditation centre—a function that remains one of Bangladesh’s most important yet underdeveloped health system priorities.
Across the world, accredited laboratories operate under rigorous internal quality control, participate in external quality assessment programmes, and undergo regular accreditation based on international standards such as ISO 15189. These mechanisms ensure that laboratory results are accurate, reproducible, and comparable across institutions. Bangladesh still lacks such a comprehensive national quality assurance system. Although many diagnostic laboratories maintain commendable professional standards, there is no nationwide mechanism that routinely verifies the quality and consistency of laboratory testing. Consequently, the same test performed in different laboratories may not always produce equally reliable results.
NILMRC was established precisely to address this gap. Unfortunately, its organisational capacity remains far below what was originally planned. The initial proposal envisaged 735 positions to support nationwide laboratory networking, quality assurance, research, training, accreditation, and advanced diagnostics. However, only 260 positions were approved, while the Ministry of Finance authorised just 118. Of these, only about 52 permanent staff currently serve the institute, with many essential functions conducted by outsourced personnel. Such staffing is clearly inadequate for an institution expected to provide national leadership.
Besides, NILMRC lacks biomedical engineers to maintain sophisticated laboratory equipment, as well as specialists in information technology, health informatics, molecular biology, biostatistics, laboratory quality management, and data science. Physicians are often required to manage procurement, administration, and technical operations alongside their clinical responsibilities. These limitations inevitably constrain the institute’s ability to perform its national functions.
Encouragingly, NILMRC has initiated the process of obtaining ISO 15189:2022 accreditation for 22 diagnostic services through the Bangladesh Accreditation Board. Laboratory physicians and technologists are also receiving specialised quality assurance training with support from the Mérieux Foundation. These initiatives represent important progress towards international standards.
However, much of this nationally significant quality assurance programme currently depends on donor funding that will eventually end. No dedicated government financing has yet been allocated to sustain these activities. It must be noted here that quality assurance is a permanent national responsibility that requires predictable public investment.
The other challenge is that the institute’s time and resources are increasingly devoted to day-to-day diagnostic tasks because of its reliability. This diverts attention from the institute’s broader national responsibilities—developing laboratory standards, coordinating quality assurance programmes, strengthening laboratory networks, conducting advanced research, and supporting accreditation. Around the world, successful national reference laboratories focus primarily on technical leadership while routine diagnostics are increasingly decentralised. Bangladesh should pursue a similar strategic direction.
The country has already invested substantially in NILMRC’s infrastructure and advanced equipment. The next step should be institutional reform by granting NILMRC greater functional autonomy, similar to national laboratory institutions in Australia, Singapore, and South Africa, and enabling faster recruitment of specialised professionals, more efficient procurement, stronger research collaboration, and greater financial flexibility.
The institute should also establish a dedicated national quality assurance and accreditation wing to coordinate external quality assessment programmes, develop national laboratory standards, support accreditation, and promote continuous professional development for laboratory professionals nationwide.
Operational reforms are equally important. Advanced diagnostic and research institutions cannot function optimally within traditional government office structures. A five-day professional workweek combined with rotational staffing for extended laboratory operations would better align NILMRC with international best practices while ensuring uninterrupted patient services.
Bangladesh should also establish a national laboratory research and innovation fund to support genomic medicine, molecular diagnostics, precision medicine, antimicrobial resistance surveillance, and translational biomedical research. Public universities, research institutes, and international partners should become active collaborators in this national effort.
Healthcare depends on trust. Patients trust physicians. Physicians trust laboratory reports. Governments trust surveillance data. Researchers trust scientific evidence. Without reliable laboratory systems, these foundations become fragile. The pandemic clearly demonstrated that strong laboratory systems are indispensable not only for patient care but also for disease surveillance, outbreak preparedness, antimicrobial resistance monitoring, and national health security.
Empowering NILMRC through greater autonomy, adequate staffing, sustainable financing, and a comprehensive national laboratory quality assurance system would strengthen not only one institution but every hospital, every diagnostic laboratory, every physician, and ultimately every patient in Bangladesh. Reliable laboratory results save lives. Building a trusted national laboratory system is therefore not simply a technical reform; it is a strategic investment in the quality, credibility, and resilience of Bangladesh’s healthcare system.
(The article is based on primary data collected by the author himself.)
Dr Syed Abdul Hamid is professor in the Institute of Health Economics at the University of Dhaka.
Views expressed in this article are the author's own.
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