New diagnostics for multi-drug resistant tuberculosis in India: Innovating control and controlling innovation

Abstract

Among the challenges for tuberculosis control is the emergence of multi-drug resistance, which has led to the search for new diagnostic solutions worldwide. The focus of this article is the interplay between innovation of diagnostics for multi-drug resistant tuberculosis in India and control through standardization of operational and technical processes. Innovation in diagnostics is closely related to processes of standardization. As a form of social ordering, standardization not only controls patients, bacteria, artefacts, health-care staff and medical providers, but also the diagnostic process as such. On the basis of qualitative fieldwork, I analyse the innovative efforts of a demonstration project for a new test by an international NGO and the development of tests by smaller players. The main argument is that a balance is needed between the extremes of controlling the diagnostic process through standardization in such a way that it becomes exclusive for particular local settings or expertise, and innovating a diagnostic test without standardizing operational processes, which is not programmatically feasible. These negotiations between innovation and control can be found in situated assessments, yet require flexibility in standardization.