Rising to healthcare action
Africa's public health systems will be improved by recognising the clinical laboratory as the heart through which disease detection and management can be strengthened.
This was the crux of a ministerial call-to-action document that was signed at the first international conference of the African Society for Laboratory Medicine (ASLM) in Cape Town early this month.
The call-to-action committed the ministers of health of South Africa, Mozambique, Tanzania, Nigeria, Kenya and Cameroon to improving Africa's healthcare systems through strengthening and upgrading the quality of laboratory services, resources and systems.
Greater emphasis on laboratory training and development, accrediting systems to ensure quality patient care and developing and implementing policy across the region were identified as the main drivers for a dramatic improvement in the continent's disease detection capabilities.
The four-day conference, themed "Accurate Laboratory Diagnostics — a Pillar of Quality Healthcare", was attended by hundreds of laboratory professionals, clinicians, specialists, researchers, students, members of government and policy makers from around the world. They discussed initiatives to strengthen national laboratory health systems and networks, diagnostics and their impact on healthcare delivery and disease surveillance throughout Africa.
Established in 2011 and headquartered in Addis Ababa, Ethiopia, ASLM is a pan-African member organisation for laboratory professionals. Its aim is simple: to improve healthcare in Africa by strengthening laboratory services. These services are pivotal to disease diagnosis, epidemiological surveillance, outbreak investigations, effective treatment and monitoring, and research and development. These lead to disease prevention and a better life for all.
Poor laboratory systems have a direct impact on the health of nations across Africa. Slow or incorrect diagnoses, inadequate resources and poorly trained staff are commonplace, leading to severe disease and health system challenges.
ASLM's chief executive Dr Tsehaynesh Messele, said medical laboratories across the continent are underdeveloped and cannot meet the testing demands of rapidly growing healthcare delivery services. The region also lacks strong national and regional regulatory systems to prevent the introduction of poor quality diagnostic products.
Figures from the World Health Organisation's (WHO's) regional office show Africa has less than one laboratory professional for every 10 000 people.
Fewer than 400 laboratories in Africa are accredited by international standards, and 90% of those are found in South Africa.
Determined to be about action rather than talk, ASLM is partnering with governments, international, regional and national organisations, private companies and other agencies to achieve what it calls its strategic "2020 vision" for the upgrading of healthcare in Africa over the next eight years. The vision has four major goals:
• to train and certify 30 000 laboratory professionals and clinicians;
• to enrol 2 500 laboratories in the WHO's quality improvement programme called Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) and to enable 250 laboratories to achieve accreditation by international standards;
• to develop strong, harmonised regulatory standards for diagnostic products that ensure patient safety in at least 25 countries (50% of Africa) throughout the five economic regions of the continent; and
• to develop national public health reference laboratories to support training, evaluation of diagnostic technologies, disease detection, and evidence-based policy development across the region.
The accreditation of laboratories would mean sustained adherence to internationally acceptable quality standards, maintenance of robust systems and processes and would ensure cost-effective, affordable and clinically relevant services across Africa.
"ASLM's 2020 goals aim to strengthen diagnostics both in laboratories and at the point of care, to ensure that there are good diagnostics on the front line, better patient-clinician interaction, and that patients have confidence in the medical care being provided," said Messele.
Government support and buy-in are crucial for the achievement of these goals.
Chairman of the ASLM board and scientific director for laboratory services in the Clinton Health Initiative Dr Trevor Peter said tackling the huge healthcare challenges facing the African continent will take a multi-pronged approach.
"It's one thing looking at the technical side of healthcare — the science and its implementation — but all efforts come to nothing without an enabling environment: the right policies in place, appropriate political positions, resources appropriately allocated, and emphasis placed behind initiatives and programmes that enable technical people to do their work."
"We can do all the planning and approval of curricula for the implementation of large initiatives to train people in service, but unless governments and their ministries of health are politically behind the drive, it can all be for nothing. The signing of the call-to-action is a significant step in the right direction, because it places diagnostics on top of the pile of health issues on which Africa's governments need to focus," said Peter.
In his opening address to the conference, South African Minister of Health Dr Aaron Motsoaledi said building laboratory capacity to provide rapid, accurate, affordable and reliable diagnostic tests will enable healthcare workers across Africa to deliver more effective, life-saving treatment.
"This will have a direct on reducing mortality, optimising the expenditure of healthcare resources, and improving the quality of healthcare for this dramatically under-served population." "We know that every lab test and every lab result is not just an inanimate sterile test: it represents a person, a South African or a person living in our country and dependent on our public health system," said Motsoaledi.
He highlighted the need for funding to be better balanced in its allocation of resources, with greater emphasis on laboratory diagnostics and supportive infrastructure. For this to be achieved a paradigm shift was necessary, acknowledging the critical importance of basic laboratory testing to provide accurate diagnoses and result in the prompt treatment of disease.
Motsoaledi also emphasised the importance of unifying donor and public efforts to address specific needs within the regions, with the intention of long term sustainability.
He cited South Africa's HIV epidemic as one of the largest in the world, with more than 5.6-million infected people. "The accurate diagnosis and subsequent monitoring of HIV-positive individuals was critical. Every lab test represented a person: a South African. Inaccurate results, whether falsely positive or falsely negative, have profound effects on human lives, as well as wasting valuable resources." "Policy makers and healthcare providers must understand that accurate diagnosis is essential for the prevention and treatment of disease in sub-Saharan Africa," said Motsoaledi.
Department of health director general Precious Matsoso said that harmonisation and collaboration are critical for Africa's healthcare.
"A critical mass of highly functional laboratory services needs to be strategically placed to allow for immediate mobilisation when there is disease outbreak. Harmonisation will see different economic blocks working together and sharing facilities, resources and expertise."
"Laboratories play a strategic role in the diagnosis and management of communicable diseases, such as HIV and TB, and non-communicable diseases that require routine testing, like diabetes.
"A third category requiring laboratory analysis is accidents and sexual violence. All of these rely on accurate test results from highly functional, competent laboratories, and speed and reliability are essential. Raising the level of competency and performance in labs across Africa will benefit the entire continent," said Matsoso.