An open letter to the presidential advisor on health

The President of the Republic of Ghana, His Excellency Nana Addo Dankwah Akufo Addo during his swearing-in ceremony on 7th January 2017 called on all Ghanaians to be citizens and not spectators. In line with this call, I have decided to speak up about some events I have observed in the diagnostic sector of our health care system specifically the medical laboratory sector.

There have been calls by scores of Ghanaians on the government to clean up the medical laboratory sector of quacks as the Bank of Ghana (BoG) did in the "banking sector clean up". Being in the medical laboratory sector myself, I have noticed additional problems such as:

1. Difficulty in accessing funds to buy new analytical devices (machines), laboratory consumables, and logistics necessary to ensure laboratory operations go uninterrupted.

The medical laboratory departments in most health facilities represent the sectors that generate the highest income from services offered in the health sector.

One will not be wrong to say that the unit is the milking cow in the health sector. In spite of huge sums of money generated from medical laboratory services, funds are not available in numerous instances to buy laboratory reagents and other consumables, leaving staff with no choice but to refer patients to seek help outside the hospital to have these investigations carried out at higher costs.

2. Inadequate medical laboratory infrastructure

Constructing medical laboratories in some health facilities have been an afterthought. Medical Laboratories are set up after the project completion but never at the initial stages in most cases.

The president during his 8th national address to give updates on COVID-19 said: "the virus has exposed the deficiencies of our healthcare system, because of years of underinvestment and neglect."

After 63 years of independence, do we have a single Biosafety Level (BSL) 4 laboratory in Ghana? Biosafety laboratories range from levels 1 to 4, and refer to facilities and structures put in place to protect laboratory personnel and their environments from various infectious agents depending on the level of risk these infectious agents pose to laboratory personnel and their environments.

Food spoilage Staphylococcus aureus can be handled in a BSL 1 laboratory. Disease-causing (pathogenic) strains of Staphylococcus aureus, Escherichia coli, etc are handled in BSL 2 laboratories.

Growing the organism capable of causing tuberculosis (Mycobacterium tuberculosis) requires a BSL 3 laboratory. Handling highly infectious organisms such as the Lassa virus, Ebola virus, SARS virus, etc requires a biosafety level 4 laboratory. BSL 4 laboratories do not employ the services of orderlies (cleaners). Decontamination of the working area is always carried out by the scientists who work in the BSL 4 laboratories.

I know of four BSL 3 laboratories in Ghana which were either entirely established or upgraded by foreign donors.

a. The Noguchi Memorial Institute for Medical Research (NMIMR) was largely established by Japan with collaborative support from Ghana government.

b. The Kumasi Centre for Collaborative Research into Tropical Medicine (KCCR) was largely built by Germany with support from the government of Ghana.

c. The upgrade of the Veterinary Services Department (VSD) laboratory in Pong-Tamale upgraded to the standard of a BSL 3 laboratory by Canada. The same is said of the Western Veterinary Laboratory in Takoradi, Western Region.

Why do we have to wait for foreigners to set up BSL 3 laboratories as a country? Thankfully, NMIMR and KCCR have come to our rescue with the advent of the outbreak of Influenza (KUMACA H1N1) and currently, SARS COV-2 (COVID-19).

Is the government not capable of establishing many BSL 3 laboratories and at least one BSL 4 laboratory in the country or it lacks the financial prowess to do so?

3. Quality of laboratory services

Different people in the service chain have different understandings and definitions when it comes to the quality of laboratory services. The patients' definition of quality laboratory services could be based on whether:

a. He had a warm reception on his visit to the laboratory.

b. A very comfortable patient waiting area was available whilst waiting for laboratory results.

c. A short turn-around time (time taken from the moment sample was taken to when the client receives laboratory report), without recourse necessarily to the details contained in the laboratory report.

The Physicians' definition may comprise the swift processing of reliable and accurate laboratory reports with comments making the laboratory report easy to understand and interpret.

To the medical laboratory professional, he looks at the definition of quality in the following aspects:

a. Having a conducive, safe environment and one fit for the purpose of undertaking medical laboratory investigations.

b. The smooth running of all the laboratory operations ranging from pre-analytical, analytical, and post-analytical stages of medical laboratory investigations.

c. The ability to undertake both Internal Quality Controls (IQC) and External Quality Assurance (EQA).

Running IQC ensures that the analytical devices or machines are properly working guaranteeing the accuracy and reliability of dispatched results, etc.

Medical laboratories do roll onto Inter Laboratory Comparisons and EQA programs which allow the quality of the results they churn out to receive scrutiny and certification by some internationally accredited institutions.

High ratings of enrolled medical laboratories by these internationally accredited institutions give the general public confidence about the quality of laboratory results churned out by these laboratories.

There are times some laboratories either lack quality control reagents to do the IQC or adequate funds to enroll in these EQA programmes.

A situation like this is certainly a very big blow to quality laboratory services delivery. The quality of medical laboratory services in this situation cannot be guaranteed, at all levels (the primary, secondary, tertiary levels) of the health care system.

4. Lack of representation of Medical Laboratory Professionals at all levels of the health care system unlike there are directorates for: medical, pharmacy, nursing, administration and finance.

It is anticipated that a policy will put in place a framework for the structured development and professional growth of the laboratory system in Ghana in the areas of Laboratory testing; Equipment, Reagents and consumables; Infrastructure; Quality Management System; Financing Laboratory Services, etc.

The presidential advisor on health, Dr. Anthony Nsiah-Asare said during the ministerial press briefing of 5th May 2020 that "when I sleep I pray for those at the labs. We should encourage them, in fact, we should do what other countries do so that at every 4 o'clock we will all come out and for about 5 minutes we will all clap for them.

This is what people are breaking their backs, 24 hours a day. They are all working 24 hours a day and this is the good thing they are doing for mother Ghana".

I wish to add my voice in commending all professionals involved in COVID 19 testing in all the laboratories across the lengths and breadths of Ghana.

I commend especially Medical Laboratory Scientists (specialist Virologists) of the KCCR in the persons of Drs. Augustina Angelina Sylverken and Michael Owusu for their regular education via media engagements.

I believe that conversations surrounding the NHLP are no news to Dr. Nsiah-Asare as some very important events in the "life" of this policy includes:

a. Development of the policy document between 2010 and 2013 by collaboration between the Centre for Disease Control and Prevention (CDC), Atlanta - USA and Ghanaian collaborators from the Ministry of Health (MoH).

b. Hon. Shirley Aryittey, minister of health and the Director-General of Ghana Health Service (GHS) at the time appended their signatures to the final document in 2013, awaiting implementation till date.

c. Declaration of strike action by the Ghana Association of Medical Laboratory Scientists (GAMLS) asking the government to come out with a road map indicating implementation of the NHLP in August 2016 and July 2018.

Every now and then, the Ghana Association of Medical Laboratory Scientists (GAMLS) has not kept mute over the implementation of this policy.

I believe Dr Nsiah-Asare may be very busy, but I doubt the events surrounding the NHLP are neither events he did not notice nor have no knowledge about.

Medical laboratory professionals will be very much proud of Dr. Nsiah-Asare if he uses his high office of influence to facilitate the implementation of the NHLP that seeks to improve laboratory services in Ghana.

There have been RUMORS that some cadre of health professionals are fighting the implementation of the NHLP behind the scenes?

I call on Dr. Anthony Nsiah-Asare to fast track the implementation of the NHLP using his high office as prove of his love and prayers for medical laboratory scientists.

Dr Anthony Nsiah-Asare, I KNOW THAT YOU CAN PERFORM AS PRESIDENTIAL ADVISOR ON HEALTH, be a hero, do something that will cause your name to be indelibly printed in the hearts of medical laboratory professional and Ghanaians as a whole.

Medical laboratory professionals want the implementation of the NHLP NOW!!!
Written by:

Pascal Sedor

Medical Laboratory Professional