Ghana must enhance medical laboratory systems through policy framework

Obviously, China recorded cases of the novel Coronavirus (COVID-19) late December 2019 in one of their industrial Province, Wuhan.

The Systemic Acute Respiratory Syndrome (SARS COV-2) outbreak was by 30th January, 2020 declared a Public Health Emergency of International Concern (PHEIC) and finally as a pandemic on 11th March same year by the World Health Organisation (WHO).

Ghana recorded its first (index) cases of the virus from two persons who have returned from foreign countries - a sad report received on March 12. Thereafter, a local transmission was reported in Tema in the Greater Accra region.

The advent of local community cases of COVID-19 led to Ghana's aggressive response to the global threat. Among implemented strategies was conducting enhanced contact tracing of persons infected with the virus, and ensuring that these contacts are tested and isolated from the community - a strategy that led to the formation of teams that went to suspected epicenters to collect data on contacts and also take sputum samples for Laboratory analysis.

The success of the contact tracing was that a lot of specimens were collected for testing. However, the intervention was faced with a challenge of testing: the only confirmatory evidence of a carrier of the virus.
However, prior to the eventual declaration of the outbreak as a pandemic and thereafter, the WHO encouraged countries to "test, test and test".

The only way nations can adhere to advice of the WHO was to depend on Medical Laboratory systems already available in their respective countries.

Unfortunately for Ghana, our laboratories were not ready (as in healthcare infrastructure-wise) due to the neglect of the the sector by the authorities over the years. The medical laboratory sub-sector of health is noted to be one of the most neglected departments of health in Ghana and most developing countries.

Today, there is no gainsaying to the fact that medical laboratories are the least to be considered in the design of a health care facility. Healthcare authorities hardly see any importance in the involvement of the practitioners of medical laboratory science in topical issues regarding the sub-sector. There has not been any deliberate attempt to equip medical laboratories in Ghana by the these authorities.

Meanwhile, in an attempt to support medical laboratories to produce accurate, reliable and timely results in the management of patients, the Center for Disease Control (CDC) of the good people of the United States of America and its partner organisations not in the wishy-washy conducted a baseline assessment of medical laboratories in some selected African countries including Ghana.

The assessment led to the roll-out of a program and policy document to Strengthen Medicaledical Laboratories Towards Accreditation (SMLTA) - aimed at building Quality Management Systems (QMS) for the selected laboratories. At the end of the SMLTA program, only four laboratories in Ghana had four (4/5) stars rating - standards that have further significantly reduced in our laboratories in barely a decade. The question is: can these laboratories boast of the same star rating today?

The CDC again looked at the national health laboratory framework in terms of organisation and coordination. This assessment pointed out that medical laboratories are neglected and uncoordinated; leading to the formation of a technical committee with sponsorship from the CDC to draw a policy framework for healthcare laboratories in Ghana. The exuberant of the committee led to the development of the National Health Laboratory Policy (NHLP) and two other policies including a strategic policy for laboratory accreditation process in Ghana.

These policies never saw the light of implementation after its official enforcement by the then Minister of Health, Hon. Shirley Aryeetey. The NHLP, over the years, has been gathering dust in some office of the Ministry of Health as the neglect of the medical laboratory continues. If the NHLP framework had been implemented to strengthen our medical laboratories, issues regarding COVID-19 testing would have significantly been minimized though without neglecting the fact that even the laboratories of many developed countries are facing challenges with testing.

It is noteworthy that the benefit of the enhanced contact tracing in Ghana was lost due to testing capacity deficits. It averagely takes two weeks for traced samples to be tested and related contacts to be informed of their positive - status COVID-19 results. Within the weeks of testing delay, the positives cases may have interacted with others and possibly transmitted the infection if they had it. Though it may be true that Ghana has tested for COVID-19 more than many other countries, what is the essence of laboratory results after the many weeks of delay in achieving the aim of the enhanced contact tracing?

To share in the usefulness of enhanced contact tracing, timely medical laboratory test result is paramount - demanding that managers of the health system begin to look at the medical laboratory science and its meritorious professionals holistically. In this era of evidence-based medical and public health decisions making, it is suicidal to continue to neglect medical laboratories and significant other diagnostic professions.

Additionally, beyond contact tracing and required basic systems, there is the need to reconsider the training and motivation of medical laboratory scientists. Current trends in training of medical laboratory professionals try to focus on advancing molecular diagnostic tools that has proven its worth with time. Some of the emerging and re-emerging infectious diseases of today require modern technology-based tools and continuous training and sub-specialization of professionals.

It is time for governments in the West African Region including Ghana to recognize the newly established West African Postgraduate College of Medical Laboratory Science in building the needed workforce for the future - as recognised in the NHLP. It is also important to harmonize curricular of medical laboratory training institutions and ensure strict enforcement of regulations of practitioners.

The neglect of medical laboratorians is also evidenced by the lack of urgency to the resolution of issues regarding their remuneration since 2012 - another area to channel some resources. Apart from logistic challenges, the professionals are less motivated.

There is an urgent need to implement the National Health Laboratory Policy. COVID-19 pandemic may not be the last of pandemics to hit the world. Further neglect of medical laboratories will only mean that we (the future orchestrators) have refused to learn from the events of today to build a good future for ourselves. In my perspective, the future is here with us today; how we make utilize this opportunity of a lifetime can make a tremendous difference. God bless our homeland Ghana and the government to implement the NHLP and take the bold step to improve our health system significantly.

Author: Solomon Kwashie

Medical Laboratory Scientist

Vice-Chairman, Ghana Association of Medical Laboratory Scientists, Greater Accra Branch.