MEDICAL LABORATORY SYSTEMS IN SUB SAHARAN AFRICA; THE CASE OF GHANA AFTER THE 2008 MAPUTO DECLARATION

 

On the 22nd-24th January, 2008, representatives of governments in Sub-Saharan Africa together with developing partners, professional associations and academic institutions met in Maputo, Mozambique in a consensus meeting on Clinical Laboratory Testing, Harmonization and Standardization. The meeting that was meant to change the story of medical laboratory practice in Sub-Saharan Africa among many others recognized the need to expand and further develop quality-assured laboratory services as part of a greater framework of health system strengthening within resource-limited settings.

There was also a recognition that in resource-limited settings, several challenges have resulted in inadequate laboratory systems to support the scale-up of programs. These include a lack of leadership and advocacy, human resources, career path and retention of staff, national laboratory policy, strategic planning (budgetary concerns), insufficient physical infrastructure, supply chain management, and quality management systems (quality assurance).

After several deliberations, there has a call on governments to support laboratory systems as a priority by developing a national laboratory policy within the national health development plan that will guide the implementation of a national strategic laboratory plan. Governments were and are also encouraged to establish a department of laboratory systems within the Ministry of Health.

Again, the meeting called on national governments with support of their donors and partners in resource-limited settings to develop national strategic laboratory plans that integrate laboratory support for the major diseases of public health importance including HIV, tuberculosis and malaria. There was also a call on donors and implementing partners to make sure that in supporting laboratory strengthening, there is proper consideration given to fostering national ownership. Also, worthy of mentioning was the call on academic institutions and research funders to accelerate efforts to develop new diagnostic tools applicable to resourced-limited settings.

Some years after this declaration, donor partners supported Ghana with close to One Million Dollars in order to put together a National Health Laboratory Policy through a formal consultative process. The process led to the development of a final document signed by the then Minister of Health in 2013. The anticipation was that the final launch and implementation of the documents would have confirmed Ghana’s commitment to the Maputo Declaration. Unfortunately, the opposite is the case. The document was abandoned by the Government of Ghana. Till today, the document remains on the shelves of the Ministry of Health of Ghana gathering dust.

In 2014, the World Bank group recognizing the importance of medical laboratories as a backbone of diagnosis in the world over inclulding Africa, reviewed the medical laboratory system in the entire African continent and concluded the following; “since the 2008 Maputo Declaration of Medical Laboratory Strengthening, there has not been much more importance placed on laboratory services and the role of qualified medical laboratory professionals in the provision of quality, timely and reproducible results for patients’ care.” The question one may ask is whether or not if the conclusion is fully reflective of the situation in Ghana. This conclusion is not very different from our situation in Ghana owing to the challenges facing the profession in the country.

Ghana’s respond to the Maputo Declaration has yielded some results for the sector. Before 2013, medical laboratory professionals were unregulated by a law of parliament. The commitment of government led to the passage of Act 857:2013 establishing the Allied Health Professions Council; even though professionals still keep complaining about the many numbers of professional groupings regulated by the council making the council less effective. This has brought some level of sanity in the sector regarding the training and eventual qualification of professionals to practice. It is important noting that beyond the law, parliament is yet to pass a legislative instrument to fully operationalize the Act 857 especially the part one that established the AHPC. Also, the passage of the Health Institutions and facilities Act in 2011 has brought some sanity in the establishment of medical laboratory facilities in Ghana.

With all these support from Government of Ghana, medical laboratorians continue to complain about the continuous neglect of medical laboratory services. In 2018, medical laboratory professionals in Ghana laid down their tools in industrial action on issues of implantation of National Health Laboratory Policies, conditions of service of medical laboratory professionals and representation of medical laboratory professionals in healthcare governance. The reason for this industrial action is not far from the calls for change proclaimed in Maputo in 2008.

Till today, the Ghana Association of Medical Laboratory Scientists continue to advocate for the implementation of the National Health Laboratory Policies that will help in the proper coordination and control of medical laboratory sector. With the support of donors like DANIDA, USAID, The European Union through the BUSAC Fund, the advocacy continues till today. The question one may ask is whether or not the duty bearers are seeing the importance of the advocacy work and the need to bring the medical laboratory professionals to the discussion table to resolve all issues for the implementation of these important documents.

The global pandemic of COVID-19 further exposes the weak structures of medical laboratories in Ghana. At the initial stages of the pandemic in Ghana, only two research facilities belonging to the University of Ghana and the Kwame Nkrumah University of Science and Technology were testing for the virus which resulted in high turnaround time for results. The overall effect was that, at some points, the surveillance capacity of the health service was affected. Currently, testing has been extended to some few laboratories in the country. The lead role played by the Noguchi Memorial Institute for Medical Research (NMIMR) and the Kumasi Center for Collaborative Research (KCCR) underscore the fact that governance structure is very paramount in ensuring effective coordination of medical laboratory sector of Ghana.

Thankful to COVID-19, the President of the Republic of Ghana in one of his addresses to the nation on Strategies for Combating the Effects of COVID-19, recognized that Ghana has a weak medical laboratory system and promised improvements in the laboratory systems. This was refreshing to hear. It is said that a problem identified is a problem half solved. But with commitment, the problem will continue to be half solved. Beyond the recognition, laboratorians are expecting commitment from duty bearers in improving the medical laboratory sector holistically. It is worth noting that medical laboratories, both in the public and private sector, will thrive if the enabling environment is created by government for the sector.

Medical laboratory practice in Ghana definitely has improved over the years. Today, Ghana can be proud of the Doctor of Medical Laboratory Science degree mounted at the University of Development Studies; a degree to replace the four years Bachelor of Science in Medical Laboratory Science. It is refreshing to note that Ghana is the first country in the West African region to mount this programme. Ghana can also boast of a youthful profession with a lot of postgraduate qualification. It also worth noting that the medical laboratory profession in Ghana contributed to the establishment of the West African Postgraduate College of Medical Laboratory Science (WAPCMLS). Ghana hosted the first regional meeting to set the ball rolling for the final investiture of the college with its headquarters located in Nigeria. Ghana can also be proud of at least one public sector laboratory accredited to the ISO 15189:2012 with others making efforts towards achieving accreditation status.

These achievements and efforts made by scientists in Ghana give hope to the future of the profession in the country. With all these, we can but say that the profession has a bright future. What is now left is for the Government of Ghana to revisit the Maputo Declaration and review the calls made on governments to help improve the sector. This will not be in the interest of the professionals but also the population served by these professionals. There is also the need for government to see the professional body (Ghana Association of Medical Laboratory Scientists) as partners in the development of the medical laboratory practice in the country. It is time for government and corporate organization to lend some support to the health professional bodies including the Ghana Association of Medical Laboratory Scientists so that the body continue to remain relevant.

In conclusion, medical laboratory practice has improved over the years in Ghana even though governmental support can be better than it is now. The professionals continuously are putting in effort to improve the training and practice of the science. We can only continue to move forward and grow together as we call on the Ministry of Health to renew efforts to keep the practice relevant as an important profession in the diagnosis and public health. Government will improve the practice by the implementation of the National Health Laboratory policy and other related documents.

Solomon Dzidzornu Yao Kwashie
Medical Laboratory Scientist
([email protected])

 

 

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