Laboratory Services: The Backbone of a Health System

Published on 28th May 2019

In a globalised era where pathogens regularly cross international borders and when controlling the spread of communicable diseases is a priority, laboratory services are increasingly being recognised as the pillar of national and global disease surveillance programmes.   

To better monitor and control global public health threats the World Health Organisation (WHO) introduced International Health Regulations (IHR 2005) which require countries to report certain disease outbreaks and public health events. This necessitates that every country has a well-functioning and accessible laboratory service capable of producing accurate results in a timely manner.  

In South Africa, the medium-term expenditure estimate for 2018/19-2021 for the National Health Laboratory Services (NHLS) has risen to R27.1billioni from expenditure of R23.7 billion in the previous three years.   This service caters for 80% of the population through 268 laboratories across the country. The National Institute for Communicable Diseases, a division of the NHLS, works in line with international health regulations to improve surveillance for detection of diseases and to strengthen the response capacity for public health emergencies. 

Professor Rajiv Erasmus, President of the South African Association for Clinical Biochemistry, and Vice President of the College of East, Central and Southern Africa (COPECSA), says that the laboratory is integral to diagnosing the major diseases in Africa, such as TB, HIV, malaria and diabetes. He adds that the strength of the laboratory network is often a direct reflection of the success of control programmes for these diseases.

“Medical laboratorians contribute to the effective delivery of patient care by producing accurate results for diagnostic tests, that ensure the safety of the patient and enable doctors to make effective treatment decisions,” he says, adding that inaccurate test results can lead to ineffective treatments and further spread of disease.   

Research laboratories are often at the cutting edge of developing fast and accurate diagnosis technologies. For example, Antrum Biotech Healthcare Innovations, who will be showcasing their technology at the upcoming Africa Health Exhibition, to be held from the 28 – 30 May in Johannesburg, have developed an extrapulmonary TB diagnostic test strip. Unlike existing diagnostic tests, this TB test can be conducted at the point-of-care (POC), so that treatment can start immediately, instead of waiting for results from the laboratory.  

Professor Erasmus, the conference chair at the newly introduced Laboratory Medicine conference at Africa Health, says that the emergence of POC testing technologies presents a significant opportunity to improve access to diagnostic testing for priority diseases within Africa. 

 “This is particularly important in low- and middle-income countries (LMICs) where sophisticated laboratory equipment and trained technicians are often in short supply. Prof Erasmus explains that in these contexts restricted access to diagnostic testing can result in fewer follow up visits and could mean that many patients are failing to receive the treatment they need. 

Ryan Sanderson, Exhibition Director for Africa Health, says that the introduction of internationally renowned laboratory exhibition, Medlab Africa to the Africa Health Exhibition will provide conference delegates with an entrée into several global organisations at the cutting edge of laboratory solutions, such as POC testing.  

“Delegates will be able to observe first-hand, some of the advances being made in the area of diagnostics and have access to some of the world’s biggest names in lab medicine, such as AGD, BMS Group, Fapon Biotech, Getinge and Mindray,” he says.  

POC technologies significantly reduce the number of patients lost to follow-ups, and decrease the costs associated with laboratory-based diagnosis. However, even as POC technologies become more widely available, laboratory services remain as important as ever. Prof Erasmus says this is because quality and accuracy assurance are central to any POC testing programme and scaling up POC testing without simultaneously building laboratory quality assurance capacity is counter-productive and leaves providers unable to guarantee the accuracy of test results. 

Beyond individual patient care, “laboratory services are crucial to the effective control of epidemics” says Prof Erasmus. Laboratory services are the only mechanism for collecting the information necessary to detect and prevent disease outbreaks and other public health threats. This includes information about how a disease enters the population, the conditions under which it spreads, and the most effective mechanisms for preventing transmission.  Researchers also use laboratory services for the development of new vaccines to prevent communicable diseases, as well as to monitor and evaluate the effectiveness of national vaccination programmes.    “Laboratory services have been central to identifying and monitoring anti-microbial resistance (AMR),” says Prof Erasmus. AMR occurs when disease-causing microorganisms develop resistance to the drugs used to treat them. This increases the spread of infection among the population and can lead to disease outbreaks. Low- and middle-income countries, which bear a higher burden of infectious diseases are particularly hard hit, as AMR makes treating infectious diseases much more expensive.  

Prof Erasmus adds that laboratory services in many LMICs face a number of challenges that undermine the strength of the health system as a whole, including a lack of national policies and strategic plans for laboratory services, and a short supply of trained laboratory professionals.  

Public-private partnerships are increasingly recognised as an important tool for overcoming these challenges. For example, in Ethiopia, HEMA Laboratories partner with international organizations to provide mobile voluntary testing and counselling for HIV to those who may otherwise be unable to access these services. Similarly, PEPFAR and the U.S. Centers for Information.

Disease Control and Prevention are working with Ministries of Health in Ethiopia, Kenya, Mozambique, and Uganda, and private sector partners, to upskill laboratory workers.  

Dr Dawit Moges, CEO of Hema Advanced Diagnosis Labs, says “there is a dire need to partner with private sector players to harness their additional capacity.” Formalised collaboration between government and private actors can leverage private sector human resources, expertise, infrastructure and financial capital for the public good.  

Africa Health 2019 will bring together a host of prominent thought leaders from across Africa under the theme, “The future of healthcare today: Re-envisioning Africa’s healthcare system”. A few speakers at this flagship conference include Dr Alfred Madigele, Minister of Health and Wellness in Botswana; Dr Joyce Moriku Kaducu, Minister of State for Primary Healthcare in Uganda; and, Mr Faried Fezoua, President & CEO of GE Healthcare Africa. Discussions will centre around current and future health imperatives for the region. 

“We believe that this platform will facilitate public and private sector partnerships that will ultimately result in greater access and efficiencies in healthcare across the region”, concludes Sanderson. 

The impressive faculty of expert conference chairs and speakers at the Laboratory Services Conference includes both Professor Erasmus and Dr Dawit Moges. 

Africa Health Exhibition and Congress will be held from the 28 – 30 May at the Gallagher Convention Centre, Johannesburg. Organised by Informa Exhibition’s Global Healthcare Group, it is the largest platform on the continent for international and local companies to meet, network and do business with the rapidly expanding African healthcare market. In its ninth year, the 2019 event is expected to attract more than 10,500 healthcare professionals, with representation from over 160 countries and over 600 leading international and regional healthcare and pharmaceutical suppliers, manufacturers and service providers. 

Courtesy: HWB Communications Pty Ltd.  


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