In this interview with EVEREST AMAEFULE, Prof. Anthony Emeribe, Registrar/Chief Executive Officer of Medical Laboratory Science Council of Nigeria, explains the importance of medical laboratory in medicare and challenges of the sector
What is the position of medical laboratory science in sound health care delivery?
Medical laboratory service is at the base of modern health care delivery. Though there could be more, there are four fundamental pillars in the health care industry — medical or clinical services, the medical laboratory services, the pharmaceutical services and the nursing services. To operate a hospital or health institution, the absence of any of these four would means that you don’t have well rounded services.
Globally, modern health care services rest on accurate laboratory results. Over 75 per cent of the indices used in patient management and care come from laboratory services. In developed countries, the figure has moved to 85 per cent. In other words, if a person wants a holistic care, most of the indices that are required by the doctor to attend to the patient will come from the laboratory. In essence, where poor laboratory services persist, you cannot have efficient health care delivery system. Laboratory service is at the heart of modern health care delivery.
Do we have the human capacity in Nigeria to meet the requirement of medical laboratory services? Are there no hospitals that do not have laboratories?
A hospital that has no laboratory is not a hospital ab initio. It could actually be a clinic. You cannot have a laboratory without a clinic, because a laboratory is at the heart of the hospital. A health practitioner practising without laboratory indices is actually not giving optimal health care. I don’t see how a health care practitioner — whether it is a doctor or a nurse or a community health officer or whatever — can effectively attend to a patient without making use of laboratory results; and that is what we want to correct in the country.
One challenge we have is that of quacks, obviously. A number of laboratories we have in the country are manned by people who don’t have any knowledge of laboratory science. So, we need to get them out of the system because they are not helping our health care practitioners, what with the poor quality results they issue out. We have levels of practice — the laboratory scientist, the technician and the assistant, but the point is that most of the health facilities we have, particularly at the state and local government level, are clogged with people who are not trained and licensed to perform laboratory services. With the advocacy we are now mounting, the health care institutions are trying to put square pegs in square holes in giving effective health care delivery.
Is the preponderance of quacks in the industry the result of inadequate professionals?
I will not say so. We have well over 35,000 workforce, with scientists being about 18,000, laboratory technicians about 8,000 and laboratory assistants that can give care at the primary health care level being about 11,000. Obviously, we have reasonable level of manpower, but the trend is that a lot of people don’t understand what the laboratory is and they think they can just come in. It is not just a matter of mixing one thing or the other and then writing something. Some laboratories even issue results without conducting any test. Some issue results without having the right equipment and reagents because they don’t have the know-how, whereas we have people on the ground that can do the work. That is the point we are trying to make.
Where are the professionals?
That is a very good question. After graduating from the university, medical lab graduates are supposed to go for internship, before going for their national youth service. Some stay for three years before getting a placement. That gives you a little bit of the issue. They stay for that number of years because of limited establishments in the secondary and tertiary health institutions for them to complete their training. What we are saying is that there is that pool which health institutions in the country can tap into. Even among those who are qualified, some are unemployed because of displacement by those who should not have anything to do with laboratory practice in the country. There are health facilities that go for those that are not qualified because they pay them much less. So, it is not as if our laboratory personnel indices is that bad; rather, it is a matter of restructuring the system that is required.
What has the council been doing to rid the profession of quacks?
That is part of our advocacy. We are trying to let the public know the importance of making use of laboratories that are registered with the council. Those are the laboratories that are enrolled in the council’s quality improvement scheme. Laboratories should have the minimum benchmark in terms of space and facility, human resources, and processes in place. If members of the public don’t know these, they will not be properly guided. That is why we run jingles and advocacy packs. Of course, we have the problem of inadequate resources to sustain them, but we have started with the distribution of leaflets, and running jingles, among others.
The public should realise that without proper laboratory diagnosis, their health care will be compromised. We do realise that poor laboratory services is one major reason why affluent Nigerians leave the country to seek medical services abroad. And by so doing, we record huge capital flight that could otherwise be used to develop in-country facilities. One major way of stemming that is to have appropriate diagnostic services in the country. You can have brilliant physicians and brilliant surgeons, but if they don’t have correct results to work with, they can’t perform miracle. So, the cornerstone of having quality modern health services is through the laboratory. Laboratory service is not only about finding out what is wrong, it helps during recovery, while it also helps to forecast future diseases.
How can one identify a good laboratory?
We are trying to assist the public by hanging signs that a laboratory is registered. Any laboratory that is registered in Nigeria, you will be seeing ‘Registered by the Medical Laboratory Council of Nigeria.’ If it gets to the level accreditation, you will also see that it is ‘Accredited by the Medical Laboratory Council of Nigeria.’ We hope that with this, the public will be guided to where they can access reasonable level of laboratory care.
What is the difference between a ‘registered’ laboratory and an ‘accredited’ laboratory?
A registered laboratory means that the laboratory has met the minimum requirement in terms of manpower, space, facility, equipment, and minimal process documentation to operate as a medical laboratory. Accreditation is another ballgame completely. Accreditation means that the laboratory has been registered, has keyed into a continuous quality improvement and has been inspected. Registration, inspection and quality improvement are mandatory to climb up the quality ladder.
In Nigeria, we have adopted the World Health Organisation Afro Quality Improvement. This means that a laboratory can be assessed to be zero star, one star, two-star, three-star, four- or five- star. Where we have built a laboratory to climb up to the point of five stars, then that laboratory can seek accreditation. By accreditation, we mean that we are now vouching that the processes in place have met international standards. So, registration is different from accreditation. It takes a while; it takes resources to build up, to climb the ladder. So, while you are climbing from zero star to four, what we are giving you is national certification, from one star to four stars. And we want every laboratory to achieve that. When a laboratory gets 95 per cent, it should write us to say it is ready for accreditation. Accreditation is either yes or no. That is the difference between the two.
What proportion of laboratories in Nigeria is accredited?
Accreditation is new in this part of the world. In Africa, we have about 320 laboratories that are accredited. Three hundred are in South Africa, 20 are in the rest of Africa. It was only in 2010 we started working towards accreditation. What we had as in-country accreditation was more or less national certification, not accreditation proper. This time around, Nigeria, through the Medical Laboratory Science Council, has adopted international standards to make sure that any laboratory accredited by the council can be accredited by any other body in the world. As a matter of fact, we are a little more stringent and peculiar to our own environment. We have put those standards in place; they were not there before. We partnered with laboratories to start working them up. We are looking forward to the next two years, when we hope to have laboratories at that level. Currently, we have the 445 Air Force Hospital Laboratory that is at the five-star level. Very soon, we will get it properly accredited. Five-star means you have scored 95 per cent. So, there are little things they are putting in place. Maybe before the year ends, they will be there.
In essence, we don’t have any laboratory that is accredited in Nigeria?
We don’t have any laboratory that is accredited by the Medical Laboratory Science Council. There is a laboratory that has been advertising that it has been accredited by a South African agency. That is without our knowledge. As I said, accreditation is a yes or no thing. But we want to make sure that many Nigerian laboratories work up the quality ladder and are prepared for accreditation by the council or any other global body. Normally, the tradition is that even if you are up there, you have to get the national accreditation before you can talk of any other institution elsewhere accrediting you. That is the acceptable standard.
Does it mean that any laboratory that is not registered is illegal?
By law, any laboratory that is not registered by the Medical Laboratory Science Council is illegal. By the rules and regulations of the country, we are the only body empowered to do that. So, if you are not in our database, it means you are practicing illegally.
How many registered laboratoriesdo we have in the country?
In our database, we have about 5,349 laboratories, but there are others that are not in yet. We have heard figures as much as 10,000 laboratories in the country, but out of the 5,349 in our database, only about half are properly registered. We have sealed over a thousand of them.
Even when they are in your database?
We have to capture them in our database and then go and inspect. If they don’t meet the minimal requirement, we shut them down. Being shut down is not a permanent thing, though, as they will be reopened once they