An African Alliance

Laboratory services often lack recognition for their crucial contributions to healthcare. In many African countries, where medical resources are commonly low, this has resulted in a lack of investment, training and education, and a “bottleneck” in the healthcare system – without the right diagnosis, the appropriate treatment cannot follow, and many people face missed or inaccurate diagnoses, inappropriate treatments, and serious or even fatal consequences.

This prompted the Royal College of Pathologists (RCPath), working in partnership with the College of Pathologists of East, Central and Southern Africa (COPECSA), the British Division of the International Academy of Pathology (BDIAP) and the East, Central and Southern Africa Health Community (ECSA-HC) to initiate the LabSkills Africa (LSA) project: a collaboration aimed at improving diagnostic speed and accuracy in labs around Africa, and therefore healthcare overall. Having trained in Africa myself, I saw this as an opportunity to give something back, and to contribute to improved diagnostic services in the region.

Targeting health and mortality

The pilot of the project involved 20 laboratories; four each in Kenya, Tanzania, Uganda, Zambia and Zimbabwe. Together, these laboratories serve a combined population of 100 million people, and perform over 1.7 million tests every year.

The aim of the project is to improve the diagnosis and management of health conditions related to the United Nations Millennium Development Goals (MDGs) of reducing child mortality, improving maternal health, and combatting HIV/AIDS, malaria and other diseases, by focusing on improving seven key tests (see Figure 1). As well as increasing diagnostic accuracy and proficiency, the project hopes to shorten turnaround times, strengthen front-line services, and improve clinical decision-making based on test results.

Understaffed and invisible

Like in many other places around the world, the visibility of pathologists and laboratory professionals is a huge issue in Africa. The profession is competing with more well-recognized areas of medicine such as pharmacy and radiography, and although patients and doctors alike understand why we need medications and X-rays, they often don’t realize the crucial importance of lab work. Because it functions quietly in the background, the laboratory simply isn’t prioritized, and as a result is often left behind when it comes to decision making and resource allocation.

Another challenge is the lack of a trained, adequately qualified workforce. Particularly in district hospitals, there is a huge deficiency in fully trained staff. Often, the most qualified people leave for other positions, leaving many medical lab assistants (MLAs) and very few qualified scientists and doctors to do the job. This lack of training, and a lack of understanding of the importance of diagnostic testing, means that often clinicians must diagnose their patients without adequate evidence.

Seeing stars

As a biomedical scientist, my aim during my time working with RCPath on LSA was to improve quality standards in the labs I visited. This didn’t come without challenges – in short-staffed, resource-poor hospitals, time is very precious. It can be hard to get people to dedicate time to quality issues when they are trying to focus on taking care of patients – understandably, extra training can seem like an additional time burden. But with very few exceptions, we found that people were willing to get behind the initiative.

I found that our two-pronged approach to quality improvement worked well:  the project trained pathologists, senior biomedical scientists and laboratory managers in leadership and quality management – and provided hands on technical skills development training for 40 laboratory technicians and technologists. As time went on, it was truly gratifying to see the labs I worked with improve their compliance with international standards. We were able to see real changes in standard operating procedures, and guideline and policy documents. As members of the World Health Organization Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) program, the labs were able to see how they’d improved in meeting the essential standards – one in particular even moved from two to three stars on the WHO scale.

All in this together

For me, the most memorable moment of this project was watching one of the participating countries hold a meeting between the four hospitals we visited, and seeing them sharing their quality control (QC) methods. For example, the staff were having trouble getting a control sample to use for urinalysis – they couldn’t afford to buy it. But one lab had started using saline spiked with various analytes as a cheaper alternative, and they were able to share this method with the other hospitals. Seeing them working together and supporting each other, and showing initiative, was extremely rewarding.\

But with any project of this nature, it’s important to question what the long-term impact will be. By choosing four key hospitals in each of the countries, we hope our work will have a knock-on effect, as they form supportive networks and continue to help each other. Some of the people we worked with have already begun preparing their own QC materials, which they are now sending on to other labs. This is great to see! The staff will also continue to have access to their UK mentors, and can ask for any advice and assistance they might need. These measures mean that both the hospitals we visited, and others around these countries, can continue to learn and improve.

The importance of mentorship

I believe one of the keys to our success in this program was that we provided mentorship, as opposed to simply training, or “aid”. In a donor-recipient relationship, I don’t think you get the best results – the donor may choose what to provide, and often the training or equipment received in this way is not relevant to many of the hospitals. Africa is a very big place, and you simply can’t generalize.

But a mentor-mentee dynamic is different; it isn’t patronizing, and fosters understanding. It’s a friendly relationship with someone who wants to assist you – they’ve been through these issues before, and they can guide you along the path to improving. It allows the training to be led by the mentee, who can say “these are the problems we have, and this is the help we need.”

Getting involved

Although my work with LSA has been, in my opinion, a great success, there is still a lot to do, and we need to get more people involved in mentoring. Professional bodies could really help, by mentoring professional bodies in Africa, and using their wealth of experience to assist with a wide number of issues. I’d love to see the different societies involved in lab work get behind this – from hematologists to chemists – to help us all move forward together. This will help to raise awareness of the important work we do as lab professionals, whether we do it in the UK, Africa, or anywhere else in the world.