In today’s global world, the health concern of one country must be of concern to other countries especially with regards to infections. This reason necessitated a high level advocacy across the globe to help improve the structure of medical laboratories across Sub Saharan Africa. The Organisations that are concerned with the global efforts to fight HIV infection, tuberculosis, malaria and antimicrobial resistance are all well aware that medical laboratory services are the “Achilles heel”[Src].
Unfortunately, medical laboratories have been under supported in the health systems of developing countries including Ghana resulting in poor quality diagnosis and woefully inadequate disease surveillance. In Ghana as a case study, the labor market of laboratory professionals is marked by sluggish supply of qualified and well trained staff, inconsistent public health policies and relatively low wages. This results in high staff turnover where the highly trained and experienced professionals either move to the private sector or join higher learning institutions. The nature of medical laboratory practice in this country is evident of the fact that funding for the sector has been neglected over the years.
In the developed worlds, medical practice is completely evidence based which means the laboratorians work hand-in-hand with the physicians and other members of the health team to achieve objective diagnoses to help in the decision making process. Unfortunately in Ghana, most of the treatment and medical decisions are rather empiric or guess work, leaving the patients in high risk with regards the treatment process because of the current nature of the medical laboratory structure.
To put this into perspective to the Ghanaian public, before you are scheduled to take a blood transfusion it the laboratorian known as medical laboratory scientist who must confirm that you need the the blood transfusion. it is the laboratorian who will make sure that your blood matches with that of your donor. He will make sure that your donor is not in danger after the donation. He will make sure that the blood you are receiving is of high quality and free of all infectious agents. This is done to ensure that you don’t go home with new diseases.
But if there is no quality of service in the laboratory, if the reagents for all this analysis are not of high quality, the laboratorian cannot perform magic, there are more likely to result in errors as the process is completely scientific. When errors occur you may be transfused with blood that will cause you more harm than good and this may even lead to death as it has in may cases in this country. This is just one example of how quality in the medical laboratory may affect you.
However, in the medical laboratory, it is not just about achieving quality but to maintain it and this is one of the most daunting tasks in the medical laboratory. It is clear that without a proper quality, medical laboratories are essentially unsafe for patients. When the laboratory produce poor quality results, it causes mistrust among the other team members of the healthcare delivery system and this can be dangerous to evidence based medicare as physicians and other prescribers may ignore future results in their decision making process which is extremely dangerous to the patients.
The rules to quality however is not in mere will for it but in stringent policies and regulations. The medical laboratory requires two things to function properly which is personnel and and equipment. Personnel as used here covers the management down to the laboratory cleaners and equipment involves reagents and other consumables. If there is a lapse in any of this there cannot be quality laboratory service which means there cannot be quality health care delivery in the country. The quality of modern healthcare delivery rest on the existence of evidence which is provided largely by the medical laboratory making it the heart of the medical care.
Unfortunately, in Ghana, medical laboratory professionals figure prominently among neglected cadres in health systems. It is the most understaffed sector in the hospital and was often larded with staff of low qualifications until recently with the vigorous work of the leadership of the profession. The sector is also hindered with limited career opportunities though it is a widespread problem in the country. Laboratorians often work in poorly equipped facilities which do not systematically adhere to safety standards, and this leaves the personnel prone to an unreasonable level of health risks. These factors adversely affect the performance of laboratory professionals, who are the backbone of quality diagnostic.
Many professionals in Ghana have gone on strike on several occasions including members of the health team for various reasons but most this reasons are often rather for improvement of service conditions for personnel. One of the reasons why people hardly hear of medical laboratory scientist in this country is largely because they hardly go on strike. The professionals have often resolve to handling their issues diplomatically which has not worked out well in the pass. The relevance of this professional practice is so deep that it is not easy going on strike as the healthcare system cannot go on without these services and the private sector is not developed enough to handle the pressure.
This current strike action is a decision made in order to balance between continuous provision of services and improvement of quality and consistency in service delivery. The government of Ghana have recently adopted a standard for laboratory quality through the Ghana Standard Authority which includes two of the three key things the Ghana Association of Medical Laboratory Scientist GAMLS are asking for which are a distinct directorate for the profession and a creation of medical laboratory account separate from the medical account as seen with nurses and pharmacist. The third element they are asking for is for a correction of an error in the placement of some of its ranks in the Single Spine Salary Structure which has persisted over 6 years even though it was generally admitted as an error since 2012.
I personally think if the government cares about the people it should not allow this strike action to drag on for longer than necessary. The profession has been silent and this has dragged on for far too long. During their last congress in Sunyani, the minister of health made very loud promises with regards to this issue and his words ended up being empty because some people are said to be relentless working against the said improvements.
At the last congress of the Ghana Association of Medical Laboratory Scientist
The people of Ghana have to support this professionals in their quest to improve the quality of services. I see that this strike is not for selfish reasons and for the scope of services that this profession provides. Medical laboratory is pivotal to a quality healthcare system but it should be noted that this is a sector that has no room for compromises if any nation wants to take its healthcare delivery seriously.
The quality of the medical laboratory results also depends on full cooperation from other members of the heath team as research have shown that most (68%-87%) of laboratory errors are non-analytical errors[Src]. This is because samples for analysis often come from the physicians and nurses and an error with the sampling process automatically invalidates further procedures in the medical laboratory. In the same vein the physician have to depend largely on data from the laboratory to make any decision given that as much as 93% of the objective data in the clinical record is contributed by the laboratory[Src].
This is the reason why it worries me to know that instead of physicians helping in the fight to achieve quality in this sector on which the quality of their job depends on, they are rather engaging in activities that seek to sabotage this process by engaging the services of non-professionals especially at the district levels. However, the statement from President of the Ghana Medical Association (GMA), Dr Frank Ankobeah, asking the government to meet the demands for the medical laboratory scientist is commendable as it is a sign of the beginning of stringent collaboration with the professional bodies of the health sector.
It is time that the healthcare provider truly put the patient first. The government need to know that there is no way to improve healthcare delivery without improving the medical laboratory first. Allow the professionals to manage the profession and allow them access to funds they generate so they can achieve and maintain quality and consistency. This is not going to end the problems faced by the medical laboratories in Ghana but it is a huge step in that direction.