October 4, 2010

Medical labs in Nigeria will soon be ranked by category, says EMERIBE

Currently, the problem of misdiagnosis has become a public health concern in Nigeria. This has not only caused a lot of medical errors but had led to the deaths of so many Nigerians. Good Health Weekly however spoke to the new Registrar/Chief Executive of the Medical Laboratory Science Council of Nigeria (MLSCN), Prof.  Anthony Emeribe, a Professor of Haematology in the College of Medical Sciences, University of Calabar and a Medical Laboratory Scientist with specialisation in haematology.

In this interview with Chioma Obinna, he reels out new measures by the Council to tackle misdiagnosis as well as protect and ensure patients’ human rights. Excerpts:

On the problem of misdiagnosis

The primary goal of the Council is to see that Nigerians have the best of care laboratory wise. First of all, I will like to appreciate what the Federal government has done through the PEPFAR programme for medical laboratories in this country. It is not enough but it is something. The VAMED project too, under former President  Olusegun Obasanjo tried to rehabilitate some tertiary health institutions and then the laboratories got a little part of the funding and some new equipment were procured for some of the teaching hospitals.

But much more, the United States government through the PEPFAR programme has done a lot to the medical laboratory in Nigeria and 14 African countries. The US Government through this programme has injected  over17 billion US dollars to African countries to tone up the quality of healthcare to HIV & AIDS  patients and part of  that support has gone into  trying to tone up the number of laboratories for screening and full investigation.

Emphasis shift

After the first five years, the emphasis has now shifted to trying to assess and evaluate the quality of services not just a matter of increasing access but also the quality of the access. For council, that is a very important aspect of services because that comes in really at the heart of the goals of council. It is not just a matter of working into a medical laboratory and getting a test done. What matters is the quality of test done. If the reagents and chemical used is not working well, you don’t get a good result.

If the person is not appropriately trained you don’t get a good result. If you don’t have reasonable level of power supply, you don’t get a good results. If you don’t have the right equipment you don’t get a good result. So there are a number of things that affects the quality of laboratory test results and these are the things that Council over the recent years have been trying to look at.

Inspection & assessment

Before I came into office, this Council  tried to inspect over 2000 medical laboratories by way of having an overview or subjective assessment of what these laboratories look like. Out of this number, over a 1000 of  them were found not worthy and were  closed down. About 1,093 passed the preliminary testing.

Now, what Council has decided doing is to key into World Health Organisation African Regional office checklist for external quality assessment of the medical laboratories. This is a checklist recommended for African countries and it is not just subjective but it is also measurable.

On the field

You can also score what you are going to the field to look at. The things we look at include; documents and records, management reviews as regards to the testing and quality, organisation and personnel in that laboratory, client management and customers services, things like equipment, internal audit, procurement of equipment and information management amongst others.

We also look at occurrence and incident management, should there be an accident or a staff has an injury, how is such documented and managed. Finally we look at the facilities and safety. These are the 12 core areas that council is intending to start looking at in all public and medical laboratories.

On scoring of laboratories

Let me use this medium to pass this information to Nigerians, after the assessment next year, we intend to start scoring these facilities. We will begin to categorise these laboratories.There will be six levels of outcome of this assessment. First level, is a zero level, which means that, that laboratory is not really worth to be a medical laboratory. Any score below 55 per cent is zero. But if the laboratory scores between 55 and 64 per cent, we give it one star.

For a laboratory that scores between 65 to 74 per cent we give it two star laboratory, a  laboratory that scores 75 to 84 per cent is regarded as a three star laboratory and a laboratory that score 85 to 94 per cent is a four star laboratory.  Any laboratory that scores 95 and above is regarded as a five star laboratory and such a laboratory can readily pass any form of international accreditation.  So that is the plan council have for Nigerians.  Our advocacy is to all  persons requiring healthcare services so that as from next year  we are going t
o have signs to indicate where the laboratories fall.

The third outcome is that, you will get the self study manual from Council. Do a self study check of your facilities. We are going to send our assessors to go look at what is on ground, check what you have failed and then find out where you really belong and score. There is also a review of that process. We will also have corrective actions of follow up to support you to build.

On protection of patients’ rights in terms of misdiagnosis

Nigerians are becoming more aware of their rights and privileges and health is a very crucial aspect of human rights. We have a Council that is sensitive to this. The law setting up the Council made provision for a disciplinary committee and in that committee, there is a set of rules set up by the Chief Justice of the Federation that takes care of that aspect.

For wrong results,  one is by quacks – those who are not licenced to practice medical laboratory science and malpractice by those licenced to practice and are doing the wrong thing. Nigerians must be encouraged not to patronise them .

It is going to take a lot but we want to ensure that those qualified to practice are doing the right thing. For any member of this Council that malpractices, the disciplinary committee through the investigation panel will get the person publicly  tried and if convicted, then you stand a chance of losing your licence or being heavily fined, whatever, as prescribed by the law.

On getting complaints across to the Council

We already have some complaints. Any patient  who feels that he has not received the best of services, should get it documented and report to Council. We will need the name of that facility and of course the name of the practitioner and what the complaint is all about.  Then, we would take it to the investigation panel of the disciplinary committee.  The public need to know that. The day and the time all sorts of things happen in healthcare is coming to an end.  The essence of the council is to protect Nigerians.

On identification of acts of professional negligence

For instance, a patient goes to a doctor and he prescribes a test, the test is done and the result gets back to the doctor  and something goes wrong, that is one channel.  Another channel, a patient can go to a laboratory private or public, to  check up something, in either case, the result are not what it should be and because of that, that person is prescribed a wrong treatment or suffers some forms of damage or dies in the process. Of course, you can sue the health institution, the doctor and the laboratory scientist.

When you sue, during investigations where there are lapses will definitely come up. If you go to a private facility to do a test, for example HIV, and one is not positive and the laboratory results says positive and the patient starts taking treatments and eventually another laboratory facility  finds out that such a patient was not positive to HIV, of course you have the right to directly sue the laboratory  scientist.

On number of scientists in Nigeria

We have about 14,000 laboratory scientists in our records but a good number are outside  the country.  If you look at that ratio to 150 million Nigerians what does it give you? Ordinarily, the WHO recommended  one medical laboratory scientist to about 10,000 patients.

We  have the laboratory  technicians and assistants who are to work in primary health laboratories but because we don’t have  enough medical laboratory scientists a number of these subordinate staff in some primary health and some general hospitals are working alone.

We don’t have enough and even the few we have are roaming the streetsin search of employment.  Internship is a problem.  We are now looking into good private hospitals where our members can do their internship without waiting for a long time after graduation.

Collaboration with partners

The Council is embarking in  collaboration with partners to have a five weeks full training for laboratory practitioners.  When we are through with the planning we are going to advertise  scientists who are interested will apply and do the screening and enroll for the training. It is those who now pass that would be used in the field next year.

On his legacy

I should be remembered as somebody who was here, who at the core of his heart has the interest of Nigerians at heart through rendering quality services. We want to ensure that laboratory test results from any facility in this country is genuine. We want to ensure that the quality of chemicals and reagents being imported into this country for use are genuine. The day and age of anybody bringing in reagents and chemical of all sorts would have come to an end by the time I finish my tenure.