Edward  Gabkwet, a military personnel, wrote from Abuja
Overtime, majority of African public health laboratories delivered sub-optimal services and were not in a position to contribute to quality health system as most performed poorly, hindered by dilapidated infrastructures, poor development and implementation of quality management systems. Functioning laboratories are essential to identify a disease, ensure patients get the correct treatments and allow resistance to be tracked.

Yet years of neglect and underfunding in Africa has left laboratories without water, electricity, equipment and laboratory health workers. According to the non-governmental organisation, Treatment Action Group, TAG, this has led, as an example, to simple smear microscopy – a method used to diagnose tuberculosis (TB) – only being available in 18 per cent of public health facilities in a country like Kenya. This poor disease detection allows diseases to spread. Similar instances are rampant in most African countries.

The World Health Organisation, WHO, recognises quality laboratory services as key to improving global health and reaching Millennium Development Goals. Strengthening the breadth of laboratory services accessible to clients, and ensuring that results are accurate, reliable, reproducible, and rapid enough to be useful is crucial to improved health outcomes. The establishment of a formalized system to improve public medical laboratories throughout Africa occurred in several steps.

In 2008, in Mozambique, African Caribbean and Pacific Group of States leaders joined in the Maputo Declaration. As part of a larger set of health goals, the declaration included global efforts to strengthen laboratory systems and services in resource-limited countries. Later that year, in Senegal, the WHO African Regional Office (WHO-AFRO) laboratory network called for the establishment of a “step-wise” accreditation process.

In July 2009, in Kigali, Rwanda, WHO-AFRO, together with US partners and a group of health experts and policymakers from 13 African countries, launched the WHO-AFRO step-wise laboratory accreditation programme. The programme uses a five star rubric and clearly defined goals to evaluate the quality of service and competence of laboratories as they progress toward international quality standards.

External authorities monitor improvements through a series of evaluations using a comprehensive, standardized accreditation checklist. Based on performance, each laboratory is awarded a star rating. Through this tiered accreditation process, laboratories gradually improve the quality of their performance. The improvement goals used in this accreditation process, often referred to as the “Twelve Pillars of Laboratory Quality Improvement”, define clear components of a quality laboratory system. The programme also includes training and support for laboratories through the SLMTA (Strengthening Laboratory Management Toward’s Accreditation) principles.

The WHO-AFRO step-wise progress goals meet standards used worldwide, but the step-wise approach recognises that improvement takes time and often occurs in increments, especially in resource-limited settings. The five-step quality improvement process prepares laboratories for international accreditation. The WHO AFRO step-wise accreditation process does not replace existing accreditation frameworks. Rather, it provides an interim pathway to the realisation of international laboratory standards.

In 2010, Medical Laboratory Science Council of Nigeria, MLSCN, adopted and customised the WHO/AFRO checklist as a tool for accreditation of laboratories in Nigeria. This action was informed by the desire to drive a culture of quality and efficient health laboratory care to the public and the need to strengthen Nigerian laboratories systems to deliver services that meet international best practices.

This tool also offers Nigerian laboratory systems an opportunity for the international health community to monitor its progress over time, and easily benchmark Nigeria laboratories against laboratories in other African countries. One of the features of this national accreditation programme is that it affords laboratories opportunity of progressive rise on the accreditation ladder.

Within the last one year, a total of 36 laboratories in Nigeria have been assessed, majority of which were either zero or one star, with a few having two and three stars. In line with MLSCN’s statutory function, and sequel to an invitation, the Council visited the 445 Nigerian Air Force Hospital (445 NAFH) laboratories to assess for the purpose of accreditation.

This visit, which took place from the 17th to 19th of May, turned out to become a land mark assessment for accreditation in the history of Nigerian national laboratory accreditation programme, as it heralded the birth of the first five laboratory in Nigeria; a feat no other laboratory in Nigeria has hitherto achieved.

This laboratory which has been receiving technical support from US-Department of Defence, in a manner akin to other Nigerian government agencies, has advanced its quality system essentials to a level that complies with international standards and best practices, an enviable position that all other laboratories in Nigeria, both implementing partner supported and non-supported, are encouraged to attain.

This achievement could not have been possible without the commitment of Chief of the Air Staff, Air Marshal Mohammed Dikko Umar to quality services in the NAF health sector.

The hard work of the management and staff of 445 NAF Hospital and Laboratory as observed during the assessment is also commendable.