How to ensure quality human disease diagnosis, by Emeribe

A professor of medical laboratory science at University of Calabar, Cross River, Prof. Anthony Ogbonna Emeribe, has made recommendations on how to ensure quality human disease diagnosis, management and research.

Emeribe, of the Faculty of Medical Laboratory Science, at the university’s 102nd inaugural lecture titled, “Sanguis: Gateway to Quality Human Disease Diagnosis, Management and Research” recommended effective implementation of Nigeria Essential Diagnostics List (NEDL); that Federal Ministry of Health (FMoH), States Ministry of Health (SMOH) and Agencies need to train medical laboratory professionals on ISO 15189, which is the standard that guides medical laboratory services across all levels of care; and that they should implement and plan towards quality improvement and accreditation.

ISO 15189 Medical laboratories are requirements for quality and competence is an international standard that specifies the quality management system requirements particular to medical laboratories.

Sanguis is Latin word for blood.
Emeribe, who was a former Registrar/Chief Executive of the Medical Laboratory Science Council of Nigeria (MLSCN), said this would further minimise the reported barriers to quality diagnostics across the country and also build capacities at all levels of care thereby reducing referrals and out of pocket payments. “It should be made mandatory for all laboratories to key into the EQA programme of the National External Quality Assessment Laboratory or any other accredited External Quality Assessment (EQA) programmes,” he said.

According to Emeribe, it is recommended that the public sector and Non Governmental Organisation (NGO)/Faith Based Organisation (FBO) laboratories need additional support for the provision of multiplex In vitro diagnostics (IVDs), improved governance structure, quality and data management, trainings, communication, utility supplies, procurement planning and management to minimize/eradicate stock-outs.

Furthermore, Emeribe said it is pertinent to procure equipment that is linked to the recommended tests and ensure all medical laboratory equipment and IVDs are verified and validated at the Public Health IVD Control Laboratory before use. He said capacity should be built in-country towards the manufacturing of these IVDs to make access easier and affordable.

The scientist said inter-professional rivalry should be better managed by strict adherence to public service rules, legislations and approved schemes of service, which delineate and specify job descriptions for the different health cadres.

Emeribe recommended that the inadequate number of qualified personnel observed in most of the laboratories is not in consonance with the ample numbers of training institutions and qualified medical laboratory scientists and technicians unemployed and under-employed over several years in the country. He said there are also an inadequate number of pathologists and this anomaly should be addressed urgently with fresh recruitments and the replacement of unqualified staff rendering medical laboratory investigations.

The former MLSCN boss said efforts should be made to ensure that more tests are covered under the National Health Insurance Scheme (NHIS) with more citizens enrolled geared towards attainment of Universal Health Coverage (UHC) by 2030.

Emeribe further recommended strong support for the Nigeria NEDL through advocacy at the National Council on Health, Governors’ Forum, National Assembly (NASS), State Houses of Assembly, Committee of Chief Medical Directors (CMDs) etc. for ownership and use at all levels of the health care system.

He urged support for certification and accreditation of medical laboratory services for quality care delivery. Emeribe said MLSCN and Medical and Dental Council of Nigeria (MDCN) should collaborate to facilitate the success of the desired joint accreditation drive with institution of National Quality Taskforce to monitor implementation of ISO 15189.

The scientist advocated yearly Medical Laboratory Services Forum involving all laboratory professionals to encourage teamwork and mutual respect for improved service delivery.

He also recommended acceptance and optimal use of the public health Invitro Diagnostics Control Laboratory for regulation and validation of all test kits and reagents before use in the country and the National External Quality Assessment Laboratory proficiency test panels for laboratory results validation. Ditto for use of MLSCN published guidelines for laboratory infrastructure development at all tiers of the health system.

Emeribe called for strengthening of the National Association of Marketers/Vendors of Medical Laboratory Equipment and IVDs with Code of Ethics to drive supplies of quality laboratory consumables and equipment.

He said NHIS and other Health Insurance Schemes should strive to increase the scope of test menu available to clients and called for adherence to the Federal Government of Nigeria (FGN) approved schemes of service for the different medical laboratory professionals by all service providers.

Emeribe advocated unfettered/dedicated Laboratory Services Revolving Fund for effective and efficient services in all public hospitals and that all unqualified laboratory personnel (not certified by MLSCN or MDCN) should be posted out of laboratory testing schedules and such fresh appointments stopped forthwith.

He said Inspectorate Division of the FMoH, SMoH and SERVICOM should be mobilised to liaise with MDCN and MLSCN for continuous quality monitoring of health facilities.

SERVICOM is an acronym for Service Compact With All Nigerians. It is a social contract between the Federal Government of Nigeria and its people.

Emeribe advocated for MLSCN presence at the Ports to ensure that IVDs and reagents are imported in good condition including those, which require cold chain.

He said more private and public laboratories should be encouraged to get accredited as it is in South Africa, and that laboratory professionals should use generated data in the laboratories to drive advocacy and educate management on ISO 15189 Standard for medical laboratory services.

Emeribe said there should be enforcement of IVD regulation with MLSCN validation and certification made part of vendor prequalification for procurement purposes. He said health facilities should be encouraged to recruit adequate numbers of medical laboratory scientists and pathologists to match volume and scope of services.