The Nigeria Centre for Disease Control (NCDC) is partnering private sector laboratories to aggressively scale up the number of COVID-19 tests conducted in the country and meet its target to test 2 million citizens over the next three months.
NCDC’s readiness to partner private sector laboratories is coming on the heels of concerns that Nigeria, Africa’s most populous country, is not testing nearly enough compared to other countries in the continent. Experts have underscored the centrality of testing to the fight against COVID-19.
“You can’t fight a virus if you don’t know where it is,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organisation (WHO), said in his opening remarks at the Mission briefing on COVID-19 on March 12.
Nigeria plans to conduct 50,000 tests in each state and the Federal Capital Territory over the next three months. Chikwe Ihekweazu, director-general of NCDC, had informed that 2 million test kits were being expected from the Global Fund.
But with the country’s current testing capacity per day, this goal may not be achievable. Nigeria conducts only about 900 to 1,400 tests per day across 24 laboratories in the NCDC laboratory network. This is still short of its target to carry out 1,500 to 3,000 tests daily.
As at May 13, a total of 30,657 tests had been conducted in the country and of these, nearly 5,000 came back positive. But Nigeria needs to conduct at least 22,000 tests daily for the next 90 days to meet its target, and NCDC says a key response strategy to reducing the impact of the COVID-19 pandemic is to expand diagnostic testing to ensure a large number of people can access testing which is key in containing the virus.
The integration of private sector labs is expected to significantly bridge the testing gap among other variables, Emeka Oguanuo, spokesperson of NCDC, said. He, however, quickly noted that the centre does not have any projection of the number of tests expected from private laboratories.
“It is not clearly cut out how many tests we expect from private sector laboratories, because the partnership is voluntary and for now, we don’t know how many from the private sector will come on board,” Oguanuo told BusinessDay.
He said in addition to the private sector, the government is working to activate PCR labs and repurpose TB testing machines, GeneXperts, for COVID-19 testing. There are about 400 GeneXperts across the country.
While Nigeria has only managed to carry out just above 30,000 tests since the country recorded its index case in February, Ghana, South Africa, Mauritius and Djibouti have achieved commendable rates of testing. South Africa is leading in Africa with nearly 200,000 tests conducted.
Key to the high rates of testing achieved in South Africa is integration of private sector laboratories. Experts say integration of private sector labs can increase testing by 60-80 percent.
Patrick Dakum, CEO of the Institute of Human Virology Nigeria, agreed that the integration of the private sector can help the country scale up rapidly the number of tests conducted. He, however, advised that sample collection be scaled up side by side.
Dakum said there would be a need to involve the private sector also in mobilising communities to accept community-based testing so they can willingly come out for their samples to be taken.
In South Africa, a vast majority of cases there have been tested by private laboratories. By the end of April, a total 187,495 tests had been carried out in South Africa. Of this number, private sector laboratories conducted a total of 105,419 tests which represents 57 percent, while government-owned laboratories tested 80,006 representing 43 percent of the total tests, health authorities said.
The NCDC is not losing sight of this important fact. The centre admitted that in the course of fighting the COVID-19 pandemic globally, laboratories from the private sector have been an important resource to assist with increasing the scale of testing through the provision of resources, either through financial support or leveraging existing infrastructure and technical expertise. As at the end of March, health authorities say 80 percent of tests had been conducted by private laboratories.
Guidelines for partnership
The NCDC has published guidelines to harness the public and private sectors to rapidly expand diagnostic testing across the country. It said in a statement that the mechanism for engagement would be between the state and private sector laboratory, with technical guidance and support from NCDC.
It said a Memorandum of Understanding (MOU) may be signed between the state and the private sector that provides details of cost implications and operational support and as part of its national mandate, NCDC is responsible for providing technical support to the private laboratory.
The principles of engagement with the private sector laboratories are that all private sector laboratories should have valid registration with relevant national and state level authorities to perform diagnostic testing. All staff working within the facilities should be appropriately trained and registered with appropriate national bodies.
Private laboratories are required to abide by the rules of public health laboratories listed above.
The NCDC expects that where feasible, testing should be conducted at no cost to the patient. If private patients are charged for diagnostic tests, it should be at cost with no additional charges.
NCDC said it would commit to supplying reagents and extraction kits for continued operations. Where possible, private sector labs should work with states to procure reagents.
Following the announcement of its plans to integrate private sector laboratories, NCDC lately announced the activation of Everight Diagnostic & Laboratory Services in Imo State as a COVID-19 testing laboratory.
Everight, a private local business, describes itself as “one of the leading radiology and pathology service providers in Nigeria”.
Experts react
But some experts in the private sector have expressed different opinions on the guidelines published by NCDC.
A private laboratory operator who spoke on the condition of anonymity said the guidelines offer an opportunity for private labs to partner with state governments in a PPP approach.
He, however, said the guidelines are not ‘economic-sensitive’ to the private practitioners and not far-reaching enough to positively impact the testing landscape.
“There are very few private labs who meet the requirements of setting up PCR labs. At best this gives them the chance to start developing the lab from scratch which is capital-intensive and will take some time to get up to speed,” the private operator told BusinessDay.
He explained that the guidelines only speak to the RT-PCR platform.
“I was hoping that it would address other testing platforms or testing modalities like COVID-19 rapid diagnostic test kits which have been widely used in other countries,” the person said.
“For example, the NCDC could have said that private labs have been empowered to use COVID-19 rapid diagnostic test kits as a surveillance and screening tool. So, anyone that wants to test can approach the private labs for this. All positives from the rapid test kits will then be subjected to confirmation using the RT-PCR platform,” he said.
