Strengthening diagnostics in Africa: Pathway to building resilient health systems
Providing quality health care in Africa is a complex problem. The health systems in most of the continent are weak, with practically non-existent diagnostics infrastructure at the primary health care level. Diagnostics play a critical role in the detection, monitoring, control, and management of diseases.
Access to quality-assured laboratory diagnosis remains suboptimal and undervalued in Africa due to factors ranging from limited human, financial and technical resources to poor laboratory evaluation and accreditation systems. Limited access to diagnostics has dire consequences on Africa’s health system, leading to erroneous diagnosis, ineffective treatment, avoidable deaths, and an inability to determine the true prevalence of diseases.
A study in a tertiary referral center in Kumasi, Ghana, showed that 40% of children who had been given a WHO-defined clinical diagnosis of malaria were confirmed to actually have bacterial sepsis. Another study in Nigeria found the accuracy of clinical diagnoses of typhoid fever, when compared with laboratory culture confirmation, to be approximately 50%.
Covid-19 and limited access to diagnostics in Africa
The critical need for a truly functional diagnostics system in Africa has been brought to full light by the current Covid-19 pandemic. When the first COVID-19 case was reported in Egypt in February 2020, only two African countries (Senegal, with its Pasteur Institute and South Africa) were capable of detecting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the urgent need to increase Covid-19 testing and monitoring in Africa, many countries have worked hard to significantly increase their number of testing laboratories.
The challenges faced by African laboratories in diagnosing and combating the Covid-19 infection in Africa are not peculiar to the pandemic, but rather an offshoot of the critical challenges already confronting diagnostics and laboratory medicine in Africa.
Strategies to strengthening diagnostics in Africa
Strategic partnerships can be deployed in addressing this critical shortage of diagnostics across the continent. To make more diagnostics available, the public (national and international), private, and commercial sectors all need to play a role. Key players like the African Society for Laboratory Medicine (ASLM), the Africa Centres for Disease Control and Prevention (Africa CDC), the World Health Organisation (WHO), and UNICEF need to do even more than they currently do.
The recent partnership between Bloom Public Health, Katchey Laboratories, and ND Western Limited (an indigenous oil and gas company in Nigeria) to establish a well-equipped diagnostics center serving the Niger Delta region of Nigeria is one to be emulated. In this partnership, financial resources, technical resources, and human resources were channelled by different partners to achieve such an amazing outcome.
Key issues that must be addressed urgently to strengthen diagnostics in Africa include:
1. Balancing the allocation of resources: There is a current inequity in the availability of funds for laboratory diagnostics. Funding organisations need to balance the allocation of funds by placing more priority on laboratory diagnostics and supportive infrastructure. Governments of African countries also need to place greater emphasis on diagnostics in their budget allocation.
There is also a need for more strategic international partnerships to invest in diagnostics capacity in Africa. Recently, Gavi, the Vaccine Alliance, through its partnership with WHO, UNICEF, CDC, the Institut Pasteur Dakar, Centre Pasteur Cameroon, and the Uganda Virus Research Institute, invested in boosting yellow fever diagnostics capacity across Africa. This has led to a quadrupling of the number of laboratories able to confirm yellow fever samples on the continent and the availability of the first commercial yellow fever PCR testing kit.
2. Implementation of laboratory training programmes to strengthen the existing infrastructure: A major challenge to increasing Africa’s diagnostics capacity is the insufficiently trained healthcare workers to manage diagnostic tools effectively. There is a need to establish local training and education programmes for current and future diagnostics healthcare workers. In 2012, Roche partnered with the U.S President’s Emergency Plan for AIDS Relief (PEPFAR) to establish the Roche Scientific Campus in South Africa, which provided training and education for lab technologists, healthcare professionals, and policymakers.
3. Increased introduction and utilisation of new technologies to develop affordable, rapid diagnostic tests: Increasing the availability of non-culture-based methods for diagnosis of infectious diseases, such as rapid HIV and malaria tests can potentially help to overcome short-term logistical and educational barriers, while efforts are being made to achieve more long-term infrastructure improvement. These non-culture-based tests typically require minimal sample preparation or preservation and can be performed with little technical expertise.
4. Establishing systems for laboratory accreditation and monitoring: Few countries in Africa have established laboratory quality standards and laboratories with international accreditation as per ISO 15189-2012 medical laboratory requirements. There is a need for African countries to develop well-defined processes for quality assessment and accreditation systems across the continent.
It is necessary to ensure that all efforts in strengthening laboratories because of the pandemic are sustained and built upon post-pandemic. This is crucial to increasing Africa’s diagnostics capacity, hence, delivering more effective, life-saving treatment, reducing mortality, optimising the expenditure of health care resources, and overall, building a resilient health system on the continent.
Professor Anyakora is the CEO of Bloom Public Health and a public health expert.
Odibeli is a pharmacist and the Research and Communications Coordinator at Bloom Public Health.