Why Reforms are Necessary for Health Laboratory Service

The attention of the Kwara State Government has been drawn to some positions on the ongoing reforms in the public health laboratory services sector.

Such positions largely misconstrued the strategic partnership government is having with private bodies to improve the quality of services available in our laboratories. This partnership, to be clear, will remove crass inefficiency and sharp practices while considerations are given to the indigent members of the public in line with the ethos of the administration.

It is pertinent at this juncture to let the people of Kwara know the antecedence of our laboratory services in the state and what led to the need for us to improve our services through a PPP arrangement.

As we all know, quality of results coming from our laboratory directly impacts quality of the care we offer to our patients. In recent time, the public hospitals have recorded a number of casualties due largely to poor quality services and unethical practices by some officials in our laboratory.

This ranges from extortion of patients in need of blood transfusions, overcharging of patients, and opportunistic referral of patients to private labs, especially those owned by these officials. This is official sabotage perpetrated by persons paid from public purse.

Three examples of near-misses arising from such inefficiency, conflict of interest, and sharp practices may suffice.

A retired nurse of Kwara State civil service brought his son for appendectomy (surgery) but was refused surgery because one of our labs tested him positive for Hepatitis B. He was later moved to another hospital (after a private lab confirmed him negative) where he was also confirmed negative. At the time, his appendix had ruptured and we nearly lost that young man due to negligence, lack of commitment and poor quality service.

Another instance was the case of a very sick woman at the General Hospital Ilorin. She was being wheeled into a vehicle by her teenage son to run some tests at a private lab. Curious that such a sick woman could be discharged for Lab test under such a risky condition, the hospital management quickly investigated what had gone wrong. It was discovered that this was a case of negligence and lack of empathy on the path of the government Lab workers. The claim that the test cannot be done at the GHI lab was found to be false as the same test was immediately run at the insistence of the Office of the DG of Hospital Management. The treatment of the woman was diligently followed by the government to ensure all is well until she was discharged hale and hearty. There is no telling how many of such cases had gone undetected with dire consequences on the health of the victims.

Another instance was a report that was generated by the lab for a patient for potassium. The result that was issued to a life patient was a value that even a dead patient could not produce.

There were many of such unfortunate scenarios, which required the government to act fast in public interest.

Government’s remedial actions

The Kwara State Hospital Management Board has held several meetings with stakeholders within the state laboratory services to discuss these problems and generate solutions.

Part of the problems was lack of automation and sabotage at our various laboratories. The government had procured 10 auto Analysers and distributed same across the three senatorial districts. Today, less than four are working perfectly due to poor management and sabotage.

The government had also engaged some companies to have equipment lease arrangement as is being suggested by some persons. Indeed, the UITH is having a similar arrangement, including PPP-driven services to run complete laboratory services. This is contrary to the claim that is being sold to the populace.

Government’s research of the equipment lease at UITH revealed that it is not going well. For the purpose of the public, it is important to explain equipment lease arrangement.

When you lease equipment with this arrangement, you will only use their own reagents. Closed machines can only use prescribed reagents and that is usually quite expensive. Government’s analysis of the proposition shows that patients will be paying significantly more than what is currently charged in those labs. So the government decided to abolish the mission in public interest. This is the experience with those who had implemented the arrangement. The government is not going that route in public interest.

To tackle the issue of credibility on the results from our labs, the government had to introduce a quality control measure by bringing in laboratory consultants into the lab. The system was such that Lab consultants must sign off the results from our lab before such results are released to the patients/customers. But this system was frustrated and those consultants had to leave to save their lives in the face of threats and intimidation.

Strategic partnership with private sector

The government is entering into a partnership with private bodies to ensure efficiency, credibility of test results, and deepen public trust. Even so, in appreciation of the social nature of healthcare delivery, His Excellency Governor Abdulrahman Abdulrazaq has given a strict instruction to see the MOU and the terms of contract before he can give a go-ahead.

He said he wants to make sure that: (1) Services are rendered at cheaper rate; (2) quality is significantly improved through a world class standardisation such that results produced from our lab can be tenable anywhere in the world; (3) all tests are done in our hospital, especially making GHI as a reference lab; and (4) that hospital services being social service, a percentage of our indigent patients have access to care; that some of our staff are embedded in the process so as to improve quality and competence over time.

It is to be stressed at this point that no one will lose their job as a result. We can reassign as appropriate.

If there is any takeaway from the COVID-19 emergencies, it is that we need to build capacity and strengthen efficiency of our local health services. This can only be achieved if we all put our feet down and not allow persons with vested interests to manipulate the system for their own selfish agenda. A situation whereby public facilities are destroyed and made inefficient for private businesses to thrive is definitely at the expense of the collective interest of the state and this should not be allowed to continue.