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Disheartening: The create, loot and share must stop in the public sector laboratory system

We have been following keenly the development at the Tamale Teaching Hospital in respect of the CEO’s and Management decision to enter into a Public Private Partnership (PPP) to run various laboratory services and in our strife to protect the patient and enhance effective laboratory practice we wish to lay our concerns and to prompt stakeholders.

The management and its Chief Executive Officer (CEO) have publicly advertised for interested private companies (Labs) to send proposals to enable them participate in a selection process to provide various laboratory services. The management claims this is in line with the vision of MOH/TTH on the basis of Public Private Partnership (PPP) agreement.

We view this as a step to further cripple and deepen the misfortunes of public sector medical laboratory service delivery. It is disheartening that a tertiary facility, which serves as a training centre for both undergraduate and postgraduate medical and allied health professionals including medical laboratory scientists and medical doctors, would consider a policy that would eventually make it difficult if not impossible to advance the training and internship of health professionals; not to mention the dangerous potential to weaken the laboratory departments in that facility.

Considering the CEO’s allegations and assertions in the past days however, it is clear he has very little knowledge about laboratory practice and is rather using his position to impose on the ordinary Ghanaian what he thinks is feasible and easily achievable. His assertions are awry to deceive the public and also make the public believe that Laboratory scientists are unprofessional and unfriendly to patients.

We are aware of the major expansion and rehabilitation works currently underway at the Tamale Teaching Hospital to turn it into an ultra-modern tertiary heath facility to better serve its mandate of providing high quality and affordable advanced health services to the people of all three northern regions and part of the Brong Ahafo region of Ghana including clients from the southern part of Burkina Faso. There can never be quality health care delivery without a strong medical laboratory diagnostic service.

We find it extremely surprising that Dr. Prosper Akambong, the CEO, who himself hails from northern Ghana where the poverty level is huge, and his management, would contemplate any such decision to aggravate the plight of the people of the northern regions. Cost of accessing health care in a public facility cannot be affordable if a critical service as laboratory diagnostics is privatized.

As it stands, no ISO private Laboratory in Ghana is accepting the national health insurance scheme (NHIS) and none of them will be able to provide effective service if they should accept and go by the charges and arrangements for the national health insurance claims. Also there are very few tests that are incorporated in the NHIS, which includes only basic tests like full blood count (FBC), malaria test and not specialized test like PSA, thyroid function test, and hormonal assays.

These specialized tests are the ones used for definitive diagnosis and also for monitoring. These are tests that are normally required for the aged. These tests are very expensive. Can the ordinary Ghanaian pay for them in the private facilities which can cost hundreds of Ghana cedis per test?

The CEO asserts that management undertook a study of the Ridge Hospital. The case of the Ridge Hospital is not as he sought to put out there. At the Ridge Hospital, there is a private facility that collects samples for tests. The Ridge Hospital lab is not able to run during periods of machine breakdowns or no reagents to run. Any test that is done at the facility is strictly CASH and CARRY.

Here patients are at liberty to assess any lab facility of their choice. The case of Korle Bu Teaching Hospital (KBTH) is not different. However, the TTH seeks to allow the private lab to run various tests without efforts to repair broken machines and supply reagents to the laboratory. The CEO’s assertion that there is PPP at Komfo Anokye Teaching Hospital is a blatant lie.

The CEO and the hospital management should rather be taking steps to provide the requisite equipment, reagents and logistics for the laboratories to enable the laboratory personnel to deliver on their mandate of providing accurate and reliable test reports timeously. If the laboratories are not performing as expected, it cannot be lack of capacity to do so, but simply due to lack of the necessary tools and materials to work with. Per the Labour act, 2003 ACT 651, it is wrong and bad to employ staff without providing them logistics for their work and turn to blame them for inefficiency and low productivity.

A question that begs answering is that, can leadership of the hospital give reasons for their position? We don’t agree with the reasons they have sought to put out in the media in the past days. Do they mean Scientists in the hospital cannot provide quality services when given the same resources and assistance they intend to give to the private operators? And since when did they realise the laboratory hasn’t been functioning to full capacity?

It must be known that no private medical laboratory in Ghana is achieving its success through poor recognition, poor management and disregard for its Scientists. In the minds of the CEO and the management, the private facilities would manage the TTH lab better. But what actually makes the difference between these private entities and the public laboratories is that, medical laboratory scientists take decisions with management in the private laboratories, and operate the lab as an entity rather than as an accessory.

What we need is strict adherence to standards and internal policies. Some are rusting on the shelves of the Ministry of Health. Yes, the very National Laboratory Policy Documents are rusting on the shelves at the MOH over squabbles as to the management and operations of medical laboratories in Ghana. There are and have been various attempts to marginalise the laboratory profession and its service delivery. However, there are well established facts that modern medical practice revolves around medical laboratory diagnosis.

We find it very strange that various professions have directorates right from the ministry level to the CHPS compound except the laboratory profession. These directorates are part of every management decision and yet the case of laboratory practice looks bizarre.

We find it very hard to understand how the CEO would want to run a public referral hospital with a vision “To be the center of excellence for quality tertiary health care, medical education and research” and yet work to destroy the laboratory? Why is the CEO not using his position to attract suppliers to supply laboratory equipment to aid diagnosis? If the CEO cares to know, the knowledge, competencies and expertise of the laboratory staff at the TTH hospital far exceeds a lot of their counterparts in the facilities of the potential bidders.

We find the decision of the CEO and management of the TTH, the only referral and teaching hospital within the northern belt of the country, totally unacceptable, absurd, whimsical and incongruous with the attainment of the mission and vision of the very institution they superintend.

What is there in this so-called PPP agreement decision that should we sit and watch it happen?
*That the construction of the ultramodern health facility should become just a white elephant?
*That the CEO can decide to make whatever laboratory tests he deems available to the people of Ghana?
*That our qualified and licensed medical laboratory scientists be underutilized made redundant or laid off?
*That the good people of Ghana would have to pay more for laboratory services to the CEO and his cronies (whoever wins the tender). This is because as it stands no ISO private Lab is accepting the National health insurance.
*That patients would have to wait for days for their tests results before their conditions can be attended to?
*What happens to patients who report at the hospital but cannot afford the high costs of private laboratory services; that they should go back home until they get money to come and pay and have their tests done?
*What happens to the Diagnostic Related Grouping (DRG) module of the NHIS which pays for service inclusive of the laboratory test; that NHIS is no longer using DRGs for payment?

At a time when public health laboratories are making frantic efforts to get accredited through the CDC SLMTA/SLPTA program, why does the CEO of the largest hospital in the northern regions find more joy in this act? Is it an attempt to create loot and share the hospital’s purse with his cronies through such infamous and patient unfriendly policy?

What’s preventing the CEO and management from making laboratory supplies available for tests to be done in the hospital? The abilities, competencies and expertise of the staff of the hospital’s laboratory, cannot be doubted. Even if the laboratory needs medical laboratory experts and specialists they are available in Ghana.
All over the world, tertiary health facilities are the last resort to any health service delivery including laboratory services. Why is the CEO running down the only referral health facility at the heart of northern Ghana? Why is he allowing the financial benefits of the so called PPP to override the cost impact and consequential effect on the health of the people of the northern regions in particular and Ghanaians as a whole?

It is very appalling the insistence of the CEO and management to go ahead with the PPP despite protest by the hospital’s Medical Laboratory Scientists. The MLS have professed their willingness and readiness to ensure the laboratory works to standard with the provision of the necessary equipment and reagents. We view this resistance as a way to create, loot and share if not worse. We stand strongly with them and in any decision they would to undertake to stop this “killer” policy.

We wish to unequivocally call on management to rescind this decision as it will increase cost of health and overburden the already overstrained underprivileged citizenry of the northern regions. Quality Laboratory Services is a RIGHT and not a PRIVILEGE.

We believe this is the way to go;
1. The management of TTH should rather consult the operations of the Western Regional hospital or Eastern Regional Hospital on how they achieved their FOUR STAR standard. Or to the Bungoma District Hospital laboratory, Kenya, on how they achieved their ISO- 15189 accreditation status. This time they should send Lab Scientists and managers rather than sending people who have absolutely no knowledge about Laboratory practice.
2. The CEO should help generate policies and internal arrangements to make referral cases go to Labs with standard. We beg to differ with his assertion that MLS have labs where they direct patients. We are well informed that some medical doctors actually write on Lab referral forms which Labs their Patients should go because they get monthly and annual rewards depending on the cases they present. In standard practice, it is the Lab which is supposed to make arrangements for referrals and not the medical doctor or CEO who has little knowledge on laboratory practice.
3. The CEO and management should use their positions to attract equipment and reagent suppliers to beef up the machinery of the hospital. He should ensure there are engineers to work on broken equipment.
4. There should be separate accounts created in our health centres to manage the revenue of laboratories. The practice of effective medical laboratory needs continuous investment and cannot be achieved by operating it as a subsidiary department. Reserving a percentage (about 60%) of Laboratory output in its reserves will make us have effective Labs in Ghana.
5. The above will call for a separate store management system for the laboratory.
6. Finally, the Ministry of Health should take it upon itself to ensure continuous education of medical laboratory practitioners in area of laboratory management, quality control management, accreditation management, Lab accounting, instrumentation, Lab statistics, and store management. This will provide the needed specialists who can maintain medical labs up to standard.

We call on all who believe in the concept of making quality healthcare affordable, patient friendly to join us nib this “killer” policy in the bud to avert its dangerous consequences on the people of Ghana. We wish to state our willingness to resist this in whatever means possible. Thank you
Writers:
Maxwell Akonde (MLS)
Leading Member, COMELS

Kyeremeh Evans (MLS)
Leading Member, COMELS. President and Co-founder of Patient Safety Advocacy Africa (PSA2)

Alfred Tetteh (MLT)
Member of COMELS, Chairman of the Heath
Workers Union, Brong Ahafo chapter and
Co-founder of Passion Medical Relief.

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