MEDICAL EXPERT COMMENTS – STRENGTHEN CLINICAL AND PUBLIC HEALTH LABORATORIES IN GHANA TO HANDLE TESTING FOR COVID-19 AND OTHER OUTBREAKS

Following laboratory confirmation for the diagnosis of the 2019 Novel Coronavirus (SARS-CoV-2) outbreak in Ghana; the code name being COVID-19, the general public is alarmed and fear has heightened among the populace. Several people have been asking whether we are ready as a country to fight this pandemic? Ghana Association of Medical Laboratory Scientists (GAMLS) would like to assure the public and all Ghanaians that we have the needed human capacity with the requisite knowledge and competence to screen, collect samples, safely manage the samples, and testing same to confirm or rule out the diagnosis for suspected cases of the COVID-19 infection.

We wish to reiterate the commitment of GAMLS and its members to providing the best of our professional services to the citizens of Ghana. We are also appealing to the President of Ghana, H.E. Nana Akuffo Addo and the Government of Ghana, the Ministry of Health (MoH), the Ghana Health Service (GHS), all other stakeholders and the general public to take interest in our bid to strengthen the clinical and public health laboratories in the country. We wish to also appeal to the MoH and GHS to consider apportioning part of the allocated 100 million US dollars and other funds meant to support the fight against COVID-19 to equip the clinical and public health laboratories in the country. GAMLS should also not be left out in the necessary strategic policy formulations to ensure that funds meant for the laboratory are used in a cost-effective manner.

There is a need to strengthen our health systems to be able to detect, track, manage and contain the infections recorded so far in the country. The need to scale up the capacity of at least the five teaching hospital laboratories and the public health laboratories (PHLs) in order to spread out the testing facilities across the country (Northern, Middle, and Southern belt) and to address other future outbreaks is imperative.

It is instructive to note that at the moment, the National Public Health Reference Laboratory (NPHRL) and Central Laboratory Services at Korle Bu in Accra and Zonal Public Health Laboratory in Tamale are known to have the capacity to perform specialized testing services but are yet to receive any scale-up in diagnostic capacity or training. They have two PCR machines and certified biosafety cabinets which could be suitable to test in this pandemic situation. With minimal structural modifications, logistics and refresher training, these PHLs could provide expanded testing to the entire country in order to reduce result turnaround time (TAT).

It is also our fear that, as suspected cases are increasing, the pressure that is mounting on the only two facilities testing for the infection in Ghana is going to be overwhelmed and the system might break down soon since we are going to experience a longer turnaround time and delays in releasing results for suspected cases. This can seriously endanger the health of people who do not have the COVID-19 but have been suspected and quarantined together with patients who actually have the COVID-19. The fear might be unbearable to suspected cases and their contacts. Also, the current system of transporting samples from remote areas to the two testing facilities is very risky and that can even compromise the quality of the final results. We need more testing sites to serve as a check for one another in ensuring very accurate and reliable laboratory results. Looking at the level of stigma attached to the infection, relying on one or two places of testing without enough provision for verification from alternative testing sites is not the best. Currently, most facilities lack the necessary materials to even take samples for onward referral to the existing testing sites.

We are worried and concerned that in this emergency mode, MoH and GHS could forget about its own apex, regional and zonal laboratories that provide specialized testing on a day-to-day for the people of Ghana and thus miss this opportunity to empower them to even do more. The association would, however, like to commend the Government of Ghana as well as managers of the Ghanaian health system for their efforts so far. We wish to thank the MOH/GHS for training a very small number of laboratory professionals and other health workers in the country on the appropriate use of PPE and sample handling however we wish to call for a more aggressive and coordinated approach considering the central role of laboratory professionals in the sample collection, management and confirmation of diagnosis for both suspected and unsuspected cases.

As a matter of urgency, the Government of Ghana should reconsider and seal the loopholes in our health policy system to correct some of these challenges. The United States in the last few weeks changed laws with the aim of combating the pandemic. Most of their laboratories are now able to perform the testing for SARS-CoV-2 and Ghana should be doing the same especially when the human resource which is the most critical thing is readily available. We shall continue importing everything including COVID-19 from China. The COVID-19 is beyond race, gender, politics, power, religion, money or social class. Let us get more serious and use coordinated efforts to contain it otherwise we would pay dearly for it.

Since 2013, Ghana with support from health partners like Center for Disease Control (CDC) and other stakeholders, developed National Health Laboratory Policies and Laboratory Strategic Policies to strengthen and standardize clinical laboratories in the country but the Ministry of Health has been dragging feet in launching and implementation of these important policy documents. The Ghana Association of Medical Laboratory Scientists (GAMLS) has in the past 6 years embarked on at least three (3) nationwide strikes actions to demand the implementation of these documents but to no avail and the documents are just gathering dust on shelves at the ministry of health. Only God knows what is preventing the government of Ghana and the MoH implementing such valuable documents.

By strengthening the clinical and public health laboratories in Ghana, we have nothing to lose as a nation; we would only make gains in ensuring that Ghanaian laboratories are ready and well equipped enough to put confidence in our healthcare system to provide the needed services required to protect the public in times like this to fight global pandemics and other outbreaks.

If the laboratory documents in question had been implemented, it would have ensured that at least 20 laboratories across the country are able to test and confirm such cases.

Whilst we commend the support provided to the Noguchi Memorial Institute for Medical Research (NMIMR) and Kumasi Center for Collaborative Research into Tropical medicine (KCCR), there are other existing systems and platforms that must be strengthened as well to enable the medical laboratories perform their duties in the fight of the COVID-19 pandemic and beyond.

GAMLS wishes to call on all its members across the country to adhere STRICTLY to the WHO-approved procedures for collecting the COVID-19 samples (including sputum and other infectious body fluids) from suspected persons and testing by wearing the necessary basic personal protective equipment (PPE) including N95 and approved diagnostic protocols.

Once again, the association wishes to assure the citizenry of our commitment to providing the best of our professional care in these difficult times. We encourage all Ghanaians and the general public not to panic but to follow the basic infection prevention and control measures that have been published severally by the ministry of health. Hand hygiene (washing hands frequently with soap and water and using alcohol-based hand sanitizers) and observing good cough etiquette remain the most efficient ways of preventing the transmission of the droplet and airborne infections. As much as possible avoid crowded areas and be willing to call for a medical check-up should any of the signs or symptoms of respiratory infection be noticed.