Did the Registrar of Health Facilities Regulatory Agency compromise and err?

A letter dated on the 31st of May 2021 and written by the Registrar of the Health Facilities Regulatory Agency (HeFRA) has suggested that “basic laboratories across the country are to be headed by licensed medical laboratory technicians” and further positioned that “Primary, Secondary and Tertiary Laboratories are headed by either a laboratory medicine specialist or a licensed biomedical scientist”.

The letter makes reference to the very ACT of Parliament that established the Agency in Part 1 of the HEALTH INSTITUTIONS AND FACILITIES ACT, 2011 that was given assent by the President on 31st December 2011. As far as stakeholders are concerned, the law has not been amended and no known legislative instrument has been enacted to operate with the ACT 829, 2011.

When it comes to the requirements of those who can practice medical laboratory science in Ghana, the agency respectfully makes reference to the Health Professions and Regulatory Bodies ACT, 2013 (ACT 857), Part 1 which under the Schedule on page 70 states that “the study and practice of laboratory investigations for diagnosis and treatment by health professionals including Medical Laboratory Technician, Medical Laboratory Technologist, and Medical Laboratory Scientist.

 The recent strike action that started from Komfo Anokye Teaching Hospital Chapter of Ghana Association of Medical Laboratory Scientists (GAMLS) bothered on the rejection of two physicians that were posted as part of the laboratory staff by management. These physicians described as specialist in “Clinical Haematology or Laboratory Physicians” were products of the Ghana College of Physicians and Surgeons (GCPS). Unfortunately, the law that gives power to the Ghana Medical and Dental Council (GMDC) in Part 2 of Health Professions and Regulatory Bodies ACT, 2013 (ACT 857) has no mention of these practitioners. One can take a look at the interpretation of “Medicine” in the law and it is clear that these specialties are alien to the law.

It is no wonder the GCPS at their appearance and presentation to the Prof. Ernest Ayeetey’s Committee, they requested for the Ministry of Health (MoH) to amend the laws to enable the Medical and Dental Council to regulate the practice of the Physicians who are specialising in aspects of the medical laboratory.

Based on these information from the existing laws (ACT 829 and ACT 857), the HeFRA developed the checklist for requirements and assessment of facilities and to enable HeFRA to register facilities that make application. On the website of HeFRA (http://hefra.gov.gh/index.php/downloads/, accessed on 01Jun2021), the checklist available and in use for the assessment of Medical Laboratories is Version 1.3, dated 17 Nov 2017. On this document it is clearly stated that “the minimum qualification for a person in charge of a laboratory shall be

• A qualified Medical Laboratory Scientist with a minimum of a first degree certificate
  as a medical laboratory scientist (with 5 years post qualification experience and in
  good standing with Allied Health Professions Council of Ghana).
• Qualified Medical Laboratory Scientists with a minimum of a certificate as a
  medical laboratory scientist.

This in addition to other requirements apart from personnel is needed to get a medical laboratory facility accredited by HeFRA.

Until recently, when the issues about Laboratory Physicians had not broke, HeFRA was cool and operated as expected. In May 2018, three individuals pertitioned the President of Ghana to remove the Registrar of HeFRA since he did not have the required qualification to manage the institution.

This had come after the industrial actions by the Ghana Association of Medical Laboratory Scientists (GAMLS) in 2016 and 2018 for implementation of National Health Laboratory Policies and Creation of Laboratory Directorate respectively. These requests hinged on a possible way to reslve an impasse between Medical laboratory Sceintists and Physicians who are specializing in laboratory medicine at the GCPS. Since then, every opportunity has been used to ensure the Physicians will always supervise the Medical Laboratory Scientists.

On 31st May 2018, the Registrar of HeFRA was reported to have been sacked.

Currently, the Registrar of HeFRA is a medical doctor with specialty in Internal Medicine. There is no doubt he might have got the position by merit but no one can also dispute the fact that his presence might enure to the benefit of his profession.

The current Registrar has worked hard to make sure all benefit from the existence of the HeFRA. What he has not been successful to do is to change the law to accommodate some changes some stakeholder might have suggested. Although the legislative instrument to the law is not finally approved, the checklist to assess medical laboratories has changed. One key significant change on the form is who can be a medical laboratory practitioner in-charge of a facility. It is not surprising the allien profession (Laboratory physician) according to the  laws of Ghana has been inserted into the draft document.

 A harmonized inspection tools in a draft stage in August 2020 when presumably Parliament was not in session subtly found the successfully insertion of Laboratory Physicians and to prescribe them role.

If one looks at the successes the current Registrar has chalked and the projection he has been able to give to his primary profession, one will not be surprised to note the demand for Medical Officers to head the Inspectorate Units of HeFRA. Thoguh one wonders why the specific need for Medical Officers to be in-charge of the inspectorate units, you can also not deny them on grounds of qualification.

It is clear that the topmost and influential positions at HeFRA are all occupied by medically qualified professionals. No wonder it was easy to come to the aid of their mother professional group and the GCPS. One expects professionals to exhibit allegiance to their professions but not in a manner which bothers on changing the position of the law to suit ones whim and caprice.

The recent letter from the HeFRA registrar was a subtle way to change a law made by parliament without going through the appropriate processes. Introduction of laboratory physicians in the equation of “Who can head medical laboratories” by the Regstrar was unacceptable.

Parliament is called upon to look into the matter and let all those who are at fault to pay for the consequences of their decisions. Being at a privilled position should be handled to the benefit of the people for which the person have been appointed.

The action to write the ill-informed letter to te Ghana Medical Association must be condemned with all available forces and with the contempt it deserves. Such lawlessness must be criticised constructively.