Olorukoba: Nigeria Needs to Improve on Accreditation of Laboratories
What is Roche doing to advance the cause of diagnostics in Nigeria?
Roche is a global company synonymous with healthcare. We have the pharmaceutical arm, diabetes care and Roche Diagnostic where I belong. In Nigeria, we are popular in areas such as diagnostics which handles viral loads like HIV management, hepatitis; tissue diagnostic such as cancer care amongst many things. We also carry out routine clinical chemistry. In Nigeria, we don’t only provide the instruments but the support for them. The support includes engineering, technical services and training.
How do we address issues of inaccurate lab test results in Nigeria?
This forms the bedrock of why we are here. The best test in the world is useless if it is not accurate. The African Society of Laboratory Medicine (ASLM) was formed with a major objective to assist in ensuring quality of results. In any industry or profession, you have standards. Within a lab space, the mark of quality and competency is usually certified by a body. We do have challenges with the quality of the outcome of our labs. The ASLM as part of its objectives is to assist labs with programmes such as training.
While ASLM does trainings in partnership with America Centre for Disease Control (CDC), one of its focus areas is to try and solve the challenge of questionable lab results. In Nigeria, there is a responsibility to ensure good lab practice and quality test with the Medical Laboratory Council of Nigeria. There is an accreditation programme in Nigeria for laboratories. I also want to encourage in anyone in an event where you need the services of a lab, you need to ask a few questions. Has it been registered by a council? Are they accredited?
Are there criteria a standard lab must meet?
Well, yes and no. When you come to purchase our instruments, my first instinct is not to sell, but to ask questions. I won’t give you a quote. I will ask you the rate of test you want to do, how many samples you are getting, where is your lab we need to inspect. We also ask you if you have fully trained lab scientists. We are doing this so that you will provide what is fit for the purpose. We will then advice you.
What is responsible for questionable lab results in Nigeria?
First, there are a lot of very good labs in Nigeria but they are still not enough because the country is massive. The general challenge ranges from economic, infrastructure, and so on. It is difficult to have a lab working if you don’t have electricity 24/7 and good telecoms. All these are things that are unnecessarily difficult given our circumstance. It starts from there. We need a certain level of expertise, dedication and capital to function effectively.
Nigeria sometimes go to other countries for lab test when there is an epidemic outbreak, how do we tackle this?
I think we do have very good labs and that are able to do a lot sophisticated investigations in Nigeria. We are in very close working relationship with the ministry of health at many levels. What we can do is to engage them in specific matters like the yellow fever issue. We do have well trained scientists and centers of excellence in Nigeria. There are quite a lot of investments that health ministries have put on ground. My commitment to you is that we will look at it.
What is your organisation’s involvement in the treatment of hepatitis?
We have been involved in hepatitis management for a very long time. HIV however, is probably our biggest success story. In the scheme of things, we have roughly between 1.3 – 1.5 million patients on treatment for HIV in Nigeria. Each and every one of them needs to have their viral load tested because that is the only way to know if there treatment is effective. A HIV positive patient on effective treatment has his number of viral load in his system suppressed and that reduce the chances of transmission. This is the only way you can control the epidemic. This implies that every patient needs to check their viral load from time to time. About 80,000 people are currently doing that.
Virtually, 95-98 per cent (700,000) of those tests are done on Roche platform. We were the pioneers of this test in 2002. As I am speaking to you, Nigeria has top range instruments for viral load in the world. Before, we had 27 labs doing this 800,000 test. Now, we have put in place three labs doing exactly the same number within the year. One instrument can do 3000 tests a day. It has not been done anywhere else. We are equipped now to deal with any epidemic because we have the capacity. These instruments can do HIV, HPV, TB and a whole range of others. They are just three; two in Abuja and one in Lagos. Combine together, they have the capacity to take care of the country and improve efficiency. The ministry of health didn’t spend a dime on the instrument procurement. They gave us the support.
2006 is when we really got involved in Hepatitis. The current project we have amongst many is with Taraba State. The facts are that 50,000 patients will be screened over the next five years. We started this in the last quarter of 2017. Since then we have screened 1000 patients, and in the partnership with the state government.
On cervical cancer, what people don’t know is that 30 per cent of those women who have been told that they are negative are in fact positive. The current state of screening for cervical cancer is not as accurate as it seems. But now we have the technology to be nearly 100 per cent accurate to pick that 30 per cent, such that a woman who has the disease would be easily detected and recommended for further investigation.
Looking at the state of labs and scientist in Nigeria, what do you think needs to be improved?
We need to improve on how we perform accreditations. We need to also improve our level of awareness. For instance, every Nigerian knows that once a drug is purchased, there is need to check for the NAFDAC number. So we need to get to that stage that when you are going for a test, you will ask question on whether the lab is accredited or not because it is the accrediting body that we will hold responsible when anything goes wrong.
It is not a short, easy and cheap journey. It is a long, difficult and expensive one. We need to dedicate ourselves and start asking the right questions. This is the single most important thing I think should be improved upon.
What has been the challenge, and how do you think government can come in?
I think the challenge is a systemic one. There are so many challenges. I don’t usually like saying this because that is what everybody says, but everybody is saying it because it is the truth that funding is a big challenge. We are all saying it but the question is where does the funding come from, where is the funding used and how is it used? I will love a situation where health sector gets lot more funding, labs and diagnostics. This is not an anecdote but people say that it appears to be an anecdote but it is the fact- we say that over 70 per cent of medical decisions requires some form of diagnosis and yet about two per cent of fund on health are spent on lab diagnostics. Does that make sense? So, I am appealing for two things. First, the health care spending should be increased. Within the health care spending also, investment in diagnostics sector should also be increased because we need to have quality diagnostics to know what is wrong with us.
Are there other states you are talking to?
We are still in discussion with various state governments. Taraba State took up the challenge and I think it was a matter of right timing. I think we were that fortunate. We are hopeful that other state governments will partner with us. We believe in partnership because the government cannot do everything, it is impossible. There is nowhere in the world that government does everything. The best hospitals in the world have some private inputs. In this country we are still working towards that.