An assessment of the availability of Medical Laboratory Services in primary health care centres in Ogbia LGA, Bayelsa State, Nigeria.
Atiegha C and Suama P
Department of Medical Laboratory Sciences, College of Health Technology Otuogidi-Ogbia, Bayelsa State.
Stella U. K.
Department of Medical Laboratory Science, Rivers State University, Port-Harcout.
Department of Health Information Management, College of Health Technology, Otuogidi-Ogbia, Bayelsa State.
All correspondence to: E-mail: firstname.lastname@example.org
Services at the Primary Health Care (PHC) are the first set of health services that are provided at the grass-root or rural level. A medical laboratory is a place for examination of materials derived from human body for the purposes of providing information on diagnosis of diseases.
The objective of this study is to assess the level of provision of medical laboratory services in primary health care centers in Ogbia local government area of Bayelsa-State, Nigeria. This study was carried out in 20 functional primary health facilities. A descriptive survey design involving questionnaire and a check list was used to assess information on the issue. The results reveal that only 20 primary health facilities operate in the LGA of over 55 communities. Among them only 9 health facilities are offering skeletal medical laboratory services. It further revealed a grossly under staffing of medical laboratory personnel. Medical laboratory services in the health centers in Ogbia Local Government of Bayelsa State, Nigeria are yet to be fully developed. We recommend therefore that policy makers should focus their attention in providing the needed manpower and equipments to boost health care services in these health care facilities.
Key words: Laboratory, PHC, Diagnosis, Scientist, Technician, Grass root.
n India the National Rural Health Mission (NRHM) Itaught wise to look at the ways in which the missions and goals of Primary Health Care (PHC) had been strengthened in the rural settings. This process is carried out in order to explore the avenues for more upgrading. As part of the commitment of the NRHM to improve public health care services, one of its core strategies had been to strengthen PHCs to meet the level of the countries Public
Health Standards, IPHS (1).
However, the World Health Organization (WHO) had defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Health can also be seen as the ability to adapt and manage physical, mental and social challenges throughout life. ‘Health for All’ is a programming goal of the WHO, which envisions securing the health and well- being of people around the world that has been popularized since the 1970s. It is the basis for the WHO’s primary health care strategy to promote health, human dignity and enhanced quality of life (2).
Furthermore, health service is seen as the essential part of a Nation’s social security in which the state is compulsorily obligated by its constitutional provisions to direct its policies toward ensuring that there are adequate medical services for all persons, including management, prevention and treatment of diseases. Health care services
in Nigeria are rendered as an integrated services. However, it was further reorganized into three tiers by the Federal Civil Service in the year 1988 under the auspices of the federal ministry of health. The tiers are the primary, secondary and tertiary health care’s (3).
Services at the PHC are the first set of health services that are provided at the grass-root or rural level. Health care (services) here requires contact with the community health facilities. This level of health care service identifies the health chalenges of the inhabitants and resolve them using appropriate technologies. Referring much serious and complicated cases to the secondary or tertiary health care service delivery. It is the cornerstone of the rural health services (4).
These days quality health care of patients has become more dependent on findings of medical laboratory investigations (5).
Good Laboratory policies are the decisions which are taken in consultation with other medical staff to enable the laboratory to operate reliably and efficiently in accord with other departments (6).
Medical laboratory can be defined in several ways by different authors: a specialized laboratory for carrying out investigations (routine or research) on human specimen sin order to generate accurate and reliable result; where tests are carried out on clinical specimens in order to get information about the health of a patient pertaining to the diagnosis, treatment and prevention of diseases; a place for
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measurement and examination of materials derived from human body (fluids, tissues, excreta, cells, etc.) for the purposes of providing information on diagnosis, prognosis, prevention or treatment of diseases; a branch of medical science that plays a vital role in public health and disease control; is where clinical pathology tests are carried out on clinical specimens to obtain information about the health of a patient and to aid in diagnosis, treatment and prevention of diseases( 7,8).
Medical laboratory science as a multidisciplinary field encompassed medical microbiology, haematology, clinical chemistry and histopathology. The discovery of microscope by Antony Van L., a German Scientist revolutionized the field of medical sciences (9). The place of medical laboratory science in medicine and public health is very fundamental. Medical laboratory science is key in disease identification, disease control and surveillance and in treatment of patients. Yet this very important services is still under provided or utilized (10).
Medical Laboratory personnel includes multiple categories of Medical laboratory science practitioners who have different levels of education and training ranging from medical laboratory assistants, medical laboratory technicians and medical laboratory scientists with their particular functions accordingly (11).
There are mainly two types of medical laboratories that process the majority of medical specimens. They are the hospital based and private based laboratories. Hospital based laboratories are medical laboratories that are located within the hospital that perform tests on patient whereas private laboratories are located outside the hospital that also perform tests on patients (12,13). Although specific routine tests are not limited to few, it is expedient that medical laboratory facility at the primary health care level perform at least these routine tests such as urinalysis, pregnancy test, blood grouping/Rhesus typing, Haemoglobin genotyping, haemoglobinestimation, tuberculosis test and serological assays (4).
Number of medical laboratory analysis had greatly impacted on the operations of PHC. Medical Laboratory diagnosis as the branch of diagnostic activities of PHC is saddled with the duty of producing laboratory tests results needed for the effective treatment of diseases (8,10).
It is clear that the role of medical laboratory in medicine and the society at large can and will never be over-emphasized. Though, there had been series of complains concerning the services in the laboratory at PHC level; they provide the physicians and other health care givers the information to detect disease, predisposition to disease, establish prognosis, guide patients management, monitor efficacy of treatment, confirm or refute a diagnosis. Reports obtained revealed that patients got inadequate satisfaction in regard to primary health care service delivery. The low turn up could be attributed to the non-equipment in the laboratory and bad information management system. It is apparent that patients do not effectively assess the services of medical laboratory at the primary health care level, possibly due to its non-establishment at the level of primary health care provider or simply due to lack of political will to make it functional (14, 15, 16). Despite these great functions and benefits of medical laboratory services, it had been reported that this service had been under assessed in general health practices at the PHC level (17).
However in the practice of modern Medicine, medical services had proven to be comprehensive and of global health standard only with the support of basic laboratory facilities to serve as the important determinant influencing the utilization of health services (18).
It is therefore clear that primary goal of PHC entail the involvement of ‘appropriate technology’ which is designed to equip the health facilities to render effective and quality medical care (19).
The ‘Bedrock” of modern medicine they say is the Medical laboratory. It plays a role that cannot be quantified in the three tiers of health services and the society at large. Therefore, this study is aimed at assessing the medical laboratory services in primary health care centres in Ogbia local government area of Bayelsa-State, Nigeria.
MATERIALS AND METHODS
This study was carried out in 20 functional primary health care facilities in Ogbia Local Government Area of Bayelsa State. A descriptive survey designed was used to assess the Medical Laboratory Services in the region. Subjects
The study subjects were the head of the Health facilities. This instrument was further divided into two sections: section ‘A’ includes names of community, health facilities and staff cadre in the laboratory, while section ‘B’ includes type of tests conducted. Ethical approval was obtained from the officers in charge from the respective health facilities and the committee of ethics and man power development, college of Health Technology, Otuogidi, Ogbia-Town, Bayelsa state.
An interview guide/checklist was used as method of data collection. The data were analyzed and results were presented in tables.
From the data generated, only 20 communities had health centres, of which 9(45.0%) operate medical laboratory services while 11(55.0%) had no medical laboratory services (figure 1).
Out of the 9 available medical laboratories, the staff manning them are 5(55.6%) medical laboratory technicians, 1(11.1%) are medical laboratory assistants and 3(33.3%) are community health extension workers (Table 1).
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Table 1: Personnel in charge of the laboratory
|Medical Laboratory Technician||5||55.6|
|Medical Laboratory Assistant||1||11.1|
|Community Health Extension Worker||3||33.3|
Of the 9 functional medical laboratories, the quality of services are 4(44.4%) good, 5(55.6%) are fair and 0(0.0%) and poor (Table 2).
Table 2: Quality of MLS
Of these 9 functional medical laboratories, 3(33.3%) offer regular services while 6(66.7%) have irregular services (figure 2).
Figure 2 Regularity of laboratory services provided
Table 3 gives the laboratory tests carried out in each of the health centres. In these 9 functional health facilities, 8(88.9%) parameters:Blood grouping, Hb-genotype, Hb-estimation, Hepatitis B, urinalysis, malaria parasites test, pregnancy test and HIV screening are carried out Otuogidi health facility, 6(66.7%) parameters: Blood grouping, Hb-estimation, urinalysis, malaria parasites test, pregnancy test and HIV screening are done in Otuoke health facility, 5(55.6%) parameters: HIV screening, Hb-estimation, urinalysis, malaria parasites test and pregnancy test are done in Otuakeme health facility, 4(44.4%) parameters: HIV screening, urinalysis, malaria parasites test and pregnancy test are carried out in Emeyal health facility, 3(33.3%) parameters: HIV screening, urinalysis, malaria parasites test and pregnancy test are done in Otuobagi health facility, 2(22.2%) parameters: HIV screening and malaria parasites test are done in Kolo health facility, while 3(33.3%) parameters: HIV screening, malaria parasites test and pregnancy test are carried out in Okodi, Oloibiri and Ewoi health facilities respectively (Table 3).
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Table 3: Panel of Tests done in MLS
|Laboratory’s Location||Test Done||Frequenc|
|PHC Otuogidi||Blood grouping, Hb-Genotype, Hb-estimation,|
|Hepatitis B, Urinalysis, MP Test, PT Test & HIV||8|
|PHC Otuoke||ABO Blood grouping, Hb-estimation, HIV|
|screening, Urinalysis, MP Test &PT Test||6|
|PHC Otuakeme||HIV screening, Hb-estimation, Urinalysis, MP|
|Test & PT Test||5|
|PHC Emeyal||HIV Screening, Urinalysis, MP Test & PT Test|
|PHC Otuobagi||HIV screening, Urinalysis, MP Test & PT Test||4|
|PHC Okodi||HIV screening, MP Test & PT Test||3|
|PHC Oloibiri||HIV screening, MP Test & PT Test||3|
|PHC Ewoi||HIV screening, MP Test & PT Test||3|
|PHC Kolo||HIV screening & MP Test||3|
Our study revealed that there are only 20 established primary health care centres in Ogbia Local Government Area of Bayelsa-State (which has over 55 communities) that are providing health services to the people in the communities. This finding is not in tandem with NRHM, 2005 which has the commitment of improving public health care service deliveries as one of its core strategies to strengthen PHCs to meet the level of Public Health Standards (1).
With this limited number of health facility, it is obvious that most of the persons residing in most communities within the rural areas in the local government had no access to quality health services. This issue also negates what Dibia, (2002) pointed out. He said health service is an essential part of a Nation’s social security which mandated the state to direct its policies toward ensuring adequate medical services for all persons (3).
The fact that of the twenty existing Health facilities only 9 are offering medical laboratory services which indicates that the quality of health service delivery rendered to the people is grossly inefficient and as such, undermined the role of medical laboratory services. This finding are also in contrast with the agreement of the World Health Assembly, that said WHO advocates for basic laboratory services and using appropriate technologies to support and strengthen clinical and public health activities at the PHC level (19,20).
The study further revealed an inappropriate staff strength and cadre working in the medical laboratory department that may not be able to face more rigorous analysis. There are also high tendencies of releasing wrong or falsified tests results because there are no qualified and trained medical laboratory scientists to verify and ascertain the validity of the generated tests results. We identified the presence of untrained, incompetent, non-qualified and non-licensed laboratory workers in all the laboratories. Invariably, the facilities are operated by quacks. It is therefore obvious that the tests results generated in these facilities may not be accurate.
This study also revealed a massive substandard, poorly functional and a dilapidated medical laboratory system with series of complains of dissatisfaction from patients. This had really hampered the progress to patients’ treatment. This findings are in agreement with that of Coulter & Ellim, 2006, attributing a poor functional medical laboratory and monitoring scheme majorly to the lack of political will, thereby causing health set back during treatment (15).
The quality of medical laboratory services depend greatly on the personnel involve in the diagnostic processes. Poor staffing posed an impediment to patients’ satisfaction to service deliveries. Our findings are in consonant with Sambo et al., 2010, whose record revealed that patients returns home with insufficient satisfaction owing to poor service delivery at the primary health care level (16).
The type of laboratory tests done is so skeletal and inconsequential. These array of tests varies significantly from one facility to the other that are managing to provide laboratory services. This findings negates that of Azad, 2012, who highlighted some of the essential laboratory services that should be provide at the primary health care level (4).
World Health Organization (WHO) believed in ‘Health for all’. However, this declaration had not been achieved because so many persons or patients are still deprived from accessing quality health services. These services are carried by trained, certified and license medical laboratory scientists only and as such, the services of medical laboratory scientists are often demanded by the requesting officers (physicians) or the patients concern. Medical laboratory science is the bed rock of modern medicine hence, when medical scientists are not integrated in patients’ management, the patients had been denied to accessing quality health service delivery. The role of medical laboratory scientists is so pivotal in health services and the society at large. Ironically, there are only 20 primary health care facilities that offered health services in Ogbia Local Government Area of Bayelsa State, of which
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only 9 are offering a skeletal medical laboratory services in other to attend to the health need of the people which is grossly inadequate. The medical laboratories are not furnished, no equipment or reagents. The staff strength is totally inadequate characterized with unqualified and non-licensed personnel. Common routine clinical tests that cut across all the units in the laboratory are not comprehensively done. Results generated are not reliable and reproducible consequent upon, detrimental to patients’ treatment. Lack of political will by the ruling class is another impediment that had resulted in the dilapidated nature of the health industry hence, hampered the WHO programme of ‘Health for All’, since patients cannot and are not accessing quality medical laboratory services at the third tier of health services. We therefore recommend that the authorities ( state and local government as well as federal agencies) should commence the equipmenting, staffing and training of all cadre of laboratory personnel as well as the provision of new laboratries for the health facilities that do not have them in order to enhance quality and efficient health care for the inhabitants.
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