Reliable diagnostics a huge barrier to improving health across Africa
www.canadianhealthcarenetwork.ca
June 27, 2011
The Bura Health Centre’s medical lab in North Eastern Kenya is small and cramped, with cracks in the walls,
poor drainage and old equipment. The lab has no electricity, relying solely on solar panels.
Technician Abdi Abdullahi is one of 
three staff members working at the lab, performing 40 to 50 tests every day,although their work is limited by the lack of resources.
“I can only carry out routine tests here, like urine and stool examinations, blood slides for parasites and sputum microscopy for TB,” says Abdullahi. “Complicated tests must be referred to the district hospitals.”
Abdullahi refers patients for testing at the two district hospitals but they are 60 and 75 kilometres away. Due to poor roads in the area, it takes an entire day to travel to either hospital, get the requested results and returnhome. Many patients simply can’t make the trip so they are left untreated or are misdiagnosed.
Access to reliable diagnostic testing is a huge barrier to improving health across Africa, particularly in rural communities. It’s estimated only 8% of all laboratories in sub-Saharan Africa meet international accreditation standards.An average rural lab in Africa serves anywhere from 5,000 to 15,000 people and, like Abdullahi’s laboratory, most have poor infrastructure, insufficient staff and equipment shortages.
The World Health Organization also links Africa’s lack of diagnostic services to the emergence of antibiotic resistant organisms in diseases like malaria and TB.
Canadian contribution
Founded in 1957 as the Flying Doctors, the African Medical and Research Foundation (AMREF) is the world’s leading African-based health development organization. Its laboratory program was developed in 1985by University of Toronto-educated Dr. Jane Carter and is the only programof its kind on the continent.
Canadian physician and biochemist Dr. John Nixon first visited Africa in 1981. He became well aware of the impact better diagnostic services would have on improving health across the continent. He eventually became president of AMREF Canada’s board of directors after retiring from his position as medical director at MDS Health Group in Toronto. Dr. Nixon travelled to Africa often, visiting rural laboratories and clinics across the continent to better understand the challenges and needs. He was a driving force behind the expansion of AMREF’s laboratory program across Africa and its recognition by the World Health Organization.
Dr. Nixon died suddenly in 2006, but his legacy lives on today.
“He recognized how basic science appropriately placed can add to disease recognition and control, even in very remote and difficult areas,” says Dr. Carter. “From the very beginning he was a great advocate for strengthening diagnostic services across Africa.”
Seven former MDS colleagues created the Dr. John Nixon Memorial Fund in his honour. Every year the fund pays for tuition, transportation and living expenses for enrollment of two rural lab technicians in AMREF’s lab refresher training course in Nairobi.
Managed with Kenya’s Ministry of Health, the 12-week course equips technicians with up-to-date skills and knowledge in essential diagnostics.
“Our father was passionate about the need to build effective and sustainable laboratory services in Africa to improve the quality of healthcare by Africans, for Africans,” said Olivia Nixon, the youngest of Dr. Nixon’s four daughters.“We are very proud that our father’s legacy continues through this program.”
In February, technician Abdullah Abdullahi from the Bura health centre received one of the scholarships.
Setting the standards in Africa
Along with providing continuing education, AMREF’s lab program provides technical assistance, disease outbreak investigations and research.
The program works in 20 African countries and consults worldwide with a main laboratory in Nairobi that manages disease outbreaks from across the region.
Most recently, AMREF has expanded into developing diagnostic standards and guidelines, leading the first African regional lab quality assessment scheme, which will be implemented in Kenya, Uganda, Tanzania and Zanzibar.
The regional initiative provides regular lab testing services to ensure rural laboratories meet standards of care necessary for effective diagnoses.
To strengthen the program further, Martin Matu and Stephen Munene, from AMREF’s laboratory team in Nairobi, are now attending a 10-day clinical microbiology testing program at the University of British Columbia. Led by UBC Professor Dr. Michael Noble, one of the world’s leading experts in laboratory quality assessment, the course will equip the AMREF participants with new technical, managerial and administrative.
With the implementation of the East African quality assessment scheme and the scholarships supported by Dr. John Nixon’s Memorial Fund, AMREF and its Canadian partners are having a major impact in improving Africa’s diagnostic services.
Rx Africa: Prescriptions for Better Health is a seven part editorial series between Rogers Healthcare Group and AMREF Canada on AMREF's innovative solutions tackling Africa's health care worker crisis.
Read past articles in the series;
E-learning program for nurses improves access to training by 1,400% (May19, 2011)
Surgical Outreach Leaves Lasting Legacy in Underserviced Africa (April 29, 2011)
Bringing Care to Africa from Above (March 22, 2011)
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