The African Society for Laboratory Medicine is a pan-African organization tasked with improving the clinical laboratory capacity in Africa is celebrating 10 years since its formation. In this discussion with the CEO Nqobile, Ndlovu we talk about ASLM’s journey since its formation and future opportunities and challenges in clinical laboratory capability in Africa
The yawning and overwhelming need for and importance of high-quality, world-class laboratory testing capability and capacity in Africa has never faced greater scrutiny than during the current Covid-19 pandemic. Adding into the mix is the sporadic outbreaks of Ebola across several central and western African countries and the long list of food-borne, communicable and lifestyle diseases that continue to weigh heavily on Africa.
With the Covid-19 pandemic hitting the headlines as 2020 unraveled, the first major concern was how African countries could test its population for the Covid-19 virus efficiently, accurately and fast, to enable countries to track the progress of the pandemic in local populations, and to enable trade and travel to continue – despite the lockdowns and travel restrictions.
The African Society for Laboratory Medicine (ASLM) is a pan-African membership organization that is tasked with improving the capacity and quality of clinical laboratory testing in Africa. With its head office in Addis Ababa, Ethiopia and a new office in South Africa, the Society is celebrating 10 years since its inception in 2011.
Its founding followed several initiatives by major stakeholders in Africa to have a common strategy on laboratory testing capability across Africa, including in 1998 when the World Health Organisation (WHO) Regional Committee for Africa passed a resolution urging member states to evaluate the laboratory component of disease control programs as the first step towards strengthening disease surveillance in Africa.
Further, the 58th session of the Committee in Yaounde, Cameroon in 2008 re-affirmed the regional commitment to strengthening laboratory capacity in the continent. The Maputo declaration in 2008 and the ASLM-Ministerial call for action of December 2012 added the needed impetus and fuel to birth and grow ASLM to what it is today.
LEADING AFRICA’S TRANSFORMATION
Leading the charge at ASLM is CEO Nqobile Ndlovu, a Zimbabwean national whose role is to work together with the Board of Directors and other partners including Africa CDC to chart the path forward for the organization.
Nqobile joined ASLM in 2013 as a Program Manager, and over the years moved up the chain into the Program Coordinator role, then the Project Lead. He later became the Acting CEO mid 2018, becoming the substantive CEO in 2020.
With a history of working with the ASLM even before its inception in 2011 and having been involved also in its conceptualization as the Laboratory Coordinator at the African Field Epidemiology Network, the CEO is well versed with the role and the future direction of ASLM in Africa.
He reveals that it is at the Kampala declaration in 2011 that the idea of the creation of ASLM was mooted as the body to represent and be the voice to improve the state of medical laboratories in Africa.
Talking of the last 10 years since its inception, Nqobile says that the status of medical laboratories is better than they were 10 years ago, but that lots more work needs to be done – and that the importance of ASLM continues to grow every day.
“Laboratory testing is one of the most neglected areas in healthcare in Africa. Many people prefer just treating patients or managing conditions without really taking a sample for testing in the lab. That kind of approach has heavy consequences because you are managing conditions that require the doctor to know exactly what he/she is dealing with and without proper diagnosis, you may end up getting even sicker and potentially lose your life.”
“If we don’t really build our laboratories services, it is going to be very difficult to achieve Universal Health Coverage (UHC). Right now, if you look at the issues of Covid-19, testing is a critical issue, even as we have got vaccination being rolled out across Africa, there are areas where vaccination has not yet been successfully implemented and we are relying on testing to identify infected people for isolation and treatment.”
“As a result of the pandemic, we are seeing a growing need for laboratory services because of all these challenges. There are several issues that we are observing during this crisis including that of unskilled workforce in Africa and challenges with coordinating laboratory services so that they can serve the local populations that need these vital testing services. The third issue is that of insufficient funding – laboratory services have been neglected and therefore not much funding has been put into the sector. Further, there are other competing health needs, and every government has to prioritize its spending areas and laboratory services have not been at the forefront of healthcare budgets in many countries in Africa.”
He says that despite the progress made, these are some of the issues that were and still bedevil the sector.
“ASLM was established to be the voice that brings together the community of laboratory experts and other healthcare workers so that we can improve the state of laboratory services, and in so doing, increase patient access to high quality laboratory testing across the continent,” the CEO states.
PARTNERS ADD VALUE TO ASLM
Nqobile enthuses that the idea of setting up ASLM resonated with many different stakeholders, with many international, regional, and local partners joining hands together to get the Society off the ground. When ASLM was launched, every organization in the health space lauded the need to set up the body, including laboratories across the continent.
He applauds the work and financial and technical support from Africa Centres for Disease Control and Prevention (ACDC), the US Centers of Disease Control & Prevention (CDC), WHO Regional Office for Africa, UNITAID, Global Affairs Canada, Fleming Fund and many others.
Laboratory testing is one of the most neglected areas in healthcare in Africa. Many people prefer just treating patients or managing conditions without really taking a sample for testing in the lab
“I want to acknowledge all the international and regional partners, and even individual health workers who have been great partners to ASLM. We don’t want to take all the credit because their contributions, whether financial, technical and other support has contributed immensely to what we have achieved in the last 10 years.”
“They trusted in us, they have been patient with us, and they have worked with us. The collaborations we have had, even within the ministries of health in many Africa countries, has made the ASLM brand name to be recognized in the laboratory systems across Africa and beyond”
ASLM MAKES ITS MARK
As ASLM marks its 10-year anniversary, the CEO is proud of the milestones and the achievements the Society has made, especially in advancing its core mandates in the laboratory medicine profession and associated networks in Africa.
Chief to these achievements has been its delivery on the five strategic pillars, which includes improving the laboratory networks, workforce and quality of laboratory services, while boosting data and communication and contributing to better regulations in the sector in Africa.
“Our vision as ASLM is for a healthier Africa through access to quality laboratory services for all, and our mission statement is improving clinical and public health outcomes in Africa by enhancing professional laboratory practice, science and networks, says the CEO. “ASLM exists to build laboratory capacity across the continent. We have 5 strategic pillars and number one, and two priorities is around building laboratory networks and laboratory workforce in Africa.”
He informs us that in terms of the workforce, the ASLM has over the last 10 years contributed a lot in enhancing in-service training for laboratory workers to improve on their confidence and competence. These training efforts over the years eventually culminated to the launch the ASLM Academy in March 2020 “ASLM has been a very strong pillar in developing training programs, that have been accepted regionally and at the country level. We work with ministries of health and implement our programs through these ministries since we want these programs to be owned and driven by the ministries of health in the countries where we work.”
The ASLM Academy is a platform where medical laboratory professionals from Africa and across the globe can access online, face-to face training and information packages that can be used towards continuous professional development. It focuses on delivering practical, problem-solving learning packages that support the advancement of knowledge and skills in laboratory medicine, assisting in recognising the value of various in-service trainings for individual career development.
The other key priority training area for the Society has been improving quality management systems, with a focus on the people who are working in the laboratories to ensure better quality results of testing. “How to ensure that when a patient visits a hospital and the doctor receive the results from the lab that they can be confident that this result is accurate and reliable, and the doctor can act on the result?” he poses.
With more than 10,000 members across Africa and beyond, ASLM has conducted dozens of in-service trainings together with its partners, with more than 200 members participating in its laboratory system community of practice. It has also offered several fellowship programs in HIV/AIDS and anti-microbial resistance (AMR).
Significant progress has been further made in enhancing the capacity of laboratory managers and laboratories in Africa.
For example, ASLM is leading the implementation of a program called Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) which was established in 2009 by the World Health Organization’s Regional Office for Africa as a framework for improving the quality of public health laboratories in developing countries.
ASLM will be soon rolling out a training program called LABNET LEAD that is aimed at strengthening leadership capacity for managing laboratory networks. ASLM is also supporting another sister program called Strengthening Laboratory Management Toward Accreditation (SLMTA).
Nqobile explains that SLMTA is a task-based training and mentoring tool kit provided to laboratory personnel in a multi-workshop implementation model, with a framework that defines the tasks a laboratory manager must perform in order to deliver quality laboratory services that support optimal patient care.
“SLMTA empowers laboratory managers to initiate immediate laboratory improvement measures, even without additional resources and its training activities are designed to enable laboratory managers to accomplish tasks using tools and job aides to enhance their management routines.” It is implemented by laboratory personnel through work plans that prepare and support laboratory quality improvement.”
The SLIPTA program is a framework of auditing that checks and monitors the improvement process in a laboratory facility. The audit identifies gaps, non-conformities and provides recommendations for corrective actions and is developed in line with the ISO 15189:2007 Standards and the 12 Quality System Essentials of the CLSI Laboratory Quality Management System Guidelines.
Through standardised processes, SLIPTA measures and evaluates the progress of laboratories towards international accreditation and awards a certificate of recognition with 0-5 star ratings, enabling laboratories to develop their quality management systems in order to produce timely, reliable and accurate laboratory results.
The CEO reveals that since the launch of this program the number of ASLM certified laboratories in Africa has increased to 633 in 2019, with the proportion of laboratories achieving international accreditation outside South Africa increasing. “These programs are geared towards establishing systems that ensure quality of the results and have been adopted by the ministries of health to improve their laboratories. We then followed up on these laboratories by auditing and certifying them.”
Across Africa, there are currently 23 SLIPTA participating countries and more countries are adopting the program. . “As we speak right now, we have over 600 laboratories across the continent that we have certified; although we know there are more labs that have undergone this process because countries took ownership and ran away with the program.”
MORE WINS AND RESOURCES
“If you look at our last pillar, which is knowledge and communication, ASLM has created a laboratory community of practice (CoP), a peer-to-peer learning platform. Through these CoPs, we are bringing all the individuals across the continent to learn from one another, institutions to learn from one another, and even programs to learn from one another.”
Known as LabCoP, the platform fosters knowledge exchange and joint learning by linking together country teams and global experts and sharing the knowledge and best practices on laboratory systems strengthening amongst ministries of health in Africa.
LabCoP has grown beyond its initial focus on viral load testing and now covers waste management, monitoring & evaluation, HIV, tuberculosis, COVID-19, other essential testing services, and the potential of testing several diseases through single platforms.
Among other goals, LabCoP aims to enable laboratories meet the UNAIDS 95-95-95 treatment targets via South-South learning amongst laboratorians, clinicians, policymakers, patients and communities with the goal of strengthening laboratory systems to improve health outcomes.
Activities including webinars and teleconferences using the ECHO model with interactive case-based learning and short didactics to facilitate knowledge exchange and joint learning, form the core of the platform.
These forums enable countries to come together and present their success stories and turn them into a recipe or a formula that give other countries the knowledge on how to implement similar activities in their own settings to achieve success.
“Over the last 10 years, we have had more than 30,000 connections that brought different people together – not only laboratory workers but also clinicians because we understand that the laboratory cannot operate in isolation. We also brought in social scientists since they deal with the community – our programs must connect to the community in which we operate. We are very proud that over the last 10 years we have brought the laboratory community together in Africa through ASLM.”
The connections and knowledge sharing by ASLM members is also complemented by the bi-annual ASLM conferences, which have taken place since 2012 and is attended by over 1,500 delegates every year. The next edition takes place mid-November this year, virtually.
“These are unique conferences – the first time the ASLM Conference was held, it opened a huge platform for the laboratory community to come together and share their achievements and share the lessons that they are learning. It has also become the platform of exchanging experiences and challenges. We have a feeling that this year’s virtual conference will enable a lot of people attend not only from Africa, but also from the US, Europe, UK and Asia.”
“This year our 5th biennial international conference will be focusing on “Responding to outbreaks through resilient laboratory systems: Lessons learnt from the COVID-19 pandemic”. This is a timely discussion given the COVID-19 pandemic and we aim to address several key issues throughout the conference, including outbreak response, laboratory response and lessons learnt and ownership, partnership and innovation.
The other key achievement in building networks by ASLM its LabMap initiative, which assists countries with GIS localization of their laboratory capacity to better manage their network and optimization their testing services. Utilizing the LabMap data improves functionality of national and regional laboratory networks by mutualising existing resources, increases diagnostic testing capacity and surveillance coverage of laboratory networks and helps prepare the region for and respond to disease outbreaks, such as the current Covid-19 pandemic.
Further, ASLM’s Diagnostic Evidence Hub is a knowledge platform that provides national reference laboratories, national regulatory authorities and diagnostics stakeholders with key information from published studies on the technical performance of new in vitro diagnostic products. It enables ASLM member organisations access to publicly available technical data in order to inform decision-making and support in-country registration and adoption of new, impactful, and quality-assured diagnostic products.
ASLM is a member of the Integrated Diagnostics Consortium which focuses on enabling the deployment of a robust, efficiently utilized testing capacity and a healthy and secure market with competitive supply, in a global market for diagnostics that does not meet the needs of the millions of people living with HIV, TB, HPV, Hepatitis and other diseases. “Current testing coverage is low, yet demand continues to grow sharply in the face of limited resources, highlighting the need for innovative approaches.”
And lastly, ASLM’s Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP) is a multi-organization and multi-national collaboration that seeks to establish a system for the collection, storage, and analysis of antimicrobial resistance (AMR) and antimicrobial use (AMU) data across Africa.
REGIONAL EXPANSION ON THE CARDS
From its head office in Ethiopia and its new office in South Africa, Nqobile says that the Society manages its activities across the continent, but the sheer size of the continent and its varied regulatory and infrastructure holds them back in delivering on their mandate in every country.
“Currently, we have intra-country activities in 35 countries out of 54; we are yet to expand to the northern part of Africa. We have worked in different countries in the other regions of the continent; of course, the situation is different in every country and the strategies applied in each are different. When you are looking at implementing programs, the pace at which you will move, will vary from region to region as well.”
“This is one of the reasons why we are expanding our footprint to have our presence in all these different regions, so that we understand the culture and the local context so that when we move in with our programs, we don’t face a lot of challenges. We are beginning to have an approach where we want to establish our presence and I think we are already doing that, in the sense that in all these different regions, we have our staff based in these countries.
He further elucidates that there are new opportunities brought by Covid-19 and vital lessons unearthed by the Society during the past nearly 2 years of the pandemic.
“When Covid-19 pandemic began in December 2019, as the Society we created a virtual platform in early 2020 to disseminate information updates by inviting experts with the right knowledge to disseminate this information to our members. I am proud to say that ASLM really played a key role in making sure that the community stays abreast on the developments, in-terms of testing protocols, the Covid-19 itself and emerging issues as it rolled on into the rest of the year to date. The platform had a huge attendance as everyone was keen to understand what was happening around the disease.”
The pandemic, he adds, has provided the opportunity to ASLM to demonstrate its role as the leading voice to the laboratory medicine fraternity in the continent.
There are more positive outcomes from the pandemic. “For the first time, laboratory services have received huge attention, not only within Africa but internationally; everyone has been talking about testing, testing, testing. The pandemic provided the opportunity to expand and decentralize testing from the huge, big laboratories to district or local settings. On the innovation side of things, it brought the opportunity to develop rapid testing kits that took 10-30 minutes. Covid-19 has really brought the laboratories to the forefront and the resources and infrastructure that have been made available for laboratory services because of the pandemic has provided the opportunity for the laboratories to really become more visible and more prepared for the next pandemic,” he states.
THE FUTURE IS BRIGHT
With its work cut out and ASLM having its plans to grow further, the future can only be brighter for the Society and the laboratory medicine sector in Africa
“Looking into the next 5 to 10 years, our inspiration is to have more country driven approaches and solutions; that’s where we want to put our energies because if we do that, we know there is going to be continuity and there’s going to be sustainability. For the last 10 years or so, which has been beautiful, all these brilliant ideas and solutions have been coming from outside the continent but now that we have established these peer-to-peer learning platforms, local knowledge, south to south collaborations etc., we want to harness that as ASLM and begin to see these solutions being expanded and scaled up and owned by African countries.”
“We have seen over the years that some of these solutions are already here. As ASLM, we would like to guide countries to utilise solutions that they have come up with to growth them and expand them further, to move laboratory medicines in Africa to another level.”
This feature appeared in the February 2022 issue of HealthCare Africa. You can read this and the entire magazine HERE
