Clinical Laboratory Accreditation Transposition of Clinical Laboratory Accreditation on Sub Sahara Africa; Effects and contradictions



Table of Content

Introduction3

Whence comes the pressure?3

What is meant by reducing costs?4

Disease burden in Africa5

Pathology services of some African countries7

Problems facing pathology services in Africa25

Effectiveness of the service27

Does science only belong to the 'developed' world?27

Pathology as a support for primary care as well as more advanced levels of care27

Market forces to hone service28

Investment in pathology to improve quality of service28

Examples of a pathology service proportional to care29

Conclusions30

References31

Transposition of Clinical Laboratory Accreditation on Sub Sahara Africa; Effects and contradictions

Introduction

Health managers throughout the world, faced with burgeoning costs and lead by hordes of consultants and Adam Smith disciples advising on free market economics, have identified the pathology service as one of which cost can be reduced by lowering the standard of and limiting skills, automating, and by restricting investigation. This, in the face of the rapid development of technical skills, knowledge and of science appropriate to the care of a patient, and in an era where error is unacceptable. (Rabuffetti and Benvenuti 2001 638-643)

Whence comes the pressure?

Where care is paid through medical insurance, there seems to be a drive by the insurance industry to reduce their risk and therefore costs. Politicians have a significant interest in reducing the taxation bill to the public, pathology services being a ripe target everywhere. In South Africa, there is the additional pressure to move from inappropriate reliance on tertiary care to the level of primary care. Within this scenario pathology is in danger of being regarded as a tertiary service, a premise with which we disagree. Clinicians often lead the fiddle playing as they dance to the current managerial tune of divides after all if money is taken from pathology their own budgets can be inflated.

What is meant by reducing costs?

Are we talking about reducing costs of a Western standard of health care with unlimited access to every frontier crossed by scientific medicine? Where every cell can be tweaked and pharmacologically twiddled, every unwanted fold of skin pushed back to its youthful place, children made tall and beautiful, drugs invented, marketed and thrust down throats to sustain a lifestyle fed by gluttony and sloth, complaining all the while of the consequences. Where Lazarus rising from the dead is the rule of the day - eternal life is here to stay at any cost? (Croce and Cappozzo 2000 260-266)

Or do we mean to limit health care across the board? Most Africans have no health care at all and no access to pathology services. The laboratories and health services of the developing world account for only 5% of the world's consumption of laboratory instrumentation and reagents. There are no reductions to be made. Could this pressure mean the demise of pathology? Certainly within some Western countries, pathology is in danger of being reduced to the level of a bald reporting service as if context and nuance were irrelevant - a neutered medical Reuters. This trend has become most evident in clinical biochemistry - “The machine ...