A comprehensive district-level laboratory intervention after the Ebola epidemic in Sierra Leone

Mesman, Annelies W.; Bangura, Musa; Kanawa, Sahr; Gassimu, Joseph; Dierberg, Kerry; Sheku, Mohamed M.; Orozco, Juan Daniel; Marsh, Regan H.

doi:10.4102/ajlm.v8i1.885

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…Yet we found overall availability of essential diagnostic tests, especially manual assays, to be low and to vary considerably. These results possibly reflect the focus of post-Ebola laboratory strengthening on strengthening molecular units in tertiary care laboratories in tertiary care facilities and PLOS GLOBAL PUBLIC HEALTH national reference laboratories, with little investment in improving diagnostic systems at a primary care level [12,31].…”

Section: Discussionmentioning

confidence: 99%

“…In this article, we build on this growing evidence base to assess the availability of essential diagnostic tests and diagnostic systems in primary health care facilities across the Western Area in Sierra Leone. Conducted five years after the West Africa Ebola Virus Disease (EVD) outbreak, which drew international attention to the under-resourcing of national diagnostic systems in the region [11,12], our study seeks to identify outstanding resource gaps in the provision of essential diagnostic services at a primary care level.…”

Section: Introductionmentioning

confidence: 99%

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The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone

Street

Vernooij²,

Koker³

et al. 2023

PLOS Glob Public Health

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This article assesses the availability of essential diagnostic tests in primary health care facilities in two districts in Sierra Leone. In addition to evaluating whether a test is physically present at a facility, it extends the concept of availability to include whether equipment is functional and whether infrastructure, systems, personnel and resources are in place to allow a particular test to be “ready to hand”, that is, available for immediate use when needed. Between February 2019 and September 2019, a cross-sectional mixed-methods survey was conducted in all 40 Community Health Centres (CHCs) in Western Area, one of five principal divisions in Sierra Leone. The number of rapid diagnostic tests (RDTs) available ranged from 1–12, with 75% of facilities having 9 or less RDTs available out of a possible 17. While RDTs were overall more widely present than manual assays, there was wide variation between tests. The presence of RDTs at individual facilities was associated with having a permanent laboratory technician on staff. Despite CHCs being formally designated as providing laboratory services, no CHC fulfilled standard World Health Organisation (WHO) criteria for a laboratory. Only 9/40 (22.5%) CHCs had a designated laboratory space and a permanently employed laboratory technician. There was low availability of essential equipment and infrastructure. Supply chains were fragmented and unreliable, including a high dependency (>50%) on informal private sources for the majority of the available RDTs, consumables, and reagents. We conclude that the readiness of diagnostic services, including RDTs, depends on the presence and functionality of essential infrastructure, human resources, equipment and systems and that RDTs are not on their own a solution to infrastructural failings. Efforts to strengthen laboratory systems at the primary care level should take a holistic approach and focus on whether tests are “ready-to-hand” in addition to whether they are physically present.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone

Street

Vernooij²,

Koker³

et al. 2023

PLOS Glob Public Health

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“…Innovative services seek to reduce hospitalizations through better follow-ups in primary healthcare [4]. Increased investment in new equipment generates positive outcomes, such as detailed diagnoses, successful treatments, and effective disease prevention that improve performance, including the economic performance of organizations [13].…”

Section: Investment In Health and Prevention Savingsmentioning

confidence: 99%

From Human Rights to the Right to Health: A Systematic Literature Review

Nogueira¹,

Marques²,

Goncalves³

2022

IJSWPM

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This study aims to analyze literature that reflects on prevention in health, with a focus on humanization and medium-and long-term impacts on the economy of countries and suggest future research that further expands this topic. The use of the SMARTER method to select the articles included in the literature review and choose the best alternatives presents a series of techniques and methods to support decision-making when there is a multiplicity of criteria. Through a systematic review of the literature over the past 41 years, articles were selected using the SCOPUS database, where 96 studies were analyzed after using the SMARTER selection criteria. The results point to the need to review and improve policies, interventions, and public activities that address prevention in health, with less emphasis on the curative approach and without neglecting economic and social facets. A strong argument highlighting the importance of the economic factor lies in the possibility of increasing participation in the labor market and combating social inequalities.

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“… 1 , 2 , 3 During and after the outbreak, the public laboratory was a key target for interventions aimed at improving laboratory services, including training of personnel, provision of equipment and infrastructural improvements. 4 , 5 , 6 Several publications have explored the experiences of international laboratory teams concerning their diagnostic achievements and laboratory support during and after the outbreak. 7 , 8 , 9 , 10 , 11 , 12 , 13 Other publications have focused on the experiences of frontline health workers, including nurses and doctors.…”

Section: Introductionmentioning

confidence: 99%

Invisible and undervalued: A qualitative study of laboratory workers’ experiences and perceptions of laboratory strengthening in Sierra Leone

Jalloh,

Vernooij,

Street

2024

African Journal of Laboratory Medicine

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Background: The 2013–2016 West Africa Ebola outbreak highlighted the importance of laboratory capacity to outbreak response while also revealing its long-standing neglect. The outbreak prompted massive international investment into strengthening laboratory services across multiple healthcare settings.Objective: In this article, we explore hospital-based clinical laboratory workers’ experiences and perceptions of their everyday working environment in Sierra Leone, and how recent investments in laboratory strengthening have shaped these.Methods: This qualitative study draws on in-depth interviews with eight laboratory workers and participant observation of laboratory practices at a tertiary referral hospital in Freetown between April 2019 and December 2019. Interview and observational data were coded and analysed using a reflexive thematic approach.Results: The Ebola outbreak prompted international investments in automated devices, biosafety training, and a new dedicated infectious diseases laboratory. However, little investment was made in the infrastructure and supply systems needed to sustain routine laboratory work or keep machines functioning. Laboratory workers perceived their work to be under-recognised and undervalued by the government, hospital managers and clinical staff, a perception compounded by under-use of the hospital’s laboratory services by clinicians.Conclusion: Understanding laboratory technicians’ views, experiences, and priorities is essential to any sustainable laboratory-strengthening effort. Investments in personnel should match investments in technologies and infrastructure for outbreak response.What this study adds: This study contributes to an understanding of how clinical laboratory personnel in Sierra Leone view and experience their work, and introduces the concept of social invisibility to explain these experiences.

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A comprehensive district-level laboratory intervention after the Ebola epidemic in Sierra Leone

Cited by 5 publications

References 24 publications

The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone

The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone

From Human Rights to the Right to Health: A Systematic Literature Review

Invisible and undervalued: A qualitative study of laboratory workers’ experiences and perceptions of laboratory strengthening in Sierra Leone

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