MANPOWER DEVELOPMENT; An Essential Tool For Effective And Sustainable Health Services

Theo. L. Olawoye, M.Sc.(St.And.) Ph.D.(Ib.)FIBMS(Lond) FMLSCN. Professor of Biochemistry, School of Sciences, The Federal University of Technology, Akure. Ondo State.

It is with a great sense of honour and privilege that I greet you all, as Guest Speaker in the Third of the Series of Annual Public Health Lectures organized  by the National Association of Medical Laboratory Scientists of Nigeria. The theme of the lecture as publicized is “ MANPOWER DEVELOPMENT: An essential tool for effective and Sustainable Health Services.’’

Coming soon after the Association’s 2nd Continuous Professional Development and Collaborative Workshop which took place at Akure, Ondo State on the 19th November 2008; I believe that my choice as Guest Speaker at this Public Health Lecture was not predicated by chance but as offshoot of the Akure Workshop.

Incidentally at the Akure lecture I challenged the AMLSN and all Stakeholders in the practice of Laboratory Medicine in Nigeria to brace up for an inevitable Repackaging of the Manpower Training and Practice of Medical Laboratory Science to meet Nigeria’s Millennium Development Goals (MDG’s) of the 21st Century. In today’s lecture, we shall also continue in our collective enterprise towards reshaping our common destiny as biomedical scientists and public health stakeholders. The emphasis of this lecture is on Manpower Development as an essential tool for effective and sustainable Medical Laboratory Services Delivery in our Public Health System.

AN OVERVIEW OF THE NATION’S MILLENNIUM DEVELOPMENT GOALS AS IT AFFECTS PUBLIC HEALTH.

World leaders came together in New York in September 2000 for a high-level event convened by the UN Secretary-General and the President of the UN General Assembly to renew commitments to achieving the Millennium Development Goals by 2015 and to set out concrete plans and practical steps for action. The Millennium Development Goals (MDG’s) were developed out of eight chapters of the United Nations Millennium Declaration, signed on the 25th September 2000.

The MDG Africa Steering Group, issued its recommendations, laying out practical steps, strategies and costed programmes needed to achieve the Millennium Development Goals in Africa, in a landmark report produced and endorsed by the United Nations and other major development institutions. These are:

• End Poverty and Hunger
• Achieve Universal Education
• Ensure Gender Equality
• Ensure adequate Child Health
• Ensure adequate Maternal Health
• Combat HIV and other Infectious Diseases
• Promote Environmental Sustainability
• Promote Global Partnership

Thus the Millennium Development Goals (MDGs) represent commitment by governments worldwide to do more to reduce poverty and hunger and to tackle ill-health, gender-inequality, lack of access to education, lack of access to clean water, and environmental degradation. They also include commitments to reduce debt, increase technology transfers and build development partnerships. The MDGs are interrelated and interdependent, as trying to tackle one goal, involves the other. Thus to reduce poverty (Goal 1, Target 1) steps have to be taken to ensure adequate nutrition and have a healthier population. To have good health also depends on astute use of natural resources and environmental sustainability.

Only the FOUR underlisted goals are directly relevant to Medical Laboratory Science Practice in Nigeria and are listed only for the purpose of this discuss.

• Reduce child mortality
• Improve maternal health
• Combat HIV/AIDS, malaria and other diseases.
• Ensure environmental sustainability

Therefore Manpower Development in Medical Laboratory Science for the Millennium requirements therefore must be geared towards enabling the millennium compliant medical laboratory scientist to reposition himself for effective attainment of these goals.

MANPOWER DEVELOPMENT FOR EFFECTIVE AND SUSTAINABLE PRACTICE OF MEDICAL LABORATORY SCIENCE IN NIGERIA.
To newly qualify and be registered in Nigeria, a medical laboratory scientist today by Nigerian law must  earn a bachelor's degree in Medical Laboratory Sciences (Clinical Laboratory Science) or in any life science, in which case accreditation and one year internship in an accredited training program certified by  the Medical Laboratory Science Council of Nigeria is also required. Where the training is not presently directly in a University, the training Institution must be affiliated to a Nigerian University for the award of the affiliate University Degree.

A fair number of Nigerian Universities now offer graduate level programs for a career in Medical Laboratory Science, as more and more obstacles are being surmounted.

Trained people are the key to the health infrastructure. Without appropriate trained manpower, other resources of health system are under utilized, or even wasted. Priority should be given to manpower training and in particular to development of local training programs for doctors, nursing and paramedical staff and others in the health care team to meet the growing needs of community health services staffing nationally.

A variety of international agencies provide important project development funds for government and non-government health services in the areas. These agencies also allocate funds for social and economic development projects directly and indirectly linked to health conditions of the areas.

The United Nations Development Program (UNDP) in particular has provided large scale financial assistance to help foster development of health services.

Knowledge has become the most important factor for emancipation of any people or class of people. Knowledge through its capacity to improve the skills of any professional group like medical laboratory scientists, augments productivity and constitutes the profession’s competitive advantage in the country’s search for relevant manpower for her Millennium Development Agenda. Findings from several studies and current economic indices show changes and innovations in economic, political, social as well as technological systems requires adjustments and refocusing of training curricula of educational systems to meet the current demands of globalization. The training of medical laboratory scientists cannot be an exception.

The curriculum of what is to be taught in our universities offering Medical Laboratory Science should be a prime concern now than ever before to the Nigerian Medical Laboratory Science Council and the Association of Medical Laboratory Scientists of Nigeria.

CASE FOR THE GLOBALISATION OF THE TRAINING CURRICULA FOR BIOMEDICAL SCIENTISTS.

Medical science, in general, has been working towards the globalization of Medical training. For instance, education systems of physicians and nurses have been brought up to international standards since international health and education related organizations like WHO and UNESCO showed their concern over the world wide health problems, and got involved in supporting health for everyone programs.

A consortium of researchers in Clinical Laboratories in the Republic of Korea recently (2006) published a compendium of logical data justifying a call for the introduction of an internationally unified curricula for Biomedical Laboratory Science (BLS) education. The argument for this was based on the justification that diagnosis and the cure of diseases should be globally standardized. The International Federation of Biomedical Laboratory Science (IFBLS) has also declared its mission statement to play a key role in medicine by ensuring good laboratory practice (GLP), for sound human health all over the world.

Many different names are used worldwide to define the profession; like Medical Technology (MT), Clinical Laboratory Science(CLS), Medical Laboratory Technology (MLT), Biomedical Science(BMS), and Medical Laboratory Science(MLS), etc. However, all those different names come to one goal, that is, the key for the cure. It was argued that IFBLS is the most appropriate organization to initiate the launching the taskforce for the development of world widely applicable curricula for BLS education by setting up an administrative body to study the unified BLS education curricula and international certification programmes.

When the project becomes materialized, it is expected that IFBLS could be attracting more members, monitoring the standard of BLS, and conducting balanced manpower deployment throughout the world by the unified curricula and consequentially implementing certification programs.

When this happens, the IFBLS of which the AMLSN  is an affiliate member can:

• become a more influential organization attracting more members
• promote world wide recognition as indispensable professional organization
• initiate a variety of mission projects.
• facilitate upgrading the standard of BLS by monitoring education and  curricula of the member countries.

In recent times, nearer home here in Nigeria, the National Universities Commission (NUC), in pursuance of its objective of an orderly Manpower  Development in university pharmacist education in Nigeria, and, particularly in forestalling a crisis in the mounting of varied pharmacy programmes by different Universities in Nigeria, convened a meeting of stakeholders to discuss the B. Pharm and Pharm. D programmes on Tuesday 30thJanuary, 2007.

Prof. Placid C. Njoku, former Director of Quality Assurance, chaired the stakeholders’ meeting. In attendance were representatives of Hon. Minister of Health, PCN and PSN, and Deans of Faculties of Pharmacy in Nigerian Universities. Others were, the representative of the National Employers Consultative Association, Members of the House Committee on Health, Visiting Professors in NUC, Staff of the Departments of Quality Assurance and Academic Planning and Research.

All the Pharmacy professionals and the Representative of the Minister of Health at the meeting indicated their support for the adoption of the Pharm. D in Nigerian Universities. It was their view that the Pharm. D programme would be taught in six (6) years and that new courses in Pathology and Pharmacovigilance would be introduced.

The Clinical Pharmacy component  were expanded to include other areas of the discipline. The training of Pharmacists would henceforth be patient-oriented rather than product-oriented. At the end, the stakeholders were in concert with each other that graduates of Pharmacy profession with Pharm. D would be better equipped to handle new developments in Healthcare Delivery and that the new direction is in line with the new National Health Policy.

After the exhaustive deliberation that addressed the key issues in the training of Pharmacy professionals, the stakeholders agreed to recommend a paradigm shift in the training of  Pharmacists to make them sensitive to the new challenges in healthcare delivery. This involved a change from drug-oriented to a patient-oriented training of Pharmacists.

The foregoing are meant to highlight that the AMLSN and MLSCN as stakeholders of the Medical laboratory Science Profession in Nigeria, cannot sit on the fence as it were in the push for continuous manpower development.

The National Universities Commission (NUC) is saddled with the responsibility and leading role to ensure quality of teaching and research in all University based courses, including Medical Laboratory Science, butas a professional course, the NUC will rely on the Medical Laboratory Science Council of Nigeria and the AMLSN  to provide the benchmark for the “Minimum Standard”  for the Bachelors Degree in Medical Laboratory Science (BMLS).

• TRAINING CURRICULUM  FOR NIGERIAN MEDICAL LABORATORY SCIENTSTS.

Medical Laboratory Science has moved a far distance from being an evening course for school leavers in hospital laboratory side labs or just professional courses in the now defunct schools of Medical Laboratory Science.

The present trainees now undergo their basic training in Universities or in systems affiliated to a University. This single development also calls for the evaluation of the human capital particularly the teaching workforce which are expected to implement the provisions of the repackaged curriculum for quality education that is globally competitive.

I believe that  the Medical  Laboratory Science Council of Nigeria in conjunction with the AMLSN  and other stakeholders should consider a from time to time reviewing of the training curriculum to meet the National challenges of the 21st  Century.  Such curriculum should constantly reflect what we value as a nation and seek for a virile heath care system. It should convey knowledge, the prerequisite for promotion of development, understanding and capabilities and be concerned with what is to be taught and how it is to be taught, and should be a curriculum that  will enable us to anticipate the changes and medical challenges which the country will face in the future.

A curriculum that will make our products more discerning people, capable of seeing through the political and business hucksterism of the country and thereby be employers of labour rather than job seekers in government hospitals.

Such programme must incorporate recent advances in medical science and technology. We need a curriculum that is fully in harmony with National development priorities and which provides impetus for achieving our vision of being among the 20 most industrialized nations by the year 2020.

NEW FRONTIERS IN LABORATORY MEDICINE
Laboratory Medicine occupies a central position among the Life Sciences owing to the advances made in modern biochemistry and molecular biology and their impacts on human health/pathogen biology and diseases in recent decades; a decade named the ‘decade of molecular biology’.

Now at the apex of these advances are health related breakthroughs like human and pathogen screening projects which have given rise directly or indirectly to new or redefined concepts such as bioinformatics, biotechnology, functional genomics, proteinomics, pharmacogenomics, structural and chemical biology, vaccinology etc.

Also to be able to train the total person, the new curriculum should incorporate aspects of sociology,entrepreneurship and Introduction to Medical vocabulary.
Areas of application of Biotechnology to Health care in the production of Hormones, blood products and vitamins are also relevant for inclusion.

New scientific frontiers have emerged leading to improvement in methodology in various laboratory analyses. The current training curricula should be upgraded to include new concepts both in theory and practice, e.g. PCR techniques which have found wide applications in medicine. Also laboratory methods now available commercially for measuring resistance of the HIV genome to commonly used ARV drugs due to the high turnover of the virus and laboratory typing of viral antigenic surface proteins are now possible.

Bio-Informatics And Telematics.

Information Technology is now one of the major components of the technological infrastructure for health management. All sub-sectors dealing with the generation, transmission and utilization of demographic and epidemiological data
such as bio-informatics, bio-statistics, and the decision support systems (DSS) are finding increasing use in health planning and management.

Telemedicine programmes bring experts together to assist local doctors in the management of complicated cases. A pilot project on telemedicine in primary health care is currently ongoing in Nigeria. Some of the major hospitals can take up online consultation service with other specialists within the country as well as abroad .Efforts are underway to link tertiary care institutions Nationally with major super-speciality institutions in other regions so that patients could benefit from tele-consultation.

Medical Laboratory Science Laboratories in Nigeria can benefit from the scheme which will link one laboratory resource with another.

• CURRICULUM  OF  UNIVERSITIES  OFFERING  MEDICAL LABORATORY  SCIENCE DEGREES IN NIGERIA.

Universities mounting Degrees in Medical Laboratory Science in Nigeria  like the University of Nigeria, Nsukka,  Ambrose Alli University, Ekpoma, Achievers University, Owo, etc. equally have good and well conceived training programmes, which however need to be reviewed from time to time in tune with recent developments in Laboratory medicine worldwide to prevent obsolescence.

• QUALITY CONTROL IN  MANPOWER DEVELOPMENT

The benefits of a Standard Quality Assurance System for Laboratory Analysis in the Nations health care delivery are immense. This will lead to improved efficiency and effectiveness within the laboratory, as a result of Consistency and Continuous Performance Improvement (CPI)

Medical laboratory staff  will thus be empowered and be more confident about the services they provide. The greatest source of friction between medical doctors and  medical laboratory scientists have to do with the reliability and reproducibility of laboratory results. Therefore Improved products and services from both hospital and private medical laboratories to meet the needs of our customers will engender confidence in Laboratory Services and the Medical Laboratory Profession.

• CAPITALISATION OF PRIVATE LABORATORY OUTFITS

Once upon a time there were hundreds of mushroom banks in Nigeria. Some of these so called banks which provided banking services to unsuspecting public could be owned by a man, his wife and children as directors and family needs could draw on the resources of these outfits without hindrance and the bank collapsed. This was the fate of many community banks. After Professor Soludo’s intervention leading to recapitalization of the banking industry, it was no longer business as usual for those who were milking the industry with little or no benefit to society.

The scenario in many of our privately owned medical laboratories in the country today is similar to that of the ‘failed banks’ before 1999. Today we have hundreds of failed medical laboratories because they were established in the first place to provide food for the family rather than being along term investment for public good or to boost the medical laboratory profession. Therefore with the wind of change occasioned by privatization and influenced by a new National Economic Development Strategy (NEEDS) , only businesses that  are competitive survived. Nigerians now have a choice between Nitel and other telecommunication  providers !. Many of the private medical laboratories that closed down were in most cases only capable of a few laboratory tests and with a more discerning public could not survive competition or lately the regular quality assurance standard embarked upon by the AMLSN or the MLCN.

The closure of many private laboratories is not a credit to the profession, therefore the AMLSN must embark on a strategy to REVIVE the failed laboratories by facilitating or brokering the recapitalization of the laboratories. The laboratories in a zone can come together in groups of 5 and pool resources to have one big laboratory owned by the stakeholders. Such recapitalization can be easily financed by banks or through a loan from the Association‘s Cooperative Multipurpose Thrift and Credit Society were some of the members are still in regular employment to serve as collateral for the loan.

• CAPITAL INVESTMENT BY AMLSN FOR PROFESSIONAL EMPOWERMENT

Many academic staff unions in Universities and Polytechnics operate   Cooperative Multipurpose Thrift and Credit Societies through monthly salary deductions at source. By this method members have taken loans in millions of naira to build houses, buy cars and establish good and quality businesses.

I have reason to believe that the AMLSM does this at branch level. I also assume that the National AMLSN receives regular monthly check-offs as members monthly dues to the National body.  Seed money from such check-offs are best used to fire investments for the association like buying land and property in choice areas of the country like Lagos and Abuja.

As the major consumer of reagents and diagnostics in the medical field the AMLSN should invest in and dominate the reagent market not only by buying and selling reagents and glassware but by establishing and owning manufacturing laboratories that may be beyond the individual capability and employ members who have the skills to run such outfit. A laboratory to manufacture standard antisera in blood transfusion and microbial serology is imperative as well as one to produce/breed and maintain small experimental animals for sale.

As part of the Manpower Development process, the Medical Laboratory Science Council of Nigeria; to be a relevant player in the medical renaissance must not only be concerned about licensing and regulating the quality of laboratories but must go a step further to regulate and encourage medical laboratory scientists to produce a good proportion of the consumable reagents for the Nigerian market. By this the profession can ensure quality assurance and generate sustainable revenue and employment for medical laboratory scientists. Nigerian pharmacists compound and sell most of the suspensions and tonics dispensed in clinics and many analgesics in the market.

• EMPOWERMENT THROUGH PROFESSIONAL POSTURE

Medical laboratory Scientists have contributed so much to modern medicine as we know it today in Nigeria, yet received or acknowledged for so little.

Leaders of the profession must be proactive and be in term with long term planning for the benefit of the upcoming generation of scientists. Medical laboratory science must not be viewed as a path to a meal ticket, or one in which the younger members are seen as overambitious competitors, because of their zeal for self improvement, but as a calling in which we must struggle towards leaving the profession better than we met it.

The modest progress recorded in the curriculum and training of medical laboratory scientists today is due to the to the fact that some medical laboratory scientists who believed very early, and still believe that the war of emancipation of medical laboratory sciences in Nigeria will only be won by self improvement and curriculum development and not through the law courts.

Medical laboratory scientists must improve and guard their image in the Medical Team. This must be achieved in an atmosphere of tolerance, cooperation and being team players, not confrontation or anger which unconsciously is a sign of fear. By the right demeanour and conduct, medical laboratory scientists can dictate the pace of Medical research without doing anyone’s bidding.

• WHAT THEN IS THE VISION AND MISSION ?

I do not have any pretensions about my vision nor I am I apologetic for my belief that medical laboratory scientists in Nigeria have not been empowered to reach  or achieve their potentials within the health care system.

 A lot of the obstacles are man made. In most  institutions they are being obstructed from self development and acquiring higher degrees like other Nigerians. There may be still some short- sighted managers of our Health Care Delivery System who can not see far why all the fuss about self development for medical laboratory scientists and others in the health care system,  as being in the National interest,  and so do not agree with the theme of this lecture, that is; Manpower Development is an essential and incontrovertible tool for effective and sustainable Health services.

I hear such people complaining, Why do nurses or medical laboratory scientists or even pharmacists want to develop their potentials? Why are nurses not content to operate like ward maids of the 18th Century, and  then be immortalized as the ”Lady with the Lamp”.  Why do they want a B.Sc Nursing?
Afterall  Florence Nightingale did not have a B.Sc., so why them?

And as for these Medical Lab people ! ;  why can’ t  they  be content as laboratory assistants or technicians. All they are needed for at the present state of our National development,  is to be able to recognize malarial  trophozoites  and worms on microscope !

And these pharmacists ? What is Doctor of Pharmacy ?. All they are needed for is to dispense the drugs like dispensing assistants; even when they formulate and make the drugs. Who needs their expertise or advise in drug use? The 18th century status quo in health care delivery must be maintained !

We are all agreed that the most successful  Minister of Health so far in Nigeria is Professor Olikoye Ransome Kuti of blessed memory. With foresight  and as a good team player, he recognized the potentials of other professionals and used NURSES effectively in the Expanded Immunization Programme  in  villages and hamlets where there may be no Doctors, and  placed Nigeria on the merit list of the World Health Organisation (WHO) in Primary Health Care Delivery.

The Medical Laboratory Science Profession must therefore repackage itself and place in the public domain for appropriation for National Development and be a leading competitor in the imminent medical renaissance in the country.

• CONCLUSION and ACKNOWLEDGEMENTS

I have a dream that the Medical laboratory science profession is yet to achieve its destined height in the country where it can meaningfully husband a self reliant health delivery service as envisaged in the often quoted National Millennium Declaration.

What then needs to be done to get the profession to the desired height? Unfortunately for now most government owned laboratories, state and federal, continue to rank very poorly as the most ill equipped laboratories when compared to some private laboratories. In most of our state hospital laboratories, doctors base their diagnosis on results from mushroom private laboratories because the state ministry allocates little money to the purchase of reagents and equipment.  Sometimes there are no viable blood banking facilities and it is common practice for patients in government hospitals to be infused with blood x-matched in outside laboratories. In essence government needs to address the issues of all impediments to the full development and emergence of our medical laboratories as centers of excellence.

The Nigerian Medical Laboratory Science Council must spearhead the pressure on Government Parastatals responsible for the development of Medical Laboratories in Nigeria. Curiously while the Ministry of Science and Technology listed the Institute of Science Laboratory Technology as one of the Institutes under it; The Medical Laboratory Science Council  was not listed on Web as a parastatal of any Ministry.

On a final note I want to thank the Association of Medical Laboratory Scientists of Nigeria for the singular honour of inviting me to deliver this year’s Public Health Lecture.
To every one else in this hall and especially to those who may not share my optimism about the Medical Laboratory Science profession, and are being skeptical and asking, “can we”?.  I extend an invitation to recall what President Obama told the Americans on the eve of his historic and world re-defining election:“Yes we can”.