Abstract
BackgroundCommunities in rural, low-resource settings often lack access to reliable diagnostics. This leads to missed and misdiagnosed cases of disease and contributes to morbidity and mortality.ObjectiveThis paper describes a model for providing local laboratory services to rural areas of Ghana, and provides suggestions on how it could be adapted and expanded to serve populations in a range of rural communities.MethodsThe Tropical Laboratory Initiative (TLI) system in Ghana comprises one central laboratory where samples delivered from clinics by motorbike riders are analysed. Test requests and results are communicated on a mHealth application, and the patient does not have to visit the laboratory or travel beyond the clinic to receive a test. The TLI also serves as a research base. The laboratory is accredited by the National Health Insurance Authority, and accepts the national health insurance. The TLI serves several communities in Amansie West, Ashanti region, and currently works with 10 clinics. The nearest hospital is a one-hour drive away and is the only other nearby facility for diagnostics beyond basic rapid tests.ResultsDemand for services has increased yearly since the launch in 2010, and the TLI currently provides over 1000 tests to approximately 350 patients monthly. The majority of patients are female, and the most common tests are for antenatal care. Our experience demonstrates that laboratory services can be affordable and most components already exist, even in rural areas.ConclusionMinistries of health in low-resource settings should consider this model to complement the rapid tests available in clinics. Integrating with an insurance system promotes financial sustainability.
Highlights
Access to reliable diagnostics can be a barrier to appropriate, timely medical treatment in resourcelimited settings
The Tropical Laboratory Initiative (TLI) model demonstrates that a strong national laboratory system covering rural areas has potential for both epidemiologic surveillance and research on new or improved diagnostics
All or many components of a successful laboratory system already exist in rural areas, and there is often no need to invest in costly and complicated infrastructure, or in extensive training if services fit within what health workers are equipped to offer and interpret
Summary
The TLI was designed to serve a network of partner clinics. The model consists of one central rural laboratory, composed of three rooms – the main laboratory, a phlebotomy room, and an office – and staffed with two laboratory technologists and two motorbike riders who deliver samples from nearby clinics. The motorbike riders, who are not laboratory scientists, were trained in safe blood collection and sample storage as part of a special training module developed by the President’s Emergency Plan for AIDS Relief (PEPFAR). They support nurses by collecting blood or other specimens from patients as requested by clinic staff. The TLI receives insurance reimbursements, so that any Ghanaian enrolled in the NHIS can receive TLI services for free This supports the sustainability of the business model and promotes universal access to diagnostic services. The TLI will pursue accreditation through Stepwise Laboratory Quality Improvement Process Towards Accreditation (http:// www.aslm.org/what-we-do/slipta/) as recommended by the Ghanaian government
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