Thursday, 28 March, 2024
HomeNews UpdateSA's NHLS in 'critical condition'

SA's NHLS in 'critical condition'

The National Health Laboratory Service (NHLS) – a national asset at the heart of the country’s healthcare system – is in a critical condition. According to a Mail & Guardian report, it is in debt to the tune of R5bn, is leaking skilled staff, and many of the employees who remain are demoralised.

The ongoing financial crisis has severely affected the service’s capacity to deliver necessary services, leaving the future of laboratory testing in South Africa in jeopardy and creating a leadership void, amid perceptions that embattled chief executive officer Sagie Pillay might be on his way out.

This grim picture was sketched by health experts who work closely with the service and three senior people inside the NHLS, who spoke on condition of anonymity. "We've never had a test not come out, but we've hit the wall," said a senior staff member, adding that he was on the verge of walking out.

According to NHLS detractors, financial mismanagement is the problem; others believe fault lies with a dysfunctional board. Others say it’s because two provinces aren’t paying for services rendered. According to Health Minister Aaron Motsoaledi, it’s the chaotic, glitch-riddled billing system. Some blame an "interfering minister".

Health experts say that, whatever led to the mess, the implications are "horrifying" – and must be resolved urgently and permanently. "Without the NHLS, the country's health system cannot function," says social justice organisation Section27's executive director Mark Heywood. "The NHLS is responsible for most HIV and tuberculosis tests in the public health system and plays a critical role in screening for cervical cancer. HIV and TB treatment depend on accurate and timely tests. Without the service, TB, HIV and cancer patients won’t have access to diagnostic testing, which means they won’t be properly treated. The implications are serious: without lab tests, there can be no other services."

"Yes," agrees Professor Francois Venter from the Wits Reproductive Health and HIV Institute, "the NHLS has been lurching from crisis to crisis for four years. It’s nothing short of a monumental stuff-up."

Earlier this year Motsoaledi said faults in the service's billing system were to blame for its financial woes. One of his reforms is to bypass the provinces and pay the service a global lump sum directly from the treasury. Another is to create a national public health institute to monitor disease and respond to outbreaks. It would include the National Institute for Communicable Diseases, the National Institute for Occupational Health and the National Cancer Registry, which is currently run by the service, as well as two new institutes – the National Institute for Non-Communicable Diseases and the National Institute for Injury and Violence Prevention. The minister has also said the cost of training pathologists and technicians, another of the service’s tasks, would become the education department’s responsibility.

But Motsoaledi's reforms are "too little, too late", says a source. "The problem is, we've lost so many staff. In the last year 30 pathologists have left – and we already had fewer than we needed. We've lost all their years of experience. They are leaving through sheer frustration. We’ve also lost 30% of our technologists. People with 10 years' experience are being replaced by people fresh out of (college)."

Dr Francesca Conradie, president of the Southern African HIV Clinicians Society, says it is worrying that technicians and technologists are leaving. "Laboratory testing is a labour-intensive technical service – we train them; we want them to stay with us. If they don’t, we’ll see a decline in quality." She describes the service as an innovative laboratory network that uses technology – such as the celebrated GeneXpert programme, which diagnoses active TB throughout South Africa much faster than ordinary laboratory procedures – to link all systems to a single, central database. According to Conradie, South Africa's ability to deliver outstanding HIV care is dependent on laboratory testing. "For TB and HIV, laboratory investigations are needed to initiate and monitor therapy. Ten or 15 years ago we took a wise decision to have a viral load supported programme; we can’t afford to let that fall down because of administrative issues."

Despite the crisis, the service's quality hasn't dropped "yet", according to a source, who warns that this will happen when unpaid suppliers shut down their services.

[link url="http://mg.co.za/article/2015-01-09-crisis-in-laboratory-threatens-the-nations-health"]Full Mail & Guardian report[/link]

MedicalBrief — our free weekly e-newsletter

We'd appreciate as much information as possible, however only an email address is required.