How to improve disease diagnosis in Nigeria, by Roche

Taofeek Oloruko-oba is the Country Head, Roche Diagnostics in Nigeria. Roche is a global pioneer in pharmaceuticals and diagnostics. He spoke to journalists on how to improve disease diagnosis in the country. NKECHI ONYEDIKA-UGOEZE was there.

What are you currently doing in Nigeria to advance the course of diagnostics?
In Nigeria, we have full range solutions at Roche diagnostic. We are popular in areas such as diagnostics, which handles things like viral loads, which is popularly in fields like Human Immuno-deficiency Virus (HIV) management. Also, hepatitis is a big challenge in Nigeria; we are in that area also. Our solutions also range in terms of tissue diagnostic, which is very important for cancer care amongst many things. We also carry out routine clinical chemistries. Our solutions are instruments that run these tests and the reagents that are used with those instruments. In Nigeria, we don’t only provide the instruments but the support for them. It is of no use you if you cannot support. We offer support in areas such as engineering technical services and training. The company is in different levels. We also have scientists who are responsible for training and day-to-day support of all the labs we have solutions based in around the country. These are some services we offer in Nigeria.

How can your company help to address the problem of inaccurate lab test results?
This forms the bedrock for why we are here. The best test in the world is useless if it is not accurate. Quality is the watchword. The African Society of Laboratory Medicine (ASLM) was formed and has its major objectives as how to assist and facilitates across Africa to improve the quality of the results. In any industry or profession, you have standards. Within a lab space, a body usually certifies that mark of quality and competency. This is not a small thing. There are a lot of things that need to be done. We do have challenges with the quality of the outcome of our labs. The ASLM as part of its objectives is to assist labs with programmes like this. We have partner with ASLM right from inception. ASLM was formed in 2008 and the first congress was in 2012. This is the first the congress being held outside South Africa. While the training done by ASLM in partnership with the American Center for Disease Control (CDC) and prevention helps lab become accredited, quality control and good lab practice is the right word. The training is held at our campus. Rush Scientific campus in South Africa is a dedicated campus for training on lab related issues. So since 2013, CDC in collaboration with ASLM has been taking people from across Africa desired to be trained. That is one important area we are trying to solve the challenge of questionable lab results. In Nigeria, there is responsibility of ensuring good lab practice and quality rest with the Medical Laboratory Council of Nigeria. The council is working hard in that respect. There is an accreditation programme in Nigeria for Lab. I also want to encourage in anyone in an event where you need the services of a lab, you need to ask a few questions. Has it been registered by a council? Are they accredited? Though it is an important question because it is a difficult task, long journey and not cheap to get accreditation but by asking them, you are cementing the importance that our consumers want to know the test result they are getting is the right thing. We have to spread the message.

What do you think is responsible for the unreliable lab results?
First and foremost, there are a lot of very good labs in Nigeria but they are still not enough because Nigeria is a massive country. I think the general situation we have is we are all facing challenges of various sort ranging from economic, infrastructural, and so on. It is difficult to have a lab working if you don’t have electricity 24/7 and good telecoms. All these are things that are unnecessarily difficult given our circumstance. It starts from there. We need a certain level of expertise, dedication and capital to function effectively.

Are there criteria a standard lab must meet?
Well, Yes and No. You have seen some of our instruments and you come to us purchase them. My first instinct is not to say okay, I will give it to. My first thing is to ask you questions. I won’t give you a quote. I will ask you the rate of test you want to do, how many samples you are getting, where is your lab we need to inspect. We also ask you if you have fully trained lab scientists. We are doing this so that you will provide what is fit for the purpose. We will then advise you.

Nigeria sometimes take samples to countries like Senegal where they have reference lab especially when there is an epidemic outbreak, what is your company doing about this?
I think we do have very good labs and that are able to do a lot sophisticated investigations in Nigeria. We are in very close working relationship with the ministry of health at many levels. What we can do is to engage them in specific matter like the yellow fever issue. We do have well trained scientists and centers of excellence in Nigeria. There is quite a lot of investment that the ministry of health has put on ground. My commitment to you is that we will look at it and engage

Part of the things you deliberated on during conference was how Africa can prevent and control the next pandemic in Africa, how can Africa do this and what role can Roche play to achieve this?
We have a way and we will continue to forge strong public private partnerships with government and stakeholders in order to strengthen the health system. One of the things we want to achieve out of that is Universal Health Coverage (UHC). There is an alignment here that speaks to being prepared for the next epidemic. If you do not have a strong health system, any epidemic that comes would have a devastating effect. We heard the story of the Spanish flu, which was the deadliest epidemic ever. Almost 19 million human beings die. Again, we have had similar epidemic after that but there wasn’t so bad because there have been an improvement in the health system. What the government and how we are assisting is very evident.

Why do you have so much interest on hepatitis?
Our company as a company has been involved in Hepatitis for a very long time. HIV however, is probably our biggest success story. In the scheme of things, we have roughly between 1.3 – 1.5 million patients on treatment for HIV in Nigeria. Each and every one of them need to have their viral load tested because that is the only way to know if the treatment is effective. A HIV positive patient on effective treatment has his number of viral load in his system suppressed and that reduce the chances of transmission. This is the only way you can control the epidemic. This implies that every patient needs to check his or her viral load from time to time. About 80,000 people are currently doing. Virtually, 95-98 per cent (700,000) of that test is done on Rush platform. We are the pioneers of this test in 2002. As I am speaking to you, Nigeria has top range instruments for viral load in the world. Before we had 27 labs doing this 800,000 test. Now, we have put in place three labs doing exactly the same number within the year. One instrument that can run 3000 tests a day is amazing. It has not been done anywhere else. We are equipped now to deal with any epidemic because now we have the capacity. These instruments can do HIV, HPV, TB and a whole range of others. They are just three, two in Abuja and one in Lagos. Combined together they have the capacity to take care of the country and improve efficiency. The ministry of health didn’t spend a dime on the instrument procurement. They gave us the support.

2006 is when we really got involved in Hepatitis. The current project we have amongst many is with Taraba state. What are the facts? We want to screen 50,000 patients over five years. We started this in the last quarter of 2017. Since then we have screened 1000 patients have been screened and all in the partnership with the state government.

On cervical cancer, what people don’t know is that 30 per cent of those women who have been told that they are negative are in fact positive. The current state of screening for cervical cancer is not as accurate as it seems. But now we have the technology to be nearly 100 per cent accurate that can pick that 30 per cent. So that a woman who has the disease would be easily detected and recommend her for further investigation. We can go on and on. So we have partnering with the ministry of health in many aspects.

How would you rate response of government in your partnership?
Honestly speaking, without being political here, the government has been very enthusiastic. We are all aware about the reality of life- the conflicting priorities and limited resources. I will give you an example. Recently, the guidelines for cervical cancer screening, in my entire experience, it was the first test that was done as pass by the society, the minister of health was very instrumental in encouraging us. I think we need to talk to ourselves. We all have a role to play in becoming a better society. I always say that the government cannot do everything alone and we typically have that mindset.

Looking at the state of labs and labs scientist in Nigeria, what do you think needs to be improved upon?
The first thing I will say is that we need definitely improve on how we perform accreditation. That is not negotiable. We need to also improve our level of awareness. For instance, every Nigeria knows that once a drug is purchased, we need to check for the National Agency for Food, Drug Administration and Control (NAFDAC) number. Every Nigerian knows that. So we need to get to that stage that when you are going for a test, you will ask question on whether the lab is accredited or not because it is the accrediting body that we will hold responsible when anything goes wrong because they have standard that have set and it is expected that this lab has gone through all steps required to get accredited. It is not a short, easy and cheap journey. It is a long, difficult and expensive journey. We need to dedicate ourselves and start asking the right questions. This is the single most important thing I think should be improved upon.

What have been your challenges and where do you think the government can come in to help?
I think it is a systemic think. There are so many challenges. I don’t usually like saying this because that is what everybody says but everybody is saying it because it is the truth that funding is a big challenge. We are all saying it but the question is where does the funding come from, where is the funding used and how is it used? I will love a situation where health sector gets lot more funding, labs and diagnostic. This is not an anecdote but people say that it appears to be an anecdote but it is the fact- we say that over 70 per cent of medical decisions requires some form of diagnosis and yet about two per cent of fund on health are spent on lab diagnostic. Does that make sense? So, I am appealing for two things. First, the health care spent should be increased. Within the health care spent also, investment in diagnostics sector should also be increased because we need to have quality diagnostic to know what is wrong with us.

We are still in discussion with various state governments. Taraba state took up the challenge and I think it was a matter of right timing. I think we were that fortunate. We are hopeful that other state government will partner with us. We believe in partnership because the government cannot do everything, it is impossible. There is nowhere in the world that government does everything. The best hospitals in the world have some private inputs. In this country we are still working towards that.

For Taraba state, I think we should consider that they have a high prevalence. For them it is right there in their force. Probably, the motivation is higher. Other states also do have high prevalence, but maybe they have other priorities. It behooves us to identify where our priority needs to align. We are definitely working in other states. We are working amidst constraints also. We have our operating standard procedures because it is expensive to start and not finish. Our passion as a company is to make our solutions relevant and benefit to Nigerians.