Chapter five

Organization of health
laboratory service in Ethiopia
 Objectives

Following successful completion of this

chapter, you will be able to:
 Describe brief history of health laboratory
organization in Ethiopia
 Describe the activities of different levels of
laboratories in developing country.
 Outlines

• Organization of health laboratory service in Ethiopia

• Structuring of laboratory service in developing
country.
• Activities of community based PHC laboratories
• Activities of district hospital laboratories
• Activities of regional hospital laboratories
• Activities of central and public health laboratories.
 1. Organization of health laboratory service in Ethiopia

 The Italian established the first health laboratory

in Ethiopia during the Second World War.
 Immediately after independence, a British
scientist took over health laboratory activities in
AA and they were organized under the name of
the Imperial Medical Research Institute.

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 The British handed the organization over on a

contractual basis to French team. The French
 developed the first well-organized laboratory in the
country under the name Institute Pasteur D’
Ethiopie.
 they established facilities for the production of
vaccines, and some diagnostic services (1951-1964)
 Rabies was the main research area for French team in
Ethiopia.
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 cont…

 The name of the institute was changed to

Central Laboratory and Research Institute
(CLRI), and the Ethiopian scientific and
medical officers took over the responsibility
and managed to keep the service active.
 They attracted some able Ethiopian candidates
and introduced more activities.

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 Meanwhile laboratory technicians training

programs were launched at the Gondar public
health college, the Menelik II Hospital and the
Jimma hospital among others.
 In Ethiopia, the health care system includes
community health service, health posts, health
centers, and hospitals at district/rural, regional
and central referral levels.
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 cont…

 According to the report of Federal MOH in

2009/2010 there were
111 hospitals,
2,689 health centers,
14, 432 health posts

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 Diagnostic laboratories are the main

components of these facilities starting from the
health centre, although the size and complexity
is different at different levels.
 The current health laboratory service delivery
system in Ethiopia is organized in such a
structure that follows the general health care
delivery of the country.
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 The organization of the health care delivery system

involves
 General Specialized Referral Hospitals,
 Federal Hospitals,
 Regional Hospitals,
 Zonal Hospitals,
 District Hospitals,
 Health Centers and
 Health Posts.

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 cont…

 Following the above mentioned structure of the

care delivery system, the laboratories included are:
-
 National laboratory at EHNRI
 General Specialized Referral Hospital laboratories
 Regional Laboratories
 Zonal hospital laboratories
 District Hospital laboratories
 Health center laboratories.

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 In addition, there are several laboratories

under the
Armed Forces health department,
Police forces health departments;
Blood bank centers,
Private hospitals and clinics
NGO hospitals and clinics
Stand-alone diagnostic laboratories.

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 cont…

 A laboratory service network consists of : -

I. Community based primary health care (PHC) laboratories
II. District hospital laboratories
III. Regional hospital laboratories
IV. Central and public health laboratory
 The various activities of these laboratories need to be clearly
defined and carefully coordinated.
 Good communication channels and effective back up referral
systems b/n laboratories are essential.

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 1.1 Activities of community-based PHC laboratories

 Community based PHC laboratories are

becoming increasingly important in many
developing countries.
 Essential health care facilities which at one
time were only available to a minority of the
population are now becoming community-
based and accessible to all.

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 cont..

 The work of the community based PHC

laboratory is
to support PHC in investigating, controlling, and
preventing major disease in the community
Promot health care by integrated health
education.

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 cont..

 Without appropriate laboratory support from PHC,

 diseases are often misdiagnosed or
 remain undiagnosed until they are advanced and
accompanied by serious complications w/c requires
hospitalization of patients.
 Inaccurate diagnosing often results in drugs being used
incorrectly.
 In the Ethiopian context, the PHC laboratories are
called district and health centre laboratories.
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 The main functions of community based PHC

laboratories are as follows: -
1. To investigate by referral or testing onsite important
diseases and health problems affecting the local
community. Depending on geographical area such
investigations will usually include: -
– Bacterial diseases:- (TB, Leprosy, meningitis, etc)
– Parasitic diseases: - (malaria, Schistosomiasis, etc)
– Skin mycoses ( fungal infections)
– Other cause of illhealth : - ( anemia, diabetes, etc)

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2. To assist the health worker in deciding severity of a

patients’ condition
3. To collect and refer specimens for testing to the
regional/district laboratory, including
 Faecal specimens for the investigation of major
enteric pathogens
 Specimens for culture and sensitivity to diagnose
and assist in the treatment and control to monitor
drug resistance.
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 cont..

4. To notify the district hospital at an early stage of any

lab result of public health importance and send
specimens for confirmatory tests.
5. To screen pregnant women for anemia, proteinuria
and malaria, and refer serum for antibody testing
6. To promote health care and assist community
health education by, e.g. demonstrating
microscopically the parasites of important local
diseases
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 cont..

7. To keep careful records w/c can be used by health

authorities in health planning
8. To request from the district/regional lab on a
regular basis, further supplies of reagents,
standards, controls, stains, specimen containers and
etc
9. To send a simple informative monthly report to the
district laboratory of the work carried out and
results obtained in PHC lab.
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 1.2 Activities of district hospital
laboratories.

 Have an important role in supervising the work of

the peripheral community-based labs, testing
referred specimens, and performing a range of tests
compatible with the work of the district hospital
 The main functions of a district hospital lab are as
follows: -
1. To perform a range of tests relevant to the medical,
surgical, and public health activities of the district
hospital
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 cont…

2. To support the work of the community based labs by: -

 Testing referred specimens
 Providing reagents, controls, other essential lab
supplies and etc
 Visiting each primary health centre once a month
to inspect and discuss the investigations being
performed
 Training community health lab workers and
organizing refresher courses.

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 cont…

3. To refer specimens to the regional lab that cannot be

tested in the district lab or are more economically tested
in batches in the regional lab
4. To notify the regional lab of any result of public health
importance and to send specimens for confirmatory tests
5. To participate in EQA programs organized by the regional
lab
6. To report every 3 months to send to the regional lab of
the work and needs of all the labs in the district.

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 1.3 Activities of regional hospital care
laboratories

 The main functions of the regional lab are as follows:

-
1. To perform a range of tests as required by the medical and
health needs of the region
2. To operate a regional blood transfusion centre.
3. To prepare reagents, controls, standards, and
specimen containers
4. To investigate epidemics and perform tests of public
health importance in the region.
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 cont…
5. To support the work of the district hospital labs in the
region by: -
Testing referred specimens.
Providing blood collecting packs, reagents, and etc
Collecting blood donated in the district for testing in the
regional transfusion center
Delivering tested donor blood for use and (This case is
being performed by blood banks in Ethiopia)
Visiting each district hospital lab every 3 months to
discuss with the technical and medical staff
Training lab techs and organizing refresher courses.
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 cont…

6. To send specimens that requires specialist

investigation to the central and public health
lab
7. To participate in EQA program organized by the
central lab
8. To prepare a report every 6 months to send to
the central and public health lab of the work
and needs of all the labs in the region.
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 1.4 Activities of central and public health
laboratory

 This lab is responsible for the planning, expenditure,

and coordination of the national lab service
 It has equally important roles in ensuring
 the reliability of the service,
 the appropriateness of its technology,
 training and motivation of its workforce, and
 ensuring that the service extends into areas of health
needs and its facilities are made available to as many
people as possible

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 It is also responsible for the prompt lab investigation of

epidemics and outbreaks of serious illness among
communities.
 The main functions of a central and public health lab are
as follows: -
 To formulate a professional code of conduct for medical lab
personnel
 To perform a range of specialist tests not normally undertaken
in the regional lab e.g. viral, cytological, forensic and etc

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 To carry out appropriate research into important

national health problems
 To organize a national lab service
 To evaluate new technologies, standardize
techniques, and test the appropriateness of new
equipment
 To procure supplies for the national lab service and
to organize an efficient system of requisition,
distribution, and maintenance of equipment
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 cont…

 To prepare control sera, complex biochemical

reagents and culture media that require
standardization and are more economically
prepared in the central lab, and etc
 To communicate and collaborate with international
organizations in promoting lab standards and code
of safety for indigenous medical labs
 To train specialist technicians and to organize lab
teaching seminars

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 cont…
 To prepare, and where required, translate appropriate
training manuals for the d/t lab training programs
 To prepare lab request forms, record sheets, order
forms, and other essential stationery w/c require
standardization
 To prepare and distribute an annual report on the
activities of the country’s lab service, to coordinate
the work of the lab service within the national health
programme, and to prepare a budget for presentation
to health authorities

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