There is an increase in health facilities, including laboratories, with each dispensary, health centre or hospital having a laboratory in the East, Central and Southern Africa.

However, despite this, these laboratories do not have enough qualified laboratory physicians (pathologists), it emerged yesterday.

The issue came up at the opening of the 13th biannual meeting of the Association of Pathologists of East, Central and Southern Africa (APECSA), yesterday in Kigali, which is running until Wednesday.

Prof. James Kitinya, a founding member of the APECSA, said despite an increase in the number of pathologists over decades, in the region, this increase has not been proportional to population or increase in facilities.

This, in some parts, has led to some clinicians not relying on laboratory tests while treating patients; which pathologists, clinicians and policy makers agree that it limits the quality of health care.

"A visit to a rural dispensary, health centre or district hospital will show patients, are seen, and examined by a clinician,” Kitinya said, adding that, "laboratory test results are not used in patient management decisions.”

The meeting, held under the theme; "Resetting the pathology agenda in the East, Central and Southern African,” has brought together about 200 pathologists from the sub-region and beyond to deliberate on matters relating to medical laboratory practice and pathology teaching in the APECSA region.

Pathology is the science of the causes and effects of diseases, especially the branch of medicine that deals with the laboratory examination of samples of body tissue for diagnostic or forensic purposes.

According to Dr Fabien Ntaganda, the president of Rwanda Society of Pathologists, Rwanda currently has 15 pathologists in total.

Available statistics show that Uganda has 18, Kenya has 110, while Tanzania has 123.

According to Dr Andrew Kanyi Gachii, Head of Kenya Association of Clinical Pathologists, the numbers represent a "huge gap” compared to the number of the population they serve.

In fact, in the sub-region, the pathologist to population ratio is about 1 to 1.3 million people in each country."The number of pathologists is still very low compared to the number of clinicians and consequently the population,” Kitinya added.

Dr Diane Gashumba, the Minister for Health, acknowledges that pathology plays a "critical role” in guiding clinical decisions about patient diagnosis and treatment.

She urged pathologists to forge collaboration, standardise practices and education,” as diagnostic technology evolves at a fast rate.

"Pathology still faces the persistent problems of low access, lack of access, lack of equipment and reagents and staff rotation, low financing and low and lack of quality,” Gashumba said, adding that this is the right time for the practitioners to think about resetting the agenda.

She called on APECSA member states to support the College of Pathologists of East, Central and Sothern Africa (COPECSA), to fulfill its education and training mandate.

Challenges faced by pathologists in the region

Prof. Emile Rwamasirabo, the Acting CEO of King Faisal Hospital, Kigali, said the standard approach to care has severely been undermined by the poor financing of health care in most African countries with few pathologists, few and poorly equipped laboratories, and difficulties at acquiring consumables.

"Empirical treatment of common conditions in health centres, district hospitals, private clinics and, to a large extent, in referral hospitals with very little support from the laboratory remain the mainstream "modus operandi” in many parts of Africa,” Rwamasirabo said.

Dr Robert Lukande, the president of APECSA, underlined that pathologists in the region face numerous challenges including; inadequate numbers and working in isolation; laboratories that are underfunded, long turnaround times of test results, and being "ignored” by clinicians in formulation of diagnoses and treatment decisions.

Other challenges faced by these physicians include, lack of accreditation of most laboratories, among others.

"A country without good pathology practice will not provide quality health care and, therefore, will not experience development,” he said.

Chantal Gégout, from World Health Organisation (WHO) Rwanda office, said given the growing importance of health laboratories and emphasis on evidence-based medical and public health practices, "it is imperative that health laboratories are strengthened to provide critical inputs in making informed decisions and contribute to UHC and achieving SDGs.”

Meanwhile, APECSA marked its 25th anniversary, yesterday, in Kigali.

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