NIMR, U.S., WHO begin programme to accredit, certify Nigerian laboratoriesEMBARRASSED by the inability of any laboratory in the country to conduct DNA tests on the victims of the June 3, 2012 DANA air crash and their relatives for easy identification of corpses, the Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, has raised a team to develop the institute's capacity to perform such tests.NIMR also decried a situation where less than two per cent of the national budget is allocated to science and health research. They, however, recommend that a percentage of the profit made by all companies in Nigeria be used to set up a special fund for research.The NIMR said as part of efforts to boost quality management systems in Nigerian laboratories to enable over 6,000 laboratories registered by the Medical Laboratory Science Council (MLSC) obtain International Standard Organisation's (ISO) accreditation and get certified by the World Health Organisation (WHO), the research institute with support from the International Association of National Public Health Institute (IANPHI) in Atlanta, United States (U.S.), the U.S Centres for Disease Control and Prevention (CDC), and the WHO African Region (AFRO) has begun a programme, Strengthening Laboratory Management Towards Accreditation (SLMTA).Director General of NIMR, Prof. Innocent Ujah and Co-ordinator Research, Planning and Management of NIMR, Dr. Oni Idigbe, at an interactive session with The Guardian said only two Nigerian laboratories out of over 6,000 are accredited by the ISO and none is certified by the WHO to conduct clinical trials for Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), tuberculosis and malaria vaccines.SLMTA is an alternative training approach in laboratory management and quality management systems with the goal of producing measurable improvement and preparing laboratories for accreditation based on international clinical laboratory standards.Ujah said, 'to strengthen the tiered laboratory systems of its member countries in a stepwise fashion, WHO-AFRO has established a Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) initiative in accordance with its core functions of setting up norms and standards and building institutional capacity. In partnership with WHO-AFRO, the CDC, the American Society for Clinical Pathology (ASCP) and the Clinton Foundation developed this task-based, hands-on training programme to facilitate implementation of this initiative.'This programme aims to strengthen laboratory management, achieve immediate laboratory improvement, and accelerate the preparedness toward accreditation.'He said NIMR has received 18-month grant from IANPHI worth over N32 million to train 24 SLAMTAs to help upgrade laboratories from the zero star to five star status.After the DANA crash the DNA samples of the victims and their relatives were sent abroad for genetic test in order to get accurate identification of the dead. Will this SLAMTA project build the capacity of Nigerian laboratories to be able to do DNA tests'Ujah said, 'let me say that genetic studies are going on in NIMR. At the moment we are doing DNA studies on bacteria and viruses. For instance we are doing DNA studies on HIV and tuberculosis. Now these things come in, and in response to the demand, the capacities are built. We found that there were gaps after the DANA crash and the institute is putting in place a team to look into the details of how to be able to start this process. As a matter of fact the issue of even determining paternity is something we have been thinking about but we have to look at ethics.'You know science is universal and we have to follow standard procedure and processes and we needed to look at the ethics. Even the issue of DNA testing for DANA crash victims we needed to put the ethical components together before we can do it. Now we are looking at the possibility of setting up our own lab that can address this gap that we have, as well as, address the ethical consideration, the processes because it must go through the ethics before we can start.'By and large we are responding to the needs of the country and that is what the institute is for. You will find out you cannot start de novo any research without looking at the needs of the country and the institute stands to respond to the health priority needs of this country. So when it happened we saw there is a gap.'What I am saying is that do you have the capacity to do the DNA test in NIMR and will the SLAMTA project enhance your capacity'Ujah said, 'it will to an extent but not total because it is not just the training, we have to get the equipment and these equipment are very expensive so we need to make advocacy to government and to private sector to support because we don't believe that government alone can do all these. So we go to government and also seek the support of private sector and philanthropists.'Many Nigerians have the capacity in terms of knowledge and skill but the equipment are not there and unless the equipment are there and they are standardised, and we follow the procedure there is nothing we can do. I mean you could see that we have forensic pathologists in this country and they help in no way in ensuring that we get this right.'Despite the fact that these tests were not done in Nigeria, the processes that led to these samples being shipped out were done by our forensic pathologists and I must mention Prof. John Oladapo Obafunwa, the vice chancellor of Lagos State University (LASU), who co-ordinated it as a forensic pathologist. So we have the people but we need to complement our skills and knowledge with the equipment that we need.'Does NIMR have a WHO certified lab'Idigbe said, 'we have an ISO lab, that is our human virology lab. It is one of the two labs with ISO accreditation in the country. In most cases, WHO rarely comes to accredit a whole laboratory. WHO comes in and says 'you are doing this particular programme, we are accrediting this programme because it meets WHO standard.' In the human virology lab we have a sequencer with which we do resistance testing, we do our genomic studies on HIV and the rest of them. For you to be able to say you did this, you did the genomic testing and in this patient, what you isolated is type one HIV, it has to be with a sequencer. Once you start using a sequencer, the WHO has to accredit it.'We got a sequencer donated to us by the Harvard School of Public Health. We have been working with the Harvard School of Public Health. They have been going through WHO accreditation process for genomic typing and they have just gotten to the point of obtaining WHO accreditation for that particular typing. We now have the genetic typing for TB. Before to test for TB you have to wait for eight weeks but right now we have equipment that can do TB diagnosis within hours, that has been accessed by CDC and we have gotten a CDC certificate for this. And in addition our TB lab is undergoing this SLAMTA accreditation and by the last assessment we are a Four- Star.'Why is NIMR yet to get WHO certification'Idigbe said, 'we are hoping that by the next assessment we hit a Five-Star and become WHO certified lab. It is a process and to be honest with you the limiting factor is funding'If we have adequate funding most of these things we are doing wont be from donors. If government will say this is the main health and oldest research institute in the country we will give you so much we will be able to get results. We went to Washington for the AIDS conference and the chief executive of the U.S. National Institute of Health (NIH) came and gave us his budget of $35 million, which they give out to the rest of the world.'How much do you have for health research in the country' That is, what is the priority, at what level, is research of high priority to the government of Nigeria'Research is not on our high priority list. When you look at the national budget research is always there towards the end. So we must have that culture for research. We must know that research drives development because it brings up innovation and then give you more money for research.'How can research drive development''Just to show you how research drives development, when HIV/AIDS was first discovered it was a case of helplessness and hopelessness. If you have HIV you will die. There were no two ways about that but today through science, through research, through investment if you die of HIV/AIDS it is like dying from hypertension or diabetes. And that is investment, you have to invest in health, there are no two ways about it.'I think the first thing is to identify research as a priority. It is not enough to say what you've done' Then we will ask what is your investment' Where is your result' What was your investment' If you do not invest in something you cannot get anything out of it. You cannot take anything out of nothing. At the moment what we are saying is that the private sector should try and come and support the government. Although there are other competing needs for government, we think that the issue of prioritising research not just health research will help us drive development.'I will want to say that we need real investment because we have very intelligent and brilliant Nigerians. We have the skill, we have the capacity but we do not have the facility and it is the facility that actually will help us to drive the process.''To help make it a standardised issue, a pronouncement was made many years ago that for every country, two per cent of the budget should be for health research. It was there in Abuja Declaration. We are far from it.'What percentage of the budget is for research'Ujah said, 'unfortunately I don't know.There is improvement in the universities now through the Tertiary Institution Trust Fund. If a percentage of profit from industries were contributed for health research and if you aggregate that with the government support, I believe we would have been on the path of prioritising research for development.
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