The "ready-to-hand" test: Diagnostic availability and usability in primary health care settings in Sierra Leone

Alice Street; Eva Vernooij; Francess Koker; Mats Stage Baxter; Fatmata Bah; James Rogers; Momoh Gbetuwa; Mikashmi Kohli; Rashid Ansumana

doi:10.1371/journal.pgph.0000604

The "ready-to-hand" test: Diagnostic availability and usability in primary health care settings in Sierra Leone

PLOS Glob Public Health. 2023 Feb 10;3(2):e0000604. doi: 10.1371/journal.pgph.0000604. eCollection 2023.

Authors

Alice Street¹, Eva Vernooij¹, Francess Koker², Mats Stage Baxter³, Fatmata Bah², James Rogers⁴, Momoh Gbetuwa⁵, Mikashmi Kohli⁶, Rashid Ansumana⁷

Affiliations

¹ Department of Social Anthropology, School of Social and Political Sciences, University of Edinburgh, Edinburgh, United Kingdom.
² Kings Sierra Leone Partnership, King's Centre for Global Health and Health Partnerships, Freetown, Sierra Leone.
³ Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
⁴ James Rogers, Laboratory Technical Working Group, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone.
⁵ Momoh Gbetuwa, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
⁶ Mikashmi Kohli, FIND, Campus Biotech, Geneva, Switzerland.
⁷ Rashid Ansumana, School of Community Health Sciences, Njala University, Bo, Sierra Leone.

Abstract

This article assesses the availability of essential diagnostic tests in primary health care facilities in two districts in Sierra Leone. In addition to evaluating whether a test is physically present at a facility, it extends the concept of availability to include whether equipment is functional and whether infrastructure, systems, personnel and resources are in place to allow a particular test to be "ready to hand", that is, available for immediate use when needed. Between February 2019 and September 2019, a cross-sectional mixed-methods survey was conducted in all 40 Community Health Centres (CHCs) in Western Area, one of five principal divisions in Sierra Leone. The number of rapid diagnostic tests (RDTs) available ranged from 1-12, with 75% of facilities having 9 or less RDTs available out of a possible 17. While RDTs were overall more widely present than manual assays, there was wide variation between tests. The presence of RDTs at individual facilities was associated with having a permanent laboratory technician on staff. Despite CHCs being formally designated as providing laboratory services, no CHC fulfilled standard World Health Organisation (WHO) criteria for a laboratory. Only 9/40 (22.5%) CHCs had a designated laboratory space and a permanently employed laboratory technician. There was low availability of essential equipment and infrastructure. Supply chains were fragmented and unreliable, including a high dependency (>50%) on informal private sources for the majority of the available RDTs, consumables, and reagents. We conclude that the readiness of diagnostic services, including RDTs, depends on the presence and functionality of essential infrastructure, human resources, equipment and systems and that RDTs are not on their own a solution to infrastructural failings. Efforts to strengthen laboratory systems at the primary care level should take a holistic approach and focus on whether tests are "ready-to-hand" in addition to whether they are physically present.

Copyright: © 2023 Street et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This research was supported by the European Research Council under EU Horizon 2020 programme (Grant Number 715450, awarded to AS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.