Strengthening  laboratory systems  key to quality health system-Expert

Pankemwa Joy Shimang is the Unit Head for Clinical Laboratory Field Operations and Project Manager, Resolve to Save Lives Project, of the Institute of Human Virology, Nigeria (IHVN.  In this interview, she speaks on the role laboratory systems play in epidemic and pandemic preparedness, the impact of the Resolve to Save Lives project, and the effects of self-medication, among others.

By Ojoma Akor

Can you briefly tell us about the Resolve to Save Lives Project?

Resolve to Save Lives is a global public health organization. Established in 2017, its mission is to address preventable deaths by partnering with local governments and public health organizations in the countries where it provides support.

IHVN implemented the Laboratory Systems Strengthening (LSS) Project in collaboration with the Federal Ministry of Health, Medical Laboratory Services Directorate, and the Nigeria Center for Disease Control (NCDC)—the project aimed to strengthen Quality Management and Specimen Referral Systems in Public Health Laboratories and Networks.

IHVN implemented the project in two phases. The first phase was from 2020 to 2021, and the second phase ran from 2024 to 2025. Resolve to Save Lives funded both phases.

What is the role of laboratory system strengthening in health security and epidemic preparedness or pandemics?

You cannot contain what you cannot confirm. And disease agent confirmation begins in the laboratory. The Nigerian laboratory system is central to our health security agenda. It is about ensuring that people, infrastructure, quality systems, governance, and everything behind our laboratories work together seamlessly. Every disease confirmation begins in the laboratory; strengthening laboratory systems is critical and fundamental to public health.

In public health, every response starts with a question that only a laboratory can answer. And the questions usually are: What is making this patient sick? And how is it spreading? So, strengthening laboratory systems positions laboratories to answer questions quickly and accurately, guiding the prevention and intervention measures that should be in place.

As a laboratory scientist, I have experience working in the Nigerian clinical laboratory setting and in public health for several years. I have seen samples having to leave one state and go to another just for confirmation. And people having to send samples out of the country. I’ve also seen turnaround times for outbreak pathogens run into weeks, with frontline scientists working without functioning referral pathways.

The Resolve to Save Lives project tangibly changed some of these pictures I described. These include establishing and inaugurating State Laboratory Technical Working Groups in selected states like Bayelsa, Kano, Nasarawa, and the FCT. These efforts created functional subnational governance to coordinate laboratory quality and specimen referral systems where none previously existed.

The states that we supported through the Resolve to Save Lives project have improved and are better positioned for epidemic response. They now have stronger laboratory systems.

In this context of global health security and outbreaks, strong laboratory systems allow us to detect diseases early and confirm diagnoses accurately and reliably. They enable us to monitor disease and its spread and provide public health authorities with evidence on how best to respond to outbreaks. The faster we detect a threat, the greater our chances of containing it before it becomes a full-blown epidemic or pandemic.

The laboratory is often invisible when everything is working well, but it becomes indispensable when lives are on the line. So, laboratory system strengthening is not just about buildings, equipment, or technology. It’s also about building a system that Nigerians can depend on. Please ensure the building supports the equipment, the technology and equipment are compatible, the personnel are competent, and they are highly motivated to stay.

Otherwise, you will keep training, and they will keep leaving if they are not motivated to stay within your system. So, I hope we continue to invest in our laboratory system before the next emergency reminds us why a strong, resilient system matters.

What are the current major gaps that still exist, and how has Resolve to Save Lives helped in addressing them?

Nigeria is significantly better prepared to respond to epidemics. We have strengthened specimen referral systems, improved diagnostic capacity at different levels, and strengthened quality management systems.

These laboratories are continuously being optimized for integrated disease testing. The COVID-19 pandemic also accelerated investment in laboratory infrastructure and coordination.

It revealed our capacity and helped us to quickly strengthen areas that were far below where they needed to be. It has left our country much stronger than before—the same thing with the Ebola outbreak in the DRC. SARS reminded us that infectious diseases will not respect borders. It has reinforced the need for countries to strengthen laboratory systems for early detection continuously.

 Despite these lessons learned, and all that stakeholders, subject matter experts, and governments have put in place, gaps remain that make it difficult to sustain progress after donor support ends. I have worked in external donor support for public health improvement for a while, and I can see that most of our sources remain external. This makes it difficult to sustain progress in workforce retention and sustainability after donors leave.

This is critical because we have trained several laboratory personnel who move to places with better opportunities either within or outside the country. These challenges persist and are negatively affecting the sustainability and progress of the interventions. Many of our laboratory system strengthening activities still depend on donor funding, though the government has made some milestones.

One of our greatest achievements with the Resolve to Save Lives project is securing government ownership by strengthening subnational laboratory governance. Policies are key to our efforts, but implementing them matters.

However, let’s start with the policy. Let’s start with proper governance. Let’s start with coordination. One objective of the Resolve to Save Lives Project was to strengthen quality systems and sample referral systems, mainly at the subnational level. We established State Laboratory Technical Working Groups (TWGs), which are multisectoral and include experts from human health, animal health, and environmental health.

These experts came together to chart the way forward and guide the government on how best to implement, or what policies to implement, for global health security. We have institutionalized multisectoral TWGs at the state level. We built local capacity instead of creating parallel structures, which allowed the group to decide what is best for them in their state. That means that the improvements we have made are more likely to be sustained, with continued benefits for Nigerians long after the project ends.

What is your advice to the Federal Government and other stakeholders on repositioning Nigeria’s laboratory system?

It is not far from ensuring that we have the right policy regardless of the emerging disease or threat. I would always say the first step in controlling an outbreak is making an accurate and timely diagnosis, which only a laboratory with effectively interrelated systems can provide, and this system goes beyond equipment and personnel.

It is beyond technology and tools; governance and resources are also key and must work together.

You cannot have a state-of-the-art laboratory without competent laboratory scientists. And you cannot have competent scientists without the resources, coordination, and governance needed to make the system function effectively.

As mentioned, a strengthened laboratory system will accelerate pathogen confirmation. And it will also extend testing and diagnostic coverage.  I remember that some years back, only one or two laboratories in Nigeria could perform, or even test for, Lassa fever. Still, today the NCDC network has more than five functional molecular laboratories, and turnaround time has greatly reduced.

So, generally, the biggest difference today is that our laboratories are better connected, better equipped, and better coordinated. Imagine an outbreak has just been reported in a community. Before protocols or testing Standard Operating Procedures are developed, and before any action is taken, one question must be answered: What are we dealing with? And guess who is expected to answer that question – the laboratory.

Most of the time, laboratories come under immense pressure during public health emergencies. They are expected to identify the cause of illness while maintaining high standards, and they must do so quickly. They often face increased testing demand, supply-chain disruptions, fatigue, and other factors. Note that a laboratory scientist doesn’t just produce your result; they provide feedback.

So, it’s not merely about improving laboratory capacity; it is about how well we connect, how well those laboratories are sustained and governed, and the capacity of the laboratories. Policies may exist, but the government needs to reinforce monitoring of their implementation.

There are so many guidelines and policies out there. Sometimes you think they don’t exist until you approach the Federal Ministry of Health or the mandated agency. You’ll be surprised by the kinds of documents and policies we actually have that have been approved by the Honorable Minister of Health, and by their content. Still, they are not getting to the implementation level.

What is your advice to the government and other stakeholders on sustaining the impact of Resolve to Save Lives project?

Sustainability is very important. We want to look back and see that whatever initiatives the IHVN Laboratory System Project has brought about are sustained by government; we have focused on building government ownership rather than creating parallel systems, and we’re hoping that we have strengthened national laboratory governance, locally built capacity, and embedded quality management systems within existing governance systems.

In the future, I would also like to see policies that invest in the laboratory workforce through continuous professional development and retention strategies. Government must be deliberate about that. We’re losing quite a lot. I mean, during COVID-19, you can’t imagine the number of healthcare workers, particularly scientists, who left the country because there was an open window, and it was very easy because of the need out there.

If the government implements intentional strategies to motivate scientists and health workers to offer their services in the country, it will reduce brain drain.  Policies should also promote an integrated laboratory network. We currently have a fragmented network; it has improved compared to five or ten years ago, but more work remains.

We have a government-initiated national integrated sample referral network. But funding and ensuring the functionality of this national integrated sample referral system still depend on donors. So, the movement of HIV viral load samples and Early Infant Diagnosis is dependent on CDC/PEPFAR. Without funding for that stream, moving those samples will be challenging—same with yellow fever, Lassa fever, and the like.

So, when government owns, finances, and leads the laboratory system, I believe that the benefit will extend far beyond any single project into a resilient national health system and global health security.

What is your advice to the general public on self-medication?

Many times, people self-medicate because they want to find quick relief from symptoms. However, treatment without diagnosis is like driving without a map. You may move, but you may not reach the right destination.  You may treat the symptoms, but not the causative agent. Many illnesses share similar symptoms. An untreated, ignored causative agent can lead to more severe negative effects on the body.

 So, self-medication without proper laboratory testing can delay correct diagnosis and worsen the illness. For example, if someone has a microbial infection and takes an antibiotic before going to the lab for a culture/sensitivity test, the organism may be suppressed rather than treated because the antibiotic may not be the right one for that organism. Another issue is that by the time the individual goes to the laboratory, the organism may not be detected, even though it is still in the body. That automatically delays the correct diagnosis.

The organism may have gone below the detectable limit but has not been eliminated from your body. Doctors and clinicians cannot prescribe based on what they cannot see. So, you’re going to go back home, and of course, your illness may worsen. Sometimes, that also leads to antimicrobial resistance and can cause more serious harm.

We need policies that subsidize the cost of medicines for citizens. I know we have different insurance schemes. People are usually advised to use the available insurance schemes.