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

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...

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Autores principales: Street, Alice, Vernooij, Eva, Koker, Francess, Baxter, Mats Stage, Bah, Fatmata, Rogers, James, Gbetuwa, Momoh, Kohli, Mikashmi, Ansumana, Rashid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021322/
https://www.ncbi.nlm.nih.gov/pubmed/36962729
http://dx.doi.org/10.1371/journal.pgph.0000604
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author Street, Alice
Vernooij, Eva
Koker, Francess
Baxter, Mats Stage
Bah, Fatmata
Rogers, James
Gbetuwa, Momoh
Kohli, Mikashmi
Ansumana, Rashid
author_facet Street, Alice
Vernooij, Eva
Koker, Francess
Baxter, Mats Stage
Bah, Fatmata
Rogers, James
Gbetuwa, Momoh
Kohli, Mikashmi
Ansumana, Rashid
author_sort Street, Alice
collection PubMed
description 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.
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spelling pubmed-100213222023-03-17 The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone Street, Alice Vernooij, Eva Koker, Francess Baxter, Mats Stage Bah, Fatmata Rogers, James Gbetuwa, Momoh Kohli, Mikashmi Ansumana, Rashid PLOS Glob Public Health Research Article 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. Public Library of Science 2023-02-10 /pmc/articles/PMC10021322/ /pubmed/36962729 http://dx.doi.org/10.1371/journal.pgph.0000604 Text en © 2023 Street et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Street, Alice
Vernooij, Eva
Koker, Francess
Baxter, Mats Stage
Bah, Fatmata
Rogers, James
Gbetuwa, Momoh
Kohli, Mikashmi
Ansumana, Rashid
The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone
title The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone
title_full The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone
title_fullStr The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone
title_full_unstemmed The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone
title_short The “ready-to-hand” test: Diagnostic availability and usability in primary health care settings in Sierra Leone
title_sort “ready-to-hand” test: diagnostic availability and usability in primary health care settings in sierra leone
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021322/
https://www.ncbi.nlm.nih.gov/pubmed/36962729
http://dx.doi.org/10.1371/journal.pgph.0000604
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