Owusu Michael, Nkrumah Bernard, Acheampong Godfred, Afriyie Stephen Opoku, Addae Ebenezer Kojo, Owusu George Senyo, Sambian David, Frimpong Joseph Asamoah, Mohammed Aliyu, Komei Abbas Abdul-Karim, Boateng Gifty, Laryea Eunice Baiden, Angra Pawan, Abdulai Farida Njelba, Asiedu-Bekoe Franklin, Barradas Danielle T
Centre for Health System Strengthening, Kumasi, Ghana.
Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
PLOS Glob Public Health. 2025 Sep 11;5(9):e0004735. doi: 10.1371/journal.pgph.0004735. eCollection 2025.
The outbreak of the COVID-19 pandemic exposed the fragile health system in Ghana and in particular, its specimen referral system (SRS), which for years had been limited to Tuberculosis (TB), HIV Viral Load and Early Infant Diagnosis among few laboratories. The implementation of a siloed SRS with the sole focus on TB, HIV viral load, and early infant diagnosis has been to the detriment of other diseases of public health importance. This programmatic activity aimed to assess the feasibility of an integrated specimen referral system (ISRS) in Ghana's Greater Accra and Northern Regions. Between January and November 2022, we established and piloted an ISRS through extensive stakeholder engagements using the hub and spoke model. As part of the intervention package, capacity building workshops, logistics support and transportation were provided to all program facilities. Standard paper-based log books and interviews were employed to collect data from 105 health facilities (84 in Greater Accra and 21 in Northern Region) to evaluate the ISRS's successes, challenges, and develop future scale-up recommendations. Overall, 4,239 samples ranging from suspected cases of measles, monkeypox, COVID-19, yellow fever (YF), acute flaccid paralysis, TB, Buruli ulcer, HIV viral load (VL), early infant diagnosis (EID), and meningitis were transported during the program period. The turnaround time (TAT) varied across diseases: 1-2 days for TB/COVID-19, 5-7 days for YF, 7-14 days for influenza, and 14 days - 3 months for VL/EID cases. The quality of specimens referred improved, with only 2 samples rejected during the pilot. Qualitative analysis uncovered improvements in ISRS efficiency including, sample delivery, TAT, documentation, coordination and logistics, monitoring and tracking, sample quality, and record-keeping. This preliminary programmatic activity provides evidence of the feasibility of creating a nationwide ISRS to facilitate the quick detection and management of all diseases of public health importance in Ghana.
新冠疫情的爆发暴露了加纳脆弱的卫生系统，尤其是其样本转诊系统（SRS），多年来该系统仅限于少数实验室进行结核病（TB）、艾滋病毒载量检测和早期婴儿诊断。仅专注于结核病、艾滋病毒载量检测和早期婴儿诊断的孤立样本转诊系统的实施，对其他具有公共卫生重要性的疾病产生了不利影响。这项规划活动旨在评估在加纳大阿克拉和北部地区建立综合样本转诊系统（ISRS）的可行性。在2022年1月至11月期间，我们通过使用中心辐射模型与广泛的利益相关者进行接触，建立并试点了一个综合样本转诊系统。作为干预措施的一部分，为所有项目设施提供了能力建设讲习班、后勤支持和运输服务。采用标准纸质日志和访谈从105个卫生设施（大阿克拉地区84个，北部地区21个）收集数据，以评估综合样本转诊系统的成效、挑战，并制定未来扩大规模的建议。在项目期间，共运送了4239份样本，涵盖疑似麻疹、猴痘、新冠、黄热病（YF）、急性弛缓性麻痹、结核病、布鲁里溃疡、艾滋病毒载量（VL）、早期婴儿诊断（EID）和脑膜炎病例。不同疾病的周转时间（TAT）各不相同：结核病/新冠为1至2天，黄热病为5至7天，流感为7至14天，艾滋病毒载量/早期婴儿诊断病例为14天至3个月。转诊样本的质量有所提高，试点期间仅有2份样本被拒收。定性分析发现综合样本转诊系统在效率方面有所改进，包括样本运送、周转时间、文件记录、协调与后勤、监测与追踪、样本质量和记录保存。这项初步的规划活动证明了建立全国性综合样本转诊系统以促进加纳所有具有公共卫生重要性疾病的快速检测和管理的可行性。
