NHLS: Playing a vital role on SAs Health Landscape

Leadership talks to National Health Laboratory Service CEO, Ms Joyce Mogale



As part of an introduction to readers, can you give us some background on the NHLS? When was it established and what is its main role?
The National Health Laboratory Service (NHLS) was established in 2000 by an Act of Parliament, amalgamating the former South African Institute for Medical Research (SAIMR), National Institute for Virology and National Centre for Occupational Health as well as university and provincial state diagnostic laboratories. The NHLS is the largest diagnostic pathology service in South Africa with the responsibility of supporting the national and provincial health departments in the delivery of healthcare through diagnostic services. It provides laboratory and related public health services to over 80% of the population through a national network of laboratories. We have specialised divisions, which includes the National Institute for Communicable Diseases (NICD), National Institute for Occupational Health (NIOH), National Cancer Registry (NCR) and South African Vaccine Producers (SAVP) which is the sole producer of antivenom in Africa.
Can you give us some history about yourself, your education, management roles etc. as well as your history with the company?
I’m the former Regional Executive Manager of the NHLS, region, which was called Northern region and now fall under Limpopo and Mpumalanga region. I hold the following qualifications: Masters in Business Management, Postgraduate Diploma in Health Management, BSc (Hons) status in Medical Sciences, Higher National Diploma in Medical Technology and National Diplomas in Medical Technology. I’ve previously worked as a Deputy Director: Laboratory Services in the Department of Health and Welfare in Limpopo, the then Northern Province. I held strategic positions as Director in SMME: for the Department of Finance and Economic Development, among other successes. I also established my own business, which enabled me to train professional nurses and doctors throughout the country on the Integrated Management of HIV and TB. During my time as Executive Manager of the Northern Region I introduced the balanced scorecard concept in the organisation. I’m very passionate about the performance measurement of goals and objectives.

Can you highlight your main roles and responsibilities?
• Strategic direction of the NHLS
• Continuous improvement of the service delivered to our shareholders
• Oversee financial management to ensure cost effectiveness and efficiency in the utilisation of resources • Build, improve and maintain a good working relationship with our stakeholders
• Promote a culture that reflects the organisation’s values, encouraging good performance and rewards productivity

You have been hailed as the NHLS Superwoman, largely responsible for the spectacular financial turnaround of the organisation. What were the biggest challenges that you faced in the beginning?
• Resistance to change
• Lack of skilled personnel as the organisation had lost staff in numbers
• The state of apathy of the employees

What has been the motivation behind your work ethic? Are you proud of what you have achieved in such a short period of time?
I was tasked to turn the organisation around by the shareholders, which is a huge responsibility and enough to challenge one’s work ethics. I also take this job as an opportunity to dispel the notion that only certain people can be trusted with such positions. I am content that the organisation is now stable in all aspects.

Can you tell us more about the Priority Programmes addressing HIV and TB? What do these programmes entail?
The NHLS offers testing for HIV and associated opportunistic infections such as tuberculosis, Cryptococcus and Hepatitis to more than 80% of the South African population. The NHLS established the National Priority Program (NPP) unit to focus on addressing the National Department of Health’s need to provide increased access to Leadership talks to National Health Laboratory Service CEO, Ms Joyce Mogale Ms Joyce Mogale, CEO CORPORATE PROFILE 75 patient testing in order to enhance Treatment and Care programs. The NHLS provides statistics related to HIV and TB to the National Department of Health to assist in monitoring the impact of interventions made to combat the epidemic.

How has the NHLS maintained good public awareness of these diseases and the preventative methods and medical action available?
The NPP has expanded activities into the Correctional Services and the peri-mining communities, thereby improving public awareness of these diseases and improving access to 
  laboratory services. The team represents NHLS at local and international forums, as part of various National Task Teams and has provided input into policies and guidelines to promote awareness of the diseases. The NPP also takes part in various National HCT campaigns where on-site GeneXpert testing is provided to communities, thereby improving public awareness.

There has been a significant increase in HIV viral load tests. Has this been a positive development? Yes, the increase in viral load tests has allowed for an increase in access to viral load testing for the South African population and has meant that more people who are on ARV treatment are being monitored appropriately. This has been a huge success for the HIV program in South Africa.
Can you tell us more about the mobile laboratories for TB testing? What do these laboratories encompass?
The mobile laboratories contain two GeneXpert IV analysers and are also equipped with airconditioners, fridges, and all other equipment and supplies needed to perform GeneXpert testing. Six of these mobile TB units were deployed within the communities to undertake Xpert MTB/RIF testing for TB. The six districts with a high proportion of mines in South Africa that have been identified for focused attention are:
• Lejweleputswa in the Free State;
• Dr Kenneth Kaunda and Bojanala Districts in the North West;
• West Rand in Gauteng; and
• Waterberg and Sekhukhune in Limpopo.

What preparations are being undertaken for the upcoming National Health Insurance initiative? Additionally, can you briefly explain what the National Health Insurance is?
NHI White Paper deliberately states that NHI represents a substantial policy shift that will necessitate massive reorganisation of the healthcare system, both public and private. In South Africa, our Universal Health Coverage is called National Health Insurance (NHI).
According to Honourable Minister Aaron Motsoaledi in his budget speech 10 May 2016, he defines NHI as the Universal Health Coverage. “NHI is a reflection of the kind of society we wish to live in—a society that will be based in values of justice, fairness and social solidarity.
NHI will represent a desire to share so that the population can best utilize what both systems have to offer rather than segmentalised in a way not consistent with our Constitution.”
In preparation for the NHI the NHLS has crafted its Annual Performance Plan to ensure that the organisation is ready to meet the NHI requirements. There are plans to improve infrastructure in pilot NHI district laboratories. Our main focus is to improve the quality of service rendered in all our laboratories by improving our processes and systems to support National Health coverage.

What is the current turn-around time for conducting tests and is this something that can be improved upon? What are the delaying issues that arise during this process?
The turn-around time for the HIV and TB tests are between 48 to 96 hours. NHLS has been consistence in adhering to these turn-around times. There are however, isolated incidences where results are delayed. These delays are usually caused by unexpected interruptions in our routine processes. The NHLS always strives to better its service delivery, and for that reason there is always room for improvement.

The NHLS is the only laboratory service that trains pathologists in South Africa. Why is this area of research so important?
To ensure continuous comprehensive pathology services to the country, it is essential to maintain a sustainable pathology professional pipeline, this include the provision of the training platform for pathologists, together with our academic partners.
The NHLS academic platform for pathologists is accredited by the HPCSA and provides a world class platform for the training of our internationally renowned pathologists. The skills and expertise of this group contributes substantially to the intellectual property of the organization, driving the national pathology curriculum, optimising the service platform and enabling translational research.
With regard to research specifically: NHLS staff contributes substantially to the national research output, in terms of blue sky research translation to policy.

You’ve previously stated that your goal is to ensure that the NHLS becomes the benchmark of an efficient laboratory service in Africa. Do you feel that you have achieved headway in this regard?
NHLS is highly regarded on the African continent for efficiency at all levels of operations. The challenge is to continuously improve and benchmark with the best diagnostic laboratory services in the world.

Looking ahead, what more needs to be done to ensure the continuing success of the organisation?
The NHLS board of Directors and the Minister of Health has approved the NHLS Strategic Plan and Annual Performance Plan for the current year. The plans developed will guide the activities to ensure continuing success of the organisation.