Medical laboratory governance beyond rhetoric: Who should control diagnostic services in Ghana?

Recent years have seen increasing professional tensions within laboratory medicine across diverse health systems, reflecting broader global debates on role delineation, leadership authority and control of diagnostic services. 

Such tensions are not unique to Ghana but have been observed in several mature systems, where interactions between laboratory physicians and Medical Laboratory Scientists, or their equivalents, have raised questions about operational control, professional scope and governance.                                                                      

In the United Kingdom, for instance, within the National Health Service (NHS), earlier ambiguities between consultant pathologists and biomedical scientists were progressively resolved through regulatory reform, professional standardisation, and clearer differentiation between operational and clinical roles.                                                                                                        

In the United States, frameworks such as the Clinical Laboratory Improvement Amendments (CLIA) have stabilised professional boundaries by anchoring laboratory leadership in competency-based certification and accreditation rather than exclusive professional identity.

Similarly, in South Africa, the National Health Laboratory Service (NHLS) exemplifies a hybrid governance model that integrates pathologists, clinical scientists, and technologists within a unified institutional structure, thereby mitigating jurisdictional conflict through defined career pathways and shared oversight.

Across these contexts, a consistent lesson emerges: effective laboratory governance is best achieved through regulatory clarity, functional differentiation, and collaborative systems design, rather than through hierarchical contestation – an insight that is directly relevant to the evolving situation in Ghana’s laboratory medicine landscape.

Korle Bu Dispute: National flashpoint 

Recent developments at the Korle Bu Teaching Hospital have pushed a long-simmering professional tension into the national spotlight.

Disagreements over laboratory access, leadership appointments and service directives have escalated into threats of industrial action, exposing a deep divide between laboratory physicians and Medical Laboratory Scientists (MLS). At the centre of the dispute are questions of control, professional jurisdiction, and patient safety, issues that demand careful analysis beyond rhetoric.                    

The position advanced by the Korle Bu Doctors Association (KODA) reflects genuine concerns, particularly around clinical integration and training.

However, resolving this impasse requires more than competing claims.

It demands a clear understanding of how modern laboratory systems function, how roles are defined by law, and how patient safety is actually safeguarded in contemporary healthcare environments.

Evolving competence: Changing profile

Historically, laboratory services in Ghana evolved within pathology-led structures, where medically trained specialists exercised both interpretive and operational control.

However, this model has undergone significant transformation, driven by the advancement of laboratory education to the bachelor’s degree level and beyond, alongside increasing technological complexity and evolving regulatory frameworks. 

The question of laboratory leadership must ,therefore, be situated within the changing competency profile of Medical Laboratory Scientists (MLS), which has expanded in response to developments in biomedical science and diagnostic practice.                                                                                                                                    

 Contemporary MLS training is underpinned by robust, competency-based curricula that integrate molecular diagnostics, laboratory informatics, quality management systems and translational research.

Beyond foundational training, structured pathways now exist for advanced professional development, including postgraduate academic qualifications at the Master’s and PhD levels, as well as the emerging professional doctorate programme, the Doctor of Medical Laboratory Sciences (MLS.D).                                                                            

In parallel, professional progression is reinforced through membership and fellowship training within the recognised West African Postgraduate College of Medical Laboratory Science (WAPCMLS), emphasising specialist expertise, leadership and governance competencies.

Collectively, these academic and professional frameworks equip MLS practitioners not only with advanced technical proficiency but also with the managerial, regulatory and strategic capabilities required for laboratory leadership.

As such, the contemporary MLS is not merely a technical operator but a scientifically grounded professional prepared for roles in laboratory governance, quality assurance, and systems-level decision-making. This transformation is not unique to Ghana; rather, it reflects a broader global shift in the organisation and delivery of diagnostic services.

Legal foundations: Statutory recognition, professional autonomy                            

In Ghana, this transition is firmly grounded in law. The Health Professions Regulatory Bodies Act 2013 recognises Medical Laboratory Science as an autonomous profession, with defined scope, standards and accountability.

MLS professionals are trained and licensed to generate, validate and assure the quality of diagnostic data – the very foundation upon which clinical decisions are made. Any interpretation of “merit-based leadership” that equates merit solely with a medical degree is therefore difficult to sustain within this statutory framework.

Understanding Laboratory Practice:

At the heart of the current debate is a conceptual misunderstanding of laboratory practice. Modern laboratory medicine operates across two interconnected but distinct domains: the analytical (technical) and the clinical (interpretive). MLS professionals are responsible for the analytical domain, ensuring accuracy, reliability, and quality, while laboratory physicians focus on interpretation, consultation and clinical application. These roles are complementary, not hierarchical.

Who manages the laboratory?

Functional control

This distinction also clarifies the issue of workspace control. In healthcare systems worldwide, operational environments are managed by professionals with the requisite technical expertise.

Nurses coordinate wards and operating theatres; similarly, MLS professionals manage laboratory spaces.

Their responsibilities include specimen handling, analytical processes, quality systems, biosafety, and regulatory compliance.

Laboratory physicians remain essential to clinical interpretation, but the day-to-day management of laboratory workflows is functionally aligned with MLS competence.

The writer is a Lecturer/consultant Medical Laboratory Scientist,

University of Health and Allied Sciences (UHAS), Ho.Interrogating key claims: Access, models and ‘scope creep’

Claims that laboratory physicians have been excluded from laboratory spaces must be treated with caution. In modern systems, access is governed by role and function, not professional identity.

Physicians continue to engage with laboratory services through clinical consultation, result interpretation, and multidisciplinary decision-making.

However, unrestricted access to analytical workflows is not a universal requirement and is often regulated to maintain quality and safety standards.

Equally, the frequent appeal to “international best practice” requires closer scrutiny.

There is no single global model that places laboratories exclusively under physician control.

In the United Kingdom, biomedical scientists lead laboratory operations while pathologists provide clinical oversight. In the United States, laboratory leadership may be held by physicians or doctoral-level scientists. South Africa’s system reflects a hybrid approach. Across these contexts, the consistent principle is clear: laboratory governance is collaborative and functionally differentiated.                     

The argument that MLS leadership represents “scope creep” also warrants reconsideration. Laboratory medicine is inherently interdisciplinary. MLS professionals are not seeking to perform clinical roles; rather, they are exercising leadership within their legally defined technical domain. Framing this as encroachment risks obscuring the very structure that ensures diagnostic accuracy.b

Patient safety, evidence-based governance                                                                        

Patient safety, often cited as the central concern, must be grounded in evidence. Laboratory quality is measured through objective indicators, error rates, turnaround times, proficiency testing and accreditation standards such as ISO 15189.

These systems place primary responsibility for quality management and analytical validation in the hands of trained laboratory professionals. Without empirical data demonstrating compromised performance, claims of risk remain speculative.

Toward a co-governance model for laboratory systems                                            

Ultimately, the current standoff reflects not just a professional disagreement but a governance gap. Sustainable solutions will not come from industrial action or institutional dominance.

They will emerge from a clear, structured model of co-governance, one that recognises the distinct but inter
dependent roles within laboratory medicine.                                                            

In such a model, MLS professionals would lead laboratory operations, quality assurance and technical validation, while laboratory physicians would lead in clinical interpretation, consultation and test utilisation.

This is not a compromise; it is the model underpinning high-performing laboratory systems globally.

 Beyond professional contestation                                                    

The debate at Korle Bu should ,therefore, not be framed as a contest for control, but as an opportunity to modernise laboratory governance in Ghana.

The strength of diagnostic services lies not in hierarchy, but in the integration of complementary expertise within a regulated, quality-driven system anchored in mutual respect and recognition of distinct professional mandates and professional autonomy.

The writer is a Lecturer/consultant Medical Laboratory Scientist, University of Health and Allied Sciences (UHAS), Ho.