The practice of pathology in Africa.

In attempting to advance the health of women and children in Africa, practitioners should be cognizant of the history of health care delivery in the continent and the nature of the existing systems. Although autopsies began in Africa several millennia ago, traditional healers have held sway for many centuries and continue to do so for most of Africa's people. The role of laboratory medicine in advancing modern health care has been impeded by its ever-increasing high cost, lack of confidence in the system, lack of adequately trained personnel, and inadequate provision of facilities and training opportunities. This is partly caused by the continent having the highest proportion of young children in the world, an exceptionally heavy disease burden, and a low proportion of tax payers. For laboratory medicine to have its intended effect in making accurate diagnoses, national, minimal standards for certification and practice should be formulated. There should be periodic inspections, rewards for excellence, and opportunities for professional development. It is recommended that laboratory medicine be practiced in a 4-tier system, with the highest in teaching hospitals, and the lowest in primary health care clinics. For the practice of anatomic pathology to advance, an effective referral system and an equitable minimal and maximal workload for each pathologist are needed. The changing dynamics of urbanization, with massive unemployment rates, unhealthy life styles, and the continued role of traditional healers calls for gifted leaders to come to the fore and facilitate internal and external cooperation with diverse health care agencies.