An integrated approach to Laboratory Systems Strengthening

Rosemary Emodi | International Manager

Context: challenges in Africa

• Extreme shortage of effective, quality pathology services.

• Human Resources of Health (HRH) Crisis:– Inadequately trained staff– Chronic under-staffing– Under-resourcing– Inadequate supervision– Poor quality monitoring systems

• Role of pathology and laboratory medicine services is often misunderstood by patients, clinicians and policy/decision-makers.

• Poor quality laboratory services has resulted in increased instances of misdiagnosis, inappropriate or inadequate treatment and investigations.

• African laboratories lack credibility. Low clinician confidence in laboratory test results.

Context: project rationale

• WHO defines health systems as all organizations, people and actions whose primary intent is to promote, restore or maintain health.

• The laboratory is a critical component of health systems improvement and plays a pivotal role in disease prevention, surveillance and control.

• Strengthened laboratory health systems will:

– enhance the prevention, early diagnosis and treatment of diseases; and

– make the attainment of major global health targets within the Sustainable Development Goals (SDGs) possible.

• Accurate and appropriate diagnostic testing is increasingly recognized as a strategic need to improve global health

Improving laboratory testing

Health Systems Strengthening

Improving pathology services

Raising standards & quality

Skills training

Knowledge transfer

Leadership development

Mentoring

Building laboratory capacityThe Royal College of Pathologists

College of Pathologists of East, Central & Southern Africa

British Division of the International Academy of Pathology

East, Central & Southern Africa Health Community

Aga Khan University Hospital Nairobi

University of Stellenbosch Cape Town

3 year pilot project

The Programme: Overview

20 laboratories

Zimbabwe

Tanzania

Uganda

Zambia

Kenya110 million people

1.7 million tests

Laboratory workforce

Pathologists

Laboratory Technologists

Biomedical Scientists

Laboratory Technicians

The Programme: Key Tests

Rapid HIV antibody

Rapid Malaria

Haemoglobin Determination

Urinalysis

Malaria Smear

TB Smear Microscopy

Peripheral Blood Film

Global Health

The Programme: Components

Courses

Mentoring

Training &Assessments

Projects

Personal Development

Monitoring &

Evaluation

Recognition

The Programme: Courses & Training

Technical Skills Development

Leadership & Quality Management

Developed in collaboration with the University of Stellenbosch

We trained 60 senior laboratory managers, biomedical scientists and pathologists.

A 5 day Leadership Retreat in Moshi, Tanzania formed part of the training.

Developed in partnership with the Aga Khan University Hospital Nairobi.

We trained 40 technologists and technicians.

A 5 day Technical Skills Retreat in Nairobi, Kenya formed part of the training.

The Programme: Assessments

External Quality Assurance (EQA) Assignments

• To monitor and evaluate progress;• Three sets of EQA assignments were conducted across all

20 laboratories;• Assignments covered all 7 tests;• Conducted by Aga Khan University Hospital Nairobi

Workplace-based Assignments

• Equipment downtime.• Laboratory strategic plans• Business case for introducing a new test or equipment• Laboratory user satisfaction survey.• Sample rejection policy• Business case for training.

The Programme: Projects

Laboratory Improvement Projects

5 national improvement projects implemented.

Kenya

Tanzania

Uganda

Zambia

Zimbabwe

Improving Haemoglobin Determination

Point of Care Testing (POCT)

Improving Malaria diagnosis: Multidisciplinary

Strengthening the clinician-laboratory interface

Standardising methods & equipment validation

Leveraged the skills, knowledge & expertise of highly qualified and experienced pathologists, biomedical and

clinical scientists as volunteer Course Mentors

The Programme: Mentoring

• Mentored laboratories and course participants.• Undertook lab visits to assess progress – 33 visits in total• Delivered on-site training.• Supported development and implementation of laboratory

improvement projects.• Contributed to the development of the course curricula

and training materials.• Participated in the Leadership & Technical Skills Development

Retreats.• Set additional workplace-based assignments based on

identified gaps and development needs.• Course mentors spent a combined total of 20,000 hours on

the programme.

LabSkills Africa Recognition Awards (LARA) Scheme

The Programme: Recognition

to acknowledge & celebrate achievements of the laboratories and participants.

• Laboratory Improvement

• Leadership

• Personal Development Planning

• Scientific Writing

• Learning Journal

• Leadership Retreat Workbook

• Strategic Planning

• Most Improved Laboratory

• Rising Star: Future Leaders

• External Quality Assurance

• Game Changer: Innovation

Project BoardDr Shahin Sayed, Secretary-General, COPECSA

Dr Alec Howat, President, BDIAPDr David Bailey, Vice President, RCPath

Dr Maadh Aldouri, Director of International Affairs, RCPathMiss Joanne Brinklow, Head of Educational Standards, RCPath

Project Management

Africa Steering CommitteeDr Shahin Sayed, Secretary-General, COPECSA

Dr Edda Vuhahula - TanzaniaDr Andrew Gachii – Kenya

Dr Robert Lukande – UgandaDr Maxwell Hove – ZimbabweDr Victor Mudenda - Zambia

Project TeamMiss Rosemary Emodi, International Manager, RCPath

Miss Umo Young, International Projects Officer, RCPathMiss Angela Mutuku, Programme Coordinator, COPECSA

Innocent Abayo, Programme Assistant, COPECSA

African leadership has been an essential and critical feature of this project and

collaboration.

African Leadership

We established an Africa Steering Committee which was chaired by the Secretary General of COPECSA and made up of 5 senior highly experienced pathologists who acted as Country Leads. These Country Leads represented the national professional pathology organisations:

• Kenyan Association of Clinical Pathologists

• Association of Pathologists of Tanzania• Association of Pathologists of Uganda• Zimbabwe Association of Pathologists

The impact

Turnaround Times

70% of laboratories reduced TATs

Average 20% reduction in TATs

16 time stamp machines donated

Increased accuracy in recording TATs

Inspired Zambia MoH to purchase time stamps

Standard Operating Procedures

Development of SOPs where none existed.

Garissa Provincial Referral Hospital: 30 SOPs developed.

Improved testing processes & procedures.

Clinicians/ Users

Increased clinician confidence in lab tests

95% of laboratories conducting user surveys

Improved relationship between labs & clinicians

Measurable improvement in the quality and accuracy of diagnostic tests performed.

Improved professional relationship between pathologists, scientists and technologists.

Improvement in WHO-SLIPTA star (accreditation) ratings for some laboratories.

The impact

In-house controls produced for urinalysis and haemoglobin determination.

Improved knowledge,

understanding & experience

Partnerships

Track record

Capacity-building Model

Complex Projects

Global health

Evidence-based

Health SystemsStrengthening

Collaborations

Recognition

Next steps

• Formalize the LabSkills Partnership for East, Central & Southern Africa.• Expand the menu of tests to include anatomic pathology.• Develop the LabSkills Model further and deliver it in other regions and

countries: Nigeria, South Sudan, Sierra Leone, Myanmar • Establish a research dimension to LabSkills Africa – to strengthen research

capability.• Work with COPECSA to harmonize pathology training and standards within

the ECSA region.• THET Knowledge Exchange & Sustainability Award

Next steps: Zambia

• Working with University Teaching Hospital (UTH) Lusaka and the School of Medicine to support the MMED Pathology Training Programme.

• Visiting lecturers from UK and the region.

• Working with our Country Advisor, Dr Victor Mudenda.

Sharing the learning, building a regional network

Kampala Conference (September 2015)

Social Media: Connect Follow Like!

@RCPath_Global

/globalpathology

/globalpathology

Kampala, Uganda, 2015

An integrated approach to Laboratory Systems Strengthening

Rosemary Emodi | International Manager Dr Maadh Aldouri | Director of International Affairs