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 The Royal College of Pathologists Building laboratory capacity College of Pathologists of East, Central & Southern Africa Improving pathology services British Division of the International Raising standards & quality Academy of Pathology East, Central & Southern Africa Skills training Health Community Aga Khan University Hospital Knowledge transfer Nairobi Leadership development University of Stellenbosch Cape Town Mentoring 3 year pilot project
The Programme: Overview 20 laboratories Kenya 110 million people Tanzania 1.7 million tests Uganda Zambia Laboratory workforce Zimbabwe Pathologists Biomedical Scientists Laboratory Technologists 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 Monitoring Training & & Assessments Evaluation Mentoring Personal Recognition Development Projects
The Programme: Courses & Training Technical Skills Development 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. 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.
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 Improving Haemoglobin Determination Tanzania Point of Care Testing (POCT) Uganda Improving Malaria diagnosis: Multidisciplinary Zambia Strengthening the clinician-laboratory interface Zimbabwe Standardising methods & equipment validation
The Programme: Mentoring Leveraged the skills, knowledge & expertise of highly qualified and experienced pathologists, biomedical and clinical scientists as volunteer Course Mentors 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.
The Programme: Recognition LabSkills Africa Recognition Awards (LARA) Scheme 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 Management Project Board Dr Shahin Sayed, Secretary-General, COPECSA Dr Alec Howat, President, BDIAP Dr David Bailey, Vice President, RCPath Dr Maadh Aldouri, Director of International Affairs, RCPath Miss Joanne Brinklow, Head of Educational Standards, RCPath Africa Steering Committee Dr Shahin Sayed, Secretary-General, COPECSA Dr Edda Vuhahula - Tanzania Dr Andrew Gachii – Kenya Dr Robert Lukande – Uganda Dr Maxwell Hove – Zimbabwe Dr Victor Mudenda - Zambia Project Team Miss Rosemary Emodi, International Manager, RCPath Miss Umo Young, International Projects Officer, RCPath Miss Angela Mutuku, Programme Coordinator, COPECSA Innocent Abayo, Programme Assistant, COPECSA
African Leadership African leadership has been an essential and critical feature of this project and collaboration. 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 Development of SOPs where none existed. Standard Operating Garissa Provincial Referral Procedures Hospital: 30 SOPs developed. Improved testing processes & procedures. Clinicians/ 70% of laboratories reduced Users TATs Average 20% reduction in Turnaround TATs Increased clinician Times 16 time stamp machines confidence in lab tests donated 95% of laboratories conducting user surveys Increased accuracy in recording TATs Improved relationship between labs & clinicians Inspired Zambia MoH to purchase time stamps
The impact In-house controls produced for urinalysis and haemoglobin determination. 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.
Global health Collaborations Track record Improved knowledge, Health Systems Capacity-building understanding & Strengthening Model experience Evidence- Partnerships Recognition based Complex Projects
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! /globalpathology @RCPath_Global /globalpathology Kampala, Uganda, 2015
An integrated approach to Laboratory Systems Strengthening Rosemary Emodi | International Manager Dr Maadh Aldouri | Director of International Affairs
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