An integrated approach to Laboratory Systems Strengthening Rosemary - - PowerPoint PPT Presentation

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
• rganizations, 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 capacity The 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 Kenya

110 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 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

Project Management

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 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

• f 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 Systems Strengthening

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