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
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 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 Health Systems Strengthening Building laboratory capacity Improving pathology services Raising standards & quality Skills training Knowledge transfer Leadership development Mentoring
The Programme: Overview 20 laboratories 110 million people 1.7 million tests Laboratory workforce Pathologists Kenya Tanzania Uganda Zambia Zimbabwe 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 & Evaluation Training & Assessments Mentoring Recognition Personal 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 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
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. Garissa Provincial Referral Hospital: 30 SOPs developed. Standard Operating Procedures Improved testing processes & procedures. 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 Clinicians/ Users Increased clinician confidence in lab tests 95% of laboratories conducting user surveys Improved relationship between labs & clinicians
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.
Track record Global health Collaborations Improved knowledge, understanding & experience Capacity-building Model Health Systems Strengthening Complex Projects Partnerships Evidencebased 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! /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