Evidence from 617 laboratories in 47 countries for SLMTA-driven improvement in quality management systems

Abstract

BackgroundThe Strengthening Laboratory Management Toward Accreditation (SLMTA) programme is a large-scale effort to improve the quality of laboratories in resource-limited countries.ObjectivesThis study sought to evaluate the first four years (2010–2013) of SLMTA implementation.MethodsCountry-level data were submitted by SLMTA programme leads and compiled globally. Performance was measured before (baseline) and after (exit) SLMTA implementation using an audit checklist which results in a percentage score and a rating of zero to five stars. Some laboratories continued to monitor performance in post-exit surveillance audits. We evaluated score improvements using two-tailed t-tests for equal variances and estimated the number of tests performed by SLMTA laboratories based on star level.ResultsSLMTA was implemented in 617 laboratories in 47 countries in Africa, the Caribbean, Latin America and Southeast Asia. At the baseline audit, the laboratories scored an average of 39% on the checklist and 84% of them were rated below one star. As of December 2013, 302 laboratories had completed the SLMTA programme; mean checklist scores increased from 39% at baseline to 64% at exit (p < 0.001) over an average 16-month programme duration. Ninety-two laboratories conducted a surveillance audit at a median of 11 months after their exit audit; 62% further increased their performance. Six SLMTA laboratories have achieved accreditation status. In total, the 617 SLMTA laboratories conduct an estimated 111 million tests annually. Only 16% of these tests were conducted by laboratories with at least one star at baseline, which increased to 68% of tests after SLMTA training. Thus, approximately 23 million tests are conducted annually by laboratories previously at zero stars that now have one to five stars; this number is projected to increase to 58 million when currently-enrolled laboratories complete the programme.ConclusionSLMTA has transformed the laboratory landscape in resource-limited countries worldwide and has the potential to make a substantial and sustainable impact on the quality of laboratory testing and patient care.

Improving quality in national reference laboratories: The role of SLMTA and mentorship

“…The 22 other laboratories in Nigeria’s first SLMTA round had similarly impressive results, moving from an average baseline of 60% to 87% at exit audit; 16 of the laboratories achieved four to five stars. 13 These successes inspired Nigeria to implement a second round of SLMTA in 2013 and to begin discussions regarding further national expansion of the programme. Because of the potential benefit of on-site mentorship, national experts are being trained in Nigeria to play this critical role.…”

Translating a National Laboratory Strategic Plan into action through SLMTA in a district hospital laboratory in Botswana

“…To spearhead the MOH’s National Laboratory Strategic Plan, Strengthening Laboratory Management Toward Accreditation (SLMTA), a structured quality improvement programme, was selected to assist in the development of QMS within healthcare facilities. 10,11 Since its launch in 2009, SLMTA has demonstrated success in many countries 12 because of its task-oriented measureable design.…”

Implementation research: a mentoring programme to improve laboratory quality in Cambodia

“…Since 2010, 47 countries, including Cambodia, have implemented the SLMTA programme and many have reported their successes in improving laboratory quality 28 , 29 …”