Laboratory system strengthening and quality improvement in Ethiopia

Abstract

Background In 2010, a National Laboratory Strategic Plan was set forth in Ethiopia to strengthen laboratory quality systems and set the stage for laboratory accreditation. As a result, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme was initiated in 45 Ethiopian laboratories. Objectives This article discusses the implementation of the programme, the findings from the evaluation process and key challenges. Methods The 45 laboratories were divided into two consecutive cohorts and staff from each laboratory participated in SLMTA training and improvement projects. The average amount of supportive supervision conducted in the laboratories was 68 hours for cohort I and two hours for cohort II. Baseline and exit audits were conducted in 44 of the laboratories and percent compliance was determined using a checklist with scores divided into zero- to five-star rating levels. Results Improvements, ranging from < 1 to 51 percentage points, were noted in 42 laboratories, whilst decreases were recorded in two. The average scores at the baseline and exit audits were 40% and 58% for cohort I (p < 0.01); and 42% and 53% for cohort II (p < 0.01), respectively. The p-value for difference between cohorts was 0.07. At the exit audit, 61% of the first and 48% of the second cohort laboratories achieved an increase in star rating. Poor awareness, lack of harmonisation with other facility activities and the absence of a quality manual were challenges identified. Conclusion Improvements resulting from SLMTA implementation are encouraging. Continuous advocacy at all levels of the health system is needed to ensure involvement of stakeholders and integration with other improvement initiatives and routine activities.

A comprehensive review of the SLMTA literature part 1: Content analysis and future priorities

“…Six papers presented experiences from a single laboratory 7,10,17,26,28 or a single hospital, 9 14 presented data from two to 45 laboratories within a single African country, 8, 12,–15,18,–22,25,29–31 one discussed activities in two Southeast Asian countries, 23 one covered data from four countries in the Caribbean Region 11 and six had a general or global focus. 1,16,23,24,32,33 In total, these studies included detailed information on SLMTA implementation in 211 laboratories in 18 countries.…”

“…11 Another reported that ‘prior to the introduction of SLMTA, several trainings and quality improvement initiatives had been implemented in hospitals and laboratories in Ethiopia, but little improvement was noted’. 12 In Botswana, there had been ‘slow progress in implementing QMS’, and authors noted that ‘previous training of healthcare workers has focused on general management topics rather than identifying tangible tasks to bring about change, making the training difficult to apply in the laboratory’. 28 …”

“…Authors noted that also during this timeframe, countries began to develop five-year laboratory strategic plans – Kenya 14,15 and Ethiopia 12,13 in 2005; Botswana 20,28 and Lesotho 21 in 2008; Zimbabwe 30 in 2010; and Ghana 25 and Namibia 19 in 2012. These plans called for laboratory strengthening and development of QMS, some specifying accreditation goals.…”

“…At the facility level, many authors reported the importance of engaging hospital and senior management from the beginning so as to ensure their buy-in and ownership of the programme 7,12,17,20,25,26,28,29,30 and to promote institutionalisation and thus sustainability. 18 Many also noted the importance of a strong commitment and team spirit amongst the laboratory staff 7,9,10,18,20,28,29 and a willingness to build a culture of quality 17,26 and problem solving.…”

Perceptions and attitudes toward SLMTA amongst laboratory and hospital professionals in Ethiopia

“…8 Hiwotu et al detail SLMTA implementation in Ethiopia, documenting substantial improvements to laboratory quality. 9 …”