Weighing the costs: Implementing the SLMTA programme in Zimbabwe using internal versus external facilitators

Abstract

BackgroundIn 2010, the Zimbabwe Ministry of Health and Child Welfare (MoHCW) adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a tool for laboratory quality systems strengthening.ObjectivesTo evaluate the financial costs of SLMTA implementation using two models (external facilitators; and internal local or MoHCW facilitators) from the perspective of the implementing partner and to estimate resources needed to scale up the programme nationally in all 10 provinces.MethodsThe average expenditure per laboratory was calculated based on accounting records; calculations included implementing partner expenses but excluded in-kind contributions and salaries of local facilitators and trainees. We also estimated theoretical financial costs, keeping all contextual variables constant across the two models. Resource needs for future national expansion were estimated based on a two-phase implementation plan, in which 12 laboratories in each of five provinces would implement SLMTA per phase; for the internal facilitator model, 20 facilitators would be trained at the beginning of each phase.ResultsThe average expenditure to implement SLMTA in 11 laboratories using external facilitators was approximately US$5800 per laboratory; expenditure in 19 laboratories using internal facilitators was approximately $6000 per laboratory. The theoretical financial cost of implementing a 12-laboratory SLMTA cohort keeping all contextual variables constant would be approximately $58 000 using external facilitators; or $15 000 using internal facilitators, plus $86 000 to train 20 facilitators. The financial cost for subsequent SLMTA cohorts using the previously-trained internal facilitators would be approximately $15 000, yielding a break-even point of 2 cohorts, at $116 000 for either model. Estimated resources required for national implementation in 120 laboratories would therefore be $580 000 using external facilitators ($58 000 per province) and $322 000 using internal facilitators ($86 000 for facilitator training in each of two phases plus $15 000 for SLMTA implementation in each province).ConclusionInvesting in training of internal facilitators will result in substantial savings over the scale-up of the programme. Our study provides information to assist policy makers to develop strategic plans for investing in laboratory strengthening.

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

“…We identified 28 published manuscripts focusing on the SLMTA programme, 1,7–33 including 26 published concurrently with this article, 1,7-20,22-31,33 one previously-published article summarising the development and methodology of the SLMTA programme 32 and one previously-published study regarding SLMTA implementation in Lesotho 21 (Table 1). 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.…”

“…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.…”

“…The most-commonly reported challenge was that of staff attrition. 10,11,13,17,20,21,29,31,32 One study of programme implementation in the Caribbean region reported the following:…”

Working toward a sustainable laboratory quality improvement programme through country ownership: Mozambique’s SLMTA story

“…For example, in Zimbabwe, Shumba et al found that it cost less over the long term to engage and train local quality managers as auditors, trainers and mentors than to import international consultants to do the job. 10 Minimizing costs is essential because programmes that require unacceptable levels of resource commitment are unsustainable. 6 …”

Maximising mentorship: Variations in laboratory mentorship models implemented in Zimbabwe

“…This was done through the use of an inventory of all resources and payments made for the programme. 8 Costs calculated included: the three training courses which were attended by the mentors; mentorship costs such as salaries, travel and lodging, internet access and laptops; and supervisory costs (Table 1). This analysis was limited to the direct costs of providing mentorship and supervision only.…”