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

Abstract

BackgroundLaunched in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has emerged as an innovative approach for the improvement of laboratory quality. In order to ensure sustainability, Mozambique embedded the SLMTA programme within the existing Ministry of Health (MOH) laboratory structure.ObjectiveThis article outlines the steps followed to establish a national framework for quality improvement and embedding the SLMTA programme within existing MOH laboratory systems.MethodsThe MOH adopted SLMTA as the national laboratory quality improvement strategy, hired a dedicated coordinator and established a national laboratory quality technical working group comprising mostly personnel from key MOH departments. The working group developed an implementation framework for advocacy, training, mentorship, supervision and audits. Emphasis was placed on building local capacity for programme activities. After receiving training, a team of 25 implementers (18 from the MOH and seven from partner organisations) conducted baseline audits (using the Stepwise Laboratory Quality Improvement Process Towards Accreditation [SLIPTA] checklist), workshops and site visits in six reference and two central hospital laboratories. Exit audits were conducted in six of the eight laboratories and their results are presented.ResultsThe six laboratories demonstrated substantial improvement in audit scores; median scores increased from 35% at baseline to 57% at exit. It has been recommended that the National Tuberculosis Reference Laboratory apply for international accreditation.ConclusionSuccessful implementation of SLMTA requires partnership between programme implementers, whilst effectiveness and long-term viability depend on country leadership, ownership and commitment. Integration of SLMTA into the existing MOH laboratory system will ensure durability beyond initial investments. The Mozambican model holds great promise that country leadership, ownership and institutionalisation can set the stage for programme success and sustainability.

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.…”

“…The Rwanda Ministry of Health aimed to enroll all 48 central and district hospital laboratories in the accreditation preparation process, 29 and the Ministry of Health in Mozambique established a National Laboratory Policy, which outlined their commitment to implement QMS and to pursue accreditation for reference and provincial hospital laboratories. 18 The focus on laboratory quality improvement led these countries to implement the SLMTA programme in order to help them improve their quality management.…”

“…For example, Zimbabwe’s National Quality Assurance Program established a Training and Mentorship Department; 30 Kenya’s Ministry of Health created a National Accreditation Steering Committee to coordinate laboratory accreditation activities; 14 and Mozambique established a National Laboratory Technical Working Group to build a framework for a national laboratory quality improvement programme, to lead and coordinate its implementation and to monitor and maintain results. 18 …”

“…26 In Rwanda, 17 local mentors were trained to roll out the SLMTA programme. 29 In Mozambique, 15 auditors were trained 18 and in Ghana, 15 mentors and 11 auditors were trained. 25 Several papers discussed national plans to train additional mentors and auditors.…”

The SLMTA programme: Transforming the laboratory landscape in developing countries

“…The need for extensive but affordable site support has led countries such as Cameroon, 30 Mozambique, 33 Swaziland and Zimbabwe 34 to establish structured mentorship programmes with full-time facility-based local mentors -a model spearheaded by Lesotho. 32,35 This model has welldefined goals for each mentoring engagement, extended contact time on site, defined periods when mentors are absent, consistent approaches across laboratories and measurement of progress using standardised tools.…”