Laboratory strengthening is a component of Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS), a five-year project to build local capacity for the delivery of sustainable, high-quality and comprehensive HIV/AIDS prevention, treatment, care and support services. FHI 360 implements SIDHAS in 13 states in Nigeria.
What is laboratory strengthening and how is SIDHAS meeting this need?
Lab strengthening is a form of support to improve the capacity of a lab for quality service delivery, helping to achieve optimal performance, increase productivity and efficiency, deliver accurate and replicable diagnostics services, achieve customer satisfaction and promote safety. Lab strengthening also provides infrastructural development, equipment maintenance and quality control services to allow timely delivery and accurate results.
FHI 360 has supported the improvement of labs through training and mentoring to facilitate good quality management systems and record keeping. This work in lab improvement aligns with the World Health Organization Africa Regional Office (WHO-AFRO) initiative known as Strengthening Laboratory Management Towards Accreditation (SLMTA). Working within SLMTA parameters with our Nigerian government counterparts provides regular collaboration and deepens the leadership, stewardship and sustainability of the country’s labs.
You were one of the authors of “Piloting Laboratory Quality System Management in Six Health Facilities in Nigeria.” What was involved in these pilots?
This paper reviews SIDHAS efforts in piloting WHO-AFRO recognition and accreditation preparedness in six labs in Nigeria. We were able to measure the positive impact on the labs through rigorous performance tests. The work done during this research led to further improvements toward a formal international accreditation status and scale-up of WHO-AFRO Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) implementation in Nigeria.
The pilots began with the earlier Global HIV/AIDS Initiative Nigeria (GHAIN) project because the Nigerian government saw the need for hospitals and labs to work within a set of standards for delivery of reliable health care results. The labs were formerly recognized by WHO-AFRO during the SIDHAS project.
Were the pilots successful and how?
Definitely, the successes are prominent in the accompanying chart. It shows the six pilot labs significantly increased in points on their quality and competency audits when comparing baseline and exit performances. An increase in SLIPTA points shows an improvement in a lab’s overall testing capacity.
The achievement of the lab at General Hospital Lagos was outstanding and an unexpected success because it is an integrated lab. This site is special because of its ability to integrate quality improvement across five of its department labs, as compared to other facilities that manage only the routine labs and single-disease focuses, for example, antiretroviral therapy labs.
Why is it important for a lab to be accredited and how does this relate to lab strengthening?
An accredited lab will consistently provide precise and accurate results in a timely manner to guide clinicians in patient management. The patient must be satisfied with the services provided. Clinical diagnosis without the benefit of quality laboratory results often results in patient mismanagement and inappropriate treatment leading to poor outcomes.
A lab that is accredited must meet 12 quality system essentials. These include documents and records, management reviews, organization and personnel, client management, equipment, evaluation and audits, purchasing and inventory, process control, information management, corrective actions, incidence management, and facilities and biosafety. Scoring is based on a one-to-five-star rating.
Improvement of these individual system essentials will help in the overall strengthening of the labs.When a lab is strengthened, it increases the community’s confidence in the quality of the lab’s services. Click To Tweet
Can FHI 360 help scale up more labs and integrate them? What are the next steps for the SLIPTA labs?
Yes, more labs have been supported to achieve accreditation through the SIDHAS project. An example is the Holy Family Catholic Hospital, Ikom. At the onset of the project, this was a single-disease lab for antiretroviral therapy services, but it is now a renovated and integrated lab. The entire accreditation process had the committed support of hospital management, which was critical to ensure success. FHI 360 will continue technical support to the SLIPTA labs and mentor these sites to attain the highest five-star rating. Our approach to measure and classify the level of lab service integration is scalable across supported labs as a means to improve quality systemwide. We hope more labs will continue to be accredited.
What is the connection between strengthening a lab and strengthening an entire community?
When a lab is strengthened, it increases the community’s confidence in the quality of the lab’s services. This satisfaction leads to more people using the services and ultimately culminates in better and improved health care services and outcomes.
A strengthened lab will have the capacity to accurately identify and isolate specific disease organisms that are of public health concern and thus help in the control of epidemic and disease outbreaks, contributing to strong and healthy communities.