Original Research

Laboratory system strengthening and quality improvement in Ethiopia

Tilahun M. Hiwotu, Gonfa Ayana, Achamyeleh Mulugeta, Getachew B. Kassa, Yenew Kebede, Peter F. Fonjungo, Gudeta Tibesso, Adino Desale, Adisu Kebede, Wondwossen Kassa, Tesfaye Mekonnen, Katy Yao, Elizabeth T. Luman, Amha Kebede, Mary K. Linde
African Journal of Laboratory Medicine | Vol 3, No 2 | a228 | DOI: https://doi.org/10.4102/ajlm.v3i2.228 | © 2014 Tilahun M. Hiwotu, Gonfa Ayana, Achamyeleh Mulugeta, Getachew B. Kassa, Yenew Kebede, Peter F. Fonjungo, Gudeta Tibesso, Adino Desale, Adisu Kebede, Wondwossen Kassa, Tesfaye Mekonnen, Katy Yao, Elizabeth T. Luman, Amha Kebede, Mary K. Linde | This work is licensed under CC Attribution 4.0
Submitted: 21 August 2014 | Published: 03 November 2014

About the author(s)

Tilahun M. Hiwotu, Ethiopian Public Health Institute (EPHI), Ethiopia
Gonfa Ayana, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Achamyeleh Mulugeta, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Getachew B. Kassa, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Yenew Kebede, US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia
Peter F. Fonjungo, US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia and International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States
Gudeta Tibesso, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Adino Desale, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Adisu Kebede, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Wondwossen Kassa, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Tesfaye Mekonnen, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Katy Yao, International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States
Elizabeth T. Luman, International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States
Amha Kebede, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
Mary K. Linde, The American Society for Clinical Pathology (ASCP), Chicago, United States


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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 hoursfor 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 ratinglevels.

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% ofthe 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.


Keywords

Quality, Improvement, Accreditation, Audit, Strengthening Laboratory Management Toward Accreditation (SLMTA)

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