Building local human resources to implement SLMTA with limited donor funding: The Ghana experience

Bernard Nkrumah,Katy Yao,Samuel Duh,Nii A Kotey,Rowland Adukpo,Beatrice Van Der Puije,Celia J.I Woodfill,Veronica Bekoe,Elizabeth T Luman,Peter N Fonjungo,Patrick A Njukeng,Fazle N Khan,Nii A Addo

doi:10.4102/ajlm.v3i2.214

Abstract

BackgroundIn 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources.ObjectivesTo demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources.MethodLocal partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental training on internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM).ResultsThe local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors’ salaries, SLMTA training and improvement project support.ConclusionBuilding in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such models promote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

Highlights

The recent drive by the World Health Organization’s Regional Office for Africa (WHO AFRO) and the US President’s Emergency Plan for AIDS Relief (PEPFAR) toward strengthening laboratory systems in Africa is a historic step in the improvement of health systems
This paper describes how a country like Ghana, which receives very limited funding, was able to achieve marked improvement in laboratory quality management by empowering local partners to implement the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme
Laboratories in all three cohorts demonstrated a steady improvement in the implementation of quality management systems (QMS), as was illustrated by the median Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) scores at each audit (Figure 2)

Summary

Introduction

The recent drive by the World Health Organization’s Regional Office for Africa (WHO AFRO) and the US President’s Emergency Plan for AIDS Relief (PEPFAR) toward strengthening laboratory systems in Africa is a historic step in the improvement of health systems. The programme was implemented successfully with limited donor funding and local human resources

Objectives

Methods

Results

Discussion

Conclusion