Abstract
BackgroundThe Strengthening Laboratory Management Toward Accreditation (SLMTA) programme is designed to build institutional capacity to help strengthen the tiered laboratory system. Most countries implement the SLMTA three-workshop series using a centralised model, whereby participants from several laboratories travel to one location to be trained together.ObjectivesWe assessed the effectiveness and cost of conducting SLMTA training in a decentralised manner as compared to centralised training.MethodsSLMTA was implemented in five pilot laboratories in Cameroon between October 2010 and October 2012 by means of a series of workshops, laboratory improvement projects and on-site mentorship. The first workshop was conducted in the traditional centralised approach. The second and third workshops were decentralised, delivered on-site at each of the five enrolled laboratories. Progress was monitored by repeated audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist.ResultsAudit scores for all laboratories improved steadily through the course of the programme. Median improvement was 11 percentage points after the first (centralised) training and an additional 24 percentage points after the second (decentralised) training. The estimated per-laboratory cost of the two training models was approximately the same at US$21 000. However, in the decentralised model approximately five times as many staff members were trained, although it also required five times the amount of trainer time.ConclusionDecentralised SLMTA training was effective in improving laboratory quality and should be considered as an alternative to centralised training.
Highlights
International Organization for Standardization (ISO) 15189 accreditation is viewed worldwide as the gold-standard mark of competence for clinical laboratories
In 2009, four public hospital laboratories were selected by the Ministry of Public Health, Cameroon to enrol in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme: Buea Regional Hospital Laboratory (BuRHL), Bamenda Regional Hospital Laboratory (BRHL), Laquintinie Hospital Laboratory Douala (LHLD) and the Yaoundé Central Hospital Laboratory (YCHL)
Laboratoire d’Analyses Médicales du Centre (LAMC) had the largest improvement of 69 percentage points (Figure 1)
Summary
International Organization for Standardization (ISO) 15189 accreditation is viewed worldwide as the gold-standard mark of competence for clinical laboratories. Large-scale public health programmes, such as the US President’s Emergency Plan for AIDS Relief (PEPFAR), have highlighted gaps in laboratory services, emphasising the urgent need for quality improvement.[7] The World Health Organization’s Regional Office for Africa (WHO AFRO) has responded by launching the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) scheme, which is a phased approach to quality improvement.[8]. The Strengthening Laboratory Management Toward Accreditation (SLMTA) programme is designed to build institutional capacity to help strengthen the tiered laboratory system. Most countries implement the SLMTA three-workshop series using a centralised model, whereby participants from several laboratories travel to one location to be trained together
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