Wednesday, November 29, 2017

Quality Progress Taking Hold in African Countries

I was looking at some earlier files and presentations, going back to 2004-2005.  The subject from this retrospective “look-back” was my involvement in laboratory quality in African countries.  My introduction was through a senior partner group participating in the US President’s Emergency Program for AIDS Relief (PEPFAR) program set up by George W. Bush.  To the credit of the people responsible, they were able to see that establishing a program of monitoring for AIDS diagnostics was going to require the establishment of Africa based laboratories capable of Quality and Competent practices.  

Back then there was lots of evidence that this was going to be a major barrier.  Laboratories were working with at best rudimentary equipment, usually with out-dated reagents.  Samples all too frequently were being delivered to the laboratory not in typical sample container tubes, but more likely in repurposed medication vials.  Additives like heparin were being added by hand and pipette with little sense of precision.  In microbiology, critical samples such as blood cultures were a travesty,  with reliability closer to 30-40%; huge false positive results from contamination and false negative results from faulty media and terrible technology.  
When I think back to those days, my amazement of what is happening today is triple underlined and reinforced in gold.  

This week we are finishing off a 21-week on-line course that was put on for 15 Quality Assurance Officers.  This group has the same level of knowledge and sophistication about laboratory quality as peers almost anywhere in the world, and truly better than most.  Our discussions about things Quality, like internal audit, quality indicators, document control, quality control, inventory management, Lean, 5S, Six-Sigma, SIPOC would parallel or surpass many laboratories in much wealthier laboratories.   

So how did the laboratories get from then to now?  With a lot of work both from without and within.

Importantly governments from around the world, and US in particular, have spent a ton of tax-payer supported money, supporting laboratories, equipment, PEPFAR partners, mentors, and education.
But all that and a another dollar and a half would still not buy a Starbucks coffee were it not for a massive effort from the Africa Society for Laboratory Medicine (ASLM).  It was ASLM who with the support of World Health AFRO who introduced two programs; Strengthening Laboratory Management Toward Accreditation (SLMTA) and Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA).  SLMTA is an education program to promote education and knowledge about laboratory quality and SLIPTA is a graduated check-list that allows laboratories work at their own pace towards preparation for international accreditation. 

SLMTA and SLIPTA were introduced and implemented into some 1000-plus laboratories in near 50 different countries.

I know these programs were effective in moving the progress towards success because we had introduced earlier progenitor programs under the PEPFAR banner.  SLMTA and SLIPTA differed from what we did because they were Africa created, Africa taught and mentored, and Africa monitored.  

[To be honest, I am not sure that I see international accreditation as an important goal for many laboratories anywhere in the world, much less in Africa.  Most laboratories don’t do enough international work that then need to achieve accreditation to keep them in the international flow.  I do see the international documents a worthy goal, and a standard that states, provinces and countries everywhere can and should adopt in lieu of home-brew accreditations. 
But while that is a side digression, let me just say the next step to African laboratory quality is going to have to require African countries stepping up to the plate and demanding laboratories meet certain accreditation expectations for the sake of patient safety.]

To be fair and honest, many (most) laboratories in Africa that I have seen would not be able to function providing services in most developed countries, but that is NOT the fault of the laboratories.  The single biggest problem is that equipment and reagent distributors do not serve the laboratory community in Africa in the same way as they do in Europe or North America.  Part of this is money, and part is passivity, but the reality is that African population is around 1.2 billion people, and there is every reason they should be able to expect and demand better service.

But getting back to my original commentary.  Over the last 15 years we have seen monumental progress in medical laboratory performance and quality in many African countries.  
I would like to delude that I had a tiny role to play in this, but that would be grandiose thinking.

 African physicians are now in a position that they can actually make clinical decisions based on laboratory test results.  That was not the case a mere 15 years ago.

There clearly is more work to be done, but I NEVER would have imagined that we would see the levels of success that we are seeing today. 


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