Building Human Resource Capacity for Quality Assurance

IDI experts in laboratory science work across Uganda and beyond providing capacity building, technical assistance, training and monitoring services to bring laboratories to the highest quality. We enable health systems in Africa to provide accurate and reliable laboratory services to better serve patient needs and more effectively respond to diseases such as HIV, malaria and tuberculosis (TB) and other infectious and noncommunicable diseases.

Since inception, IDI has conducted over 100 types of laboratory trainings, reaching over 1,000 lab technicians and managers from Uganda and eight other African countries—with pre-and post-test scores as evidence of impact. These continue to receive onsite support and supervision. Additionally, our lab training programme has attracted much interest in and outside Uganda with our Ministry of Health-approved curricula translated and used in French-speaking Africa.

From the basic principles of laboratory accreditation to professional certification programme in laboratory leadership and management, we train in HIV lab techniques and good laboratory practices, lab management and training of trainers, lab monitoring and evaluation, logistics supply chain management system, biosafety and biosecurity, and customized SLMTA/SLIPTA training. Usually, the training is followed by well-organised mentorship and support supervision of the trainees to ensure continuous improvement so that standards and/or accreditation, once achieved, are maintained or surpassed. We also conduct Trainer of Trainers’ sessions for lab staff who are taken on as facilitators and mentors, and supported to transfer acquired knowledge and skills to their colleagues as well as offer support supervision to lower lab facilities within their vicinity. Other trainings include:

• In-service Quality Management Systems (QMS) training, mentoring and implementation
• Development and support of national proficiency testing programmes
• Strengthening pre-service educational programmes in medical laboratory science and in-service clinician training on use and interpretation of HIV viral load testing, scale up, and monitoring
• Development and support of laboratory referral networks
• Strategic planning and policy development to address laboratory practice
• Biosafety training

Remaining at the pinnacle of professionalism and client expectations

In 2003, IDI Core Lab became the second laboratory in Africa—and the first in sub-Saharan Africa—to attain the College of American Pathologists (CAP) accreditation status. Reaccredited every two years, the IDI Core Lab equipped with the state-of-art equipment for clinical diagnostic tests has established itself for over 20 years as a world-class clinical research and human diagnostic facility.

Used as a reference lab to support other national and regional labs towards accreditation, IDI’s Core Lab has won several global lab quality awards. These include the Uganda Centres for Disease Control and Prevention-Uganda Laboratory, the College of American Pathologists (CAP), United Kingdom National External Quality Assurance Schemes (UKNEQAS), Centre for Disease Control–Model Performance Evaluation Program (CDC-MPEP), Quality Assurance and Standardization for Immunology (QASI), and American Proficiency Institute (API).  Other awards and recognition for quality testing services are the prestigious Medical Laboratory Observer’s Award and the International DAIDS Microbicide Trial Network and the African Society for Laboratory Medicine.

Close to 60 labs across Uganda and some African countries have been supported to improve quality and operations using available resources and achieve international accreditation standards.

Taking Aim at International Standards

We implement lab quality management systems using the Strengthening Laboratory Management Towards Accreditation (SLMTA)—known as SLMTA—to train managers to improve laboratory operations using available resources and achieve international accreditation standards. We also support public health laboratories in developing countries or resource limited settings to achieve ISO 15189 standards using the Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (SLIPTA) approach. While SLIPTA measures the laboratory quality by conducting audits, SLMTA provides the how-to with training and mentoring.

We have established partnerships with major lab programme players in Uganda, including the Central Public Health Laboratories, a department of the Ministry of Health in Uganda responsible for providing stewardship for the national health laboratory network. Other players include the Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Uganda Virus Research Institute, and National TB Reference Laboratory of which IDI has implemented a range of lab management capacity-building programmes.

To date, IDI has supported six district hubs to achieve ISO 15189 standards, and over 75 labs to improve their operations and quality using customised SLMTA/SLIPTA models followed by Good Laboratory Practice Management Training. These have been enrolled for SLMTA by the Ministry of Health/Central Public Health Laboratories significantly improving their ratings.

We also conduct training workshops and support the Ministry of Health teams to provide mentorship to the field staff. We recruit site mentors to oversee the implementation of SLMTA at the facilities, including the development of an SLMTA electronic database to be used by Central Public Health Laboratories to monitor the progress of the labs based on the WHO/AFRO checklist items/questions on 12 quality essentials. We also support health facilities to develop quality manuals and standard operating procedures for lab processes.

Our laboratory experts conduct regular assessments and audits to gauge a laboratory’s performance and potential. Our assessments compare laboratories against international standards, identify gaps and opportunities for improvements and then supply them with sustainable, efficient solutions to improve their diagnostic services. We focus on priority action items targeting patient and staff safety and then support the laboratories in addressing all issues, allowing them to achieve accreditation. As part of this, we work with both government and clinical stakeholders to create cost-effective, long-term plans that strengthen laboratories according to local need.

We have audited laboratories across Uganda and in over 10 African countries. We have also partnered with ministries of health in countries, such as Malawi and Eswatini to improve their national laboratory strategic plans and goals for national laboratory improvement. This work has been supported by national and international donors, such as the U.S. Centres for Disease Control and Prevention (CDC), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Agency for International Development (USAID), the US Department of Defense (DOD) and Becton-Dickinson. Others include the East African Public Health Laboratory Network (EAPHLN) and the Inter-Religious Council of Uganda (IRCU)—for which IDI provided lab technical to several faith-based organisation health facilities across the country. In many African countries, IDI is an active advisor to the ministry of health on laboratory strengthening matters. For example, in Uganda, IDI is an active member of the health ministry’s Laboratory Coordinating Committee, which oversees laboratory improvements across the country.

Driven by the desire to develop sustainable lab management and referral systems, IDI has designed and developed lab infrastructure and systems at all levels of the healthcare system in Uganda and beyond using its unique Laboratory Capacity Pyramid Approach. The approach considers four-tier hierarchy of capacity needs: 1) tools; 2) skills; 3) staff and infrastructure, and 4) structure, systems and roles.

Where appropriate, we enrol district reference laboratories selected by the Ministry of Health on the Standard Strengthening Laboratory Management Toward Accreditation (SLMTA)/SLIPTA) approach and trains laboratory personnel to establish Laboratory Quality Management Systems (LQMS) and Good Laboratory Practice (GLP) in the process of preparing them to achieve ISO 15189 accreditation. Leveraging its pinnacle position in the lab services, IDI established Laboratory External Quality Assurance schemes. We support the establishment of laboratory-related procurement, logistics, and sample transportation systems. Our Core Lab is closely linked with the IDI’s Health Systems Strengthening Programme with the former acting as a backup and referral lab under the IDI outreach programme and at the same time serving as a model for in-service lab personnel attachments.

IDI’s lab outreach activities span all levels of the Ugandan health system, extending from supporting the management of the Central Public Health Laboratories (CHPL) right through to improving conditions and quality at remote rural labs. IDI lab staff have extensive experience in supporting countries in the accreditation of labs and integration of locally appropriate sustainability mechanisms. As an integral player in the health systems strengthening in the region, IDI’s experienced lab team has supported nearly 130 labs ranging from regional to health centre III facility labs across Uganda. Out of these, close to 60 labs have been supported to achieve international accreditation, including a reference lab in Eswatini (formerly Swaziland). See IDI-supported Accredited Labs.

High-quality laboratories are essential for countries to accurately measure disease prevalence, for health systems to provide accurate diagnoses and for clinicians to guide appropriate treatment. With the support of donors and partners, IDI has provided technical assistance to establish and redesign laboratories and to expand testing services in existing facilities across the country. This is intended to support our outreach activities across the country as well as specialized research labs (up to biosafety level 3), particularly in the context of emerging infectious diseases.

We have also guided renovations of laboratories at all levels across the country to enhance the work flow, lab safety and hygiene. Our experienced lab team provide clear structure, roles and systems to guarantee that facilities have the space required to improve operations and lab service outcomes. Approximately 20 labs have been renovated or refurbished and their structures organised in specialised sections such as CD4, Haematology, Chemistry, Parasitology, and Microbiology, enhancing their delivery capacity and biosafety.

At IDI, we enable laboratories in some of the most resource-limited settings to achieve internationally recognized standards for quality. In Uganda, we support the Ministry of Health to conduct the lab quality assessments to equipment needs according to the appropriate guidelines for each level of the lab, ensuring that investment in equipment is commensurate and new equipment are compatible with the existing stock and lab human resource capacity for maximum efficiency. At least seven districts lab hubs have been provided with high-quality equipment to support peripheral labs without the capacity to run tests such as CD4, CBC, and Chemistry. The lab hubs are also provided with biosafety cabinets for proper infection control and their staff trained on the use of the different equipment to ensure competence and quality lab services. To ensure continuous service provision, we procure basic equipment, such as microscopes, centrifuges, fridges, water baths, autoclaves waste bins, pipettes, blood bank fridges, freezers, and furniture, and negotiated agreements with reputable service providers to provide preventive maintenance for the equipment.

IDI provides a strong linkage between health facilities at all levels and the national supply chain, including the National Medical Stores (NMS) to ensure continuous supplies of reagents and other lab consumables. We train lab staff and district focal persons in good logistics and supply chain management practices, followed by mentorship and support supervision to improve their capacity to make orders to main warehouses and monitor the delivery and use of lab supplies. Using the district local government structure, we support district focal persons to supervise peripheral labs to ensure accurate, timely orders to NMS and in return reduce stock-outs.

IDI supports the training of lab staff on the use of Ministry of Health Management Information Systems (HMIS) lab-focused tools. We also provide follow-up mentorship and support supervision to ensure proper use of the tools for consistent, high-quality data collection and utilisation.

To ensure seamless transportation of lab samples, IDI established model district reference labs which also function as hubs for lower-level health facilities. These are supported to recruit motorcycle lab couriers to maintain a transportation network around the hubs for prompt collection, processing, and results transmission of lab samples across the network.

IDI staff play key roles in opening laboratories that can detect TB in high-need countries. Our experts guided the creation of the first biosafety level-3 laboratory in Uganda, enabling technicians to work in a controlled environment that reduced the risk of contracting the airborne bacteria that causes TB. Our skilled technicians have also trained staff in several countries in the use of malaria microscopy.

Driven by the mission to strengthen health systems in Africa, IDI has been heavily involved in the strengthening of laboratory leadership and management systems at the Central Public Health Laboratory (CPHL) in Uganda. The support has included the development of accreditation plan, building CPHL’s capacity in project planning, quality systems management, leadership, training, teamwork, and communications to enhance Centre Public Health Laboratories’ effectiveness. The institute has also supported the development of lab monitoring and evaluation systems for Central Public Health Laboratories to monitor, prepare indicators and write reports with emphasis on data utilisation.  The institute also continues to participate in the development of national documents, such as a Generic Quality Manual, Mentorship Guide and Mentorship Curriculum, National Lab Policy, Lab Quality Master Plan and Lab Certification and Accreditation Plan.

IDI developed a Lab Technical Assistance Unit to pool together a wide variety of skills available within IDI ranging from strategic planning, leadership, financial management, grants acquisition and management, lab information systems, lab accreditation, and lab quality assurance through to lab infrastructure project development and implementation. Through this unit, IDI has replicated many of the lessons and best practices it has acquired nationally and internationally, notably in Malawi and Swaziland. Examples of technical assistance assignments successfully executed include a project for Strengthening Laboratory Leadership and Management Systems at Swaziland Health Lab Service. In this project, IDI partnered with Uganda Research Council to fast-track the lab improvement process in relation to developing the leadership and management capacity of the lab programme and developing the quality systems of at least 15 labs with a view to achieving WHO accreditation using the SLMTA/SLIPTA. The focus was placed on three main priority areas:

• Strengthening lab leadership and management by training lab managers, reviewing of the lab Strategic plan (2013-2018), and developing the M&E plan for the lab strategic plan
• Developing a lab-specific M&E system by training the lab staff in M&E using the M&E curriculum and its utilization as a management tool
• Developing Lab Quality Management systems using the basic LQMS and SLMTA/SLIPTA approach and preparation of selected labs for international accreditation.

Laboratories are on the frontline of protecting everyone’s health. Laboratory safety sustains the wellness of local communities and the people who live, work, and play in them. Safe laboratories enable trained staff to conduct accurate and timely tests and research without jeopardising the health workers, the environment, or the public. By protecting laboratory staff and the public from biological, chemical, environmental, or physical hazards, IDI is leading to strengthen a culture of laboratory safety.

Following the successful implementation of the US CDC-funded Global Health Security Partner Engagement project, IDI has continued to work around the clock to build the capacity of the national laboratory system. This has enhanced the specimen referral network between different levels of the national lab system, laboratory information and supply chain management systems, and increased the number of laboratories that participate in national and international quality assurance programmes and proficiency testing in Uganda. Laboratories have been classified according to their capacity so that targeted support is provided to build their capacity and that of the Central Public Health Laboratories.

Additionally, centralised collection of Antimicrobial Resistance (AMR) data has started (and will be scaled up nationwide). AMR surveillance based on the WHONET data management system is being introduced and surveillance protocols are being developed, along with the expansion of the national AMR surveillance and stewardship task forces which will spearhead development of a national legal framework, for AMR management. The institute plans to revitalise the Medicine Therapeutic Committees at key supported sites to track the use of commonly prescribed antibiotics, establish an antimicrobial stewardship system and strengthen national infection prevention and control capacity in selected healthcare facilities.