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

Abstract

Background In 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. Objectives To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Method Local 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). Results The 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. Conclusion Building 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.

A comprehensive review of the SLMTA literature part 1: Content analysis and future priorities

“…Six papers presented experiences from a single laboratory 7,10,17,26,28 or a single hospital, 9 14 presented data from two to 45 laboratories within a single African country, 8, 12,–15,18,–22,25,29–31 one discussed activities in two Southeast Asian countries, 23 one covered data from four countries in the Caribbean Region 11 and six had a general or global focus. 1,16,23,24,32,33 In total, these studies included detailed information on SLMTA implementation in 211 laboratories in 18 countries.…”

“…Authors noted that also during this timeframe, countries began to develop five-year laboratory strategic plans – Kenya 14,15 and Ethiopia 12,13 in 2005; Botswana 20,28 and Lesotho 21 in 2008; Zimbabwe 30 in 2010; and Ghana 25 and Namibia 19 in 2012. These plans called for laboratory strengthening and development of QMS, some specifying accreditation goals.…”

“…29 In Mozambique, 15 auditors were trained 18 and in Ghana, 15 mentors and 11 auditors were trained. 25 Several papers discussed national plans to train additional mentors and auditors. 8,18,19,25,26,29 One critical consideration for auditor training is to ensure high qualifications and consistency between them.…”

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

“…Using locally available staff, however, yields restricted teams, since health expertise in MNH is limited in the rural areas and may compromise the quality of mentorship [21, 22]. However, it lowers the cost of travel and facilitation of an external team of mentors [23]. We experienced the problem of spending large resources in travel because most of our external mentors were based in the capital city.…”

“…Districts were able in the short term to budget to modestly maintain mentorship, but expansion will clearly be limited due to lack of resources. The most sustainable path for mentorships seems to be through utilising health workers at higher-level facilities within each district [23]. There are, however, concerns about the limited numbers of suitable mentors that can be trained and who will consistently perform as such, given a voluntary dimension to the mentorship process [33].…”