Clinical Referral Laboratories in Rwanda

Abstract

ObjectivesWe investigated the quality system performance in Rwandan referral laboratories to determine their progress toward accreditation.MethodsWe conducted audits across five laboratories in 2017, using the Stepwise Laboratory Quality Improvement Process Towards Accreditation checklist. Laboratories were scored based on the World Health Organization grading scale (0-5 stars scale) and compared with earlier audits.ResultsBetween 2012 and 2017, only one laboratory progressed (from four to five stars). Four of the five laboratories decreased to one (three laboratories) and zero (one laboratory) stars from four and three stars. Management reviews, evaluation, audits, documents, records, and identification of nonconformities showed a low performance.ConclusionsFour of five laboratories are not moving toward accreditation. However, this target is still achievable by energizing responsibilities of stakeholders and monitoring and evaluation. This would be possible because of the ability that laboratories showed in earlier audits, coupled with existing health policy that enables sustainable quality health care in Rwanda.

Physicians’ satisfaction with clinical referral laboratories in Rwanda

“…Such low ratings in these services have also been reported in Ethiopia, the USA, and Saudi Arabia [ 3 , 6 , 17 , 21 ]. The physicians’ poor rating of TAT corroborates the findings of assessment done across these laboratories in 2017, which found that TAT was not regularly monitored in three out of the four laboratories [ 15 ]. Even though the targets of TAT are set, sustainable improvement would only be possible if there is regular monitoring to continuously identify and address the gaps.…”

“…Reciprocal communication and a discussion platform for stakeholders could offer a better solution for service improvement. Studies recently conducted in these laboratories also found a communication gap between laboratories and clinicians and poor performance in conducting management reviews [ 9 , 11 , 22 ]. These reviews should discuss the underlined issues, strategies, and the role of each stakeholder in a laboratory improvement program.…”

“…They are equipped with modern laboratory equipment. Recent studies in these laboratories did not find that personnel and finance were a challenge for quality [ 11 , 15 ]. The four laboratories are technically supervised by the NRL.…”

“…In Rwanda, the quality of health care is at the heart of health sector and it is recurrent in its planning circle. The accreditation of health facilities has been ongoing for more than a decade [ 9–14 ]. Starting in 2010, clinical referral laboratories embarked on the accreditation process and have received different quality performance scores over the years [ 9–11 ].…”

“…The accreditation of health facilities has been ongoing for more than a decade [ 9–14 ]. Starting in 2010, clinical referral laboratories embarked on the accreditation process and have received different quality performance scores over the years [ 9–11 ]. However, physicians’ perspectives on the quality of laboratory services have not yet been documented.…”