External quality assessment in resource–limited countries

Abstract

IntroductionHealth laboratory services are a critical component of national health systems but face major operational challenges in resource-limited (RL) settings. New funding for health systems strengthening in RL countries has increased the demand for diagnostics and provided opportunities to address these constraints. An approach to sustainably strengthen national laboratory systems in sub-Saharan African countries is the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. External Quality Assessment (EQA) is a requirement for laboratory accreditation. EQA comprises proficiency testing (PT), rechecking of samples and on-site evaluation.Materials and methodsA systematic literature search was conducted to identify studies addressing laboratory EQA and quality monitoring in RL countries. Unpublished reports were also sought from national laboratory authorities and personnel.ResultsPT schemes in RL countries are provided by commercial companies, institutions in developed countries and national programmes. Most government-supported PT schemes address single diseases using a vertical approach. Regional approaches to delivering PT have also been implemented across RL countries. Rechecking schemes address mainly tuberculosis (TB), malaria and human immunodeficiency virus (HIV); integrated rechecking programmes have been piloted. Constraints include sample transportation, communication of results, unknown proficiency of referee staff and limited resources for corrective action. Global competency assessment standards for malaria microscopists have been established.ConclusionsEQA is vital for monitoring laboratory performance and maintaining quality of laboratory services, and is a valuable tool for identifying and assessing technology in use, identifying gaps in laboratory performance and targeting training needs. Accreditation of PT providers and competency of EQA personnel must be ensured.

A pilot study to introduce a local external quality assurance scheme for D‐dimers in the National Health Laboratory Service, in South Africa

“…Laboratory medicine can improve knowledge of the prevalence and demographics of diseases facilitating detection and improving patient outcomes further ensuring cost‐effective healthcare . In the developed world including countries such as the United States of America (USA), laboratory test results influence 60%‐70% of critical medical decisions, with approximately 50% of all testing being performed in peripheral, community‐based laboratories . In resource limited (RL) countries which include the majority of African countries, laboratory testing probably influence only 45% of medical decisions …”

“…In addition, it can identify training requirements. EQA providers and personnel should always be appropriately accredited …”

Análisis de los programas de evaluación del desempeño de malaria de los laboratorios de salud pública y privados de colombia 2015-2016

“…Es necesario fortalecer la participación de los Laboratorios de Salud Pública y Secretarías de Salud en el programa de PEID de malaria (20), ya que aunque el objetivo de ajustar los criterios de envío de las láminas de malaria fue disminuir el número de láminas enviadas al LNR, todos los departamentos deben participar en esta actividad como parte del aseguramiento de la calidad del diagnóstico. Además, teniendo en cuenta el número de casos de infecciones mixtas y de complicaciones y mortalidades por malaria notificados al SIVIGI-LA durante estos años, no se está cumpliendo con los criterios de envío definidos por el LNR para este evento.…”

Essential in-vitro laboratory diagnostic services provision in accordance with the WHO standards in Guragae zone primary health care unit level, South Ethiopia

“…Though, diagnostic laboratory services are a critical component of national health systems but face major operational challenges [18]. Lack of access to good-quality diagnostic tests in this region has been a major contributor to the enormous burden of infectious and non-infectious diseases [19].…”