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Laboratory Quality Stepwise Program in Cambodia

From September 2013 to September 2016, I-TECH conducted an implementation science research project to improve laboratory quality in Cambodia. The primary objective of the project was to implement a mentored laboratory quality stepwise implementation (LQSI) program to strengthen the quality and capacity of Cambodian hospital laboratories. As a result, target laboratories improved their operations in the areas of: biosafety, organization, personnel, equipment maintenance, purchasing and inventory, testing accuracy, process management, documentation and communication.

The project recruited and trained four laboratory technician to be mentors, training staff from 12 referral hospital laboratories in quality management systems (QMS), and reinforcing skills acquisition through in-person mentoring. Participating laboratories reported a 36% increase in quality management, 29% improvement in data management, and 25% improvement in specimen collection and handling. The laboratories established the foundational practices of a QMS, and the LQSI program has improved the recognition of the laboratory within the hospitals.

Improving Laboratory Quality in Cambodia

The I-TECH Cambodia Lab team. L to R: Sophanna Song, Cat Koehn , Siew Kim Ong, and Sophat Sek

I-TECH’s laboratory program began in Cambodia in 2013 with the goal to improve operations and regional biosurveillance and biosecurity through improved laboratory quality assurance and management practices. In collaboration with the Cambodian Ministry of Health, the World Health Organization (WHO), and the U.S. Centers for Disease Control and Prevention (CDC), and with funding provided by the Department of Defense and DTRA, I-TECH strengthens the Cambodian laboratory system through:

  • Implementation of an intensive mentoring program at 12 national and provincial public health laboratories;
  • Leadership and management capacity building of MoH laboratory leaders;
  • Mentoring and capacity building the National Animal Health and Production Research Institute (in collaboration with Washington State University);
  • Job specific training delivered in service and through educational programs such as the Quality Assurance Certificate Course (in collaboration with the University of British Columbia);
  • Support for laboratory workforce development through on-site technical assistance and training;
  • Support for national laboratory system policy development.

I-TECH Presents Laboratory Systems Strengthening Data at ASLM 2018

Representatives from the International Training and Education Center for Health (I-TECH) attended the fourth international African Society for Laboratory Medicine (ASLM) conference in Abuja, Nigeria, on 10-13 December 2018.

The theme this year focused on the role of laboratories in preventing and controlling the next pandemic. I-TECH had seven abstracts accepted at the conference that highlighted the laboratory systems strengthening work done by I-TECH in Cambodia, Côte d’Ivoire, and Zambia. The full abstracts presented by I-TECH can be found in the ASLM 2018 Conference Abstracts Conference Book.

Below is a summary of I-TECH presentations:

I-TECH Laboratory Systems Strengthening Team at ASLM 2018.
I-TECH Laboratory Systems Strengthening Team at ASLM 2018. Pictured (L to R): Sitting – Lucy Perrone, Felicity Golopang, Larissa Koffi; Standing – Sylvestre Kone, Nayah Ndefru, Siew Kim Ong.

Oral Abstracts

  • Siew Kim Ong, I-TECH Cambodia Project Coordinator, was lead author and presenter for the “Improved Laboratory Compliance to Quality Standards in Cambodian Laboratories through On-site Trainings.” This abstract reviewed the effect of training in 12 I-TECH-mentored laboratories in Cambodia on laboratory processes (Page 27).

Poster Sessions

  • Nayah Ndefru, I-TECH Seattle Laboratory Strengthening Specialist, presented an abstract titled, “Effectiveness of Using a Mixed Approach of On-site Mentoring and Tele-mentoring for Improving Laboratory Quality Management Systems: Lessons From Cambodia.” The presentation looked at the lessons learned in the implementation of a Quality Management System (QMS) in 12 national hospital laboratories throughout Cambodia and the 2018 pilot approach to addressing the QMS gaps identified in an earlier baseline survey (Page 55).
  • Larissa Koffi, I-TECH Côte d’Ivoire RTCQI Specialist, presented two posters: One titled, “Analysis of EQA HIV Serology Data in Côte d’Ivoire Reveals Gaps in Quality Testing.” The second poster was “Analysis of HIV Point of Care Testing Sites in Côte d’Ivoire Reveals Gaps in Tester Competence.” The posters displayed the results of a retrospective study that can inform strategies and interventions for improved quality at HIV testing sites (Page 200).
  • Sylvestre Kone, I-TECH Côte d’Ivoire Laboratory Quality Specialist, presented a poster titled “Improving Quality and Capacity of the Laboratory System in Côte d’Ivoire.” The poster detailed the work the team is doing to train and mentor laboratory staff in hospital laboratories towards achieving international quality standards (Page 242).
  • Felicity Gopolang, I-TECH Laboratory Mentor Consultant, presented a poster titled, “Implementation of a Professional Development Program in Laboratory Leadership and Quality Management in Zambia from 2016-2018.” The poster outlined the impact of the Program on quality improvement (Page 206).
  • Pat Sadate-Ngatchou, I-TECH Seattle Senior Laboratory Advisor, was lead author on the poster titled “Improvement of Quality Practices within HIV Point-of-Care testing (POCT) Sites in Côte d’Ivoire Through Implementation of the Rapid Test Continuous Quality Improvement (RTCQI),” which explored the impact of the implementation of RTCQI in POCT site audits (Page 246).

About ASLM
The mission of ASLM is to improve clinical and public health outcomes in Africa by enhancing professional laboratory practice, science and networks. Based on five strategic pillars, ASLM serves the community of laboratory professionals and promotes the value of strong medical laboratories to key stakeholders such as the Ministries of Health, research laboratories, and universities. ASLM is an independent, non-profit organization endorsed by the African Union and headquartered in Addis Ababa, Ethiopia.

http://www.aslm.org/

Best Practices

To address the UNAIDS Sustainable Development Goals for elimination of HIV/AIDS, tuberculosis, malaria and other diseases by 2030, and the PEPFAR 3.0 goals, I-TECH leverages the technical expertise of its universities and partners, the broad experience of its funders, and best practices from 15 years of implementing programs.

 

Transition & Sustainability

The International Training and Education Center for Health (I-TECH) works in partnership with host country governments, universities, professional associations, non-governmental organizations, private sector groups and funding agencies to strengthen local capacity and build sustainable health systems.

I-TECH follows a partnership model that guides the provision of technical services and technical assistance toward local ownership and sustainability, creating projects and programs that can be readily transitioned into national systems.

Based at the University of Washington, I-TECH draws upon a strong global network of public health professionals. The approach described in this document is customized in each country to respond to local needs and priorities. In addition, each I-TECH country office team aligns the model with the unique Partnership Framework Implementation Plans of the partner host government.

1. IDENTIFY NEEDS in consultation with host country governments

I-TECH works with host country governments to assess existing health systems and identify specific areas where the delivery of health care could be improved. This early collaboration helps to ensure that technical assistance accurately reflects the country’s specific health strategies and priorities.

2. STRUCTURE PARTNERSHIPS that integrate projects into existing systems

In each partnership, I-TECH develops roles, responsibilities, and timelines based on a long-term vision of integrating projects into existing national systems. As part of this vision, I-TECH recognizes and leverages the strengths and resources of national systems, building on and maximizing these efficiencies. The partnerships that emerge are attuned to the needs, realities, and structure of host country systems. Thus, they build and maintain lasting capacity within host country systems, maximize cost-effectiveness, and produce projects that can be more readily scaled up to meet national goals.

3. SECURE TECHNICAL RESOURCES from affiliated universities, partners, and the I-TECH network

As a center based at the University of Washington, I-TECH has direct access to a wide variety of technical specialists. In addition, I-TECH draws upon a robust global network of locally based public health professionals. These specialists provide a wide range of technical expertise to meet project needs.

4. PROVIDE TECHNICAL ASSISTANCE AND SERVICES tailored to actual needs and resources

I-TECH is committed to technical services and technical assistance approaches that build upon and support the existing strengths of local health systems. In addition, I-TECH prioritizes the use of local and regional expertise, an approach that builds the capacity of local experts to meet locally determined needs.

5. MONITOR PERFORMANCE; evaluate achievement of objectives and measure outcomes

I-TECH implements projects within a quality improvement framework designed to track progress in institutional capacity building and guide successful implementation. Using the framework, implementers monitor the progress of each project against specific benchmarks of success; for example, the progressive transfer of skills and capacity to local institutions. This methodology ensures that objectives are met and provides data to adjust approaches as projects evolve.

6. TRANSITION PROJECT into national systems to ensure sustainability

The ultimate goal of I-TECH’s partnership model is to improve health outcomes by strengthening local capacity and building sustainable health systems. I-TECH’s technical services and technical assistance are tailored from the initial planning stage to produce projects that can be successfully absorbed into national systems within mutually determined and realistic timeframes. Recognizing that a successful transition takes time, I-TECH offers transition support in a variety of technical areas including quality improvement and grant management.

Leadership & Management

Training on leadership and management in health is a major focus of I-TECH’s health systems strengthening efforts. I-TECH works in close collaboration with the Department of Global Health’s E-Learning Program (eDGH) to ensure that training content on leadership and management can be offered at low cost in even remote areas by using e-learning approaches and technologies to expand the reach of its training programs.

Program Highlights

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Quality Improvement

I-TECH’s quality improvement approach emphasizes ongoing assessments of program aims and operations. Country projects apply continuous quality improvement (CQI) strategies targeting both programmatic and management activities. Small-scale, practical Plan-Do-Study-Act (PDSA) cycles are used to construct improvement goals, test proposed changes, and implement adjustments, leading to increased quality of operations, service delivery, and care.

Program Highlights

Continuous Quality Improvement Collaborative in the Caribbean
Since 2013, I-TECH has led quality improvement (QI) collaboratives in the Caribbean region, enabling multidisciplinary teams at health facilities to work toward a common goal of improving care and treatment for HIV-positive patients ...
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Case Finding and Retention in Care in Mozambique
I-TECH works with the Mozambique Ministry of Health (MISAU) to expand a pilot project to provide an assisted partner services intervention. The project is aimed at encouraging patients newly diagnosed with HIV infection to disclose their status to their partners, and bring them to the clinic for testing ...
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Quality Improvement (QI) of HIV Care and Treatment, and Expanded Clinical Mentoring in Mozambique
I-TECH provides assistance to MISAU in implementation of the national Quality Improvement for HIV Services (QIHS) Strategy, with the goal of improving HIV clinical care through the training of clinicians in QI cycles (Plan-Do-Study-Act) and mentoring to improve weak performance indicators. To expand the impact of its programming, ART Committees ...
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Site-level Data Improvement and Use in Namibia
I-TECH continues to focus efforts on the improvement of data quality and use of data to improve clinical decision making. I-TECH works at the site level to build awareness and buy-in for data quality and use among site-level management and health care workers. On-site I-TECH Monitoring and Evaluation (M&E) Officers ...
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Integrating Research and Practice

Program Highlights

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Monitoring & Evaluation

I-TECH’s monitoring and evaluation staff work to ensure the efficacy of health care training sessions and programs by applying their expertise in cost analysis, data collection, and measurement to rigorous evaluations of these interventions.

In addition to routine monitoring and evaluation (M&E) and continuous quality improvement (CQI), I-TECH designs and implements operations research (the application of research methodology to inform and improve program design and management) and special studies for both I-TECH country programs and our partners. These activities enable us to answer strategic questions concerning the selection and effectiveness of program interventions. The team analyzes and designs evidence-based solutions to increase relevance, access, and scope of HIV services.

Monitoring ongoing projects and programs allows for midstream corrections; key findings are communicated to managers and leaders to improve programmatic decision making. Results are disseminated through publication, when appropriate.

Additionally, I-TECH has significant capacity in the rapidly expanding field of health informatics for resource-limited clinical settings. I-TECH develops tools and systems—such as the Training System Monitoring and Reporting Tool (TrainSMART)—and provides technical assistance for electronic medical records, training management, and remote clinical diagnostic systems.

Program Highlights

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Human Resources for Health

The effective diagnosis, care, and treatment of infectious diseases require a skilled and motivated health care workforce, and sustainable systems to educate and train those workers. I-TECH uses a systemic approach to build the skills and knowledge of, and foster attitude changes in, health care staff and those who train and educate them.

The following model outlines I-TECH’s human resources for health-based approach to achieving comprehensive patient-centered care. Each component of the model, including a strong enabling environment, supports an optimized health workforce as the foundation of an effective service delivery system.

Program Highlights

Improving Laboratory Quality in Cambodia
I-TECH’s laboratory program began in Cambodia in 2013 with the goal to improve operations and regional biosurveillance and biosecurity through improved laboratory quality assurance and management practices. In collaboration with the Cambodian Ministry of Health, the World Health Organization (WHO), and the U.S. Centers for Disease Control and Prevention (CDC), ...
Read More
Key Populations Preceptorship Program in Trinidad and Tobago
Reducing stigma and discrimination toward vulnerable groups in health care settings can have a positive impact on enrollment in care, retention in care and treatment, and viral suppression of HIV. The Key Populations Preceptorship (KPP) program is a simulated one-on-one patient-provider training program that brings together a health care provider ...
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Laboratory Quality Stepwise Program in Cambodia
From September 2013 to September 2016, I-TECH conducted an implementation science research project to improve laboratory quality in Cambodia. The primary objective of the project was to implement a mentored laboratory quality stepwise implementation (LQSI) program to strengthen the quality and capacity of Cambodian hospital laboratories. As a result, target ...
Read More
Nursing Efficiency and Task-Sharing in Tanzania
I-TECH Tanzania led the development of the task-sharing policy guidelines for Health Sector Services approved in 2016 as well as the policy’s operational plan. While task-sharing is a widely known HIV service delivery efficiency strategy, still there is continues gaps between national strategies and actual implementation at the site-level [1,2] ...
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