I was looking at some earlier files and presentations, going
back to 2004-2005. The subject from this
retrospective “look-back” was my involvement in laboratory quality in African
countries. My introduction was through a
senior partner group participating in the US President’s Emergency Program for
AIDS Relief (PEPFAR) program set up by George W. Bush. To the credit of the people responsible, they
were able to see that establishing a program of monitoring for AIDS diagnostics
was going to require the establishment of Africa based laboratories capable of
Quality and Competent practices.
Back then there was lots of evidence that this was going to
be a major barrier. Laboratories were
working with at best rudimentary equipment, usually with out-dated reagents. Samples all too frequently were being
delivered to the laboratory not in typical sample container tubes, but more
likely in repurposed medication vials.
Additives like heparin were being added by hand and pipette with little
sense of precision. In microbiology,
critical samples such as blood cultures were a travesty, with reliability closer to 30-40%; huge false
positive results from contamination and false negative results from faulty
media and terrible technology.
When I think back to those days, my amazement of what is
happening today is triple underlined and reinforced in gold.
This week we are finishing off a 21-week on-line course that
was put on for 15 Quality Assurance Officers.
This group has the same level of knowledge and sophistication about
laboratory quality as peers almost anywhere in the world, and truly better than
most. Our discussions about things
Quality, like internal audit, quality indicators, document control, quality
control, inventory management, Lean, 5S, Six-Sigma, SIPOC would parallel or surpass many laboratories in much
wealthier laboratories.
So how did the laboratories get from then to now? With a lot of work both from without and
within.
Importantly governments from around the world, and US in
particular, have spent a ton of tax-payer supported money, supporting laboratories, equipment,
PEPFAR partners, mentors, and education.
But all that and a another dollar and a half would still not
buy a Starbucks coffee were it not for a massive effort from the Africa Society
for Laboratory Medicine (ASLM). It was
ASLM who with the support of World Health AFRO who introduced two programs; Strengthening Laboratory Management Toward
Accreditation (SLMTA) and Stepwise Laboratory Quality Improvement
Process Towards Accreditation (SLIPTA). SLMTA is an education program to promote
education and knowledge about laboratory quality and SLIPTA is a graduated
check-list that allows laboratories work at their own pace towards preparation
for international accreditation.
SLMTA and SLIPTA were introduced and implemented into some 1000-plus
laboratories in near 50 different countries.
I know these programs were effective in moving the progress
towards success because we had introduced earlier progenitor programs under the
PEPFAR banner. SLMTA and SLIPTA differed
from what we did because they were Africa created, Africa taught and mentored,
and Africa monitored.
[To be honest, I am not sure that I see international
accreditation as an important goal for many laboratories anywhere in the world,
much less in Africa. Most laboratories don’t
do enough international work that then need to achieve accreditation to keep
them in the international flow. I do see
the international documents a worthy goal, and a standard that states,
provinces and countries everywhere can and should adopt in lieu of home-brew
accreditations.
But while that is a side digression, let me just say the next
step to African laboratory quality is going to have to require African countries stepping up to
the plate and demanding laboratories meet certain accreditation expectations
for the sake of patient safety.]
To be fair and honest, many (most) laboratories in Africa
that I have seen would not be able to function providing services in most developed
countries, but that is NOT the fault of the laboratories. The single biggest problem is that equipment
and reagent distributors do not serve the laboratory community in Africa in the
same way as they do in Europe or North America.
Part of this is money, and part is passivity, but the reality is that
African population is around 1.2 billion people, and there is every reason they
should be able to expect and demand better service.
But getting back to my original commentary. Over the last 15 years we have seen
monumental progress in medical laboratory performance and quality in many
African countries.
I would like to delude that I had a tiny role to play in this, but that would be grandiose thinking.
African physicians
are now in a position that they can actually make clinical decisions based on
laboratory test results. That was not
the case a mere 15 years ago.
There clearly is more work to be done, but I NEVER would have
imagined that we would see the levels of success that we are seeing today.
