The impact of SLMTA on Proficiency Testing (PT)/ External Quality Assessment (EQA) participation and performance
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1 The impact of SLMTA on Proficiency Testing (PT)/ External Quality Assessment (EQA) participation and performance SLMTA Symposium, ASLM Conference 2016, 3 rd to 4 th December 2016
2 Presentation Outline Introduction Laboratory system strengthening in Zimbabwe Proficiency Testing (PT) Methods Results Challenges Lessons learnt Recommendations
3 Introduction Laboratories key to the health delivery system Disease diagnosis Monitoring treatment Disease surveillance Research Numerous challenges face laboratories in Africa Resource limitation Sub-optimal quality systems & infrastructure
4 Laboratory system strengthening in Zimbabwe Numerous initiatives Establishment of a local PT programme 1998 Development of SOPs 1999, revised 2006 MoHCC laboratory directorate Set policy, strategic plan
5 PT Services Provided by ZINQAP Clinical chemistry Full blood count CD4 Microbiology Serology POCT systems
6 Laboratory system strengthening in Zimbabwe - SLMTA Piloted in laboratories 3 workshop series Rolled out 2012 Imbedded mentorship laboratories laboratories
7 Proficiency Testing (PT) External quality assessment (EQA)] Key indicator of laboratory quality and service delivery Zimbabwe unique position PT Programme running since 1998 PT data available prior to the implementation of SLMTA
8 Methods Retrospective analysis of PT data prior to and post SLMTA implementation Determine participation Before, during after the implementation of SLMTA Comparison of SLMTA & non-slmta labs Assess performance in selected analytes
9 Percntage of Laboratories Results: Participation - FBC 100% 90% 80% 70% 60% 50% 40% 30% 20% ResponseRate Cohort1 ResponseRate NonSLMTA 10% 0% 2004/5 2005/6 2006/7 2007/8 2008/9 2009/ / / /13 Year
10 Results Participation FBC General increase in participation in PT in all laboratories Pre-SLMTA 48% (40% - 49%) Post SLMTA 62% (60%-65%) Comparison of SLMTA and non-slmta labs Non-SLMTA labs 61% (55%-63%) SLMTA - 78% (73% - 88%)
11 Percentage of Laboratories Results Participation Clinical Chemistry 100% 90% 80% 70% 60% 50% 40% ResponseRate Cohort1 30% 20% ResponseRate NonSLMTA 10% 0% 2005/6 2006/7 2007/8 2008/9 2009/ / / /13 Year
12 Results: Participation Clinical Chemistry Similar observation for Clinical Chemistry - General increase in participation in PT in all laboratories Comparison of SLMTA and non-slmta labs Non-SLMTA labs improvement from 41% to 55% SLMTA laboratories improvement 61% to 78%
13 Percentage of laboratories Results: Performance Hb 100% 90% 80% 70% 60% 50% 40% 30% 20% Acceptable-SLMTACohort1 Acceptable-NonSLMTA 10% 0% 2004/5 2005/6 2006/7 2007/8 2008/9 2009/ / / /13 Year
14 Results: Performance Hb SLMTA labs generally performed better than non-slmta laboratories, Eve prior to piloting SLMTA Improvement in performance observed after implementing SLMTA
15 Percentage of laboratories Results: Performance ALT 100% 90% 80% 70% 60% 50% Acceptable-Cohort % 30% Acceptable-NonSLMTA 20% 10% 0% 2005/6 2006/7 2007/8 2008/9 2009/ / / /13 Year
16 Challenges Limited appreciation of PT Limited transport infrastructure and courier systems for the distribution of panels Poor communication systems for submission of results Limited oversight
17 Discussion Implementation of SLMTA had a positive impact on PT participation and performance NB: Participation was quite good even prior to SLMTA Performance of non-slmta laboratories also seemed to improve Concern over the laboratories not participating no means of determining the quality of testing
18 Lessons Learnt PT is a useful tool that can be used to monitor the quality of testing. Can be used to determine the impact of interventions implemented Identify gaps or challenges in the system Laboratories & testing sites must participate in PT to monitor quality of testing PT must be cost efficient for wide up-take
19 Recommendations Mandatory participation in PT Establishment of local PT programmes More cost efficient Allows for more effective remedial action Supervision and monitoring of PT participation and performance
20 Thank You Improving laboratory and testing Quality Systems for quality health service delivery
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