Piloting laboratory quality system management in six health facilities in Nigeria

Abstract

Background: Achieving accreditation in laboratories is a challenge in Nigeria like in most African countries. Nigeria adopted the World Health Organization Regional Office for Africa Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (WHO/AFRO- SLIPTA) in 2010. We report on FHI360 effort and progress in piloting WHO-AFRO recognition and accreditation preparedness in six health facility laboratories in five different states of Nigeria.

Method: Laboratory assessments were conducted at baseline, follow up and exit using the WHO/AFRO- SLIPTA checklist. From the total percentage score obtained, the quality status of laboratories were classified using a zero to five star rating, based on the WHO/AFRO quality improvement stepwise approach. Major interventions include advocacy, capacity building, mentorship and quality improvement projects.

Results: At baseline audit, two of the laboratories attained 1- star while the remaining four were at 0- star. At follow up audit one lab was at 1- star, two at 3-star and three at 4-star. At exit audit, four labs were at 4- star, one at 3-star and one at 2-star rating. One laboratory dropped a 'star' at exit audit, while others consistently improved. The two weakest elements at baseline; internal audit (4%) and occurrence/incidence management (15%) improved significantly, with an exit score of 76% and 81% respectively. The elements facility and safety was the major strength across board throughout the audit exercise.

Conclusion: This effort resulted in measurable and positive impact on the laboratories. We recommend further improvement towards a formal international accreditation status and scale up of WHO/AFRO- SLIPTA implementation in Nigeria.

Figure 1. Performance of the various laboratories at baseline to exit audit as measured by the WHO-AFRO SLIPTA checklist.

Numbers (0–5) on the bars represent the WHO/AFRO star rating. FMC: Federal Medical Center Owerri; GH: General Hospital Lagos; GH: General Hospital Calabar; DLHMH: Dr Lawrence Henshaw Memorial Hospital, Calabar; CH: Central Hospital Benin; IDH: Infectious Disease Hospital Kano,

Figure 2. Performance of the various laboratory departments in General Hospital Lagos at baseline to exit audit as measured by the WHO-AFRO SLIPTA checklist.

Numbers (0–5) on the bars represent the WHO/AFRO star rating. BACT: Bacteriology, IMMLOGY: Immunology & Serology, *PARA: Parasitology, HAEM: Haematology, CHEM: Chemistry, *BTS: Blood Transfusion Services, * did not participate in the baseline audit.

Figure 3. Performance of the various laboratories across the Quality Systems Essentials, as measured by the WHO-AFRO SLIPTA checklist from baseline to exit audit.

Fig 3A: FMC Owerri; Fig 3B: GH Lagos; Fig 3C: GH Calabar; Fig 3D: DLHMH Calabar; Fig 3E: CH Benin; Fig 3F: IDH Kano (Doc & Rec: Document and Record, Mgt Rev: Management Review, Org & Pers: Organization & Personnel, Client Mgt; Client Management & Customer service, Eqpmt: Equipment, Int Aud: Internal Audit, Purch & Inv: Purchasing & Inventory, Proc Cont: Process Control and Internal & External Quality Audit, Info Mgt: Information Management, Corr Actions: Corrective Actions, Occurrence/Inc Mgt: Occurrence/Incidence Management & Process improvement, Fac & Safety: Facilities and safety).

Figure 4. Average performance of all laboratories across the Quality Systems Essentials, as measured by the WHO-AFRO SLIPTA checklist from baseline to exit audit.

(Doc & Rec: Document and Record, Mgt Rev: Management Review, Org & Pers: Organization & Personnel, Client Mgt; Client Management & Customer service, Eqpmt: Equipment, Int Aud: Internal Audit, Purch & Inv: Purchasing & Inventory, Proc Cont: Process Control and Internal & External Quality Audit, Info Mgt: Information Management, Corr Actions: Corrective Actions, Occurrence/Inc Mgt: Occurrence/Incidence Management & Process improvement, Fac & Safety: Facilities and safety).