Developing external quality assessment programmes for primary health: care level in resource limited countries |
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Authors: | J Y Carter Orgenes E Lema Christine G Adhiambo Sadiki F Materu |
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Institution: | (1) Laboratory Programme, African Medical and Research Foundation, (AMREF), Nairobi, Kenya e-mail: amrefclinical@amrefke.org, KE |
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Abstract: | Laboratory services are an essential component of health care delivery in tropical countries and play a vital role in improving
the accuracy of clinical diagnosis and the investigation of disease outbreaks. In developing countries, laboratories face
numerous constraints to providing quality services, including poor selection of techniques, difficulties in equipment availability
and maintenance, and shortages of supplies, staffing and supervision. Currently in the eastern African countries (Kenya, Tanzania
and Uganda), internal quality control procedures are inconsistently carried out in most laboratories. National External Quality
Assessment Schemes (EQAS) have been established in all countries addressing a limited number of tests, but are constrained
by difficulties of sustainability and poor coverage. The Laboratory Programme of the African Medical and Research Foundation
(AMREF) has been operating a simple EQAS for primary heath care laboratories since 1993. Tests addressed are those carried
out in primary health care laboratories in eastern Africa. A total of 81 laboratories from 5 countries in the eastern African
region have participated in the scheme since 1993 and 9 distributions were submitted since the start of the scheme. No laboratory
participated in all distributions; 24 (30%) laboratories participated in 4 or more distributions. Of these, the hospital laboratories
in Kenya and Tanzania showed improved average mean scores between the first two and subsequent distributions. The educational
benefit of participation in the scheme is emphasised. There was an overall low rate of participation of laboratories (35%)
once the scheme was expanded to include laboratories outside direct AMREF project activities. Contributing factors include
shortages of staff and lack of time in busy rural laboratories, together with difficulties in communication; however, the
voluntary nature and lack of appreciation of the benefits of participation may also play a role. To increase participation
in the scheme and to address the quality of laboratory services throughout the region, AMREF is currently developing a Regional
EQAS in collaboration with the Ministries of Health of Kenya, Tanzania and Uganda, in affiliation with the World Health Organisation
(WHO). The approaches used to establish reference values for haemoglobin samples are discussed. The scheme has also been utilised
to examine the performance of different techniques for haemoglobin estimation, demonstrating the inaccuracy of the visual
comparator methods.
Received: 13 April 2002 Accepted: 5 July 2002 |
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Keywords: | Laboratory Primary health care Quality assurance Developing countries |
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