The medical laboratory came to the forefront in patient care in sub-Saharan Africa when the world became aware of the spread of HIV/AIDS during the 1980s. Clinicians needed to know a patient's diagnosis in order to design a treatment plan to improve the patient's quality of life.
Up until that point, medical laboratories in many resource-limited countries could do very little testing and had virtually no quality control measures. When HIV/AIDS became prevalent, many countries and nonprofit healthcare organizations worldwide responded, sending automated equipment to resource-limited countries to use for testing. Yet laboratory professionals in many countries were unable to use the equipment due to a lack of training, as well as regular electricity, a distilled water source, and controls.
Increasing skills
In 2005, the American Society of Clinical Pathology (ASCP) joined the President's Emergency Plan for AIDS Relief (PEPFAR) initiative, the cornerstone of the U.S. President's Global Health Initiative, to combat HIV/AIDS and tuberculosis in sub-Saharan Africa and to alleviate suffering related to infectious and chronic disease. Working with the Centers for Disease Control and Prevention, which had established relationships with administrators of government public health laboratories in the initial PEPFAR countries, ASCP consultants conducted assessments of the countries' existing laboratory structure and helped to design basic and continuing education to broaden local laboratory professionals' knowledge and skill sets.
ASCP consultants—the majority of them laboratory professionals—began by conducting training for currently employed laboratory professionals through the Strengthening Laboratory Management Toward Accreditation (SLMTA) program. The goal of the program was (and is) to improve the skills of laboratory professionals in PEPFAR countries by guiding them through improvement projects. The first training workshops focused on general laboratory safety, hematology, clinical chemistry, CBCs, and specimen collection. These workshops helped the laboratory staff upgrade their skills with regard to operating the automated equipment, running quality controls, and interpreting test results to ascertain whether the systems are working normally in the machine before patient specimens are run.
Overcoming hurdles
The feedback that consultants received from trainees who implemented these processes was generally positive, but they did say that many challenges remained, including long turnaround times, stock-outs, and down-time. These tended to lower clinician trust and confidence in laboratory results.
In some of the countries where ASCP consultants were working, there were at first very few pathologists and trained clinical laboratory personnel. Minimally educated and untrained lab personnel were running and reporting the lab tests. It was critical that they receive training and the necessary knowledge and expertise in using the equipment.
In addition, one of the biggest hurdles was supply chain management. When staff uses automated equipment, test volume increases and laboratories need to have reliable inventory control and procurement in place. In the early years of ASCP involvement, no structure was in place to ensure that orders placed at the start of the month would be delivered by the end of the month. Some hospital administrators did not recognize that receiving supplies in a consistent and timely fashion was critical to delivering accurate and reliable test results. Many laboratories did not have a comprehensive list of supplies that needed to be kept in stock. An additional challenge was that lab managers generally did not do their own ordering, and their health system's purchasing departments often were not aware of the urgency of their orders, or of the necessity of filling the specific request, without substitutions.
A companion program, Stepwise Laboratory Improvement Process Toward Accreditation (SLIPTA), was developed to provide laboratories with a checklist to use as they worked toward achieving accreditation.
Building sustainable systems
Today, most labs have a complete supply list, including specific vendors. The infrastructure and supply chain has improved. Hospital administrators review their annual budgets and see the cost-benefit of having accurate laboratory reports and reliable test results. They are now implementing quality management processes across other departments as well. Getting supplies to rural laboratories continues to be a challenge.
ASCP's PEPFAR training has expanded to collaborate with universities that have medical laboratory training programs. ASCP's pre-service work includes assessing the university's curricula, training faculty in the operation of current equipment, and expanding their knowledge to prepare their students to work in medical laboratories. This workforce initiative will greatly enhance the PEPFAR countries' pool of highly trained professionals who can improve the efficiency and quality of diagnostic testing and treatment.
As quality control processes have improved, tests are more accurate. With that, clinicians can base diagnoses on lab results, which has improved patient care. This is a major area of accomplishment for the PEPFAR initiative.
In the end, these initiatives all improve the quality of patient care. Medical laboratory professionals around the world share a commitment to quality results and a desire to make a difference in people's lives. By training colleagues in other countries in how to improve testing and reporting of results, ASCP laboratory professionals are having a positive impact on many lives.
In resource-limited countries, as elsewhere, medical laboratory professionals may not be visible to the patients, but they are playing a crucial role behind the scenes to make sure that the clinician has the accurate information needed to deliver a correct diagnosis.
