In FY 2008, the American Society for Clinical Pathology (ASCP) received a five-year cooperative- agreement to build capacity for laboratory infrastructure in nations severely affected by HIV, including Mozambique. In September 2008, ASCP supported a phlebotomy training developed by the MOH by purchasing and shipping phlebotomy supplies and equipment. In March 2009, ASCP facilitated a CD4 Testing Training of Trainers for twenty individuals from the MOH National Institute of Health. In July 2009, ASCP supported the new National Trainers with printed and digital material and supplies as they facilitated their first CD4 training of Mozambican laboratory technicians.

In FY 2009, ASCP received funds to implement laboratory capacity building activities in Mozambique. These activities include revision of curricula for pre-service training of clinical laboratory professionals , clinical chemistry and hematology Training of Trainers, support for trainers to facilitate future trainings of laboratory staff, basic lab operations training, and facilitation and support for two meetings for development of a National Quality Assurance Strategy for Mozambique. These activities align with the Partnership Framework objective to 'Strengthen lab services to support HIV care and treatment programs' and the objective to 'Increase the number of health care workers in Mozambique and improve the capacity and quality of pre-service, in-service training and faculty development'.

In FY 2010, ASCP aims to address the next generation indicators for increasing the number of laboratories with capacity to diagnose and monitor therapy and the number of laboratories making measurable progress towards laboratory accreditation, through in-service trainings, pre-service curriculum strengthening, and on-going support of quality assurance programs. The pre-service programs implemented in 2009-2011 will increase laboratory competency among graduates, build specific skill sets for future reference lab scientists, and increase the quality and depth of the superior level lab course offered by the Ministry of Education. In-service trainings will refresh the theoretical knowledge base of practicing laboratory technicians and provide hands-on training for use, maintenance, and trouble- shooting on testing instruments. These activities are designed to reach the Partnership Framework

objective to 'Strengthen laboratory support services for HIV diagnosis and management'.

ASCP aims to support the sustainability of capacity-building activities by giving Mozambicans ownership over all ASCP pre-service training curriculums and preparing them to deliver the material themselves. Training of Trainer participants will build their presentation and facilitation skills in order to roll-out subsequent trainings throughout the country. Likewise, laboratory course faculty will receive support in designing new lesson plans, writing objective-based tests and developing new teaching skills. The pre- service programs, in particular, address the need for a self-sustained education system for lab scientists. The central ingredient to success of the pre-service programs is faculty development and organizational buy-in. Through long and short-term faculty mentorships, ASCP is able to assist faculty as they learn new curriculum, teaching techniques, and software. With dedicated and knowledgeable faculty, students will be more motivated and better prepared once in lab settings.

The pre-service programs will be a recruiting tool for new laboratory technicians. Students will be attracted to programs that allow for degree advancement through the integration of the curriculum between programs. These factors will contribute to an increase in new lab personnel and higher retention rates for trained professionals seeking advancement.

ASCP activities will focus on building the capacity of laboratory technical staff from provincial laboratories in all 11 provinces through pre-service and in-service technical trainings. Quality improvement trainings will focus specifically on staff from 5 provincial laboratories which have been identified to be targets for the first year of quality improvement towards national accreditation. Training participants will be determined by the MOH according to their training plan.

The goal of the ASCP program is to build laboratory capacity throughout Mozambique to increase the number of nationally accredited laboratories with capacity to diagnose HIV infection and monitor therapy.

In-service trainings will be supported to build capacity for quality management through laboratory systems strengthening efforts. These trainings will follow a systematic format proposed by the CDC- sponsored SLMTA (Strengthening Laboratory Management Towards Accreditation) initiative. In addition, quality meetings to bring the provincial quality managers together to meet regularly with Central level MOH leaders will be supported. During these quarterly meetings, quality concepts will be taught and practical lab improvement projects will be developed. During subsequent quality meetings, quality managers will report back results of their most recent quality improvement project and then continue learning new skills and developing another quality improvement project.

To measure the impact of in-service trainings, ASCP will conduct a baseline assessment of participant labs in advance of all in-service trainings. The baseline assessment will utilize the WHO-AFRO Level II checklist that was developed to monitor progress of labs towards accreditation. At 6 and 12 month intervals, ASCP staff and consultants will perform an M&E assessment to determine the impact of the quality improvement training on each lab. This program serves as an evaluation of ASCP trainers and curriculum as well as a benchmark for labs as they strive for accreditation.