This activity links to activities HLAB MOHSW 7758, 7779 NIMR, CDCBase 7834, CLSI 7696, AIHA7676, ASCP 7681, AMREF 7672, RPSO 7792, BMC 7685, ZACP 8224, DoD 7746; Track 1 ART CU7697/7698, EGPAF 7705/7706, HARVARD7719/7722, AIDSRelief 7692/7694, DoD7747, Blood Safety; CT NACP 7776, TB/HIV 7781, PMI, SCMS 8233, FHI 7712; SI NACP 7773, MOHSW 7761

There is a need for robust Laboratory Information Systems (LIS) at Ministry of Health and Social Welfare (MOHSW) Tanzania administered laboratories. Demand for prompt and reliable laboratory testing services has increased as Voluntary Counseling and Testing (VCT) for HIV and Anti-retroviral (ARV) Treatment Programs expand across the country. In addition, laboratories face an increased demand for aggregate statistical data reporting from MOHSW and Health and Human Services/Centers for Disease Control and Prevention (HHS/CDC). Currently laboratory managers collect and tally data manually from multiple handwritten laboratory ledger books which makes the data transfer long, laborious and prone to transcription errors and reduces technician time for actual testing.

APHL's proposed activity during FY 2007 is to expand technical assistance activities in Tanzania to identify and install a sustainable LIS solution in MOHSW administered laboratories based on the business needs of the laboratory personnel, MOHSW and HHS/CDC Tanzania. In FY 2007 APHL's goal is to provide Tanzania expanded technical assistance in the implimentation of the LIS. APHL proposes to provide LIS capabilities in five zonal laboratories, five regional laboratories (one in each of the four zones and Zanzibar) and at the MOHSW Diagnostic Directorate at headquaters in Dar es Salaam. This will involve the modification of infrastructure, acquisition of hardware and software and their installation and the training of laboratory personnel on basic computer skills and the LIS.

In FY 2006, APHL performed detailed laboratory assessments at Shinyanga Regional Laboratory and Bugando Medical Centre Referral Laboratory in the Lake Zone and Singida Regional Laboratory and Mbeya Referral Laboratory in the Southern Highlands. Artifacts of these laboratory assessments include documentation of current laboratory infrastructure and operations, documentation on development and implementation of recommendations to strengthen and standardize current paper based practices and procedures, and the definition of the basic business and system requirements that an LIS must have for deployment at any laboratory in Tanzania. This basic requirements information will be used to develop a Request for Proposal (RFP) to identify an appropriate LIS solution and begin deployment activities. The RFP will include the infrastructure development and installation, user training and software and hardware maintenace training.

APHL will assist MOHSW in designing basic computer training programs and vetting local schools for the provision of basic computer training which will be funded by MOHSW. APHL in consultation with MOHSW will undertake the contractual processes and procure computer hardware and contract an LIS vendor to work with APHL and MOHSW on the modification of a base LIS system to focus on the testing protocols for HIV screening, confirmation, and ART monitoring. This will include instrument interfaces between key equipment and the selected LIS. This work will be aided by the requirements and need assessment documents generated in FY 2006. APHL will purchase needed hardware such as computers, label printers, labels, printer heads, and laser printers

In order to prepare the laboratory personnel for a change in their normal business and to ease the transition from a paper based to an electronic LIS, APHL will work along side MOHSW and HHS/CDC Tanzania to introduce the paper based strengthening and standardization concept developed during FY 2006 to the 10 laboratory sites and MOHSW Diagnostic unit. This will include introduction and use of a unique specimen identifier, universal test requisition forms, standardized laboratory register headings, standardization of result terminology; and the definition and standardization of statistical needs and analysis. This paper based system will initially be piloted in the four sites before general introduction into all the laboratories and will form a basis for the electronic system. At the laboratory the reception staff will accession the tests into the registers or computers where the electronic system is installed while the laboratory technicians will enter the test results. The laboratory in - charge will be responsible for making the reports and

transmitting them to MOHSW where the electronic data base will be located. The data will be transmitted directly to MOHSW from the ten regional laboratories referral laboratories in electronic format whilst the remaining regional and district laboratory data will be transmitted in fax, electronic or paper base whichever will be applicable. APHL will train 30 technicans at referral level, 52 technicains at regional level and 114 technicans at District level on the LIS paper based system. One hundred and fifty technicians and two information technology personnel at MOHSW will be trained on Strategic Information (SI) activities by the end of the implementation exercise in 2008. The Information technology personnel in collaboration with HMIS personnel and HHS/CDC staff will monitor the quality of data produced.

APHL will provide technical assistance in the management of the project and and procurement activities. APHL will assign a LIS subject matter expert to this project to work closely with MOH Tanzania and HHS/CDC Tanzania during the course of FY 2007.

APHL will collaborate with local partners to deliver a Laboratory Management & Leadership Workshop in Dar-es-Salaam designed with the assistance of the Tanzanian public health laboratory community.The workshop will provide an introduction to basic managerial concepts and methods, which will be used in an immediate and practical way to analyze, enhance and improve current health laboratory management and to plan strategically. In addition to the laboratory management concepts, a secondary focus of the workshop will be on a specific laboratory related project as identified by the local laboratory community. Leadership, financial management, team building, communication, motivation, problem solving, organizational structure are some of the topics to be covered during the course of the training. APHL has found it instrumental to have representatives from the various in-country laboratory system tiers during the Laboratory Management Workshops. This will be incorporated into the Tanzania training plan. This workshop will target laboratory managers, supervisors and directors. Representatives from various geographical regions within Tanzania will attend this training. Follow-up assessments and support will be provided to works.

With plus up funds, the strengthened paper based system will be expanded to the whole country after the successful implementation at the pilot sites. This will be followed by an electronic LIS to 11 sites including the MOHSW headquarters to facilitate rapid collection of accurate and reliable data. APHL will undertake infrastructure development, procurement of computer hardware and software, maintenance of software and staff training. APHL will also develop, procure and distribute the necessary initial stationery for the paper based LIS and monitor its implementation.