TITLE: Improving Quality and Information Systems at Ministry of Health Laboratories

NEED and COMPARATIVE ADVANTAGE: There is a need for robust Laboratory Information Systems (LIS)

at Ministry of Health and Social Welfare (MOHSW)-Tanzania administered laboratories throughout

Tanzania. Demand for timely 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 partners. Currently laboratory managers collect and tally data manually from multiple

handwritten laboratory ledger books. USG has assisted MOHSW with the renovation of a National HIV

Quality Assurance Laboratory and Training Center (NHQALTC) and as quality systems development will

continue to be a requirement for ensuring reliable laboratory testing. As a leader on quality laboratory

systems and an LIS expert in the international public health arena, and as the lead partner for LIS

implementation in Vietnam, Mozambique, and Tanzania, APHL is well suited to provide technical assistance

in these areas.

ACCOMPLISHMENTS: Paper based strengthening training materials and laboratory tools were developed

and printed. Paper based strengthening trainings were delivered at field sites. Computer hardware for the

LIS pilot was purchased and installed. LIS pilot launched in 4 sites - the Shinyanga Regional Hospital

Laboratory, the Songea Regional Hospital Laboratory, Mbeya Referral Hospital Laboratory, and the

Bugando Medical Center Laboratory

ACTIVITIES: In FY 2008, APHL will use its experience in developing a five-year strategy and

implementation plan for the NHQALTC. This will complement activities by the Clinical and laboratory

standards institute (CLSI) who will focus on the development of standards and document development and

the American Society for Clinical Pathologist (ASCP) whose focus is on the development of quality

assurance for Chemistry, Hematology and CD4 count tests. The American Society for Microbiology (ASM)

will focus on quality assurance for opportunistic infections and TB. APHL will begin plans to working with

care and treatment partners to link the information from the laboratory to care and treatment clinics. APHL

will expand paper based information tools for implementation to the rest of the regions beyond the four pilot

sites. The specimen identification system that was drafted in FY 2007 will be finalized thereby enabling the

procurement of labels for the four pilot sites. Quarterly reporting forms registers will be printed while

pending laboratory registers for histopathology, general laboratory management and general laboratory LIS

management tools will be reviewed and printed. APHL will provide technical assistance on the training of

150 participants on the use of the reviewed tools. A package of finalized tools will then be sent to sites

where training on the use of the tools has been conducted for implementation. APHL will monitor and

evaluate the implementation process.

To ensure standardized quality training is delivered, APHL will use lessons learned from the pilot sites to

refine existing training materials (power points, users' manual, facilitators' guide, etc.) and develop job aids.

The remaining implementation of the paper passed tools at the remaining seven sites is completed by end

of FY 2007. APHL has trained trainers in Tanzania who will train the additional regions and district hospital

laboratories. APHL will provide the necessary technical assistance in FY 2008.

APHL will launch the expanded electronic LIS in FY 2008. LIS Working & Management Group meetings will

be held to review phase one electronic LIS pilot with MOHSW, USG and other stakeholders, continue basic

computer training for 100 pilot site users, with the assistance of the University of Dar es Salaam, which has

assisted MOHSW and APHL with LIS implementation. With MOHSW, APHL will identify 11 regional

laboratory sites for expanded electronic LIS implementation and determine a schedule for installation and

implementation. The Mkapa Foundation in Tanzania has undertaken solar power installation for all regional

laboratories. APHL will liase with the Mkapa Foundation in order to complement the solar power installation

for the electronic LIS where necessary.

APHL will assist the MOHSW with the development of a five-year strategic implementation plan for the

NHQALTC. The five-year plan will be in collaboration with in country and USG laboratory partners. The five

-year plan will detail initial program capacity building and highlight program needs to ensure sustainability

through 2012. Components of the plan will include: organizational structure, human resources, capital

equipment requirements, training, pilot programs, scale up, expansion of services, and proficiency testing

implementation with timelines for implementation of each component. Each of the USG laboratory partners

will use their expertise and focus on specific areas such as implementation of standards and document

development (CLSI); Quality assurance in chemistry, hematology and CD4 testing (ASCP), Quality

assurance for opportunistic infections and TB (ASM) and LIS implementation for the center by APHL. APHL

will avail its expertise and resources to support the preparation of CD4, HIV serology, chemistry and

hematology panels including training and training materials. APHL will assist MOHSW in the development

of standardized assessment tools and feedback forms for monitoring the implementation of the five-year

strategy.

LINKAGES: APHL is committed to supporting strong linkages with: the Ministry of Health and Social

Welfare to continue providing technical resources and guidance for the implementation of the projects

throughout the country; MOHSW laboratories, especially the Muhimbili Laboratories, to continue to serve as

resources for LIS and Laboratory management, planning and reporting; The University of Dar-Es-Salaam to

continue to provide basic computer training for LIS users; APHL to collaborate with ASCP, ASM and CLSI

to assist the MOHSW with the development of a National HIV Quality Assurance Laboratory and Training

Center; APHL to work with MOHSW, and ART care and treatment partners to facilitate flow of information

from the laboratories to their clinics.

CHECK BOXES: This activity focuses on in-service training and capacity building of laboratory staff and

infrastructure support, and Strategic Information with the electronic LIS and data monitoring activities.

M&E: Both paper based tools, as revised with APHL assistance, and electronic tools will be used to capture

patient data. Pre and post tests as well as training evaluation forms will be shared with all participants from

the Laboratory Management Workshops. The results from these surveys will serve as the tools to capture

the effectiveness of the training.

The effectiveness of the LIS implementation will be monitored through feedback from laboratory personnel

on the ease of data entry, the ability to generate management and aggregate reports, and the receipt of

data by the MOHSW and care and treatment sites. Quarterly reviews of the NHQALTC strategic

implementation plans will be conducted. Seven percent of the APHL budget is dedicated to monitoring and

evaluating the effectiveness of this program and its activities.

Activity Narrative: SUSTAINAIBLITY: APHL will work with the Ministry of Health and Social Welfare and with the pilot sites to

ensure capacity is built within the Ministry to sustain the ongoing initiatives. This will be through the training

of trainers for both the paper based systems and the electronic LIS system. The roll-out of training beyond

the regional levels will be supported by the MOHSW and regional level trainers. APHL will continue to offer

technical assistance to the trainers.