AMREF is funded to improve staffing capacity at Health Center III [HC III] and strengthen laboratory

services at Health Centre IV [HC IV] and above in Uganda. In particular, the focus is on improving district

laboratory staffing levels at HC III to enable them upgrade to Laboratory Assistants; improving the status of

the electrical and water system facilities at the Laboratory Assistants' training schools, strengthening

capacity of laboratory staff, clinicians and counselors serving at Ministry of Health (MoH), UPDF, Police,

Prisons and FBO laboratories at HC IV and above; and supporting strengthening of the Central Public

Health Laboratory's internal and external quality control system. In FY07, AMREF improved the

laboratories' capacity to offer HIV testing to support VCT, TB screening and other key tests related to

opportunistic infections diagnosis that is of reliable quality. 41 laboratories were strengthened based on

Ministry of Health (MoH) standards, through provision of select supplementary equipment or improved

infrastructure. Skills of 70 laboratory staff, 54 clinicians and 66 counselors were strengthened through

structured in-service training and support supervision. Follow-up of the trained health workers was carried

out at their duty stations to consolidate practical skills. Based on the National Laboratory Assessment

Survey, Ministry of Health [2004], and through support supervision, laboratories were assessed for

infrastructure improvement and 48 laboratories in 31 districts were identified.

20 students are being sponsored for the laboratory technicians' course in three schools in-country. The

national quality control system in support of HIV/AIDS was strengthened to enhance its capacity to monitor

laboratory services by providing the Central Public Health Laboratory (CPHL) of MoH with materials for

HIV/AIDS quality control which is in addition to the two laboratory technologists and vehicle. In addition, a

computer network has been installed for use with the MoH infrastructure to support data collection from the

districts to CPHL.

Quality control materials were prepared and distributed to 111 laboratories. Results from 94 laboratories

met the expected standards, while four laboratories did not measure to expectations, hence a need for

results targeted support to the staff. They were trained in the methodologies and techniques of the tests for

the quality control materials that were provided by the supervisors. 13 laboratories were not able to carry

out the tests due to lack of equipment and diagnostics; this was addressed with CPHL.

40 motor cycles were procured and distributed for use by District Laboratory Focal Persons (DLFP) in 35

districts, Uganda Protestant Medical Bureau, Uganda Muslim Medical Bureau, Uganda Prisons; Uganda

Police and CPHL. These are used to monitor laboratory services in the districts/ institutions. A set of three

textbooks [District Laboratory Practice in Tropical Countries by Monica Cheesbough Vol I; District

Laboratory Practice in Tropical Countries by Monica Cheesbough Vol II and III; Practical Laboratory Manual

for Heath Centres in Eastern Africa, by Jane Carter and O. Lema] were provided to 81 health facilities at

various levels in 45 districts. 12 HC IIIs in northern Uganda [Amuru, Gulu, Kitgm and Pader] received a

copy each of Practical Laboratory Manual For Health Centers In Eastern Africa; Jane carter and Standard

Operating Procedures For Diagnosis And Monitoring HIV/AIDS And Related Conditions

On-site training on internal quality control was conducted for 16 HC III laboratory staff. 12 of these are now

practicing internal QC. Four quarterly support supervisions/onsite trainings (with an emphasis on the

performance of TB, HIV, Malaria testing, record keeping, infection control/prevention internal quality control

and carrying out essential tests for HC III level) were conducted. Quality Control (Blood and sputum slides)

for malaria and TB case detection respectively was conducted for 23 health centre III laboratories.

In FY08, AMREF will continue to strengthen laboratory services nationwide through strengthening skills of

health workers at HC III and above, and, collaborate with RPSO to improve laboratory physical

infrastructure of an additional 20 laboratories. This will improve the laboratories' capacity to offer HIV

testing to support VCT, TB screening and other key tests related to opportunistic infections diagnosis that is

of reliable quality. Laboratories will be equipped based on the MoH standards. The project staff will

continue to work with the National Laboratory Technical Committee to identify equipment gaps at facility

level and agree on practical interventions. The project will continue to strengthen skills for health workers

through refresher trainings and support supervision. Training will target 30 clinicians on appropriate

utilization of and planning for laboratories, 40 laboratory staff in essential new technology for testing HIV

and related conditions, planning for laboratories; 30 counselors on new initiatives on counseling and the role

of the laboratory in counseling. AMREF will continue to support in-service training of 25 laboratory

technicians and 157 assistants. 50 microscopists from HC III [in the project's original coverage area] will be

sponsored for the laboratory assistants course. Eight laboratory training schools will be supported through

provision of supplementary equipment, text books and diagnostics as provided for by the course curricula,

to improve practical training. We will work with the Ministry of Education and Sports [MoES], and, Ministry

of Health [MoH] to review the training curricular for the laboratory technicians and assistants so as to update

the content of the units on management of clinical laboratories as well as to update the emphasis on the

clinical values and benefits of laboratory diagnostic tests. CPHL, UVRI, NTRL and AMREF will monitor

performance of laboratory services through technical collaboration and sharing activity reports. Under

UVRI's stewardship, AMREF will assess the quality of laboratory services through development and

production of quality control materials and analysis of results from the laboratories, sharing of activity

reports, attending technical review meetings and promoting use of the national HIV testing algorithm. Gulu,

Amuru, Kitgum and Pader districts have extremely poor laboratory services with a high indication of need

for HCT services. On-site training and support supervision will continue to be provided in these districts to

scale up laboratory services at HC III.

New activities will focus on strengthening laboratory staff capacity in maintenance and repair of health

laboratory equipment to support the medical engineering section of MoH. Laboratory staff at HC III and IV

will be supported to acquire management skills to improve the laboratory services management system.

MoH and MoE&S in collaboration with AMREF will design an in service course to train microscopists who

currently do not have entry requirements for the laboratory assistants course. This will standardize and

improve quality of laboratory performance.