In 2004, AMREF received PEPFAR funds through CDC for strengthening laboratory services at Health

Center IV (HC IV) and above in Uganda. Activities include: identifying laboratory infrastructure for

rehabilitation by working with Regional Procurement and Support Office [RPSO] and Ministry of Health

[MOH]; equipping laboratories with essential equipment for managing OIs; strengthening health care

workers' skills through training; strengthening laboratory quality assurance and enhancing stakeholder

support for health laboratory services.

To-date, 21 health unit laboratories have been rehabilitated and are now functional namely: Atiak, Baale,

Bugiri, Bufumbo, Busesa, Butenga, Bwijanga, Buyinja, Kawempe Kityerera, Kiyunga, Kotido,

Kyanamukaaka, Lyantonde, Magale, Muyembe, Moroto, Namayumba, National TB Reference Laboratory,

Pader, Pajule, Rakai. The rehabilitation has improved quality of laboratory services, attitude of patients and

clinicians to lab services and morale of lab staff. 151 labs have been provided with essential lab equipment

including: microscopes, centrifuges, haemoglobinometers, counting chambers for white blood cells,

microlitre pipettes, water filters, spirit lamps, tally counters (single and multi-key); wire loop holders ,

nichrome wire and cold boxes. The equipment has improved quality of results and access to lab services.

10 CD4 machines at 10 Regional Referral Hospitals were repaired, and has enabled the clinicians to start

eligible patients on ART, while monitoring their progress. A total of 12 water tanks and one set of invertors

were provided to Kiwoko, Jinja, Ishaka and Rubaga Laboratory Training Schools, which has improved the

sanitation standards and availability of regular electricity at the schools for practical teaching and library

use. Kiwoko, Jinja, Ishaka, Lacor, Kitovu, Nsambya, Mengo, Mulago and Rubaga Laboratory Training

Schools were provided equipment {11 computers, 34 microscopes, 5 Centrifuges, 18 Sahli

haemoglobinometers}, diagnostics (18 Liver function test kits , 8 Pancreatic function test kits, 60 Blood

grouping sera sets comprising anti A, anti AB ,anti B and anti D) plus a range of essential chemicals to

support practical training. These schools also received an assortment of 719 text books in 15 different titles

to support teaching and learning. As a result, the average success rate in final exams at these schools has

increased from 40 to 50%. Capacity has been built for 74 District Laboratory Focal Persons [DLFPs]

through TOT lab management and supportive supervision; these were drawn from districts, Catholic

Medical Bureau, Protestant Medical Bureau and Muslim Medical Board. These currently form the core

National Training Team for this activity and they support district health authorities and other development

partners to train heath workers in support of HIV care and management. A curriculum for In-Service training

of lab staff , SOPs for lab staff Performance Monitoring Tools were developed. Refresher training based on

MOH's national standards has been conducted for 231 lab staff , 181Ddoctors and Clinical Officers and 225

Counselors. This has enhanced skills and team work amongst the cadres improving on the care and

management of HIV and related conditions at the health units. 395 reference books, in 3 titles, have been

provided to 147 labs to consolidate technical skills at these sites. 30 microscopists [(un-trained staff

working in labs at Health Center III) from the post-conflict districts of Amuru, Gulu, Kitgum and Pader, have

benefited from training in testing for HIV, Syphilis, Tuberculosis and Malaria. This has improved the staff's

work approaches, their patient relations and the quality of test results has continued to improve. 29 students

are being sponsored for the three year diploma course in Laboratory Technology at eight schools in country;

11 of these will sit for their final exams in September 2008. 159 microscopists have been sponsored for two

year certificate course in laboratory technology; 20 have qualified and have reported back to their respective

health units where they were previously working. Five Lab School Trainers are being sponsored for the two

year Diploma course in Health Tutorship; two will sit for their final exams in September 2008. In consultation

with the Infrastructure Division of MOH and the Central Public Health Laboratory [CPHL], the AMREF plan

for a basic laboratory was accepted as a good standard reference plan and it is being used by RPSO and

MOH as a foot print to rehabilitate existing laboratories and construct new ones. AMREF participated in the

review of the East African Regional External Quality Control (EAREQAS) Protocols that were developed by

the MOH of Health of Kenya, Tanzania and Uganda with support from AMREF. They have been adopted to

prepare proficiency panels for national laboratory QC. AMREF is promoting internal QC by using on site

training during support supervision. CPHL is aware and the difference is that CPHL is emphasising external

QC of mainly bacteriological cultures and CD4 counts. Diagnostics are procured from Joint Medical Stores.

Internal QC conducted on spot during support supervision, following the NTLP protocol emphasizes the

need for application of internal lab QC which is a good laboratory practice. CPHL has worked with AMREF

to strengthen the capacity of DLFPs [including the Faith Based hospitals] to effectively conduct support

supervision at laboratory units under their jurisdiction through the utilization of a support supervision tool,

that is being used countrywide. Lab performance was monitored through support supervision together with

the DLFPs [public and faith based], District HIV Focal Persons and Counselor Supervisors. It was

established that in 67 districts that participated, 87 of 171 labs had the capacity to perform HIV monitoring

tests. This is attributed to lack of equipment, diagnostics and untrained lab staff. The average lab utilization

by clinicians was 27%; based on accuracy and completeness of records at 99 health units. Utilization rate at

Faith Based health units was seen to be better than at public health units. .Labs in new districts were

utilized much less than those in the mother districts. This may have resulted from a much less established

supply chain or reagents and supplies and more inadequately staffed health facilities. In order to improve

quality of the performance of laboratory equipment, 15 lab staff; (11 from Regional Referral Hospitals, 2

from CPHL and 2 from AMREF) were trained in basic repair and maintenance of lab equipment. They each

were provided with a tool kit and four have assisted labs to repair microscopes, centrifuges and

refrigerators. Ten lab staff at hospitals with CyFlow CD4 counting equipment were trained in proper use and

maintenance of the equipment; support supervision was provided at their sites and they were re-oriented in

general maintenance of these machines and requisitioning diagnostics for these machines from the National

Medical Stores. 23 lab staff from Regional Referral Hospitals, Jinja Lab Training School, and the Faith

Based health units were trained in the maintenance and basic repair of haematology analysers.. MOH

would like this activity to be extended to lab staff working at lower level health units so as to minimize

failure of critical equipment. DLFPs in the post-conflict districts of Amuru, Gulu, Kitgum and Pader were

trained on basic preparation of internal QC materials-the QC test results of the 25 functional labs has

improved from 5% correct to an average of 60%. To further improve QC monitoring, CPHL was provided

with a vehicle, and a computer network was installed at the office. AMREF has worked with MOH and the

Ministry of Education and Sports to follow up the sponsored students who are at the schools, during the

school term. Consultative meetings ware held in 13 districts - Bukwo, Jinja, Kabale, Kampala, Kapchorwa,

Kitgum, Kisoro, Mbarara, Masindi, Mbale, Mukono, Pader and Wakiso districts. The District Health Officers

and Secretaries for Health pledged to promote the laboratory services in annual district development plans.

Activity Narrative: The DLFPs need to acquire computer skills in order to use computer facilities at the district offices for record

keeping and report writing. Challenges include: low numbers of tutors at the training schools; the field

attachments required to complete the course are increasing the costs to the schools and students; some of

the mature-entrant students are not able to cope with the intensity of the course. They have been out of

school for so long and this has affected their performance; the dynamics of the global economy has

increased affected the students.

In FY 2009, AMREF will assess lab infrastructure and identify approximately 20 labs for rehabilitation

through RPSO during support supervision of lab staff and document the state of repair for RPSO. AMREF

will also provide laboratory technical support to A&E firms in designing laboratory plans for remodeling. This

will be nationwide and the rehabilitated labs benefit the communities/clients served at the lab through

improved patient flow , privacy and confidentiality plus the lab staff by working in a safer and more lab work

tailored environment. Supplementary equipment will be provided to labs at HC IV, District and Regional

Referral Hospitals. Equipment distributed will be based on gaps identified during support supervision, and

MOH's equipment norms for health units. 10 district hospitals [Moroto, Kitgum, Anaka, Kalangala, Adjumani,

Kamuli, Bukwo, Nakasongola, Kisoro, Sironko] and one Prisons health unit will be provided with

supplementary equipment to conduct CD4, liver, kidney and pancreas function tests. CPHL will train 40

DFLPs or their deputies and 10 RLFPs in good lab management practice; this will enhance their

management skills and participation during the district planning sessions. AMREF will work with MoH's HR

Department to establish the Health Laboratory Practice Course through distance learning. In addition, 20

Laboratory Assistants from the districts of Bukwo, Kisoro, Kotido, Adjumani, Yumbe, Sembabule, Pallisa,

Ntungamao Kampala, Mukono, Bundibugyo, Tororo and Kamuli will be sponsored in fulfillment of the

continued professional development strategy of the MoH. Refresher trainings will be conducted to

strengthen skills for 40 laboratory staff in essential technology for testing HIV and related conditions; these

participants will be drawn districts previously supported by the AIM project. 30 clinicians from the same

districts will also benefit from training on appropriate utilization of and planning for laboratories. In

collaboration with MOH and District Health Officers, long term training will be offered to 30 lab technician

students and 92 lab assistant students. In addition, 30 new Microscopists serving at HC III will be sponsored

for the 2 year Certificate course; they will be selected from districts [including AIM project supported

districts] that have had few microscopists sponsored such as Amolatar; Amuria, Bushenyi, Butaleja,

Budaka, Katakwi, Koboko, Kumi, Mityana, Tororo, Yumbe, Moyo, Nebbi, Jinja, Arua, Soroti, Kaberamaido,

Lira, Pader, Masaka, Rakai, Mubende, Kaliro and Busia plus Uganda Prisons, Uganda Police and Uganda

Peoples Defence Forces. Training opportunities will increase gender equity by ensuring that both male and

female participants are selected for the courses. In addition, the long term courses promote females who

are currently fewer in the laboratory profession in the country. Lab Technologists from district hospitals will

receive training in maintenance and repair of health lab equipment.. The training emphasizes preventive

maintenance. Failure of lab equipment has been caused mainly by limited user skill to prevent simple faults

from growing into major ones. A needs assessment for the training of workshop staff for repair of lab

equipment will be carried out to ascertain the required scope of training; 42 staff who were trained from the

Regional Referral Hospitals will be supported financially to assess the status of equipment at district

hospitals. Those who were trained from the districts will assess the status of equipment at HC IV labs and

mobilize technical assistance for major repairs within the regions. Technical assistance will be drawn from

the district staff. Each group will be expected to carry out minor service and repair of some equipment like

microscopes, centrifuges and colorimeters. They will liaise with regional maintenance departments to

procure the required spare parts. 8 lab training schools will be supported to set up a QC system and

prepare select QC materials (Glucose, RPR, HIV, TB, total Protein, WBC counts, Haemoglobin, Intestinal

Parasites, Blood parasites, Cryptoccocus). They will also be provided with essential semi-automated

supplementary equipment like haematology analyser, Flow cytometer, spectrophotometers plus diagnostics

to improve practical training. AMREF will collaborate with CPHL in monitoring performance of lab services

through sharing technical input on lab systems development and monitoring , validating quality of reagents

provided to health units through sampling and testing selected reagents for quality and quantity of

specified characteristics. Through this programme, 70 DLFPs will conduct lab technical consultative

meetings with lab staff in the districts twice a year to review and set approaches of improving performance.

They will also conduct a joint support supervision with 70 HIV Focal Persons, 70 Counselor Supervisors and

70 District Health Officers twice a year to consolidate good lab practices. AMREF will work with the

Commissioners of Disease control, and Clinical Services and CPHL to conduct one consultative meeting for

lab services with Regional Hospital Medical Superintendents, and RLFPs to enhance stakeholders support

so as to promote sustainability. AMREF will collaborate with UVRI in assessing the quality of lab services

through production of QC materials, analysis of results from the labs, giving feed back, carrying out

remedial action(s) and involving UVRI staff in facilitating courses. The Programme will support MOH to

finalize the development of an abridged in-service course for microscopists who lack entry requirements to

the lab certificate course. AMREF will support the national Health Tutors College to conduct short in-service

courses for Lab Trainers and Instructors, at lab schools, who may not have the academic entry

requirements to the Health Tutors Course.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13255

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13255 4012.08 HHS/Centers for African Medical 6425 583.08 Laboratory $583,000

Disease Control & and Research Services

Prevention Foundation Strengthening at

Health Center IV

and Above

8277 4012.07 HHS/Centers for African Medical 4796 583.07 $703,000

Disease Control & and Research

Prevention Foundation

4012 4012.06 HHS/Centers for African Medical 3173 583.06 $1,238,000

Disease Control & and Research

Prevention Foundation

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Military Populations

Refugees/Internally Displaced Persons

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $310,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.16: