GLOBAL CLINICAL SERVICES GLOBAL HEALTHCARE SERVICES GLOBAL INITIATIVE AWARD

“Improving the Quality of Life... “ AGHPF Volume 12 No.104 January 2019 News & Message from Management Info

The beginning of a new year has always been an exciting time at A Global Healthcare Public Foundation (AGHPF). Turning the calendar does not only give us a chance to look ahead but also to look back at the past years. We have maintained our focus on providing high quality services with a proactive approach. Our success recipe is the teamwork, which includes highly trained technical staff, well-informed support staff and most importantly our Board. To help us focus our capacity and improve our service delivery to our customers in an effective way, AGHPF embarked on a 90-day Quality Management System development program that led to our certification to ISO 9001:2015 Standard and trained ISO 9001:2015 auditors.

Healthcare continues to change faster than any of us can keep pace with and this shows no sign of slowing down. So as I look into 2019, what am I thinking about…?

Developing Healthcare information technology that gives us capabilities to see and understand in real time changes to our quality management system of quality controls, management and reliability of testing results.

Transferring knowledge, skills and development that will continue to develop talent in our laboratory scientists wherever they are. This will certainly improve patient experience and strengthen healthcare quality.

Peak Performance of our Associates, stakeholders and all interested parties and individuals. To achieve this we must focus on simplification, synergy and scale to thrive in a healthcare space of rapid change.

Looking forward we want to continue to earn the respect and confidence of our customers, their families and the communities we serve. Our expansion motive will remain unchanged as we develop and strengthen the three divisions at AGHPF. We have already started with AG Quality Consultants (AGQC) to manage our more robust quality programs.

I now invite you to join me in anticipating what we will accomplish Inside This Issue together in this New Year 2019. • Message from Management • International accreditation of Accept my best wishes to you for a prosperous 2019. laboratories • Assessments: • Mentorships Kilian Songwe, PMP. • Reaching for the stars President & Regional through SLMTA Director -Africa INTERNATIONAL ACCREDITATION OF LABORATORIES

Worldwide, laboratory accreditation is a priority and Walter Reed Project, Catholic Medical stakeholders appreciate the benefits that accrue Bureau, Mildmay Uganda, Baylor Uganda, Rakai from it. This international recognition of medical Health Sciences Project, East African Public Health laboratories through accreditation specifically Laboratory Network, RHITES E, RHITES EC, RHITES- ensures; International recognition of the accredited SW, RHITES Acholi and RHITES Lango) has been laboratory as qualified and competent to provide strengthening laboratory Quality Management reliable test results; reduction in waste and thus Systems (QMS) thus leading the laboratories to affordable testing; improved performance of international accreditation. Thus, AGHPF develops laboratory staff thus enhancing staff discipline and technical competences of laboratory personnel sense of professionalism among other benefits. with clear work plans, process-maps, mentorships, learning tools and trainings led by experts in various In 2016, the Ministry of Health through the ISO standards. Central Public Health Laboratories selected 16 well performing laboratories from the SLMTA So far, with technical assistance in form of scheduled programme that were fast-tracked for accreditation audits, trainings and mentorships provided by AGHPF to ISO 15189:2012 by the South African National in partnership with CPHL and other IPs, 4 out of the Accreditation System (SANAS). Ministry of Health 16 laboratories have already achieved accreditation with support from Centers for Disease Control and to ISO 15189:2012 by SANAS. The accredited Prevention (CDC) under PEPFAR and in collaboration Hospital facilities are; Kiryandongo General Hospital, with Implementing Partners (A Global Healthcare Kayunga District Hospital, St. Francis Hospital Public Foundation - AGHPF), Infectious Diseases Nsambya & Mildmay Uganda laboratories. Institute, The AIDS Support Organization, Makerere ACCREDITATION MILESTONES

Tier 2 Tier 3 Tier 1 Tier 4 October 2018 Accredited Kiryandongo General Hospital Kayunga General Hospital St. Francis Nsambya Hospital. April 2018 To apply for Assessment To be Assessed February 2019 Accredited Early 2019 Atutur General Hospital Mildmay Uganda Lab General Hospital Kilembe Mines Hospital 1st November 2018 Lyantonde General Hospital Tororo General Hospital Surveillance Assessment / Entebbe General Hospital Re-accredited

What laboratory Personnel had to say about accreditation

‘‘Our laboratory is now being trusted. We did a customer satisfaction survey in October 2018 and our clinicians scored the laboratory 100% which was not in the past. Our patients also have trust in our services,’’ Ms. Kuteesa Solome, Laboratory Quality Manager, Kayunga District Hospital, Kayunga District Hospital. Immediate Left, Ms. Solome Kuteesa with colleagues at Kayunga District Hospital Lab during a recent assessment of the Lab ‘I feel proud working in an accredited laboratory and ‘‘Our laboratory has become a point of reference to many there is self-esteem that comes with it. The laboratory laboratories that want to learn from us; Recently Quality is a shining star and it serves as a consultant for quality Officers, Laboratory Managers from RHITES – Acholi for other departments in the hospital. Accreditation project visited us for a learning tour in December 2018. has improved patient management in terms of quality Client satisfaction with laboratory services has improved results,’’ Mr. Nvule Henry Pecos, Deputy Quality to greater than 90%,’’ Mr. Olak Patrick, Laboratory Assurance, Quality Control Manager, St. Francis Quality Officer, Kiryandongo General Hospital Lab. Hospital Nsambya Laboratory.

L-R, Mr. Olak Patrick, Quality Officer Kiryandongo General Hospital L-R, The Laboratory Quality Assurance Officer, Ms. Nakitto Gloria Lab sharing a light moment with AGHPF’s Moses Matovu in the and her Deputy displyaing the lab’s accreditation certificate laboratory

ASSESSMENTS AGHPF conducts Mock Assessments across Tier 3 Laboratories: In order to prepare the three tier – 3 laboratories for accreditation assessment by SANAS, AGHPF in partnership with CPHL conducted mock assessments across these facilities to prepare the laboratory for assessment by SANAS.

Mr. Baluku Eziron, Laboratory Technician doing routine work for L-R, Mr. Baluku William, Lab Technician with AGHPF’s Maryanne conformamnce to SOPs at Kilembe Mines Hospital Lab Otieno during a recent mock assessment of Kilembe Mines Lab AGHPF Conducts Surveillance Assessment at Mildmay Uganda Laboratory

Following Mildmay Uganda Laboratory accreditation to ISO 15189:2012 by SANAS, it is a prerequisite for the laboratory to undergo surveillance audit.

In order to prepare the laboratory for surveillance assessment, AGHPF conducted a surveillance audit at the laboratory to ensure the sustainability of the Quality Management System and to prepare the laboratory for assessment by SANAS.

AGHPF’s Ms. Maryanne Otieno, Prof. Kilian Songwe and Mr. Silver Mashate conducted the surveillance audit.

Right, AGHPF’s Quality Assurance Senior Specialist, Ms. Maryanne Otieno with Brenda Namukwaya , Microbiologist, Mildmay Lab during surveillance audit af the lab

MENTORSHIPS Mentorship is an important vehicle to establishing evidence of nonconformity clearance was and strengthening quality management systems submitted and accepted by SANAS. The and helping laboratories achieve accreditation mentorships also focused on developing a work goals. plan for laboratories towards sustaining their Quality Management System implementation. AGHPF through well-structured mentoring supports selected hospital laboratories to achieve Mentorships for Tier 3 Accreditation long-term and sustainable QMS implementation. Laboratories: In order to prepare the tier 3 laboratories (Kilembe General Hospital, Atutur Post Accreditation Assessment Mentorships:: General Hospital and Tororo General Hospital Following the assessment and recommendation Laboratories) for accreditation assessment, of the three Hospital Laboratories (Kiryandongo AGHPF in partnership with key implementing General Hospital, Kayunga District Hospital and partners of these facilities conducted scheduled St. Francis Hospital Nsambya laboratories) for mentorships. AGHPF through its resident mentors accreditation to ISO 15189:2012 by SANAS. at these hospital laboratories has continued AGHPF conducted targeted mentorships at these to offer mentorship support in preparation for facilities to support them in undertaking proper SANAS assessment scheduled for February 2019. root cause analysis and corrective actions for non-conformities identified and subsequently Third left, AGHPF’’s Laboratory Mentor, Ivan Ssekidde taking Atutur Gen. Hosp. Lab team through a mentorship session

TRAINING Training is an integral part of AGHPF’s technical support to Uganda’s Ministry of Health/Central Public Health Laboratories. AGHPF conducts periodic and well - structured trainings targeting laboratorians from selected hospital facilities. All these training are geared towards strengthening technical competences and translating various technical issues into day-to-day applications.

‘‘I can now see clearly how QMS is supposed to be implemented,’’– SLMTA Workshop 1 participant

REACHING FOR THE STARS THROUGH SLMTA

The Strengthening Laboratory Management The Supplemental SLMTA curriculum includes Toward Accreditation (SLMTA) program is a three workshops with two weeks mentorships structured quality improvement curriculum in between the three workshops to support designed to achieve immediate and tangible laboratories towards the implementation of advances in health service delivery. improvement projects. The SLMTA program is evaluated through audits based on the Stepwise In the last 10 years, the SLMTA program has been Laboratory Quality Improvement Process Towards rolled out and implemented widely in Uganda Accreditation (SLIPTA) Checklist. with over 100 laboratories benefiting from it. CPHL identified the need to build capacity for AGHPF designed the SLMTA Supplemental more SLMTA trainers and mentors to achieve training program to strengthen the linkages continuous quality improvement in various between the SLMTA curriculum, ISO 15189:2012 SLMTA sites. and the SLIPTA checklist. The modifications are aimed at reducing the period required to prepare In 2017, CPHL in collaboration with AGHPF used laboratories for accreditation. their vast experience in working with laboratories in the SLMTA program and preparing them The Supplemental SLMTA program has achieved for accreditation to develop a supplemental enduring impact on laboratory personnel who curriculum for SLMTA that spans over 9 months. have undergone SLMTA supplemental trainings thus achieving positive changes in attitude towards the culture of quality. After successfully implementing the full cycle of SLMTA – 1 Supplemental Program that targeted 25 hospital facilities at different levels of healthcare system, SLMTA – 2 Supplemental Program was rolled out last year. Tier 2 targets 20 SLMTA facilities at various levels of healthcare.

SOME OF THE OUTSTANDING TRAININGS CONDUCTED IN 2018

Focus Group Discussion during SLMTA Supplemental training

Internal auditor’s course based on ISO them in auditing and in addressing non conformities 19021 : 2018:: in our Quality Management System. This will ultimately improve service delivery to the community,’’ In order to strengthen skills of the laboratory Mr. Charles Draleku, Laboratory Technologist/ personnel in auditing technical requirements Mentor, URC Soroti Region. and management requirements, AGHPF in partnership with CPHL conducted Internal Mentor’s course for supporting Auditor’s Course. The trained personnel were Continual Quality Improvement: equipped with necessary skills to systematically develop and implement the Internal Audit ‘‘Mentorship is one of the building blocks for program across various SLMTA sites. continuous quality improvement and as CPHL, we selected laboratory personnel to undergo a ‘‘When I go back to my area of work, I am going mentorship course in order to prepare them to better to support all the departments that are under my support various facilities,’’ Dr. Susan Nabadda, mandate to improve SLMTA performance and support CPHL’s Executive Director.

Participants from SLMTA sites and Facilitators pose for a group photo with CPHL’s Executive Director, Dr. Susan Nabadda after the Mentors’ Course AGHPF in collaboration with CPHL conducted Kitebi Health Centre III, St. Francis Hospital a five-day training for mentors geared towards Nsambya Laboratory and Kisenyi Health Centre supporting Continual Quality Improvement. The IV for allowing their facilities to be used as training brought together 20 mentors selected practicum sites for this training. A copy of the from the National Resource of Mentors. audit was availed to these sites to improve their QMS. The trained mentors were assigned to different SLMTA laboratories on the Cycle 2 Supplemental The training was conducted by Mr. Muhammad program and will form a pool of laboratory Koopman, SANAS affiliated Assessor, E.D ZINQAP, professionals to fast track the quality improvement Ms. Sibongile Zimuto and AGHPF’s Prof. Kilian process and subsequently accelerate these Songwe, affiliated with the College of American laboratories towards accreditation. Two Pathologists – Laboratory Accreditation Program mentorships have so far been conducted. (CAP - LAP),

Internal Auditor’s Course based on ISO 15189 : 2012 Systems Course 19011 : 2018: for Assessment and Accreditation Laboratories: During the month of October 2018, AGHPF and CPHL conducted a six day Internal Auditor’s AGHPF in collaboration with CPHL and other IPs Course based on 19011:2018 for 21 laboratory conducted the ISO 15189:2012 Systems Course personnel. for assessment, accreditation laboratories and CPHL. The requirement training took place from The training was designed to refresh laboratory August 06 to 10, 2018. personnel to meet requirements of a strong Quality Management System based on the new Quality Management System Standard (I9011:2018). The Internal Auditor’s Sensitization Meeting: Course was conducted to strengthen laboratory staff on how to conduct professional and ethical AGHPF in collaboration with CPHL and other audits based on ISO 19011:2018. IPs conducted a two-day Laboratory QMS A number of methods were used to ensure delivery Sensitization Meeting in September 17- 18, of the training and skills transfer; field practicum 2018. The meeting was organized at the start using SANAS Checklist, group assignments, of the SLMTA Supplemental Cycle 2, in order homework, power point presentations and daily for leadership to understand their roles and learning debriefs. responsibilities in supporting Laboratory Quality Management Systems (LQMS). Special acknowledgment goes to CPHL, IPs supporting audited facilities and the facilities;

Participants pose for a group photo with CPHL’s Executive Director, Dr. Susan Nabadda after the QMS Senstisation meeting ASLM 2018: Abuja My Take Home Message: African Society for Laboratory Medicine.

By Moses Matovu, Quality Assurance Specialist, AGHPF

2. Good Governance is crucial to the success of Health care system – For a nation’s health care system to be successful, it needs robust financing, a well-trained and adequate work force, accountability, and well-maintained facilities, which are impossible to attain without good governance. To improve governance and subsequently the performance of health systems it is critical to identify the weak points that contribute to poor performance such as absenteeism, corruption, little or no L-R, AGHPF Associates; Moses Matovu & Maryanne Otieno, accountability of providers, weak information Quality Assurance Senior Specialist with Professor Oyewale Tomori systems amongst other factors. These shortcomings prevent effective management, At AGHPF, we strive to strengthen quality systems as those in charge may not be empowered to and knowledge transfer in meeting national, ensure that the desired performance attains a regional and internationally accepted standards minimum standard. in medical laboratories to undertake effective 3. The Next pandemic – Improved disease surveillance that allows early detection of all surveillance across the countries has ensured public health threats. that healthcare professionals are now able to detect viruses and other microorganisms The 4th Conference of the African Society for that over 30 years ago had gone undetected. Laboratory Medicine (ASLM) was held in Abuja, Nigeria from 10th -13th December 2018. This year, Emerging pandemics continue to threaten the focus was on “Preventing and Controlling the public health and have been sustained by global Next Pandemic”. This event provided a platform commerce, travel and disruption of ecological for stakeholders in the international laboratory systems. Efforts to increase preparedness medicine community to address issues, share through improved predictions of viral best practices and develop innovative approaches emergence, spread and patterns of diseases, to combat current and emerging health threats. severity, targeted reduced transmission and Together with my fellow AGHPF Associates (Prof. improved vaccination should receive renewed Kilian Songwe and Ms. Maryanne Otieno), we were urgency in order to anticipate and manage the excited to attend the ASLM 2018 Conference. next pandemics. Here with my take home message; “I really do not know what virus will cause the next 1. The need for context based health care epidemic or pandemic, and to be honest, in a way, we instead of imported solutions – Evidence don’t need to know… I think even if we did, it will distract based healthcare as it is contemporarily us from the critical function that we have of shaping conceived is based on the view that clinical the entire system”, Dr. Chikwe Ihekweazu, in his talk decisions should be built on the best available on “The Next Pandemic: What, When, Where?” scientific evidence. The evidence for practice across health professions should be influenced It is crucial that medical laboratories position by the experience of clinicians in everyday themselves more strategically to support practice placed within a broader context epidemiological surveillance systems. This that is grounded in practice as reiterated by can only be realized when laboratories meet Professor Oyewale Tomori, “it is important for the internationally recognized standards each nation to design its own primary health care through accreditation such as ISO 15189:2012 system because it knows the needs of its people.” (Requirements for Quality and Competence in Medical Laboratories). AUDITS:

An audit in laboratory medicine may be defined as a process of review and evaluation of laboratory performance. The ultimate objective of an audit in a medical laboratory is to improve patient care by enhancing laboratory performance and making better use of resources.

AGHPF Supports SLIPTA Exit Audit: AGHPF supported the SLIPTA Exit Audit process that was undertaken across the 18 SLMTA laboratories. Commencing 29th October to 1st November 2018, a team of 27 auditors, 9 Trainee auditors and 18 ASLM certified auditors performed the ASLM audit across 18 facilities at different levels of healthcare. The auditors systematically asked for records to shows evidence of SLIPTA implementation in the targeted facilities. This was the third audit performed in a period of 10 years.

Following the SLIPTA Exit Audit, AGHPF in collaboration with CPHL organized the SLIPTA Audit debrief meeting which was geared towards receiving the report of the SLIPTA Audit and obtaining recommendations on how to improve subsequent audits was organized.

‘‘Ministry of Health/CPHL selected a total 100 hubs to undergo the SLIPTA process,’’ Mr. Steven Aisu, SLIPTA Focal Person.

‘‘We want to achieve quality wherever laboratory services are offered,’’ Dr. Susan Nabadda, CPHL’s Executive Director.

Cross section view of participants at the SLIPTA Exit Audit Debrief meeting at Ridar Hotel, Uganda.

Standing, Mr. Habtamu Asrat,Lead Auditor, ASLM presenting Audit finding during the debrief meeting

Baseline Audit for 20 SLMTA Facilities: AGHPF supported CPHL to conduct a baseline audit across the new cycle of 20 SLMTA facilities enrolled on the SLMTA Supplemental program by CPHL. The findings from the audit informed the structure and areas of emphasis for the SLMTA Supplemental Cycle – II activities that started in September 2018. KEY ACHIEVEMENTS FOR THE YEAR 2018 1 2 3 AGHPF in partnership with CPHL 6 other laboratories were enrolled 3 Laboratories (Kilembe and other Implementing Partners on Tier – III accreditation pipeline. Mines Hospital, Atutur provided technical assistance to 4 They are Masindi General Hospital General Hospital & laboratories (Kiryandongo General (MSG); Kilembe Mines Hospital Tororo General Hospital) Hospital, Kayunga General Hospital, (KMH), Atutur General Hospital submitted accreditation St. Francis Hospital Nsambya and (AGH), Tororo General Hospital application documents Mildmay Uganda) and led them (TGH), Lyantonde Hospital (LH) to SANAS for document to attaining accreditation to ISO and Entebbe General Hospital review and were 15189:2012 by SANAS. (EGH). accepted. 4 5 Networked with CPHL and Built capacity of laboratorians in Scientific Communication; other IPs to leverage resources • 16 submitted abstracts to HuQAS • 11 accepted and presented. for laboratory systems strengthening. AGHPF has been building the capacity of laboratory professionals in Scientific Communication. September 20th – 21st 2018, 11 laboratory technologists presented abstracts at the 18th Annual Human Assessment Services (HuQAS) Scientific Conference under the theme; ‘‘Quality Laboratory 6 Diagnosis in Achieving Universal Healthcare’’. 3 AGHPF Associates participated at the ASLM2018 Conference held in ‘‘The Scientific Communication Conference that was conducted by Abuja. AGHPF greatly improved my skills in abstract writing and presentation Submitted 17 abstracts to ASLM; and that’s why I managed to do a great presentation at the HuQAS Conference,’’ Hamisa Nangosa, Senior Biochemist, Mulago National 14 abstracts were accepted for poster Referral Hospital Clinical Laboratory presentation 7 8 9 AGHPF in collaboration with During ASLM2018, 4 AGHPF AGHPF in partnership with CPHL and CPHL developed the SLMTA supported laboratories other IPs (Infectious Disease Institute Supplemental training (Kiryandongo General Hospital, and Makerere University Walter Reed curriculum to strengthen Kayunga General Hospital, Project) led the first Government the linkages between St. Francis Hospital Nsambya General Hospital laboratories the SLMTA curriculum, and Mildmay Uganda) were (Kiryandongo General Hospital and ISO 15189:2012 and the recognized as best performing Kayunga District Hospital) to ISO SLIPTA checklist. laboratories in Africa. 15189:2012 accreditation by SANAS. 10 AGHPF was officially recognized by the Ministry of Health as the principal implementing partner in supporting laboratories to attain international accreditation to ISO 15189:2012 by SANAS. AGHPF IN THE COMMUNITY

AGHPF Reaches Out to Baylor Uganda Clinical Centre of Excellence:

AGHPF through its humanitarian arm (Global Healthcare Services) carried out a corporate social responsibility initiative at Baylor Uganda Clinical Centre of Excellence where it organized a Christmas party for the children supported by the Centre.

“Through Global Healthcare Services division, AGHPF is constantly committed to improving the quality of lives in communities. The Christmas season is a great opportunity for AGHPF to celebrate with various children supported by Baylor Children’s Clinical Centre of Excellence. Reaching out to the communities through compassion is part of our values and core existence,” AGHPF’s Regional Director – Africa, Prof. Kilian Songwe said.

AGHPF team joins the Baylor Uganda team for a photo moment with some of the items for the children

Some of AGHPF Associates & Baylor Uganda Staff join the various children during a cake cutting moment AGHPF IN PICTURES

Immediate Left, AGHPF’s Regional Director, Prof. Kilian Songwe receives a certificate of appreciation from the Minister of Health, Hon. Dr. Ruth Aceng during the handover of acreditation certificates to the three Sharing of ideas between AGHPF & I-TECH during the ASLM2018 recently accredited labs Conference

In the middle, Sten Westgard,Director of Client Services and Technology for Westgard QC with Standing, AGHPF’s Mulindwa Muhammad emphasizing an issue with an AGHPF Associates; Moses Matovu & Maryanne Otieno illustration during the Mentor’s Course for Continual Quality Improvement

Participants from SLMTA Sites pose for a group photo with Course Participants pose for a group photo after the CDC IP Parners meeting Facilitators after the SLMTA Supplemental Workshop

Fourth Left, Prof. Kilian Songwe poses for a group picture with other participants during the Training of Multilingual Lab Experts on Diagnostic Policies, Guidelines and Tools, Brazzaville, Congo, 21st -25th Jan Standing, AGHPF’s Moses Matovu giving his presentation during the Mentor’s Course 2019

About AGHPF A Global Healthcare Public Foundation (AGHPF) is a non profit organisation fully registered in Uganda and is dedicated to improving the Quality of Life by providing sustainable high quality, affordable services and strengthening systems for individuals, communities, industries and government.

Contact AGHPF News & Info Follow AGHPF: [email protected] Facebook.com/A Global Healthcare Public Foundation Plot 12 Makindu Lane, Kololo Twitter.com/aghpf_uganda P.O Box 75048, Kampala, Uganda Website: www.aglobalhf.org