e P car ubl th ic l F a F o e P u

H n H

l d G

a

a

b

t

A

i ‘‘Improving the Quality of Life…’’

o

o l

n

G

A

AGHPF NEWS VOLUME 12 No.107 APRIL – JUNE 2019 & INFO Advancing Competencies to improve Quality of Life…

Message from the Regional Director For over 15 years, AGHPF has been a premier organization INSIDE THIS ISSUE providing technical assistance to businesses, organisations and governments in the area of public health and diagnostic ±± Message from the quality improvement in laboratory medicine, thus leading Regional Director to international accreditation of laboratories to numerous ± standards. ± April – June 2019 Milestones Internationally, there is consensus among stakeholders that medical laboratories are an essential and fundamental part of ±± AGHPF: Stengthening health systems and play a critical role in the detection, response National Lab Systems in and prevention of diseases. Uganda Continuous Quality Improvement (CQI) has increasingly ±± Three Laboratories become one of the most recognized approaches to improving healthcare delivery and Maintain Accreditation is measured by the accreditation of laboratories. However, to achieve accreditation or to ISO 15189:2012 certification goals, there is need to build capacity and improve competencies of laboratory ±± SLMTA Supplemental professionals in terms of knowledge, skills and experience needed to implement and Program: Strengthening maintain a functional Quality Management System (QMS) capable of producing high quality results using efficient and effective methods and procedures. Continuous Quality Improvement Laboratories cannot effectively carryout their duties if the competencies of the personnel ± working in the laboratories are not strengthened to meet the changing environment ± AGHPF NEWS and evolving standards. AGHPF identifies Continuous Quality Improvement needs of laboratories at various healthcare levels and develops customized courses and practicums FACTOID to ensure effective and sustainable knowledge transfer. AGHPF focuses on advancing competencies of the laboratory workforce, which ensures Did you know that there are 10 that they master the principles, concepts and methodologies towards continual quality public medical laboratories in improvements for suitable and effective QMS implementation. Uganda that are accredited to ISO 15189 by SANAS? We continue to collaborate with Health Institutions and Ministries of Health of host governments to identify and advance competencies towards improving the quality of 70% of the SANAS accredited life for communities, by providing sustainable high quality services thus strengthening laboratories in Uganda attained quality systems. accreditation in the last two years Now, enjoy your reading of what we have done in the last three months and please working with MoH/CPHL and share your thoughts. AGHPF with support from the Centers for Disease Control and Best Regards, Prevention (CDC) - Uganda.

Connect with AGHPF: Kilian Songwe, PMP President & Regional Director –Africa [email protected] 1 ISO 9001:2015 Certified Organization April – June 2019 Milestones

Three recently recommended Three Laboratories maintained laboratories submitted corrective accreditation status after their annual actions to the South African National assessment. These Laboratories are; Accreditation System (SANAS). These laboratories are; • Kayunga General Hospital Laboratory • Atutur General Hospital Laboratory • Kiryandongo General Hospital • Kilembe Mines Hospital Laboratory Laboratory • Tororo General Hospital Laboratory • St. Francis Hospital Nsambya Laboratory

Entebbe General Hospital & Masindi General Hospital Capacity built in 103 participants in Laboratories have applied for strengthening Quality Management SANAS Assessment System activities.

Kiryandongo Gen. Hosp. Lab Staff & Management, CPHL’s Gaspard Guma, SANAS Assessor, AGHPF Team & IDI Representative celebrating maintenance of Accreditation to ISO 15189:2012 after the Surveillance Assessment

2 ISO 9001:2015 Certified Organization AGHPF: Strengthening National Laboratory Systems in Uganda:

Through the collaboration between A Global Healthcare SANAS recommended three more (Atutur General Hospital, Public Foundation (AGHPF) and the Ministry of Health/ Kilembe Mines Hospital and Tororo General Hospital) CPHL , there has been a three fold increase in the number of Laboratories for accreditation. The accreditation process accredited public medical laboratories in Uganda over the past builds laboratories’ capacity to contribute to the Joint United three years. Most recently in May 2019, Kiryandongo General Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 Hospital, Kayunga District Hospital, St. Francis Nsambya Goals through improving accuracy and confidentiality of Hospital Laboratories maintained their accreditation to ISO the testing services. 15189:2012 by SANAS. Between February and March 2019, HIVHIV prevalence byby region and accessaccess toto accreditedaccredited testingtesting servicesservices

HIV Prevalence West Nile: 3.1% 8.0% North-East: 3.7% 1. Tororo General Hospital Laboratory Mid-North: 7.2% 2. Atutur General Hospital Laboratory 3. Kiryandongo General Hospital Laboratory 3 3.1% 4. Kayunga General Hospital Laboratory 2 Central 2: 7.6% 5. 4 Mid-East: 5.1% St. Francis Hospital Laboratory Mid-West: 5.7% Kampala: 6.9% 6. Mildmay Uganda Hospital Laboratory 7 5 1 6 7. Kilembe Mines Hospital Laboratory East-Central: 4.7% Central 1: 8.0%

South-West: 7.9% UGANDA POPULATION-BASED HIV IMPACT ASSESSMENT (UPHIA 2016–2017)

A study conducted by Maurice Musheke et al showed that some of the major barriers to the uptake of HIV testing include perceptions of breach of confidentiality and lack of confidence in the health systems (https://bmcpublichealth. biomedcentral.com/articles/10.1186/1471-2458-13-220). Uganda has taken huge strides towards bridging this gap by establishing a National Quality Assurance Program that supports laboratories towards accreditation hence fast tracking the achievement of the ‘‘90-90-90’’ goals where all positive cases are identified as positive and the second ‘‘90’’ where all positive cases are initiated on treatment and the third ‘‘90’’ where accurate viral load testing services are provided to ascertain viral suppression. PopulationsPopulations served served by by Accredited Accredited Laboratories Laboratories

Approx. 15.7% of the population in Uganda (6,728,200) have access to accurate, reliable and timely routine testing services from 1 Accredited Laboratories 1

3 3 6 4

https://www.citypopulation.de/php/uganda-admin.php

3 ISO 9001:2015 Certified Organization Three More Laboratories Maintain Accreditation to ISO 15189:2012:

Accreditation is the process by which an authoritative body gives formal recognition that an institution or person is competent to carry out specific tasks. Accreditation is important for the recognition of test results nationally and internationally and is immensely beneficial in supporting an achievable and efficient health-care system. The South African National Accrediting System (SANAS) conducted an annual assessment across the three Hospital Laboratories (Kayunga District Hospital, International Standard Kiryandaongo General Hospital & St. Francis Nsambya Hospital) that attained ISO 15189:2012, Medical ISO 15189 accreditation status by SANAS in October 2018. This annual assessment was Laboratories – Requirements geared towards establishing whether the operations of the laboratories are undertaken for quality and competence in compliance with the requirements of ISO 15189:2012. The three hospital laboratories maintained their accreditation to ISO 15189:2012. Maintenance of accreditation is a confirmation of presence of functional and effective QMS implemented in compliance with the International Standard at the Hospital Laboratories.

‘‘We cannot afford to lose our accreditation status and we are not improving our QMS for only accreditation but for better patientcare and service delivery,’’ Dr. Kisembo Godfrey, Laboratory Director/Medical Superintendent, Kiryandongo accredited Gen. Hosp. Laboratory.

Prior to and after attainment of accreditation by the three Hospital Laboratories, AGHPF in partnership with the Central Public Health Laboratories and the respective Implementing Partners continued to offer technical assistance in form of audits, structured mentorships and trainings to support laboratories in sustaining established QMS.

All the three Labs Maintained Accreditation to ISO 15189:2012:

Kiryandongo General Hospital Lab St. Francis Nsambya Hospital Lab

Kayunga District Hospital Lab

4 ISO 9001:2015 Certified Organization SLMTA Supplemental Program: Strengthening Continuous Quality Improvement:

Strengthening Laboratory Management Toward Accreditation (SLMTA) is a structured quality improvement program that uses work based learning projects to effect immediate and measurable laboratory improvement while empowering laboratory personnel to implement practical quality management to ensure better patientcare. SLMTA training program spans from 12 to 18 months. In a bid to strengthen Continuous Quality Improvement (CQI), AGHPF designed a robust SLMTA Supplemental Curriculum. AGHPF’s SLMTA Supplemental Curriculum has the following modifications; • Introduction of ISO 15189:2012; • Re-organisation of the SLMTA modules training delivery in a sequential order for development of sustainable QMS; • Strengthened linkages between SLMTA, SLIPTA and ISO 15189:2012; • Reduction in the time of the SLMTA Program to nine months. An Exit audit is conducted at the end of the nine months by the African Society for Laboratory Medicine (ASLM). Since inception of the SLMTA Supplemental Curriculum in 2017, two cohorts of 25 and 20 laboratories respectively at various levels of healthcare have benefited from the SLMTA Supplemental Program. From April to June, a combined 103 laboratory personnel have benefited from the SLMTA Supplemental Program. Key trainings conducted as part of the SLMTA Supplemental Program include; SLMTA Trainer’s and Mentor’s Workshop, SLMTA Supplemental Training and the Internal Auditor’s Course for SLMTA Laboratories. The various trainings benefited SLMTA Trainers and Mentors, Laboratory personnel drawn from 20 laboratories and CPHL Staff. Improvement in SLIPTA Performance (2018 - 2019)

Madi Opei

Kitgum R. Camp Abim

Matany Aber

Buliisa 30 Laboratories certi ed 1 Star Rating 2 Star Rating Soroti 3 Star Rating Hoima 4 Star Rating Serere Kakindu Kagadi Masafu Kyenjojo Kibgoga Iganga

Kyegegwa Mityana Jinja Ssembabule Wakiso Mubende Rwekubo Mbarara MC Lyantonde Rakai Buyinja

Kanungu Rukunyu

5 ISO 9001:2015 Certified Organization What SLMTA Trainers and Mentors had to say about the SLMTA Supplemental Program:

I have learnt how to relate the ISO 15189:2012, WHO SLIPTA Checklist and fusing it with the daily laboratory operations. The SLMTA Supplemental program has enabled me to learn from the mentors on the key implementation challenges at the sites and readjust my sessions to suit problem solving sessions.

SLMTA Supplemental Program has enabled me support sites from lower Star ratings like 0 – 1 Star and they have achieved remarkable 3 Stars and above for example Masafu Hospital, Matany Hospital and using the same supplemental knowledge, I supported Jinja Regional Referral Hospital & Iganga General Hospital to attain a 4 Star and 3 Star respectively in the October –November, 2018 African Society for Laboratory Medicine (ASLM) audit.

Since it is a 9 months program, laboratories have been supported to provide accurate and reliable results as the training majorly focuses on patient care.

The long term effect is improved customer satisfaction as the challenge and problems are absorbed in the laboratory.This improves the laboratory's productivity - Mr. Chris Kisawuzi, SLMTA Trainer & Mentor/Regional Quality Assurance Coordinator, Eastern Uganda, UNHLS

The SLMTA Supplemental Curriculum was a comprehensive program that not only benefited the facility I am mentoring (Kitagata hospital) but also empowered me to mentor my resident facility (Kilembe Mines Hospital) with the knowledge acquired towards achieving accreditation to ISO 15189:2012. The program enriched me with knowledge about Laboratoy Quality Management System (LQMS) and practical ways of problem solving especially in resource limited areas. It changed my attitude towards challenges in QMS implementation from ideal to reality and how best one can work through the ideal to achieve the desired goal (3 star) while facing the reality.

As a result of the Supplemental program, most of the Laboratory staff including the Laboratory Director have adopted a positive mindset that once quality is improved, patient care is improved as well and the community will be able to get trusted test results, care, treatment, reduced costs in terms of wastage, and strengthen Quality Improvement – Mr. Zamarano Henry, Laboratory Mentor, Kitagata General Hospital.

SLMTA Trainers, Mentors and Facilitators posing for a group photo after the SLMTA III Trainer’s and Mentor’s Course 6 ISO 9001:2015 Certified Organization AGHPF NEWS

Right, AGHPF’s E.D Prof.Kilian Songwe sharing a light moment with the Ag. Commissioner, Laboratory Services, MoH, Dr. Susan Nabadda as CPHL’s Senior Lab Advisor, Mr. Steven Aisu and others look on.

Extreme Left, AGHPF Lab Mentor, Ms. Bellinda Nalwoga sharing a light moment with Kayunga Dist. Hosp. Lab team during SANAS Surveillance Assessment

Some of the SLMTA Mentors and Trainers in a group discussion during the SLMTA III Trainers & Mentors Course

Right, AGHPF’s QAS Mashate Silver examining evidence provided during Mock Assessment at St. Francis Hospital Nsambya Laboratory

Standing, AGHPF’s Lab Mentor, Sandra Matinyi & Prof. Kilian Songwe offering guidance to participants during the Statitical Process Control Course.

Standing,Ms. Harriet Musoke, AGHPF’s Training Coordinator explaining the Participant Training Tool Kit during the Internal Auditor’s Course conducted in April CPHL’s National Training Coordinator, Ms. Bakunda Kamaranzi collating 2019 participants expectations during the Statistical Process Control Course 7 ISO 9001:2015 Certified Organization e P car ubl th ic l F a F o e P u

H n H

l d G

a

a

b t

A

i

o

o l

n

G

A

Connect with Us:

[email protected] Tel: +256 414 53 1960 | E-mail: [email protected] | Website: www.aglobalhf.org

8 ISO 9001:2015 Certified Organization