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Strengthening lab quality in sub-Saharan Africa.

What would you do if you were asked to improve care for millions of patients in the developing world who have limited access to the high-quality diagnostic laboratory services that we in the United States take for granted? What if treatments for some of the world's most challenging diseases affecting these patients, such as HIV/ AIDS, malaria, and tuberculosis, were increasingly available--but the tests to make diagnoses from which to determine therapy were not?

Recently, as an advisor to an international conference to launch an ambitious laboratory-accreditation project, I was in the unique position of helping to point a dozen countries--which include Botswana, Cameroon, Cote d'lvoire, Rwanda, Ethiopia, Kenya, Malawi, Nigeria, Senegal, Tanzania, Uganda, and Zambia--in the right direction to continuous improvement in quality testing.

Held in July 2009 in Kigali, Rwanda, the conference, "Strengthening Laboratory Management," represented the culmination of years of dedicated effort by laboratory professionals and supporters from the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC) Global AIDS program, the William J. Clinton Foundation, and the American Society for Clinical Pathology (ASCP), to assist medical laboratories in sub-Saharan Africa achieve accreditation of their laboratory services through task-based training and expanded diagnostic-test capacity. One hundred forty host-government laboratory personnel, health experts, and policymakers from these 12 countries met for the first-ever World Health Organization Regional Office for Africa (WHO-AFRO) accreditation program.

Fortunately, over the last few years, the seeds for a five-step accreditation process had been planted and have started to bear fruit with this historic meeting. The ASCP, American Society for Microbiology, the Clinical and Laboratory Standards Institute, and the Association of Public Health Laboratories and their volunteers, supported by the CDC, have worked in the sub-Saharan African countries to provide basic training and infrastructure development support to laboratory professionals and laboratories. Countless others have been involved to date, both from the United States and other developed countries.

The immediate goal for the conference was not to adopt an accreditation model where laboratories would immediately be evaluated by the standards presently existing in developed countries. Rather, our goal was to establish a multicountry commitment to adopt and progressively move closer to fulfilling a new set of standards.

The WHO-AFRO African accreditation program will operate with support from the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, program. This accreditation process is unique in that, instead of being a "pass or fail" system, the program is divided into tiers, allowing laboratories to move up the tiers incrementally as the percentage of benchmarks met increases, ultimately, to reach the point where they would qualify for full, internationally recognized accreditation.

But the intermediate steps are essential; nobody wants to set these laboratory professionals and country health leaders up for failure--the goal is to establish a roadmap for success. Laboratory professionals truly can change the world.

Lee H. Hilborne, MD, MPH, is medical director, Quest Diagnostics Southern California, and deputy director, Global Health, RAND Health, in Santa Monica, CA. An expert in laboratory quality standards, Dr. Hilborne was president of ASCP in 2008, and is formerly a professor in the Department of Pathology at the UCLA School of Medicine-Los Angeles, associate director, UCLA Medical Center; and director, UCLA Center for Patient Safety and Quality, UCLA Healthcare.
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Author:Hilborne, Lee H.
Publication:Medical Laboratory Observer
Geographic Code:60AFR
Date:Dec 1, 2009
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