# Presentation: 818049

## NATIONAL LABORATORYOF PUBLIC HEALTH Provincial Quality  Assessment

**Presented by Dr. Simoth Denna**

## NLPH Q.A/Q.C at Provincial level

-     **1. Supervision:**
**  ****- Standardized checklist **
**  ****- Direct observation during test performance**
**  ****- Discussion with provincial Staff  (MD’s, Lab.)**
**2. Training**
**  ****- Training courses at NLPH**
**  ****- On the job training **
**  ****- Training by request (e.g. Spectrophotometer)**
**3. ****Proficiency testing ****for HIV/STI**** tested ****	****blood  bags in the Provinces**

## General Objective

**Strengthening of laboratory services to provide better quality of health care in Referral Hospitals**
**Assure quality in Provincial Laboratories**
**To facilitate communication**
**To provide corrective measures for improving quality.**

## Organization Chart of Laboratory Supervision

## Growth of Provincial Supervision in Quality Assessment

**1999 to 2002 **
**	****- 6 provinces regularly supervised  **
** ****2003 to 2004 **
**   ****	****- 18 provinces out of 24 **
**Since April 2003**** Q.C. ****for HIV/STI**** ****tested blood bags in 14 provinces**
- 				(WHO, GTZ, UNICEF, CDC Atlanta & MoH).

## Provincial Lab. Staff Training

**      ****1. Laboratory Safety and Hygiene**
**	****    ****- 4 days /90 trainees. **
**      ****2. HIV rapid testing, specimen collection **
**          ****- 2 days/ 70 trainees**
**      ****3. Spectrophotometer use & Lab. quality     ****	****   ****	**** improvement:**
**	****    ****- 1 Week/100 trainees**
**      ****4. RPR testing**
- 		                        (WHO, GTZ, Health Net, Care, CDC. Atlanta, MoH)

## Central level TrainingProvided by NLPH in Phnom Penh

**Participants from Central Level** (Phnom Penh)
- 	**1.** **Basic of IQC**
**  ****	****	**** ****- 5 days/ 20 trainees **
**	****2. QA for  Central Supervision team (CST)**
**	****    ****- 4d/ 18 trainees****	**
**	****3. Lab. Tech. training at UHS & TSMC  for MDs, ****	**** Phs, laboratory technicians**** **
- 					             (GTZ, CDC-Cambodia & WVI)

## Central level TrainingProvided by NLPH in Phnom Penh

**Participants from Provincial Level**
- 	**1.** **QC specimen collection, storage and transport **
**	****    ****- 3days 28 trainees**
** ****	****2. Syphilis testing **
**        ****- 3 days 80 trainees **
**     ****3. Good Lab Practices ****(SOP, Temperature)**
**	****   ****- 2 weeks/90 trainees.**
-                         (RACHA, WHO, UNICEF,GTZ, CDC-USA & MoH).

## EQC of HIV/STI Sera from Blood Banks in 14 Provinces 2003-2004

** **   **BB     Kt      KP    KC    PS   KCN   SV    PV    KT    TK     SR    KK  PH    OMC **

**1422**

**449**

**329**

**1645**

**471**

**830**

**662**

**163**

**639**

**1131**

**18**

**0**

**889**

**2**

**Total= 8650**

## Discordant Results  Province-NLPHApril 2003-June2004

**Total of samples = 8,650**

**14**

**4**

**22**

- 35

**24**

**4**

**13**

**00**

## Quarterly HIV/STD Monitoring (2003-04)

- April –June        July – Sept             Oct.-Dec.        Jan-March

## EQC Testing Strategies in NLPH

**HIV:****  **       **1. Screening test: ELISA**** ****(Genscreen HIV 1/2)**
**	****                ****2. Confirmatory Test: PA**** ****(SED HIV 1/2)**
**HBs-Ag:****   1. Screening test: ELISA ****(Monolisa Biorad)**
**	****                ****2. Confirmatory test: PA**** ****(Serodia)**
**HCV-Ab:**** 1. Screening: ELISA**** ****(SD HCV)**** & Rapid test          **
**	****	****         ****2. Confirmatory test: HCV PA**
**Syphilis:****   1. Screening Test: RPR**** (****Card Test)**
**	****	****         ****2. Confirmatory test : TPPA/TPHA**** ****qualitative ****	****         ****3. TPHA quantitative**

##  Procedure to develop the provincial  EQC System

**Fund Raising:**
**	****	****- Travel central staff**
**	****	****- Allowances Provincial staff**
**	****	****- Consumables**
**	****	****- Materials (e.g. ice boxes)**
**	****	****- Reagents ****	**
**	****	****- Stationery**
**	****	****- Training**
**	****	****- Transportation of specimens**

## Procedure to develop the provincial  EQC System

**Development of forms:**
**   ****- ****Specimen collection**
**    ****- Handling**
**	****- Sending**
**	****- Payment procedures (taxi, provincial staff)**
**Development of curricula for training**
**Identification of provincial staff**** ****for storage, handling & sending of Q.C. specimen**

## Procedure to develop the provincial  EQC System

**Training:**
- 	    	- **Specimen collection**
**	****	****- Storage (how long, where)**
**	****	****- Transport of specimen**
**Organization in the Provinces:**
- 		**- Taxi for Specimen transportation**

## Future Activities 

**EQC for Provinces**
**          ****- Preparation of serum panels for HIV, ****	**** ****	****  Hepatitis B/C & Syphilis**
**	****	****- Quarterly sending of EQC panels to the ****	**** ****	****  provinces **
**Extension of provincial Quality Assessment **
**	****	****- to all provinces**
** **

## Recurring Problems in the provincial laboratories 

**Supply ****with quality equipment and reagents is not guaranteed** **(expired, not in time, no budget)**
**Laboratory facilities**** are often not specific for laboratory work**
**New equipment is not in use**** and stored improperly:**
**	****- Lack of technical skills of lab staff**
**	****- Lack of  Reagents**
**	****- Irregular electricity or water supply**
**	**

## Recurring Problems in the provincial laboratories

**Non qualified staff run laboratory services**
**Most laboratories in the provinces are under used: **
**     ****	****  ****- lab staff do not feel responsible for their work**
**	****  ****- Weak skills for lab result interpretation **
**        ****- Conflict of interest (private activities)**
**	****  ****- No request by MD’s due to lack of confidence    ****	****in  lab results and low skills for lab medicine**

## THANK YOU