# Presentation: 660112

## TB LABORATORY NETWORK                  IN GHANA

_***SAMUEL KOBLA KUDZAWU***_
*&  SIMON K. ADOBOE *
***GHANA***

## TB SITUATION IN GHANA

- Major public health problem
- NTP estimate over 52,000 new cases of all forms of TB each year equivalent to 281 per 100,000 population
- Estimated new smear positive cases is 123 per 100,000 population
- Officially reported new cases around 12,000 annually

## SPUTUM SMEAR MICROSCOPY

- It is the backbone or pillar of the DOTS control strategy
- Review of Ghana’s NTP (established in 1994) undertaken by MOH/DANIDA in 1998 identified SSM as the weakest component of the DOTS control strategy
- NMIMR/MOH/JICA Collaborative Infectious Diseases Project initiated in 1999 to strengthen TB diagnosis and treatment nationwide

## SITUATIONAL ANALYSIS OF TB LABS

- NMIMR/NPHRL charged to assess at first hand the real situation of labs performing SSM in Ghana in terms of:
-  	Manpower, Technical skills, Documentation, Supplies, Equipment, Working environment, Disposal & Training needs
- 114 labs in the 10 regions of Ghana visited between March 2000 & May 2001
- _Urgent need to standardize SSM & implement QA thru training of lab personnel identified_

## MIDDLE-LEVEL MANPOWER TRAINING IN SSM

- Development of National TB Laboratory Manual & Selection of participants
- The Training Objectives were:
- 	To improve skills in SSM
- 	To impart necessary biosafety techniques
- 	To introduce Quality Assurance
- 4 Trainings held between September 2001 & February 2002
- 44 public lab personnel, 1 private & 10 RTC’s trained
- Training Follow – up  visits paid to all trainees

## TRAINING IMPACT

- Improved quality of smear examination
-    and documentation
- Better attitude of lab personnel to TB
- 		Biosafety & Role in TB Control
- Regional TB lab Training organized in all the 10 regions
- Over 250 lab personnel trained in all the 10 regions of Ghana between 2002-2003

## SMEAR PREPARATION [TRAINING PARTICIPANTS]

## READING ABILITY [TRAINING PARTICIPANTS]

## READING ABILITY [UNDER FIELD]

## PILOT  SSM  QA   &  TRAINING

- Pilot SSM QA Programme initiated in March 2000 – May 2002 in Accra
- Largely successful
- Need to implement QA nationwide
- Experienced gained led to:
-     Development of QA Manual & Workbook
-     Training of 30 QA Assessors & Coordinators
- 3 Training Sessions held:
- 	1st Training 6-14th January 2003 (UE,UW,ER,GAR)
- 	2nd Training 10th –18th February 2003 (WR, VR, BAR)
- 	3rd  Training 7th – 15th April 2003 (NR, ASR, CR)
- Participants were 2 regional lab personnel selected by each region and the RTC

## WHAT IS SSM QA

- It is a system set-up purposely to _continuously improve and maintain the efficiency and reliability of TB laboratory services at all levels of the microscopy network_
- This will ensure that information generated by each lab is _accurate, reliable & reproducible_

## NATIONAL TB REFERENCE LABORATORY

**NATIONAL TB REFERENCE LABORATORY**
**NPHRL/NMIMR *****(P3 FACILITY)***

**INTERMEDIATE LABORATORY**
**REGIONAL PHL**
**REGIONAL HOSPITAL LABS**

**PERIPHERAL **
**LABORATORY**
**Priv. Hospital  Laboratories**
**Private Laboratories**

**PERIPHERAL **
**LABORATORY**
**District Hospital Labs**
**Sub-Dist Hosp Labs**

**PERIPHERAL**
** ****LABORATORY**
**Quasi Gov’t Hosp Labs**
**Mission/Security Labs**

***TB MICROSCOPY LAB NETWORK IN GHANA***

## Quality

**Assurance**
**The 3 Components**

**External Quality**
**Assessment**

**Quality Control**

-       **Quality**
**Improvement**

## QUALITY CONTROL OR INTERNAL QUALITY ASSURANCE

- It is a process by which each laboratory _systematically_ and _effectively_ monitors its own performance in terms of:
- Technical procedures
- Equipment (Microscope)
- Quality of stains
- Documentation (Prompt Rec. & Reporting, SOPs)
- Biosafety
- Communication
-  **It is the responsibility of all lab personnel**

## EXTERNAL QUALITY ASSESSMENT (EQA)

- It is the 2nd Component of QA
- It is a process by which each _laboratory performance_ is _assessed _by personnel from a _higher level_
- It includes:
- On-site Evaluation (Supporting Visit)
- Blinded Rechecking
- Panel Testing

## QUALITY IMPROVEMENT

- It is the 3rd Component of QA
- It is a process by which the components of SSM Services are continuously analysed in order to find ways to _permanently _remove identified obstacles to success
- It takes _prompt remedial or corrective action_ on errors, constraints and weaknesses identified during QC & EQA
- It is carried out by NTP Managers

## ACHIEVEMENTS

- SSM is now strengthened in Ghana after QA implementation nationwide
- The private health sector is currently being trained under the Public-Private Mix, Global Fund Project
- There has been a sharp increase in case detection
**IMPROVEMENT IN LAB SUPPLIES NATIONWIDE**

**Notes:**
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## CHALLENGES

- Transportation
- Lack of lab personnel
- Heavy workload
- Lack of funds