# Presentation: 745385

## BOTSWANA  MEDICAL LABORATORY QUALITY ASSURANCE PROGRAM  2001 – 2006

**SALIWE NFILA**
- PRINCIPAL MEDICAL LABORATORY SCIENTIST
- NATIONAL HEALTH LABORATORY
- GABORONE - BOTSWANA

## STRUCTURE OF THE PRESENTATION

- MAP AND DEMOGRAPHICS  OF BOTSWANA
- BOTSWANA HEALTH ORGANIZATION AND STRUCTURE OF THE REFERRAL SYSTEM
- LABORATORY SERVICES IN THE COUNTRY
- NATIONAL QUALITY PROGRAM 2001-2006
-  Background
-  Goal and Objectives
-  Strategies
-  Program Plan
- CONCLUSION

##  BOTSWANA DEMOGRAPHICS

- Total Area;582,000 Square Kilometres
- Population – 1,700,000
- Capital – Gaborone
- Life Expectancy – 67 to 42 years
- Natural Resources; Diamond, Cattle, Wildlife, Copper and Nickel.
- National Languages; English and Setswana

## BOTSWANA HEALTH ORGANIZATION STRUCTURE OF THE REFERRAL SYSTEM

- The Referral System comprises successive levels of Institutions of Health Facilities i.e hospitals and Laboratories, each having increasing degree of sophistication

## REFERRAL SYSTEM

**REFERRAL SYSTEM**

**MOBILE STOPS**

**HEALTH POSTS**

**CLINICS**

**PRIMARY HOSPITALS**

**DISTRICT HOSPITALS**

**REFFERRAL HOSPITALS**

**NATIONAL HEALTH LABORATORY**
**(REFERENCE LABORATORIES)**

## LABORATORY SERVICES IN THE  COUNTRY

- 17 Voluntary Counseling & Testing Centers (VCTs)
- 32 Government Laboratories
- 3 Clinic Laboratories
- 16 Primary Hospital Laboratories
- 6 District Hospital Laboratories
- 3 Referral Hospital Laboratories
- 1 National Health Laboratory (NHL)
- 3 Reference Laboratories
- 3 Mission Hospital Laboratories
- 3 Mine Hospital Laboratories
- 15 Private Laboratories

## NATIONAL QUALITY ASSURANCE PROGRAM; 2001-2006

- Background
- Botswana Laboratory Assessment (February/March 2001)
- CDC / APHL / Botswana Consultants & Scientists
- Laboratory Infrastructure and capacity
- HIV/AIDS, TB,STI &OI
- Laboratory Testing in General
- To address testing priorities and Manpower needs

## Three Major Recommendations on QA

- Comprehensive Quality Assurance Program
- Quality Manager at National Level
- CDC Technical Expertise
- All diagnostic services must be certified and operate under accepted QA standards (includes Government, research, and private sector)
- Laboratory Manpower and Equipment
- ARV,MTCT,VCT & Laboratory testing in General
- Training

## Local Laboratory Team
August 2001
Emphasis on Quality Control
No system in Place

Recommendations
Holistic Approach to Quality Management
Implementation of  the Hierarchical Quality Management  concepts 
Total Quality Management (TQM), Quality Management (QM), Quality System (QS), Quality Assurance (QA), & Quality Control (QC).

- August 2001
- Emphasis on Quality Control
- No system in Place
- Recommendations
- Holistic Approach to Quality Management
- Implementation of  the Hierarchical Quality Management  concepts
- Total Quality Management (TQM), Quality Management (QM), Quality System (QS), Quality Assurance (QA), & Quality Control (QC).

## PROGRAM PLAN 2001-2006

- GOAL;
- All Medical Diagnostic Laboratories in the country, ( includes Government, Mission, Mines and Private Sector) must be certified and operate under accepted Laboratory Standards.

## Program Objectives

- Five Major Objectives
- To identify and prioritize needs for the program implementation through Conducting a situational Analysis by 2002
- To establish the Program Structure to facilitate the implementation process by 2003.
- To ensure that all laboratory Personnel receive  necessary training for the implementation, monitoring and evaluation of the Program by 2004
- To develop relevant protocols for the implementation of the NMLQP by 2005.
- To ensure compliance with all requirements for   medical laboratory Practice through Monitoring and Evaluation.

## Program Strategies

- Capacity to implement and maintain the Program
- MOH Leadership commitment and support
- Personnel – Hardworking and Dedicated to Quality Services
- Laboratory Equipment and Supplies / Reagents – Satisfactory, ? Replacements/ Back-ups
- Referral System
- Laboratory Models
- Performance Management System (PMS)
- Annual Performance Plans (APP)

## Program Strategies

- Laboratory Policies, Standards and other Regulatory Documents
- BHP Act  (2001), BMLPS, SOPs, ISO/IEC 17025 &  ISO 15189
- Monitoring
- -  Laboratory Visits
- -  External Quality Assessment and Audits
- Stakeholders; Tremendous External Support
- 	-  CDC / WHO / ACHAP / HAI – technical support and
- 	   training
- Local  support – BOBS /  BNPC / IDM - Training

## Quality is a PDCA circle

**Quality is a PDCA circle**

**PLAN**

**DO**

**ACT**

**CHECK**

## NMLQAP PLAN : 2001 – 2006 IMPLEMENTATION GANTT

## Benefits of a Quality System

- Organization – Improved Efficiency and Effectiveness
- 	                     - Consistency and Continuous Performance
-                             Improvement (CPI)
- Staff             -   Defined Structures, Authority Levels and 		       Responsibilities.
-                         -   Confident and Empowered Personnel
- Customers  -  Improved Products / Services (Servqual)
-                            meeting their Needs
- 			  -  Confidence in Laboratory Services.

- source: BOBS

## Achievements

**Program Structures**
- Appointment of National Quality Manager for Laboratory Services
- Appointment of National Laboratory Quality Committee
- Facility PIC / Laboratory Quality Managers
**Training has Commenced**
- QA (QC & EQA), QS, PMS
- Management & Leadership skills
- Quality Managers

## Achievements... cont.:

**Laboratory Standards and Policies**
- BMLPS
- National Blood Transfusion Policy
- SOPs
**Implementation**
- Performance Management System (PMS)
- QC  ( Microbiology / TB , HIV )
- EQA Programs ( National / International)
- Audits

## External Quality Assessment

- NATIONAL EQA SCHEME
- Organizers – NHL and NH
- Participating Laboratories – All Government / Mission /Mine.
- ? Private Sector
- Annually
- International EQA Schemes
- Thistle, S.A. – Hematology / Clinical Chemistry
- National Health Laboratory Services , S.A. – Microbiology / HIV / Hepatitis
- National Blood Transfusion Services, Zimbabwe – ABO Grouping / Compatibility Testing ( WHO – Regional EQA Scheme)
- Participating Laboratories ; NHL, PMH, NH and NBTS, NTBRL.

## Challenges

- Shortage of Staff
- Laboratory Space
- Customer Satisfaction
- Malpractice / Litigation

## CONCLUSION:

**Quality Management**

**External Quality Assessment Program**

**QC Procedures**
**DAILY**

**SOPs**

**Supplies**

**Equipment**

**Supervision**

**Training**

- EQA samples to Referral /  District / Primary / Others

- Results to NHL

- Feedback and advice from NHL

- Referral / District / Primary & Others

- National Health Laboratory (NHL)

**CONCLUSION:**
**Quality Assurance Program in Botswana**

**1**

**2**

**3**

## QUALITY

-   “QUALTY IS NEVER AN ACCIDENT; IT IS ALWAYS THE RESULT OF HIGH INTETION, SINCERE EFFORTS BY ALL, INTELLIGENT AND SKILLFUL DIRECTION AND EXECUTION, IT REPRESENTS THE WISE CHOISE OF MANY ALTERNATIVES”
-   ( Source; BOBS)