Laboratory Quality Stepwise Program in Cambodia

Posted on March 26, 2019June 1, 2023

From September 2013 to September 2016, I-TECH conducted an implementation science research project to improve laboratory quality in Cambodia. The primary objective of the project was to implement a mentored laboratory quality stepwise implementation (LQSI) program to strengthen the quality and capacity of Cambodian hospital laboratories. As a result, target laboratories improved their operations in the areas of: biosafety, organization, personnel, equipment maintenance, purchasing and inventory, testing accuracy, process management, documentation and communication.

The project recruited and trained four laboratory technician to be mentors, training staff from 12 referral hospital laboratories in quality management systems (QMS), and reinforcing skills acquisition through in-person mentoring. Participating laboratories reported a 36% increase in quality management, 29% improvement in data management, and 25% improvement in specimen collection and handling. The laboratories established the foundational practices of a QMS, and the LQSI program has improved the recognition of the laboratory within the hospitals.

Improving Laboratory Quality in Cambodia

Cambodia Clinical Mentoring Health Systems Strengthening Human Resources for Health Laboratory Systems Leadership & Management Lucy Perrone Quality Improvement

Posted on March 26, 2019May 14, 2019

*The I-TECH Cambodia Lab team. L to R: Sophanna Song, Cat Koehn , Siew Kim Ong, and Sophat Sek*

I-TECH’s laboratory program began in Cambodia in 2013 with the goal to improve operations and regional biosurveillance and biosecurity through improved laboratory quality assurance and management practices. In collaboration with the Cambodian Ministry of Health, the World Health Organization (WHO), and the U.S. Centers for Disease Control and Prevention (CDC), and with funding provided by the Department of Defense and DTRA, I-TECH strengthens the Cambodian laboratory system through:

Implementation of an intensive mentoring program at 12 national and provincial public health laboratories;
Leadership and management capacity building of MoH laboratory leaders;
Mentoring and capacity building the National Animal Health and Production Research Institute (in collaboration with Washington State University);
Job specific training delivered in service and through educational programs such as the Quality Assurance Certificate Course (in collaboration with the University of British Columbia);
Support for laboratory workforce development through on-site technical assistance and training;
Support for national laboratory system policy development.

I-TECH Presents Laboratory Systems Strengthening Data at ASLM 2018

Cambodia Cote d'Ivoire eLearning/Distance Learning Laboratory Systems Leadership & Management Lucy Perrone Quality Improvement Zambia

Posted on January 23, 2019January 30, 2019

Representatives from the International Training and Education Center for Health (I-TECH) attended the fourth international African Society for Laboratory Medicine (ASLM) conference in Abuja, Nigeria, on 10-13 December 2018.

The theme this year focused on the role of laboratories in preventing and controlling the next pandemic. I-TECH had seven abstracts accepted at the conference that highlighted the laboratory systems strengthening work done by I-TECH in Cambodia, Côte d’Ivoire, and Zambia. The full abstracts presented by I-TECH can be found in the ASLM 2018 Conference Abstracts Conference Book.

Below is a summary of I-TECH presentations:

I-TECH Laboratory Systems Strengthening Team at ASLM 2018. Pictured (L to R): Sitting – Lucy Perrone, Felicity Golopang, Larissa Koffi; Standing – Sylvestre Kone, Nayah Ndefru, Siew Kim Ong.

Oral Abstracts

Siew Kim Ong, I-TECH Cambodia Project Coordinator, was lead author and presenter for the “Improved Laboratory Compliance to Quality Standards in Cambodian Laboratories through On-site Trainings.” This abstract reviewed the effect of training in 12 I-TECH-mentored laboratories in Cambodia on laboratory processes (Page 27).

Poster Sessions

Nayah Ndefru, I-TECH Seattle Laboratory Strengthening Specialist, presented an abstract titled, “Effectiveness of Using a Mixed Approach of On-site Mentoring and Tele-mentoring for Improving Laboratory Quality Management Systems: Lessons From Cambodia.” The presentation looked at the lessons learned in the implementation of a Quality Management System (QMS) in 12 national hospital laboratories throughout Cambodia and the 2018 pilot approach to addressing the QMS gaps identified in an earlier baseline survey (Page 55).
Larissa Koffi, I-TECH Côte d’Ivoire RTCQI Specialist, presented two posters: One titled, “Analysis of EQA HIV Serology Data in Côte d’Ivoire Reveals Gaps in Quality Testing.” The second poster was “Analysis of HIV Point of Care Testing Sites in Côte d’Ivoire Reveals Gaps in Tester Competence.” The posters displayed the results of a retrospective study that can inform strategies and interventions for improved quality at HIV testing sites (Page 200).
Sylvestre Kone, I-TECH Côte d’Ivoire Laboratory Quality Specialist, presented a poster titled “Improving Quality and Capacity of the Laboratory System in Côte d’Ivoire.” The poster detailed the work the team is doing to train and mentor laboratory staff in hospital laboratories towards achieving international quality standards (Page 242).
Felicity Gopolang, I-TECH Laboratory Mentor Consultant, presented a poster titled, “Implementation of a Professional Development Program in Laboratory Leadership and Quality Management in Zambia from 2016-2018.” The poster outlined the impact of the Program on quality improvement (Page 206).
Pat Sadate-Ngatchou, I-TECH Seattle Senior Laboratory Advisor, was lead author on the poster titled “Improvement of Quality Practices within HIV Point-of-Care testing (POCT) Sites in Côte d’Ivoire Through Implementation of the Rapid Test Continuous Quality Improvement (RTCQI),” which explored the impact of the implementation of RTCQI in POCT site audits (Page 246).

About ASLM
The mission of ASLM is to improve clinical and public health outcomes in Africa by enhancing professional laboratory practice, science and networks. Based on five strategic pillars, ASLM serves the community of laboratory professionals and promotes the value of strong medical laboratories to key stakeholders such as the Ministries of Health, research laboratories, and universities. ASLM is an independent, non-profit organization endorsed by the African Union and headquartered in Addis Ababa, Ethiopia.

http://www.aslm.org/

Best Practices

To address the UNAIDS Sustainable Development Goals for elimination of HIV/AIDS, tuberculosis, malaria and other diseases by 2030, and the PEPFAR 3.0 goals, I-TECH leverages the technical expertise of its universities and partners, the broad experience of its funders, and best practices from 15 years of implementing programs.

Transition & Sustainability

The International Training and Education Center for Health (I-TECH) works in partnership with host country governments, universities, professional associations, non-governmental organizations, private sector groups and funding agencies to strengthen local capacity and build sustainable health systems.

I-TECH follows a partnership model that guides the provision of technical services and technical assistance toward local ownership and sustainability, creating projects and programs that can be readily transitioned into national systems.

Based at the University of Washington, I-TECH draws upon a strong global network of public health professionals. The approach described in this document is customized in each country to respond to local needs and priorities. In addition, each I-TECH country office team aligns the model with the unique Partnership Framework Implementation Plans of the partner host government.

1. IDENTIFY NEEDS in consultation with host country governments

I-TECH works with host country governments to assess existing health systems and identify specific areas where the delivery of health care could be improved. This early collaboration helps to ensure that technical assistance accurately reflects the country’s specific health strategies and priorities.

2. STRUCTURE PARTNERSHIPS that integrate projects into existing systems

In each partnership, I-TECH develops roles, responsibilities, and timelines based on a long-term vision of integrating projects into existing national systems. As part of this vision, I-TECH recognizes and leverages the strengths and resources of national systems, building on and maximizing these efficiencies. The partnerships that emerge are attuned to the needs, realities, and structure of host country systems. Thus, they build and maintain lasting capacity within host country systems, maximize cost-effectiveness, and produce projects that can be more readily scaled up to meet national goals.

3. SECURE TECHNICAL RESOURCES from affiliated universities, partners, and the I-TECH network

As a center based at the University of Washington, I-TECH has direct access to a wide variety of technical specialists. In addition, I-TECH draws upon a robust global network of locally based public health professionals. These specialists provide a wide range of technical expertise to meet project needs.

4. PROVIDE TECHNICAL ASSISTANCE AND SERVICES tailored to actual needs and resources

I-TECH is committed to technical services and technical assistance approaches that build upon and support the existing strengths of local health systems. In addition, I-TECH prioritizes the use of local and regional expertise, an approach that builds the capacity of local experts to meet locally determined needs.

5. MONITOR PERFORMANCE; evaluate achievement of objectives and measure outcomes

I-TECH implements projects within a quality improvement framework designed to track progress in institutional capacity building and guide successful implementation. Using the framework, implementers monitor the progress of each project against specific benchmarks of success; for example, the progressive transfer of skills and capacity to local institutions. This methodology ensures that objectives are met and provides data to adjust approaches as projects evolve.

6. TRANSITION PROJECT into national systems to ensure sustainability

The ultimate goal of I-TECH’s partnership model is to improve health outcomes by strengthening local capacity and building sustainable health systems. I-TECH’s technical services and technical assistance are tailored from the initial planning stage to produce projects that can be successfully absorbed into national systems within mutually determined and realistic timeframes. Recognizing that a successful transition takes time, I-TECH offers transition support in a variety of technical areas including quality improvement and grant management.

Leadership & Management

Training on leadership and management in health is a major focus of I-TECH’s health systems strengthening efforts. I-TECH works in close collaboration with the Department of Global Health’s E-Learning Program (eDGH) to ensure that training content on leadership and management can be offered at low cost in even remote areas by using e-learning approaches and technologies to expand the reach of its training programs.

Program Highlights

Building the Capacity of the Health Workforce in India

I-TECH India PL has worked with stakeholders to develop national training curricula for health care staff on delivering HIV care and treatment services. In addition, it has:

Planned and implemented training programs for various cadres of clinical and program staff;
Participated in medical officer training programs at the national ...
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Enhancing Quality of Healthcare Activity in Cambodia

The overall goal of the Enhancing Quality of Healthcare Activity (EQHA) program in Cambodia is to improve the quality of public and private health services in national and sub-national health systems by August 2023. The project, funded by the US Agency for International Development (USAID), is being implemented by Family ...
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HIS Leadership and Governance in Kenya

As a key member of the Kenya electronic medical record (EMR) system technical working group, I-TECH works to implement and standardize the EMR systems used in the management of national HIV and AIDS care and treatment data. Similar efforts have focused on ensuring that different electronic systems can communicate with ...
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HIS Strategic Planning in Cameroon

National strategies, policies, and governance define the implementation environment for health information systems (HIS) and are recognized as a foundational building block for health system goals, including universal health coverage and control of HIV and other infectious diseases. I-TECH is supporting Cameroon’s Ministry of Health (MOH) to develop a national ...
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Quality Improvement

I-TECH’s quality improvement approach emphasizes ongoing assessments of program aims and operations. Country projects apply continuous quality improvement (CQI) strategies targeting both programmatic and management activities. Small-scale, practical Plan-Do-Study-Act (PDSA) cycles are used to construct improvement goals, test proposed changes, and implement adjustments, leading to increased quality of operations, service delivery, and care.

Program Highlights

Improving Data Quality and Strengthening Capacity in Côte d’Ivoire

Through a five-year cooperative agreement with the United States (US) Health Resources and Services Administration (HRSA) under the US President’s Emergency Plan for AIDS Relief (PEPFAR), I-TECH implements the Quality Improvement (QI) Solutions for Sustained Epidemic Control (QISSEC) project in Côte d’Ivoire. This project aims to support Côte d’Ivoire in reaching the ...
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Reducing HIV through Voluntary Medical Male Circumcision in Zimbabwe

Since 2013, the ZAZIC Consortium has been implementing Voluntary Medical Male Circumcision (VMMC) as part of a combination HIV prevention package approved by the Ministry of Health and Child Care (MoHCC) in Zimbabwe. Unlike other VMMC programs in the region, the ZAZIC model uses an integrated approach, blending local clinic ...
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Achieving Targets through Performance-Based Financing in Zimbabwe

ZAZIC employs an innovative performance-based financing (PBF) system to speed progress towards ambitious voluntary medical male circumcision (VMMC) targets. The PBF schedule, which started at $25 USD and now varies from $6.50-$14 USD depending on the location and the circumcision team, is continually refined to set the program up for ...
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Laboratory Quality Stepwise Program in Cambodia

Integrating Research and Practice

Program Highlights

Field Epidemiology Training Program (FETP) in Tanzania

For Tanzania to meet a WHO-specified target of one or more epidemiologists per 200,000 population [1] it will require an additional 250 epidemiologists who are well-trained and geographically distributed in all regions of the country. To help address this gap, I-TECH, in collaboration with the Centers for Disease Control and ...
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Layering Research and Practice in Haiti

The EMR iSanté enables research on population health in Haiti, including the implementation of Option B+. This work was presented at the International AIDS Society Conference in 2015 ...
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Quality Improvement in Ukraine

I-TECH applied the Clinical Assessment for Systems Strengthening (ClASS) methodology and tools to assess over 30 regional and local HIV care sites and facilities since 2014 ...
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Strategic Information in Ukraine

I-TECH in Ukraine has worked to implement the Training System Monitoring and Reporting Tool (TrainSMART) via its partners, supporting adaptation of the tool per partners’ specifications and training stakeholders on its use since 2013 ...
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Monitoring & Evaluation

I-TECH’s monitoring and evaluation staff work to ensure the efficacy of health care training sessions and programs by applying their expertise in cost analysis, data collection, and measurement to rigorous evaluations of these interventions.

In addition to routine monitoring and evaluation (M&E) and continuous quality improvement (CQI), I-TECH designs and implements operations research (the application of research methodology to inform and improve program design and management) and special studies for both I-TECH country programs and our partners. These activities enable us to answer strategic questions concerning the selection and effectiveness of program interventions. The team analyzes and designs evidence-based solutions to increase relevance, access, and scope of HIV services.

Monitoring ongoing projects and programs allows for midstream corrections; key findings are communicated to managers and leaders to improve programmatic decision making. Results are disseminated through publication, when appropriate.

Additionally, I-TECH has significant capacity in the rapidly expanding field of health informatics for resource-limited clinical settings. I-TECH develops tools and systems—such as the Training System Monitoring and Reporting Tool (TrainSMART)—and provides technical assistance for electronic medical records, training management, and remote clinical diagnostic systems.

Program Highlights

Case Finding and Retention in Care in Mozambique

I-TECH works with the Mozambique Ministry of Health (MISAU) to expand a pilot project to provide an assisted partner services intervention. The project is aimed at encouraging patients newly diagnosed with HIV infection to disclose their status to their partners, and bring them to the clinic for testing ...
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Cervical Cancer Screening and Treatment in Namibia

I-TECH supported the Ministry of Health and Social Services in 2017 and 2018 in the development and dissemination of the national Cervical Cancer Prevention Guidelines including algorithms for screening, referral, and post cryotherapy instrument disinfection, and monitoring and evaluation tools ...
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Enhancement of Health Information Systems and Data Quality in India

I-TECH India PL has provided national, state, and facility level technical assistance for improving quality, analysis and presentation of ART program data; developed innovative tools for tracking program progress based on data analysis of selected indicators over a period of time and submitted for national scale-up; and provided technical mentoring ...
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HIV Recency Surveillance in Malawi

The International Training and Education Center for Health (I-TECH), in collaboration with the Malawian Ministry of Health (MOH) and the Centers for Disease Control and Prevention, began implementing recent HIV infection surveillance in April 2019. The project aims to establish a surveillance system among persons newly diagnosed with HIV infection ...
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Human Resources for Health

The effective diagnosis, care, and treatment of infectious diseases require a skilled and motivated health care workforce, and sustainable systems to educate and train those workers. I-TECH uses a systemic approach to build the skills and knowledge of, and foster attitude changes in, health care staff and those who train and educate them.

The following model outlines I-TECH’s human resources for health-based approach to achieving comprehensive patient-centered care. Each component of the model, including a strong enabling environment, supports an optimized health workforce as the foundation of an effective service delivery system.

Program Highlights

Advanced Disease and Patient Care/Cryptococcal Antigen Screening and Treatment in Tanzania

High-quality, effective, and evidence-based service delivery for HIV care and prevention requires a broad continuum of integrated and linked services to ensure consistent and high-quality client management over time. With the World Health Organization's (WHO) recommendation to “Treat All," eligibility for antiretroviral therapy (ART) among People Living with HIV (PLHIV) ...
Read More

Building the Capacity of the Health Workforce in India

I-TECH India PL has worked with stakeholders to develop national training curricula for health care staff on delivering HIV care and treatment services. In addition, it has:

Planned and implemented training programs for various cadres of clinical and program staff;
Participated in medical officer training programs at the national ...
Read More

Clinical Mentoring in Haiti

I-TECH introduced its clinical mentoring program in Haiti in 2006. A team of physicians, nurses, and psychologists provide technical assistance to 20 sites in the MSPP care and services network to help strengthen HIV- and AIDS-related services. During site visits, CHARESS mentors conduct clinical rounds ...
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eLearning Programs for Health Care Workers in Trinidad and Tobago

I-TECH partners with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH), the National AIDS Coordinating Committee (NACC) of the Office of the Prime Minister, and other local organizations to make accessible learning and capacity-building opportunities for all cadres of health care workers.

Learning Management System (LMS): ...
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