Innovative strategies for a successful SLMTA country programme: the Rwanda story

ABSTRACT

Background: In 2009; to improve the performance of laboratories and strengthen healthcare systems; the World Health Organization Regional Office for Africa (WHO AFRO) and partners launched two initiatives a laboratory quality improvement programme called Strengthening Laboratory Management Toward Accreditation (SLMTA); and what is now called the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA). Objectives: This study describes the achievements of Rwandan laboratories four years after the introduction of SLMTA in the country; using the SLIPTA scoring system to measure laboratory progress.Methods: Three cohorts of five laboratories each were enrolled in the SLMTA programme in 2010; 2011 and 2013. The cohorts used SLMTA workshops; improvement projects; mentorship and quarterly performance-based financing incentives to accelerate laboratory quality improvement. Baseline; exit and follow-up audits were conducted over a two-year period from the time of enrolment. Audit scores were used to categorise laboratory quality on a scale of zero ( 55%) to five (95% - 100%) stars. Results: At baseline; 14 of the 15 laboratories received zero stars with the remaining laboratory receiving a two-star rating. At exit; five laboratories received one star; six received two stars and four received three stars. At the follow-up audit conducted in the first two cohorts approximately one year after exit; one laboratory scored two stars; five laboratories earned three stars and four laboratories; including the National Reference Laboratory; achieved four stars.Conclusion: Rwandan laboratories enrolled in SLMTA showed improvement in quality management systems. Sustaining the gains and further expansion of the SLMTA programme to meet country targets will require continued programme strengthening