ABSTRACT
Introduction: The Lesotho Ministry of Health and Social Welfare's (MOHSW) 5-year strategic plan; as well as their national laboratory policy and yearly operational plans; directly addresses issues of accreditation; indicating their commitment to fulfilling their mandate. As such; the MOHSW adopted the World Health Organization Regional Headquarters for Africa's Stepwise Laboratory Quality Improvement Toward Accreditation (WHO-AFRO-SLIPTA) process and subsequently rolled out the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme across the whole country; becoming the first African country to do so. Methods: SLMTA in Lesotho was implemented in two cohorts. Twelve and nineteen laboratory supervisors and quality officers were enrolled in Cohort 1 and Cohort 2; respectively. These 31 participants represented 18 of the 19 laboratories nationwide. For the purposes of this programme; the Queen Elizabeth II (QE II) Central Laboratory had its seven sections of haematology; blood bank; cytology; blood transfusion; microbiology; tuberculosis laboratory and chemistry assessed as separate sections. Performance was tracked using the WHO-AFRO-SLIPTA checklist; with assessments carried out at baseline and at the end of SLMTA. Two methods were used to implement SLMTA: the traditional 'three workshops' approach and twinning SLMTA with mentorship. The latter; with intensive follow-up visits; was concluded in 9 months and the former in 11 months. A standard data collection tool was used for site visits.Results: Of the 31 participants across both cohorts; 25 (81) graduated (9 from Cohort 1 and 16 from Cohort 2). At baseline; all but one laboratory attained a rating of zero stars; with the exception attaining one star. At the final assessment; 7 of the 25 laboratories examined at baseline were still at a rating of zero stars; whilst 8 attained one star; 5 attained two stars and 4 attained three stars. None scored above three stars. The highest percentage improvement for any laboratory was 51; whereas the least improved dropped by 6 when compared to its baseline assessment.The most improved areas were corrective actions (34) and documents and records (32). Process improvement demonstrated the least improvement (10). Conclusion: The SLMTA programme had an immediate; measurable and positive impact on laboratories in Lesotho. This success was possible because of the leadership and ownership of the programme by the MOHSW; as well as the coordination of partner support