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A laboratory supported by the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) project achieves a four-star rating on WHO-AFRO recognition scheme

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A four-star rating for a SIDHAS-supported UBTH ART lab provides evidence that collaborative efforts pay off

The World Health Organization, Regional Office for Africa (WHO-AFRO) in collaboration with other stakeholders, developed and launched a novel laboratory accreditation approach known as Strengthening Laboratory Management Towards Accreditation (SLMTA) in Kigali, Rwanda in 2009, to strengthen efforts to improve on laboratory service quality. This program intends to provide a pathway for measuring, monitoring and recognizing improvement toward the realization of international laboratory standards and subsequent application to a national or internationally recognized accreditation body. FHI 360, in collaboration with other implementing partners and the Government of Nigeria (GON) adopted the WHO-AFRO recognition system and currently, six SIDHAS supported laboratories including UBTH, have attained varying levels of WHO AFRO recognition.

The University of Benin Teaching Hospital (UBTH) antiretroviral therapy (ART) laboratory began its journey as a laboratory when it was originally enrolled into the SLMTA program under the Institute of Human Virology Nigeria (IHVN) Action project. A baseline audit of the laboratory, conducted in 2010 by SLMTA auditors, gave the facility a score of <55% which amounted to the zero-star rating.

In 2010, the hospital was enrolled in the WHO-AFRO Stepwise Laboratory Quality Improvement Process towards Accreditation (SLIPTA) program in Nigeria, a program established to encourage, support and recognize the implementation of quality management systems (QMS) in medical laboratories in a stepwise manner. Medical laboratories that successfully pass this process and attain 85-94% or >95% score receive “four-star” or “five-star” levels of recognition respectively, and are, then, recommended and supported for l and international accreditation.

The USAID-funded Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) project, which is led by FHI 360 and managed by Achieving Health Nigeria initiative (AHNi) in Edo State, began supporting UBTH in 2013. The SIDHAS Edo state team immediately began providing technical assistance, trainings, mentorship, infrastructural upgrades and supplies of equipment and commodities until the facility completed and exited the initial SLMTA 4-year program in 2014.

By December 2014, UBTH moved from “zero star” to a WHO-AFRO “one star” grading, after a post-SLIPTA exit audit for the facility was conducted by external auditors from the African Society for Laboratory Medicine (ASLM). This was a source of encouragement for the facility and the hospital management demonstrated a high level of commitment to address gaps and non-conformances cited from the previous audit.

Inspired by their quality improvements to do even more, UBTH reviewed and updated all service delivery Quality Management System (QMS) documents – policies, manuals, SOPs, job aids and forms. Equipment maintenance protocols were instituted and as a result, faulty equipment are now repaired promptly, reagents and consumables supplied, and fuel procured to power generators. These efforts led to improved documentation at the laboratory, good clinical laboratory practice (GCLP) and quality safety practices have become a culture. To ensure sustainability of this quality improvement process, the  SIDHAS team continued to provide technical support for the laboratory accreditation process through training and mentoring of the hospital management, lab managers and quality officers to take charge of the process in their facilities and build a sustainable system for continual improvement.

On the 7th and 8th of April 2017, another ASLM SLIPTA audit was conducted at the facility and the UBTH ART laboratory, which includes the polymerase chain reaction (PCR) laboratory, was later awarded a WHO AFRO “four-star” rating after a review by the Independent Advisory Committee of WHO AFRO. This is significant because the ART laboratory also serves as a referral hub for HIV laboratory services to many hospitals in the south-south and south-west regions of Nigeria.  As at 2017 December, a total of 5,755 clients currently receive ART at the facility.

Indeed, hard work and commitment from all relevant stakeholders does pay off!

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