2018年-世界发展银行全球_Performance_Evaluation_of_Public_Health_Laboratories_in_Kenya_60页_1mb

Performance Evaluation of Public Health Laboratories in Kenya

Core Content

This document presents the findings of a performance evaluation of public health laboratories in Kenya under the East Africa Public Health Laboratory Networking Project (EAPHLNP), conducted in February 2018. The evaluation aimed to document progress, lessons learned, and suggest improvements for the future. It focused on five key performance dimensions: test turnaround time (TAT), test volumes, test accuracy, client satisfaction, and scores achieved in SLIPTA audits. The report also analyzed the influence of EAPHLNP interventions on laboratory performance, professional relationships, and sustainability concerns.

Main Results and Key Findings

1. Laboratory Performance Over Time

• Test Volume: A positive trend was observed in the volume of GeneXpert tests, one of the key technologies introduced by the project. However, results for other tests were mixed.
• Turnaround Time (TAT): The acquisition of modern equipment improved TAT for TB and microbiology tests. For other tests, there were no conclusive findings, and clinical workers noted room for improvement.
• Test Accuracy: External quality assessment (EQA) results showed a positive impact of EAPHLNP interventions on test accuracy, though the analysis was limited by sample size.
• Client Satisfaction: There was a slight improvement in satisfaction, attributed to greater confidence in test results, a broader range of tests, and a more welcoming attitude from laboratory staff.
• SLIPTA Scores: There was a strong overall improvement in SLIPTA scores across all EAPHLNP-supported laboratories between 2011 and 2016.

2. Outbreak Response and Disease Surveillance

• Participating laboratories became more involved in disease surveillance and outbreak response, such as recent cholera outbreaks.
• Cross-border surveillance committees and joint investigations were noted as innovative practices, viewed positively internationally.
• However, the project's effect on outbreak response was not clearly demonstrated due to limited data in the outbreak and rumor log.

3. Laboratory Worker Skills and Motivation

• Training improved the skills and motivation of laboratory personnel, enabling them to conduct newer and more performant tests.
• Automated equipment was highly appreciated and increased confidence in test results among clinicians.
• Joint training with clinical staff improved professional relationships and collaboration.
• Key factors enhancing motivation included working in a conducive environment, opportunities for professional growth, and regular interaction with clinicians and hospital directors.

4. Relationship Between Laboratory and Clinical Staff

• Improved laboratory services and facilities strengthened the relationship between laboratory professionals and clinicians.
• Factors contributing to this improvement included the introduction of new tests, increased confidence in results, and joint training activities.

5. Perceived Role of EAPHLNP Interventions

• The highest-ranked interventions were facility upgrades, SLMTA training, and regular SLIPTA assessments.
• Laboratory improvement funds were particularly valued by laboratory technologists for daily operations.
• Mentorship and operational research were also important, though not universally prioritized.

Key Stakeholder Concerns on Sustainability

• Supply Chain Issues: Lack of regular reagent supply and equipment service contracts.
• Infrastructure Gaps: Limited power backup, disruptions in air conditioning, and absence of backup machines.
• Integration Challenges: Limited integration of Laboratory Information Management Systems (LIMS) with hospital information systems.
• Staffing Concerns: Concerns over staffing levels and continuity of operations.

Recommendations

1. Share Findings with County Governments: To inform budget allocation and ensure the sustainability of laboratory services.
2. Enhance Results-Driven Approaches: By improving data use and strengthening accountability mechanisms, including performance-based financing.
3. Continue Joint Learning Initiatives: Promote collaboration between clinicians, surveillance officers, researchers, and laboratory staff, and organize exchanges between different laboratory sites.

Project Overview

• The EAPHLNP aims to establish a network of high-quality public health laboratories in East African Community (EAC) member states, including Kenya, Rwanda, Tanzania, Uganda, and Burundi.
• Kenya leads in operational research and disease surveillance; Uganda in laboratory networking and accreditation; Tanzania in training and capacity building; Rwanda in ICT, PBF, and MDR-TB; and Burundi co-leads PBF with Rwanda.
• The project is coordinated by the East, Central, and Southern Africa Health Community (ECSA-HC) in collaboration with the EAC.
• The evaluation methodology was adapted from the Rwanda evaluation and tailored to the Kenyan context, considering the unique health system dynamics and ongoing reforms.

Study Limitations

• Data Availability: Routine data for TAT, test volumes, and client satisfaction were limited due to outdated paper-based systems.
• Selection Bias: Comparison sites were selected based on data availability, which may have introduced bias.
• Qualitative Insights: Perspectives from key informants were subject to individual biases, and the range of views was limited by the number of participants.

Conclusion

The evaluation highlights the positive impact of the EAPHLNP on laboratory performance, particularly in terms of test accuracy, client satisfaction, and professional relationships. However, it also identifies key challenges that need to be addressed to ensure the long-term sustainability of the project. The findings are intended to support internal discussions and inform future strategies for strengthening public health laboratory services in Kenya and other EAC countries.