Technology Rollout of ‘Labs for Life’ project to improve health services

Proper diagnosis of diseases is often reliant on laboratory tests. The generated results – be it from blood, stool or tissue samples – inform health workers on the treatment to administer.

Therefore, without well-equipped and proper functioning laboratories, patients’ lives are at risk.

It is for this reason that the government in partnership with the US President’s Emergency Plan for Aids Relief (PEPFAR) and Becton, Dickinson and Company (BD) recently launched a programme dubbed “Labs for Life” to improve laboratory services in the country.

This programme builds on ongoing efforts by the Ministry of Health and the World Health Organisation (WHO) aimed at equipping laboratories in Kenya to enable them meet the accreditation requirements set by the International Organisation for Standardisations (ISO 15189).

Five laboratories located in Kwale, Narok, Makueni, Lodwar and Nairobi counties have been prioritised by the Ministry of Health to participate in the first phase of the programme. Five more laboratories will be added in 2015.

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“We want to move these 10 labs from zero stars to five stars so that they can be ready for accreditation,” said Renuka Gadde, BD vice president.

“For many years, laboratory services in the public sector have been of low quality. And so in most cases, they have not contributed productively to patients diagnosis and management,” noted William Maina from the ministry’s Directorate of Preventive and Promotive Health during the launch. (See video)

Currently, the only public health laboratory in East Africa that has received ISO 15189 accreditation is the National HIV Reference Laboratory (NHRL) in Kenya.

According to Nancy Bowen, NHRL manager, the accreditation was awarded after key reforms aimed at improving the quality of services offered.

She notes that meeting the ISO requirements was not a walk in the park. However, NHRL fast tracked this process through the adoption of digital platforms and technologies.

This is the approach that the “Labs for Life” programme seeks to adopt as they cascade the NHRL successes to other laboratories across the country.

Thomas Gachuki, the National Public Health Laboratories ISO Programme Manager, notes that operations at NHRL are now paperless, thanks to a software known as the Laboratory Information Management System (LIMS) that harmonises activities in all departments.

Database

He says when clients bring samples to NHRL for tests, all information is captured into the LIMS database.

This includes the list of samples brought, specific HIV tests required, the health facilities the samples originated from, name of clinicians that ordered the tests and demographic information about the patients.

Thereafter, Mr Gachuki says, a unique barcode is generated for each sample, eliminating transcription errors common with manual labelling.

The unique barcode also comes in handy whenever samples need to be traced.

Once barcoded, LIMS is used to distribute the samples to appropriate laboratory sections based on the tests required, be it immune or HIV viral load monitoring. The manager therefore, does not need to move from one department to another doing this.

Thereafter, scientists working in the laboratory log into the system and begin testing samples assigned to them.

“So we always know who is working on what. And in case of any problem we direct the concerns to that specific person. This alleviates unnecessary blame games,” says Kepher Otieno, the molecular diagnostic and research specialist at NHRL.

He adds that once the results are ready, LIMS automatically sends them to specific health facilities, clinicians or clients that ordered them. This guarantees the confidentiality of patients’ results.

“The prompt feedback saves time hence ensuring patients concerns are addressed within a short time,” Mr Otieno says.

LIMS also puts in place checks to ensure that all generated results are reviewed by three authorised persons before they are sent to clients.

“Consequently, the quality of tests results released from this laboratory are now of high standards,” notes Risper Sewe, the NHRL quality assurance manager.

She says that if samples are rejected, (for example because they are contaminated or not labelled properly) LIMS sends an alert to the client informing him/her of the same.

As all these activities are taking place in the laboratory, Ms Sewe can monitor operations in different sections through LIMS from her office and is thus able to promptly address issues such as delays.

One other important feature of LIMS is its compatibility with the Proficiency Testing (PT) System, a tool designed to identify and correct weaknesses among laboratory staff conducting HIV tests in Kenya.

Bera Kipkerich, a laboratory systems specialist, says LIMS has the unique advantage of being programmable.

“The system came when it was generic. But we added modules to it slowly by slowly and configured it to meet the needs of NHRL through consultations with all stakeholders,” he says.

“I would recommend that counties embrace this participatory approach as they introduce LIMS in their labs.”

Part of the reforms at NHRL also involved the uptake of advanced technologies such as the digital Elisa and ABOT Molecular Roche machines that are automated and can accurately test many samples at once.

“This has been very instrumental when dealing with huge samples during large studies such as the Kenya Aids Indicator Survey,” explains Sophie Mwanyumba, a serologist at NHRL.

Because of the ISO accreditation, NHRL will become the first government laboratory to undertake HIV drug resistance tests. Currently only public research institutions such as Kemri and private laboratories perform them.