Dr. Ephantus Njagi EQA Practice in Kenya: History and Lessons Learnt 1

Scope Introduction Practice in Kenya Challenges Lesson learned 2

External Quality Assurance (EQA) Offers a means of measuring laboratory performance in relation to the general accuracy of tests performed by laboratories Increases patient and physician confidence enhanced confidence reduces overall costs of medical care related to diagnostic testing 3

External Quality Assurance (EQA) Measure of Accuracy Peer vs. Proficiency Reports SDI: Standard Deviation Index: SDI = (Lab mean –Group mean)/Group SD CVI: CV Index: CVI = Lab CV/Group CV Evaluation Identify deficiencies Construction of corrective/preventative action plans Monitoring of plans through resolution DOCUMENT: Acceptable results as well as failure results 4

External QA in Laboratories in Kenya largely a phenomenon of the last 10 years Initially UKEQAS, Randox and SA commonly used Local initiative began in 2000: HUQAS Need for accurate test results driven Research Demand by clinician Growing need to do better enhancement possibilities twin-track audit/assessment lacking audit –management of quality and standards assessment – inspection based reviews 5

Challenges experienced: 7 years of EQAS National coordination Planning Distribution Testing Data analysis Feedback and follow-up 6

National coordination Laboratory guidelines and standards Guidelines and standards Standardized laboratory procedures Policy on quality assurance Policy or guidelines on reagents and equipment use 7

Planning Lack of information on existing EQAS Lengthy registration process Fit in or out Low influence in the EQAS design or content Cycle of registration Resources and timelines Expensive Payment logistics Delay in invoices Foreign currency demand may harbour public laboratory particpation 8

Distribution Shipping Distance- occasionally leading to delay in delivery/loss of sample materials Couriers-issues of link between couriers-sender-receiver Lack of harmonised delivery system Post office Courier Scheduling of material delivery never provided in advance 9

Testing Initially fear “special” treatment Greater range of diagnostic procedures than normal Special scrutiny for results before reporting Late submission of results Failure to submit some reports Mix-up of reports; right results on wrong report forms Scored even on “not examined” materials Results entered or published on website with notification No regular meetings to discuss results No emphasis on the educational aspects Development of local experts never realized 10

Data analysis No prior training on interpretation “self teach approach” Understanding some graphs may needs certain skills Appropriateness of the score outside country of analysis no scoring scheme can be universally applicable or relevant. 11

Feedback and follow-up Distribution summaries and individual results sheets posted arrives within 7 to 10 days. post may be erratic Difficult to arrange peer groups Harder communications Expensive phone calls s letters Follow up done after each round 12

National EQAS System development according to our needs Participants may communicate with organizers more directly Participants could suggest modification of the scheme Local expert development Employment creation More management work Greater budget Time consuming 13

Lesson learned Improved relationship between clinicians and the laboratory Increased use of laboratory Researchers Clinicians increased Revenue collection Raised motivation and confidence of laboratory staff 14

“ Teamwork is so important that it is virtually impossible for you to reach the heights of your capabilities or achieve the goals that you want without becoming very good at it.” Brian Tracy Thank You 15