1. Jeroen Van’t Pad Bosch, Technical Director Elizabeth Glaser Pediatric AIDS Foundation, Tanzania EGPAF PROJECT HEART STRENGTHENING HEALTH SYSTEMS THROUGH LABORATORY SUPPORT AND QUALITY MANAGEMENT

2. BACKGROUND EGPAF is supporting 147 CT sites and 850 PMTCT sites in Tabora, Shinyanga, Kilimanjaro, Arusha, Mtwara and Lindi regions Good laboratory services (CD4, hematology and biochemistry) are essential for the provision of quality HIV services Laboratories in Tanzania are still in need of substantial support to reach this goal

3. EGPAF/TANZANIA LAB SUPPORT Goal: To enable clinical laboratories to provide fast, accurate and reliable results that improve the quality of patient care in Tanzania Provision of technical and financial support to zonal, regional, district and lower-level facilities to implement quality laboratory services

4. EGPAF/TANZANIA LAB SUPPORT TEAM Program Coordinator (Dar es Salaam) Program Officers (One per region) Mentors and assists PO’s Quarterly reports on lab program activities Identifies training needs Communication between sites, MOHSW, MSD National-level lab meetings Site-level assessments and supportive supervision On-site trainings Respond to equipment and supply chain needs Communication between regional, district and lower level sites, MOHSW, MSD

6. APPROACH Needs assessment – MOHSW laboratory evaluation tool – 93 laboratories evaluated to date Comprehensive support package – Custom made – Capacity building – Involving local stakeholders Monitor progress and adjust support – Quarterly lab performance assessment

7. NEEDS ASSESSMENT Challenges in communication and coordination – Weak laboratory networks, sample transportation, QA systems, supply chain management, (preventative-) maintenance Lack of trained / skilled staff Inadequate infrastructure Low quality lab services with long turn around times

8. SUPPORT and MONITORING PROGRESS Supportive supervision – 138 visits to 44 hospitals in six regions since 2008 – Strengthening lab networks 20 trainings – Quality system management, instrument use, trouble shooting, (preventative-) maintenance, IT, supply chain management Infrastructural improvements – 14 laboratories renovated – Over 130 lab machines purchased

9. ACHIEVEMENTS All supported laboratories have started to implement QA systems Marked improvement in procedures, safety awareness, record keeping Regional and referral labs are designating QA officers; followed by district labs Fewer and shorter breakdowns

10. ACHIEVEMENTS % of total sites assessed (n=44) * Two technicians per site, a total of 30% (87/287) of all lab staff.

11. CHALLENGES Ongoing site level assistance needed, emphasizing lab quality essentials Further capacity building and training is needed including GCLP Shortages and low motivation of HR Further support needed for lab networks, sample transportation, quality assurance

12. NEXT STEPS TOWARD SUSTAINABILITY Supporting KCMC as national reference lab towards accreditation Further strengthening supply chain management Equipment and infrastructure support Implement national lab strategic plans

13. KEYS TO ONGOING SUCCESS Senior EGPAF laboratory staff in each region – Strong working knowledge of Tanzania MOHSW guidelines, lab technical areas – Strong relationships with key partners and site management – Prioritize developing and retaining qualified staff MOHSW and USG leadership – Development of quality guidelines, lab SOPs – Prioritization of lab issues (funding, assistance) Communication with sites, lab organizations, and partners – Ensure coordinated efforts

14. ACKNOWLEDGEMENTS EGPAF/Tanzania Laboratory Team: – Dennis Haule, Abdul Mpanga, Abubakari Mariri, Albertho Chengula, Kennedy Kalago, Musa Msiganga – Tara Suntoke (EGPAF/US) EGPAF Partners and Clients MOHSW / NACP CDC / USAID For their great effort and support in the fight against HIV/AIDS in Tanzania

15. Thank you very much for listening!