DEVELOPMENT OF DOCUMENTS STANDARD OPERATING PROCEDURES (SOPS) IN ZAMBIA

GABERONE, BOTSWANA 28TH JULY 2003

Presented by: Grace C. Kahenya MSC. FIBMS Laboratory Specialist Central Board of Health Lusaka, Zambia

Map of Zambia showing 9 provinces

Background, contd
Adult HIV/AID prevalence rate 16% Incidence of new smear positive TB cases 512 / 100,000 cases population 60% of TB patients are HIV sero positive

Life Expectancy at birth 37 years.

Zambia Public Heath Laboratories

Total number of Laboratories 154
Ministry of Health Central Board Of health (Laboratory Specialist) Level III Laboratories 4 Level II Laboratories 14 Specialized Laboratories Chest Diseases Laboratory Zambia National Blood Transfusion Service Virology Laboratory Occupation Health Board Tropical Diseases Research Center

Level I Laboratories 74

Health Center Laboratories 47

Back ground of Laboratory Services in Zambia

In 1994 Medical Laboratory Policy project was initiated by Ministry of Health and supported by Ireland Aid. Objectives of the project were :- to conduct a situation analysis of Laboratory services in Zambia - to develop standards - to develop policies and strategies to guide the development of the service within the context of health Reforms.

Summary of Situation Analysis findings

Majority of laboratories failed to deliver the most critical elements of the Basic Health Care package. Inadequate skills and competences of the few available laboratory staff. Lack of equipment, supplies and national standards. Poor laboratory infrastructure. The results provided a framework for policy development.

National Medical Laboratory Policy

Process of development - working groups were formed in all areas of the major constraints in the situation analysis study. Goals of Policy - To improve and maintain Laboratory services at an optimum standards through the development and implementation of a comprehensive and co-ordinated policy. - To provide national technical guidelines for the improvement and provision of Laboratory services at each level of health care delivery.

Policy Components
- Test selection and use guides rational use of Laboratory tests. - Basic inputs main functional requirements of Laboratory. - Quality Assurance quality of service, Quality control, External Quality assessment and Monitoring and Evaluation. - Safety - Ethic - Research and development - Local, Regional and international collaboration.

Implementation Plan of Policy (5 years)

Short term plan (priority) - Basic inputs (equipment, supplies, human resource and infrastructure) Long-term Plan - Full implementation of the policy and development of a sustainable system to support the services at all levels.
The situation analysis provides baseline indicators against which progress could be measured. The policy was launched in March 1997 and implementation started same year.

Achievements on the Development of Documents

Guidelines developed:
Integrated logistic and supply management and quantification. Rational use of Laboratory tests at Health centre level. Standard equipment list and specification at each level of care. Basic maintenance of laboratory equipment. Test profiles and standard operating procedures at all levels of care. Standards of laboratory building designs at all levels of care. Rationalise the existing staff through redeployment training and development of standards. Upgrading of existing certificate schools to Diploma level with increased output by 2005. Establish a degree course at UNZA.

Quality System Documentation Quality Manual

What to do

Policies

Processes

How it happens

Procedures / work Instructions

how to do it (SOPs)

Standard Operating Procedures (SOPs)

List of test profiles to support the Basic Health care package at each level. SOP for each test to standardise the methods used at each level Identify inputs Training, staff, supplies and equipment. List of equipment and specification at each level of care. Standard design of laboratories at each level of care.

Standard Operating Procedures (SOPs)

Develop SOPs that are: - appropriate to the local environment - Cost effective and utilize reagents and equipment that are readily available. - Support the Basic Health care package - Provide Laboratory staff with user friendly guidelines.

Development Process
Development process was participatory involving all stakeholder at the various levels of care. Working committee in all the medical laboratory science displines were formed. Guidelines based on the results of the situation analysis were developed and given to the working committees. A format for the SOP was provided to all working committee. A schedule work plan was developed and given to the working committee.

References
Serve as a source of the information The references used in Zambia were from Text books e.g. 1. District laboratory, Practice in Tropical countries, Part 1 & 2 by Monica Cheesbrough 1998 2. Practical Laboratory Manual for Health Centres in Eastern Africa 1994 by Jane Cater and O. Lema Published standards and guidelines Laboratory information technology manuals Unpublished information obtained from experts in the field Applicable regulations

Approval
An Editorial committee consisting of subject experts was formed to edit the draft SOPs. Edited SOPs were pre-tested for user friendliness and reproducibility. Final editing was done before the approval by a team of experts. Implementation of SOPs. Health Centre 2000 District Level I 2002 District Level II and III 2003

Distribution
Training of the users was conducted for use and orientation of documents. Distribution was through the Provincial Health Office Starting with the Health Centres The SOPs provided reference material for most laboratories.

Revisions
The Central Board of Health through the Laboratory specialist office have the mandate to institute revision. Revisions of SOPs will only be done after the evaluation.

Way Forward
Review the National Medical Laboratory Policy 2004 Establish Continuining Professional Development. 2003 Establish National Quality Assurance Programme 2004 Monitoring and Evaluation of SOPs for Health centre and level 1 2003