PEPFAR-supported Lab Mentorship Initiative Yields Remarkable Improvements in Quality of Service at Temeke Hospital Laboratory in Tanzania
Having successfully led Temeke Hospital Laboratory from zero to a 3-Star rating, Lab Manager Grace Maliva isn’t resting until the lab achieves full accreditation, hopefully by the end of 2015. After that, she has her eyes set on bigger healthcare management roles and is eager to contribute to efforts to improve the quality of healthcare services in Tanzania.
It is a dawn like no other at Temeke District’s largest healthcare facility in Dar es Salaam, the bustling business capital of Tanzania. Jubilant young men and women in white coats are cheering, laughing, and happily embracing one another. In the midst of this joyous outcry, a calm and modest looking young woman with intricately braided hair speaks quietly. What she says causes her colleagues to cheer even louder. There is an explosion of applause as they surround her. She smiles at them, lifts her hands in the air, and shouts “TMK oyeee!” “Oyeeeee!” they resound.
One of the youngest female Regional Laboratory Managers in the city, Grace Maliva joined the Temeke Hospital lab team as a technician in 2008. At that time, the facility showed no promise of an exciting career for the young scientist. Instead, the infrastructure was poor and the staff extremely limited, which contributed to an overall lack of motivation and little regard for quality of service. In fact, over the next few years, the Ministry of Health and Social Welfare conducted two Strengthening Laboratory Management towards Accreditation (SLMTA) assessments at Temeke awarding the lab zero stars each time.
As a result, the Ministry engaged the American International Health Alliance’s HIV/AIDS Twinning Center to roll out a comprehensive laboratory quality improvement program (LQIP) at Temeke. Launched in 2006, the LQIP is implemented through a twinning partnership that links the Ministry of Health and Social Welfare and Boulder Community Hospital in Colorado thanks to support from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the US Centers for Disease Control and Prevention (CDC) in Tanzania, and the US Department of Health and Human Services, Health Resources and Services Administration (HRSA).
This initiative offered Grace — and team members working in some 23 regional hospital laboratories throughout Tanzania — opportunities to develop skills and improve HIV/AIDS-related diagnostic services through in-service training, mentorship, and supportive supervision from both Tanzanian and American laboratory experts.
“The mentors helped us to develop quality manuals, procedures, and policies, and to map our processes against them, which eventually helped us to change not only our approach, but also our thinking,” Grace explains.
Grace was promoted to Lab Manager in 2013 and she was determined to raise the bar for the lab and her team. With her eye on the prize of earning full accreditation for the lab, she redoubled her commitment to quality improvement. By the end of the year, the Ministry awarded Temeke Laboratory two stars following a SLMTA assessment. This milestone further invigorated Grace and her team and, in collaboration with the AIHA mentors, they intensified their efforts by utilizing Stepwise Laboratory Improvement towards Accreditation (SLIPTA), a World Health Organization (WHO) framework to strengthen lab services and quality.
“We fixed our efforts on helping patients receive more reliable and timely test results through constant feedback, monitoring of indicators, and continuous self-assessment,” Grace says, full of pride as she recounts being honored by the President of the United Republic of Tanzania with the 2014 Best Healthcare of the District accolade during a May Day celebration.
But for Grace and Temeke Hospital Laboratory, the best was yet to come.
In July 2014, a team of experts from WHO’s Africa Office arrived at Temeke Hospital. They spent a full day and night conducting a thorough examination of the lab before awarding it a 3-Star rating on the SLIPTA scale.
“It was at the break of dawn when the Quality Officer received an email notification and broke the news. People had refused to go home after the assessment and we were all waiting anxiously at the hospital,” Grace admits.
This triumph would open many doors for both Temeke Lab and its leader. Both the hospital and district administrations recognized the work of the lab and provided additional support. The Ministry of Health and Social Welfare started to view the lab as a breeding ground for quality-minded laboratory scientists and soon began sending other workers to the facility to learn.
Some members of the Temeke Hospital Laboratory team with their mentor, Mr. Gamaliel Kisyombe, a few weeks before the SLIPTA accreditation.
Because of her adroit leadership and commitment to quality, Grace has been requested to oversee quality improvement elsewhere at Temeke Hospital, including the radiology, surgery, pharmacy, and medical records departments. She is doing this by replicating quality assurance practices now observed and practiced at the lab.
Despite all this, Grace says she is not content with what she and her team have accomplished.
“We are working hard to attain the highest performance standards in the WHO scale and ultimately receive full international accreditation, by end of 2015,” she says proudly, expressing her wish to help members of her team develop the knowledge and skills they need to become international lab mentors and assessors. “There is an amazing sense of quality awareness and adherence, as well as a revived passion among members of the team to offer the best diagnostic services. Now, any little complacency is reproached by everyone.”