Improving health systems and clinical laboratories

 Narrative of the Current Status quo

Reception of quality health services is a desire of every patient; this desire inherent and has been enshrined in our constitution as a fundamental human right, various laws, international treaties, protocols and declarations. Everyone deserves assurance that at the time of their vulnerability when sick, they will check into a health facility and receive a type of health service that will lead to revival and healing.

However, this assurance is far from most Ugandans; the experience of checking into our hospitals (Both public and private) is horrible to many and the psychological torture, depression and stress are deep hitting.

It is always not a hilarious experience for many so to say. Most Ugandans strongly believe that our hospitals are death traps and places where only the mercy of God can bail one out though this may not be so right all the time; many Ugandans believe that health workers in our hospitals are heartless and the whole sector is a mockery and collection of unethical people.

Of course this is the image the media has created though not so true. Many newspaper articles and report have been published with many indicating that our health sector is in a putrefying state left wantonly to the dogs.

In this article I want to propose an alternative thought or thoughts which I think if implemented will broadly ensure quality health services in this country. It may not be a magic bullet because it takes time but I believe it can bolster and overhaul the system and dump it into a position where it can deliver comparatively quality health services. 

A culture of quality and customer satisfaction is the missing link

In searching for solutions to better our health sector, many have fronted solutions like increased funding, infrastructure improvement and many others which are indeed good ideas but not magic bullets.

In my view to increase funding without first installing quality assurance systems will be an endeavor in futility and services will continue to be low quality even with huge investment. In these five years, the ministry of health should think of devising ways of rolling out quality assurance systems at all tiers of the sector.

The concept of quality improvement (QI) and total quality management (TQM) has been applied in the developed world to better health services and it has been the cornerstone of excellent health systems and health services for a long period of time.

In the developed world, Health facilities invest heavily in quality improvement and the documented evidence of improved services from local facility performance informs the steps to more quality improvement up the chain.

This culture of quality has been entrenched and developed into hospital accreditation schemes and regional Health facilities accreditation bodies and institutions. Through accreditation institutions, hospitals struggle to keep standards and continue to offer better services lest they drop in status because this affect revenue since patient numbers dwindle. 

I strongly believe that Uganda needs this arrangement if we are to realize value for money and betterment of health services

Sadly, the quality improvement culture has failed to take shape in most health facilities across Uganda and the entire chain of health care delivery because we have not deeply though about it and how to institutionalize it and or probably we have not sensitized ourselves on how it works.

Most of the procedures and processes are handled in a haphazard manner simply because public facilities loose nothing like accreditation status when they fail to offer a good service. In the private sector, insurance companies have tried to force some degree of quality service delivery from the health services suppliers who seek to get business from them and this should be encouraged.

According to my experience and observation, lack of knowledge on quality management and quality improvement with goal of customer satisfaction has greatly affected service delivery right from higher tiers down to the lowest health tier.

The WHO Strengthening Laboratory Management Towards Accreditation (SLMTA); Lessons learnt

Having recognized the central role laboratories play in delivery of evidence based medicine and health services, and the pathetic state laboratories were in across Africa and Asia, the World Health Organization at various levels of decision making committed to scale up the quality of laboratory services and improve HIV care services.

A scheme code named SLMTA was borne and it has been rolled out in Africa and Asia through funding from majorly the US people through CDC and USAID. The scheme targets clinical laboratory leaders in public facilities, Private not for profit and recently private facilities; mentor them into application of the International Standards Organizations (ISO) standards for laboratories through tasks training using a checklist called the SLIPTA checklist.

It is no longer a secret that this program has improved the quality of services offered by laboratories across Africa and Asia and especially in Uganda.  I have firsthand experience on how this quality improvement program has greatly improved clinical lab service from very indescribable pathetic services to "accreditable" clinical laboratories in this country on record five years.

Under this quality system arrangement, numerous clinical lab managers have been trained, labs audited, quality assurance systems installed and operationalized across the country.

Way forward

If such a Quality assurance and accreditation system is fully rolled out across the health services supply chain and health sector leaders and servants appraised based on their contribution to delivery of quality health care and customer satisfaction, then we will be able to talk objectively about revamping the rotting health systems. If there is anything to crave for in this country about offering quality services, it should be quality management system and facilities accreditation institution or body.

Health training institutions must include total quality management (TQM) and quality assurance in the curriculum across board in order to entrench the quality culture right from training. This is grossly lacking.  

The government should budget for quality improvement and write down laws that setup and describe the running of health services under the supervision of an independent National accreditation institution or even a regional one. 

Kenya has one called KENAS and as well South Africa has one called SANAS for clinical laboratories. The body among others should be tasked to audit health facilities and produce a list of health care facilities meeting the required standards both in the public and private sector covering all types of services.

This will force providers to be sensitive while delivering services and clients will be well guided on where to seek health services based on information provided by the accreditation body. With installation of a quality culture and customer based service delivery, the entire health sector will improve naturally and organically on record speed.

Already the tools are available from the international standards organization and WHO plus those made locally. We can agree on more quality tools and instruments which we can use to have our hospital accountable to the people as they provide health services.

It is not easy at the start but we can try it out the quality way and see how it works out for the betterment of our lives.

Kasibante Samuel

Biomedical Scientist

Medical Laboratory Technologist-Haematology