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Tanzania Moves to Build Laboratory Capacity

At Mwanza’s Bugando Hospital, one of the largest in Tanzania, laboratory workers sometimes must wait months for necessary supplies to run common medical tests.

Omany Kapande, a lab technician, said delays in the supply line and a lack of training slow productivity.

“We will perform tests but be waiting for the reagents for up to three months” said Kapande.

The CD4 count machine used to determine the level of an HIV infection couldn’t be used for a month because the chemicals were not available. The hospital and surrounding facilities that rely on the lab had to make treatment decisions without knowing CD4 counts of patients during that period.

Dr. Lee Hilborne, past-president of the American Society for Clinical Pathology, an organization that has worked to improve laboratory capacity in Tanzania, said laboratories play a key roll in doctors’ ability to treat their patients.

“If you don’t get the right diagnosis you have two problems. One is you potentially overtreat people for something they don’t have…or you may undertreat people because you miss the diagnosis,” said Hilborne.

In comparison to labs at other hospitals in the country — such as the one at Kahama’s regional hospital that consists of just one microscope — Bugando is well-equipped. It has high-tech equipment donated by Columbia University that can process DNA and RNA extractions, blood analysis and CD4 counts.

But the gaps in training and organization still cause problems. Kapande says the space is too small to function efficiently. To address those concerns Tanzania’s government has partnered with the Abbott Fund to build capacity in its laboratories.

Abbott is constructing modern, standardized labs in each of Tanzania’s 23 districts, including a new lab at Bugando that will double the size of the existing workspace.

Once renovation of the laboratories is done, the organization also puts mentoring programs into place, helping to streamline processes, implement safety procedures and quality control and continue lab worker training.

“The labs run more efficiently, and then see a tenfold increase in the number of tests done in the laboratory,” said Christy Wistar, divisional vice president for the Abbott Fund, who is based in Tanzania.

“What we are trying to do is to develop a culture that there is no reason not to give a patient a result within 24 hours.”

Wistar said that with improvement to Tanzania’s lab capacity will come improvements not only with diagnosis and treatment of HIV, but will also allow more time to be spent on chronic conditions, like diabetes.

Laboratory capacity and quality is a concern in many African countries, prompting a new push to accredit laboratories. The initiative, led by the World Health Organization and the President’s Emergency Plan for AIDS Relief, was announced in late July andincludes 13 countries: Tanzania, Rwanda, Botswana, Cameroon, Cote d’Ivoire, Ethiopia, Kenya, Malawi, Nigeria, Senegal, Ghana, Uganda and Zambia.

Its intent is to help the nations address shortages of equipment, management and training in laboratories. The American Society for Clinical Pathology and the Clinton HIV/AIDS Initiative will assist with training. The ASCP is planning to assign volunteer U.S. lab professionals to partner with labs in those countries.

“The whole goal of this is to change the definition of what constitutes a lab in those settings,” said Hilborne, of the ASCP. He stressed that progress will take time.

“We don’t expect these hospitals to become accredited overnight…we don’t want to set up these labs to fail,” he said. The program’s strengths, according to Hilborne, are its flexibility for countries’ individual needs and those countries’ ability to share information on best practices.

“There is no reason for every country to do the same experiment, you want to learn from what everyone else is doing,” Hilborne said.

Perthena Latchaw, an ASCP volunteer who has traveled to Tanzania eight times since 2005, said increasing the number of trained staff in Tanzanian labs is a must.

“It is very difficult for those people, especially in the faith-based hospitals where the lab technicians and technologists may also be the instructors. They are doing double and triple duty,” Latchaw said.

She has already seen improvements in Tanzania’s labs over the last few years, including an expanding menu of tests they can offer. Accreditation will build on that, she said.

“I think it’s going to be the nail that makes them all work toward standardization and give them a sense of confidence and pride in what they do,” Latchaw said.

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