Malaria Diagnosis in EMRO

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Malaria Diagnosis in EMRO
Quality Assurance of Laboratory Diagnosis of
Malaria
Dr. Guy Barnish Malaria Knowledge Programme LSTM
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The evidence for over-diagnosis
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Malaria diagnosis
Malaria Diagnostic Tests
Lab use
Field use
Clinical Micro Antigen PCR
Antibody RDT ELISA
Most Gold Most V. accurate
Historical Common Std Recent V.
expensive
Appropriate Inappropriate
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The Need

• Meeting on QA of Laboratory Diagnosis in Iran,
  September 2001 accepted
• The need for Quality Assurance in EMRO, and
• The need for standardisation of laboratory
  diagnosis of malaria throughout the region

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What is Quality Assurance (QA)?

• All those activities that ensure that health
  services meet or exceed expectations of quality
• It is a set of activities that monitor and
  improve performance
• It is a systematic and planned approach
• It is a continuous process

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Why is it needed?

• To consistently provide reliable and high
  quality malaria results to, and for, patients
• Improve health services, so that they are
  respected and used
• _________________________

IT IS PROPOSED THAT ALL COUNTRIES IMPLEMENT THE
SAME SYSTEM
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What is needed? - planning
FOR EACH MALARIA CONTROL PROGRAMME

• Begin at the top support needed
• National Co-ordinator
• Regional/provincial supervisors
• Initiate and conduct the process
• Monitor, train, assess, evaluate
• Laboratory staff the teams

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The QA Cycle
Design QA system
Set standards
Evaluation
Quality improvement
Quality control
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What is needed 1 ?

• Goal
• To provide an efficient, effective, accurate and
  reliable laboratory diagnosis of malaria service
• Aims
• To improve the laboratory diagnosis of malaria
• To provide a practical guide, which if followed,
  ensures high quality laboratory diagnosis of
  malaria

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What is needed 2 ?

• National Co-ordinator
• Well qualified senior laboratory technologist
  with a reputation for delivering good quality
  work, and an interest in teaching or educational
  commitment

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What is needed 3 ?
2. Regional laboratory technologists These are
the front line supervisors. They initiate and
conduct the training and monitoring in the
malaria diagnostic laboratories. They assess
each situation and provide information to the
National Co-ordinator They are responsible for
high quality laboratory outputs, ensure
equipment and supplies are maintained Their role
is to support, monitor and evaluate the
laboratories and staff, and train or re-train and
ensure the QA cycle results in overall improvement
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What is needed 4 ?

• 3. Laboratory staff the teams
• Note Quality is built in to every aspect of the
  work
• All members of the laboratory comprise the QA
  Team those who interact with the laboratory
• Everyone understands the Goal and Aims
• The Team Leader should inspire the staff to
  produce good results
• Ensure patient satisfaction
• Involve management and doctors
• Regular (3 monthly) evaluation and re-training

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How ?

• Identify the member of the Quality Team
• List SOPs and Indicators
• Set standards and targets
• Select priority issues for quality monitoring and
  improvement
• Analyse the quality problems
• Develop solutions to the quality problems
• Evaluate the quality improvements

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There is more, but
Thank you, and best wishes
I would like to thank Drs. H. Atta, P. Beales, D.
Payne, P. Trigg, A.E. Beljaev, W.H. Wernsdorfer,
A. Rietveld, P. Ringwald, A. Adeel and D. Haran,
and Professor H.M. Gilles for their assistance
and contributions.