THE Technical Operations Department is responsible for managing all aspects of the laboratory service and is the key bridge between laboratory operations and clinical practice.
Despite the challenges faced by the technical operations department, it is encouraging to note that a close review of the operational business plans and activities that were set to be executed shows that a substantial number of them were in fact successfully implemented. The department made every effort to live up to our business principles and stick to the company’s core values by delivering a comprehensive pathology service of the highest quality, to both public and private clients. NIP set a strategic framework and efforts were focused on this as a priority.
NIP identified five key result areas to concentrate on in order to provide a road map that would help guide the organization and inform substantive decisions.
These areas are as follows:
• Service delivery
• Market growth
Service levels and continuous quality improvements are maintained throughout our network of laboratories. Some notable examples of these include the following:
• NIP supported the Ministry of Health and Social Services (MOHSS) in addressing the country’s considerable tuberculosis burden as indicated by the high TB incidence rate, frequency of TB/HIV co-infection, and burden of multidrug-resistant TB. From the beginning of the year under review, NIP rolled out 29 GeneXpert instruments of different models in 24 sites, covering central, district, and regional settings. The instruments were deployed in the highest TB specimen volume laboratories in order to further increase the testing capacity. GeneXpert MTB/Rif testing is being provided at all districts apart from some locations where it is available at the nearest referral district laboratory.
• NIP also partnered with MOHSS in a range of activities aimed at curbing HIV/ AIDS, TB, Malaria, and Bilharzia. Our laboratories participated in the TB drug Resistance Survey (DRS); a TB mass campaign among prison inmates in all regions; and the HIV sentinel survey that was completed in July, 2014.
• A total of 5,285,513 tests were performed during the year under review, compared to 4,313,981 tests performed in the previous financial year – representing a 22.5% increase. A total of 302,573 HIV viral load tests were performed across the country in the year, compared to 84,742 in the previous year. This represents a 257.1% increase in tests, and a similar increase in forecast for 2015-16 as the number of patients starting Antiretroviral (ARV) treatment keeps rising. There were two laboratories in the country that were able to perform viral load testing in 2015. However, additional instruments are to be placed at Rundu, Walvis Bay, Engela, Onandjokwe, Katima Mulilo, and Eenhana laboratories to cope with higher volumes.
Accreditation: A great deal of support is provided by executive and senior management in helping to prepare the Windhoek Central Reference laboratory, SWAMED, Katutura and Rundu private laboratories for the South African National Accreditation System (SANAS) assessment. These laboratories were due to be assessed during February, 2015. However, due to delays by SANAS, they were only assessed in May 2015. All the laboratories assessed, however, are expected to gain SANAS accreditation.
Internal quality control and external quality assurance: It is pleasing to note that the overall assessment found that our operational areas had, on average, achieved the IQC and EQA target compliance requirements.
NIP reviewed its specimen collection and results delivery routes, in order to achieve the optimum pre and post-analytical turnaround times (TAT). It is forecast that changes implemented will lead to an increase in the delivery of specimens to the laboratories, helping to improve workflow and better TAT.
Funded by PEPFAR, the NIP team held workshops to begin the training of healthcare workers on TB specimen collection and general specimen collection handling. It is also pleasing to note that there were fewer client complaints recorded during the latest client survey, indicating a general improvement in service. Overall, only non-gynaecology specimens and surgical histology achieved an acceptable level of TAT, during the course of the year. The TAT for fine needle aspiration has taken longer than is desirable for some months, although it was established that there were contributing factors, namely the day of the week when these cases were collected in the FNA clinic and the agreed set TAT. We’re pleased to report that this issue was addressed and the situation rectified in February 2014, and by March 2014, a significant improvement was already noted.
A significant improvement for PAP smears was also recorded at the end of October 2014, following the appointment of an additional cytotechnologist. A vehicle was procured for making deliveries and a driver recruited in order to improve on the turnaround time and service for the Oshakati private laboratory. As a result, the internal transport service, including delivery of results to doctors, has improved significantly. There was also a significant improvement on pending lists in all laboratories following the introduction of a ‘pending test list’ timetable. Supervisors ensured that staff members adhered to the list and a number of laboratories were able to report 100% target achievement.
Improvement levels of 85-90% of phoning out critical and urgent results was achieved during the year, and systems have been put in place so that at the end of all shifts staff make sure that results are communicated to clinicians. A number of laboratories in the central area have room for improvement in this regard, as the target for all laboratories remains 100% compliance for the phoning out of critical and urgent results to clinicians.
Work load statistics: CD4 test volumes have decreased by 56.5% from 252,206 in 2013- 14, to 109,831 in 2014- 15, due to changes in the guidelines for the use of the antiretroviral drugs for treating and prevention of HIV infection. The workload analysis carried out during the period under review found that most laboratories are adequately staffed. Graduates of the Polytechnic of Namibia were recruited to fill all vacant positions during the past year. Laboratory infrastructure improvement: The laboratory environment has greatly improved following renovations and upgrading of the infrastructure. The key aim of this exercise was to create a safe environment for the staff, and one that is conducive for greater efficiency. Renovations at Otjiwarongo mean that the laboratory now meets the required standard, as prescribed by ISO 15189.
Other laboratories are also being structurally improved, including Windhoek Central Reference Laboratory, Oskahati, Rundu, Khorixas, and Katima Mulilo. The Omuthiya and Eenhana laboratories are being purpose built as completely new structures. Construction of the new hospital at Outapi, started during the year and the current CDC- Namibia building has been allocated to NIP for use as a laboratory, and has proved to be perfectly adequate. Permission has been obtained from Tsumeb State Hospital to renovate the old eye clinic and convert it into a laboratory. The floor plan has been completed and approved by the Ministry of Works and Transport, and a Bill of Quantity has also been provided.
Confidente. Lifting the Lid. Copyright © 2015