PLoS ONE (Jan 2014)

Implementing and measuring the level of laboratory service integration in a program setting in Nigeria.

  • Henry Mbah,
  • Olubunmi Ruth Negedu-Momoh,
  • Oluwasanmi Adedokun,
  • Patrick Anibbe Ikani,
  • Oluseyi Balogun,
  • Olusola Sanwo,
  • Kingsley Ochei,
  • Maurice Ekanem,
  • Kwasi Torpey

DOI
https://doi.org/10.1371/journal.pone.0107277
Journal volume & issue
Vol. 9, no. 9
p. e107277

Abstract

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BACKGROUND:The surge of donor funds to fight HIV&AIDS epidemic inadvertently resulted in the setup of laboratories as parallel structures to rapidly respond to the identified need. However these parallel structures are a threat to the existing fragile laboratory systems. Laboratory service integration is critical to remedy this situation. This paper describes an approach to quantitatively measure and track integration of HIV-related laboratory services into the mainstream laboratory services and highlight some key intervention steps taken, to enhance service integration. METHOD:A quantitative before-and-after study conducted in 122 Family Health International (FHI360) supported health facilities across Nigeria. A minimum service package was identified including management structure; trainings; equipment utilization and maintenance; information, commodity and quality management for laboratory integration. A check list was used to assess facilities at baseline and 3 months follow-up. Level of integration was assessed on an ordinal scale (0 = no integration, 1 = partial integration, 2 = full integration) for each service package. A composite score grading expressed as a percentage of total obtainable score of 14 was defined and used to classify facilities (≤ 80% FULL, 25% to 79% PARTIAL and <25% NO integration). Weaknesses were noted and addressed. RESULTS:We analyzed 9 (7.4%) primary, 104 (85.2%) secondary and 9 (7.4%) tertiary level facilities. There were statistically significant differences in integration levels between baseline and 3 months follow-up period (p<0.01). Baseline median total integration score was 4 (IQR 3 to 5) compared to 7 (IQR 4 to 9) at 3 months follow-up (p = 0.000). Partial and fully integrated laboratory systems were 64 (52.5%) and 0 (0.0%) at baseline, compared to 100 (82.0%) and 3 (2.4%) respectively at 3 months follow-up (p = 0.000). DISCUSSION:This project showcases our novel approach to measure the status of each laboratory on the integration continuum.