Sierra Leone National Rapid Assessment of Laboratory Capacity and Systems
This report provides the first national level picture of laboratory capacity across the country and is essential in being able to plan for comprehensive delivery of a basic package of essential health services, including maternal and newborn health services.
This assessment was conducted to inform the revision of the national laboratory strategic plan. By adopting a mixed-methods approach, the survey based on WHO laboratory systems assessment tools was administered by teams when visiting each site. In order to obtain triangulation and more in-depth information, qualitative methods including focus group discussions, observation, key informant interviews and open-ended questions in the survey.
Among the 315 facilities sampled (22-24 per district), a total of 184 facilities had either a dedicated laboratory or TB/DOT worker. Laboratory capacity was assessed among these 184 facilities, which was including 20 out of the 21 government hospitals. Some key findings are presented below.
- Laboratory testing is available at CHCs (primary health care level); testing services are therefore relatively accessible for communities.
- An overreliance on manual methods of performing and estimating lab tests was identified, and very few automated methods were being used.
- Over four-fifths (83%) of all facilities did not have guidelines on how to transport specimens.
- Very few facilities (13%) were able to provide appropriate packaging for specimen transportation.
- Two-thirds (65%) of all laboratories (including more than one-half of government hospitals) did not have a dedicated water supply.
- One-quarter (27%) of all CHCs had no source of functional electricity, hampering their ability to provide 24-hour curative services, as laid out in the BPEHS.
- All hospitals had at least one source of electricity.
- There were inadequate numbers of appropriately trained laboratorians. Of the 181 CHCs sampled, nearly one-third (30%) did not have a single laboratory worker.
- Many laboratory workers were performing tasks for which there is inadequate evidence of standardised training/qualifications.
Reagents, equipment and supply systems:
- Laboratory supply chains were inadequate, leading to delays in supply and frequent stock-outs, compounded by the lack of or weak stock management in many facilities.
- The vast majority of facilities did not have the capacity to purify or distil water: 82% of facilities lack a water distillation unit and 80% lacked chemicals or a filter to purify water.
- Key items of test kits, laboratory reagents, and consumables and equipment are missing from many government facilities with laboratories.
- Most public/private laboratories had no standard operating procedures in place.
- Quality assurance mechanisms are in place in a minority of laboratories.
- There are no national standardised laboratory forms or reporting mechanisms.
- Most facilities lack designated phones and computers with access to the internet hampering information sharing and management.
- Only 11% of facilities have health and safety protocols in place.
- Only half (54%, n=100) of facilities could provide evidence of waste management procedures being in place.
- Shortages in supplies of essential biosafety and waste disposal equipment exist at all facility levels.
- There were insufficient guidelines that outline minimum requirements, standardisation and national systems to enable improved laboratory governance.
- No laboratory accreditation, registration and licensing systems are currently in place for laboratories.
The findings identified priority areas that need to be addressed to strengthening the laboratory system based on these gaps.The sub-report acts as an executive summary of the assessment, providing a summary of the methods, findings, strengths, weaknesses, opportunities and threats, and outlines recommendations and next steps.
A presentation given by Dr Lebby, Director of Directorate of Hospital and Laboratory Services, also provides an overview of the key findings and recommendations.Ministry of Health and Sanitation, Government of Sierra Leone. (2015).