IMPACT OF MENTORSHIP ON IMPROVING THE QUALITY OF RURAL HEALTH FACILITY LABORATORIES: A CASE STUDY OF MUKONO DISTRICT.

Introduction
Improvement of the quality of testing services in public laboratories is a high priority in many countries. Consequently, initiatives to train laboratory staff on quality management are being implemented. Mentorship may be an effective way to augment these efforts to meet Medical Laboratories- requirements for quality and competence. Mukono General Hospital Lab is a Hub that serves all the health facilities in the district and oversees the quality of the peripheral laboratories that are served by the Hub to ensure that the quality of patient care in the district is improved.

The Lab Hub has organized and conducted a continuous mentorship program for the peripheral Health facilities for QMS implementation and monitoring. The program is supported by the Ministry of Health, Uganda and Makerere University Walter Reed Project (Implementing partner).

Methodology/ Interventions:

Mentorship was implemented at six rural health facility laboratories in the district (1 Hospital Lab and 5 Health Center laboratories) between October 2021 and June 2022. The mentorship model that was implemented had the mentor fully embedded within the operations of each of the laboratories. It was delivered in a series of two monthly mentoring engagements initially and follow-up visits respectively including follow-up via phone calls.

In total, each laboratory received 20 days mentorship that was separated by 2-4 weeks. Quality improvements were measured at baseline and at intervals during the mentorship using the WHO-AFRO SLIPTA checklist and Site Improvement through Monitoring Systems (SIMS) Assessment Tool focusing on the areas of QMS implementation, Lab Biosafety, Personnel competency assessment across tests, Availability of SOPs, Waste Management, IQC and EQA across all tests and HIV viral load specimen referral and results management.

Results:
At the beginning of the mentorship, all laboratories were at the SLIPTA zero star rating and scored yellow (needs improvement) and red (needs urgent remediation) in the SIMS assessment. After the initial 3months of mentorship, the hospital lab had improved from zero to one star (48% to 58.7%) and scored 70%green (Meets standard) and 30 yellow (needs improvement) in SIMS. The 5 Health Centers were still at zero star but had improved averagely from 39% to 54% using the SLIPTA tool and scored on average 57% green and 43% yellow in SIMS Assessment. At the end of 9months, the Hospital lab was at 2 stars (67%) SLIPTA rating and scored 85% green and 15% yellow in SIMS Assessment. The 5 Health Centers had improved from zero to one star (57.3%) SLIPTA rating and scored 71% green and 29% yellow in SIMS Assessment.

Conclusion:

The mentorship program resulted in significant measurable improvements in the Laboratories. We recommend that mentorship be incorporated into laboratory quality improvement and management training programs, in order to accelerate the progress of laboratories towards implementing and sustaining Quality Management Systems for proper patient care.