Background
Optimum laboratory performance remains cardinal to definitive clinical disease diagnosis, prognosis and surveillance. In low and middle-income countries (LMICs) most public health clinical diagnostic laboratory capacity and their sustainability are at various levels of development. The objective of this study was to asses available opportunities and challenges faced by public health clinical diagnostic laboratories in Uganda so as to provide data to inform capacity building in such and similar settings.
Methods
A descriptive cross-sectional study was conducted between 10th Dec 2018 and 31 Jan 2019. All the 14 public health clinical diagnostic laboratories in Ministry of Health Regional Referral Hospital establishments in Uganda were purposively sampled. A standardized data abstraction tool was developed from the elements of ISO 15189 and 17025 laboratory standards and check list. Data were analysed using PRISM data analysis program and excel. Proportions were computed and some correlations deduced. Ethical approval was obtained before data collection commenced.
Results
Thirteen (13) of the laboratories participated in the study and their data included in the analysis. All the laboratories had: qualified laboratory staff, conducted quality improment meetings and kept laboratory records and documents. Of these, 12 (92.3%) had organizational structures endorsed by the respective hospital administration, functional basic laboratory equipment in the departments of haematology, microbiology, parasitology, clinical chemistry, Immunology and molecular biology. All the laboratories were government supported and offered free diagnostic services while 11 (84.6%) offerd surrveilance services. Eight (61.5%) laboratories were licenced by Allied Health Professionals, twelve (92.3%) were involved in internal quality control programs, eleven (84.6%) were enrolled on External Quality assurance testing programs while one (7.7%) was fully accredited by South African National Accreditation System (SANAS). The challenges identified included; under-staffing 10 (76.9% ), insufficient infrastructure 1 (7.7%), supplies stock-outs 3 (23.1%), inadequate equipment 2 (15.4%) and hard copy laboratory results. Additionally, they lacked independent budgets, finance management and autonomous financing.
Conclusion
Various challenges identified hindered public health diagnostic laboratories in Uganda to operate at full diagnostic capacity, overcoming them will standardise quality and attain equity of services across the country.