title: Critical review of the Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA): suggestions for harmonization, implementation and improvement.
abstract: OBJECTIVE
  Clinical laboratories in low- and middle-income countries (LMIC) need fundamental improvement because quality laboratory services are essential for the decision-making capacity of clinicians, health workers and public health authorities. To this end, a tiered accreditation scheme Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) was developed by WHO-AFRO, CDC and others for clinical laboratories in LMIC. One to five stars are accredited to laboratories based on the level of compliance with a checklist. Our aim was to evaluate the quality and applicability of this accreditation scheme compared with international quality standards.
  
  
  METHODS
  We performed a critical review of this scheme to formulate recommendations for implementation, harmonization and improvement. Two analyses were performed: one assessing its coverage of the ISO 15189:2007 standard and one to identify and evaluate priorities of the accreditation checklist.
  
  
  RESULTS
  Although the content of the checklist covers all aspects of total quality management, it strongly prioritizes resource management activities. We recommend identifying critical requirements for each tier of accreditation to assure a certain level of quality for each tier or instead using a pass/fail approach towards accreditation. In addition, the checklist should include more questions for assessing proper management, ethics and continuous improvement to meet ISO 15189.
  
  
  CONCLUSIONS
  Launching accreditation schemes for laboratories in LMIC should be encouraged. After further optimization of SLIPTA, clinical laboratories may certainly benefit, leading to more correctly diagnosed patients and less waste of resources.
authors.affiliation: KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands.
authors.forename: Tjeerd A M
authors.initials: TA
authors.lastname: Datema
authors.forename: Linda
authors.initials: L
authors.lastname: Oskam
authors.forename: Stella M
authors.initials: SM
authors.lastname: van Beers
authors.forename: Paul R
authors.initials: PR
authors.lastname: Klatser
mesh_terms: D000068:Accreditation / Q000592:standards*; D057189:Checklist / Q000592:standards*; D003657:Decision Making; D003906:Developing Countries; D006295:Health Resources; D006801:Humans; D007391:International Cooperation; D007753:Laboratories / Q000941:ethics / Q000458:organization & administration / Q000592:standards*; D011634:Public Health; D011786:Quality Control; D058996:Quality Improvement; D017749:Total Quality Management