title: Laboratory system strengthening and quality improvement in Ethiopia.
abstract: BACKGROUND
  In 2010, a National Laboratory Strategic Plan was set forth in Ethiopia to strengthen laboratory quality systems and set the stage for laboratory accreditation. As a result, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme was initiated in 45 Ethiopian laboratories.
  
  
  OBJECTIVE
  This article discusses the implementation of the programme, the findings from the evaluation process and key challenges.
  
  
  METHODS
  The 45 laboratories were divided into two consecutive cohorts and staff from each laboratory participated in SLMTA training and improvement projects. The average amount of supportive supervision conducted in the laboratories was 68 hours for cohort I and two hours for cohort II. Baseline and exit audits were conducted in 44 of the laboratories and percent compliance was determined using a checklist with scores divided into zero- to five-star rating levels.
  
  
  RESULTS
  Improvements, ranging from < 1 to 51 percentage points, were noted in 42 laboratories, whilst decreases were recorded in two. The average scores at the baseline and exit audits were 40% and 58% for cohort I (p< 0.01); and 42% and 53% for cohort II (p< 0.01), respectively. Thep-value for difference between cohorts was 0.07. At the exit audit, 61% of the first and 48% of the second cohort laboratories achieved an increase in star rating. Poor awareness, lack of harmonisation with other facility activities and the absence of a quality manual were challenges identified.
  
  
  CONCLUSIONS
  Improvements resulting from SLMTA implementation are encouraging. Continuous advocacy at all levels of the health system is needed to ensure involvement of stakeholders and integration with other improvement initiatives and routine activities.
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Tilahun M
authors.initials: TM
authors.lastname: Hiwotu
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Gonfa
authors.initials: G
authors.lastname: Ayana
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Mulugeta
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Getachew B
authors.initials: GB
authors.lastname: Kassa
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia.
authors.forename: Yenew
authors.initials: Y
authors.lastname: Kebede
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia ; International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Fonjungo
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Gudeta
authors.initials: G
authors.lastname: Tibesso
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Adino
authors.initials: A
authors.lastname: Desale
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Adisu
authors.initials: A
authors.lastname: Kebede
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Wondwossen
authors.initials: W
authors.lastname: Kassa
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Mekonnen
authors.affiliation: International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States.
authors.forename: Katy
authors.initials: K
authors.lastname: Yao
authors.affiliation: International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Luman
authors.affiliation: Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
authors.forename: Amha
authors.initials: A
authors.lastname: Kebede
authors.affiliation: The American Society for Clinical Pathology (ASCP), Chicago, United States.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Linde