title: Building local human resources to implement SLMTA with limited donor funding: The Ghana experience.
abstract: BACKGROUND
  In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources.
  
  
  OBJECTIVE
  To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources.
  
  
  METHODS
  Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental training on internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM).
  
  
  RESULTS
  The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors' salaries, SLMTA training and improvement project support.
  
  
  CONCLUSIONS
  Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such models promote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.
authors.affiliation: US Centers for Disease Control and Prevention, US Embassy, Ghana.
authors.forename: Bernard
authors.initials: B
authors.lastname: Nkrumah
authors.affiliation: Global Health Systems Solutions, C75/20 Amanfro Street, Abelenkpe, Ghana.
authors.forename: Beatrice
authors.initials: B
authors.lastname: van der Puije
authors.affiliation: National AIDS Control Program, Ghana Health Service, Ghana.
authors.forename: Veronica
authors.initials: V
authors.lastname: Bekoe
authors.affiliation: National Public Health Reference Laboratory, Ghana Health Service, Ghana.
authors.forename: Rowland
authors.initials: R
authors.lastname: Adukpo
authors.affiliation: Global Health Systems Solutions, C75/20 Amanfro Street, Abelenkpe, Ghana.
authors.forename: Nii A
authors.initials: NA
authors.lastname: Kotey
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, United States.
authors.forename: Katy
authors.initials: K
authors.lastname: Yao
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, United States.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Fonjungo
authors.affiliation: US Centers for Disease Control and Prevention, Atlanta, United States.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Luman
authors.affiliation: Global Health Systems Solutions, C75/20 Amanfro Street, Abelenkpe, Ghana.
authors.forename: Samuel
authors.initials: S
authors.lastname: Duh
authors.affiliation: Global Health Systems Solutions, Cameroon.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Njukeng
authors.affiliation: National AIDS Control Program, Ghana Health Service, Ghana.
authors.forename: Nii A
authors.initials: NA
authors.lastname: Addo
authors.affiliation: US Centers for Disease Control and Prevention, Cote d'Ivoire.
authors.forename: Fazle N
authors.initials: FN
authors.lastname: Khan
authors.affiliation: US Centers for Disease Control and Prevention, US Embassy, Ghana.
authors.forename: Celia J I
authors.initials: CJ
authors.lastname: Woodfill