title: Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership.
abstract: BACKGROUND
  Nonstandardized specimen-transport logistics, lack of laboratory personnel to transport specimens, lack of standard specimen containers, and long turnaround time (TAT) hindered access to quality laboratory services. The objective of the Becton, Dickinson, and Company (BD)-US President's Emergency Plan for AIDS Relief (PEPFAR) Public-Private Partnership (PPP) was to support country-specific programs to develop integrated laboratory systems, services, and quality improvement strategies, with an emphasis on strengthening the specimen-referral system (SRS).
  
  
  METHODS
  In 2007, through the Centers for Disease Control and Prevention (CDC), the Ethiopian Public Health Institute (EPHI) joined with the BD-PEPFAR PPP to strengthen laboratory systems. A joint planning and assessment committee identified gaps in the SRS for prioritization and intervention and piloted the system in Addis Ababa and Amhara Region.
  
  
  RESULTS
  The PPP established standardized, streamlined specimen logistics, using the Ethiopian Postal Service Enterprise to support a laboratory network in which 554 facilities referred specimens to 160 laboratories. The PPP supported procuring 400 standard specimen containers and the training of 586 laboratory personnel and 81 postal workers. The average TAT was reduced from 7 days (range, 2-14 days) to 2 days (range, 1-3 days) in Addis Ababa and from 10 days (range, 6-21 days) to 5 days (range, 2-6 days) in Amhara Region.
  
  
  CONCLUSIONS
  This study highlights the feasibility and untapped potential of PPPs to strengthen laboratory systems. This planned and structured approach to improving specimen referral enhanced access to quality laboratory services.
authors.affiliation: Centers for Disease Control and Prevention (CDC).
authors.forename: Yenew
authors.initials: Y
authors.lastname: Kebede
authors.affiliation: Centers for Disease Control and Prevention (CDC) CDC, Atlanta, Georgia.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Fonjungo
authors.affiliation: International Center for AIDS Care and Treatment Programs, Columbia University.
authors.forename: Gudeta
authors.initials: G
authors.lastname: Tibesso
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Ritu
authors.initials: R
authors.lastname: Shrivastava
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: John N
authors.initials: JN
authors.lastname: Nkengasong
authors.affiliation: Centers for Disease Control and Prevention (CDC) CDC, Atlanta, Georgia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kenyon
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Amha
authors.initials: A
authors.lastname: Kebede
authors.affiliation: Becton, Dickinson, and Company, Franklin Lakes, New Jersey.
authors.forename: Renuka
authors.initials: R
authors.lastname: Gadde
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Gonfa
authors.initials: G
authors.lastname: Ayana
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D005002:Ethiopia; D006801:Humans; D007753:Laboratories / Q000458:organization & administration / Q000592:standards*; D017056:Medical Laboratory Personnel / Q000193:education*; D009313:National Health Programs; D055818:Public-Private Sector Partnerships; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D013048:Specimen Handling / Q000592:standards*; D013997:Time Factors; D014481:United States
keywords: postal system; public-private partnership; specimen-referral system; training; turn around time