THE NATIONAL ESSENTIAL DIAGNOSTICS LIST

 The Essential Diagnostics List establishes a priority diagnostic list that will facilitate decision-making for appropriate selection, quantification, procurement, and resource allocation for priority diagnostics across each level of care. It is a critical tool that provides an anchor to enhance laboratory service delivery at facility level, in a similar manner to the role the essential medicines list plays

 Plan for 2024

 •   Implement EDL document to 47 counties targeting service providers, policy makers and implementing partners within counties. This includes developing documents and tools that can be used at facility level to facilitate utilization of the document e.g., checklists and at KEMSA level to improve the procurement process for diagnostics.

•   The document will inform equipment standardisation in the country including the diagnostic procurement processes.

•   With limited funding resources for EDL, CHAI leveraged on the GC7 application process to include EDL document printing, dissemination strategies to help implement EDL document. CHAI intends to support the MoH to realise this plan.

 AMR

 Irrational antibiotic prescription across different levels of facilities in the country is at 45-69%, with limited to no use of culture and sensitivity tests to guide prescription. Key to addressing these challenges is having a strong laboratory systems that feeds into an active surveillance system, that ensure the right information is available at the right time and in the right place to inform patient management and public health decisions. However there are massive challenges to access, cost and quality microbiology tests including limited utilization of existing microbiology diagnostics that are often manual.

 2023 work

 •   In collaboration with GARDP and MTaPs held two meetings to align efforts of AMR stakeholders, including developing a stakeholder dashboard that tracks, where work is ongoing and which work is being done.

•   Inclusion of gonorrhoea in priority pathogen list for surveillance purposes.

 Plan for 2024

•   Developing demand forecasts and quantification tools for use across sentinel sites to support planning for supplies and thus reduce stockouts

•   Increasing visibility of existing diagnostic tools such as molecular platforms, that could be leveraged to conduct AMR tests and new diagnostics tools such as culture readers.

 PROJECT STELLAR

 The availability of an integrated data management system is lacking as there are different versions of systems including the manual registers that need to be streamlined and/or harmonized, an example being the covid registers that were deployed during the pandemic. This variation makes it difficult for the government to plan, allocate and effectively use resources for data management and decision making. Moreover, collating national program indicators in the laboratory services docket is a challenge associated with different types of data systems that have been deployed in the country making aggregation of this data set a challenge at the national level

 2023 work

•    Integration between hospital management information system (HMIS, Medboss) and Labware (LIMS) was done to improve clinical diagnostic workflow, turn-around-time and quality of data generated and shared across platforms; from Facility-county-national. This was done in some level 4/5 and 6 facilities where LIMS were deployed.

•   Developed LIS policy guidelines.

•   Standardization of laboratory test reports to improve information management, data collection and reporting throughout the laboratory network.

•   Coding lab tests using LOINC model (H7) for integration purposes.

 The Outcome/input

 Integration has facilitated interoperability across 3 main LIMS and the HMIS that has allowed seamless data flow. a) Data Quality & integrity has facilitated faster, accurate diagnosis and timely treatment of patients.

b) TAT for clinicians’access to patent test results reduced.

c) Has saved time by removing the manual entrance of tests information from the instrument to the KHIS, thus increasing productivity and sample throughput which play a key role in all quality controls and testing labs.

Sustainability

 MoH ownership and counties demonstration to scale up services using the available budget they have.

   EQUIPMENT STANDARDIZATION AND HARMONIZATION

 Laboratory networks adopting shared test menus, technology platforms, and supplies across multiple facilities can consolidate testing volumes. This consolidation facilitates smoother negotiations for bulk discounts on reagents, consumables, and related laboratory services compared to the complexity of dealing with various suppliers. Restricting the number of order transactions and enhancing the predictability and accuracy of forecasts contribute to increased efficiency in the procurement process.1 This would require some degree of central coordination of procurement. To tackle the current challenge of fragmentation of laboratory equipment, KEMSA has requested the support of CHAI to conceptualize different models/strategies to address this issue.

 A. One such model includes the consignment model/supermarket model. This model allows suppliers to own and manage their diagnostic commodities, while KEMSA is simply responsible for the stock that sells and for any selling expenses. This intends to provide a win-win solution for both the supplier and KEMSA, as it allows for reduced expenses for both parties in terms of expiries. The supplier can ensure that their stock moves off the shelf without the need to take on additional costs, and KEMSA is able to offer county facilities diagnostic HPTs without incurring a risk of overstocking. An important benefit, however, is the ability of the KEMSA to place diagnostic product in front of a larger number of prospective customers and achieving the UHC agenda.

B. Access versus capability and capacity.

 Despite having equipment, laboratories are running sub optimally. The reasons are varied including equipment downtime, poor servicing and maintenance, reagent and consumable stockouts. The result is poor access to tests for patients as and when needed. There is need to think through models where payment is tagged on tests delivered versus availability of equipment which will require a shift in the business as usual model of payment.

 The innovative diagnostics team plans to explore these models and work in liaison with KEMSA to develop feasible strategies to address above challenges.