Improving laboratory quality and capacity through leadership and management training: Lessons from Zambia 2016-2018.

BACKGROUND: Competent leadership and management are imperative for delivering quality laboratory services; however, few laboratory managers receive job-specific training in organisational management and leadership. OBJECTIVE: To develop and evaluate participants' competencies in organisational leadership and management as measured through learner and laboratory quality improvement assessments. METHODS: This professional development programme employed a mentored, blended learning approach, utilising in-person didactic and online training, with the practical application of a capstone project in the laboratories. Programme impact was evaluated through a series of pre- and post-laboartory assessments using the Stepwise Laboratory Improvement Process Towards Accreditation checklist, as well as learner-competency assessments through online quizzes and discussions. RESULTS: From 2016 to 2018, 31 managers and quality officers from 16 individual laboratories graduated from the programme having completed capstone projects addressing areas in the entire laboratory testing process. Laboratories increased their compliance with the International Organization for Standardization 15189 standard and all but two laboratories significantly increased their accreditation scores. Two laboratories gained three stars, two laboratories gained two stars, and five laboratories gained one star. Five laboratories subsequently achieved International Organization for Standardization 15189 accreditation in 2019. CONCLUSION: This programme taught leadership theory to laboratory managers and allowed them to implement leadership and management practices in the laboratory setting. Programmes such as this complement existing laboratory quality management training programmes such as Strengthening Laboratory Management Toward Accreditation.

Strengthening provider-initiated testing and counselling in Zimbabwe by deploying supplemental providers: a time series analysis.

BACKGROUND: Expansion of provider-initiated testing and counselling (PITC) is one strategy to increase accessibility of HIV testing services. Insufficient human resources was identified as a primary barrier to increasing PITC coverage in Zimbabwe. We evaluated if deployment of supplemental PITC providers at public facilities in Zimbabwe was associated with increased numbers of individuals tested and diagnosed with HIV. METHODS: From July 2016 to May 2017, International Training and Education Center for Health (I-TECH) deployed 138 PITC providers to supplement existing ministry healthcare workers offering PITC at 249 facilities. These supplemental providers were assigned to facilities on a weekly basis. Each week, I-TECH providers reported the number of HIV tests and positive diagnoses they performed. Using routine reporting systems, we obtained from each facility the number of clients tested and diagnosed with HIV per month. Including data both before and during the intervention period, and utilizing the weekly variability in placement locations of the supplemental PITC providers, we employed generalized estimating equations to assess if the placement of supplemental PITC providers at a facility was associated with a change in facility outputs. RESULTS: Supplemental PITC providers performed an average of 62 (SD = 52) HIV tests per week and diagnosed 4.4 (SD = 4.9) individuals with HIV per week. However, using facility reports from the same period, we found that each person-week of PITC provider deployment at a facility was associated with an additional 16.7 (95% CI, 12.2-21.1) individuals tested and an additional 0.9 (95% CI, 0.5-1.2) individuals diagnosed with HIV. We also found that staff placement at clinics was associated with a larger increase in HIV testing than staff placement at polyclinics or hospitals (24.0 vs. 9.8; p < 0.001). CONCLUSIONS: This program resulted in increased numbers of individuals tested and diagnosed with HIV. The discrepancy between the average weekly HIV tests conducted by supplemental PITC providers (62) and the increase in facility-level HIV tests associated with one week of PITC provider deployment (16.7) suggests that supplemental PITC providers displaced existing staff who may have been reassigned to fulfil other duties at the facility.

US e-learning course adaptation to the Ukrainian context: lessons learned and way forward.

BACKGROUND: Access to continuing education opportunities is limited for Ukrainian healthcare workers, and the need is acute in order to support healthcare reform efforts currently underway in Ukraine. Online learning is a cost-effective mechanism for continuing education since healthcare workers can remain on the job during training. It also provides a means of keeping health professionals up to date on their knowledge and skills in rapidly changing and increasingly complex healthcare environments. METHODS: This paper describes the process of adapting an existing e-learning course from a US institution to the Ukrainian setting. Course participants' feedback was used to evaluate the effectiveness of the adapted version that was piloted twice in 2016-2017 with 53 participants in total, 46 of whom completed the course and contributed to the evaluation. RESULTS: This was the first fully online course on Leadership and Management in Health (LMiH) to be offered in Ukraine. Several lessons were learned during course adaptation when multiple aspects of the Ukrainian environment were taken into account including 1) linguistic accessibility, 2) access to the Internet, 3) computer literacy, and 4) novelty of online learning. Based on these findings, course material was first adapted by translating it from English to Ukrainian with the emphasis on cultural adjustment of idioms and real life examples. Then, using the first pilot results and participants suggestions, videotaped interviews with local healthcare management experts were added in order to further enhance cultural suitability as well as relevance and applicability of the course concepts. The last but not least lesson learned consisted in the fact that enhancing, transitioning, and sustaining online learning to new contexts required engagement of key stakeholders, national level support, and technical assistance through implementation and beyond yet turned out to be both cost-effective and sustainable investment of limited resources. Formative evaluation confirmed that the adaptation efforts resulted in a course relevant and acceptable to healthcare professionals in Ukraine. CONCLUSION: Transition of the course to local ownership was accomplished in partnership with the Ukrainian Family Medicine Training Center in the Bogomolets National Medical University in Kyiv: LMiH is now certified for continuing medical education credit and offered twice a year by this institution. Lessons learned from this experience provide a roadmap for rapidly increasing access to new knowledge and skills for healthcare workers by adapting existing online resources to local needs; they are used to facilitate rapid expansion of other continuing education offerings in Ukraine: additional online courses from the University of Washington (UW) are planned for adaptation.

Cameroon mid-level providers offer a promising public health dentistry model.

BACKGROUND: Oral health services are inadequate and unevenly distributed in many developing countries, particularly those in sub-Saharan Africa. Rural areas in these countries and poorer sections of the population in urban areas often do not have access to oral health services mainly because of a significant shortage of dentists and the high costs of care. We reviewed Cameroon's experience with deploying a mid-level cadre of oral health professionals and the feasibility of establishing a more formal and predictable role for these health workers. We anticipate that a task-shifting approach in the provision of dental care will significantly improve the uneven distribution of oral health services particularly in the rural areas of Cameroon, which is currently served by only 3% of the total number of dentists. METHODS: The setting of this study was the Cameroon Baptist Convention Health Board (BCHB), which has four dentists and 42 mid-level providers. De-identified data were collected manually from the registries of 10 Baptist Convention clinics located in six of Cameroon's 10 regions and then entered into an Excel format before importing into STATA. A retrospective abstraction of all entries for patient visits starting October 2010, and going back in time until 1500 visits were extracted from each clinic. RESULTS: This study showed that mid-level providers in BCHB clinics are offering a full scope of dental work across the 10 clinics, with the exception of treatment for major facial injuries. Mid-level providers alone performed 93.5% of all extractions, 87.5% of all fillings, 96.5% of all root canals, 97.5% of all cleanings, and 98.1% of all dentures. The dentists also typically played a teaching role in training the mid-level providers. CONCLUSIONS: The Ministry of Health in Cameroon has an opportunity to learn from the BCHB model to expand access to oral health care across the country. This study shows the benefits of using a simple, workable, low-cost way to provide needed dental services across Cameroon, particularly in rural areas.

Direct-to-consumer marketing of osteoporosis drugs and bone densitometry.

OBJECTIVE: To determine whether there is an association between a woman's exposure to direct-to-consumer (DTC) advertisements for 2 osteoporosis drugs and presentation for bone densitometry. METHODS: A matched case-control study was conducted between October and December 1998 at an academic primary care clinic in Seattle, WA. Seventeen women from the study population (aged >/=18 y, seen in the previous 2 y at the academic primary care clinic) presented for bone densitometry. All 51 women completed a self-administered questionnaire. RESULTS: Women familiar with 1 of 2 osteoporosis drugs due to exposure to advertisements had 9 times the odds of densitometry (unadjusted OR 9.3, 95% CI 1.0 to 86). Multivariate analysis, including confounders such as education level and whether a woman had previously had 3 screening tests (mammography, Pap smear, serum cholesterol), revealed a significant and strong association between exposure to advertisements and densitometry (adjusted OR 29, 95% CI 1.6 to 511). CONCLUSIONS: DTC marketing may increase health services utilization. Further independent evaluation of DTC marketing based on available observational evidence is feasible and warranted.