Assuming you are the overseer of medical laboratory service delivery system in your district,

explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.

The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]

Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.

A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.

The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]

The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.

The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]
Assuming you are the overseer of medical laboratory service delivery system in your district,
explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.

The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]
Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.

A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.

The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]
The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.

The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]
Assuming you are the overseer of medical laboratory service delivery system in your district,
explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.
The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]

Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.

A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.

The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]

The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.

The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]

Assuming you are the overseer of medical laboratory service delivery system in your district,
explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.

The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]

Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.

A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.
The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]

The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.
The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]

Assuming you are the overseer of medical laboratory service delivery system in your district,
explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.

The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]

Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.

A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.

The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]

The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.

The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]

Assuming you are the overseer of medical laboratory service delivery system in your district,
explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.

The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]

Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.
A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.

The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]

The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.

The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]

Assuming you are the overseer of medical laboratory service delivery system in your district,
explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.

The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]

Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.

A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.

The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]

The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.

The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]
Assuming you are the overseer of medical laboratory service delivery system in your district,
explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.

The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]

Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.

A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.

The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]

The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.

The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]
Assuming you are the overseer of medical laboratory service delivery system in your district,
explain what areas you would pay attention on so that your system delivers services that are
effective, safe, good quality personal and non-personal care to those that need it, when needed,
with minimum waste.

Quality laboratory service is essential for a wide range of diagnosis, treatment and monitoring in
health care delivery and they lie at the heart of the health care services provided to patient and
the community.[1,2] It has been noted that in Sub-Saharan Africa, the major challenge for
delivering quality health service is the lack of reliability of medical laboratory services.[1]
Laboratories are critical for the diagnosis and management of many conditions that are common
in Sub-Saharan Africa and which are associated with childhood and maternal mortality (e.g.
severe anemia, malaria, TB, HIV/AIDS and neglected tropical diseases).[2] The health
laboratories afford strategic support equally to clinical and public health services in providing
quality services but due to lack of awareness on the laboratory service role in many developing
countries, laboratory services have shortage of resources, poor management system, lack of
quality assurance program, shortages of equipment, shortage of training and poor staff
motivation system.[1,3] This paper seeks to identify areas in the laboratory delivery system so
that delivery services are effective, safe, and provide good quality personal and non-personal
care to those that need it.

The first barrier for improvement of quality of health care system is usually human capacity
development and it is well known that quality of laboratory service is dependent on technical
skills and the motivation of human resources.[1] According to the Malawi Health Sector
Strategic Plan II, it states that improving availability, retention, performance and motivation of
human resources for health is essential for effective and equitable health service delivery.[4]
Currently, the vacancy rate for laboratory technicians in Malawi is 62% which means that
laboratories are understaffed which affects their work. In any country, a well-performing health
workforce is one which is available, competent, responsive and productive.[5] Countries are at
different stages of development of their health workforce but common concerns include
improving recruitment, education, training and distribution; enhancing productivity and
performance and improving retention.[6] To achieve this, actions are needed to manage dynamic
labor markets that address entry into and exits from the health workforce and improve the
distribution and performance of existing health workers.[5] The district should assess the need
for laboratory human resource and ensure there is a system in place and regulatory mechanisms
which manage deployment and their distribution. The district needs to think of ways how to scale
up numbers and skills of health workers, in ways that are relatively rapid and sustainable while
also engaging partners.[5] The district should organise laboratory technicians for effective
service delivery at different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.[5] The district should establish job related norms, deployment of
support systems and enabling work environments to make the work environment friendly which
promotes retention of staff.[6] Engaging stakeholders and sectors e.g. training institutions,
professional groups, civil service commissions helps to make sure that the district is adequately
supplied with human resource and in return the district can provide information on information
to include in training of laboratory technicians .[5] The district can also support the redesign of
training programmes to produce spectrum of health workers to deliver health services and
explore and document ways to maximize the use of priority programme training initiatives, and
mechanisms such as accreditation to assure quality of training programmes.[5] This can also be
done by offering in-service training to laboratory workers based on the demands of their work.
The district needs to work on ways of synthesizing evidence and evaluations on ways to organise
the heath workforce for more effective service delivery and improved health worker
performance, strategies to better retain health workers that include attention to both salaries and
working conditions and differential effects on male and female staff, and ways to monitor worker
performance.[5]
Studies conducted in Sub-Saharan African identified the lack of laboratory supplies and
inadequate equipment as one of the barriers for effective laboratory services.[1] An estimated
50% of medical equipment in developing countries is not used, either because of a lack of spare
parts or maintenance, or because health workers do not know how to use it.[5] As stated above, it
is important to provide in-service training to laboratory staff which should also include trainings
on how they should use equipment found in the laboratories. There is need ensure there is a
supply and distribution of essential diagnostics and equipment within the district’s laboratories to
ensure accessibility. The district also needs to know the essential diagnostics and standardized
equipment which are prescribed by the Ministry of Health which guide procurement, and
training. To achieve these objectives, there should be procurement, supply and storage systems
that ensures laboratories are well equipped and have the necessary resources. Policies will help
to make sure standards to promote quality diagnostics are implemented. They will also help to
make sure newer technologies are easily which yield better results.

A financing governance system supported by relevant legislation, financial audit and public
expenditure reviews, and clear operational rules to ensure efficient use of funds.[6] The district
needs to have a good health financing system that raises adequate funds to ensure people can use
needed services, and are protected from financial catastrophe.[5] This also applies to laboratory
services, people may face financial barriers in accessing laboratory services due to the distances
to reach the laboratory. The district can find alternative ways to resolve this by transporting
specimens to laboratories from areas far from the laboratory. The district also need to ensure it
has adequate funding for laboratories and the funds are used equitably and efficiently.

The World Health Organisation recognizes that each country’s specific context and history
shapes the way leadership and governance is exercised, but common ingredients of good practice
in leadership and governance can be identified.[6] This can also be said for the different districts.
Each district has its own history and so leadership and governance will be shaped by the
dynamics of the district. The district needs to be able to translate policy goals concerning the
laboratory into its implications for financing, human resources, technology, diagnostics with
relevant guidelines, plans and targets.[6]
The district also needs to have well written policies that will be used to come up with laboratory
standards, quality control management system for laboratories that will guide in service delivery
at the laboratory. Evidence from research done show that implementation of laboratory
standards helps laboratories to demonstrate a well-functioning quality management system,
technical competence and customer-focused services that contribute to health care services.[1]
There should be standards, norms and guidance to ensure access and essential dimensions of
quality, safety, effectiveness, integration, continuity and people-centeredness.[6] The
laboratories have to provide services which meet the demand of the user’s i.e. diagnostic tests
relevant to the health conditions which are found in the district. Barriers to accessing laboratory
services can also impede service delivery, therefore raising the public’s awareness towards the
services which are provided by the laboratory and also reducing barriers which might be cultural,
social, and financial and gender in origin.[5] The district also need to ensure that there is
management in place to oversee daily running of the laboratories and also to encourage
innovation and maintains accountability and consistency of the services. These policies will also
help to ensure there is patient safety, and systems and procedures that improve safety.[5]

The district also needs to assess the infrastructure of the laboratories such as buildings, utilities
such as power and water supply, waste management, transport and communication. Under-
resourced laboratory infrastructure, inadequate power supply, power supply interruptions poor
communication system in developing countries is another challenge for quality of diagnoses
which lead to inadequate treatment, increased morbidity, and inaccurate determination of the
burden of disease.[1] The district needs to work with partners and other stakeholders on how
infrastructure and logistics can be improved.

The health system consists of all people, organisations and actions whose primary intent is to
promote, restore or maintain health and a health system like any other system is a set of inter-
connected parts that must function together to be effective.[5] Changes in one area have
repercussions elsewhere and improvements in one area cannot be achieved without contributions
from the others.[5] Interaction between building blocks is essential for achieving better health
outcomes.[5] To improve laboratory services in the district, it requires both technical and
political knowledge and action.[5]