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SESSION TWO

SESSION TWO. STRUCTURE OF LABORATORY SERVICE IN TANZANIA. NATIONAL CENTRAL PATHOLOGY LABORATORY Public Health Laboratory which are group A Laboratories. Zonal Referral Laboratory (Group A Laboratory). Regional Hospital Laboratory(Group B1 Laboratory). Health Center Laboratory

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SESSION TWO

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  1. SESSION TWO STRUCTURE OF LABORATORY SERVICE IN TANZANIA

  2. NATIONAL CENTRAL PATHOLOGY LABORATORY • Public Health Laboratory which are group A Laboratories Zonal Referral Laboratory (Group A Laboratory) Regional Hospital Laboratory(Group B1 Laboratory) • Health Center Laboratory • Dispensary Laboratory • Maternity Unit Laboratory • Mobile health Laboratory District Laboratory(Group B2 Laboratory)

  3. COMMUNITY BASED LABORATORY FACILITIES • They Include Health center laboratories, Dispensary laboratories, mobile health laboratories, maternity health units. • They are grouped as Group C Health Laboratory

  4. Why need a Community Based Laboratory? • The reliable community based laboratory improves the quality of Primary Health Care (PHC) hence avoiding patients and pregnant women to travel to the district hospital for essential laboratory tests.

  5. Community Based Laboratory Community based Health Laboratory is considered effective in PHC if the Laboratory:- • Meets the health need of individuals and the community at large • Operates in acceptable way • Be accessible to the community and affordable • Be reliable and sustainable

  6. Community Based Laboratory Why do we need a health center with a Laboratory facility? • Because a laboratory testing can establish the true cause of illness hence enabling correct treatment to be prescribed at a patient’s first attendance.

  7. FACTORS TO CONSIDER BEFORE ESTABLISHING A LABORATORY IN A HEALTH CENTER UNIT • Will the laboratory affect on the morbidity and mortality in the area? How will the results of tests be used? • Is the health center sufficiently well attended and What is likely to be the demand for laboratory tests • Is there trained local community health workers or is it possible to train local community health workers to use laboratory facilities correctly in early diagnosis, follow-up, care and local disease survillence?

  8. FACTORS OF ESTABLISHING A LABORATORY IN A HEALTH CENTER UNIT • Is there a person trained or can be trained to perform the required laboratory tests and manage safely and efficiently a health center laboratory? • Can the necessary measures be taken to ensure the safe collection, transport and disposal of specimen? • Is it possible for the Health laboratory to be visited regularly by the district Laboratory coordinator from the district hospital?

  9. FACTORS OF ESTABLISHING A LABORATORY IN A HEALTH CENTER UNIT • Is it possible to organize reliable systems to supply the laboratory with reagents and other essential supplies? • Is the cost of running the laboratory affordable, including cost of supplies, maintenance equipment and staff salaries? How will these expenditures be met? • Can the health center provide adequate facilities for laboratory effectively and safely?

  10. BASIC REQUIREMENT FOR A HEALTH CENTER LABORATORY • A building or two rooms (reception 2x2m & working 5x4m) with secure door, water proof floor, insect screened windows that provide adequate light and ventilations. • Should be accessible by road through a year, • Should have an identified address • Should have toilets for male and female patients • Reliable clean running water source.

  11. BASIC REQUIREMENT FOR A HEALTH CENTER LABORATORY • Walls and floors should be impervious to water and have washable surface. • Roof should be of corrugated sheet/concrete roofing/Tiles • Should have sufficient working benches (height 75cm width 50cm). Bench tops should be smooth without cracks easy cleaning and disinfection. • Separate sinks for cleaning laboratory ware and hand washing

  12. BASIC REQUIREMENT FOR A HEALTH CENTER LABORATORY • Reliable source of power • Fitted with washable working surface, seating for patients and staff, secure storage cupboards and shelving. • Laboratory staff(a laboratory technician, assistant or a health worker trained to carry out all laboratory duties and one or two laboratory aides)

  13. DUTIES OF A HEALTH CENTER LABORATORY WORKER • To collect specimens from patients for testing • To examine specimens microscopically • To perform appropriate diagnostic and screening tests • To collect and refer specimens for specialist testing • To participate in community health education and disease surveillance. • To keep or necessary laboratory records • To prepare diagnostic reagent and all necessary consumable

  14. ACTIVITIES OF A HEALTH CENTER LABORATORY • To investigate by referral or testing on the site diseases and health problems affecting the local community. The investigations might include:-

  15. ACTIVITIES OF A HEALTH CENTER LABORATORY • Bacterial and Viralinfection: including Tuberculosis, Meningitis , cholera, gonorrhoea, Syphilis, Vaginitis, Urinary Tract Infections, Respiratory tract infections, bacillary dysentery, relapsing fever and HIV.

  16. ACTIVITIES OF A HEALTH CENTER LABORATORY • Parasitic diseases: malaria, schistosomiasis, lymphatic filariasis, African trypanosomiasis, loiasis, onchocerciasis, amoebic dysentery, giardiasis, strongyloidiasis, trichuriasis and hook worm disease.

  17. ACTIVITIES OF A HEALTH CENTER LABORATORY 2. To assist the health worker in deciding the severity of patient’s condition and prognosis 3. To collect specimens and refer for testing to the district laboratory. These includes water samples, fecal specimen for microbial investigations, serum for antibody testing, specimen for biochemical testing, specimens for culture and antimicrobial sensitivity testing.

  18. ACTIVITIES OF A HEALTH CENTER LABORATORY 4. To notify the district hospital laboratory at an early stage of any results of public Health importance and send specimen for confirmatory test. 5. To screen pregnant women for anemia , proteinuria and malaria and refer serum to the district laboratory for antibody screening for diseases such as TORCHs, and STIs.

  19. ACTIVITIES OF A HEALTH CENTER LABORATORY 6. To promote health care and assist in community health education.eg by demonstrating microscopically parasites of public health importance. 7. To produce and keep health records which can be used by health authorities in health planning.

  20. ACTIVITIES OF A HEALTH CENTER LABORATORY 8. To keep an inventory of stock and other laboratory supplies. 9. To send an informative monthly report to the district hospital laboratory of the work carried out and results obtained.

  21. DISTRICT HOSPITAL LABORATORY • Is a Referal hospital to Public health Laboratories • The size of District laboratory will depend on the area served by the district hospital,. Generally the district hospital laboratory may consist a number of connected laboratories or subdivided laboratory room.

  22. DISTRICT HOSPITAL LABORATORY STAFF • Two Registered Laboratory Technologist • Two Licensed Laboratory Technologist • Two Laboratory attendants

  23. ACTIVITIES OF A DISTRICT HOSPITAL LABORATORY 1. To decide which laboratory tests are needed and can be performed at district level. The decision must be made in consultation with district health management team, public health officer and clinical team. The selected tests must be needed in:

  24. ACTIVITIES OF A DISTRICT HOSPITAL LABORATORY • Curative health care to establish or confirm a diagnosis, asses patient’s condition, prognosis and monitor progress during treatment. • Disease surveillance and rapid investigations of epidermics • Health protection, health promotion and health education • Health planning

  25. ACTIVITIES OF A DISTRICT HOSPITAL LABORATORY 2. With the district laboratory coordinator, to manage effectively the district laboratory network 3.To prepare and implement Standard Operating procedures(SOP) for all district laboratory activities

  26. ACTIVITIES OF A DISTRICT HOSPITAL LABORATORY 4. To support the work of outreach laboratories e.g. • By testing specimens referred from health centers and maternity health units and then returning the results timely, • Confirming test results that indicates serious or is of major public health importance, • supplying Standards, controls, stains and other essential laboratory supplies,

  27. ACTIVITIES OF A DISTRICT HOSPITAL LABORATORY • Checking and validating the performance of equipment, • Visiting each outreach laboratory each three months and training of health center laboratory personnel • organizing a district external assessment scheme.

  28. ACTIVITIES OF A DISTRICT HOSPITAL LABORATORY 5. To refer specimen to the regional laboratory that can not be tested in the district laboratory. 6. To participate in any external quality scheme organized by a regional laboratory or Central laboratory

  29. ACTIVITIES OF A DISTRICT HOSPITAL LABORATORY • To keep accurate records and send a report to the district management team and to the regional laboratories officer.

  30. GENERAL ROLES OF LABORATORY IN DISTRICT HEALTH CARE 1. DIAGNOSIS BY GIVING:- • More accurate with fewer misdiagnosis • Earlier diagnosis 2. TREATMENT • Correct treatment with drugs used selectively • Less –over describing • Side effects and progress monitoring

  31. GENERAL ROLES OF LABORATORY IN DISTRICT HEALTH CARE 3. Assessiment /screening • Is referral required? • Pregnant women screened for ill health • Donor blood screened for pathogens 4. EPIDERMICS • Earlier pathogen identification • Earlier containment

  32. GENERAL ROLES OF LABORATORY IN DISTRICT HEALTH CARE 5.SURVEILLANCE/CONTROL • More effective • Disease carriers identified • Contacts traced • Water supplies tested

  33. GENERAL ROLES OF LABORATORY IN DISTRICT HEALTH CARE 6. Health Information • Causes of disease • Sources of infection • Risk factors • Prevalence and incidence

  34. THE OUTCOME OF THE ROLES AND FUNCTIONS OF THE DISTRICT LAB 1. Improvement of the quality or care with acute illiness more rapid diagnosed, less preventable advanced /chronic illness and reduce mortality • 2.Reduce transmission of infectious diseases 3. Lower expenditure on drugs

  35. THE OUTCOME OF THE ROLES AND FUNCTIONS OF THE DISTRICT LAB 4. More efficient use of health resources 5.Better health planning and management 6. Greater patient satisfaction 7. Greater motivation of health wokers

  36. REGIONAL HEALTH LABORATORY • This is the laboratory attached to the regional/Imtermidiate Hospital. • It is equivalent to group B1 Laboratory • It is a referral Laboratory for District Laboratory

  37. NATIONAL OR CENTRAL PATHOLOGY HEALTH LABORATORY • It is the highest laboratory level in the country • It is equivalent to group A laboratory • It is the referral hospital for a regional Laboratory

  38. GUIDELINES FOR A PRIVATE HEALTH CLINICAL LABORATORY STANDARD REQUIREMENT FOR HEALT LABORATORIES

  39. GROUP C HEALTH LABORATORY Group C laboratory Is the lowest level of health Laboratory service which is attached to a dispensary or Health Center or can operate as autonomous Private Health Laboratory.

  40. STANDARDS FOR GROUP C HEALTH LABORATORY • PREMISES • Reception (2x2m) and one working room(5x4m) • Two washing Sinks one at Reception and another at working room • Two bench/wall shelves one for working reagents and another for manuals and records • Three waste bins colour coded, Red, black and yellow

  41. STANDARDS FOR GROUP C HEALTH LABORATORY 2. FURNITURE • One table for reception • One chair for reception • One bench for patient at reception • Two stools/chairs at the working room

  42. STANDARDS FOR GROUP C HEALTH LABORATORY 3. ESSENTIAL MAJOR EQUIPMENT • Binocular microscope, • Centrifuge machine, • Hemoglobinometer/Lovibond comparator • Weighing scale • Kerosene stove • Sprit Lamp • Staining rack

  43. STANDARDS FOR GROUP C HEALTH LABORATORY 3. ESSENTIAL MAJOR EQUIPMENT • Tally counter • Boxes for microscope slides • Cover glass • Differential counter • One refrigerator with freezing compartment for reagents ang vaccines • Glucometer • Improved Neubauer,s chamber

  44. LABOLATORY GROUP C ESSENTIAL TESTS AND METHODS ESENTAL TESTS AND METHODS Blood Tests • Hemoglobin(Haemoglobincyanide method), Blood film(Romanosky and field stain) • Total Leucocyte count(Turk’s method) • Differential Leucocyte count cellmorphology(Romanosky and field stain) • Sickle cell screening test(, Sodium Metabisulphite slide test) • Syphillis screening(VDRL/RPR) • Glucose(Glucometry)

  45. LABOLATORY GROUP C ESSENTIAL TESTS AND METHODS URINE TESTS • Urine Glucose(Glucostic/Benedict’s test) • Urine Protein(Albustix/Sulphosalicylic acid) • Urine Sediment(Direct microscopic examination)

  46. LABOLATORY GROUP C ESSENTIAL TESTS AND METHODS STOOL TESTS • Protozoa /Ova(Direct Microscopy/ Iodine saline preparation) • Cells, Crystals(Direct Microscopy

  47. LABOLATORY GROUP C ESSENTIAL TESTS AND METHODS SPUTUM • AFB(Ziehl Neelsen Stain) SKIN • AFB, Fungal element(Ziehl Neelsen Stain, Direct Potassium Hydroxide preparation) PUS/EXUDATES • Trichomonas, Bacteria(Direct Saline preparation,Microscopy, Gram staining)

  48. STANDARDS FOR GROUP C HEALTH LABORATORY 5. PRESERVATION AND POSTING • Swab specimen for culture: Use stuart transport medium • Sputum for TB culture: Empy sterile bottle 6. STAFF • One Licensed Laboratory Technologist • One Laboratory assistant

  49. GROUP B2 LABORATORY • The health Laboratory facility which is attached to a primary district hospital Or can operate as an autonomous Private health Laboratory. It serves as the first referral laboratory for group C Laboratory

  50. REQUIREMENT STANDARDS FOR GROUP B2 STAFF • Two Registered Laboratory Technologist • Two Licensed Laboratory Technologist • Two Laboratory attendants

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