Implementing a regional integrated laboratory proficiency testing scheme for peripheral health facilities in East Africa

Introduction: Regular participation in external quality assessment (EQA) is critical for maintaining laboratory performance and is required for laboratory accreditation. Proficiency testing (PT) is effective for providing EQA, but available schemes rarely address the range of tests performed by peripheral laboratories in resource-limited settings. The East African Regional External Quality Assessment Scheme (EA-REQAS) was established in 2004 to address this need. Materials and methods: Surveys were distributed biannually comprising seven different panel materials and questions addressing laboratory, clinical and public health topics. Preserved materials were prepared using standard procedures and validated by accredited laboratories to establish target values. Survey materials were shipped by courier and results returned by paper copy, email or online. Immediate feedback reports included advice for addressing errors. Composite reports addressing participants’ performance were provided to national quality assurance offices. Results: Sixteen surveys were distributed between 2008 and 2015; enrolment increased from 195 to 560 facilities. Mean response rate remained static (56-59%), but overall number of participating facilities increased. Mean performance scores increased from 51% to 68% but remained below the accepted score of 80%; individual facilities achieving 80% or more increased from 0 to 25%. Facilities participating in 10 or more surveys performed better than facilities participating in 5 or less surveys. Conclusion: PT can be applied at peripheral level in resource-limited settings and identifies poorly performing areas. PT can also be used to assess performance of equipment and test kits as part of post-market surveillance. Smaller health facilities require additional support to address deficiencies