This four year project, initiated by CAREC was approved in May 2000, under the 8th European Development Fund (EDF) Caribbean Regional Indicative Programme (CRIP).
The overall objective is to improve national and regional medical laboratory information in CARIFORUM countries, resulting in improved patient management, disease prevention and control. A higher level objective is to improve the health status of Caribbean populations.
The project aims to improve management of, and coordination between, public and private laboratories in the region, thus leading to more accessible, higher quality and less fragmented laboratory information. Principal activities include: Training of existing staff in Laboratory Management and Quality Assurance; Inclusion of these principles within the curricula of training institutions; Development of standards for laboratories and an accreditation system for monitoring of laboratory quality; Development of information systems to support disease prevention and control initiatives, Operational research to support policy development.
The financing agreement for this project was approved in August 2000 and a start-up work programme in August 2001.
Context
Health laboratories in large measure, underpin the success of disease control, elimination and prevention efforts, often being the first site of detection and confirmation of disease outbreaks. However, the quality of both public and private sector laboratory output varies widely and no regional mechanism existed before this project, for standardizing, monitoring and controlling the quality of medical laboratory output. Delays in the detection and investigation of outbreaks have led to the loss of millions of dollars in cancelled visitor arrivals and increased expenditures on local health services. Additionally, the failure to provide accurate and early diagnosis of high-impact diseases such as cancer, AIDS and diabetes has often resulted in preventable loss of life.
On the wider front, this project supports developments in trade, tourism and economic growth within participating countries. The negative impact of diseases on public well-being and on tourism markets in the Caribbean has reinforced the recognition that disease prevention and control are critical to sustainable development in this region. Without a doubt, reduction in disease outbreaks that threaten personal health and the tourism industry, a major source of economic growth, employment and foreign currency, is dependent on strong and viable health systems.
Over the past three decades, the tourism industry has become an increasingly important part of the diversification strategy of Caribbean economies and represented an overall turnover of some $20 billion US for CAREC member countries in 2000. Revenues from tourism often represent a significant percentage of GNPs – from as high as 75% in Anguilla to 25% in Jamaica (Source: Caribbean Tourism Organisation (CTO)).
The project was developed in the context of the growing realisation in the Caribbean region that medical laboratory error had reached unacceptably high levels. Such error undermines the quality of patient management, epidemiological surveillance and public health interventions. The Caribbean Epidemiology Centre (CAREC) was mandated by Caribbean countries to play a lead role in the reform of medical laboratories within the region.
CAREC used operational research to inform and promote appropriate laboratory policies and strategies, to encourage governments to allocate adequate resources and introduce new systems and to train laboratory managers on laboratory service quality assurance (QA) methods[1] both within the public and private sectors. CAREC’s advocacy efforts have convinced governments to initiate the reform of both public and private laboratories within a wider health sector reform framework.
[1] QA covers all aspects of laboratory activities: policy and programme objectives, confidentiality of patient data, lab design, safety features, personnel management, procurement, equipment calibration & maintenance, standard operating procedures, method selection & evaluation, documentation and processing of testing results, reference standards, intra- and inter-lab testing programmes & results, control of samples and records, internal audits, reports to management, corrective action, formats (methods, reports, certificates etc), programme revision & update, and financial management