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Overview of Cambodia Laboratory System &
Organizational work flow Structure
Dr. Lek Dysoley
CNM
8-12 April, 2013
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ROLES OF LABORATORY
IN ALL LEVEL FOR QA OF
PARASITOLOGICAL
DIAGNOSIS OF MALARIA
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Health Infrastructure in Cambodia
• Consists of– 77 Referral Hospitals;
– 942 Health Centers with inpatient facility
And Health Centers without inpatient facility
– 23 Health Posts: RDT
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Proportion of P.Falciparum (%) 20050 - 2020 - 4040 - 6060 - 8080 - 100
N
EW
S
Plasmodium Falcifarum
Proportion of P.Vivax (%) 2005<1010 - 2020 - 3030 - 4040 - 5050 - 95
N
EW
S
Plasmodium Vivax
MAP OF MALARIA ENDEMIC
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Roles of Central level
- Assure the quality of the parasitological diagnosis of malaria by using microscope at all levels- Examine the supplies of materials and reagents to ensure the conduct microscopy examination to diagnosis malaria at local levels- Re-cross checking of slides those are already checked at the provincial level, 30 slides (15 pos., 15 neg.) and send the result back to the target provinces- Prepare manuals and documents for laboratory at all level
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ACTIVITIES OF CENTRAL LEVEL1. Microscopist training.2. Slide examinations as part of IBN activities.3. Slide examinations as part of malaria epidemiological surveys.4. Cross-Checking of slides sent by provinces5. Slides examination for In Vivo Test6. Malaria slides examination for out patients at CNM laboratory.7. Supervision8. PCR analysis9. Internal Competency Assessment10. Slide Validation
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Roles of Provincial level
- Conduct quarterly supervision visits on regular basis to ensure maintenance of quality of laboratory services
- Examine the registration of patients and results of slides checking in the laboratory register- Check care quality of materials, reagents and supplies- Select blood slides from health centers/referral hospitals and check their quality, then provide feedback- Plan for refresher training and on the job training- Hold quarterly meeting in the province- Report to the Provincial Malaria Program Manager- Pick 30 slides (15+ and 15-) from all slides that are checked by prov to send to central level for Re-cross checking- Report and send the slides to the central level laboratory for Re-cross checking
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Roles of Operational District level
- OD laboratory can be responsible for supervising
laboratories in its area
- Conduct regular supervision visits every three
months to maintain the laboratory quality
- Randomly select 30 slides (if less than 30 slides
available, select all) with15 pos. slides with low
parasitemia 15 neg. slides
- Be aware of the quality of materials, reagents and
supplies
- Dispatch slides collected from health centers to the provincial level for quality crosschecking attached with check list and slides information sheet
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Roles of Health Facilities- Conduct tests for malaria and provide the results to doctor doctors/staff responsible for patient management
- Responsible for proper registration (writing the information about the patients, results in the laboratory register)
- Consolidate monthly reports
- Keep slides properly according to their serial numbers and other documents related to the laboratory
- Make sure performance standards and other documents provided by CNM available in the laboratory
- Laboratory technicians must be trained to conduct diagnosis with microscope
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Roles of Health Facilities(Cont.)- Provide information regularly and on a timely manner about materials and reagents of the materials to ensure the supplies.
- To avoid stock out situation, provide information urgently when there is shortage of material and reagents to Operational District Office
- Control he quality and maintain the laboratory materials and reagents
- Ensure quality control daily (if possible), weekly and monthly basis. Internally by rechecking the quality of staining and reading the slides.
- Ensure timetable is available for laboratory staff daily routine on duty and for checking their performance.
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Role Purpose
• The role provides highly specialist technical support to research teams and teaching staff (operating, maintaining and developing laboratory and research equipment and apparatus) to ensure the smooth running of a laboratory or research facility.
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Person profile
Essential knowledge, skills and experience required for role
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Main Responsibilities/ in the future
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Main Responsibilities/ in the future
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Basic Organization Structure
Peripheral/Health Centre Level
PHD Level
Central Level
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Organizational Work Flow Structure
NIH
Provincial Health DepartmentLab. Department
Operational District(OD)
Health Facilities
AFRIMNAMRU IPC
NATIONAL MALARIA CENTERLab. Department
COLLABORATIVE PARTNERS
Village Malaria Worker
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Thank You