Overview of Cambodia Laboratory System & Organizational work flow S tructure

1. Overview of Cambodia Laboratory System &Organizational work flow Structure Dr. Lek Dysoley CNM 8-12 April, 2013

2. ROLES OF LABORATORY IN ALL LEVEL FOR QA OF PARASITOLOGICAL DIAGNOSIS OF MALARIA

3. 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

4. MAP OF MALARIA ENDEMIC Plasmodium Vivax Plasmodium Falcifarum

5. 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

6. ACTIVITIES OF CENTRAL LEVEL 1. 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 provinces 5. Slides examination for In Vivo Test 6. Malaria slides examination for out patients at CNM laboratory. 7. Supervision 8. PCR analysis 9. Internal Competency Assessment 10. Slide Validation

7. 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

8. 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

9. 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

10. 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.

11. 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.

12. Person profile Essential knowledge, skills and experience required for role

13. Main Responsibilities/ in the future

14. Main Responsibilities/ in the future

15. Basic Organization Structure Central Level PHD Level Peripheral/Health Centre Level

16. COLLABORATIVE PARTNERS NATIONAL MALARIA CENTER Lab. Department NIH NAMRU AFRIM IPC Provincial Health Department Lab. Department Operational District (OD) Health Facilities Village Malaria Worker Organizational Work Flow Structure

17. Thank You