Kasusse Michael L, Tumwesigye Nazarius M, Aisu Steven, Matovu Joseph K B, Wanyenze Rhoda
Makerere University School of Public Health, Kampala, Uganda.
MakSPH-CDC Fellowship Program, Makerere University School of Public Health, Kampala, Uganda.
Afr J Lab Med. 2015 Nov 30;4(1):234. doi: 10.4102/ajlm.v4i1.234. eCollection 2015.
Improving laboratory service delivery requires a functioning logistics and supply system. Uganda's Ministry of Health uses the credit-line approach to provide laboratory supplies including commodities for CD4 test equipment.
We examined the effectiveness of the credit-line approach in improving laboratory service delivery by using the functionality of CD4 test equipment as a proxy indicator.
A cross-sectional survey was conducted at 7 level-three health centres (HC IIIs), 18 level-four health centres (HC IVs), and 10 hospitals in 15 districts of mid-northern Uganda, including the Lango (17 facilities) and Acholi sub-regions (18 facilities), between July 2013 and August 2013. Functionality, was determined through self- and interviewer-administered questionnaires. The chi-squared test was used to assess differences in functionality by sub-region, facility type, and equipment type.
A total of 38 CD4 test analysers were assessed. Of these, 26 (68%) were functional. In hospitals, 85% of CD4 analysers were functional, in HC IVs, 67% were functional and in HC IIIs, 43% were functional. The differences did not reach statistical significance. In the Lango sub-region, 72% of analysers were functional; in the Acholi sub-region, 65% were functional. Non-functionality was mainly due to lack of reagents and cartridges, as well as low staffing levels of laboratory technicians with the skills necessary to operate the equipment.
The credit-line approach supported the functionality of CD4 equipment in the surveyed facilities. However, there is a need to address issues of staffing and availability of reagents to enhance the functionality of CD4 equipment and improve patient care, especially at HC IIIs.
改善实验室服务提供需要一个有效的物流和供应系统。乌干达卫生部采用信贷额度方法来提供实验室用品，包括用于CD4检测设备的商品。
我们通过将CD4检测设备的功能作为替代指标，研究了信贷额度方法在改善实验室服务提供方面的有效性。
2013年7月至8月间，在乌干达中北部15个地区的7家三级卫生中心（HC III）、18家四级卫生中心（HC IV）和10家医院进行了横断面调查，包括兰戈（17个机构）和阿乔利次区域（18个机构）。通过自我管理和访谈员管理的问卷来确定功能情况。使用卡方检验来评估不同次区域、机构类型和设备类型在功能方面的差异。
共评估了38台CD4检测分析仪。其中，26台（68%）功能正常。在医院中，85%的CD4分析仪功能正常；在HC IV中，67%功能正常；在HC III中，43%功能正常。这些差异未达到统计学显著性。在兰戈次区域，72%的分析仪功能正常；在阿乔利次区域，65%功能正常。功能异常主要是由于缺乏试剂和试剂盒，以及具备操作设备所需技能的实验室技术人员配备不足。
信贷额度方法支持了被调查机构中CD4设备的功能。然而，有必要解决人员配备和试剂供应问题，以增强CD4设备的功能并改善患者护理，尤其是在HC III机构。
