The Community Diagnostics Programme (CDP) started in November 2006 and aimed to design and operate a functional system for providing quality-assured diagnostic services for anaemia and malaria to poor communities in five states in Nigeria. In each state a team of four laboratory supervisors/trainers designed the programme during workshops facilitated by PATHS consultants. The supervisors introduced simple diagnostic tests for malaria and anaemia into 92 primary health care (PHC) and 12 secondary health care (SHC) facilities across the five states, achieving population coverage of about 1 million. Over 150 PHC staff were trained to implement the CDP. Mechanisms were 2 PATHS Technical Brief established to provide the trained staff with supplies and to monitor the accuracy of the tests. Patients and clinicians have utilised and demanded the new diagnostic services.
For the first time in Nigeria, the CDP established a generic system for providing quality-assured diagnostics that operated across all tiers of the state health service and reached those living in poor rural areas. The system was able to monitor the quality of test performance, identify problems and deliver cycles of targeted training to improve the quality of the tests. The CDP provided a platform on which to build other simple tests that were appropriate for the health needs of the rural poor, and has produced an evidence base to inform national scale-up.
The following Key Methods were observed for ensuring accurate performance of tests at PHC level:
- On-site observation of testing process by supervisors
- Examination of laboratory records
- PHC staff test known samples provided by supervisors
- Supervisors check malaria RDT results against blood film microscopy
- Supervisors check haemoglobin colour scale results against HemoCue measurements