Creating a sustainable culture of quality through the SLMTA programme in a district hospital laboratory in Kenya

Background: Bungoma District Hospital Laboratory (BDHL), which supports a 200-bed referral facility, began its Strengthening Laboratory Management Toward Accreditation (SLMTA) journey in 2011 together with eight other laboratories in the second round of SLMTA rollout in Kenya.Objectives: To describe how the SLMTA programme and enhanced quality interventions changed the culture and management style at BDHL and instilled a quality system designed to sustain progress for years to come.Methods: SLMTA implementation followed the standard three-workshop series, mentorship site visits and audits. In order to build sustainability of progress, BDHL integrated quality improvement processes into its daily operations. The lab undertook a process of changing its internal culture to align all hospital stakeholders – including upper management, clinicians, laboratory staff and maintenance staff – to the mission of sustainable quality practices at BDHL.Results: After 16 months in the SLMTA programme, BDHL improved from zero stars (38%) to four stars (89%). Over a period of two to three years, external quality assessment results improved from 47% to 87%; staff punctuality increased from 49% to 82%; clinician complaints decreased from 83% to 16; rejection rates decreased from 12% to 3%; and annual equipment repairs decreased from 40 to 15. Twelve months later the laboratory scored three stars (81%) in an external surveillance audit conducted by Kenya Accreditation Service (KENAS).Conclusion: Management buy-in, staff participation, use of progress-monitoring tools and feedback systems, as well as incorporation of improvement processes into routine daily activities, were vital in developing and sustaining a culture of quality improvement.

Metropolitan Concern, Colonial State Policy and the Embargo on Cultivation of Coffee by Africans in Colonial Kenya: the Example of Bungoma District, 1930–1960

The widespread involvement of African peasant households in the cultivation of a high-value cash crop—coffee—in Kenya dates back only to the mid-1950s. However, this late inclusion of African households in coffee cultivation did not imply their lack of enthusiasm to cultivate the crop from an earlier date. On the contrary, European settlers in particular, and some officials of the Department of Agriculture, thwarted the aspirations of African households regarding their being permitted to cultivate coffee. The overall view was in favor of the continued imposition of an embargo on African coffee cultivation. This paper employs mainly archival records to trace the agitation for inclusion in coffee cultivation by African households in colonial Kenya generally. It then treats the specific case example of Bungoma district in western Kenya from the 1930s.Through a review of official correspondence between colonial officials in Kenya and metropolitan authorities at the colonial secretariat in London, the paper shows how such agitation conflicted with the interests of European settlers and the policies that were privileged by the Department of Agriculture in African areas within Kenya. It demonstrates that when colonial state policy shifted (due to metropolitan and local pressure) in favor of African household involvement in coffee cultivation, the latter proved themselves to be efficient cultivators of the crop. The influence of metropolitan pressures on the eventual trajectory of colonial state policy in Kenya also demonstrates that the actions of colonial proconsuls in the colony did not always reflect the wishes of the colonial secretariat in London. This was moreso the case in Kenya, where a small but politically potent segment of European settlers exerted tremendous influence on the policies that were pursued by the colonial state.