Process Step 2:
The toolkit for outsourcing laboratory services
In this section, you will learn:
- How to evaluate for optimised outsourcing
- Develop a request for proposal and vendor assessment matrix
The Diagnostic Network Optimisation informs the process for decision-making and conducting an evaluation for laboratory network outsourcing.
Decision-tree approach to evaluation
The models suggested are illustrative – there are many models that vary by country and Diagnostic Network Optimisation strategy.
The three tasks to conduct an evaluation and vendor assessment are:
Case study: The national sample and results transport network, Uganda
The Uganda tuberculosis specimen referral network followed a Diagnostic Network Optimisation approach to inform potential outsourcing.
In Uganda today, 900 peripheral laboratories refer specimens to one centralised laboratory in Kampala – the Uganda National Tuberculosis Reference Laboratory (NTRL). Specimens are transported to the NTRL for culture and drug-susceptibility testing through a combination of laboratory couriers and the national postal service – Posta Uganda. Before 2008 there was no formal specimen referral system in Uganda. Only 50 of the 900 sites participated in the referral system with negative impacts for tuberculosis testing – in the entire 2008 calendar year, a total of only 655 specimens were sent to the NTRL.
In 2008, the Ugandan Ministry of Health and the NTRL in Kampala, following a Diagnostic Network Optimisation approach, partnered with Becton Dickinson and the US PEPFAR to develop a formalised route and safe system that reduces diagnostic delays and improves tuberculosis surveillance in Uganda. The evaluation process for the exercise followed these steps:
- Diagnostic Network Optimisation approach to assessing laboratory network optimisation: using GIS software, the performance level of each peripheral site to refer tuberculosis specimens to the NTRL was assessed against district population densities. A new national specimen referral system was designed using the hub and spoke model Diagnostic Network Optimisation report disseminated.
- Inputs from Diagnostic Network Optimisation report for Strategic Vendor Questions: recommendations from the United Nations Transport of Dangerous Goods were reviewed alongside key questions for capability and capacity of in-country third-party logistics.
- Vendor Assessment Matrix: Assessment of third-party logistics led to the decision not to outsource to the private sector but rather contract to an existing public sector organisation (Posta Uganda).
The Ugandan Ministry of Health redesigned its specimen referral network into the National Sample and Results Transport Network (NSRTN) and chose to retain the sample transport function in-house. The following milestones were achieved:
- 93% of laboratory facilities (835/900) were mapped between 2008 and 2011
- 724 healthcare and postal staff members covering 72% of Uganda’s districts received specialised training
- The number of tuberculosis specimens received at the NTRL increased from 655 in 2008 to 5,813 in 2011
- Transport times were reduced, and 94% of specimens reached the NTRL successfully by 2011
Request for proposal creation for evaluation: specimen packaging for sample transportation19
The courier’s ability to comply with strict packaging specifications is a key component for evaluating sample vendors. Packaging specifications include:
The triple packaging system (figure 1)20 is used to pack samples of varying preparations (whole blood, sputum, dry blood etc.). for transportation. It prevents damage and cross-contamination of specimens.
- Primary packaging: The leakproof primary receptacle is wrapped in cotton wool or paper towel to absorb the entire contents if the container leaks.
- Secondary packaging: The cotton wrapped primary container is placed inside a secondary container, e.g., a sealed Ziplock bag.
- Tertiary packaging: The secondary container is placed upright in a cool box container – it should be shock-resistant and protect the contents from physical damage during the trip. This container should be labelled according to inter/national regulations for infectious materials.
For cold transportation conditions, cool packs are recommended for samples requiring between 2-8℃, while dry ice is best used for deep-frozen transportation at -80 ℃. These must be placed outside the secondary packaging.
Note: Refer to other Standard Operating Procedures (SOPs) for sample transportation, available here.
Summary of Evaluate
The second Process Step, Evaluate, begins by understanding the inputs from the Diagnostic Network Optimisation report in Assess. In this Process Step, you have learnt what questions to ask for outsourcing consideration. Finally, you learnt how to develop a request for proposal. The third Process Step, Contract, will focus on the contracting process for outsourcing laboratory functions for network optimisation.
18Sources: Interviews for the Toolkit for Outsourcing Laboratory Services, November 2020; Joloba et al., April 2016. Strengthening the Tuberculosis Specimen Referral Network in Uganda: The Role of Public-Private Partnerships.
19Source: Interviews for Toolkit for Outsourcing Laboratory Services s, November 2020. Challenge tuberculosis. 2014. Specimen Transportation: A How-To Guide. Available: https://www.challengetb.org/publications/Challenge_tuberculosis_Specimen_Transport_HowTo.pdf.
20Source: Biosafety and Biosecurity in European Containment Level 3 Laboratories: Focus on French Recent Progress and Essential Requirements. 2017; Boris A Pastorino, Xavier de Lamballerie, Remi Charrel; https://www.researchgate.net/figure/Basic-triple-packaging-system-for-infectious-substance-transport_fig1_317630194