Leah Naluwagga BalirunoBBLT (MUK), MSc IDM (MUK) & Fellowship in Public Health Laboratory Leadership (UNIPH/MOH) Host Site: National Health Laboratory and Diagnostics Services, Ministry of Health
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ABOUT THE FELLOWLeah Naluwagga Baliruno is a trained laboratory leader and medical laboratory specialist. She served in the capacity of President, LLP Cohort 2023, the inaugural Laboratory Leadership cohort. She holds a Master of Science degree in International Infectious Disease Management and a Bachelor’s degree in Biomedical Laboratory Technology, both from Makerere University. She is particularly interested in health laboratory systems strengthening with a focus on the health laboratory workforce. She is also interested in the application of One Health in disease surveillance and outbreak investigations. During the fellowship, Leah was hosted at the National Health Laboratories and Diagnostic disease prevention and health promotion in Uganda through early detection of the disease. Through the in-service training, she has attained great skills in laboratory leadership and management, communication, continuous quality Services (NHLDS), a department of laboratory improvement, disease surveillance, outbreak investigation, and response including data analysis, interpretation, and use. Achievements at the Host Site– Spearheaded the evaluation of the time from sample collection for Viral Load samples from “spoke” health facilities to Uganda, to receipt at the Central Public Health Laboratories for Kigezi Region from February to May 2023 and Ankole, Busoga, Teso, Karamoja, West Nile, and South and North Buganda Regions, Uganda from April to May 2023, using sample tracking data. – Led a Continuous Quality Improvement (CQI) project to improve the time taken from collection for Viral Load samples from spoke health facilities in the Kigezi Region, to receipt at the Central Public Health Laboratories (CPHL). – Reviewed national training materials for community training on HIV self-testing used countrywide. – Facilitated a trainer of trainers (TOT) training for Village Health Teams (VHTs) on the use of HIV self-testing in the community, who were commissioned by the President of Uganda and the Minister of Health in Kololo. – Supervised and provided technical support in the rollout and implementation of HIV self testing in key and priority populations. – Participated in national meetings including laboratory pillar, incident management team, and launch of national guidelines among others. Fellowship program specific achievements– Co-authored the first National Laboratory Guidelines for Preparedness and Response to Public Health Emergencies. – Participated in customising WHO Ebola Virus Disease (EVD) laboratory training manual to cater for all Viral Haemorrhagic Fevers (VHFs). – Led laboratory coordination in two outbreak investigation ▪ Meningitis in Obongi District, 2023 ▪ Cholera in Kayunga District, 2023 – Participated in three other outbreak investigations ▪ Cholera in Buvuma Island, 2023 ▪ Anthrax in Ibanda District, 2023 ▪ Anthrax in Kyotera District, 2023 – Published two articles in the New Vision ▪ Role of the laboratory in eliminating viral hepatitis by 2030 ▪ Health labour analysis: the answer to health laboratory workforce dynamics – Published additional seven articles – (Four as lead author & three as co-author) in the Uganda Public Health Bulletin. – Served as an editorial team member for Uganda Public Health Bulletin, volume 8, issue 3, July-September 2023. – Authored nine manuscripts (three as lead author and six as co-author). Eight of which are undergoing institutional clearance. – Presented abstracts at five conferences (three international and two national) ▪ 9th East African Health and Scientific Conference (EAHSC) in Kigali, Rwanda, 2023. ▪ 3rd International Conference on Public Health in Africa, Lusaka, Zambia, 2023. ▪ HuQAS 22nd Annual Scientific Conference, Mombasa, Kenya, 2023. ▪ 9th National Field Epidemiology Conference, Kampala, Uganda ▪ 10th National Field Epidemiology and 2nd National Laboratory Leadership Conference, Kampala, Uganda. – Conducted a continuous improvement project to improve sample receipt turnaround time for HIV Viral Load in Kigezi Region, Uganda, April-September, 2023 – Conducted a descriptive analysis of characterizing Vibrio cholerae isolates in Uganda between 2014 and 2023 – Conducted a capstone project to assess staffing needs of health laboratory workforce in selected health facilities in Lango sub region, Uganda Summary of Epidemiological Study:Title: Staffing needs assessment of the health laboratory workforce in selected health facilities in Lango Sub-region, Uganda, 2024 Background: The health laboratory workforce (HLW) plays a pivotal role in achieving Primary Health Care, Universal Health Coverage, International Health Regulations and Sustainable Development Goals for health in a country. Shortage in this workforce compromises the quality of test results used for clinical management, public health intervention and policy development. We assessed the staffing needs of the health laboratory workforce in three public health facilities in Lango Sub-region in Uganda, namely, Agali Health Center III, Ogur Health Center IV and Apac General Hospital from July 2022 to June 2023. Methods: We collected and analyzed data on staffing needs using the Workload Indicator for Staffing Needs (WISN) assessment tool. This was a mixed-methods study. Quantitative data on existing staffing levels of HLW by cadre was obtained from the staff list from the districts; data on recommended staffing levels in Uganda; 4 laboratory staff at H/C III, 9 laboratory staff at H/C IV and 15 lab staff at General Hospital, was got from the Ministry of Public Service guidelines on staffing structure for HLW. Data on laboratory testing was abstracted from the health management information system registers 105 and 108 for the same period. Laboratory staff requirement was calculated step-by-step based on workload. Activity standards (the time it takes a laboratory to conduct core activities and associated activities) were applied to each workload component. This was based on the same standards in all similar health facilities, considering the available working time (amount of time available in a year, per cadre, for delivering health services). The differences between the actual and calculated number of health personnel were calculated to show the level of staffing shortage or surplus for a particular cadre in a given health facility. The ratio of the actual to the required number of staff was used to calculate the WISN ratio. To determine workload pressure, the surplus/deficit staff was expressed as a percentage of the staff required by WISN. The qualitative component involved administering key informant interviews (KII) to district laboratory focal persons, human resource officers and laboratory managers to identify possible factors affecting HLW in Lango sub-region to triangulate the quantitative results obtained. Transcripts were transcribed and coded according to pre conceived themes. We presented our findings as proportions showing the WISN ratio and workload pressure. Results: The WISN calculation showed that there was a surplus of 2 laboratory technicians with WISN ratio of 1.5 and no workload pressure (-50%) in Agali Health Center III; a shortage of 1 laboratory assistant with WISN ratio of 0.8 and high workload pressure (25%) in Ogur Health Center IV; as well as a shortage of 4 laboratory assistants, 1 laboratory technician and 1 laboratory technologist with WISN ratio of 0.5 and high workload pressure (55%) in Apac General Hospital. From the KIIs identified factors negatively affecting HLW in Lango Sub region included high workload perception, low staffing levels, inappropriate laboratory infrastructure, and unsuitable equipment. Conclusion: The study highlighted the imbalances of staffing in the selected health facilities including surplus and excess staff. There is an urgent need to address human resource management issues in the district to ensure efficient delivery of health services. Further WISN assessment for all the public health facilities in Lango will help to improve the distribution of the laboratory workforce in the region. Key lessons learnt during the fellowship
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