Attachments
M. Ikuro, J. Okonji, B. Kiptoo, P. Mundia, R. Kithuka, F. Chikomera, E. Ochieng, S. Monthe, B. Waliuba, I.Bosire, S. Karuntimi, S. Malinga, S. Hussien.
Background
The International Rescue Committee (IRC) in Kenya is a non-profit humanitarian organization focused on delivering innovative, result-oriented health services and development programs that support refugees and vulnerable host communities in Kenya. IRC, as an implementing partner for the United Nations High Commissioner for Refugees (UNHCR), provides support to those impacted by conflict and disaster through direct health service delivery, partnerships, and systems strengthening, reducing their risk of illness and offering treatment when necessary. They employ a range of strategies focused on health promotion, prevention, and care.
Located in Turkana County, Kenya, Kakuma Refugee Camp was established in 1992 to serve Sudanese refugees fleeing civil war. Over the years, the camp grew into a haven for refugees from Somalia, Ethiopia, Burundi, the Democratic Republic of Congo, Eritrea, Uganda, Rwanda, and others.
Today, the camp hosts 289,861 refugees and asylum-seekers. Ammusait Hospital, specifically, serves a population of 197,000 refugees and 19,700 host community members, making it a critical hub for health services in Turkana County. The hospital provides primary health care services, surgical services, referral services to adjacent health facilities, and a wide range of laboratory services. Ammusait has a bed capacity of 180, which, at times, is stretched beyond capacity and can reach up to 300 admissions during surges. The hospital was initially established in 2016 following a demand for services within the camp and the absence of nearby healthcare facilities, with many located hundreds of kilometers away. Essential services needed to be made more easily accessible to refugees and vulnerable host communities.
Since 2010, Kenya has used the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) framework to improve quality management systems and prepare medical laboratories to achieve ISO accreditation.
However, less than 10% of enrolled laboratories had done so in the initial seven years of Strengthening Laboratory Management Toward Accreditation (SLMTA) implementation (Makokha, 2022). Efforts to achieve accreditation for laboratories in refugee settings have been limited.
Achieving International Organization for Standardization (ISO) accreditation was a rigorous process that spanned nearly four years, from January 2021 to October 2024. The journey involved several key steps. For one, the laboratory worked closely with various health partners, including the Ministry of Health, UNHCR, CDC, APHL, and IRC field. This collaboration ensured alignment with best practices and strengthened community health responses, particularly in addressing COVID-19 and routine healthcare needs.
Regular evaluations were conducted by experts, including those from the APHL, who were engaged in planning and assessing gaps and developing mechanisms to enhance processes. Additionally, training in COVID-19 PCR testing, GeneXpert reporting, and Rapid Diagnostic Testing (RDT) was also provided by specialists to build staff capacity.
A robust Quality Management System (QMS) was implemented to maintain high standards and support continuous improvement, with mentorship from the APHL to enhance staff understanding of documentation, quality control, and risk management. In March 2022, a Real-time PCR machine was installed to improve molecular testing capabilities. Staff received comprehensive training in operating the new equipment, ensuring improved accuracy in testing. Today, the lab is capable of conducting over 55 different routine tests onsite, a substantial increase in its testing capacity.