Improving Laboratories to Strengthen Health Systems

The Challenge

When COVID-19 overwhelmed health systems in Kenya, the surge in testing needs exposed serious gaps in Mbagathi Hospital's laboratory in Nairobi. Challenges ranged from broken equipment and supply shortages to slow service and limited funding.

These issues made diagnostic services unreliable and patient care less effective. Mbagathi Hospital, which serves over 1,000 patients daily and conducts 20,000 laboratory tests each month, urgently needed stronger diagnostic capacity.

CDC's Efforts

To address these challenges, CDC Kenya partnered with the Association of Public Health Laboratories (APHL) and Mbagathi Hospital to turn a once struggling public clinical laboratory into a successful self-sustaining operation. With support from CDC's Division of Global Health Protection (DGHP), the laboratory underwent intensive hands-on training, received essential equipment, and implemented modern lab management and quality assurance systems.

"As a result of these efforts, within 10 months, laboratory quality improved, which led to a spike in demand for testing services and, ultimately, increased revenue for the hospital," noted Bonventure Wachekone, PhD, Microbiologist, CDC Kenya. "This remarkable progress was achieved through a strategic partnership bringing modern laboratory management, quality assurance systems, and financial sustainability to the forefront," he said.

In March 2021, at the height of the pandemic, CDC's DGHP and APHL partnered to introduce SARS-CoV-2 molecular testing at Mbagathi Hospital to help meet the high demand for COVID-19 testing in the country. Alongside this effort, the team implemented a quality management system to improve test accuracy and consistency. The laboratory also began working toward ISO-15189 accreditation-a globally recognized certification for medical testing.

To support these improvements, the lab received essential equipment, and staff underwent comprehensive training, to strengthen skills and ensure accurate, dependable testing. The laboratory transformation process followed the World Health Organization Stepwise Laboratory Improvement Program Towards Accreditation (SLIPTA) requirements. This included incorporating thorough beginning (baseline), midterm, and end-term assessments to track progress.

A facility-focused mentorship approach was implemented providing weekly support, onsite and virtual training, and one-on-one mentorship as needed to strengthen laboratory operations.

Impact

The laboratory made significant improvements, raising SLIPTA performance from 55 percent at the beginning (baseline) to 90 percent by the end-of-term assessment. It developed clear standard operating procedures for how to run the lab and introduced consistent recordkeeping tools. Of the 64 tests routinely conducted in the lab, 70 percent were enrolled in an external quality assurance program, consistently achieving performance above 80 percent. The number of tests meeting accreditation standards grew from just 5 percent before the intervention to 69 percent after the intervention, giving patients more accurate and trusted results.

As quality improved, demand for lab services increased tenfold. Revenue from testing more than doubledꟷ representing a 259 percent increase in over two years. This financial growth reduced the laboratory's reliance on hospital budget allocations from the Ministry of Health and the county government. These gains reflect how CDC's support strengthens local capacity to help stop outbreaks before they spread, which protects Americans health and saves the U.S. money in the long run.

DGHP experts in CDC Kenya support played a key role in transforming Mbagathi's laboratory, leading to a series of positive outcomes. However, by 2022, improved operations led to a more than threefold increase in revenue, even while continuing to provide free services for vulnerable populations. These gains secured the lab's financial stability and reduced its reliance on government funding.

The lab's financial success helped strengthen the trust between the laboratory and hospital management, raising the hospital's status and opening doors to new partnershipsꟷ including antimicrobial resistance initiatives with East, Central & Southern Africa Health Community and research collaborations with the University of Nairobi.

In 2023, Mbagathi Hospital was named the "Best Performing Laboratory" in Nairobi County, recognizing its commitment to quality diagnostics and reliable service. Patients now rely on the laboratory for timely and accurate results, solidifying the hospital's reputation as a trusted facility in healthcare. "Thanks to the invaluable support from U.S. CDC Kenya, APHL, and Nairobi County, we've raised the quality of our laboratory services. This transformation has not only enhanced client satisfaction but also strengthened our financial standing, allowing us to continue delivering excellence," Martin Maitima, Laboratory Manager, Mbagathi Hospital, explained.

Broader Implications

Mbagathi Hospital's laboratory now serves as a model for other healthcare facilities in Kenya and beyond, demonstrating that quality-driven, revenue-generating laboratories can sustain themselves. Through strategic partnerships and a focus on sustainability, CDC Kenya continues to drive lasting improvements in healthcare quality and reliability.

This work is part of CDC's global health security efforts through DGHP, which helps countries detect and stop health threats at their source before they can reach the U.S. borders.

With continued training and innovation, Mbagathi Hospital aims to maintain its status as a trusted healthcare provider and further enhance improvements in laboratory diagnostics across the country. As Kenya moves toward a future of self-sustaining public health facilities, the impact of CDC Kenya's collaboration will be felt for generations to come.

CDC's preparedness work around the world delivers high returns at homeꟷsaving American lives, and ensuring a safer, stronger, and more prosperous future.