Microscopy Quality Control in Médecins Sans Frontières Programs in Resource-Limited Settings

The international humanitarian medical aid organization Médecins Sans Frontières/Doctors Without Borders (MSF) supports a wide network of medical laboratories in resource-constrained countries. Although MSF has always prioritized quality control (QC) for laboratory testing, prior to 2005 we were constrained by two significant limitations. First the QC workload was unsustainable in many programs, as MSF used the traditional protocol of reexamining 10% of negative slides and all positive slides. This is no longer considered practical [1–3]. Second MSF had no system for central data analysis as QC was performed independently at the individual laboratory level without standardized protocols. In May 2005, MSF Operational Centre Amsterdam (MSF-OCA) developed and implemented a standardized, centrally reporting QC program to monitor the quality of microscopy for malaria, pulmonary tuberculosis (TB), and leishmaniasis. The malaria component of this protocol has been adapted by the World Health Organization (WHO) as the recommended international standard for malaria microscopy QC [4]. Here we present a description of the QC protocol and an analysis over a 3-year period, the latter reflecting how the QC protocol has contributed to improved performance.