|Cascade phase||Barrier||Country||PPP||PPP Intervention||Impact||Source|
|Pre-analytical Phase||Poor and non-standardized specimen collection procedures.||Kenya||L4L||• Trained 91 HCW on safe phlebotomy collection practices.||
• Increased knowledge of phlebotomists by 41%.|
• Integration of safe phlebotomy practices into pre-service training.
|Kimani et.al., |
|Weak supply chain and unreliable specimen transportation system.||Gambia, Kenya, Lesotho, Malawi, Nigeria, Zambia, Zimbabwe.||Riders for Health||
• Accessed hard-to- reach communities for healthcare needs by providing motorcycles for transportation.|
• Trained healthcare workers on managing supply chain distribution of medicines, transportation of specimens and return of results and managed emergency referrals.
• Improved access to 14.5 million people to healthcare.|
• Transported 400, 000 specimens/year between laboratory and healthcare facilities.
WHO [23, 28]|
World Bank 
|Weak specimen transportation system.||Uganda||L4L||
• Use of GIS to map efficient sample referral network.|
• Provided standardized specimen transportation materials.
• Training of transporters to safely package and transport specimens.
• Ten-fold increase in referrals of patients sample with presumptive MDR-TB.|
• 94% specimens reached the national laboratory within the established target time of 72 h.
|Joloba et al., |
|Analytical Phase||Lack of skilled workforce, modern laboratory infrastructure to provide timely and accurate services to patients.||SSA||Global Access Program||• Engaged manufacturer and negotiated lower prices for HIV VL and EID reagents.||
• 300, 000 infants enrolled into care and treatment.|
• Provided 900,000 tests for EID.
• – Projected anticipated cost savings of $150 million in next 5 years.
|Roche Diagnostics |
|SSA||Turn Key Laboratory||• Set up‘Turn Key Laboratory’ for access to pediatric testing.||
• 900,000 tests were made available.|
• 100 laboratories in SSA now routinely offer PCR for EID.
|Roche Diagnostics |
|Mozambique||L4L||• Establishment of national laboratory quality assurance program to facilitate stepwise quality improvement of laboratory services.||• Trained and mentorship resulted in 18 MOH qualified auditors and 28 manager/quality officers capacitated to manage improvements of laboratories and steer towards accreditation.||Skaggs et al., |
• Built and modernized 23 regional-level laboratories,|
• Built outpatient center at the national hospital serving 1000 patients/day.
• Provided mentorship.
• 10 fold increase (from 110,000 to 1,158,000) in test volumes in 5 years.|
• Improved healthcare services for people living with HIV and other chronic diseases across the country.
|Abbott Fund |
|Post - analytical phase||Delayed and inconsistent delivery of VL and EID test results to patients.||Ethiopia||L4L||
• Used GIS to map and network 554 clinic facilities to laboratories testing for VL, EID, CD4 and hematology.|
• Procured 400 standard specimen transportation containers.
• Trained 586 and 81 laboratory and postal workers, respectively.
• 50% reduction in TAT (from specimen collection to reporting results) for ART patients (10 to 5 days).|
• Standardized training module used for training in all the regions
• 62% in cost savings for transporting EID specimens.
• Reduced TAT from 1 to 2 months to 5–10 days.
Kebede et al., |
Kiyaga et al. 
|Kenya, Tanzania and Rwanda||Phones for Health||
• Allowed input of health data and transfer to central database.|
• Enabled ordering medicines, sending alerts and download of guidelines.
• Enabled access to training materials.
• Facilitated transmission of results to SMS printers.
• Improved access to knowledge and information of 50,000 community health workers.|
• Reduced TAT for results delivery
• Effective monitoring of mother-to-child transmission through EID systems rolled out to 63 sites nationally.
|UNAIDS , Fogarty |