Quality Assessment Manual

The first version of the WHO Malaria microscopy quality assurance manual (2009) was based on recommendations made at a series of informal consultations organized by WHO particularly a bi-regional meeting of the WHO regional offices for South-East Asia and the Western Pacific in April 2005 in Kuala Lumpur Malaysia followed by informal consultations held in March 2006 and February 2008 in Geneva Switzerland. Subsequently extensive consultations among international malaria experts led to consensus and preparation of the manual. This second version of the Manual is based on the recommendations of experts made at a WHO technical consultation in March 2014 in Geneva Switzerland. The aim of the meeting was to review the experiences of national malaria control programmes (NMCPs) national reference laboratories (NRLs) and technical agencies in using the Manual and country experience in order to improve systems for managing the quality of malaria microscopy. This second version takes into account the many years of experience of several agencies in the various aspects of quality assurance (QA) described in the Manual. In particular the sections on assessment of competence in malaria microscopy are based on use of this method by the WHO regional offices for South-East Asia and the Western Pacific in collaboration with the WHO Coordinating Centre for Malaria in Australia and by the WHO Regional Office for Africa in collaboration with Amref Health Africa. The section on setting up and managing an international reference malaria slide bank is based on the work of the WHO Regional Office for the Western Pacific in collaboration with the WHO Coordinating Centre for Malaria Diagnosis in the Philippines. The section on proficiency testing for malaria microscopy is based on work in the WHO Regional Office for Africa in collaboration with the National Institute for Communicable Diseases in South Africa and experience in regional initiatives by Amref Health Africa. The section on slide validation is based on work by Médecins sans Frontières and the section on outreach training and supportive supervision (OTSS) is based on work by the President's Malaria Initiative Malaria Care Project Medical Care Development International and Amref Health Africa. The Manual is designed primarily to assist managers of NMCPs and general laboratory services responsible for malaria control. The information is also applicable to nongovernmental organizations (NGOs) and funding agencies involved in improving quality management systems for malaria microscopy. The Manual is not designed for QA of microscopy in research situations such as in clinical trials of new drugs and vaccines or for monitoring parasite drug resistance. It forms part of a series of WHO documents designed to assist countries in improving the quality of malaria diagnosis in clinical settings including the revised training manuals on Basic malaria microscopy (2010) and the Bench aids for malaria microscopy (2010).

professional-standards-review organizations (PSRO) in defining quality of care for the Medicare program; it is a "shared responsibility of health professionals and government to provide a reasonable basis for confidence that action will be taken, both to assess whether services meet professionally recognized standards and to correct any deficiencies that may be found" (p. 14). Similar pronouncements have been made for the quality assurance activities of the Department of Defense's CHAMPUS program and of the 1980s successor to the PSROs, the federally designated peer-review organizations (PROs), established to ensure quality and utilization-efficient care for Medicare. Links between the federal and state gov ernments and between professional associations and private review entities have been developed to make this "shared responsibility" manifest in the delivery and reimbursement of health services. This responsibility is seen in light of both pro fessional and legal accountability, a view noted by Gibson and Singhas (1978) and Alger (1980). Accountability, then, becomes a concentric concept that elaborates on the pure view of quality and reflects the federal government's consumer protection activities during the 1970s. The Joint Commission on Accreditation of Hospitals (JCAH), which has pro vided another primary historical leadership role in defining quality assurance, has promoted the evolution of the concept of resource limitations as a part of the defini tion of quality assurance.