Assessing the effectiveness of the integrated sample referral system in Tanzania: insights from a nationwide study

A well-structured laboratory network with a reliable biological sample transportation system ensures timely detection, prevention, and response to public health threats. We evaluated the sample referral system in Tanzania from July to December 2020 to identify key improvement areas. The study involved 97 hubs covering 21 of 26 regions. We collected data on management, financing, data collection, monitoring, human resources, equipment, network design, scheduling, and transportation through interviews, observations, and document reviews. Data were analyzed using Microsoft Excel and presented in tables, graphs, and charts. Overall performance was 63.6% (95% CI: 52.3-75.0). Specialized laboratory hubs scored highest, 79.5% (95% CI: 70.6-89.1). Specialized hospitals performed the best in all components, ranging from 68.8% to 100%. Regional referral hospitals were the second-best performers, ranging from 59.6% to 72.1%. Health centers performed least in management (54.8%), financing and costing (32.7%), and data collection, monitoring, and evaluation (45.2%). We found inconsistencies in the performance of sample referral hubs at various levels and components, highlighting the need for targeted capacity enhancement to improve the sample referral system. We recommend adopting context-specific strategies to address the unique needs of each hub level.