External quality assessment of smear microscopy by the National Reference Laboratory in nine states of India.

The quality of sputum smear microscopy in nine Intermediate Reference Laboratories (IRLs) was assessed based on onsite evaluation conducted by the National Reference Laboratory (NRL) in India, which supervises the IRLs for external quality assessment. The IRLs were evaluated, problems were identified, causes were explored and remedial actions were suggested. The NRL reports and feedback from the states were evaluated. Of the corrective actions recommended during the initial NRL evaluation visits, 65% were implemented within a month. Subsequent visits to seven IRLs showed 80% improvement. The NRL suggestions resulted in immediate corrective actions and had a sustained impact.