Inside the NIP’s turnaround – from 59% to 93% TAT

Kapena Tjombonde

When turnaround-time (TAT) performance across Namibia’s national laboratory network moved from 59% to 93%, the improvement represented more than an operational milestone.

It essentially meant clinicians could receive critical evidence sooner, strengthening their ability to diagnose illness and determine treatment.

Yet the most important question was not what the figures said about the institution, but whether patients experienced a faster and more dependable service.

Turnaround time is not an abstract management indicator. It measures how quickly clinicians receive the evidence they need to diagnose illness and determine the appropriate treatment.

But this TAT is influenced by a myriad of factors. Delays can obstruct clinical decisions, while dependable results can accelerate them.

The real significance of the improvement therefore is not only in the percentage, but in whether the laboratory system is ready to produce a consistently faster and more reliable national pathology service.

The scale and urgency of the challenge is evident in four figures:

-​ 9.7% of Namibian adults earn more than N$11,000 per month

-​ more than 80% of Namibians depend on public health facilities

-​ laboratory results influence about 70% of clinical decisions

-​ about 40% of Namibia’s health workforce serve more than 80% of the population relying on the public health sector.

-​ while more than 60% of the health workforce serve the remaining 20% of the population accessing private health care.

To me, these figures underscored the consequence, the urgency and the scale of the burden – but they also made consistency and equitable access indispensable.

Against that backdrop, I saw the national laboratory network not as a back-office function but as critical health infrastructure.

I believed any claim of reform had to be judged by a demanding standard: whether services remained available, accessible and dependable in the public health facilities, serving the country’s most vulnerable patients.

We acutely engaged in the turnaround anchored on three levers: people, process and technology – a famous framework often described as the “Golden Triangle”.

As a team, we knew the approach would be credible only if we changed all three simultaneously. New equipment alone would not repair weak workflows; redesigned processes would achieve little without empowered staff; and leadership development initiatives would fail if the operating system remained unreliable.

We conducted section-by-section and department-by-department deep-dive reviews to trace visible breakdowns to their root causes.

I considered this more searching than treating missed targets as isolated incidents. It allowed us to test whether recurring problems originated in staffing, procurement, logistics, people, workflow or technology – and whether our corrective action addressed the cause rather than the symptom.

This was not an overnight assignment; it took considerable time and effort.

People: We implemented a people strategy – invested in leadership development, culture change and coaching. We introduced supply-chain & logistics expertise and created a graduate development programme (GDP).

The GDP included qualified medical technologists, who often did not have a job, placed at the 13 one-man laboratories for 24 months, to gain job market experience, but also to enhance the solo operation.

Our aim was to strengthen both immediate performance and the next generation of institutional capability.

Process: We identified and mapped business processes, reviewed how work moved across the critical functions, and targeted areas for improvement and sustained management.

We paid particular attention to blood sample movements, stock management, supply chain and logistics because laboratory performance depends not only on testing, but also on the reliable movement of supplies, samples and information.

Technology: We assessed the state of laboratory and ICT infrastructure, planned upgrades and invested systematically in digital transformation.

We replaced testing platforms while strengthening the broader technology environment to deliver results faster. We automated critical processes.

It was clear that none of these pillars could succeed in isolation. Our breakthrough came from coordinating all three dimensions deliberately.

A great workforce cannot deliver consistently through broken processes; efficient processes cannot compensate for obsolete systems; and technology cannot transform an organisation whose people are unprepared to use it.

For me, the strongest evidence of our work was not the strategy itself, but the discipline we used to enforce it.

We formulated and monitored implementation plans monthly, quarterly and annually against strategic objectives. It was not just a cosmetic strategic plan; it was a daily mantra.

That cadence mattered because public-sector reform often falters between announcement and execution. Regular gauging made slippage harder to hide, responsibility easier to assign and accountability more visible.

Every week, we reviewed TAT across 37 laboratories and announced the strongest results, and I delightfully witnessed how performance moved from good to great! This visibility propelled the entire organisation to focus on its mandate.

The logic that guided us was simple but powerful: when individuals became more effective, teams improved; when teams improved, departments performed better; and when departments worked together, the organisation became effective and ultimately the laboratory system became more capable of saving lives.

The central lesson I took from this experience is not simply that transformation can work. I never saw effective operational continuity and institutional transformation as competing aims; both were conditions of a credible turnaround.
It is that reform must proceed without losing focus on the basics and/or destabilising the essential service patients need every day. A long-term redesign has value only if service is not interrupted during the reinvention.

In a nutshell, while the improved turnaround time proved vital; it created a great momentum to become the greatest benchmark regionally.

I learned that a successful turnaround is not a slogan. It is a system made measurable, accountable and dependable – so that the capacity we build in our institutions serves the broader national development agenda across all our public enterprises.

Kapena Tjombonde is the former CEO of NIP, and writes in her personal capacity.