Background:Tuberculosis (TB) is an infectious disease caused mainly by the bacillusrnMycobacterium tuberculosis and it remains a major public health problem. Globally 10.0 peoplernwere ill and 1.3 million died of tuberculosis in 2017/18.In resource limited settings, tuberculosisrndiagnosis relies on sputum smear microscopy with many variables affecting the sensitivity andrnspecificity.Tuberculosis is considered as a â€œglobal emergencyâ€ by the World HealthrnOrganization (WHO). Fluorescence microscopy (FM) can improve performance of microscopyrnand with the new light emitting diode (LED), technologies could be appropriate for peripheralrnsettings. The WHO defines External Quality Assessment (EQA) as a system for objectivelyrnchecking a laboratoryâ€™s performance using an external agency or facility. EQA participation isrnassociated with improved laboratory performance over time and is a requirement forrnaccreditation.rnHowever, many professionals in Sub-Saharan countries including Ethiopia are unable torneffectively implement quality improvement programs and many laboratories in Ethiopia remainrnwithout an accredited clinical laboratory.rnObjective: To assess the Performance of TB Smear Microscopistson fluorescent stainedrnmicroscopy among Health facilities of Eastern Region of Oromia, Ethiopia, 2018.rnMethods: Afacility based cross sectional study design was conducted on 57 government Healthrnfacilitiesin Eastern Oromia Regional State from September to December 2018. The study wasrnincluded 57 governmental health facilities (42 health centers and 15 hospitals). Panel slides werernprepared and validatedat Adama Public Health Referral and Research LaboratoryrnCentrecustomized checklist were used to conduct on site supervision and slides were collectedrnfor Random Blinded Re-checking by Lot Quality Assurance Sampling Data were collected usingrnthe three external quality assessment methods.DataTechniques. Datawaswereentered into EPIrnInfo version 7 and transported to SPSS version 21.0 for analysis. The percentof agreements,rndifferences and different types of errors were calculated. The Sensitivity, Specificity, PPV, NPVrnof smear reading by TB smear Mmicroscopist was calculated. The strength of an agreementrnamong between participant readers and the reference readers were assessed using kapparnstatistics.rnResults: In this study, the overall achievements during onsite evaluation were 62.7% and thernoverall agreement in reading among smear between mMicroscopists and Reference readersrnwere92.21%92.21 %( kappa=0.755),which was good agreement.Overallagreement. OverallrnSensitivity and Specificity of detecting TB-FM bacilli were 90.54% and 94.03% respectively.rnThe overall errors for panel test were 185(9.3%) which indicates25(1.26%) major errors,rn160(8.04%) minor errors. The overall Sensitivity, Specificity, PPV and NPV for blindedrnrechecking were 93.755.1%, 99.608%, 96.151.67% and 99.3547% respectively.rnConclusionsand Recommendation: The overall performance of panel testing and randomrnblinded re-checking were satisfactory for this study but the overall facilities assessment resultsrnfor on-site evaluation were (62.53%)this need more effort to improve the performance.rnErrorsBesides, the total errors committed were 9.3% and majority of them were minor errors andrnthe presence of this errorscommitted areare alarming for TB control program and due attentionrnshould be given for FM EQA method since the method is applied recently and not familiarizedrnas that of ZN method. This study recommended that, much effort should be made by laboratoryrnprofessionals need to up-grade their educational level to maximize the levelrnofagreement.method. Adama Public Health Referral and Research Laboratory Center and recheckingrnlaboratoriesrnshouldrngiverncorrectivernactionsrnsuchrnas,rnconsistentrnrefreshmentrntrainingrnandrnregularrnsupportivernsupervisionsrnasrnperrnthernEQArnguidelinesrnand further researches should also bernconducted.