Tuberculosis is the world's most serious infectious disease, with over 2 million deathsrneach year. About a third of the worldâ€™s populations are latently infected withrnMycobacterium tuberculosis. More than 95% of tuberculosis cases and deaths occur inrnresource-poor countries of the less-developed world. The diagnosis of tuberculosisrnmostly relies on tuberculin skin test, chest radiography, culture, and smear microscopy.rnSputum smear microscopy is the most widely used technique for the diagnosis ofrnpulmonary TB (PTB) especially in high prevalence countries. For effective TB detection,rnit is essential to assure the quality of smear microscopy. Quality Assurance (QA) is arnsystem designed to continuously improve the reliability and efficiency of laboratoryrnservices. Panel testing, one of the QA systems that can provide data on laboratoryrncapabilities and assess the current status of laboratory performance and detect problemsrnassociated with diagnostic performance. This study aims to prepare panel slides usingrnthree different methods, evaluate the efficiency of AFB smear microscopy in differentrnlaboratories in Ethiopia and the proficiency of peripheral laboratory technicians followingrntraining. Until now panel slides have been prepared by two methods. The methods usernAFB appositive and negative sputum samples treated with sodium hydroxide (NaOH)rnand N-acetyl- L-cysteine (NALC). The third procedure of preparation of sputum smearrnslides for panel testing using new artificial sputum preparation method was developedrnand examined using a cultured monocyte cell line, cultured avirulent mycobacteria andrnmethyl cellulose(MC) or polyacrylamide gel (PAM) for viscosity and background.rnSince it is expensive and tedious to grow monocytes in the laboratory we used pus drawnrnfrom acute abscesses in patients admitted to St. Paul hospital. Panel slides were preparedrnusing the above three methods and compared. Slides prepared using NaOH werernconsistent with positivity grades but were not similar with real direct sputum smearsrnmacroscopically or microscopically. But slides made using PAM and MC were consistentrnwith panel positivity grades and were similar to real direct sputum smears. Slides madernwith the three methods were found as they can be used for EQA and training inrntuberculosis laboratories and microscopy centers. The slides were sent to 56 laboratoriesrnin the country to assess the performance of laboratory technicians. The result shows thatrnthe personnel were proficient enough to detect positive smears. A total of 29 techniciansrnwere trained and tested. Their results show that there was definite improvement afterrntraining. The results before training show that there is a high possibility of falsernnegativity as a result of low performance of laboratory technicians. So panel slides havernsignificant importance in assessing the performance of laboratory technicians andrnevaluating their proficiency before and after training. Moreover since the efficiency ofrnlab technicians has significant effect on smear microscopy result, continuous externalrnquality assessment has to be conducted using methods like panel slides.rnKey words: External quality assessment, panel test, validity, Mycobacterium tuberculosis