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Essential Components of Integrated
National Laboratory Plans
2nd Meeting
of the Global Laboratory Initiative
John Nkengasong, PhD
Chief, International Laboratory Branch
Global AIDS Program
CDC Atlanta
October 15 – 16, 2009
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Outline
Existing National Laboratory Health System and
program support
Surge in funding for programs and laboratory
Essential elements of integrated Laboratory Plan
Examples of laboratory system strengthening
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Relationship between laboratory support and programs!
It is everything!
Molecular
testing –Polio,
TB, Flu, HIV
Microscopy
– TB/Malaria
Hematology,
cytometry, and
Chemistry - HIV
Serology -
HIV
Culture -TB
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Str
en
gth
en
ing
La
bo
ra
tor
y H
ea
lth
Sy
ste
ms
& S
us
tain
ab
ilit
y
Laboratory Services
La
bo
ra
tor
y S
ys
tem
s
Quality Management
System
Training & Retention
Systems
Equipment Maintenance
Systems
Supply Chain
Management System
Laboratory Information
Systems
Sample Referral
Systems
Policies
Sero
log
y
Mo
lecu
lar
Testi
ng
Hem
ato
log
y
CD
4
Ch
em
istr
y
Mic
rosco
py
Cu
ltu
re
Support Programs for:
Polio, Measles, Flu, Tuberculosis, Malaria, HIV/AIDS, Viral
Hepatitis, Sexually Transmitted infections
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Silos of National Reference Laboratories
Disease-specific laboratories are a common practice
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HIV and Polio Reference Laboratories
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National Reference Laboratory
Regional and District
Laboratories
Network of Neglected National Laboratory Systems
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World Bank MultiWorld Bank MultiWorld Bank MultiWorld Bank Multi----country AIDS Program (MAPcountry AIDS Program (MAPcountry AIDS Program (MAPcountry AIDS Program (MAP)
EDCTPWELCOME TRUST
The Bill and Melinda GATES FOUNDATION
Clinton Foundation
JICA FIND GLIUSAID GTZ
DFID - UK Department for International Development
EU
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The feasts before the famine?
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HIV/ AIDS:HIV/ AIDS:
Follow the MoneyFollow the Money
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Generosity can be a burden: Risk of emergence of parallel lab networks!
An Era of Increased Resources: An Opportunity or a Challenge?
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National Strategic National Strategic
Laboratory PlansLaboratory Plans
Foundation for developing
sustainable laboratory health
systems
National Laboratory PolicyNational Laboratory Policy
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The Maputo Declaration on Strengthening of Laboratory Systems
Call on national governments to support laboratory systems as a priority by developing a national laboratory policy within the national health development plan that will guide the implementation of a national strategic laboratory plan. Governments should establish a department of laboratory systems within the Ministry of Health.
Call on national governments with support of their donors and partners in resource-limited settings to develop national strategic laboratory plans that integrate laboratory support for the major diseases of public health importance including HIV, tuberculosis, and malaria.
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TB Reference laboratoryClinical Trial Laboratories
Tear down the walls between disease-specific laboratories
HIV Reference laboratory
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Diseases of Public Health ImportanceWhose Surge in Funding Can Drive Overall
Laboratory Strengthening Efforts
National Strategic PlansShould Integrate Major Diseases
Mala
ria
HIV
Tu
be
rcu
los
is
Po
lio, In
flue
nza
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Diseases of Public Health ImportanceWhose Surge in Funding Can Drive Overall
Laboratory Strengthening Efforts
Cross-CuttingStreams
National Strategic PlansShould Integrate Major Diseases
Mala
ria
HIV
Tu
be
rcu
los
is
Po
lio, In
flue
nza
Training/Retention
Infrastructure Development
Specimen Referral Systems
Quality Manangement Systems
Governance/Regulatory Policy
Supply chain/maintenance of equipment
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Development of National Strategic Laboratory Plan in PEPFAR-Supported Countries
Country
Engaged in
Discussion
Coordinating &
Technical Committees
Formed
Strategic Plan
Developed
Strategic Plan
Implemented
Strategic Plan
Progress Reviewed &
Evaluated
Cote d’IvoireEthiopia
Guyana
Kenya
Lesotho
Mozambique
NigeriaRwandaSwaziland
UgandaVietnam
TanzaniaSouth Africa
Namibia
Malawi
Haiti
Cambodia
Ghana
Cameroon
BotswanaBarbados
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Kenyan Laboratory Strategic Plans and Policy
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Laboratory Network Guidance
• Guide of National Public Health Laboratory Networking to Strengthen IDSR (2008).
• Focuses on how to enhancing multi-disease laboratory networks
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Diseases of Public Health ImportanceWhose Surge in Funding Can Drive Overall
Laboratory Strengthening Efforts
Cross-CuttingStreams
National Strategic PlansShould Integrate Major Diseases
Mala
ria
HIV
Tu
be
rcu
los
is
Po
lio, In
flue
nza
Training/Retention
Infrastructure Development
Specimen Referral Systems
Quality Manangement Systems
Governance/Regulatory Policy
Supply chain/maintenance of equipment
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Policy MakersPolicy MakersPolicy MakersPolicy Makers and Managers and Managers and Managers and Managers
Make it happen!Make it happen!Make it happen!Make it happen!
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TB, HIV, Malaria - Integrated Training Center, Zaria,
Nigeria
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Strengthened Laboratory Infrastructure for HIV/AIDS is being use to combat other diseases
Reference Laboratory for HIV, TB, AI
and Malaria
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• Lab Testing: – Quality Assurance – PCR – TB Microscopy
Lab Technologists70%
Training andRetention
Training, Mentorship, and Retention Strategies
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• Lab Testing: – Quality Assurance – PCR – TB Microscopy
• Public Health Microbiology• Lab Management• Training• Forecasting
Lab Managers
Lab Technologists
20%
70%
Training andRetention
Training, Mentorship, and Retention Strategies
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• Lab Testing: – Quality Assurance – PCR – TB Microscopy
• Public Health Microbiology• Lab Management• Training• Forecasting
Lab Policy Makers
Lab Managers
Lab Technologists
10%
20%
70%
• Retention Strategy• Role of Labs in Health System• Career Development of Labs
Training andRetention
Training, Mentorship, and Retention Strategies
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• Lab Testing: – Quality Assurance – PCR – TB Microscopy
• Public Health Microbiology• Lab Management• Training• Forecasting
Lab Policy Makers
Lab Managers
Lab Technologists
10%
20%
70%
• Retention Strategy• Role of Labs in Health System• Career Development of Labs
Training andRetention
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WHO AFRO Laboratory Accreditation – A Step-Wise
Approach Towards Quality Improvement
WHO AFRO *
WHO AFRO **
WHO AFRO ***
WHO AFRO ****
WHO AFRO ***** Commitment to continuous improvement
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Add Text here
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Media Coverage of Stepwise WHO-AFRO
Accreditation
Health organizations launch new lab accreditation processGovernment and health officials
from across Africa meet
NEWS IN BRIEF
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Former US President
Bill Clinton