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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