Laboratory systems and services are critical in global health: time to end the neglect?

Abstract

The $63 billion comprehensive global health initiative (GHI) emphasizes health systems strengthening (HSS) to tackle challenges, including child and maternal health, HIV/AIDS, family planning, and neglected tropical diseases. GHI and other initiatives are critical to fighting emerging and reemerging diseases in resource-poor countries. HSS is also an increasing focus of the $49 billion program of the US President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Laboratory systems and services are often neglected in resource-poor settings, but the funding offers an opportunity to end the neglect. To sustainably strengthen national laboratory systems in resource-poor countries, the following approaches are needed: (1) developing integrative national laboratory strategic plans and policies and building systems to address multiple diseases; (2) establishing public-private partnerships; (3) ensuring effective leadership, commitment, and coordination by host governments of efforts of donors and partners; (4) establishing and/or strengthening centers of excellence and field epidemiology and laboratory training programs to meet short- and medium-term training and retention goals; and (5) establishing affordable, scalable, and effective laboratory accreditation schemes to ensure quality of laboratory tests and bridge the gap between clinicians and laboratory experts on the use of test results.

Figure 1

Core cross-cutting elements of laboratory health systems that should be strengthened to support multiple diseases of public health importance. Horizontal arrows indicate cross-cutting core elements that affect laboratories and need to be addressed in a national laboratory strategic plan, regardless of the disease. These core elements must be addressed at various levels of a tiered laboratory network. The vertical arrows are examples of major public health diseases that have seen a surge in funding that can drive the laboratory systems to be strengthened in resource-poor countries.

Figure 2

Potential structure of a national laboratory network system in resource-poor countries. In this structure, clear lines of functions, authority, and responsibility are outlined from the central public health laboratory (CPHL) to the primary health center (PHC). For example, the CPHL sets policy, conducts planning, and establishes appropriate quality management systems. In larger countries, regional public health laboratories may need to take on the responsibilities of the CPHL so as to reach the PHC.

Figure 3

Proposed framework for strengthening laboratory systems globally showing the core elements of a laboratory system that need to be strengthened, with the surge in HIV/AIDS and tuberculosis funding, to provide broad-based, integrated, quality laboratory services and ensure sustainability of global laboratory investments. This approach will be needed to combat multiple global disease program needs, especially for infections that do not have specific funding. For example, for serologic diagnosis of any disease to be effective in a resource-poor country, there is a need to adequately address issues related to quality management, training and retention, equipment procurement and maintenance, supply chain management, laboratory information systems, biosafety, and policy.