Many countries in Africa have inadequate capacity to mount an effective response to regional and global public health threats.
A new regional laboratory networking project will strengthen health systems and address critical gaps in tuberculosis (TB) control in Kenya, Tanzania, Rwanda, and Uganda.
Each country will serve as a center of excellence for a key thematic area, promoting regional collaboration.
WASHINGTON, June 1, 2010—In health facilities across Eastern Africa, it is not unusual to wait long hours to be seen by a doctor or nurse, to receive urgently needed medications, or to retrieve laboratory results. In fact, wait times for laboratory results can run into several weeks—lost time as patients struggle with conditions as serious as multi drug resistant tuberculosis; lost time as infectious diseases spread undetected across national borders.
The World Bank’s recently approved US$63.66 million East Africa Public Health Laboratory Networking Project aims to establish an urgently needed network of high-quality public health laboratories. The laboratories will improve access to diagnostic services among vulnerable populations living in the cross-border areas of Kenya, Tanzania, Uganda, and Rwanda.
“The East Africa Public Health Laboratory Networking Project effectively addresses both a key weakness in health systems and a critical gap in the continental response to TB,” said Richard Scobey, Acting Director of Regional Integration in the World Bank’s Africa Region. “It represents our strong commitment to expanding access to services to vulnerable groups and highlights the innovative use of ICTs to improve public health in Africa.”
The laboratories in this regional network will serve as surveillance sites to monitor hot spots for disease transmission and will make optimal use of internet and mobile communications to improve public health. In addition, they will support the roll-out of new diagnostic technologies for drug resistance monitoring and for more efficient TB diagnosis.
The capacity to communicate outbreak-related information across national borders in real time is more important than ever before, as East Africa moves towards a common market that will allow greater labor mobility with an increased threat of disease transmission across countries.
For TB-HIV co-infected patients or those afflicted with drug resistant strains of TB, it is a struggle to obtain an accurate and timely diagnosis in a stigma-free environment.
Labs: A Critical Pillar in Health Systems
Laboratories are the weakest link in the region’s public health defenses, seriously hindering each country’s ability to confirm and respond in a coordinated manner to disease outbreaks. The laboratory networking project aims to address the common challenges facing the four countries: dilapidated infrastructure built decades ago; inadequate supply and quality of human resources which are the backbone of quality diagnostics; and manual information systems which are not effective for decision making.
“By creating a safe and productive environment and by improving the career prospects of laboratory personnel through a strong mentorship program coupled with a certificate award, we hope to restore trust in the laboratory by both clinicians and patients,” noted Dr. Willis Akhwale, Head of the Department of Disease Prevention and Control in Kenya’s Ministry of Public Health. “As we jointly scale up disease control efforts, we will focus on the evidence base for decision making which is becoming critical.”
Well functioning laboratory networks are critical for diagnosing pathogens and dealing effectively with disease outbreaks such as cholera, meningitis, and Rift Valley Fever.
“Tuberculosis control programs have been pioneers in promoting tiered networks of laboratories, hence can serve as an entry point for broader systems strengthening,” said Dr. Mario Raviglione, Director of the World Health Organization’s (WHO) Stop TB Program.
The project will adopt the WHO’s step-wise laboratory accreditation process, which promotes practical and affordable quality management systems aimed at enhancing accountability and sustainability.
“The Bank-supported East Africa Public Health Laboratory Network offers a monumental opportunity to contribute to global efforts and end the neglect of this critical pillar in health systems”, said Dr. John Nkengasong, acting Associate Director for Laboratory Science at the Center for Global Health at the United States Centers for Disease Control.
Centers of Excellence
Each country participating in the East Africa Public Health Laboratory Networking Project will become a center of excellence for a key aspect of the project. Rwanda will take the lead on ICT and performance-based financing. Kenya will serve as a center for integrated disease surveillance and response, and for operational research. Uganda will take the lead on laboratory networking and accreditation, and Tanzania will develop high-quality training programs.
“Taking a regional leadership role has an empowering effect,” noted Dr. Alex Opio,Assistant Commissioner of Health Services at the Ministry of Health in Uganda. “This is a tremendous opportunity to contribute to the new East African Community.”
Dr. Deo M. Mtasiwa, Chief Medical Officer, Ministry of Health and Social Welfare of Tanzania echoed this view. “Tanzania is committed to serve as a regional hub for training and to make optimal use of our state-of-the-art National Health Laboratory Quality Assurance and Training Centre,”he said.
Several partners have contributed actively to the design and development of the project, including the U.S. Centers for Disease Control, the World Health Organization, the United States Agency for International Development, and the International Union against Tuberculosis and Lung Disease.
Through partnerships, parallel grant financing for specialized TB diagnostics has been secured from the International Drug Purchase Facility (UNITAID) through the EXPAND-TB Project which is a collaborative effort of WHO/Global Laboratory Initiative, the Foundation for Innovative New Diagnostics and the Global Drug Facility.
The project will help implement the strategic disease control priorities of regional institutions such as the East African Community and the East, Central, and Southern Africa Health Community (ECSA-HC). ECSA-HC will play a critical convening and coordinating role at the regional level.
“We appreciate the World Bank’s effort to coordinate closely with other partners,” said Dr. Agnes Binagwaho, Permanent Secretary of Rwanda’s Ministry of Health, “this is very much in the spirit of synchronizing efforts and maximizing impact on the ground.”