The development objective of the project is to establish a network of efficient, high quality, accessible public health laboratories for the diagnosis and surveillance of TB and other communicable diseases.
The project seeks to address common lab systems weaknesses in four adjoining countries (Kenya, Rwanda, Tanzania, and Uganda) to diagnose communicable diseases of public health importance and to share information about those diseases to mount an effective regional response.
It aims to do this through an effective public health laboratory network which would follow regionally harmonized policies, strategies, and protocols to ensure prompt and high quality results.
The project also aims to strengthen linkages with ongoing regional initiatives in East Africa to improve integrated disease surveillance.
The project activities are fully consistent with broader health strategies in the four countries (which include a strong emphasis on strengthening diagnostic and surveillance capacities) and with interventions funded by other partners (as summarized in tables 1/2 below).
Partner support will include: lab accreditation (WHO), SRL establishment (WHO, USAID), technical training and technical support (CDC, FIND, WHO), facility design/rehabilitation/construction (USG/PEFPAR); and e-health/integrated disease surveillance (African Development Bank, Rockefeller Foundation).
The proposed regional laboratory network aims to:
(a) Enhance access to diagnostic services for vulnerable groups to contain the spread of diseases in cross border areas;
(b) Improve capacity to provide specialized diagnostic services and conduct drug resistance monitoring at regional level;
(c) Contribute to disease surveillance and emergency preparedness efforts through the availability of timely lab data to provide early warning of public health events; and
(d) Serve as a platform for conducting training and research. The lab network will facilitate the adoption of harmonized policies, strategies, and protocols to ensure prompt and high quality results. Priority attention will be given to networking satellite labs that serve cross border and migrant populations, and central public health labs that provide specialized services. The proposed activities aim to reinforce related activities at the national level in the participating countries. While all four countries have national networks of microscopy centers supported by governments and partners this project aims to expand networking to the regional level, complementing national efforts. The network will be backed by strong national and regional reference laboratories and institutions to build competencies of laboratory staff and to promote quality assurance.
During regional consultations, participating countries have developed a common vision and reconfirmed their commitment towards preventing and controlling the spread of communicable diseases in the Eastern Africa Region where heads of state recently signed an agreement to establish a common market which will lead to broader collaboration in all areas, including health.
They have acknowledged the importance of developing harmonized approaches, promoting specialization, and expanding information
sharing about public health issues. The countries have agreed to provide leadership at the regional level by leading working groups in key technical areas where each has a comparative advantage and would serve as a center of excellence, as follows:
KENYA — Integrated Disease Surveillance and Response & Operational Research:
Building on its relatively strong IDSR system Kenya has agreed to serve as a center of excellence for disease surveillance as well as operational research. It will:
(i) lead the development of harmonized tools;
(ii) promote cross border surveillance and joint outbreak investigations;
(iii) share lessons from the successful field epidemiology fellowship program (FELTP), and offer training programs to build regional surveillance capacities; and
(iv) collaborate closely with the EAC to strengthen the East African Integrated Disease Surveillance Network. Kenya will also lead a regional working group on operational research and work closely with ECSA-HC to develop standardized research protocols.
UGANDA — Lab networking and accreditation:
Uganda will provide leadership in establishing the East Africa public health regional laboratory network, working closely with ECSA-HC and the Regional Advisory Panel. This will involve:
(i) development of common standards;
(ii) standardization of quality assurance systems;
(iii) introduction of peer review mechanisms; and
(iv) application of the WHO/AFRO five-step accreditation process to accredit all satellite laboratories in the proposed network to progressively meet the international gold standard certification with clearly defined parameters for turnaround time, quality, and proficiency.
TANZANIA–Training and capacity building:
Tanzania will provide high quality training in laboratory techniques at its new state of the art Quality Assurance Training facility and diploma and degree programs at the Muhimbili University of Health and Allied Sciences. Tanzania will use a phased approach:
(i) initially offering short term courses;
(ii) sharing training curricula and programs with other countries;
(iii) providing TA to other countries to develop continuing education programs; and
(iv) developing e-learning approaches for distance learning.
RWANDA–ICT, Performance Based Financing, MDR-TB:
Rwanda has agreed to take a regional lead in expanding use of ICT and promoting PBF approaches for lab services, building on its well recognized successes in these areas. The ICT aspects of the project are presented in Box 1 below. Rwanda will:
(i) share its tools (e.g. standards and guidelines, reporting forms, request for proposals);
(ii) provide related training, capacity building, and technical support as well as organize site visits;
(iii) take a lead in determining the applicability of the PBF approach to public health laboratories and document and share lessons. Rwanda has also been selected as a center of excellence for MDR-TB for the Africa region by the Dutch TB Foundation (KNCV) and will also share lessons in this area.