National laboratory policies and plans in sub-Saharan African countries: gaps and opportunities.

Pascale Ondoa,Ankie Van Der Broek,Christel Jansen,Hilde De Bruijn,Constance Schultsz

doi:10.4102/ajlm.v6i1.578

Abstract

BackgroundThe 2008 Maputo Declaration calls for the development of dedicated national laboratory policies and strategic plans supporting the enhancement of laboratory services in response to the long-lasting relegation of medical laboratory systems in sub-Saharan Africa.ObjectivesThis study describes the extent to which laboratories are addressed in the national health policies and plans created directly following the 2008 momentum for laboratory strengthening.MethodNational health policies and plans from 39 sub-Saharan African countries, valid throughout and beyond 31 December 2010 were collected in March 2012 and analysed during 2013.ResultsLaboratories were addressed by all countries. Human resources were the most addressed topic (38/39) and finances and budget were the least addressed (< 5/39). Countries lagging behind in national laboratory strategic planning at the end of 2013 (17/39) were more likely to be francophone countries located in West-Central Africa (13/17) and have historically low HIV prevalence. The most common gaps anticipated to compromise the implementation of the policies and plans were the disconnect between policies and plans, under-developed finance sections and monitoring and evaluating frameworks, absence of points of reference to define gaps and shortages, and inappropriate governance structure.ConclusionThe availability of laboratory policy and plan implementation can be improved by strictly applying a more standardised methodology for policy development, using harmonised norms to set targets for improvement and intensifying the establishment of directorates of laboratory services directly under the authority of Ministries of Health. Horizontal programmes such as the Global Health Security Agenda could provide the necessary impulse to take the least advanced countries on board.

Highlights

Laboratory services are key to the quality of healthcare but have remained a historicallyneglected component of health systems in low- and middle-income countries
The need for quality medical laboratory services to form an integrated part of the health system has been widely acknowledged by key national and international players during the past decade, resulting in the mobilisation of substantial funding earmarked for laboratory improvement in resource-limited settings.[1,2]
Sub-Saharan African countries identified by the World Health Organization as experiencing a crisis in human resources for health[15] or receiving support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) were included in the study,[16] which led to a review of 41 countries in total

Summary

Introduction

Laboratory services are key to the quality of healthcare but have remained a historicallyneglected component of health systems in low- and middle-income countries. The need for quality medical laboratory services to form an integrated part of the health system has been widely acknowledged by key national and international players during the past decade, resulting in the mobilisation of substantial funding earmarked for laboratory improvement in resource-limited settings.[1,2]. Alongside these efforts, the development of a national laboratory policy and strategic plan (NLSP) relevant to each country’s needs, and aligned with its health policy(ies) and plan(s), has been advocated.[3,4,5] A national laboratory policy defines the vision and the mission of a country’s laboratory system, whereas a strategic plan provides the corresponding roadmap guiding the process of the practical implementation of the necessary laboratory system improvement.

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Methods

Results

Discussion

Conclusion