In the wake of the 2014–2016, West Africa Ebola virus disease (EVD) outbreak, the Government of Guinea recognized an opportunity to strengthen its national laboratory system, incorporating capacity and investments developed during the response. The Ministry of Health (MOH) identified creation of a holistic, safe, secure, and timely national specimen referral system as a priority for improved detection and confirmation of priority diseases, in line with national Integrated Disease Surveillance and Response guidelines. The project consisted of two parts, each led by different implementing partners working collaboratively together and with the Ministry of Health: the development and approval of a national specimen referral policy, and pilot implementation of a specimen referral system, modeled on the policy, in three prefectures. This paper describes the successful execution of the project, highlighting the opportunities and challenges of building sustainable health systems capacity during and after public health emergencies, and provides lessons learned for strengthening national capabilities for surveillance and disease diagnosis.
Introduction
Laboratories are critical infrastructure for early detection and reporting of disease, and are most effective when organized into an integrated, multi-level network, enabling timely access to appropriate diagnostic tools at each level (1, 2). Tiered laboratory networks facilitate sequential diagnostic testing to identify or confirm the etiological agent(s) causing disease. Within the laboratory network, a formal structure for the referral and transport of diagnostic specimens can minimize transfer steps and facilitate rapid diagnosis and laboratory confirmation, thus reducing the time for reporting of new cases, or an emerging outbreak, as well as improving safe and secure sample management (3–6).
The Republic of Guinea did not have a national system for referral of diagnostic specimens prior to the emergence of Ebola virus disease (EVD) in its southeastern Forest Region in late 2014. Mechanisms for transport of samples from the peripheral parts of the health system to the national level were limited to vertically-funded disease control programs, such as those managed by the World Health Organization (WHO) in collaboration with the Ministry of Health (MOH) for vaccine-preventable illnesses (7). Although the transport system for vaccine-preventable illnesses, for example, encapsulated multiple diseases such as polio and measles, it was not designed to cover all notifiable or even priority diseases and was fully supported by external funding. During the EVD outbreak in 2014–2016, an ad hoc system emerged to cope with the urgent need to refer and transport large numbers of diagnostic specimens between Ebola Treatment Units and specialized, often temporary, laboratories set up to deal with the crisis. Significant investments, including training, vehicles, and materials, were provided down to the local level to support rapid testing of suspected EVD cases. A number of international donors, including the United States, France, and Russia, provided substantial assistance with respect to laboratory capacity building, including provision of self-contained laboratory units that were later donated to the Government of Guinea (8–12). As the outbreak declined in intensity, the MOH identified an opportunity to leverage investments made during the crisis to create a comprehensive and holistic national system for specimen referral.
Based on this experience, and in the context of broader efforts to strengthen the national laboratory network, the MOH requested assistance from international partners to develop a national specimen referral system, which would cover all priority diseases requiring confirmatory diagnosis. The system needed to (1) remain consistent with national disease detection and surveillance guidelines, such as those developed under Integrated Disease Surveillance and Response (IDSR; known in Guinea by its French acronym, SIMR); (2) align with international frameworks, such as the International Health Regulations (IHR 2005); and (3) consider local constraints, such as long-term availability of resources, prospective vs. actual capacity at the different levels of the laboratory system, and sustainable transport mechanisms. This effort was initiated by the MOH in collaboration with CDC's Guinea country office and its implementing partners at Georgetown University1 (GU) and International Medical Corps (IMC). Here, we present an overview of the project, with an emphasis on specific next steps for Guinea's system of specimen referral, as well as broader lessons learned for developing national capacity on the back of a public health crisis.
Voir détails trending_flat
