Lab Matters Spring 2020 | Page 21

GLOBAL HEALTH Mapping Laboratory Capacity in Kenya for Global Health Security By Edwin Ochieng, MBA, senior laboratory technical manager, Global Health; Rufus Nyaga, informatics technical manager, Global Health; Reshma Kakkar, MA, manager, Global Health; Samantha Musumeci, MPH, specialist, Global Health; and Maria Landron, DrPH, senior specialist, Global Health Laboratories form the backbone of a country’s health system and are a key player in meeting global health security requirements, such as those set forth in the International Health Regulations (IHR). The Kenya National Public Health Laboratory (NPHL), responsible for the quality of diagnostic testing services in Kenya, is committed to supporting these goals. However, a thorough situational analysis was crucial to determine progress towards long-term global health security objectives. A Unique Project for Kenya The Laboratory Capacity Mapping Project was initiated in 2016 through the Centers for Disease Control and Prevention in Kenya. Its key objective was to determine the capacity of clinical/diagnostic testing, research, veterinary and environmental laboratories in Kenya. Laboratories at all three tiers were included to provide a comprehensive understanding of the country’s current capacity. In addition, the project would help develop a robust information system to collect, manage and display data effectively, including laboratory geographic locations. From 2016 to 2018, APHL served as a key partner to NPHL in gathering data from 1,820 facilities across all levels and tiers of laboratories. Data were captured using a questionnaire that was designed based on the capability maturity model and included categories on priority or reportable communicable diseases, policy, management of laboratory equipment and commodities, specimen testing workload and referrals, quality, biosafety/ biosecurity and zoonotic surveillance. The mapping project provided NPHL an opportunity to identify existing diagnostic laboratory testing capability, surveillance coverage and human resource capacity. These data will provide critical information for strengthening laboratory systems in Kenya, such as: • assisting policy makers to prioritize policy formulation • classifying existing sample referral networks and providing evidence for enhancing or establishing new networks • comparing performance between laboratories in the same tier to leverage available resources. NPHL expects the data to be invaluable for establishing measures to support effective preparation for and response to disease outbreaks. Lessons Learned • Stakeholder engagement is key to ensuring all health interests are addressed. This was important since the stakeholders represented counties, various sectors of national government, and different development partners. • Questionnaire development abided by the One Health approach and the technical work group members represented veterinary laboratories, research laboratories, and information and communication technology sectors. • Several iterations were needed before configuring the questionnaire into a data capture and analysis tool/system. • Having a backup plan is critical in the event the primary data collection tool does not work as planned. Kenya used DHIS2 Tracker which enables real time data collection. However, due to internet connectivity challenges, the teams had paper questionnaires available as well. Laboratory Organization Kenya’s laboratories are organized in three tiers: • national • county (equivalent to a US state) • sub-county (equivalent to a US county) Within these tiers are five laboratory levels, ranging from Level 2 to Level 6. Capability gradually increases across tiers. Level 2 labs primarily offer microscopy. A Level 6 laboratory is a national referral facility that conducts complex testing such as PCR. Moving Forward The Government of Kenya recently rolled out the Universal Health Coverage plan nationwide. As a result, it is likely that there will be changes in laboratory capacity. To keep up with these changes and routinely monitor laboratory capacity alterations, an important next step would be to enable laboratories to perform self-assessments and update their data on a periodic basis. These data, if shared across laboratory tiers and levels, would enable NPHL and other laboratories to understand their capacity relative to others in Kenya and determine progress over time. The lab mapping portal developed by APHL serves as a repository for these data and can provide up-to-date information to the government of Kenya and to counties. The completion of Kenya’s laboratory mapping activity has proven timely and significant. The questionnaire created for the laboratory-mapping project was shared with APHL’s COVID-19 incident command team to map out state COVID-19 response capacity at laboratories outside the public health system. n PublicHealthLabs @APHL Spring 2020 LAB MATTERS 19