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
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Spring 2020 LAB MATTERS 19