Date Published: July 31, 2017
Author(s): Pascale Ondoa, Ankie van der Broek, Christel Jansen, Hilde de Bruijn, Constance Schultsz.
The 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.
This 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.
National 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.
Laboratories 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. The 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.
Laboratory services are key to the quality of healthcare but have remained a historically-neglected 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
We conducted a desk review of national health policy documents. Eligible documents had to be valid throughout and beyond 31 December 2010 and were collected in March 2012. No updated or new policies were added after document collection was closed. The analysis was completed at the end of 2013.
In total, 126 documents from 39 countries were found for review (Figure 1).
The attention devoted to medical laboratories in general, and to human resources in particular, in the round of national health policies and strategic plans that appeared shortly after the international momentum for the strengthening of laboratory services underscores the robust uptake of the recommendations of the Maputo Declaration in the majority of sub-Saharan African countries. However, 17 countries (43%) were still lagging behind the process at the time of the analysis in 2013. Strikingly, countries with less advanced laboratory policies and plans were mainly located in West and Central francophone Africa with a history of low HIV prevalence and limited PEPFAR investment. Combined with the observation that most laboratory issues were addressed in the context of HIV/AIDS, this finding illustrates the key role that international, vertical, disease-specific programmes, such as PEPFAR and the Global Fund, have played in prioritising and funding the development of laboratory systems in the region. At the same time, the report suggests that areas with smaller HIV epidemics benefited less from available opportunities to advance their national laboratory policy and strategic planning.