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

Abstract

IntroductionLaboratory 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 also 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. The coherence of NLSPs with other national health guidance documents, such as national health policies, plans for development of human resources for the health sector, or disease-specific policies or plans, increases the likelihood that laboratory development strategies will be implemented.Despite the recent prioritisation of laboratory services in global and national health agendas, various aspects of the laboratory system fail to meet standards in several countries of sub-Saharan Africa. Clinical diagnostic capacity often remains insufficient for the control of HIV, malaria, tuberculosis and other infectious diseases and for responding to the rise in incidence of noncommunicable diseases. 6,7,8 In addition, the lack of laboratory-based surveillance precludes the Background: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.Objectives: 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.Method: 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. Results: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 inappropr...

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