Clinical Laboratory Networks Contribute to Strengthening Disease Surveillance: The RESAOLAB Project in West Africa

S ufficient laboratory capacity is essential to effective infectious disease surveillance and control. This is recognized in the current International Health Regulations (IHR), which identify laboratory services as a category of core capacities that all the World Health Organization (WHO) Member States are expected to develop and maintain (1). IHR Core Capacity 8 requires laboratory services for every phase of real-time event management (i.e., detection, investigation, and response), with sample analysis being performed either domestically or through collaboration centers (2). Laboratory services are considered a key component of national health systems, with the Integrated Disease Surveillance and Response (IDSR) utilizing the structures, processes and personnel of national clinical laboratory services for disease surveillance. However, laboratory services for both patient care and disease surveillance remain among the most neglected components of the overall health system in resource-poor countries. Challenges include lack of national laboratory policy and strategic planning, insufficient numbers of trained professionals, poor laboratory infrastructures, and absence of quality management systems (3). Thus, several calls have been put forth to improve laboratory capacity in resource-poor countries. In 2008, representatives of African governments, local and international partners participated in a consensus meeting on clinical laboratory in Maputo, Mozambique. Meeting participants called on national governments to develop national laboratory policies and to provide laboratory support for diseases of public health importance; and they called on donors and development partners to commit to work collaboratively with each other and with coordination from national governments to strengthen laboratory systems (4). The WHO Regional Office for Africa (WHO/AFRO) has also advocated strengthening national public health laboratories (5). Also in 2008, WHO and the US Centers for Disease Control and Prevention (CDC), Atlanta, USA, convened in Lyon, France, an international conference on laboratory quality systems. During that meeting, the need for accurate laboratory testing was stressed, with poor quality laboratory services in resource-constrained countries leading to untold misery in human lives and unnecessary expenditures due to inadequate treatment (6). Eight key interventions were identified: (i) strengthening laboratory management at all levels; (ii) strengthening infrastructure and support systems; (iii) developing human capacity; (iv) establishing a national laboratory referral network; (v) establishing a national quality assurance program; (vi) developing a comprehensive monitoring system including laboratory information management system; (vii) coordinating government and partner support activities; and (vii) mobilizing resources to finance the strategic plan. The need to integrate networks that already exist mostly those related to malaria, tuberculosis and HIV/ AIDS was also stressed. In response to these calls, several international development partners have been implementing capacity building programs that include the training of laboratory personnel in epidemiology (7), microbiology (8) and quality assurance (9). In 2005, Fondation Mérieux, with the support of the European Commission, launched a national laboratory network initiative in Mali called Action BIOMALI. In just four years, the network grew to cover more than eighty public and private laboratories. In 2009, in response to official demands from the Ministries of Health of two neighboring countries, Burkina Faso and Senegal, and with the support of the French Development Agency (AFD) and Fondation Mérieux, the Mali network was expanded into a threecountry regional network called RESAOLAB. This article