REPUBLIC OF SIERRA LEONE · Web viewObjective 7: To provide all government medical laboratories with complimentary supplies and consumables for efficient service delivery by end

REPUBLIC OF SIERRA LEONE

MINISTRY OF HEALTH AND SANITATION

NATIONAL HEALTH LABORATORY STRATEGIC PLAN

2016 - 2020

DELIVERING QUALITY LABORATORY SERVICES

Sierra Leone National Medical Laboratory Strategic Plan 2016-2020 1

TABLE OF CONTENT FOREWORD.............................................................................................................................................4PREFACE..................................................................................................................................................5ACKNOWLEDGEMENTS............................................................................................................................6EXECUTIVE SUMMARY...................................................................................................................................7ACRONYMS..............................................................................................................................................9SECTION 1: CONTEXT.............................................................................................................................13

CHAPTER 1- Introduction...................................................................................................................13CHAPTER 2: SWOT Analysis...............................................................................................................21CHAPTER 3: POLICY ENVIRONMENT.................................................................................................25CHAPTER 4: STRATEGIC DIRECTIONS.................................................................................................27

SECTION 2: STRATEGIC OBJECTIVES, INTERVENTIONS AND TARGETS...................................................30CHAPTER 1: GOVERNANCE................................................................................................................31CHAPTER 2: HUMAN RESOURCES DEVELOPMENT AND MANAGEMENT...........................................35CHAPTER 3: LABORATORY INFRASTRUCTURE AND EQUIPMENT.......................................................38CHAPTER 4: LABORATORY SERVICES & SUPPORT SYSTEMS...............................................................41CHAPTER 5: BIORISK MANAGEMENTBIOSAFETY, BIOSECURITY, BIOBANKING).................................45CHAPTER 6: INFORMATION MANAGEMENT SYSTEMS......................................................................47CHAPTER 7: EMERGENCY PREPAREDNESS AND RESPONSE...............................................................49CHAPTER 8: RESEARCH, DEVELOPMENT AND ETHICS........................................................................51CHAPTER 9: PARTNERSHIPS AND LINKAGES......................................................................................53CHAPTER 10: TOTAL QUALITY MANAGEMENT SYSTEMS (QUALITY ASSURANCE)..............................56

SECTION 3: IMPLEMENTATION MECHANISMS......................................................................................58MONITORING AND EVALUATION...........................................................................................................71

FRAMEWORK FOR THE MONITORING AND EVALUATION PLAN........................................................75FINANCING THE PLAN............................................................................................................................76ANNEXES................................................................................................................................................79

ANNEX 1: IMPLEMENTATION FRAME................................................................................................80Annex 2: Sample Budget Outline for PHU..........................................................................................99ANNEX 3: Minimum standards........................................................................................................107ANNEX 4: Emergency Response Budget Justifications.....................................................................109ANNEX 5: TEAM MEMBERS.............................................................................................................111

List of Tables and Figures

Table 1: Distribution of health facilities by district – July 2015………………………………………… 18

Table 2: Recommended laboratory staffing…………………………………………………………………….. 19

Table 3: Strategic Framework …………………………………………………………………………………………. 58


Table 4: Strategic time frame …………………………………………………………………………………………. 61

Table 5 Indicators and Monitoring Tools ……………………………………………………………………….. 73

Table 6: Estimated major costs (millions of Leones) to be worked out for 5 years period… 75

Table 7 Estimated cost for laboratory emergency response per district (US Dollars)……….. 76

Figure 1: Lab tiers………………………………………………………………………………………………………….… 19.

Figure 2: Strategic plan process flow………………………………………………………………….………….. 27

Figure 3: Strategic inputs………………………………………………………………………………….…………….. 31

Figure 4: Critical path of development……………………………………………………………….…………… 49

Figure 5: Actions to address all levels of laboratory network…………………………………………. 52

Figure 6:Network of national public health reference laboratory system……………………… 55


FOREWORD

The Ministry of Health and Sanitation (MOHS) is moving forward with its vision to improve services and instituting systems to deliver and increase access to high quality health care to reduce national mortality. The ministry’s current focus is to put these systems and supporting structures to meet the demand and supply in working towards reduced mortality.

The laboratory network system in Sierra Leone now has an approved policy and this document forms the platform for the development of the national laboratory strategic plan. The plan contains the strategic activities that ensure quality and equitable laboratory services to support disease diagnosis, treatment monitoring, disease prevention and control, and laboratory support of national surveillance and rapid response to disease outbreaks. Activities have been phased over a five year period taking cognizance of the National Health Sector priority program such as the Free Health Care Initiative and prevention of Communicable and Non-communicable infections.

The document was prepared by an expanded National Laboratory Technical Working Group, constituting of selected laboratory specialists and related health sector personnel including senior staff members from Blood Transfusion program, Disease Prevention Unit, health information, finance, statistics and surveillance units.

The final draft was validated by stakeholders, which included all related health units at central and local government health leads and key partners. The validated draft was reviewed and edited by the Laboratory and Surveillance and Epidemiology Technical working group as well as development partners prior to submission, review, and approval by the Ministry of Health and Sanitation.

On behalf of my ministry, I wish to extend appreciation for the support of the Association of Public Health Laboratories (APHL), Sierra Leone for providing technical and financial support from Centers for Disease Control (CDC), Atlanta. I also commend the commitment of the National Technical Working group and the leadership of the Laboratory directorate.

My ministry looks forward to strengthening quality health care delivery and accessible health care systems that will contribute to improving the health and well-being of the people of Sierra Leone.

Dr. Abubakarr Fofanah

Honorable Minister

Ministry of Health and Sanitation, Sierra Leone


PREFACE

The National Health Laboratory Services plays a pivotal role in the response to an effective health care delivery.

The laboratory services serves as a key component to achieving both quality clinical care and meaningful public health interventions.

The Ministry of Health and Sanitation (MOHS) has generated its 2015-2020 directional maps through the national health sector strategic plan (NHSSP) translated in the Basic Package of Essential Health Services (BPEHS) to drive improved access to affordable quality laboratory services and ultimately better health total care delivery.

Recognising the impact of outbreaks (Cholera-2012 and Ebola 2014-2015) on the implementation of the 2010-2015, this plan expanded the national priority themes from 7 to 10 each aligned by an integrated health sector team, to the national indices towards equitable and sustainable health sector performance

The Laboratory services have gained it’s recognition as critical to the advancement of national and global health security. In view of this, the interventions outlined in this plan puts premium on the minimum standards package of operations such as adequate water supply and energy , appropriate infrastructure, skilled human resource and infections control and outbreak preparedness to ensure functionality of laboratory services.

The MOHS hope that this plan will serve as the directory for laboratory support and implementation by stakeholders and partners coordinated by the Directorate of Hospital and Laboratory Services towards quality and sustainable laboratory services.

I commend the leadership of the directorate of hospital and laboratory services and appreciate the collective efforts of all directorates in the development of this road map.

Dr. Brima Kargbo

Chief Medical Officer

Ministry of Health and Sanitation


ACKNOWLEDGEMENTS

On behalf of the Ministry of Health and Sanitation, I wish to acknowledge the immense contributions of the national core team and National Laboratory Technical working Group (LTWG) for a dedicated work done in generating this document amidst multiple tasks. Their efforts in reviewing and analysing the many documents amidst a myriad of activities that led them to work out of call of duty is highly appreciated.

Key to note are the institution and key partners support to formulate the supporting tools used such as the comprehensive laboratory service assessment by DFID through Options Consultancy; Public Health Laboratory Assessment by US-CDC, China-CDC, WHO, and APHL; IDSR assessments by the Disease Prevention Directorate Surveillance officers; and the untiring efforts by the Laboratory Services and Surveillance managers and team on site verifications throughout the processes.

Our invaluable thanks to the technical support lead provided by CDC through APHL Senior Laboratory Specialists, who played an important background role to define processes and direct collations as per MOHS focus for a coordinated output.

I appreciate the efforts of the national, regional and districts health teams and the Public Health Rapid Response Team who participated in the validation of the document. A special thanks goes to key partners – WHO, US –CDC, Options Consultancy, e-Health Africa, Public health England and China-CDC, who contributed to the validation of the implementation frame. I do hope partners and stake holders will use this document to guide objectives as we drive towards sustainable and quality services.

Dr Victor Matt-Lebby

Director Hospital and Laboratory Services

Ministry of Health and Sanitation


Executive Summary

Laboratory support has a pivotal role in diagnosis and patient management, disease surveillance and outbreak investigation. At present, the laboratories of Sierra Leone are not able to provide adequate support to the clinical care services to meet the government defined basic health package.

The Ministry of Health and Sanitation subscribe to International Charters such as the GHSA, IHR and ECOWAS regulations and seek “To develop, strengthen and maintain capacities of laboratories to detect, assess, notify, and report events”. This is in line with the requirement of the ASLM declaration done in Freetown recently regarding the need to strengthen laboratory services and to:

Develop national laboratory policies within the National Health Development Plan that will guide the implementation of a national integrated laboratory strategic plan

Develop and implement a 5-year national laboratory strategic plan that addresses quality diagnosis, monitoring and surveillance of diseases of public health importance at all levels of the tiered laboratory system.

The above items require Sierra Leone to establish reliable, high quality laboratory services that can provide trusted information to guide decision making for quality health care.

In order to meet these requirements, action is needed in 10 key fields:

1. Governance (Coordination, legal framework and ethics).2. Human Resource planning, development and management.3. Infrastructure and Equipment.4. Laboratory Services & Support Systems (Logistics & Management Systems).5. Bio risk management (Health and Safety, Bio-safety, Bio-security and Bio-banking.6. Information Management Systems.7. Emergency Preparedness and Response. 8. Research, Development and Ethics. 9. Partnership & Linkages 10. Total Quality Management Systems.

This document sets out the policies and actions required to meet these needs in three sections covering the context, the strategic objectives, interventions and targets and the implementation mechanisms.

FOCUS: is to meet the National Basic Package of Essential health services toward increased access to quality service and ultimately improved health systems within the next 5 years.


1. Capacitating all 14 district laboratories to perform all test menus of the BPEHS.2. Strengthening all 5 centres of excellence facility laboratories as reference labs supporting district

and PHU.3. Coordinating partners supporting laboratories services as per national priority with geographic

equity to produce tangible outcomes.4. Instituting Public Health Laboratory network supporting IDSR.5. Establishment of integrated outbreak response.6. Establish professional regulatory body to structure and monitor laboratory staff.7. Strengthening commodity security.8. Support researches of national interest with defined outcomes.

An estimated costing plan was generated based on the national 2010-2015 investment plan updated within current financial context. Given that this is a living document, it is hoped that flexibility is employed to implement to meet the priorities with sustainable input.

An effective M and E plan to monitor laboratory service delivery using quality indicator to monitor the 10 quality elements.


ACRONYMS

AFB Acid Fast Bacilli

AFR/RC WHO/AFRO Regional Committee

AIDS Acquired Immuno-Deficiency Syndrome

APHL Association of Public Health Laboratories

ASLM Africa Society for Laboratory Medicine

BPEHS Basic Package of Essential Health Services

CD4 Cluster of Differentiation

CDC Centre for Disease Control and Prevention

CHC Community Health Centre

COMAHS College of Medicine and Allied Health Sciences

CPHRL Central Public Health Reference Laboratory

DHLS Directorate of Hospitals and Laboratory Services

DHSS Demographic Health Systems Survey

DOT Directly observed treatment

DST Drug Susceptibility Testing

DPI Directorate of Planning and Information

DPC Disease Prevention Control

EID Early Infant Diagnosis

ELISA Enzyme Linked Immunosorbent Assay

EPK Eastern Polytechnic, Kenema

EQA External Quality Assurance

EQAS External Quality Assessment Scheme

FBC Fourah Bay College


FBO Faith Based Organisation

FHCI Free Health Care Initiative

GFATM Global Fund for AIDS, Tuberculosis and Malaria

GHSA Global Health Security Agenda

GLRA German Leprosy and TB Relief Association

HAPSAT HIV/AIDS Program Sustainability Analysis Tool

HCT HIV Counseling and Testing

HPA Health Protection Agency (UK)

HIV Human Immuno-deficiency Virus

HPA Health Protection Agency of the United Kingdom

HR Human Resources

IATA International Air Transport Association

IDSR Integrated Disease Surveillance and Response

IHR International Health Regulations

IQC Internal Quality Control

LFT Liver Function Tests

LIS Laboratory information system

LIMS Laboratory Information Management Systems

LTWG Laboratory Technical Working Group

LSETWG Laboratory, Surveillance and Epidemiology Technical Working group

M&E Monitoring and Evaluation

MDCSL Medical and Dental Council of Sierra Leone

MDG Millennium Development Goals

MMCET Milton Margai College of Education and Technology

MOHS Ministry of Health and Sanitation


MSc Master of Science

NEQAS National External Quality Assessment Scheme

NGO Non-Governmental Organisation

NHSSP National Health Sector Strategic Plan

NLRC National Laboratory Regulatory Council

NLS National Laboratory Services

NPHLS National Public Health Laboratories Systems

NPHRL Network Public Health Reference Laboratories

NQAP National Quality Assurance Programme

NTBRL National TB Reference Laboratory

NTD Neglected Tropical Diseases

PCMH Princess Christian Maternity Hospital (Freetown)

PEPFAR President’s Emergency Plan for AIDS Relief

PHU Peripheral Health -Unit

PMTCT Prevention of Mother to Child Transmission

PPE Personal Protective Equipment

PRSP Poverty Reduction Strategy Paper

PHLRT Public Health Laboratory Response Team

QA Quality Assurance

QC Quality Control

RRT Rapid Response Team

TQMS Total Quality Management System

RCH Reproductive and Child Health

RH Reproductive Health

RT-PCR Reverse Transcriptase Polymerase Chain Reaction


SOP Standard Operating Procedure

TB Tuberculosis

TOR Terms of Reference

U/E Urea/Electrolytes

USAID United States Agency for International Development

WBC White Blood Cell Count

WHO World Health Organisation


SECTION 1: CONTEXT

CHAPTER 1- IntroductionThe first National Laboratory Strategic Plan (2011-2015) was generated to establish a framework for laboratory operations in Sierra Leone and to provide the much-needed direction in the areas of governance, human resource, infrastructure and equipment, stocks management, health and safety and quality systems. This was to support the government’s drive to provide a basic essential package of health services, mainly focused on primary and secondary care.

The significance of a functional laboratory system and its impact on the treatment outcomes of patients and quality of public health services cannot be over-emphasised. Laboratory support in diagnosis and patient management, disease surveillance, outbreak investigation and response is pivotal, with an increasing demand for providing scientific evidence as part of the total quality management cycle. Evidence based decision making in the diagnosis and management of illnesses is a key component of quality health care however, laboratories have not grown in tandem with health care delivery services to enable them adequately meet this demand.

The 2010-2015 plan was to address all core areas of the laboratory system, with specific emphasis on six priorities at the time that needed urgent attention, which were:

1. Weak coordination and regulation of laboratory practice at all levels of the laboratory system (Governance).

2. Infrastructural inadequacies (Infrastructure and equipment).3. Supply bottle-necks leading to interruption of services (Reagents and supplies).4. Bio-risk management (Bio-safety and Bio-security and emergency response).5. Inadequate numbers of skilled workers (Human Resource).6. Inequities in laboratory service delivery.7. Poor quality systems limiting access to quality assured laboratory services (Quality systems).

There have been achievements in some of these areas, such as, higher level of training of laboratory staff (both locally and internationally), establishment of a public health hub, the Central Public Health Reference Laboratory, which serves for some epidemic prone diseases such as Measles, Enteric bacteria diseases and Rota Viruses; Establishment of molecular unit. There are still areas in the plans which were not addressed due to the challenges experienced in the implementation, one of which was the unexpected and unprecedented Cholera Outbreak in 2012 and Ebola outbreak in 2014-2015, which also exposed the lack of outbreak and emergency preparedness within the health system.

In spite of the above achievements, Sierra Leone still continues to experience problems with the management and delivery of quality assured laboratory services to support national treatment and prevention programmes, primarily due to weak leadership at all levels of the tiered laboratory system. Other reasons for this are the lack of participation of laboratory professionals at policy and decision-


making levels, inadequate number of qualified personnel, scant and unstructured investment in laboratories and weak quality control systems.

Background

The 2010 -2015 strategic plan interventions was interrupted with two major outbreaks thus the total implementation timeframe was 3 years instead of 5 years. The plan used as part of its building block the revised International Health Regulations (IHR 2005) which requires countries “To develop, strengthen and maintain capacities of laboratories to detect, assess, notify, and report events”. In addition to the IHR requirement, WHO/AFRO has urged member countries to commit to strengthening laboratory services, in line with the following declarations and resolutions:

The Maputo Declaration on strengthening of laboratory systems: Maputo January 2008. Resolution AFR/RC58/R2: Strengthening public health laboratories in the WHO African region:

Yaoundé, Cameroon September 2008. 5th Meeting of the Regional HIV/AIDS Public Health Laboratory Network, Dakar, Senegal,

September 2008. Resolution AFR/RC59/WP/3: Policy orientations on the establishment of centres of excellence for

Disease Surveillance, Public Health laboratories, Food and Medicines regulation. Kigali, Rwanda September 2009.

Resolution AFR/RC59/R2 – Drug Resistance related to AIDS, Tuberculosis and Malaria: Issues, Challenges and the Way Forward. Kigali, Rwanda September 2009.

This 2016-2020 plan is developed with global health security in view and thus add to the above; new concepts and strategies that recognises the pivotal role of laboratory actions in disease detection, treatment monitoring, and prevention control for a sustainable health through:

Global Health Security Agenda (GHSA) 2015 –: Promote an integrated IHR accelerated plan towards world safety against infectious disease threat through innovative, multi-sectorial, local and international partnership response.

African Society for Laboratory Medicine (ASLM) Freetown Declaration 2015 ASLM—: Recognising the critical role of public health laboratory systems in supporting GHSA by requesting countries to establishfunctional public health laboratory networks for early detection and responses to emerging disease threats.

There is now an increased emphasis in strengthening laboratory systems including leadership and management structures. Over the years, the Sierra Leone Ministry of Health and Sanitation (MOHS) has gradually restructured, with the aim of improving its capacity to respond in an adequate and timely manner to the health care needs of the country within a resource constrained environment. This is in accordance with the Millennium Development Goals (MDG), World Health Organisation (WHO) and Global Health Initiative (GHI) support for governments to show leadership and to commit to strengthening health systems, including laboratory services.


As part of the efforts of the government, several documents and strategic guidelines were developed, including the Health Sector COMPACT Guide which provided the coordination platform of partners in the implementation of National Health Sector Strategic Plan (NHSSP 2010-2015) and more recently, the Health Sector Recovery plan 2015-2020, to address the challenging issues especially during the post-Ebola period.

It was therefore necessary to review the first National Health Laboratory Strategic Plan, to align it with these documents, revised and new, such as the revised Basic Essential Package of Health Services 2015, the Sierra Leone Health Sector Recovery Plan 2015-2020, of the Ministry of Health and Sanitation and the Emergency Response Manual 2015.

National Laboratory Services Directorate of Hospital and Laboratory ServicesThe National Laboratory Services (NLS) program operates under the Directorate of Hospitals and Laboratory Services (DHLS) of the Ministry of Health and Sanitation (MOHS) that provides overarching policy leadership. This includes setting national norms and standards, building capacity, and monitoring of service quality.

The NLS systems comprises of clinical-community and hospital diagnostics laboratories; Regional Reference laboratories, and Public Health Laboratories. Given the crosscutting support of laboratory services, the DHLS work closely with Directorate of Disease Prevention and Control surveillance program and Health Systems Strengthening (HSS) unit.

The DHLS at central level is inter-connected with the semi-autonomous District Health Management Team (DHMT) that provides the localised leadership and implementations through the District Medical Officer under the District Council.

The DHLS is led by a Director, National Manager, a Deputy Manager that doubles as the In-Charge of the Central Public Health Reference Laboratories (CPHRL) and Laboratory Technical Working Group comprising of a team of Laboratory Technical and Systems experts.

Basic Packages of Essential Health Services (BPEHS) and National Health Laboratory SystemsThe MOHS has as its priority five themes that will build a resilient health system. The themes listed below take into consideration recovery efforts from the recent outbreak and services that are realistic, achievable and thus sustainable through the leadership of the government:

1. Patient and health workers biosafety and biosecurity.2. Human Resource strengthening.3. Essential Health Services.4. Community ownership.5. Information and surveillance.


The BPEHS (2015-2020) serves as the platform for delivering vision of MOHS outlined in the National Health Sector Strategic Plan (NHSSP) - 2015-2020 for quality health care. The function of the package is to direct interventions and monitor progress for the effective delivery of the themes.

The BPEHS defines the level of services at each strata of care inclusive of the minimum systems standards such as infrastructures, HR, Biosafety and support services.

Recognizing the critical role of laboratory services to support comprehensive health care delivery; the BPEHs 2015-2020 is extended to include public health laboratory services in line with GHSA to strengthen prompt diagnosis, outbreak detection and action to prevent and contain biological threats.

Levels of Laboratory services Tier Systems There are 4 tiers in the network of laboratories with defined functions and test menu as per BPEHs criteria based on population needs, geopolitical zones and systems practicality as follows:

Primary Level: Laboratory service at chiefdom level is mainly provided at the Community Health Centre (CHC), which is one of the three primary levels of the Peripheral Health Units (PHUs). The test menu is limited to microscopic detection of parasites, basic clinical chemistry and serology using point of care and rapid testing device.

Secondary Level: Laboratory services at district hospitals of over 100-bed capacity provided extensive range of tests including blood service screening for safe blood transfusion. The service is more comprehensive to support secondary medical care with a higher staff caliber and also support primary level diagnosis.

Tertiary Level Laboratory services at Regional hospitals at district headquarter towns (Kenema for the East, Bo for the South, and Makeni for the North). This level is an expansion of district hospital services with additional systems capacity such as graduate level staff, infrastructures and utilities to support complex equipment and can handle complex infectious diseases and emergency services.

Public Health Laboratory Services The public health laboratories serve at national and regional level to provide overarching support and instituting quality systems. Key functions include establishing of norms and standards, emergency and outbreak response, high-end technology testing that are not cost effective at other levels, targeted training to improve and strengthen human resource; surveillance and operational research. Following the recent Ebola outbreak, the MOHS has established three Regional Hubs as centers for excellence at regional hospitals. These systems will form part of the Network of Public health Laboratories (NPHL) linked to the central hub at the Central Public Health Reference Laboratory, the Jui P3 Lab and TB Reference Laboratories.


Laboratory Mapping:

Table 1: Distribution of Health Facilities by District, July 2015

In accordance with the BPEH, functional laboratory services are available in 257 out of 1208 health facilities. These are 233 PHUs and 24 Government hospitals. The Government laboratories include district (15) and Regional (5); Forces (2) and Public health laboratories (3) in various combinations with some sites active in 2 capacities. The community level diagnosis made up of MCHP and CHP accounts for 632 and 319 facilities respectively with the capacity of performing community Rapid Diagnostic Tests for pregnancy, malaria and STI screening for antenatal care.

Following various analyses of field assessments, there are currently 179 functional laboratories with staff complements of the MOHS based on the minimum service requirement of the BPEHS. Most of the primary laboratories are operating as an offshoot of DOT centers with the capacity of testing the three Global fund supported diseases: Malaria, TB and HIV.


Figure 1: Laboratory tiers

Human Resource Laboratory staffing is one of the most acute Human Resource shortages in the country. The staffing profile per facility as defined by the BEHP (not inclusive of 24 hour service at district level) is as follows:

Table 2: Recommended laboratory staffing

STAFF LEVEL PHU DISTRICT REGIONAL PUBLIC HEALTH LABORATORY INCLUDING SURVEILLANCE RESPONSE,

SENIOR LAB SPECIALIST 5

LABORATORY SPECIALIST 5 5

LABORATORY SCIENTIFIC OFFICER

1 5 5

LABORATORY TECHNICIAN 1 3 5 5

LABORATORY ASSISTANT 1 4 5 5

HOUSEKEEPING STAFF 5 5

Source: BPEHS 2016

Sierra Leone National Medical Laboratory Strategic Plan 2016-2020

Public Health -

3

Regional Reference -5Military-1

Secondary Districts - 14Police -1

Primary PHU labs - 155

18

Based on the BPEH requirement and the number of functional laboratories at all level, there should be 329 Laboratory Assistants, 275 Laboratory Technicians and 14 graduate laboratory scientific officers. Currently only less than 30% of the skilled staffing capacity is met.

The 2015 survey showed 208 junior level cadre of laboratory personnel in all laboratories in the country including private and Faith- Based and Non-Governmental Organizations. Due to shortage, the laboratory services inherited 151 persons without formal training; working as laboratory assistants.

There are 8 mid-level scientific officers with science degree qualification but without specialized laboratory medicine curriculum training. Recently added to the pool; are 12 of 24 trained graduates bonded to the MOHS to support laboratory strengthening including outbreak and emergency response. Medical graduates are also been encouraged and supported in the field of laboratory medicine specialization.

In terms of laboratory specialists, all disciplines (Haematologist, Clinical Chemistry, Parasitologist, Virologist, Microbiologist) have at least one senior scientist but most of them are close to retirement.

Justification of a revised plan

The laboratory services form a major component of the health systems pillar which has over the years operated with the national laboratory strategic plan (2011-2015) to assist in implementing the NHSSP. This plan provided guidance to all stakeholders for the efficient operations of the public laboratories nationwide.

The laboratory provides direct cross-crossing support to many programmes in the ministry that contribute to the attainment of Millennium Development Goals. Data generated from laboratory analyses contribute to programme management and decision making. However, programmes have in the past produced individual laboratory plans addressing their specific needs without regarding the entire system, leading to duplication and sometimes skewed service delivery. The first edition of the National Health Laboratory Strategic Plan was created in 2010 to last for five years.

The 2010-2015 National Health Laboratory Strategic Plan identified that laboratories in Sierra Leone were ‘not able to provide adequate support to the clinical care services and as a result, laboratory results are not trusted and laboratory diagnostic services are underutilised.

The implementation of the strategic plan was faced with funding constraints due to competing demand on government. However the following activities were achieved:

Activating the national laboratory, surveillance and epidemiology technical working group which worked with partners to develop the listed key tools :

o National Laboratory investment plan.o Integrated Disease surveillance Strategic Plan review.o Health and Safety policy draft.o National Norms Standards for the 4 tier level laboratories.


o Development of Laboratory Basic package for essential health.o Generating the national health systems strengthening laboratory plan.

Human Resource development : o Activation of B.Sc. Honors in Laboratory Medicine.o Increase the pool of post graduate laboratory scientists.o Support the establishment of short course FELTP program.o Support intensive short courses.

Public Health Response o Activation of a Central Public Health Reference Laboratory Hub.o Establish diagnosis of epidemic prone diseases- Measles; yellow fever; Influenza,

Cholera.o Establishment of Molecular testing for Early Infant diagnosis.o Support the national testing for the Demographic Health Survey DHSS 2012 (16000)

Sample. Quality Assurance:

o Establishment of National Quality Officerso Introduction to accreditations using the SLMTA process and SLIPTA tool.o Establish national HIV EQA to 35 sites.

Laboratory Services o Increased functioning laboratories,o Increased test menu.

However key thematic areas such as regulatory, supplies and logistics, infrastructures activities were not undertaken. These limitations together with the burden of infectious epidemic prone diseases immensely weakened the laboratory services. The Government has therefore prioritised the need to improve laboratories taking into consideration new and re-emerging challenges posed by our National health system and also align with the IDSR.


CHAPTER 2: SWOT AnalysisThe Strategic plan of 2010 - 2015 was to articulate the National Laboratory policy with a focus to improve health care delivery and also monitor quality implementation towards an interrupted service delivery especially with the novel Free Health Care Initiate (FHCI).

In 2010-2015, an Environmental SWOT analysis to assess laboratory situation was based on field experiences and consultative meetings with all district lead clinicians, district laboratory supervisors, laboratory related programs such as TB, Malaria and HIV; Forces, private and faith based organization.

Given the weak laboratory response as per health indices, especially the limitation to meet the needs of the recent outbreaks, the MOHS in collaboration with partners has conducted a series of field assessments that inform the development of the NHSSP, National Health Recovery Plan, BPEHS and the recent Health Systems Strengthening plan. A more recent assessment with specific focus on laboratory systems are:

A joint partner health systems assessment conducted in 2014, revealed that only 5% of the NHSSP target, was implemented.

Post Ebola laboratory assessment was the most comprehensive as it addressed all laboratory systems indicators - July 2015

Disease Surveillance Laboratory Inventory of stool analysis for polio containment program – November 2015.

Public health laboratories quality audit towards transition and recovery plan – February and May 2015

Western Area Laboratories site assessment (Horizontal Audit)- 2016 The focus of these assessments was to identify gaps, challenges and best practices to serve as the platform for the development of an integrated National Laboratory Strategic Plan for effective and sustainable service. The elements audited as aligned in the SLMTA/SLIPTA quality indicators systems management are as follows:

Laboratory Profile.

1. Human Resource.2. Infrastructure.3. Transport and Referral.4. Management of Consumables and Stock.5. Maintenance of Equipment.6. Testing Performance.7. Specimen Management.8. Bio-safety.9. Public Health Functions.10. Organization and Management.11. Data Management.12. Supplies of Consumables & Equipment.


13. Basic Testing Capability5

ReportStrengths

The availability of a National Health Policy 2009, National Laboratory Policy 2010 and sound National Laboratory Strategic Plan (2011-2015) which provide a framework for effective implementation.

The availability of public and private laboratory structures at district level including the majority of Community Health Centres providing laboratory services nationwide.

Diagnostic testing services available across the country. Basic laboratory services closer to communities through the Global Fund and other

supported programs of Malaria, TB and HIV. There is the existence of a management structure for hospital and laboratory services by the

Directorate of Hospitals and Laboratory Services, under the Ministry of Health Services and Sanitation (MOHS).

The availability of a Laboratory Service Manager and a functional Laboratory Technical Working Group (LTWG) provides Laboratory technical assistance and advice.

Institutions are in place that provides basic laboratory education the existence of the B.Sc. honors medical laboratory course.

Existing laboratory policy documents recognize the need to establish efficient LIS. Other Ministries and programmes require laboratory support and can be expected to

contribute to LIS strengthening.

Weaknesses

Poor human resource system for laboratory personnel. Poor remuneration policy and working environment. Lack of succession policy. Inadequate funding to support implementation of policy and strategic plan. Acute shortage of qualified laboratory personnel including laboratory scientists and

technicians. Lack of scheme of service for laboratory personnel which does not reflect educational level

and skills. No system for Continuing Education of laboratory personnel. Poor laboratory infrastructure, power and water supplies which often leads to poor

infection prevention practices, organization and service delivery. Poor waste disposal systems, which includes lack of incineration equipment and absence of

proper drainage for wastewater. Weak laboratory registration and licensing system which includes a regulatory body, service

and equipment standards and SOPs.


Weak laboratories services to enable effective management of outbreak and other diseases. Partial implementation of laboratory services as per Basic Package of Essential Health

Services. Mostly seen is TB, Malaria and HIV (Global Fund Supported Programmes). Weak quality monitoring systems and inadequate supportive supervision. Limited Assurance Program. Weak transport and referral of specimen. Weak supply chain management of reagents and equipment.

Opportunities

The development of the scheme of service for laboratory personnel. Directorate of Training collaborating with the Tertiary institution for Laboratory Medicine

courses. Upgrading and restructuring of existing training institutions to produce more and better

skilled laboratory graduates. Existing procurement systems at the NPPU in place. Graduates from affiliated sciences, such as Biology or Chemistry who, if given additional

opportunities for professional development, could be trained to become laboratory staff. Health systems strengthening through the national resilient plan post Ebola which includes

laboratory support. Existence of the Laboratory technical working group. Existence of the National Laboratory Policy. Increased international technical and financial support for Post –Ebola Recovery and HIS. Increased International focus on HIS and interoperability of HIS systems.

Threats

Insufficient allocation of resources to facilitate a functional laboratory system. Internal and external brain drain. Donor dependency and foreseen donor fatigue. Uncoordinated partner donor support. Laboratory specialist professionals almost at retirement age. Laboratory decentralization. Lack of National Laboratory Professional Act.


Emergency Preparedness Laboratory Audit Despite recurring disease outbreaks, the laboratory service has not been able to fully support disease outbreak detection. For both Cholera and Ebola outbreaks, laboratory service has been a secondary service rather than be part of the primary pillar from notification through investigations to response and control.

Recognising the acute limitations, the MOHS and key partners has led a series of consultations and site visits to formulate National Public Health Laboratory (PHL) systems as part of a National public health institute. The recent Ebola outbreak has seen international partners donating high-end technology laboratories and also providing technical support to strengthen the network of PHL. Using the IDSR approach the MOHS has instituted an integrated approach by tailoring the response team to include laboratory as part of the core team members. The report of an audit based on site visits and consultation as below:

Strengths

Laboratory Response ManualNational Rapid Response Manual aligned to IDSR and GHSATraining tools generated Laboratory Response team in training.

Weakness

CoordinationLack of clear or transparent objectivesHuman resource limitation: no clear training plans for national staffFunding

Opportunities

GHSA laboratories prioritizationDonor commitment Donated laboratoriesUniversity training course

Threats

Limited Government funding allocationDonor dependency


CHAPTER 3: POLICY ENVIRONMENTThe 2010-2015 Laboratory Strategic plan translated 2010 National laboratory policy under the umbrella 2009 Health Sector Policy. This plan (2016-2020) is generated following review of the past plan within the same policy environment but with the addition of key strategic document to support a resilient health sector delivery. However this plan has the opportunity of a clearer defined NHSSP goal and performance markers for effective monitoring.

Recognizing the role of laboratory services within the national health and social security network, the MOHS has prioritized laboratory services as key input in the health sector performance index towards the Presidential Agenda for Prosperity. This all-encompassing framework includes the implementation of the NHSSP 2015-2020 through the BPEHS (2015-2020) and response to emergency and outbreak whilst remaining compliant to international charters such as IHR, GHSA and ECOWAS-WAHO.

This plan applies inter-program policies and strategic plan towards IDSR as follows:

National health and Safety Policy and Manual

National TB program TB diagnosis and treatment integrated guidelines

National AIDS Control ProgramHIV Strategic Plan 2015-2020HIV Viral Load Implementation plan

National Malaria Control ProgramNational Malaria Strategic PlanNational Malaria Quality Assurance Strategic PlanIDSR:

National Emergency and Outbreak Manual Polio Containment Protocol (2015)


Agenda for Prosperity 2013-2015“To strengthening of health program through introducing innovative strategies, new policies that will improve health outcome for Sierra Leoneans”

NHSSP Performance Markers Access Quality Equity Efficiency

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REVIEW PROCESS

The review and development of the 2016-2020 strategic plan was done by a core team under the leadership of the Directorate of Hospital and Laboratory Services in collaboration with the Directorate of Disease Prevention and Control, Directorate of Health Systems Strengthening, Planning and Research and Directorate of Training and National Laboratory, Surveillance and Epidemiology Technical Working group. The figure below outlines the process stage approved by the team.

Figure 2: Strategic plan process flow

National Priority Themes- 2016-2020: The 2010 -2015 NLSP identified seven priority themes and was expanded to 10 themes in the 2016-2020 plan as the focus moves to tangible indicators in order to respond to national health needs.

1. Governance (Coordination, legal framework and ethics).2. Human Resource planning, development and management.3. Infrastructure and Equipment.4. Laboratory Services & Support Systems (Logistics & Management Systems).5. Bio risk management (Health and Safety, Bio-safety, Bio-security and Bio-banking.6. Information Management Systems.7. Emergency Preparedness and Response.8. Research, Development and Ethics.9. Partnership &Linkages Total Quality Management Systems.10. Total Quality Management System (Quality Assurance).


CHAPTER 4: STRATEGIC DIRECTIONSThere are key strategic imperatives driving this plan;

LEADERSHIP- national direction of key roles and responsibilities HEALTH FINANCE – Coordinated; focused, accountability and transparency OPERATIONAL show plan activity and related expenditure and status of annual implementation. MONITORING – high level monitoring grid for equitable support INTEGRATION Global health – one health- Human and animal health linkage

Vision, Mission and Core Values (derived from the National Laboratory Policy and NHSSP 2015-2020)

1. Equity: Laboratory resources and services are

distributed equitably throughout the country.

2. Accessibility: Services are affordable and within reach.

3. Relevance: Laboratory services are apt for the purpose

and address the needs of the community.

4. Partnership: Promote teamwork and team spirit among

all laboratory personnel, and networking and

collaboration with stakeholders.

5. Confidentiality: Promote professionalism and ethical

practice among all staff and their relationships with

patients.

6. Timeliness: Ensure laboratory results reach the patient

on time and contribute to appropriate patient

management.

7. Customer focus: Always bear in mind who we are

serving. The customer may be the community, patient,

clinician, individual or the public good.

8. Integration: Promote team spirit and integration of

service delivery among all laboratory personnel and also

within and between programmes.


Vision

To provide Sierra Leone with a quality and appropriate laboratory service that is accessible and affordable to all using a systems approach.

Mission

To establish an integrated functional laboratory system that will provide quality service delivery and support accurate diagnoses, treatment, prevention, surveillance, research and forensic services.

27


Sub Mission/Core Values

To establish an integrated functional laboratory system at each level of care based on the Basic Package of Essential Services.

To upgrade the PHL, CRL and have a functional laboratory network to enhance service delivery and respond to emerging public health concerns and emergencies.

To support surveillance and research to inform policies and actions. To build capacity of Human resource laboratory needs of the country using a systems approach.

Core Functions

This five-year strategic plan projects that the laboratory system will oversee and implement the core functions outlined below, with the expansion of regional reference laboratories linked to public health laboratories to form the network of clinical and public health Laboratory. The core functions will provide a basis for the assessment of laboratory performance against defined national norms and standards as set in the BPEHS and capability to respond to outbreaks in the following areas:

Clinical Diagnosis:

More emphasis on clinical diagnostics to supplement quality of care from at all levels. The clinical services will be offered through the network of clinical facilities (PHU, districts and hospitals) throughout the country.

Disease Prevention and Control

In response to the revised IHR (2005) requirements and in contributing to disease prevention programmes, the approach will be a combination of community and health facility laboratory -based surveillance linking to public health laboratories for timely microbial identification and confirmation to support prevention.

Surveillance

With the Central Public Health Laboratory as the hub, the NPHRLS will be linked to the national programmes and national surveillance activities of the DPC and DPI units to ensure national capacity to detect at least 10 of the priority epidemic prone diseases.

Integrated Laboratory Data Management

The NPHRL Systems network will serve as the national focal point for capturing the laboratory data and linking it with the Health information management Systems (HMIS) for planning and decision-making.

Reference and Specialized Testing

The NPHRLS will serve to coordinate IDSR support including other specialised testing.


Food, Water and Environmental Health and Protection

Working towards the ONE-Health strategy, to support inter-sector collaboration linking environment, zoonosis and human health with the MAFFS, MWR; National Standards Bureau and the Pharmacy Board.

Total Quality Systems Management (TQSM)

Develop and coordinate all the elements of quality indicators, with the aim of promoting quality assurance programs for clinical and public health laboratories through training; proficiency testing, quality audit and customer survey.

Laboratory Management and Coordination

Provide scientific and managerial leadership in developing monitoring grid to ensure compliance with promoting, and integrating clinical and public health laboratory science into practice including developing standards for all health-related laboratories.

Public Health-Related Research

Evaluate and validate new technologies for in-country use.

HR Development and Management

Through tertiary institutions support laboratory workers. Support fast track targeted training to build the critical mass at all levels. Institute laboratory management and leadership training.

Networking, Partnerships and Communication

Develop and strengthen partnerships among the countrywide network of laboratories. Develop a national map of laboratory resources to assist partnership, communication and training.


SECTION 2: STRATEGIC OBJECTIVES, INTERVENTIONS AND TARGETS

Figure 3: Systemic Inputs


SYSTEM

GOVERNANCE

INPUTS

CoordinationLegal framework-Ethics Structure Audit /Monitorting plan

OUTPUTS

Coordinated and Effective Service

SYSTEM

Human Resource

INPUTS

Regulatory BodyStructured TrainingRecruitment and Deploymment Policy

OUTPUTS

Professional StaffEquitable staff workload ratio

SYSTEMS

Infrastructure and Equipment

INPUTS

Structure DesignMinimum standard packageNorms and Standards

OUTPUTS

Funtional and safe laboratory systems

SYSTEMS

Services and Support Systems

INPUTS

National Testing AlgorithmStocks /Inventory Management plan Storage for stocks National Testing Algorithm

OUTPUTS

Coordinated Supply chiain management Uninterupted servicesAccessibility

SYSTEMS

Bio-Risk Management

INPUTS

PolicySafety Standards Supplies

OUTPUTS

Injury, Infection prevention and Control

SYSTEMS

Information Management Systems

INPUTS

National Variable and Template Soft and hard ware

OUTPUTS

Quality Result Integrated data base for action

SYSTEMS

Emmergency Preparedness and Response

INPUTS

National Standards Manual Investment Plan

OUTPUTS

Rapid Response Operational

SYSTEMS

Research and Development and Ethics

INPUTS

Research plan

OUTPUTS

Informed decision making

SYSTEMS

Partnership and Linkages

INPUTS

Collaboration and network plan.Twinning

OUTPUTS

Adequate and Appropirate technical support

SYSTEMS

Total Quality Management Systems

INPUTS

SLMTA Processes - Quality Assessments- EQA/IQC

OUTPUTS

Quality Assured results

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CHAPTER 1: GOVERNANCE (Coordination, legal framework and ethics)

Organisation, Management and Coordination

Strong organizational and management systems provide a mechanism for effective delivery of services. This is especially important when there are many facilities offering services at different levels.

Sierra Leone operates a four-tier laboratory system (primary, secondary, tertiary and a combined function of public health and reference services with a central apex hub). Apart from the existing public health reference laboratories, all the other public sector laboratories are attached to health facilities.

MOHS provides oversight centrally through the directorate and by the district health management team. Given that laboratory and hospital services are combined, the laboratory lead-in-charge reports to the medical superintendent of the hospital and the laboratory technician in charge of a PHU reports to the district superintendent, who will in turn pass information to the directorate.

At present, there is no intermediate organizational structure to provide linkage between the districts and the Directorate. Coordination and supervisory activities are therefore undertaken from the headquarters. At district level, the laboratory manager reports directly to and is accountable to the medical superintendent. At this level the laboratory has to compete for resources with other priority hospital departments. This state is reflected all along the laboratory tiers up to national level.

Laboratory management and coordination is being strengthened by the creation of a Laboratory Directorate with regional and district management structures and strong coordination structure provided through the National Laboratory, Epidemiology and Surveillance Technical Working Group (LSeTWG) with redefined roles inclusive of advisory, advocacy and technical.

Challenges:

Low priority status given to the laboratory at all levels in resource allocation. Limited technical and management capacity of the laboratory managers at all levels to provide

effective support and supervision to the peripheral laboratories. Weak management structures and skills at all levels. Lack of an effective coordination mechanism for laboratory service providers and funding

agencies. Limited resources at central level to provide overarching coordination and monitoring.

Policy:

To establish an effective laboratory management structure in the MOHS that can provide stewardship and coordination of laboratory services at central, regional, and district levels.


Objective 1:

To strengthen the laboratory organizational and management structures to provide oversight and coordination of laboratory services throughout all the levels of health care by end 2020.

Interventions

Establish a directorate for the National laboratory Service at the MOHS by end 2020.o Engagement of MOHS and administrative units to determine the implications of setting

up the directorate by end 2020o Appoint a Medical Laboratory Services Director by end 2018.o Appoint Senior Laboratory Specialist Scientists to provide technical oversight by end

2018.o Post an administrator, accountant, personnel officer, data officer and support staff to

the directorate by end 2018.o Procure three vehicles for the directorate in 2020.

Establish clearly defined laboratory tiers with management functions and reporting structures by end 2017.

o Classify laboratories and define functions for each laboratory tier by end 2016.o Appoint five (5) Senior Laboratory Scientists to manage the different sections of the

National Reference Laboratories by end 2018.o Appoint four (4) Provincial Laboratory Scientists to manage the regions and the regional

laboratories by end 2018.o Appoint nine (9) District Laboratory Scientists to manage district laboratories by end

2019.o Initiate and coordinate Bi-Monthly National Laboratory activity updates and experiences

sharing meeting for all 14 districts and National Laboratory Strengthen the management capacity of all laboratory managers by end 2020.

o Equip all district laboratory managers with management skills by end 2017.o Provide ongoing mentorship to national and regional laboratory managers by end 2020.

Establish laboratory coordination mechanism by end 2018.o Redefine the role of the LTWG (Laboratory Technical Working Group) in collaboration

with Surveillance and Epidemiology Technical working Group (SETWG) by end 2016o Establish a secretariat for the LTWG by end 2017.o Activate LTWG monthly central meetings by end 2016.o Expand quarterly Laboratory TTM to include all districts by 2017.o Institute quality audit improvement project monitoring by 2018.


Legal and Regulatory Framework and Ethics

The NLP has now been adopted by the MOHS and will be used as the basis for developing and strengthening the laboratory system in the country. Regulatory/legal frameworks are important to ensure consistent delivery of quality laboratory services at all tiers. Professional laboratory staff are guided by codes of ethics that would ensure compliance to set standards that meet international best practices. Ethical considerations are important in service delivery to protect the rights and privacy of users of health services in the handling of information and test results. A regulatory framework specific to the laboratory system has yet to be developed.

Currently the MDCSL licenses premises for delivery of health services including laboratory services. There is no mechanism for the licensing and registration of laboratory personnel and the practice of laboratory medicine. This has led to the mushrooming of unlicensed laboratories and the entry into practice of unqualified staff. A National Laboratory Regulatory Council (NLRC) will be established to regulate practice, and to prescribe and enforce professional ethics.

Challenges:

Limited mandate and technical expertise of the National Medical Council of Sierra Leone NMCSL in addressing the full range of laboratory matters that require regulation

Lack of a professional regulatory body to address issues specific to the laboratory Lack of a written code of practice/ethics protocol on laboratory practice Limited monitoring of laboratories by the current assigned agency (MDCSL).

Policy:

To provide a framework for regulation of training, laboratory practice and observance of professional ethics in laboratory practice in Sierra Leone.

Objective 2:To provide a policy and legal framework for proper regulation, training, laboratory practice and observance of professional ethics in laboratory practice by end 2020.

Interventions:

Development of an Act for the establishment of the National Laboratory Regulatory Council (NLRC) by end 2017

o Appoint a technical committee at the MOHS to start drafting of the Bill by end 2016.


o Liaise with Solicitor General’s Office to draft the Bill for the establishment of the NLRC by end 2016

o Present the Bill to parliament for debate and enactment by end 2017

Establish and operationalize the NLRC by 2017.o Appoint members of the Council by end 2017o Hire technical and administrative staff for performing tasks related to licensing

and registration by end 2016o Draw up rules related to laboratory code of practice, professional ethics and

subsidiary legislation by end 2016o Develop a minimum standard of requirements for setting up of laboratories by

tier; review and harmonize the curriculum for laboratory training programmes.o Develop laboratory-monitoring tools to incorporate indicators for ethics

compliance monitoring.o Institute in-service training programes on ethics.

Commence licensing of all (as defined by the Act) laboratories and registration of laboratory personnel in 2018

o Identify and start licensing all laboratories appropriatelyo Commence registration of laboratory practitioners who meet requirementso Develop a transition mechanism for personnel who are practicing but would not

qualify for employment or practice under the new legislation

Objective 3:To strengthen community awareness of ethics for laboratory professionals and increase demand by service users and providers at all levels by 2017

Interventions:

Create community awareness through use of mass media on laboratory ethics, the rights of users and methods of seeking redress.

o Ensure visible display of codes of ethics in all laboratories as part of standard practice by 2017

o Create appropriate channels for complaints management in at least 30% of all public and private laboratories.


CHAPTER 2: HUMAN RESOURCES DEVELOPMENT AND MANAGEMENT The most recent survey of laboratories was undertaken in 2015. This identified 208 junior cadre laboratory personnel trained at the Ordinary National and Higher Diploma levels .They are employed by both the public and private sectors as laboratory assistants and Technicians respectively.

In addition, there are 141 persons working as laboratory assistants without formal training. Most of these have education at secondary or BECE levels only.

Currently, there are three Senior Medical Laboratory Scientists in the MOHS (1Biochemist, 1 Microbiologist and 1 Parasitologist who doubles as Laboratory Manager, and three Laboratory Physicians (Consultant Microbiology, Histopathologist and Haematologist) and eight mid-level scientific officers at first degree level in Public Service.

The laboratories are therefore understaffed in terms of trained personnel to provide technical managerial leadership at secondary and tertiary levels. The MOHS is currently supporting the formal training of all unskilled laboratory workers in public service and with respect to laboratory a competency assessment program is planned to enable deployment of staff to their right scale.

Following the recent Ebola outbreak, a team of 28 Bachelor’s degree graduates in Biological Sciences and Diploma in Medical Laboratory graduate were trained in an intensive viral molecular course for the transition of the Ebola laboratory and towards building a Public Health Laboratory Response (PLHRT). 12 of this team are now undergoing orientation and supported until absorbed by the MOHS to increase h pool of skilled professionals.

A recent increase in remuneration of health workers has helped significantly to improve staff morale and will hopefully translate to retention of personnel in public service for a much longer period than at present. A draft scheme of service for laboratory personnel has been proposed that clearly defines a career path with job descriptions to rationalize deployment and improve staff management and efficiency.

Opportunities should be created for the laboratory scientific officers to specialize in different laboratory fields of study – haematology and blood banking, microbiology, and chemical pathology, since the secondary and tertiary level services require these specialties.

Medical and Science Laboratory Technicians are trained at all the five tertiary institutions in the country (FBC, COMAHS, Njala University, MMCET and EPK). However, the curriculum is being revisited and the facilities provided at these establishments (e.g. training laboratories, equipment) needs to be greatly improved.

A curriculum for the Bachelors’ Degree in Medical Laboratory Sciences has been developed and approved by the academic structures of the University of Sierra Leone. First year classes in basic sciences have commenced but are awaiting the completion of a training laboratory for the continued running of


the course. With full support COMHAS should hopefully produce the first set of graduates in three years’ time.

Training for medical specialists in laboratory medicine is currently not available in country. Efforts are being made by the Ministry of Health for medical graduates to undergo specialty training in the West African sub-region under the auspices of the West African College of Physicians.

During the period over which this plan operates, the MOHS should recruit the full complement of laboratory scientists with appropriate qualifications, skills and competences to meet the needs of the nation.

Challenges:

Inadequate numbers of skilled laboratory professionals. Poor personnel attraction and retention programs. Limited opportunities for both postgraduate training and continuous professional development. Lack of an enabling working environment. Delayed employment of trained and qualified staff. Poor staff workload ratio across all laboratories.

Policy:

To ensure the availability of adequate numbers of laboratory personnel with the appropriate knowledge, competencies and skills to support the delivery of a comprehensive laboratory package at each level of health care.

Objective 4: To meet the minimum qualified laboratory personnel levels to support the delivery of a comprehensive laboratory package at each level of health care by end 2020.Interventions:

Deploy adequate numbers of skilled laboratory staff to all laboratory facilities by end 2020.o Conduct competency assessment of current staff and develop deployment plan. By end

2016-2017o Recruit 10 technicians yearly from 2016 – 2020 to provide services at Community Health

Clinics (CHC) and district laboratories. o Recruit annually, over three years starting 2016 - 2018 five senior laboratory scientists

including laboratory physicians to work at regional and reference laboratories.o Establish an Emergency laboratory response team at national and district level by end

2017 Improve the output and quality of laboratory personnel from training colleges by end 2020.

o Develop a training plan by end 2016.


o Complete the harmonization and standardization of the curriculum for the training of technicians at diploma level by end 2016.

o Improve on the training facilities of the training institutions by end 2017. Train a core group of scientists and laboratory physicians in specific laboratory specialties by end

2020.o Train two scientists locally in microbiology by end 2018.o Train five scientists in molecular biology by end 2018.o Train two scientists in virology and immunology in 2018.o Commence specialist training of 4 medical doctors one each in Hematology,

Microbiology, Histopathology and Chemical Pathology by end 2018.o Train 46 staff in QMS from 2017 - 2020 through on -the- job training.o Develop a structure for the upgrade of community and untrained laboratory support

workers. Develop and operationalize retention and post-training policy by 2017.

o Develop and implement a scheme of service for all cadre of lab personnel.o Conduct consultative and consensus workshop in collaboration with the Human

Resource Directorate.


CHAPTER 3: LABORATORY INFRASTRUCTURE AND EQUIPMENT

Infrastructure

The design of a laboratory is essential to ensure proper workflow and safety of laboratory staff, other health professionals and patients. The designation of separate work areas for reception, specimen collection, sample processing, assays and relaxation is a major consideration for laboratory infrastructure. Furthermore, ensuring that there is appropriate lighting, ventilation, and bench space is essential for efficient laboratory operations. Equally important is ensuring restricted access to specialized areas. Despite the importance of appropriate laboratory infrastructure, a huge gap exists in the various levels of laboratory infrastructure in Sierra Leone. According to the Rapid Response Assessment that was conducted in 2015 only three laboratories met the required internal standards.

The government plans to improve significantly on the standard of laboratories infrastructure taking into cognisance the lessons learnt from the Ebola outbreak. It is anticipated that the laboratories will meet the required international standards for quality and safety taking into consideration Infection Prevention and Control (IPC).

Challenges:

Absence of a national standard for laboratory infrastructure. Inappropriately designed and poorly ventilated laboratory space. Irregular maintenance of laboratory premises. Inconsistent power supply. Inconsistent water supplies, low water pressure and poor water quality Lack of safe disposal facilities for water/ liquid waste from laboratories Lack of proper incineration facilities for solid hazardous waste Lack of proper storage facility Lack of Appropriate archived room Lack of common and dressing room Lack of easy accessibility to laboratory by the disabled (Ramp) Lack of detached laboratory from hospital building Lack of emergency exit in the laboratories

Policy:

To provide at each level of health care delivery, laboratory facilities appropriately designed to ensure a correct, safe, functional and operational environment for effective performance and service delivery.

Objective 5: To provide adequate laboratory space appropriate for each level for effective service delivery by end 2020


Interventions:

Ensure that targeted laboratories meet minimum required standards for infrastructure and environment by end 2020

o Reviewed laboratory design to meet international standards (by the end of 2016) o Renovate /upgrade 193 laboratories that do not meet required quality and safety

standards as appropriate for their level (To include water and power supply) by end 2020.

o Construct 9 new laboratories, 3 in each of the three regions (east, north and south) by end 2019

o Inspect and carry out annual maintenance of laboratories infrastructure 2019

Equipment:

Most laboratory analyses in the country are still being done using manual methods without validation of results. There are very few automated haematology and chemistry analysers in the country. Equipment procurement is done with little involvement of laboratory personnel, sometimes resulting in purchase of inappropriate equipment.

There are no policies for procurement of laboratory equipment and procedures for installation, and for training personnel on the use, care, and regular maintenance of such equipment.

Challenges:

Inadequate involvement of laboratory personnel in the planning and procurement process resulting in the purchase of obsolete and inappropriate equipment.

Bottlenecks in the distribution of laboratory reagents and supplies. Limited storage capacity for laboratory reagents and supplies at facility level. Lack of knowledge of the appropriate conditions for the storage and distribution of reagents and

supplies. Poorly maintained cold chain. Inadequate stock control systems (to ensure supplies are maintained and time expired materials

are disposed of properly). Lack of capacity at district level for procurement of specialized equipment. Lack of involvement of suppliers in equipment installation, training and commissioning. Lack of an equipment service contract system. Lack of appropriate temperature for storage of equipment

Policy

To provide the necessary procurement directions and stock management systems for an efficient quality laboratory service at all levels


Objective 6To provide technical expertise that will align international (regional) tools and documents of equipment requirements appropriate to support the BPEHS.

Interventions:

Ensure the procurement of appropriate and adequate laboratory equipment and commodities for all levels of service delivery nationwide.

o Develop a national equipment and supplies management plan by 2016. o Equip each laboratory with equipment and supplies including stock management and

waste disposal to support approved testing platform according to the Basic Essential Package (BEP) by 2016.

o Develop and ensure compliance of the policy for service contracts on all procured equipment and supplies by end of 2016.

o LTWG to provide central oversight for the procurement, installation, distribution and maintenance of all laboratory equipment.


CHAPTER 4: LABORATORY SERVICES & SUPPORT SYSTEMS (Logistics & Management Systems)

Laboratory Services

Most district laboratories do not have the capacity fully to support the delivery of the minimum health package and other programme activities. Haematology services in almost all hospital laboratories are limited to haemoglobin estimation and occasional manual WBC counts. Microbiology services at both PHU and hospital level are limited to microscopy for TB, Malaria and parasitological examinations of faecal samples, although a limited number use rapid diagnostic tests (RDTs) for malaria, HIV, syphilis and Hepatitis B testing. Biochemistry tests are limited to urinalysis by dipsticks and occasional blood sugar estimation. Very few laboratories provide Urea and Electrolyte or Liver Function Tests (LFT), and key items in patient management. Limited histology services are offered through the histopathology unit at central level. There are no cytology or toxicology services. The Kenema hospital laboratory is the most advanced laboratory in the country and has an adjoining Lassa Fever BSL3 Containment laboratory that has the capacity for molecular and Enzyme immuno-assay. This service is of international standard and provides support to neighbouring countries.

The services for Malaria, HIV, TB, and Lassa Fever provide an opportunity for the public health laboratory to build on and expand the referral system to encompass other diseases and a much wider range of specimens.

Challenges:

Limited testing capability at all levels due to inadequacies in skills, equipment and reagents. Limited infrastructure and utilities to support laboratory service. Weak specimen referral system.

Policy:

To provide laboratory services appropriate to each level of the health care system that respond to the defined national health care package.

Objective 7: To provide laboratory services appropriate to each level of the health care system within the defined laboratory package by end 2020.

Interventions:

Define the laboratory tests and techniques to be offered at each level by end 2016. Strengthen and expand the specimen referral system to include diseases and specimens other

than those currently covered by end 2018.


Define a national stock management systems protocol by end 2018.o Revise referral and feedback tools by end 2017.o Develop and distribute guidelines and provide training on specimen packaging by end

2017.o Establish a specimen referral courier system by end 2018.o Establish a stock management protocol for all equipment, supplies and consumables at

all levels by end 2018.

Laboratory Logistics and Management System

During the EVD outbreak, the laboratory services were challenged by the scarcity of skilled human resources and management supply chain in support of laboratory services. This led to a major hindrance in the delivery of quality laboratory services. The MoHs should ensure that critical testing supplies are available when needed to prevent delays in providing pertinent testing results to patients. A robust equipment maintenance and calibration programme is thus necessary for proper and consistent functioning of all laboratory equipment and reliable test results. Adequate attention should be given to inventory and stock management including maintenance of infrastructure and equipment for a laboratory to run efficiently.

A good storage system is essential to the guaranteed integrity of laboratory commodities at all levels of distribution in accordance with the manufacturer’s instruction. The delivery of commodities to the lab facilities should be based on logistics report which should be sent to the central warehouse through the state procurement and supply chain management team.

Reagents and supplies:

Weak capacity for quantification and specification coupled with procurement and distribution bottlenecks often result in stock-outs of reagents and essential laboratory supplies. Districts attempt to fill the gaps by sourcing equipment and reagents at district level from the few local suppliers, posing challenges of availability, problems of standardisation of reagents and a lack of the benefits of economies of scale.

Challenges:

Weak inventory management. Lack of established preventative maintenance programmes. Lack of equipment management systems. Lack of vendor (equipment and supplies) service contracts. Limited systems for validation of laboratory testing results. Limited storage space for reagents, specimens, and supplies nationwide. Limited involvement of laboratory staff in the acquisition of laboratory equipment and supplies. Only one biomedical engineers to address in-country equipment maintenance needs.


Service interruption due to Non-usable equipment. Inadequate documented procedures to address notification of physicians of critical values,

delayed results and to prevent loss of laboratory data. Lack of guidelines on disposal of obsolete equipment and expired reagent. Unreliable forecasting, quantification and specifications of supplies.

Policy:

To provide the necessary procurement directions and stock management systems for an efficient quality laboratory service at all levels.

Objective 8: To provide all government medical laboratories with appropriate equipment, and assure availability of commodities (media, sera, reagents etc.) for efficient service delivery by end 2020.

Interventions:

Strengthen national testing norms and standards definitions o Update the national standard equipment list and specification for procurement at the

different levels of healthcare by end 2016. o Provide a common and appropriate laboratory equipment platform for test assays by

end 2016. o Develop essential supply list based on the test requirements for the various levels of

healthcare delivery by end 2016. Institute diagnostic and public health commodity systems

o Train 36 laboratory personnel on logistics and supply chain management by 2017. o Ensure representation of laboratory personnel on local and national procurement

committees by 2017.o To develop policy for disposal of obsolete equipment and expired reagent by 2017.

Objective 9: To provide all government medical laboratories with complimentary supplies and consumables for efficient service delivery by end 2020.

Intervention: Strengthen the storage and distribution mechanism for equipment, supplies and reagents at all levels.

Establish minimum and maximum stock levels for each laboratory by 2016.o Provide adequate reagent storage facilities at each laboratory according to the National

Basic Essential Health Package (2016- 2020).


o Provide cold storage facilities for all laboratories by end of 2016. CPHRL to validate all laboratory reagents procured in country. Provide periodic in-service training in stock management of equipment, reagents and various

supplies (2016).


CHAPTER 5: BIORISK MANAGEMENTBIOSAFETY, BIOSECURITY, BIOBANKING)Medical laboratories handle infectious waste materials and generate biological waste. It is important that the staff, the public and the environment are protected from injury or contamination by these materials.

The last Ebola outbreak led to the infection and death of several medical and laboratory staff. The lessons learned from this should ensure that all health care providers consider health and safety paramount in the operations of health facilities nationwide.

The issue of specimen repository of left over biological samples from investigations conducted in our laboratories has become more important than ever before. There had been no policy to guide specimen archiving, storage, retrieval and destruction. Vital samples from endemic and epidemic prone diseases in this country are not stored properly and their destruction is haphazard.

Well-structured and resourced bio repositories could serve as a vital resource to promote research and training of our future scientists. .

Laboratory workers are also exposed to dangerous chemicals and fire incidents and should be taught how to protect themselves from such ugly incidents.

Challenges:

Lack of laboratory bio-security policy Inadequate supply and hence insufficient use of PPE Poor waste management systems including a lack of waste disposal equipment Inadequate skilled personnel to safely package and transport infectious substances Lack of training in fire safety and containment

Policy:

To promote and sustain laboratory safety and safe laboratory practices in all laboratories in order to protect staff, products, community, and environment.

Objective 10To support all laboratories to implement the laboratory bio-safety policy and adhere to safety guidelines by end 2018

Interventions


Implement the national laboratory safety policy and guidelines by end 2018 Establish a laboratory waste management protocol by end of 2018

o Procure and distribute adequate quantities of waste disposal systems by end 2018o Procure and distribute appropriate PPE and continue to train staff in its use till 2020o Build capacity of laboratory personnel on fire safety to address chemical spills and

contamination by end 2016 Establish national repositories for the safe storage and security of biological specimen for use in

the development of an effective public health system by end 2020. Develop functional inventory and a system for specimen management (collection,

transportation, archiving and retrieval of stored specimens-Laboratory Information Management System) by end of 2020.

Develop policies for destruction, accessing retrieval and utilization, disposal of stored specimens by end of 2016.

Establish a National Governing body for overseeing bio banking by end of 2016. Establish and strengthen capacity for management, coordination, operation and maintaining of

the bio banking by end of 2018.


CHAPTER 6: INFORMATION MANAGEMENT SYSTEMSLaboratory Information System is a paper, electronic or web based system that processes, stores and manages data from all stages of medical procedures and tests, with the sharing of data on patient’s care, disease surveillance, and monitoring and evaluation of laboratory performance.

Proper implementation of LIS ensures high quality actionable data is available to users in a timely manner, it assures security and confidentiality of laboratory data by the administrator and eligible users.

This plan continues to recognise the weakness of the laboratory information systems and highlighted LIS as one of the strategic focus areas in the plan.

Policy Environment of LIS The 2009 Health Policy affirmed goal to establish and strengthen laboratory systems. The National Laboratory Policy highlights the need for national Laboratory Information Systems

(LIS). The 2011-2015 Laboratory Strategic Plan sets out mechanisms to establish and strengthen the

LIS. The strategic plan identifies Integrated Laboratory Data Management as a core function of the

laboratory system.

Strengths

Existing laboratory policy documents recognize the need to establish efficient LIS. Other ministries and programmes require lab support and can be expected to contribute to LIS

strengthening.

Main challenges

Weak lab management and coordination structures. Lack of infrastructure for data management. No standardised system for management of laboratory data. Inadequate supervision and monitoring of service delivery. Poor data collection, compilation, analysis, utilization and reporting. Limited capacity in data management. Inadequate data collection tools at laboratory level. Vertical programmes running parallel data collection systems. No harmonisation of vertical programmes data with national laboratory data. No link with DHSPPI.

Opportunities:

Increased international technical and financial support for Post-Ebola Recovery and HSS.


Increased interest and focus on HIS and interoperability of HIS systems. There are existing programmes to support LIS – DHIS. Increased demand for data use in decision making. Overall laboratory investments for more cohesive service delivery. LIS modules in pre-service lab training and continuing professional development.

Threats:

Continued dependency on donor support threatens sustainability. Power supply and telecommunications inadequacies limit the functionality of LIS. Inadequate skilled human resources and staff retention challenges. Task overload.

Policy:

To establish an efficient and integrated LIMS at all levels

Objective 11: To establish a laboratory information and management system that is integrated into the national health management information system

Interventions:

Establish an integrated system for data capturing, analysis and use at all levelso Establish a data unit at the laboratory directorate by 2017o Establish laboratory LIS TWG with defined terms of reference by end 2016 o Train district laboratory in-charges on the use of the tools and relevant software by end

2018o Provide network and information communication technology equipment at all levels by

end 2019o Establish an electronic LIMS throughout NPHRL network by end 2017 o Train specified personnel at the district laboratories in the use of the tools by end 2018o Link laboratory data unit to national data warehouse by end 2020

Establish effective data management and sharing systems by 2018o Generate Protocol for LIS integration into HIS by 2019

Establish an electronic LIMS at NPHRLo Identify the software to be used by end of 2nd quarter in 2017o Install software and train staff by end 2017


CHAPTER 7: EMERGENCY PREPAREDNESS AND RESPONSE

Public Health Functions

Sierra Leone has experienced two major epidemic-prone disease outbreaks within the past 5years; these are Cholera and the Ebola Virus Disease (EVD). Given that there had been previous Cholera epidemics, it would have been assumed that lessons learnt in handling such would have influenced the country’s preparedness in response to the 2014 EVD outbreak however, this was not so. During this outbreak, many lives were lost, including 202 frontline health service providers, further depleting the already low number of this cadre; there was exposure of the lack of capacity and preparedness within an already weak health infrastructure, in responding to other outbreaks.

This section will provide direction in preparedness and response for future outbreaks, in accordance with the Integrated Disease Surveillance and Response (IDSR) strategy adopted by WHO AFRO member states for improving public health surveillance and response. The focus areas will be on Disease Prevention and Control, Surveillance and the identification of disease outbreaks, facilitation of an appropriate response and the implementation of prevention and control measures.

Integrated Disease Surveillance and Response (IDSR)

The technical guidelines for IDSR in African Regions 2010 clearly highlighted the Laboratory confirmation of a disease to allow for timely intervention to limit the impact of the health of affected communities. Although the current drive takes into account (one world- one health) perspective that integrates human, animal and ecosystem health, the plan only addresses the human health with the flexibility to link with animal and environmental effects. With the commitment of MOH to implement IDSR, key critical development paths are considered as per figure below.

Figure 4: Critical path of development


Challenges:

Implementation of the IDSR strategy in Sierra Leone is not optimal at this point in time A lack of emergency/rapid response teams (RRTs) at all levels that is, National, District and

Community Limited training in emergency preparedness at all levels that is, national, district and community

Policy

To improve laboratory capacity for surveillance and response

Objective 12:To fully implement the IDSR strategy in Sierra Leone by 2020

Interventions:

Create a Laboratory coordinating office at the Emergency Operations Centre (EOC). Develop a Laboratory Rapid Response Operational manual, with a costed implementation plan. Integrate the laboratory emergency response into the overall national response. Train relevant national and district level personnel as part of the rapid response teams (RRTs)

for disease outbreaks.o Train 2 Laboratory scientists as part of the national level RRTo Train 14 Laboratory Scientists as part of the district level RRTs (one per district)

Establish RRTs at all levels, national, district and community. Train laboratory staff in outbreak emergency preparedness, including laboratory activation

simulations.


CHAPTER 8: RESEARCH, DEVELOPMENT AND ETHICSThe capacity of laboratories to conduct research in the country is limited. In collaboration with the Health and Biomedical Research Group a symposium has been organised to build technical capacity in proposal writing and research methodology for simple operational research that addresses the needs of the country and various ministry programmes. Members of staff are being encouraged to publish their work in both local and international peer review journals.

We can now leverage on the experience and expertizes available during the EVD outbreak and create/maintain a network of laboratories and researchers at all tiers within the country and internationally in other to strengthen the laboratories capacity to conduct research.

Challenges:

Low technical capacity in proposal writing and research methodology Laboratories poorly equipped to conduct research Lack of a national laboratory research policy Inadequate funding and resources to support research and development activities. No National research database. Laboratory data management (reporting format) not integrated.

Policy:

To promote and strengthen research that will contribute to improving the quality of health and health care delivery in Sierra Leone

Objective 13: To strengthen operational research technical capacity to enhance laboratory services in Sierra Leone by 2020

Interventions

Define research priorities relevant to laboratory services by end 2016 Establish strategic partnerships and linkages with internal and external academic

centres to collaborate and strengthen the national public health research agenda by end 2017

Collaborate with the Health and Biomedical Research group to train laboratory personnel in proposal writing and research methodology by end 2016


Advocate for funding/ Mobilize resources for operational research aligned with the Directorate of Planning, policing and information by end 2017.

Develop a national research data base by 2018 Develop an integrated data management system by the end of 2018.


CHAPTER 9: PARTNERSHIPS AND LINKAGESSierra Leone operates a countrywide network of 179 functioning laboratories, operating in a four- tiered, system, with increasing degrees of competence and capacity as you go up the tiers.

The preceding consists of the following:

Four public health laboratories. Two research laboratories—Kenema Viral Haemorrhagic Fever (VHF) laboratory in Kenema and

Mercy Laboratory in Makeni. 24 public clinical laboratories comprising of :- 12 district clinical laboratories of which 5 are

regional laboratories (MOHS); 4 laboratories run by the forces (Military, Police and Prisons); 4 laboratories run by the current universities, 4 private clinical laboratories countrywide— 3 in Western Area, 1 in the South.

Figure 5: Areas of actions to address all levels of laboratory network

Due to the weak laboratory infrastructure, inadequate numbers of skilled personnel and lack of equipment, many laboratories, in all the tiers, are neither performing to capacity nor meeting the needs of the BEPHS, the Free Health Care initiative, FHCI and the Global Health Security agenda. At the district level, there is minimal supervision and coordination of the primary health unit (PHU) laboratories. There is no intermediate technical supervisory, coordinating and monitoring unit between the districts and the central levels; all laboratories, down to PHU level, are therefore supervised from the central level.


The Central Public Health Reference Laboratory (CPHRL) serves as the hub for the network of public health labs, which include the Jui Public Health laboratory, the VHF Kenema, the Makeni Reference lab, the National TB Reference laboratory Lakka, the Neglected Tropical Disease (NTD) laboratory in Makeni, and the existing tertiary laboratories at regional level. The network of public health laboratories is moving toward integrated disease surveillance and also linking with clinical diagnostic and reference laboratories at the tertiary level.

Challenges:

Weak inter-laboratory collaboration Weak referral systems among all tiers of laboratories Weak collaboration between Surveillance and Laboratories Weak linkages and partnerships, both local and international

Policy:

To establish effective and efficient mechanisms for national and international networking and collaboration for quality laboratory services, improving access to laboratory services by the population and maximising resource mobilisation and utilisation.

Objective 14: To establish an effective laboratory network at national and international level for quality laboratory services and resource mobilization by mid-2020.

Interventions

To strengthen the national laboratory network for clinical diagnostic and reference, and public health laboratories.

Develop a national map of laboratories and laboratory resources by 2016. Establish an integrated national laboratory network of both public health and clinical

laboratories, with defined roles and responsibilities for each tier by end 2017.o Network PHU laboratories with the district laboratories by mid-2016.o Network district laboratories with the regional laboratories by end 2016.o Network the regional laboratories with NPHRL by end 2017.

Strengthen collaborative and communication linkages among all laboratories across all tiers countrywide by end 2020.

o Establish a referral system among all tertiary clinical and reference laboratories, (Connaught, Makeni, Kenema, PCMH, Ola During and Bo) by end 2017.

o Strengthen the referral system of the National Public Health Reference Laboratory (NPHRL) by end 2020.

o Strengthen partnerships among the existing network of laboratories countrywide.


Strengthen international partnerships with both laboratory and non-laboratory technical partners, for the purpose of training, research and development, efficiency and innovation and quality assurance by end 2020.

o Strengthen inter-programme linkages by 2016.o Strengthen linkage with international laboratories by 2017.

Strengthen the linkages and reporting of the Central Directorate and the national technical working groups to the Emergency Operating Centre (EOC) by 2016.

Strengthen Central Directorate and the national technical working groups to provide oversight to all laboratories, coordinate laboratory services within the regions and to support districts in disease surveillance and outbreak investigation, linking with the NPHRLS by 2020.

Provide linkages to food/water bacteriological testing at NPHRL and clinical laboratory systems in collaboration with the National Standards Bureau by end 2018.

Provide linkages to basic water testing for microbial and element contaminations to district laboratories by mid-2018.

Linkage with the Office of the National Security, ONS for emergency respo

Figure 6: Network of National Public Health Reference Laboratory System


CHAPTER 10: TOTAL QUALITY MANAGEMENT SYSTEMS (QUALITY ASSURANCE)Laboratory quality can be defined as accuracy, reliability and timeliness of reported test results. These results must be as accurate as possible, all aspects of the laboratory operations must be reliable, and reporting must be timely in order to be useful in a clinical or public health setting. However, achieving, maintaining and improving accuracy, timeliness and reliability are major challenges for health laboratories in Sierra Leone. The LQMS is for all stakeholders in health laboratory processes, from management, to administration, to bench-work laboratorians.

Present Situation:The country does not currently have a national quality assurance program to enable it to develop and implement a laboratory quality system with the exception of the TB and HIV programmes. There is no standardization of equipment and techniques, making it difficult to develop national SOPs and External Quality Assurance (EQA) programmes with the exception of the TB and HIV programmesMany laboratories do not have internal Quality Control (QC) systems in place. Only Lassa fever, Central Public Health Reference Laboratory, TB reference laboratories and the Microbiology laboratory at the Connaught hospital participate in international EQA programmes.The TB and Central Public Health reference labs are the only labs that manage national EQA for TB and HIV diagnosis.The EVD Labs participate in EQA facilitated by WHO/CDC and coordinated by the LTWG and the goal was to improve the quality of laboratory services in accordance with the International Organization for Standardization (ISO)

Challenges:

Lack of National QA Policy Lack of National Lab Quality Management System (LQMS) Manual/Handbook Insufficient number of trained staff Inadequate supporting infrastructure and equipment Lack of standardization of equipment and tests Quality and performance of most labs cannot be evaluated Poorly motivated staff Inadequate top management supportive supervision to labs

Policy:

To provide and maintain standards of operation of laboratory services to levels acceptable for assured provision of quality health care delivery through effective monitoring, evaluation and intervention.

Objective 15 To establish a Quality Management System (QMS) for quality assured laboratory test results by end 2020


Intervention:

Establish a National External Quality Assurance Programme (NQAP) by end 2016 o Develop a National QA Policy- 2016o Develop a National Lab Quality Management System (LQMS) Manual/Handbook. By end

2017o Train and assign 14 District QA Managers by end 2017o Standardise equipment and tests for each level by end 2016o Facilitate /Develop SOPs for equipment and lab procedures by end 2017o Train laboratory staff in the use of the lab quality manual and SOPs by end 2017.

Expand the National External Quality Assurance Scheme (NEQAS) in accordance with the National QA Policy by end 2020

Strengthen NPHRLs and Clinical Laboratory to prepare proficiency panels for the most commonly performed lab tests for ten diseases that meet IDSR by end 2019 o Train laboratory staff on Quality Assurance by end 2018o Enrol regional and district laboratories in NEQAS by end 2018o Work with Laboratory Technical Working Group (LTWG) to establish a National Quality

Assurance Programme (NQAP)o Support LTWG to establish a National Quality Assurance (NQA) Committeeo Develop SOPs for QA


SECTION 3: IMPLEMENTATION MECHANISMS

Table 3: Strategic Framework

Objective number

Objective Output Indicator

1

To strengthen the laboratory organizational and management structures to provide oversight and coordination of laboratory services throughout all the levels of health care by end 2020.

National Laboratory Service Directorate established.

Senior laboratory managers attend at least one management-training programme.

LTWG role expanded to include coordination in advisory capacity

No. of senior laboratory managers with management training.

Number of LTWG meetings held and accompanying report

2

To provide a policy and legal framework for the regulation, training, laboratory practice and observance of professional ethics by end 2020.

NRLC established and operational

No. of personnel registered

No. of laboratories licensed

3

To strengthen community awareness of ethic for laboratory professionals and increase demand by service users and providers at all levels from 2017

70% of laboratories staffing adhere to laboratory code of ethics

70% of laboratories staff aware of laboratory ethics and with 70% compliancy scored at lab customer service audit

4

To meet the minimum qualified laboratory personnel levels to support the delivery of a comprehensive laboratory package at each level of health care by end 2020

50% of laboratories meet staffing norms

Number of laboratories meeting staffing norms

5 To provide adequate laboratory space appropriate for each level

193 Laboratory upgraded (reorganised, renovate or

Laboratory designed approved and


Objective number


for effective service delivery by end 2020

constructed) for logical operational flow

disseminated

6

To provide technical expertise that will align international (regional) tools and documents of equipment requirements appropriate to support the BPEH by end 2016

Approved Equipment package database

National equipment and accessories - Original Manufacturer or vendor lists with specifications generated

7

To provide laboratory services appropriate to each level within the defined laboratory package by end 2020.

80% of laboratories provide full package

Report on training on applications of systems tools and reporting audit

8

To provide all laboratories with appropriate equipment and assure availability of commodities for efficient service delivery by end 2020.

Update national specification for procurement of laboratory equipment list at different level.

Provide the national standardized list of equipment and specification.

9

To provide all government medical laboratories with complimentary supplies and consumables for efficient service delivery by end 2020.

Laboratories report less than two stock outs of reagents and supplies per year.

No. of laboratories reporting >2 stock outs of tracer reagents and supplies.

8.

To establish an effective network at national and international level for quality laboratory services and resource mobilization by mid 2020.

Strengthened national laboratory network for clinical diagnostic and reference, and public health laboratories.

Linkage between Regional and Public health laboratories

Coordinated network of national and international laboratories.

9. To provide adequate laboratory space appropriate for each level for effective service delivery by

50% of laboratories renovated to meet minimum standards for

50% of laboratories meeting standards for


Objective number


end 2020. infrastructure. infrastructure.

10

To support all laboratories to implement the laboratory safety policy and adhere to safety guidelines by end 2018

100% of laboratories implementing safety guidelines

% of laboratories implementing safety guidelines

11

To establish a laboratory information and management system that is integrated into the national health management information system

Over 90% of laboratories providing timely report

No. and % of labs submitting timely and accurate report

12.To fully implement the IDSR strategy in Sierra Leone by end 2020.

Functional laboratory coordinating office at EOC.

Laboratory Rapid Response Operational manual.

80% of Regional District Laboratory and surveillance IDRS implementation

Laboratory coordinating office at EOC.

National Integrated laboratory Rapid Response Operational manual activated

13

To strengthen operational research technical capacity to enhance laboratory services in Sierra Leone by 2020.

At least 2 papers published or presented at national or international conferences per Reference laboratory per year

No. of research conducted and papers published or presented at conferences. Evidence of operational research impact on health service activities

14 To establish an effective laboratory network at national and international level for

Established tier laboratory network

Laboratory maaping and linkage map and training


Objective number


quality laboratory services and resource mobilization by mid-2020.

within a regions

Functional referral systems

Laboratory twining for technical interchange.

report.

Number of laboratories twined with international accredited laboratories

15To establish a QMS for quality assured laboratory test results by end 2020.

100% of regional/reference laboratories enrolled in NEQAS

50% of PHCs (193) laboratories enrolled in NEQAS

Reference and Regional Laboratories with >3 stars in WHO accreditation scheme

No. and % of regional/reference laboratories scoring 100% in NEQAS

No. and % of PHCs enrolled in NEQAS scoring >50%

No. of laboratories with WHO Stepwise Accreditation rating higher than 3 stars


Table 4: Strategic time frame (working frame)

Objective 1: To strengthen the laboratory organizational and management structures to provide oversight and coordination of laboratory services throughout all the levels of health care by 2018

Output Interventions

Timeframe (by end of relevant year)

Responsible Lead

Colla

bora

tion

2016

2017

2018

2019

2020

Laboratory Directorate established

Establish a laboratory directorate at the Ministry of Health and sanitation

MOHS - Policy and Administration

HRMO

Establish clearly defined laboratory tiers

Directorate of Hospital and Laboratory Services (DHLS)

All Senior laboratory managers attend at least one management training

Strengthen management capacity of laboratory managers

MOHS, DHLS

Directorate of Training

USL

WAHO

LTWG role expanded to include coordination

Establish a laboratory coordination mechanism

OFFICE of CMO

Objective 2: To provide a policy and legal framework for proper regulation, training, laboratory practice and observance of professional ethics by 2020

National Medical Laboratory Regulatory

Develop an Act for the establishment of NMLRC

Office of the Minister of Health and Sanitation

Cabinet Office;


Council (NMLRC)

Law Officers

Establish and operationalize NMRLC

NMLRC

SLMDA and Phamacy Board

Commence licensing and registration of facilities and personnel

Objective 3: To strengthen community awareness of ethics for laboratory professionals and increase demand by service users and providers at all levels.

Strengthen Community Awareness of ethics for laboratory professionals

Create community awareness through the use of mass media

NMLRC

Ethics Board

USL

Objective 4: To meet the minimum qualified laboratory personnel levels to support the delivery of a comprehensive laboratory package at each level of health care by end 2020

50% of laboratories meet staffing norms

Deploy adequate no. of skilled personnel to all laboratories

DHLS HRMO

Improve output & quality of laboratory personnel from training colleges

DHLS

Directorate of TRAINING

USL

MEST

Train core group of scientists & laboratory physicians/Clinicians


Develop and operationalize retention and post training policy

MOHS Policy and Admistration

DHLS

NMLRC

HRMO


50% of laboratories renovated to meet minimum standards for infrastructure

Ensure laboratories meet minimum standards for infrastructure

DHLS

PLANNING

HSS

LTWG

Objective 7: Provide laboratory services appropriate to each level within the defined laboratory package by 2020

80% of laboratories provide full package

Define laboratory tests and techniques by level

MOHS LTWG

Strengthen and expand specimen referral system

DHLS

Define a national stock management systems protocol

DHLS

Planning,

NPPU

Objective 8: To provide all Government laboratories with appropriate equipment and assure availability of commodities for efficient service delivery by 2020.

Laboratories report less than 2 stock-outs of tracer reagents

Update the national standard equipment list & specification for procurement at all

DHLS LTWG


and supplies per year

levels

Provide a common & appropriate laboratory equipment platform for test assays

DHLS NMLRC

Develop essential supply list base on the test requirement at all levels

DHLS

Train laboratory personnel on logistic and supply chain management

MOHS USL

Representation of laboratory personnel on local & national procurement committees

MOHS NPPU

Develop policy for disposal of obsolete equipment & expired reagent

MOHS ONS


Objective 10: To support all laboratories to implement the laboratory safety policy and adhere to safety guidelines by 2018

100% of laboratories implementing

Develop national laboratory safety policy and guidelines

MOHS

DHLS

LTWG


safety guidelines

Establish laboratory waste management protocols

MOHS

DHLSLTWG

Provide adequate PPE and train staff on use.

MOHS

Build capacity of laboratory personnel on fire safety to address chemical spills and contamination

MOHS

EPA

FIRE FORCE

Enforce safety guidelines

MOHSLTWG

ONS

Establish national repositories for the safe storage & security of biological specimen

DHLS ONS

Develop functional inventory & system for specimen management

DHLS ONS

Established National Specimen Archiving coordination centre

Develop policies for destruction, accessing retrieval & utilization, & disposal of stored specimens

MOHS

DHLSONS

Establish National Governing body to oversee bio banking

MOHSLTWG

ONS

Establish and strengthen capacity for Management, Coordination, operation and Maintaining of the

MOHS ONS


bio banking

Objective 12: To fully implement the IDSR strategy in Sierra Leone by 2020

80% IDSR implementation strategy

Create a laboratory coordinating office at the EOC

MOHS

DHLS

DPC

EOC

ONS

LTWG

Develop a laboratory Rapid Response Operational manual with a costed implementation plan

Integrate the laboratory emergency response into the overall national response.

Train national & district level personnel as part of the rapid response teams for disease outbreaks

DHLS

DIRECTORATE OF TRAINING

HSS

LTWG

USL

Establish RRTs at all levels, national and district

MOHS

DHLS

DPC

ONS

Functional regional Centres of Excellence laboratory and Surveillance

Train laboratory staff in outbreak emergency preparedness, including laboratory activation simulations

DHLS CPHRL


network

Objective 13: To strengthen research capacity to enhance laboratory services in Sierra Leone by end 2020

At least 2 publications (local and or international) presented per year from each of the public health laboratory Network

Define research priorities relevant to laboratory services from 2016

MOHSEHTIC

LTWG

Establish internal and external and linkages with academic institutions to collaborate and strengthen the national public health research agenda

MOHS

MOHS-

DIRECTORATE OF TRAINING AND RESEARCH

MEST

USL

Develop and implement short courses on research methodology for practicing medical professionals

HSS

USL

Collaborate with the Health and Biomedical Research group to train laboratory personnel in proposal writing and research methodology

DHLSHBIOMED

LTWG

Mobilize resources for operational research

MOHS HSS

Establish an integrated data management system

DHLS

PLANNING USL



80% of laboratories providing timely reports

Establish an integrated system for data capturing, analysis and use at all levels

MOHS

DHLS

Directorate of Planning

HSS

DPCEstablish effective data management and sharing systems by 2018

Establish an electronic LIMS at NPHRL

Objective 14: Establish an effective laboratory network at national and international levels for quality laboratory services and resource mobilization by mid-2020.

Strengthen the national laboratory network for clinical diagnostic & reference, & public health laboratory

Develop a national map of laboratories and laboratory resources

DHLS LTWG

Establish an integrated national laboratory network for both public health and clinical laboratories for each tier

DHLSDPC

DHMT

Strengthen collaborative & communication linkages among all laboratories across all tiers countrywide

DHLS DPC

DHMT

Strengthen international partnerships with both laboratory &

MOHS

DHLS

HSS

DPC


non-laboratory technical partners, for training, research & development

Strengthen the linkages & reporting of the central Directorate& the national technical working groups to the EOC

MOHS

DHLS

HSS

EOC

DPC

Strengthen Central Directorate & the National Technical Working Groups to provide oversight to all laboratories

MOHS LTWG

Provide linkages to food/water bacteriological testing at NPHRL & clinical laboratory systems in collaboration with the national Standard Bureau

MOHS

STANDARDS BUREAUCPHRL

Linkage with the office of the National Security, ONS for emergency response

MOHS

ONS

DPC

Objective 15: To establish a QMS for quality assured laboratory test results by 2020

80% Establish the NQAP. CPHRL NMLRC


laboratories enrolled in NEQAS LTWG

Expand NEQAS in accordance with the National QA Policy

CPHRL


MONITORING AND EVALUATION

INTRODUCTIONIn the NMLStP 2010 – 2015, monitoring and evaluation (M&E) of medical laboratory services was not given sufficient attention therefore it is deemed necessary that it forms an essential element of the National Medical Laboratory Strategic Plan NMLStP for Sierra Leone 2016-2020.

This Monitoring and Evaluation (M&E) Plan describes the approach and system developed to assess progress and impact of the overall strategic objectives of the NMLStP. Information from the M&E system will measure the extent to which activities contribute to achievement of the results described in the M&E framework. The M&E framework presents the results that the NMLStP expects to achieve in the specific priority areas.

The M&E plan will provide the platform for routine tracking of implementation of laboratory activities. It will serve to guide laboratory services management, allowing partners to adjust targets and approaches if necessary in order to meet the intended objectives and also detail the data flows required at each level and the key studies to be conducted to measure impact.

PURPOSE To guide, the core M&E activities to be implemented as a part of the NMLStP, providing strategic information on the progress of implementation of laboratory services and accomplishments, measuring the impact of interventions taken, and enabling the timely and opportune identification of problems for decision making and planning.

OBJECTIVES 1. Create an easy to use and interpret standardized National M&E system; that also meets the needs of government and partners, to monitor and evaluate the implementation of the NMLStP.

2. Identify the core indicators that will allow key stakeholders evaluate and measure the impact of the NMLStP, also providing data to compare the national accomplishments with other countries.

3. Generate strategic information for decision making in order to constantly improve medical laboratory services and management.

CRITERIA FOR SELECTION OF INDICATORSFor selection of the indicators, the guiding tools are the laboratory quality indicators that ensure practicality and quality output. In view of this the following listed below are used to build the milestones monitoring plan.

o Coherence with the policy objectives of the NMLStP and all its priority themes.o Feasibility to collect the required data taking into account indicators for which data is already

available in the country but where flow needs to be improved.


o Sensitivity to detect changes and impact of improvement monitoring through quality improvement activities

o Ability to compare indicators with other countries.o Measureable output to impact on national priority health indices,

PROPOSED M&E UNIT/ SUB-COMMITTEE An M&E Unit is proposed and should be located physically and organizationally within the MOHS headed by the M&E Officer with knowledge of laboratory quality audit and its interpretation to national health impact. The team members should have representation at Provincial and or District levels. This M&E Sub-committee should be a technical multi-sectoral body responsible of coordinating and implementing the NMLStP M&E plan.

PURPOSE OF THE M&E SUB-COMMITTEETo ensure that policy and decision makers and the public have access to timely and reliable strategic information on the implementation and achievements of the NMLStP for policy making, planning, research and general use.

OBJECTIVES OF THE M&E SUB-COMMITTEEo To coordinate and facilitate the implementation of the M&E plan including: o To finalize the proposed framework, plan and system for the M&E of the NMLStPo To facilitate/provide technical assistance to DHMTs and partners in the development of their

provincial and district M&E plans o To agree on the terms of reference for any consultant hired to conduct operational or

evaluation research relevant to the NMLStP and the aims and objectives of such research o To safeguard the quality of M&E activities that are part of the national laboratory services and

management reports, including: o To provide technical assistance to the development of studies and/or surveys required to

provide data for the national indicators. o To critically review M&E reports from the provinces, districts and any other source.o To critically review research findings, situation analysis and other relevant reports on laboratory

services and management in the country. o Submit strategic information and recommendations for decision making to the Planning division

or the relevant body for policy making, planning, research and general use.

COMPOSITION OF THE M&E SUB-COMMITTEE The Chair of the Sub-committee will be selected by the MOHS technical lead and will be part of the LTWG mandate and the appointment will be for the life of the NMLStP. The lead will work with direct support of the M&E Unit Officer responsible for Laboratory service .


o Full time members: o Representative from the DPC - Surveillance Unit of the MOHS. o Representative from the GFTAM of the MOHS. o Representative from Statistics Sierra Leone. o Representatives from MOHS Planning and Health Systems Strengthening unit o Key Health development partners such as WHO and health stakeholders.o Representative from University of Sierra Leone.

o Associate members o Representatives from Ministries of Education/Agriculture/Planning & Development.o Representative from any other relevant Unit of MOHSo M&E Focal Point from the Medical and Dental Council

ADMINISTRATIVE FUNCTIONS OF THE M&E SUB-COMMITTEE o The M&E Sub-committee will meet every quarter. Its key function is to provide continuity

between overall implementation and tracking progress toward goals/objectives established in the NMLStP and to supervise the implementation of the national M&E plan. Other functions can include but not limited to:

o Liaison between the MOHS Planning Division and the M&E Sub-committee o Collaboration with the communications officer in the design and implementation of a

communication plan of strategic information to key stakeholders and the publico Coordination with and provision of TA to National & Regional M&E Partners.o Commission & Oversee special studies and or surveys. o Convene and facilitation of quarterly and other meetings of the M&E Sub-committee.

Specifically:o Collection and organization of all information and data on topics or issues required or addressed

during the M&E Sub-committee meetings o Collection of information from institutions and organizations in order to update the

performance of national indicators and prepare a quarterly report to be presented to the MOHS Planning division.

IMPLEMENTATION OF THE M&E PLAN In order to fulfill the commitments in the M&E Plan, MOHS and its partners need to strengthen the M&E capacity at all levels, specifically, training and capacity building should be provided for the M&E Sub- Committee in the following areas:

o • Research methodology o • Advanced data analysis skills o • Technical writing o • Proposal and report writing/project management



FRAMEWORK FOR THE MONITORING AND EVALUATION PLAN

Table 5: Indicators and Monitoring Tools

Indicators Monitoring tools

No. of senior laboratory managers with management training

No. of monthly LTWG coordination meetings

% increase of qualified personnel in labs

% of laboratories meeting equitable staff versus workload ratio

% of laboratories providing full BPEHS package

% of Stock outs of tracer reagents and supplies by laboratory and length of stock out

% of laboratories meeting standards for infrastructure

% of laboratories participating in at least one of EQA and scoring >80% in NEQAS

No. of laboratories participating in WHO Stepwise Accreditation and annual % increase rating

% Laboratories providing timely reports (TAT)

% of laboratories implementing safety guidelines

No. of research papers published or presented at conferences

No. of supervision or Quality Audit visits

% of equipment down time

Supervision Checklist /Quality Audit tool

Data collection and collation forms

Laboratory request and results forms

Technical worksheets and charts

Monthly and quarterly reporting forms

MOHS Activity Grid

Reports

Monthly

All laboratories at different levels will generate weekly summaries of work done and undertake monthly monitoring of outputs.

Quarterly

Quarterly reports will be submitted to relevant management at district, regional and national levels for results monitoring and support supervision.

Evaluation

A mid-term and end-term evaluation will be undertaken. The mid-term evaluation will assess progress towards achievement of outcomes and make any necessary strategic changes where necessary. The findings and recommendations of the end-term evaluation results will inform the development of the next plan.


FINANCING THE PLAN

The plan will be financed through;

Government budgetary allocations

World Bank

Funding from GFATM

Global Health Security Agenda

DFID

USG

China CDC

Italian Cooperation

Development Partners

Cost recovery

The regular budgetary allocation by the MOHS for laboratory services for purchase of equipment had been disaggregated to the districts. However, current plan to support this plan is to return to pool-procurement at central level coordinated from the Directorate level. Other costs such as personnel emoluments, procurement of reagents and supplies, supervision, coordination and monitoring are implemented and monitored centrally.

The laboratory directorate will be required to play a greater advisory and overarching coordinating role to ensure that procurement of especially of equipment, is coordinated to benefit from economies of scale and promote standardisation. The approved national testing algorithm and test menu package will be the guide for procurement of all laboratory supplies and consumables.

GFATM and other Ministry programmes that utilise laboratory services will work towards harmonised budgets equivalent to the support they require. A significant part of the budget, represented by the gap in funding, will be met through technical and logistic assistance from development partners.

Already a significant proportion of the costs for the establishment of NPHRL Systems are being met by Development Partners, while the government will continue to meet the personnel emoluments, donor support will be required for the advanced training of senior scientists at the NPHRL.


The successful implementation of this plan will require the leadership of the MOHS to coordinate national priorities

78

Costing formulae:

The following systems and structures should be taken into consideration in estimating the bidget requirement to support the interventions 2016-2020:

Profile and Test Capability o 3 Public health Laboratories o 5 Centre of Excellence / Regional Hospital facility o 14 district laboratories o 155 PHU o Infrastructural upgrade needs of facilities o Utility such as energy and water o Human Resource Training and Recruitment o Laboratory Housekeeping and Maintenance o Central and Regional coordination

Table 6: Estimated Major costs (millions of Leones) to be worked-out for 5 years period)

CATEGORY PHU District Regional

NPHRL Management

TOTAL Le

Coordination

Reagents

Equipment

HR

Infrastructure

QMS & Safety

Research & Development

Health & safety

Information Management


Totals

Table 8: Estimated Cost for Laboratory Emergency Response per districts (US Dollars)

EMMERGENCY PREPAREDNESS

ACTVITY UNIT COST /DISTRICT /MONTH (US Dollars )

Facility readiness audit

5000 Maximum of 2 audit /year to ensure compliancy

Establishment of screening and confirmatory testing in outbreak

25000 Laboratory Rapid deployment and response within outbreak zone and specimen management for referral

Preparedness Audit 2000 Facility based readiness to set up testing and IPC set up

Human Resource 13000 ( see justification annex 3)

Laboratory coordination and analysis through the report dissemination for prompt action

Stocks 25000 Specimen men management supplies and accessories for a 25 bed capacity

Transportation TBD Leveraging of vehicle and bikes with Rapid response team manual


DRAFT

ANNEXES


DRAFT

ANNEX 1: IMPLEMENTATION FRAME

IMPLEMENTATION FRAME (BIANNUAL) inclusive of the national 10-24 month plan NA= not applicable as these have policy implications

None= no partner has been identified

Note: Partners identified to support activities maybe for part of the stated objective and not be all inclusive

Intervention Activities Timeframe

IDENTIFIED PARTNER/S SUPPORT

2016-2017

Remark

2016 2017 2018 2019 2020

Objective 1: To strengthen the laboratory organizational and management structures to provide oversight and coordination of laboratory services throughout all the levels of health care by end 2020

Establish a directorate for the national laboratory service at the MOHS

Engagement of MOHS policy and administrative leads to determine implications of setting up the directorate

NA Policy level input

Appoint a Medical Laboratory Services Director NA

Appoint a Senior Laboratory Specialist Scientists to provide technical oversight supporting DHLS

CDC-APHL

World Bank

Partners can support the MOHS in filling in these positions until


DRAFT

absorbed

Post an administrator, accountant, personnel officer, data officer and support staff to the directorate

NA MOHS

Procure three vehicles for the directorate none

Establish clearly defined laboratory tiers with management functions and reporting structures

Classify laboratories and define functions for each laboratory tier

Aligned to support BPEHS 2015-2020

Completed

Appoint five (5) Senior Laboratory Scientists to manage the different sections of the National Reference Laboratories

World Bank Support to temporarily filled until absorbed by the MOHS

Appoint four (4) Provincial Laboratory Scientists to manage the regions and the regional laboratories

NA Part of staff competency and deployment by MOHS

Appoint nine (9) District Laboratory Scientists to manage district laboratories

NA MOHS

Initiate and coordinate Bi-Monthly National Laboratory activity updates and experiences sharing meeting for all 14 districts and National Laboratory

CDC-APHL Western area covered, gap is the regional meetings

Strengthen the management capacity of all laboratory managers

Equip all district laboratory managers with management skills

CDC-APHL QMS and Laboratory Leadership training

Provide mentorship to national and regional laboratory managers

CDC-APHL Western Area covered. Reference laboratory


DRAFT

PHE partners to provide additional regional support- ongoing

Establish laboratory coordination mechanism

Redefine the role of the LTWG (Laboratory Technical Working Group) in collaboration with Surveillance and Epidemiology Technical working Group (SETWG)

CDC-APHL Structured meeting with defined outputs to monitor laboratory service delivery progress – ongoing

Establish a secretariat for the LTWG NA Policy level decision. Current support at DHLS

Activate LTWG monthly central meetings CDC-APHL Ongoing

Expand quarterly Laboratory TTM to include all district CDC-APHL

PHE

Proposal made to partners supporting PHLS to collaborate

Institute quality audit improvement project monitoring CDC-APHL;

CDC-WHO

SLMTA TEAM

TQI initiated

Objective 2: To provide a policy and legal framework for proper regulation, training, laboratory practice and observance of professional ethics by 2020

Development of an Act for the establishment of the

Appoint a technical committee at the MOHS to start drafting of the Bill

NA Draft initiated


DRAFT

National Medical Laboratory Regulatory Council (NMLRC)

Liaise with Solicitor General’s Office to draft the Bill for the establishment of the NLRC

NA MOHS

Present the Bill to parliament for debate and enactment

NA

Establish and operationalize the NLRC

Appoint members of the Council NLRC MOHS

Hire technical and administrative staff for performing tasks related to licensing and registration

NA

Draw up rules related to laboratory code of practice, professional ethics and subsidiary legislation

none To be supported through LTWG

Develop a minimum standard of requirements for setting up of laboratories by tier.

NA COMPLETED

Review and harmonise the curriculum for laboratory training programmes.

NA COMPLETED

Develop laboratory-monitoring tools to incorporate indicators for ethics compliance monitoring.


Institute in-service training programmes on ethics WHO To be supported through LTWG

Commence licensing of all (as defined by the Act) laboratories and registration of laboratory personnel Ifrom

Identify and start the licensing all laboratories appropriately


Commence registration of laboratory practitioners who meet the requirements

none To be supported


DRAFT

2016 through LTWG

Develop a transition mechanism for personnel who are practicing but would not qualify for employment or practice under the new legislation

none

Objective 3: To strengthen community awareness of ethics for laboratory professionals and increase demand by service users and providers at all levels.

Create community awareness through use of mass media on laboratory ethics, the rights of users and methods of seeking redress

Ensure visible display of codes of ethics in all laboratories as part of standard practice


Create appropriate channels for complaints management in at least 30% of all public and private laboratories


Objective 4: To meet the minimum qualified laboratory personnel levels to support the delivery of a comprehensive laboratory package at each level of health care by end 2020

Deploy adequate numbers of skilled laboratory staff to all laboratory facilities by end 2020

Conduct competency assessment of current staff and develop deployment plan

CDC-APHL

WHO

DFID-OPTIONS

Assessment tools generated.

Partner to support for a defined period until MOHS can absorbRecruit 10 technicians yearly from 2016 - 2020 to

provide services at Community Health Clinics (CHC) and district laboratories

NA

Recruit annually, over three years starting 2016 - 2018 five senior laboratory scientists including laboratory

NA MOHS


DRAFT

physicians to work at regional and reference laboratories

Establish an Emergency laboratory response team at national and district level

CDC--APHL

WHO

National level ongoing

Improve the output and quality of laboratory personnel from training colleges by end 2020

Develop a training plan by end 2016 none LTWG

Complete the, harmonization and standardization of the curriculum for the training of technicians at diploma level by end 2016

CDC-APHL

DFID- Options

Ongoing

Improve on the training facilities of the Tertairy training institutions by end 2017

CDC-APHL Training lab upgrading

Train a core group of scientists and laboratory physicians in specific laboratory specialties by end 2020

Train two scientists locally and internationally in microbiology

none

Train five scientist in molecular biology and related laboratory areas

none

Train two scientist in virology and immunology China CDC

Commence specialist training of 4 medical doctors one each in Haematology, Microbiology, Histopathology and Chemical Pathology

China CDC

Train 46 staff in QMS from 2017 - 2020 through on -the- job training

CDC/APHL; CDC-WHO; OPTIONS, PHE

Adapted SLMTA/SLIPTA TOOLS


DRAFT

Develop a structure for the upgrade of community and untrained laboratory support workers

none

Develop and operationalize retention and post-training policy by 2016

Develop, validate and implement a curriculum for training at certificate level for laboratory assistants in and out of government service by end 2017

Options/APHL Ongoing

Develop and implement a scheme of service for all cadre of lab personnel

NA MOHS; HRMO

Conduct consultative and consensus workshop in collaboration with the Human Resource Directorate

LTWG

CDC-APHL

Support through HRMO

Objective 5: Provide laboratory services appropriate to each level within the defined laboratory package by 2020

Define the laboratory tests and techniques to be offered at each level by end 2016

Strengthen and expand the specimen referral system to include diseases and specimens other than those currently covered

CDC-APHL, BPEHS Laboratory test Menu generated

Define a national stock management systems protocol by end 2018

Revise referral and feedback tools CDC-eHealth, CDC-WHO

Develop and distribute guidelines and provide training on specimen packaging

CDC-WHO

Establish a specimen referral courier system CDC-e-Health

Options

Establish a stock management protocol for all equipment, supplies and consumables at all levels

CDC-APHL At CPHRL- ongoing


DRAFT

Gap is regional reference laboratories

Objective 6: To provide all Government Medical Laboratories with appropriate equipment and assure availability of commodities (media, sera, reagents etc.) for efficient service delivery by 2020.

Strengthen national testing norms and standards definitions

Update the national standard equipment list and specification for procurement at the different levels of healthcare

CDC-APHL National Norms and standards for each level of test menu – completed

Provide a common and appropriate laboratory equipment platform for test assays

CDC-APHL Recommended vendor of equipment platform with service contract for maintenance protocol

Develop essential supply list based on the test requirements for the various levels of healthcare delivery

LTWG

Institute diagnostic and public health commodity systems

Train 36 laboratory personnel on logistics and supply chain management by 2017.

CDC-eHealth

Ensure representation of laboratory personnel on local and national procurement committees

NA MOHS

To develop policy for disposal of obsolete equipment and expired reagent

WHO


DRAFT

Strengthen the storage and distribution mechanism for equipment, supplies and reagents at all levels

Provide adequate storage facilities at each laboratory CDC-APHL Storage at CPHRL completed

Gap is other regional inventory management

Establish minimum and maximum stock levels for each laboratory

CDC-APHL Component of QMS in SLMTA /SLIPTA


Objective 8: Establish an effective laboratory network at national and international levels for quality laboratory services and resource mobilization by mid-2020.

To strengthen the national laboratory network for clinical diagnostic and reference, and public health laboratories

Develop a national map of laboratories and laboratory resources

CDC-APHL To be supported through LTWG

Establish an integrated national laboratory network of both public health and clinical laboratories, with defined roles and responsibilities for each tier

none LTWG

Network PHU laboratories to the district laboratories CDC-APHL

PHE

Linkage of NPHL in all regions

Network district laboratories to the regional laboratories

none


DRAFT

Network the regional laboratories to NPHRL LTWG

Strengthen collaborative and communication linkages among all laboratories across all tiers countrywide by end 2020

Establish a referral system among all tertiary clinical and reference laboratories, (Connaught, CHINA P3; Makeni, Kenema, PCMH, Ola During and Bo)


Strengthen the referral system of the National Public Health Reference Laboratory (NPHRL)


Strengthen partnerships among the existing network of laboratories countrywide

LTWG

Strengthen international partnerships with both laboratory and non-laboratory technical partners, for the purpose of training, research and development, efficiency and innovation and quality assurance

Strengthen inter-programme linkages DHLS Laboratory Twinning

Strengthen linkage with international laboratories DHLS

CDC-APHL

Regional and International twinning

Strengthen the linkages and reporting of the Central Directorate and the national technical working groups to the Emergency Operating Centre (EOC)

NA MOHS

Strengthen Central Directorate and the national technical working groups to provide oversight to all laboratories, coordinate laboratory services within the regions and to support districts in disease surveillance and outbreak investigation, linking with the NPHRLS

CDC-APHL DHLS LEDERSHIP

Provide linkages to food/water bacteriological

Provide linkages to basic water testing for microbial and element contaminations to district laboratories

NA MOHS and MoWR


DRAFT

testing at NPHRL and clinical laboratory systems in collaboration with the National Standards Bureau by end 2018

Linkage with the office of the National Security, ONS for emergency response

NA mohs


Ensure that targeted laboratories meet minimum required standards for infrastructure and environment by end 2020

Review laboratory design to meet international standards

NA MOHS

Renovate /upgrade 193 labs that do not meet required quality and safety standards as appropriate for their level. (To include water and power supply)

WORLD-BANK

CDC-APHL; PHE;

Global Fund;

Italian Cooperation

177 labs able to function and support BPEHS.

This includes

3 -Public health Reference Hub

5 – Centers of excellence and regional Laboratories

14 District laboratories

155 PHU

Construct 9 new labs, 3 in each of the three regions (east, north and south)

Global fund

World Bank

Inspect and carry out annual maintenance of lab infrastructure

NA MOHS


DRAFT

Ensure the procurement of appropriate and adequate laboratory equipment and commodities for all levels of service delivery nationwide.

Develop a national equipment and supplies management plan

NONE To be supported through LTWG

Equip each laboratory with equipment and supplies including stock management and waste disposal to support approved testing platform according to the Basic Essential Package (BPEHs)

CDC-APHL; PHE;

Italian Cooperation

Each partner should ensure BPEHS is implemented in supported lab

Develop and ensure compliance of the policy for service contracts on all procured equipment and supplies

none To be supported through LTWG;

Supportive Supervision

LTWG to provide central oversight for the procurement, installation, distribution and maintenance of all laboratory equipment


Strengthen the storage and distribution mechanism for equipment, supplies and reagents at all levels

Establish minimum and maximum stock levels for each laboratory

CDC-APHL Implement SLMTA and or QMS stocks management trainings

Provide adequate reagent storage facilities at each laboratory according to the National Basic Essential Health Package

CDC-APHL; PHE;

Italian Cooperation

All to ensure reagent for 12 months is available for to support MOHS as top-up


DRAFT

Provide cold storage facilities for all laboratories none

CPHRL to validate all laboratory reagents procured in-country

CDC-APHL Institute Post-market validation.

Activation of national Quality officers

Provide periodic in-service training in stock management of equipment, reagents and various supplies

WHO

Objective 10: To establish a QMS for quality assured laboratory test results by 2020

Establish a National External Quality Assurance Programme (NQAP) by end 2016

Develop a National QA Policy and Quality Manual CDC-APHL

WHO

Develop a National Lab Quality Management System (LQMS) Manual/Handbook

CDC-APHL

WHO

Activation of National adapted SLAMTA and SLIPTA

Trained and Assign 14 District QA Manager none mohs

Standardise equipment and tests by level CDC-APHL

LTWG

Inventory list generated

Facilitate /Develop SOPs for equipment and lab procedures

OPTIONS To be supported through LTWG


DRAFT

Train laboratory staff in the use of the lab quality manual and SOPs

CDC-APHL

WHO

Expand the National External Quality Assurance Scheme (NEQAS) in accordance with the National QA Policy by end 2020

Strengthen NPHRLs and Clinical Laboratory to prepare proficiency panels for the most commonly performed lab tests for ten diseases that meet IDSR

CDC-APHL

WHO

Train laboratory staff on Quality Assurance CDC-APHL

WHO

Enroll regional and district laboratories in NEQAS CDC-APHL

WHO

PHE

Work with Laboratory Technical Working Group (LTWG) to establish a National Quality Assurance Programme (NQAP)

CDC-APHL

Support LTWG to establish a National Quality Assurance (NQA) Committee

CDC-APHL

WHO

Options

Develop SOPs for QA CDC-APHL

WHO


DRAFT

Objective 11 To support all laboratories to implement the laboratory bio-safety policy and adhere to safety guidelines by 2018

To support all laboratories to implement the laboratory bio-safety policy and adhere to safety guidelines by end 2018

Implement the national laboratory safety policy and guidelines

WHO Policy and manual generated

Establish a laboratory waste management protocol WHO

Procure and distribute adequate quantities of waste disposal systems

none

Procure and distribute appropriate PPE and continue to train staff in its use till

none

Build capacity of laboratory personnel on fire safety to address chemical spills and contamination

WHO Through LTWG and National Fire Force

Establish national repositories for the safe storage and security of biological specimen for use in the development of an effective public health system

CDC-APHL Support specimen archiving at CPHRL

Develop functional inventory and a system for specimen management (collection, transportation, archiving and retrieval of stored specimens (Laboratory Information Management System)

none

Develop policies for destruction, accessing retrieval and utilization, disposal of stored specimens

none Through LTWG

Establish a National Governing body for overseeing bio banking

none Through DHLS


DRAFT

Establish and strengthen capacity for Management, Coordination, operation and Maintaining of the bio banking

None Through DHLS

Objective 12: To fully implement the IDSR strategy in Sierra Leone by 2020

Train relevant national and district level personnel as part of the rapid response teams (RRTs) for disease outbreaks

Create a Laboratory coordinating office at the Emergency Operations Centre, EOC

NA COMPLETED

Develop a Laboratory Rapid Response Operational manual, with a costed implementation plan

CDC-APHL Ongoing

Integrate the laboratory emergency response into the overall national response

CDC-APHL Ongoing

Train 2 Laboratory scientists as part of the national level RRT

CDC-APHL Ongoing

Train 14 Laboratory Scientists as part of the district level RRTs, one per district

CDC-APHL Ongoing

Establish RRTs at all levels, national, and district CDC-APHL

CDC-WHO

Train laboratory staff in outbreak emergency preparedness, including laboratory activation simulations

CDC-APHL; DTRA;- MRI Global

Ongoing


DRAFT

Objective 13: To strengthen research capacity to enhance laboratory services in Sierra Leone by end 2020

Define research priorities relevant to laboratory services from 2016

Develop a national research database none With Directorate of HSS

Establish internal and external and linkages with academic institutions to collaborate and strengthen the national public health research agenda

CDC-APHL; Twinning program and linkage to regional training institutions.

Develop and implement short courses on research methodology for practicing medical professionals

WHO

Collaborate with the Health and Biomedical Research group to train laboratory personnel in proposal writing and research methodology

COMHAS

HBIOMED

Mobilize resources for operational research NA MOHS

Establish an integrated data management system WHO Through HMIS


Establish an integrated system for data capturing, analysis and use at all levels

Establish a data unit at the laboratory directorate CDC-WHO

Options

E-Health

Establish laboratory LIS TWG with defined terms of reference

NA

Train district laboratory in-charges on the use of the tools and relevant software

CDC-WHO


DRAFT

CDC-e-Health

DFID-Options

Provide network and information communication technology equipment at all levels

WHO

Provide network and ICT equipment at all laboratory levels

CDC-WHO

Establish an electronic LIMS throughout NPHRL network

CDC-WHO

Train specified personnel at the district laboratories in the use of the tools

CDC-WHO

Link laboratory data unit to national data warehouse DFID-Options

WHO

CDC-E-health

Establish effective data management and sharing systems by 2018

Generate Protocol for LIS integration into HIS DFID-Options

WHO

CDC-E-health

Establish an electronic LIMS at NPHRL

Identify the software to be used none

Install software and train staff DFID-Options

WHO


DRAFT

CDC-E-health


DRAFT

Annex 2: Sample Budget Outline for PHU

Detail COST for a FULLY FUNCTIONAL PHU

REAGENT AND KITS

DESCRIPTIONMETHODOLOGY DESCRIPTION

KEY SHELF LIFE UNIT PRICE USD QTY

Total COST

JUSTIFICATION

VDRLVDRL Antigen & Buffered Saline Diluent

1x5ml VDRL, 1x60ml Buffer (100 tests)

24 Months $40.00 1 $40.00

These tests are to be offered at the PHU unit according to the Basic package from the National Norms and standards for the lab tier. The quantification is based on the 1 functional peripheral health units, per 25 test per day per 20 days per month giving an estimated 500

Syphilis control $35.00

Syphilis Control Positive & Negative Controls 5 x1.0ml vials of each

2x5x1ml 18 Months $35.00 1

Monoclonal Grouping Kit

3x10ml of Anti-A, Anti-B, and Anti-D

3x10ml 21 Months $24.00 1 $24.00

HBsAg Test StripsSerum/Plasma/Whole Blood - Cut off 1 ng/ml

100T 24 Months $124.00 5 $620.00

Syphilis Test Strips Serum/Plasma/Whole Blood

100T 24 Months $120.00 5

$600.00


DRAFT

tests per month for each PHU. The equipment’s are one off purchases excluding maintenance costs. The minimum standard systems to support lab operations such as energy, water supply, infrastructural design and human resource are included in this costing. The consumable costed on a quarterly basis following which replacement should have been made.

Urine Strips Glucose/Protein/Ketone

100T 24 Months $16.00 5 $80.00

Malaria Rapid test kitRDT Global Fund/MCP

30T Malaria Program 15 $0.00

HIV RDT RDT Global Fund –NACP

30T NAS/NACP 15 $0.00

Normal saline tablet 10L NA $30.00 10 $300.00

ZN stainStain Kit/Global Fund /GLRA-TB

1L NA $- 0 $0.00

Sodium metabisulfite 500g 500g 36months $40.00 1 $40.00

Field stains A and B 2 x 100g 10L 36months $40.00 1 $40.00

Giemsa stain 25g 1L 36months $50.00 4 $200.00

May-Grundwald stain

25g 1L 36months $50.00 4 $200.00

NH3 solution 1 x 1Lconcentrate 10L 12months $70.00 2 $140.00

Cholera crystal VC rapid test kit

RDT WHO 25T 24months $- 1 $0.00

Immersion oil 100ml 100ml 36months $50.00 2 $100.00

xylene(slide cleaner) 1L 1L 36months $20.00 1 $20.00


DRAFT

SUB TOTAL $2,439.00

EQUIPMENTS

HaemocuePOCT 301 model

$1,000.00 1

$1,000.00

NH3 Solution colorimeter colorimetric visible range

1500 1

$1,500.00

Microscope TB/ Malaria/Blood film/ microbiology

olympus light microscope

$1,500.00 1

$1,500.00

Manual centrifugespecimen processing

hand centrifuge/portable

$150.00 1 $150.00

Glucometer glucose analysis hand held POCT $100.00 1 $100.00

SUB TOTAL $4,250.00

CONSUMABLES

Hemocue cuvette 301 pak of 200 Pack of 200

$155.00 3 $465.00

Labware (conical flask, beaker, 100ml,

Basic kit set Polypropylene $100.00 1 $100.00


DRAFT

1000ml measuring cylinder)

Microscopic slides (clear glass unground edges-25.4 X76.2mm, 0.8mm-1mm thick) 50 slides per pack Frosted slides

$30.00

4 $120.00

Cover slips 50 per pack plastic 50x50cm $20.00 4 $80.00

Staining Tank Metal

Double rod 12x 6 tank

$50.00 1 $50.00

Fisher brand transfer Pasteur pipets Pack of 50 (plastic) Graduated to1ml

$20.00 2 $40.00

Specimen collection kit

See sheet on specimen management

Test tube rack and tubes set

Plastic coated rack and borosilicate tubes

Set of 12 tubes per rack

$25.00 5 $125.00

Timer Non digital $10.00 2 $20.00

Slide rack

Metal rods drying rack

$50.00 1 $50.00

Slide boxes Plastic 2 slides

$5.00 20 $100.00


DRAFT

container

Concave mixing tiles and stirrer

8 well ceramic mixing tile

Ceramic mixing tile for latex reaction

$30.00 2 $60.00

Sterile lancet

capped sterile/auto let

$100.00 2 $200.00

Urine containers30ml labelled container

Plastic conical base, pack of 10

$20.00 10 $200.00

Disposable scalpel set

Stainless steel handle and disposable Pack of 10

$40.00 2 $80.00

SUB TOTAL $1,690.00

SYSTEMS SUPPORT

Infrastucture upgrade 1 Renovation

Bench space upgrade

1 $20,000.00 1

$20,000.00

One-off cost Infrastructure upgrade 2 Building Purpose built

1 $50,000.00 1

$50,000.00

Infeastructural upgrade 3 reorganisation Basic maintenance

1 $5,000.00

$5,000.00

EnergyGenerator Repairs and fuel


DRAFT

maintenance and fuel support

Inverter batteryTo support backup for 24 hour power

2 $15,000.00 1

$15,000.00

Duration of operations depend on monitoring and reapirs as needed. Should coven minimum of 2 years

Solar option to support backup for 24 hour power

2 $10,000.00 1

$10,000.00

Water

Mains if pipe borne exist 1

Borehole Well or borehole 1 $20,000.00

1$20,000.00

filteration unit deioniser or water still

1 $5,000.00 1

$5,000.00

Human resource

Training

Modular targeted training including management training 2000

$2,000.00

4$8,000.00

Supported through the BSC honours course

Technical support and mentoring

Until absorbed by the MOHS

$20,000.00

1$20,000.00

2 year support to ensure functionality and linkage to district lab

Facility based surveillance

supported by partners until critical mass is

Annual amount

$6,000.00 1

$6,000.00

Part of public health response team


DRAFT

personnel

possible support priority diseases response

Health and safety

Waste management

Incineration-customised Demontfort

1 $5,000.00

1$5,000.00

One-of building of facility incineration or support up to 2 years leveraging form existing waste management systems

LIMS

Paper base

Paper reporting linked to SMS or WIFI tablet with support fund for communications

1 $2,500.00

1$2,500.00

Support for stationery and Wi-Fi linkage to district electronic based LIMS.

Specimen Management

Collection kitvacutainer set, swab, tape

1500sets $2,000.00 1

$2,000.00

Monthly specimen management support

Processing Centrifuge, tubes 1 $2,500.00

1$2,500.00

Packaging Triple packaging 10perbox $700.00

2$1,400.00

Referal Referral Transportation

Vehicle and annual fuel and

1 $50,000.00 1 $50,000 Supporting specimen


DRAFT

maintenance .00 transportation for clinical referral and public health specimen management

Bike

1 $55,200.00

1$55,200.00


ANNEX 3: Minimum standards

Laboratory Hidden Operational Costs:

Laboratory operational cost is part of the minimum required standards for the basic daily operations of the laboratory. These cost are often hidden running cost vital for the sustenance of the service:

House keeping and maintenance o Securityo Cleaning and care taking o Building maintenance and utility bills

Communicationo Information technologyo Stationery

Health and safety o Waste disposalo PPE

109

Equipment and supplies and Quality o Service contracto Safety compliant and Certificationo Installation or disposal o Quality control supplieso Subscription to EQA program o Quality Assurance improvement plan support

Human Resourceo Continuous professional developmento Workload ratio

110

ANNEX 4: Emergency Response Budget Justifications.

sn DESIGNATION

QUANTITY PER DISTRICT RESPONSIBILITY

allowance or stipend per month Logistics support

1LABORATORY RESPONSE COORDINATOR 1

COORDINATE all laboratory activities including partner support and link with surveillance and field epidemiology to support action. Ensure criteria are met to support establishment of Laboratory. Implement quality assurance response ; Assess and implement training needs $3000

1 Vehicle, Fuel, maintenance, Driver, Phone, Mobile computer or tablet with internet capacity. Stationery

2 LABORATORY MANAGER 1

Operationalized district EVD testing laboratory through technical input and ensure activation of testing at all levels. Implement national algorithm and Monitor quality of testing. Implement quality audit and supportive supervision $2500

1 Vehicle, Fuel, maintenance, Driver, Phone, Mobile computer or tablet with internet capacity. Stationery

3 SPECIMEN MANAGER 2

Ensure supplies are available at all times at the facility for collection; coordinate specimen distribution to laboratory, ensure specimen integrity through cold chain maintenance. Monitor timely transportation of specimen to lab $1500

4 Vehicles, 8 motor bikes Fuel, maintenance, Driver, Phone, Mobile computer or tablet with internet capacity and UPS facility. Stationery

4 COURIER MANAGER 2

Worth with the specimen manager for logical travel plan to transport specimen to laboratory. Maintain integrity of specimen, $1000

5Laboratory Rapid Response lab scientist 6

Perform quality assured analysis at laboratory and report result within the shortest TAT $2500

6 LABORATORY DATA LEAD 2

Generate database frame at activated site in collaboration with Surveillance counterpart, Clean raw data and analyse for error and duplication; Collate and distribute result to EOC/DERC in coordinated and timely manner. $1500

7 LABORATORY LIASON OFFICER 2

Clean and transmit a Real time accurate result from Lab runs to health facility or clinician for immediate action $1000

8 LABORATORY LOGISITICS LEAD 1Order and stock health facility courier vehicle and provide health and safety material in transport vehicle at all time.

$20002 Vehicles with capacity to transport large

111

Maintain minimum stock levels at the facility for collection and community level. Link with donor partners on supply chain to monitor national stocks. stocks,

No. Themes Responsible person(s) MOH Directorate

1 Governance Dr Lebbie & Dr SAS Kargbo Directorate of Hospital and Laboratory Services and Directorate of HSS and Planning

Ethics Dr Samai & Dr Kenneh Directorate of Training and Directorate of DPC

2 Laboratory Services & Support Systems: Logistics & Management Systems

Miss Doris Harding, Mr Massaly, Dr Z. Koroma, Mr Osman Kargbo

National laboratory Services, and Blood Services, National Malaria , TB and HIV program

3 Health and Safety, Bio-Risk Management

Prof Gevao and Dr Kamara National laboratory Services and LTWG

4 Information Management Systems

Dr SAS Kargbo Directorate of HSS and Planning

5 Research & Development Dr Samai, Dr SAS Kargbo Directorate of HSS and Planning and Research and Training

6 Partnership & Linkages Dr Y Harding LTWG/ GLRA

7 Human Resource Management Prof Gevao & Dr Kamara National Laboratory Services and LTWG

8 Total Quality Management Systems

Dr Kamara & Mr Abu George National Laboratory Services and GLRA

9 Infrastructure and Equipment Dr Kamara & Mr Abu George

10 Emergency Preparedness and Response

Dr Amara Jambai and Dr F. Dafae DCMO and Directorate Disease Prevention and Control

Technical Support APHL SIERRA LEONE

112

COLLATION TEAM Dr Victor Matt Lebby, Ms Doris Harding, Dr. Zikan Koroma, Mr Osman Kargbo, Dr. Isatta Wurie (Technical lead)

ANNEX 5: TEAM MEMBERS

113

Documents

REPUBLIC OF SIERRA LEONE · Web viewObjective 7: To provide all government medical laboratories with complimentary supplies and consumables for efficient service delivery by end