TeleMicrobiology:

A new approach to capacity building

Constance Schultsz

Relative risk of an EID event

Zoonotic pathogen, wildlife Zoonotic pathogen, non-wildlife

Drug-resistant pathogens Vector-borne pathogens

Jones et al.

Drivers: socio-economic, environmental, ecological

There are many known unknowns..

XDR-TB

CTX-M ESBLs

…and many more unknown unknowns..

“….. global resources to counter

disease emergence are poorly

allocated, with the majority of the

scientific and surveillance efforts

focused on countries from where the

next important EID is least likely to

originate.”

Laboratory Medicine : the bottleneck of the Health system Human Resources and education: weak components of Laboratory Medicine

6

The strengthening of medical laboratory systems can be achieved by

establishing and implementing comprehensive national laboratory

policy and strategic plans (also addressing HR).

7

WHO defines a human resources for health crisis in terms of doctors and nurses

Laboratory workforce is not part of WHO statistics

Global Atlas of the Health Workforce

8

Senegal

overlooks

laboratory

workers when

planning for

human resources

for health

9

Amsterdam

Institute

for Global

Health and

Development

Analysis of policy and practice regarding Medical

Laboratory Services in Sub Saharan Africa

African Field

Epidemiology

Network

Technical aspect of laboratory medicine in

resource-poor setting

Human resources for health

(WHO collaborator)

African network

(CDC/USAIDS/WHO-AFRO

collaborator)

10

Gaps, barriers and facilitators

Development of health policy and plans.

Countries Health strategic

Plan

HRH Strategic Plan Laboratory

Strategic Plan

HIV strategic plan

Benin X X

Burkina Faso X X

Burundi X X X

Cameroon X X

Côte d’Ivoire X X

Ethiopia X X X

Ghana X X

Liberia X X X

Madagascar X X

Malawi X X

Namibia X

Niger X X

Nigeria X X X

Rwanda X X X X

Uganda X X X X

Senegal X X

Tanzania X X X X

Zambia X X X

Total 16 8 4 18

11

Attention to laboratory services in national plans

0

2

4

6

8

10

12

14

16

18

nu

mb

er

of

co

un

trie

s

HSP HR plan Lab plan HIV/AIDS plan

Plans

Attention to laboratory

PEPFAR collaboration

No attention to laboratory

•Most of the plans address lab services.

•Pepfar collaboration is associated with attention to

laboratory within the HR plan.

HIV vs non-HIV Makerere University, Uganda

Infectious Disease Institute (HIV)

Hospital Microbiology

teleMicrobiology project

• To enhance diagnostic microbiology capacity

through knowledge transfer and continuous

education and training.

• Taking advantage of technical developments,

enabling high resolution imaging and distant

learning.

• Vietnam is ideal setting for proof of concept of

this approach

teleMicrobiology

Digital imaging Digital learning

+

Continuous education and training

• Interactive!

• Support available when needed

• Tailored to local needs

Focus

• Respiratory tract infections

• Blood stream infection

• Use of the eCamera

Interactive, in multiple directions

Main outcome measures of pilot project:

performance in eLearning

frequency of interactions

frequency of use of eCamera

Future development of teleMicrobiology concept:

Create networks

Use in designated program, e.g. AMR surveillance

Not restricted to any geographical region or setting!

Special thanks to

Academic Medical Center, University of Amsterdam Caroline Visser Patricia Brinke, Willy Hendriks Pascale Ondoa Menno de Jong Hospital for Tropical Diseases Nguyen van Dung Huong Lan Tran Tinh Hien Rogier van Doorn Kiestra Lab Automation Thomas Osinga Jetze Botma HealtheFoundation Fransje van de Waals Debby Heuft

Anneriet van Duin Pieter Petit Royal Tropical Institute Ankie van den Broek AFENET David Mukanga

EVD, the Netherlands