Background
If public health is to improve, then a system of biology labs offering quality services is a fundamental prerequisite. However, diagnostics is the field which has received the fewest multilateral subsidies and government investment in the last decades.
The West African Network of Biomedical Analysis Laboratories (RESAOLAB) is the first regional program in West Africa to provide a response to this public health concern.
Designed with West African healthcare stakeholders and the member countries’ ministries of health, it takes into consideration all factors affecting the laboratories’ governance and performance. RESAOLAB is incorporated within the framework of policies led by the regional and international health organizations.
RESAOLAB was started by the Mérieux Foundation in 2009 in collaboration with Burkina Faso, Mali and Senegal. In 2013, four countries joined the network: Benin, Guinea, Niger and Togo. The project starts off its third phase in 2019 as part of a partnership between the Mérieux Foundation and the Agence française de Développement, in order to continue to reinforce laboratory systems.
Objectives
Improve the quality of medical biology services in seven West African countries, by reinforcing their laboratory systems through a regional and cross-border approach.
Activities
Liaising closely with the ministries of Health from the seven countries, the RESAOLAB program is conducted and based around five areas:
- Improving regional and national governance of laboratory systems
- Improving laboratory services by setting up a standardized quality system;
- Consolidating initial training and continuing education for laboratory staff;
- Setting up a Laboratory Information System (LIS) in the network’s main laboratories;
- Reinforcing national laboratory maintenance and management systems, through a regional approach;
An operational unit, established in each ministry, is in charge of setting up activities under the supervision of a national steering committee and an international steering committee, the meetings of which are held once a year in order to follow-up on activities in the regions. The project stakeholders also meet every year at theme-based workshops in order to concordantly propose and implement various activities related to medical biology.
RESAOLAB in 3 phases : 2009 through 2023
Since the creation of the network in 2009, the objective of RESAOLAB has remained the same, to bring together West African countries around reinforcement of the quality of the clinical diagnostics, an essential step to improving public health and monitoring epidemics in this region.
RESAOLAB phase 1: 2009-2013
The RESAOLAB project was started by the Mérieux Foundation in 2009 with support from the Agence Française de Développement, on request of the ministries of Health of Burkina Faso, Mali and Senegal.
Since 2009, RESAOLAB has prepared the ground for the creation of training programs, for building and outfitting training and laboratory centers for seminars and external quality assessment, for the implementation of quality programs and for the development of tools for laboratory-based epidemiological monitoring. These advances have helped step up clinical diagnosis capacity in West Africa while improving the quality of diagnosis.
RESAOLAB phase 2: 2013-2017
In 2013, four other West African countries joined the network: Benin, Guinea, Niger and Togo.
During this second phase, RESAOLAB’s regional foothold made it possible to support other public health initiatives in medical biology in West Africa. These national or inter-country projects have seen sustainable progress in various areas (laboratory mapping, epidemiological monitoring data reporting system, etc.). From 2015, representatives from 8 other West African countries were asked to participate in the network’s workshops and annual meetings, through the WARDS ((West Africa Regional Disease Surveillance) project financed by the World Bank, via the WAHO)), thus bringing together representatives of 15 countries within the ECOWAS. These meetings gave rise to joint strategies and brought responses to the main challenges in this region.
In addition to the AFD, other partners supported this phase of the project: Monaco’s Department of International Cooperation, the Stavros Niarchos Foundation and the Islamic Development Bank
RESAOLAB phase 3 : 2019-2023
The Foundation undertakes to continue its efforts from the previous phases, while addressing other major public health topics.
RESAOLAB is starting on its third phase, which will enable the development of more efficient and reliable healthcare laboratory services, with a special focus on monitoring of antimicrobial resistance in liaison with the WHO, and on biological monitoring of great pandemics (HIV and tuberculosis) covered by the Global Fund.
This phase also serves to reinforce the argument as to the importance for countries to allocate an adequate operating budget to laboratory management and to ensure management’s empowerment. The regional network structure provides for sharing of good practices and information, elements which are crucial for efficient epidemiological monitoring and proper preparedness of responses to epidemics.
Additional activities to fight COVID-19
As of detection of the first positive coronavirus cases on the continent, the Mérieux Foundation was able to provide support for diagnosis by sending SARS-CoV-2 screening kits to Burkina Faso and Senegal.
To step up this response and to take further action to enable the network to arm itself against the epidemic, the AFD granted an additional subsidy of 1.5 million Euros to RESAOLAB through the Initiative “COVID-19 – Health in Common”. This funding is used to develop COVID-19 laboratory response strategies by mobilizing the expertise of the network to back national responses.
Achievements
RESAOLAB phase 1 and phase 2 saw the rolling out of large scale continuing education schemes, the construction and outfitting of training and quality assurance laboratories, implementation of epidemiological monitoring systems and the setting up of an intercountry network.
1 000 +
public and private laboratories which are overseen and included in the network in the seven countries
14
continuing education modules, developed jointly with the country experts as part of an improvement program
1 000 +
trained in the 14 modules over 100 sessions
20
continuing education centers built or renovated
4
laboratory directorate built/extended and equipped
100+
scholarships granted for medical biology training (Biological and Applied Medical Sciences, Master’s and specialist diploma)
16
external quality assessment sessions held
200 +
laboratories in the sub-region have an external quality control program
Laboratories policy
Laboratory management receives support for their development and running and contributes to enforcing the national laboratory supervision policy. It coordinates the work of the country’s clinical biology laboratories, verifies the level of quality of their analyses and refers the staff for training if necessary.
Diagnosis quality control
Laboratory supervision makes it possible to report on infrastructures, equipment and training of laboratory staff, in order to establish a mapping of all the laboratories in each country. It is also a means of providing support for laboratories in their quality approach.
The external quality assessment involves a comparison of the analysis results from a given laboratory with an external benchmark, thereby providing objective evidence of analysis quality. The laboratories receive test samples to be analyzed, and the level of compliance of the results is forwarded to the participating laboratories in order to implement any corrective action for the continuous improvement of analysis quality. More than 200 laboratories benefited from an external quality control program, 70 of which benefited from an international program with the specialist agency One World Accuracy.
RESAOLAB also supported the implementation of a LabBook laboratory information system (LIS) in the 7 countries and taught more than 60 people how to use it. This LIS, software developed by the Mérieux Foundation in a technical partnership with Epiconcept, aims to reinforce epidemiological monitoring via the regular collection and transmission of laboratory analysis data to the national supervisory bodies.
Training
As part of the project, educational tools meeting training needs were developed, with 14 modules developed since 2013 on the following themes:
- Antimicrobial susceptibility testing
- Biosafety
- Ebola
- Stock, reagent and consumable management
- Gestion des stocks, des réactifs et consommables
- Maintenance
- Diseases with epidemic potential
- Chronic diseases
- Quality management
- Laboratory management
- Microscopy
- Culture medium preparation and quality control
- Pre- and post-testing
- Prescribers
These modules were taught during continuing education sessions in the network and are also available by e-learning. At the same time, the project granted more than 100 training scholarships between 2013 and 2017. RESAOLAB also provided support for the EPAC (Ecole Polytechnique Abomey Calavi) in Cotonou for the development of a technicians training program in the basics of biomedical equipment maintenance.
The Mérieux Foundation, through RESAOLAB, the Project P48 by the European Commission set up by Expertise France, and the project REDISSE, provided support for four training sessions. Sixty people from the entire subregion thus received training.
Partners
Operational :
- Health Ministries of Benin, Burkina Faso, Guinea, Mali, Niger, Senegal and Togo
- West African Health Organization (WAHO)
- WHO-AFRO