Dr. Catherine Mundy: Effective and Efficient Laboratory Services and Management Building Stronger Health Systems

Dr. Catherine Mundy.Dr. Catherine Mundy.

Laboratory services are a necessary but sometimes neglected element of a strong health system. From disease control and surveillance to patient diagnosis and care, laboratories are central to public health. Where laboratory services, policies or strategy are lacking, a comprehensive systems approach can improve a nation's infrastructure and capacity to manage and finance laboratory systems.

MSH spoke with Dr. Catherine Mundy, MPhil, PhD, FIBMS, Principal Program Associate for Laboratory Services at MSH's Center for Pharmaceutical Management, about the critical role of effective and efficient laboratory services and management in a strong health system.

What role do laboratory services play in health care in developing countries?

Medical laboratory services are a critical, yet often neglected component of essential health systems in resource-poor countries. Laboratories play a central role in public health, in disease control and surveillance, and in individual patient diagnosis and care, and yet many millions of people still do not have access to reliable, basic, diagnostic laboratory services.

Why are functioning laboratory systems important for diagnosis and how do they impact public health?

A fully-functional laboratory service is a crucial component of the health care system in the fight against HIV & AIDS, tuberculosis (TB), malaria and many other diseases.  For example, laboratories have a critical role in HIV counseling and testing programs, blood safety, prevention of mother to child transmission and early infant diagnosis of HIV & AIDS, initiating and monitoring treatment for HIV & AIDS, in the diagnosis, treatment, and monitoring of sexually transmitted infections, tuberculosis, malaria and other infections.

What are the challenges for laboratory services in developing countries?

The HIV & AIDS and TB epidemics have placed a huge burden on national healthcare systems and laboratory services. Overwhelmed by the increased demand for testing, these systems were unable to cope.  Effective laboratory leadership and management are lacking—many countries do not yet have a national laboratory policy, a strategic plan, or a dedicated budget for laboratories. Moreover, sub-Saharan Africa's human resource crisis means that many public health care systems do not have enough suitably trained laboratory staff. Weak management structures, severe financial and human resource constraints, and poor infrastructure prevent the delivery of accessible, quality-assured laboratory services.

Has this deplorable situation changed in recent years?

The realization of the crucial role that laboratories play in fighting HIV & AIDS, TB and malaria and the resulting increase in funding sources [for example, from the Global Fund to Fight AIDS, TB and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR) and several others] to build laboratory system capacity was the turning point for improving laboratories. However, donor-funded laboratory strengthening efforts were often focused initially on developing appropriate technologies and providing equipment, supplies, and technical training. Attention to management and leadership weaknesses was not sufficient to leverage financial inputs or sustain improved laboratory performance. That situation is gradually changing with the focus now on strengthening laboratory systems as part of overall health systems strengthening.

What is MSH's approach to strengthening laboratory services?

Building on our management expertise, MSH works with and complements the U.S. Centers for Disease Control and Prevention's, the US Agency for International Development's, the World Health Organization's and other partners' efforts to build laboratory capacity in resource-poor countries by focusing on systems strengthening and improving management and leadership practices in the public and private sectors. MSH's Center for Pharmaceutical Management coordinates and oversees the laboratory work carried out by MSH's many global and country programs.  MSH works with global and country-level partners to improve management of human resources and laboratory equipment and commodities and to help modify quality assurance systems, laboratory standard operating procedures, and other management tools to local contexts. We have adapted several of our management tools and approaches specifically for laboratories, such as our commodity management programs, the Leadership Development Program, the model for a Fully Functional Service Delivery Point, and the Management and Organizational Sustainability Tool.

For example, in Kenya, Zambia, Nigeria and Uganda, MSH is assisting these respective governments to strengthen and expand public health laboratory systems and develop indigenous capacity to support HIV prevention, treatment, and care.  In the Philippines, Vietnam, South Sudan, Ethiopia, Mozambique, Kenya, Zambia, and Brazil, MSH is supporting TB control activities, including efforts to manage drug resistant TB. In Lesotho, Swaziland, Angola and Kenya, MSH has been building capacity in laboratory commodity management systems.