Multistakeholder approach to Laboratory Strengthening at the International Level: Global Laboratory

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Multi-stakeholder approach to Laboratory
Strengthening at the International LevelGlobal
Laboratory Initiative

• John Ridderhof, DrPH,
• Assoc Dir Laboratory Science
• National Center for Preparedness, Detection, and
  Control of Infectious Diseases, CDC
• March 25, 2009
• Rio de Janeiro, Brasil

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GLI mission

• To serve as a platform of coordination and
  communication,
• providing the required infrastructure, focused on
  TB laboratory
• strengthening, in the areas of
• Global policy guidance (norms, standards, best
  practices)
• Laboratory capacity development
• Interface with other laboratory networks,
  enabling integration
• Standardised laboratory quality assurance
• Coordination of technical assistance
• Effective knowledge sharing
• Advocacy and resource mobilisation

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• STP-GLI as an active facilitator of communication
  and provider of global infrastructure services
  synchronized to be a coherent network service

7 STP WGs
Technical Agencies
Other Laboratory Networks
Other Diseases
Capacity building (expanding SRLN, building
diverse and flexible national, regional,
international consultants base, systematic and
structured training)
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GLI strategic priorities

• Establishing GLI partnership projects
• Developing a template for country-specific
  roadmaps for laboratory strengthening
• Developing human resource strategies, including
  consultant training, training of different
  laboratory technical cadres, career development
  and retention
• Developing appropriate and adequate laboratory
  biosafety norms and standards, strategies and
  documents
• Developing a TB laboratory accreditation system
• Moving new diagnostics into countries

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5 in Western Pacific
11 Europe
2 in South East Asia
5 Americas
2 in African region
Coordinating Centre
SRL
1 Eastern Mediterranean
Under evaluation
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GLI Partners

• American Society for Microbiology (ASM)
• Association of Public Health Laboratories (APHL)
• Bill Melinda Gates Foundation
• Centers for Disease Control and Prevention (CDC)
• CDC Global AIDS Programme (GAP)
• Fondation Merieux
• Foundation for Innovative New Diagnostics (FIND)
• International Union Against TB and Lung Disease
• PEPFAR
• USAID
• KNCV
• Merieux Alliance
• Management Sciences for Health (MSH)
• Medicins Sans Frontiers
• Stop TB Partnership Working Groups (New
  Diagnostics, MDR-TB, Retooling Task Force, DOTS
  Expansion)
• National TB Programmes
• WHO
• and growing

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GLI Guidance, Tools, Programs
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GLI Projects are run on behalf of GLI, and adhere
to a collaborative spirit

• aligned with strategic agenda and priorities
• complementarity with other projects
• Liaison to GLI-S is established
• project review process established
• adequate partner representation requirements
  satisfied
• information networks utilized

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Are These Efforts Coordinated?

• Do the efforts overlap?
• Do they duplicate each other?
• Are they synergistic?
• Are there opportunities to leverage new partners?
• How many such relationships are there?

CDC
USAID
DoD
NIH
WB
IP
WHO
PAHO
BD
Training
Eth
PT
Kenya
TA
Haiti
QS
Tz
Equip
Namib
Clin lab
Malawi
Histo lab
Moz
Ref Rand Corp, CDC GLB 2008
SA
PH Lab
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Problems at District Level
WHO programs
TB
Malaria
EPI
STD
Others
National
Too many forms! Too many bosses!
Different definitions! Conflicting
priorities! No feedback! Duplication of work!
EPI
TB
STD
Malaria
Others
District
Peripheral
Community
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Training Package Components

• Presentation slides
• Trainers Guide
• Participant Manual
• Training Video/DVD
• Job Aids

Workshop In a box
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Framework for Rolling Out Training
Alignment
Readiness
Training Implementation
Monitoring Evaluation
Ensures alignment to overall strategy and secures
stakeholder support
Ensures system is ready for training rollout
Ensures effective delivery of the training
Ensures results are evaluated performance is
sustained

• Policy in place
• Funding secured
• Consensus achieved
• Roles responsibilities defined
• Rollout priorities schedules

• Learner readiness
• Trainer readiness
• Tool development
• Customization
• Translation
• Logistic/admin support

• Equipment/material requirements
• Printing/production
• Training facilities
• Registration
• Skill assessment

• Supervisor support reinforcement
• Monitoring/follow-up
• Process validation improvement
• Demonstration of success

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Overview

• Trainers Guide
• Participant Manual
• DVD
• CD-ROM

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Trainers Guide Section 3Training Basics Topics

• Knowing your Audience
• Applying Adult Learning Principles
• Being Prepared to Train
• Managing the Training
• Communicating Effectively
• Engaging the Participants
• Using Visual Aids Effectively

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Module At-A-Glance Trainers Notes
Module title marks the beginning of Text for this
module
A quick guide to the components of the module
its purpose, pre-requisites, Time, and learning
objectives
An Overview of module
A checklist of material and equipment
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Module At-A-Glance Trainers Notes
Indicates the number of corresponding PowerPoint
slide in the module
Title of the slide
Details on how to teach each slide or conduct an
activity. Includes expansion of the bullet
points on the slide
Notes on customizing the slides
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Section 2- Preparation and checklist
Section 2 provides the material requirement for
practical sessions
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Training Aids
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Additional Training tools ("workshop in a box -
WIB) IN PROCESS

• External Quality Assessment (EQA) for AFB
  microscopy (TBCAP-Union)
• Culture and DST (TBCAP-WHO, Italy SRL)
• Quality Management Systems (CDC/WHO/CLSI)

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Laboratory Quality Management System Initiative
2006 - 2008

• Leadership from WHO, CDC, CLSI to
• Harmonize / Develop instructional training
  package / toolkit on implementing a laboratory
  quality system
• Convene international conference on laboratory
  quality April 2008, Lyon France
• Develop, publish, and disseminate recommendations
  to governments advocating for the need and
  allocation of resources to implement a quality
  system

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Harmonization of QMS Training

• WHO-Lyon, CLSI, and CDC developing a harmonized
  training for QMS based on ISO 15189 and CLSI GP
  26-A3
• Initial training China
• Final revisions being made

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Laboratory Quality Management Implementation
Summary of Key Steps
Initial Steps
Pre-Implementation
Implementation
Monitoring
Timeline dependent on resources

• Lab quality management for national leaders
• Strategic laboratory plan aligned with MOH 5 year
  plan
• Political commitment

• Conduct laboratory gap analysis
• Develop implementation plan
• Resource commitments
• Training required for implementation

• Establish QS organization
• QS training
• Begin critical QS processes
• Records / documents
• Inventory management
• Process control
• EQA/PT
• Training

• Collect data on critical points
• Reporting and feedback
• Begin additional QS elements
• On-site visit and follow up evaluation
• Training

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Biosafety Initiatives

• CDC/WHO Technical consultation, Atlanta, Sept 08
• Guidance on process, design principles and
  ventilation for laboratory construction and
  renovation (funding proposal)
• Recommendations and guidance for simple fan
  boxes for smear microscopy (funding proposal)
• Guidance and training on TB laboratory biosafety
  (TBCAP)

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Simple cabinets/fan box
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BSC standards
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Planning and Constructing Laboratories
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Acknowledgements

• GLI Partners
• American Society for Microbiology (ASM)
• Association of Public Health Laboratories (APHL)
• Bill Melinda Gates Foundation
• Centers for Disease Control and Prevention (CDC)
• CDC Global AIDS Programme (GAP)
• Fondation Merieux
• Foundation for Innovative New Diagnostics (FIND)
• International Union Against TB and Lung Disease
• PEPFAR
• USAID
• KNCV
• Merieux Alliance
• Management Sciences for Health (MSH)
• Medicins Sans Frontiers
• Stop TB Partnership Working Groups (New
  Diagnostics, MDR-TB, Retooling Task Force, DOTS
  Expansion)
• National TB Programmes
• WHO

• STB/THD Laboratory Strengthening Team
• Paul Nunn (THD Coordinator)
• Kalpana Singh
• Veronique Vincent
• Karin Weyer
• GLI Core Group
• Lucia Barrera
• Francis Drobniewski
• Chris Gilpin
• Case Gordon
• Moses Joloba
• Kai Man Kam
• John Ridderhof (Chair)
• Rick O'Brien
• Tom Shinnick
• Armand van Deun

The findings and conclusions in this report are
those of the author and do not necessarily
represent the official position of the Centers
for Disease Control and Prevention