KEY ACHIEVEMENTS  | Establishing Zambia’s first microbiology network in the Copperbelt Province  | Expanding the microbiology network to the Southern ProvinceReal life impacts in Zambia’s hospital labsPartnership working with Zambia’s Ministry of HealthWhat the microbiologists in Zambia have said | What UKHSA has learned | The future of microbiology in Zambia 

Key achievements

· Collaboration with Ministry of Health, Zambia to strengthen microbiology laboratory practice leading to the formation of a network of laboratory scientists in the Copperbelt Province, the Copperbelt Microbiology Team (CBMT)

· Following the success of CBMT, the laboratory scientist network model was extended to the Southern province to form the Southern Province Microbiology Team (SPMT)

· Members of both networks report multiple benefits and have implemented the learning gained in their respective laboratories.

· Specific areas of improvement highlighted by participants include harmonization of Standard Operating Procedures, improved implementation of risk assessments, technique and method verification, quality control, and biosecurity and biosafety measures.

· Strong partnership working between UKHSA’s IHR-SP and Zambia’s Ministry of Health is helping to address ongoing gaps in laboratory practice, as well as the potential to sustainably extend the network further in the future.

Establishing Zambia’s first microbiology network in the Copperbelt Province

The UK Health Security Agency’s (UKHSA) International Health Regulations Strengthening Project (IHR-SP) provides technical assistance to strengthen compliance with the IHR in Zambia. The IHR laboratory systems strengthening component includes laboratory capacity building in areas such as laboratory diagnostics, quality management systems, biosafety and biosecurity, and leadership.

Building on existing capabilities and activities previously delivered by the UKHSA IHR-SP microbiology team at the request of one hospital laboratory in the Copperbelt Province, a gap was identified in ongoing mentorship for microbiology more widely in other hospitals in the Province. Working closely with the Zambian Ministry of Health (MOH) to co-identify areas of potential development, a provincial ‘community of practice’ network initiative was launched for pilot.

In February 2022, the MOH established the Copperbelt Microbiology Team (CBMT) to strengthen clinical and public healthcare outcomes in Zambia by providing further training and mentorship on identified areas of need, with technical expertise provided by IHR-SP. CBMT is formed of 29 microbiology laboratory scientists from across five level 3 MOH hospital laboratories in the Copperbelt province. The network meets monthly on a virtual basis, and quarterly in-person with the UKHSA team for co-delivered mentorship meetings.

Expanding the microbiology network to the Southern Province

The CBMT network has been found to have changed microbiology practices at an organisational and provincial level. Recognising this, in November 2022 the MOH expressed a request to expand the network to other provinces within Zambia. In February 2023, the IHR-SP received a request from scientists within the Southern provinces of Zambia, and subsequently, the Southern Province Microbiology Team (SPMT) was formed.

Like the CBMT, the SPMT team comprises of 29 microbiology laboratory scientists from five level 2-3 labs across the Southern province, meeting virtually monthly and participating in quarterly in-person mentorship meetings.

Real life impacts in Zambia’s hospital labs

During face-to-face network meetings, participants are encouraged to reflect on their learning from previous mentorship meetings and share positive changes in their microbiology practices as a result of the network activity. Specific areas of improvement highlighted by the participants included harmonisation of Standard Operating Procedures, improved implementation of biosafety risk assessments, improved microbiological techniques and method verification, quality control and biosecurity and biosafety measures.

Example 1 – isolating organisms of infection control and public health importance: Methicillin-resistant Staphylococcus aureus (MRSA) detection

“The collaboration and support has lifted the testing capacity of our laboratory in terms of knowledge gained to look for isolates that we never would have known about and also the provision of reagents to screen MRSA which has played a significant impact to healthcare providers on the clinical side.” - CBMT participant

“My lab isolated MRSA for the first time because we had an M100 to guide us shared with us via CBMT. And also because for the first time we demanded for cefoxitin from our management, and they listened because of the influence of the CBMT mentorships.” - CBMT participant

Example 2 – verification of cerebrospinal fluid (CSF) microscopy

“There was a complaint from clinicians on the delayed results for CSF cell counts. Considering we had had training during a face-to-face meeting on CSF processing, which came in handy in considering taking up this project. In my investigation I discovered that few staff were competent to perform cell counts on a KOVA slide or on a Neuber counting chamber, also there were no counting chambers available. But alternatively, hematology analyzers were sometimes used to perform cell counts on CSF samples. This prompted me to do a study and verify the analyzer to test for CSF cell counts and see if this would improve the TAT on the results released. Data has been collected and a report written we are at a stage of data analysis.” - CBMT participant

Partnership working with Zambia’s Ministry of Health

The IHR-SP and Zambia’s MOH have continued to collaborate on healthcare and microbiology development in the provinces. Through this partnership, MOH colleagues actively engage in in-person workshops, providing a platform to contribute their insights and expertise to discussions on microbiology development. This collaborative environment enables knowledge sharing, helping to bridge gaps in technical and biosafety concerns.

Importantly, it allows teams to raise and address current challenges directly with the collaborating partners, fostering a dynamic problem-solving approach. The information and feedback collected from these interactions are subsequently used by MOH to influence the distribution of resources and critical information in the region. To illustrate this, members of the microbiology networks and the laboratory strengthening IHR-SP teams are now involved in providing guidance for the procurement and quantification of microbiology reagents and consumables in partnership with the MOH. This is an exercise that will impact how microbiology resources are distributed amongst the laboratories in Zambia.

“Both the CBMT and SPMT have created a platform where medical microbiologists can learn, share knowledge and collaborate. It is good to see this branch of science get the recognition it deserves and bring out the benefits through the various projects participants take on.” - MOH representative.

“The network has created an opportunity for the laboratories to share best practices. The mentorship sessions have improved staff knowledge and capacity as far as microbiology testing and quality management system (QMS) is concerned. This has resulted in improved diagnosis and patient care. The laboratorians are now confident in the work that they are doing. From this network gaps in microbiology such as the availability of standard operating procedures with up to date information have been identified and now a group is working to revise the National Microbiology SOPs.” - MOH representative.

What the microbiologists in Zambia have said

We asked the participants to contribute their reflections on participation in the programme so far:

“For me coming from a lab that has received very little mentorship before I can't begin to put into words the benefits of CBMT/UKHSA interactions. Even clinicians now have more confidence in the results we are now generating.” - CBMT participant

“The network has brought about standardisation of procedures and overall professional/ technical growth. Hence closing up so many gaps and strengthening awareness in new and improved way of doing things.” - CBMT participant

“A whole lot of benefits as the network has been very supportive and informative. This network is exposure to new things. I have been part of the quality management system (QMS) in different tests but always thought of QMS in microbiology as a huge mountain so difficult to climb that one doesn’t know where to start from. But this information has given me the first few steps to standard practice and QMS in microbiology and I am definitely climbing this mountain to attain and improve service. The lessons continue giving me more confidence in the process and results am producing.” - SPMT participant

“We have seen a huge change in the way our members are appreciating the microbiology practice and the way they are networking with other labs within the membership. The knowledge uptake is improving as seen from the positive participation in the meetings. We have also seen an improvement in the application of the knowledge on the ground to improve patient care.” - SPMT participant

What UKHSA has learned

Through the routine monitoring of network activities and facilitating opportunities for reflection and learning amongst network members, MOH and key stakeholders, the following learnings and challenges have been identified:

· Since the inception of the microbiology networks, more microbiology tests have been included within the scope for laboratory accreditation

· The network has enabled collaborative working across laboratories and provinces leading to shared learnings and standardisation of microbiology processes

· Intermittent reagent stock and poor information technology infrastructure in some laboratories impacts on the ability of laboratories to deliver their clinical and public health function

The future of microbiology in Zambia

Following the successful expansion of the networks into two provinces, there is also a desire and enthusiasm to extend the network even further across the nation. This is a large task that will need a comprehensive road map facilitated by the MOH to address participation, partner support and sustainability for the future. IHR-SP continues to work closely with the MOH on existing networks and possible future plans for expansion.

“The collaboration has brought about positive change in the microbiology practices among staff as evidenced by participating laboratories. The recognition that microbiology has also received across the country through this CBMT collaboration is something that cannot go unmentioned” - CBMT senior leader.