In a continuous effort to expand Public Health Reference Lab (PHRL) infrastructure and networks to support integrated disease surveillance and response (IDSR) of priority diseases in Pakistan, a comprehensive scoping visit of Punjab provincial and Azad Jammu & Kashmir (AJK) regional labs was conducted by the technical teams of UKHSA and Pakistan’s National Institute of Health (NIH) in June.
The objectives of visits were to assess capacity within the PHRLs to test for priority diseases, understand the use of open system laboratory techniques across the networks and identify gaps and challenges faced by current operations.
Understanding the current state of play
The UKHSA International Health Regulation strengthening project (IHR-SP) and NIH team comprising of UKHSA's Country Lead. Microbiologists, public health specialists and epidemiologists met with the Director General Health Services of Punjab and AJK. The discussions provided an overview of the current PHRL systems and how they link, the status of current policies around testing of priority diseases and opportunities for collaboration to achieve Integrated Disease Surveillance and Response (IDSR) objectives across the networks.
During the site visit of PHRLs, the team met with senior leadership, managers, scientists, technologists, and data focal points. A standardized Laboratory Assessment Tool (LAT) was used to assess the PHRL capabilities encompassing the key components of PHRL governance functions, quality standards documentations, specimen management, lab information system, human resource, and bio-risk management. In Punjab province, the team visited a tertiary care hospital to explore the possibility of integrating hospital-based laboratory data with Districts Health Information System-2 (DHIS-2) a software used for IDSR in Pakistan.
Challenges faced by Public Health Reference Labs.
The scoping visit identified multiple gaps and challenges faced by PHRLs to test priority diseases. Two major gaps were i) the lack of lab information and a supportive data management system and ii) limited professional development opportunities for the staff. The PHRLs requested IHR-SP support to provide External Quality Assessment panels for respiratory and gastro-intestinal (GI) pathogens. An immediate need to develop national microbiology testing standard operating procedures (SOPs) was also identified after in-depth discussion with PHRLs.
IHR-SP’s commitment to taking action.
After the visit, UKHSA and NIH agreed on a joint action plan to provide technical assistance to PHRLs on the following deliverables:
· Development of tailored professional training programs to enhance the technical skills and knowledge of laboratory staff. The programs will be focused on open system laboratory techniques, quality assurance, and data management.
· Developing standardized protocols and harmonizing testing methodologies for priority diseases such as respiratory and GI pathogens to facilitate consistent and comparable results, with added benefit of data analysis and integration.
· Enforcement of resilient quality management systems, including assistance in crafting quality assurance policies, setting up internal quality control protocols, and implementation of external quality assessment programs.
Muhammad Sartaj, Pakistan country lead for UKHSA's IHR-SP said:
“UKHSA and NIH are dedicated to developing a joint action plan to provide technical assistance to these PHRLs to enhance their capacity for testing of priority diseases and development of tiered public health lab networks in Punjab and Azad Jammu & Kashmir. We will continue to work in partnership to implement the action plan and will keep future progress under active review.”
Sumera Abid/Wasif Shah/Asif Bettani