Preparing national tiered laboratory systems and networks to advance diagnostics in Africa and meet the continent’s health agenda: Insights into priority areas for improvement

Nine in 10 individuals carrying the hepatitis B or C virus have never been tested, while these infections are estimated to cause 60% of liver cancers and an epidemic larger than that caused by HIV. 8 In a study conducted in Senegal in 2015–2016, less than 30% of pregnant women attending antenatal care at the primary healthcare level had access to the minimum panel of screening tests for the most common clinical conditions threatening maternal and child health. 9 Almost half of the mortality cases associated with cervical cancer are due to late detection of the disease. 10 More recently, it appeared that when the first coronavirus disease 2019 (COVID-19) case was reported in Egypt in February 2020, only 2 of the 55 countries on the continent were capable of detecting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite addressing critical testing processes or delivery gaps, innovative or conventional diagnostic technologies frequently fail to translate into tangible public health outcomes. 16 , 17 , 18 The failure of diagnostics to reach a large proportion of the population in need of it can partly be linked to implementation approaches that are designed for the site level, with oversight of the tiered laboratory network requirements and insufficient attention given to the underlying laboratory systems (e.g. supply chain, workforce, finance, etc.). The WHO Joint External Evaluation 25 tool provides a high-level overview of the performance of the national laboratory network across four domains: (D1.1) laboratory testing for the detection of priority diseases, (D1.2) specimen referral and transport system, (D1.3) effective national diagnostic network and (D1.4) Laboratory Quality System, as part of the evaluation of entire national health systems to support compliance with International Health Regulations requirements. Inconsistent application of diagnostic services to outbreak response, food safety and disease notification Facilities with low capacities are allowed to deliver diagnostic services Diagnostic services cannot be optimally organised and coordinated, also during situations of disease outbreaks Structure of the tiered network The network does not incorporate testing activities at community level Results of rapid and point-of-care testing at community level are not supervised and quality controlled Network coverage and rapid response Lack of updated data on the geographic information system location of laboratory capacity Minima