Credit: MamaYe!/Sierra Leone

Strengthening laboratories for Ebola testing and diagnosis

Laboratories are an essential and fundamental part of all health systems. Despite this, many countries have seen little attention given to the strengthening of nationally coordinated laboratory services. In Sierra Leone, the significant challenges facing the laboratory system and network became particularly apparent during the Ebola outbreak in 2014-2015. This was the most significant and widespread outbreak ever recorded, with over 8,500 confirmed cases in Sierra Leone as of April 2015. Inadequate disease surveillance failed to identify Ebola and stop transmission. The laboratory system needed support to cope with the demands for rapid and reliable testing, and to ensure the safety of laboratory staff.

Recognising the critical role of laboratories in the diagnosis and treatment of Ebola in Sierra Leone, we worked on behalf of the UK government and Sierra Leone’s Ministry of Health and Sanitation (MoHS) to strengthen the Ebola testing system. In close collaboration with the Laboratory Technical Working Group (LTWG), we supported improvements in data management, information flows and laboratory system coordination to ensure prompt turnaround of Ebola test results.

After Sierra Leone was officially declared free of Ebola by the World Health Organisation (WHO) on 7 November 2015, we continued support to MoHS with a focus on maintaining zero Ebola cases in line with the Presidential Recovery Plan (2015-2017). We worked with MoHS and other partners to provide support to and monitor Ebola survivors through a programme called ‘Project Shield’.

Our team was embedded in the Directorate of Hospitals and Laboratory Services (DHLS) under MoHS to support the Directorate’s coordination and data management functions. Together with WHO and US Centre for Disease Control (CDC) we designed and established a system for standardised data reporting. As a result, this was the first time that DHLS had insight into disease trends and laboratory testing coverage. This information is critical for public health decision making and to keep Sierra Leone free from Ebola and other infectious diseases.

Project achievements

  • In Western Area (an area significantly affected by the Ebola) the average turnaround time of Ebola testing was reduced from above 24 hours in December 2014, to below 12 hours mid-2015. Our interventions included the placement of Laboratory Liaison Officers, who immediately called out laboratory results to clinicians, to ensure swift and appropriate treatment of patients. Specimen Courier Supervisors were appointed to oversee safe and swift transport of specimens from the moment of collection to delivery to the laboratory.
  • We completed a National Assessment of Laboratory Capacity and Systems for the MoHS, identifying priority needs in Sierra Leone’s laboratory system. This assessment informed the development of a long-term and evidence-informed strategic plan for strengthening medical diagnostic laboratories. 
  • We strengthened standardisation, and therefore quality of laboratory services, by developing standard operating procedures, manuals and regulatory documents.
  • Our Laboratory Score Cards brought together Medical Superintendents, District Medical Officers and Laboratory Leads to discuss the status of the laboratory and take joint action to ensure that improvements were made.

Results:

Reduced average turnaround time of Ebola testing from above 24 hours in 2014 to below 12 hours in 2015

55% of issues in the Ebola testing system were resolved as a result of our ‘problem-solving’ support

Our score cards provided evidence of improved capacity at 11 of 13 District Hospital Laboratories

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