Establishment of the Pakistan Laboratories Network
Title: Establishment of the Pakistan Laboratories Network
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Overall term: 2011 to 2013
Pakistan is a country with a high risk of outbreaks of infectious diseases, including hepatitis, cholera, typhoid fever, dengue fever and malaria. However, following the dissolution of the Ministry of Health in 2011 and the devolution of health responsibilities to provincial level, no central focal point has existed for the nationwide surveillance of infectious diseases. The country’s Health Management Information System collects data on cases of routine and communicable diseases, and a Disease Early Warning System (DEWS) is in place in conflict-affected districts, but these do not have the capacity to track the incidence of emerging infections and they cannot be relied upon to detect the onset of potential outbreaks.
A sentinel laboratory network has been established in Pakistan, maintaining a central database for the epidemiological surveillance of infectious diseases and providing a platform for a national disease early warning system. The early warning system can forecast outbreaks of diseases with pandemic potential.
The project was run by the GIZ Health Sector Support Programme. It involved the creation of a primary network of advanced diagnostic laboratories, the Pakistan Laboratory Network (PLN). This involved the collaboration of public and private stakeholders, with private laboratories – mostly operated by non-governmental organisations and the public sector – integrated to form the Network. The PLN linked together high-performance laboratories from across Pakistan, enabling them to share their data in the form of contributions to a centralised database. As a result it will be easier to trace the emergence of epidemics more comprehensively.
Following identification of the member laboratories, the project supported a range of measures to boost their capacity for the reliable diagnosis of certain communicable diseases. The priority diseases include type-A influenza, hepatitis B and C, polio, tuberculosis, dengue fever and HIV. Particular attention was paid to improving the quality of pre-diagnostic activities in the laboratories (sampling and sampling plans). The project also helped strengthen the laboratories for their roles as sentinels. Accordingly, the laboratories established standard operating procedures that ensure they meet the relevant standards when confirming priority communicable diseases (including A/H1N1 cases). The project also runs training courses to provide laboratory staff with the necessary skills to perform this work.
The GIZ project was run in cooperation with the World Health Organization (WHO). Other partners include the public-sector laboratories, Punjab Public Health Laboratory (Lahore) and DOW University (Oja) Hospital (Karachi), as well as the private institutions, Shifa International Hospital (Islamabad), Chughtai’s Laboratory (Lahore) and North West General Hospital (Peshawar).
On behalf of BMZ, the project was supported by the German Pandemic Preparedness Initiative of GIZ.
Results achieved so far
The Pakistan Laboratory Network (PLN) was established with its own Articles of Association in September 2011, by five founding members. In the course of the project, the quality and reliability of the laboratories’ diagnostic results have improved.
The first peer-to-peer consultation process was completed in October 2012. At least two technical staff from each laboratory had an opportunity to visit at least two other laboratories in different provinces, and exchange quality-related observations with them.
During the peer-to-peer consultations, all five laboratories agreed to provide monthly diagnostic data on their individual ‘top ten’ communicable diseases. The data will be submitted in the form of aggregated values, with limited demographic details such as age, gender and geographical location, which will not be identifiable or traceable to the individual patients.
One of the notable aspects of this project has been the success with which it has brought together public and private institutions in a formal network, the members of which have committed themselves to meeting an agreed set of quality standards.
According to Dr Omar Chughtai of Chughtai Lahore Laboratory, members of the network meet regularly to discuss issues of quality improvement and to share experiences. In a further positive development for disease surveillance in Pakistan, the existing members have undertaken to expand the network to include further diagnostic laboratories that are willing and able to meet the designated quality benchmarks.