Pakistan - Strategic planning for laboratories and AMR surveillance

Title: Laboratory- based Intra Action Review
Code: D21-08
Date: May - September 2021
Location: Pakistan
Client: World Health Organization Regional Office for the Eastern Mediterranean
Type of services: 

Conduct an Intra Action Review (IAR) to identify lessons learnt from the Pakistan laboratory system and network response related to the COVID-19 pandemic:

• Plan the IAR, including defining its concept, scope and objectives, trigger questions and identifying stakeholders and their roles.
• Conduct the necessary briefing and coordination with the responsible teams ahead of the IAR.
• Conduct the  virtual IAR.

Report(s): 

We designed the methodology and agenda for a virtual Intra Action Review (the first of its kind). The IAR was conducted on 14-15 September 2021. During the online meeting, 17 representatives from the laboratory system in Pakistan provided their views on the laboratory system’s response to the COVID-19 pandemic in Pakistan. 

The IAR identified many challenges, but also opportunities for improvement of the system. The participants formulated many recommendations to increase preparedness for the next outbreak, mainly related to laboratory services. However, as the laboratory system does not operate in a vacuum, recommendations for related fields were also formulated to take advantage of lessons learned and to ensure optimal functioning of the laboratory system. These included recommendations related to regulations, general emergency response planning, the surveillance system, data management, and communication.

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Title: Global Laboratory Leadership Program in-country validation
Code: D19-11
Date: July – October 2019
Location: Pakistan
Client: World Health Organization Regional Office for the Eastern Mediterranean
Type of services:
In-country validation of two modules of the Global Laboratory Leadership Program in Pakistan:
• Preparation of draft GLLP materials for the in-country validation in Pakistan
• Organization and provision of two face-to-face one-week training sessions
• Coordination and facilitation of an on-the-job assignment with a mentoring component
• Formative and summative evaluation of the overall in-country validation
Report(s):

[May 2020] WHO and NIH shared a bulletin on phase 1 of the Global Laboratory Leadership Programme (GLLP) in-country validation in Pakistan: https://lnkd.in/dcdRGFW

Source: DATOS LinkedIn Blog

[17 Sept 2019] Creating laboratory leaders in Pakistan - Management and leadership skills are not taught when one studies laboratory sciences. Still, many laboratory scientists or technologists eventually end up as a laboratory manager. Over the years we have noticed that countries recognize the need for formal laboratory management training. WHO and its partners are now developing a formal Global Laboratory Leadership Programme (GLLP), which will ultimately consist of 9 modules and will be aimed at laboratory professionals under the One Health concept.

DATOS was asked by WHO EMRO to coordinate the first official in-country evaluation of materials that were developed for the modules Leadership and Communication. From 2 to 6 September Linda Oskam and Kim Lewis taught the first 1-week, face-to-face training to 7 mid-career laboratory professionals in Islamabad, Pakistan. These included representatives from both the human health and the veterinary health laboratories.

The training was very interactive, which was highly appreciated by the participants. They are currently working on their homework assignment under the guidance of national mentors. In 2 weeks’ time we will be back for the next instalment of this training. Source:

//blog.datos-advice.nl/?p=74

[14 Oct 2019] Creating laboratory leaders in Pakistan – the journey continues: Early September, Linda Oskam was in Pakistan for the first face-to-face training of 7 laboratory managers under the Global Laboratory Leadership Programme (GLLP) of a consortium under the guidance of WHO. After a three-week interval during which the participants worked on their assignment, WHO and the National Institute of Health (NIH) organized the second face-to-face training from 30 September – 4 October 2019.

Second face-to-face training
During this week the emphasis was on the Leadership module elements policy and planning, ethics and partnership building. In addition, selected topics from the Communication module were taught, in particular media relations, risk communication and scientific communication.

Significant learning increase
All materials were still in the piloting phase, but the course was highly successful (2.5 times increase in knowledge between pre- and post-test) as well as appreciated by the participants. Source: //blog.datos-advice.nl/?p=82

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Title: Fleming Fund activities 2018

Code: D18-12

Date: April - December 2018

Location: Pakistan

Client: Mott MacDonald

Type of services:

Assessment of AMR surveillance system and identification of stakeholders and beneficiairy institutes for scoping and positioning missions in Pakistan.

Report(s):

[3 May 2018] Fighting AMR - The UK Government has set up the Fleming Fund to tackle the growing problem of drug-resistant infection. As part of its activities, the Fleming Fund will support countries to set up a sturdy, sustainable, One Health based AMR surveillance system that generates reliable data that can be reported into the Global Antimicrobial Resistance Surveillance System (GLASS)

From 11 to 20 April, Linda Oskam was part of the team that carried out the initial scoping mission to get a better idea of current AMR surveillance capacity in Pakistan. During meetings with numerous stakeholders and technical partners, it became clear that Pakistan faces enormous challenges in the field of AMR, but also that there is the will to take up this challenge.  Source: //blog.datos-advice.nl/#post52

[27 Jul 2018] In the first half July we were part of a team that prepared the Request for Proposals that the Fleming Fund will issue to strengthen Antimicrobial Resistance (AMR) surveillance in the human and animal health sectors in the country. From the information collected it became clear that Pakistan has a huge AMR problem, but also that the government is aware of this and eager to tackle the problem. Source: //blog.datos-advice.nl/#post54

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Title: National Laboratory Strategic Plan and National Laboratory Quality Standard development for Pakistan

Code: D17-18, D18-05, D18-16

Date: October 2017 - November 2018

Location: Pakistan

Client: World  Health Organization Regional Office for the Eastern Mediterranean

Type of services:

Facilitation of strategic plan development for implementation of the national laboratory policy developed in 2015 (also facilitated by DATOS experts) and development of a national laboratory quality standard for Pakistan in collaboration with the Pakistan National Laboratory Working Group.

Report(s):

[31 Oct 2017] In 2015 Linda Oskam facilitated three workshops on intersectoral National Laboratory Policy development for Pakistan. Now she returned for strategic planning.

WHO Eastern Mediterranean Regional Office (WHO EMRO) facilitates the national laboratory policy and planning process in Pakistan. In 2015, three workshops were held during which the national laboratory system was assessed, a SWOT analysis was performed and policy statements on 12 different policy topics were developed.

Now the National Laboratory Working Group, which includes representatives from different sectors as well as regions and types of laboratories, has started the development of the strategic objectives for this National Laboratory Policy. The recommendations from the Joint External Evaluation (May 2016) will also be included in these strategic objectives. This very interactive 1-week workshop generates a lot of information exchange and heated debates, resulting in the formulation of strategic objectives for more than half of the policy topics. The other topics will be covered during a second workshop which is tentatively planned for January 2018. Source: //blog.datos-advice.nl/#post40

[13 Apr 2018] Pakistan is a country with numerous clinical laboratories, of which more than 70% are part of the private sector. Although several provinces are planning to implement a licensing system, the quality of services provided by most laboratories is unknown. To be able to ensure that laboratories in Pakistan provide quality controlled and assured services, both in the human and veterinary sector, the World Health Organization Eastern Meditteranean Regional Office (WHO-EMRO), and the WHO Country Office of Pakistan requested us to assist Pakistan with the development of National Laboratory Quality Standards (NLQS).

Stepwise approach

We are following an approach similar to the one used last year, when we started the development of NLQS with/for Afghanistan. Back in 2008, during joint WHO/CDC conference on laboratory strengthening, the recommendation was made that countries should develop national laboratory standards and that countries with limited resources should consider taking a staged approach. As such it was decided to make the NLQS of Pakistan a tiered one. Level 1 contains the core licensing requirements. This is made such that the added burden to laboratories is minimized while quality of their services can still be assured. As such the requirements of level 1 can be implemented also by very small laboratories. Level 2, 3 and 4 are gradually more advanced and one builds on the other, which means that laboratories can gradually improve. From tier 4 it is only a small step towards compliance with international standards.

Two birds with one stone

DATOS also decided to make the NLQS of Pakistan such that, through its implementation, also elements of the revised International Health Regulations (2005) and the National Laboratory Policy of Pakistan are implemented. The national standard is based on the ISO 15189 international standard for quality and competence of medical laboratories. In addition, the standard also contains requirements related to laboratory biorisk management based on CWA 15793, to make sure that not only laboratory quality, but also laboratory (bio)safety and (bio)security are addressed.

Consensus approach

This week a start was made with review of the first draft of the NLQS by the National Laboratory Working Group of Pakistan, containing representatives of public and private laboratories from different provinces of Pakistan. This review, facilitated by Tjeerd Datema, will be completed in a second workshop, during which an elaborate strategy for roll-out and implementation will be designed, such that all laboratories country-wide will be trained and supported to implement the requirements of the NLQS.

Other activities in Pakistan

In addition to the development of NLQS, DATOS is also present in Pakistan for other activities, such as finalization of the National Laboratory Strategic Plan, and we are conducting activities for the Fleming Fund. We will report about this later! Source: //blog.datos-advice.nl/#post51

[3 May 2018] Finalization of the National Laboratory Strategic Plan - In December 2017 the National Laboratory Policy was endorsed by the Pakistan Federal government. We facilitated the development of this policy by the National Laboratory Working Group under the leadership of the National Institute of Health and supported by WHO. During 3 workshops in October 2017, January and April 2018 the logical next step, namely a Strategic Plan was developed and is now ready for submission to the government. Source: //blog.datos-advice.nl/#post52

[18 Oct 2018] Earlier this year we reported about our assistance to the National Laboratory Working Group of Pakistan to develop National Laboratory Quality Standards. This week Tjeerd Datema facilitated another workshop with the National Laboratory Working Group (NLWG) of Pakistan to take the next steps towards finalization of these standards.

Pakistan is a country with numerous clinical laboratories, of which more than 70% are part of the private sector. Although several provinces are planning to implement a licensing system, the quality of services provided by most laboratories is unknown. Through development of National Laboratory Quality Standards, the World Health Organization Regional Office for the Eastern Mediterranean (WHO-EMRO) and the WHO Country Office of Pakistan aim to strengthen laboratories and the laboratory system of Pakistan. To optimally meet the needs of the laboratories in Pakistan, the National Laboratory Quality Standard of Pakistan will be tiered, allowing for a phased approach to laboratory quality strengthening.

DATOS has also assisted Pakistan through WHO-EMRO with developing a National Laboratory Policy and Strategic Plan, thus aiming at overall laboratory system improvement. Source: //blog.datos-advice.nl/#post58

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