PVS Sustainable Laboratories Cohort Analysis

Laboratories provide essential information —test results— to make evidence-based decisions and develop policy for outcomes that are grounded in science. Early in the COVID-19 pandemic, reliance on laboratory-based results allowed decision makers in the health system to determine mitigation measures and strategies to reduce transmission, especially in the absence of personal protective gear, rapid test technology, treatment options, and vaccines.

Sustainable Laboratory Analysis

Many laboratories are not able to provide results in a timely, accurate, safe, secure, and consistent manner.  As the world is faced with emerging disease outbreaks, there is an urgent need for building detection capabilities as early and as close to the source as possible. This desire has enabled investments in laboratories and the development of laboratory capacity building programmes.    

Despite technical assistance, some persistent challenges are beyond the control of individual laboratories or projects investing in them. Different challenges interact with each other, putting the overall system under strain.  These challenges to sustainability undermine investments in laboratory systems, with significant costs for all. 

How do laboratory networks perform?  

Most capacity building support today aims to help laboratories become operational and has led to improved technical capacity for some diseases. However, they depend on heavy external support, with short-term gains that can be disjointed from meeting clients’ needs like Veterinary Services, producers and industry.   

How can laboratory networks become more sustainable? 

PVS Pathway data shows that current capacity building gains are unsustainable, as the capacity and capability built is underused, unleveraged, and inefficient, leading to waste. This begs reflection on capacity building approaches, coordination, and methods. The multiplication of technical projects at the laboratory section or laboratory level is not improving the overall capacity of laboratory systems and may negatively impact laboratory networks’ ability to achieve sustainability.   

Without a change in approach, laboratory networks will not be able to play their role in the national health systems or improve health security. 

Interventions targeting sustainable laboratory networks should embrace a fundamentally different approach to:  

Mark a shift in focus

to balance technical assistance with management, business, and strategy to allow systemic root causes to be seen and addressed

Build a sustainability, quality, and business culture

and reinforce that providing a public good is compatible with a healthy business model

Implement active surveillance for priority diseases

to increase sample input to laboratories to keep expertise on point and in practice, with a collateral benefit of detecting emerging disease

Increase understanding of business development and management concepts

such as supply and demand, clients and customers, business models, cases, and plans, cost accounting, revenue, economies of scale, and growth

Demonstrate proof of concept

followed by scaling up to keep fixed costs manageable

Acknowledge of the role of the private sector

for sustainable resourcing of health systems in achieving balance between internal and external investment

Implement inclusive One Health approach

to solving problems common to all labs, regardless of sector, like pooling resources across sectors, space and utility sharing, participating in common negotiations etc.

Focus on Innovation for fitness for purpose 

in equipment manufacturing, processes, research 

Insist on accountability beyond the 5-year landscape

of investors, implementers, and beneficiaries of laboratory capacity building efforts by ensuring outcomes for the health system are measured   

Enable advocacy with national governments 

What are we doing to address this?

We are reassessing our own approach towards capacity building in animal health laboratories through an impact review of our Laboratory Twinning programme. We want to understand if and how countries participating in the programme have benefitted from it in the long run and adapt our approach according to the lessons learnt.

Methodology and Data Source 

We are building countries’ ability to advocate through Sustainable Laboratories Missions which aim:   

  • to evaluate the need and demand for lab services 
  • to evaluate the cost of service delivery 
  • to identify challenges to sustainability 
  • to propose options and actions to address them 
  • to deliver evidence-based insight ready to be presented to decisions makers 

The Sustainable Laboratories Cohort contains detailed and structured data at the national laboratory network level collected from 19 countries and 171 laboratories in four Regions over the past 8 years.  In total this cohort of laboratories conducted more than 27 million tests annually.   

Results and Insights

Instructions:

  • To enlarge the dashboard or any visualisation within the dashboard, click on the arrow on the bottom right-hand side
  • You can click on any part of a visualisation to gain additional insight.

Conclusions

  • While capacity building efforts may have improved bench-top capacity for some diseases in laboratories, evidence suggests that this capacity is unsustainable: it is underused, unleveraged, and inefficient, and ultimately leads to waste. 
  • Increased investment in improving bench-top capacity with multiple disease-focused projects at the lab or lab unit levels will likely not address or improve performance for outcome indicators for sustainable laboratory networks benefitting health systems. 
  • Diversifying clients and targeting services to clients’ needs is critical to increasing the laboratory system’s sustainability and relying less on external aid, which is acknowledged to be unsustainable. 
  • The development of Animal Health programmes in the Veterinary Services focused on priority diseases and active surveillance can increase sustainability by maximising sample input and keeping expertise on point and in practice. 
  • Service delivery is more expensive in low- and middle-income countries due to low sample throughput, high import costs, and waste. We may misperceive that lower resource settings have cheaper costs, but high import costs for many capital and operating expenses, in addition to the highly technical nature of the activity, reveal hidden higher costs. 

Relevant Standards

To support countries in their efforts towards sustainable laboratory networks, we provide recommendations through our International Standards from the Manual of Diagnostic Tests and vaccines for Terrestrial Animals.   

Chapter 1.1.1

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Reliable laboratory services can be delivered only by specialised facilities that are appropriately constructed and managed to provide the operating environment where the complex interaction of qualified staff, infrastructure and scientific methods can be coordinated to deliver specialised outputs consistently and safely 

Good governance and management of a veterinary diagnostic laboratory are essential for the safe, sustainable and effective delivery of a diagnostic service 

The governing board should advise the laboratory director1 on how to meet the expectations of the customers and owners of the laboratory, but should also represent the laboratory’s interests by ensuring that these customers and owners have realistic expectations of the laboratory’s capability and capacity, both in normal day-to-day operation and during outbreaks. 

The essential prerequisite for effective laboratory management is a clear understanding of the outputs required by the managing jurisdiction. National governments should support laboratory systems by developing a national laboratory policy based on the definition of the categories of laboratory test results required for effective implementation of the national animal health policy, including tests in support of international trade. 

Cost control is an essential part of laboratory management. Continual efforts should be made to improve efficiency without compromising on quality. 

National authorities must recognise that laboratories, whilst very expensive to build, are equally expensive to operate and maintain 

Fundamental to the effective delivery of diagnostic services is the operation and maintenance of the facility and the scientific equipment. Allocation of adequate ongoing resources to this area is vital. 

The achievement of all the above, and delivery of a respected and reliable service, requires a management system with checks and balances and effective review. This will include mechanisms to ensure political accountability, transparency, responsiveness, and coherent planning to ensure sustainability 

Acknowledgements

Contributions were made by Jennifer Lasley, Emmanuel Appiah, members of the ad hoc Group on Sustainable Laboratories. 

This work was possible through the financial support received from the Weapons Threat Reduction Program of Global Affairs Canada.