Transcript Cambodial national work plan for implementation

Cambodian National Work plan for Implementation
of IHR Minimum Core Capacities and APSED
Priority Areas, 2012-2014
Laboratory
Dr. Sau Sokunna
Deputy Director of DHS
Ministry of Health
30 April 2013
Team members
Department of Hospital Services/MoH:
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Bureau of Medical Laboratory Services (BMLS):
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National Institutes of Public Health(NIPH)
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Prof Chuop Sokheng, Head of NIPH
National Blood Safety Program (NBTC)
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Dr Sau Sokunna, Director
Pharm Sam Sopheap, Chief
Pharm Monipheap, Vice Chief
Dr Hok Kim Cheng, Director
Sub TWG for Blood Safety and Lab Services
Partners:
WHO, IPC, US CDC, NAMRU-2, AFRIMS, Foundation Merieux, DMDP,
ITM, URC, CAREID, UHS, DTRA, IQLS, Temasek Foundation.
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Key Components
• Accurate laboratory diagnosis
• Laboratory support for surveillance and response
• Coordination and laboratory networking
• Biosafety
Core Capacity Area
8
Laboratory
Component:
8.1
Laboratory Diagnostic and Confirmation Capacity
CROSS REFER to OTHER Components
Status reported in 2011
Status reported in
2012
Planned actions by June 2013
There is a national Lab
policy but nothing on
Lab quality standards
nor any licensing
procedures.
A nation al policy

for lab quality
standards had been 
approved
Development of National
Lab. Information System
Sustaining the Lab EQA
programme and enlarging it
A bacteriology lab
There are SoPs to deal network,
with outbreaks
connecting the
involving national and
national, sub
international labs s and national and
more than 10 suspect
research labs
H5N1 samples are
together is
tested annually.
developed
There is EQA system
for CD4 counts for HIV
and H5N1 tests but not
for bacteriology.
Bacteriology EQA
has started
Government
involvement
MoH:
CDC, NIPH, HSD, IPC, DDF,
Provincial Bacteriology Labs
Partners involved
US CDC, USAID, WHO,
Planned Actions by June
2014
Eventual Goal

To have a public health
lab network, capable of
diagnosing most
common pathogens
and referring unusual
pathogens for further
diagnosis to national or
international referral
centres.

To build on national
diagnostic bacteriology
lab network and create
a public health lab
network involving at
least 1 national and 2
sub national labs which
practice IQC and are
enrolled in an EQA
programme
To have a fully
functional national lab
Information System
which can provide
surveillance data and
help with outbreak
detection.
Rest of Government:
Core Capacity Area
Component:
8
8.2
CROSS REFER to OTHER Components
Status reported in
Status reported in Planned actions by June
2011
2012
2013
Some basic training US CDC has

Development of
has been provided
started a
generic Biosafety and
to labs to practice
biosafety
Biosecurity SoPs for all
biosafety and
programme for
labs including
biosecurity
HIV testing
management of
infectious waste

Identify a biosafety
focal person for each
lab
Government
involvement
Partners involved
MoH:
CDC, NIPH, HSD, IPC, DDF,
Provincial Bacteriology Labs
US CDC, USAID, WHO,
Laboratory
Laboratory Biosafety and Biosecurity
Planned Actions by June
2014

Start a rolling
programme of
biosafety and
biosecurity for selected
high throughput labs.
Rest of Government:
Eventual Goal
To have in place
working practices in
the labs to ensure
safe working
environment in the
labs.
Progress against APSED priorities
• Accurate laboratory diagnosis
– Development of Laboratory Quality Standards.
– Establishment of EQA programme for Microbiology in 2012 in 5 laboratories.
– Expansion of the EQA programme to include Microbiology, Hematology and
Biochemistry in 9 referral laboratories in 2013.
– Development of a poster with instructions for collection of specimens for
laboratory testing.
– Provision of in service mentorship to referral microbiology laboratories.
– Provision of laboratory supplies and reagents to ensure uninterrupted and high
quality microbiology diagnostics.
– Implementation of a LQMS (SLMTA) in select laboratories.
• Laboratory support for surveillance and response
– Development of an electronic Laboratory Information System (LIS), pilot of the
LIS, training of laboratory staff, and roll out to 10 referral laboratories.
– Development of a national training programme for integration of laboratory and
epidemiology responses during an infectious disease outbreak.
• Coordination and laboratory networking
– Establishment of a National Medical Microbiology Laboratory Network (NMMLN).
• Biosafety
– 3 workshops on Biosafety and Biosecurty.
Ongoing activities
• Accurate laboratory diagnosis
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–
–
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EQA programmes for Microbiology, Hematology and Biochemistry in 9 referral labs.
Implementation of LQMS in 5 referral lab (starts in May 2013).
Distribution of posters with instructions for collection of specimens for lab testing.
Provision of in service mentorship to referral microbiology labs.
Provision of supplies and reagents for microbiology labs.
• Laboratory support for surveillance and response
– Integration of Laboratory Information System (LIS) into the Health Management
Information System (HMIS).
– Development of blood culture diagnostics and antibiotic resistance surveillance in 6
sentinel referral hospitals.
– Assessment of 28 laboratories that contribute to IHR capacity (July to October).
– Upgrading 2 provincial laboratories to provide microbiology diagnostics.
• Coordination and laboratory networking
– Strengthening of National Medical Microbiology Laboratory Network (NMMLN).
– Development of CamLab Network, a website dedicated to the NMMLN.
• Biosafety
– Development of National Laboratory Biosafety Guidelines.
– Certification of Biological Safety Cabinets.
IHR Indicators related Laboratory
(IHR Core Capacity 8)
Indicator
8.1.1 Laboratory Services available to test for priority health
threats
No. YES
10/15 (66 %)
3/6 (50 %)
8.2.1 Laboratory biosafety and biosecurity practices in place
Challenges and constraints
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The implementation of a National Strategic Plan for Medical Laboratory
Services (2010-2015) is progressing slowly because of lack of human and
financial resources.
Lack of laboratory biosafety regulations.
No government funding to support review of the National Policy for Medical
Laboratory Services.
No budget for dissemination of National Laboratory Quality Standards.
Limited MoH budget to support laboratories and activities aimed at
strengthening laboratories.
No national curriculum for Quality Management Systems training.
Limited commitment for strengthening of Laboratory Network.
Limited authority of MoH over laboratories in national referral hospitals.
No authority of MoH over private laboratories.
Limited knowledge of clinicians in the rational use of laboratory diagnostics
leading to under utilization of laboratory services.
Fragmentation of the laboratory system among vertical programmes.
Limited influence on procurement of laboratory commodities.
Lack of preventive and curative maintenance of lab equipment.
Priority Activities for next year
•
Need support
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Upgrade CPA3 facilities to host
microbiology labs capable of bacterial
identification and Antibiotic Sensitivity
Testing (AST).
Strengthen a team of national
assessors to provide regular lab
audits.
Develop a Quality Manual.
Disseminate National Laboratory
Quality Standards.
Support training on lab supervision at
provincial levels.
Regulation of private laboratories.
Development of IQC guidelines for
laboratories.
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Support available
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Implementation of a LQMS.
Strengthening the NMMLN.
Provide training courses for basic
laboratories equipment maintenance
Regular assessment of laboratories that
contribute to IHR capacity.
Selection and training of biosafety officers.
Development of a national EQA
programme.
Analysis of laboratory data for surveillance
obtained through LIS reports.
Develop a standard list of laboratory
equipment.
Develop an up to date inventory of public
laboratories involved in surveillance and
outbreak response.
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Thank you!
2013
IHR
Priority
Activity
2014
Estimate Source
Ja Fe M A M Ju Ju Au Se Oc No De Ja Fe M Ap Ma Ju Ju Au S O No De d Budget of Comme
n b ar pr ay n l g p t v c n b ar r y n l g ep ct v c
(USD) Funds nts
Roll out national
Laboratory Information
System (CamLIS) to at
X XXX X XX X X X X X
least 10 referral hospitals
Lab
(2 additional national
diagnos and 2 provincial.
tics
Training of lab staff at
Lab
diagnos 4 referral hospital on X X X X X X X X X X X X
CamLIS
tics
Laboratory data is
Lab
diagnos routinely collected from X X X X X X X X X X X
these labs
tics
Expand Microbiolgy
EQA program to
Lab
X XXX X XX X X X X X
diagnos include 4 additional
laboratories
tics
Lab
Development of IQC
diagnos guidelines for the labs
tics
Training on IQC
Lab
diagnos methodology for
selected lab staff
tics
Perform assessment of
Lab
diagnos laboratory quality
XX X X X X X
X X X X X X
X X XX X X X X X X X X
Implement a laboratory
quality management
system in 5 laboratories
Lab
diagnosti of the NMMLN
cs
Continue strengthening
Lab
diagnosti of the NMMLN
cs
X X X X X X X X X X X X
X X X X X X X X X X X X
Lab
Develop a standard list
diagnosti of laboratory equipment X X X X X X
cs
Implement annual
workshop on how to
ensure the supply of
laboratory reagents and
Lab
equipment are included
diagnosti in the AOP
cs
Development biosafety
and biosecurity
Lab
diagnosti guidelines for laboratory
cs
Lab
Select and train a
diagnosti biosafety and quality
cs
officer in NMMLN
X
X X X X X X
X X X X X X X
X X X X X X X X X X X X
Lab
Roll out of biosafety
diagnosti training to additional
cs
CPA 3 and national labs
X X X X X X X X X X X X
Setting up a log book for
Lab
adverse events on
diagnosti biosecurity and biosafety
cs
in labs for each lab
Develop an up to date
inventory of public
laboratories involved in
surveillance and
outbreak response
Lab
diagnosti
cs
X X X X X
APSED 2010
APSED (2010)
1. Surveillance, Risk Assessment and
Response
CAREID project
Surveillance, Outbreak
Investigation and Response
2. Laboratory
3. Zoonoses
4. Infection Prevention and Control
5. Risk Communication
6. Public Health Emergency
Preparedness
7. Regional Preparedness, Alert and
Response
8. Monitoring and Evaluation
Emergency Preparedness and
Response
Risk Communication
Biosafety,
Quality Management System
Laboratory Networking
Lab diagnostics
Activity
Roll out national Laboratory Information System
(CamLIS) to at least 10 referral hospitals (2
additional national and 2 provincial
Responsible
Agencies/
Depts
BMLS/DHS,
WHO/
SubTWG
2013
1st Q
2nd Q
2014
3rd Q
4th Q
1st Q
Done
Training of lab staff at 4 referral hospital on CamLIS
WHO/ BMLS
On going
Still Process
Laboratory data is routinely collected from these labs
Expand Microbiolgy EQA program to include 4
additional laboratories
Development of IQC guidelines for the labs
BMLS/DHS
BMLS/DHS
WHO/NIPH
Done
BMLS/DHS
WHO/NIPH
Not Yet
Not Yet
Training on IQC methodology for selected lab staff
Perform assessment of laboratory quality
management
BMLS/DHS
WHO/NIPH
BMLS/DHS
WHO/NIPH
Others Partner
Not Yet
(May/13 to March/14)
2nd Q
3rd Q
4th Q
Lab diagnostics
Activity
Implement a laboratory quality
management system in 5 laboratories of the
NMMLN
Continue strengthening of the NMMLN
Develop a standard list of laboratory
equipment
Implement annual workshop on how to
ensure the supply of laboratory reagents
and equipment are included in the AOP
Responsible
Agencies/
Depts
BMLS/DHS
WHO/
2013
1st Q
2nd Q
3rd Q
4th Q
No ( May/13 to Jan/14 )
BMLS/DHS
WHO/DMDP/FM
/NUMR2/AFRIMSI
TM.
BMLS/DHS
WHO
2014
Done
Ongoing
BMLS/DHS
No(Nov/13)
Development biosafety and biosecurity
guidelines for laboratory
Select and train a biosafety and quality
officer in NMMLN
BMLS/DHS
WHO
BMLS/DHS
WHO
No ( May to Dec/13 )
No ( May to Dec/13 )
1st Q
2nd Q
3rd Q
4th Q
Lab diagnostics
Activity
Responsible
Agencies/
Depts
Roll out of biosafety training to additional
CPA 3 and national labs
BMLS/DHS
WHO/
Setting up a log book for adverse events on
biosecurity , biosafety in labs for each lab
BMLS/DHS
/NIPH/WHO
Develop an up to date inventory of public
laboratories involved in surveillance and
outbreak response
2013
1st Q
2nd Q
Ongoing
BMLS/DHS
WHO
( April to Aug/13)
2014
3rd Q
4th Q
1st Q
2nd Q
3rd Q
4th Q
Other activities
2013
Activity
Develop a National Quality Manual Template of
laboratory
Provide Training of National labs and Labs CPA3
1st step at 11 referral hospitals on NQMT
and each labs must be prepared/SOPS
laboratories assessment in
legal private sector (supervisory checklist)
Develop one-year AET curriculum
Responsible
Agencies/
Depts
1st Q
BMLS/DHS
/Sub TWG
BMLS/DHS
/Sub TWG
On going
BMLS/DHS
/Sub TWG
On going
CDC, WHO
CDC, WHO
3rd Q
Done
Conduct one-year AET course
Training of AET Supervisors (FET Plus)
2nd Q
2014
Done
4th Q
1st Q
2nd Q
3rd Q
4th Q
ACHIEVEMENT 2012
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Developed the national laboratory network
Developed and publish the NMLQS, but not yet dissemination to PHLs
Developed and CamLIS , 6 pilot.
Workshop on Biosafety Implementation and Biorisk Analysis, 4-8 April 2012 Sunway Hotel,
BMLS/DHS-AFRIMS
Workshop on Biosafety and Shipment 10-14 Sept, 2012 Sunway Hotel, CAREID
Launching Workshop for development of the National Laboratory Network in Cambodia, and
Training opportunity Jul 2012 – Dec, 2013
QMS/ Writing the QM ongoing, will finishing in Q1/2013
EQA for Microbiology 2012 5 microbiology labs (3 national levels and 2 provincials)
LABORATORY NETWORKING



NMMLN was nominated in Cambodia 2012 by the MoH
ToR document defining core, associate and advisory members approved
by MoH
RR document created and also work plan to address specific QMS
objective to support of NSP 2010 -2015.

CARIED Project.

QA/QC

Lab network

Biosafety and Epi/Lab

SLMTA Implementation in Cambodia


Foundation Merieux in Cambodia ( Globe network)
Others
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SLMTA in Cambodia, June 2011-2012
Improvement in the Score of the
Safety Section of the Checklist
Equipment Maintenance
Cambodian MOH delegation developing SLMTA
action plan at the CDC office in Phnom Penh.
Launching Workshop for development of the
National Laboratory Network in Cambodia, and
Training opportunity Jul 2012 – Dec, 2013
Under opening ceremony by HE. Prof Ung Sam
An, Director of NIPH, Chairman of Sub TWG
Advanced Biorisk Management Workshop
Hanoi, Vietnam, February 13th – 17th, and Bank Kok, Thailand, 5-10
June, 2012 CAREID
Workshop on Biosafety Implementation and
Biorisk Analysis, 4-8 April 2012 Sunway Hotel,
BMLS/DHS-AFRIMS
Workshop on Biosafety and Shipment
10-14
SlideSept,
23 2012 Sunway Hotel,
CAREID
Achievement in 1st Quarter/ 2013
•
2 times for Sub TWG and 4 times for small group lab services
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Workshop on blood culture, are 7 sites 5 Provinces and 1 NIPH supported by 5 sponsor namely
WHO, ITM, SHCH, DMDP, ITM ,FM with the collaboration BMLS/DHS and UHS, 21-22 Feb,
2013
•
•
Workshop on EQAS program, there are 9/10 sites with upgrade 3 labs
( 6/2012 and 3/2013) 15 March, 2013 at Cambodiana Hotel
•
W/s on Biosafety and Biorisk management and BSC hazard Inc MoU between MoH and TLL,
26-29 March, 2013
•
Meeting of NMMLN at Sunway Hotel, 8 April, 2013
1st Quarter/ 2013
Training workshop on EQAS, 15 March, 2013 at
Cambodiana Hotel. Supported by WHO
Cambodia MOH signed an MOU with TLL on March 2013
at Sunway Hotel
On Capability and Capacity Building in lab Biorisk
Management and Biosafety
1st Quarter/ 2013
Workshop on Blood Culture. 21-22 Feb, 2013 at UHS
Supported by WHO, DMDP,ITM,FM ,NAMRU-2 AND HSCH
Meeting of NMMLN, 08 April, 2013 at Sunway Hotel.
Supported WHO
Ongoing 2nd Quarter/2013
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W/s on Calibration and BSC at Siem Reap, 29-31 April, 2013
LQSI workshop 7-9 May, 2013 at Cambodiana Hotel,
Finished a Quality Manual
Finished and upgrade CamLIS and CamLab Website
EQA for Microbiology 2013: from 5 to 9 microbiology labs
APSED Key milestones, where are we?
Year 1  Guide on establishing a public health
diagnostic laboratory developed
Year 2  EQA mechanism for dengue
established
Year 3  Public health diagnostic laboratories
established
Year 5  Functional exercise to test public
health laboratory system
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IHR Indicators related Laboratory
(IHR Core Capacity 8)
Indicator
8.1.1 Laboratory Services available to best for priority health
threats
No. YES
15/10 (66 %)
6/3 (50 %)
8.2.1 Laboratory biosafety and biosecurity practices in place
Challenges and constraints
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-
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The implementation of a National strategy that seeks to improve testing quality in public
health laboratories is progressing slowly because lack of human and financial resources (Quality
testing)
There is no Biosafety guideline. Bio-safety manual will use to protect hazard and address the
challenges identified by APSED priority and IHR. In public and private
No budget to dissemination and publish ( NQLS and National Quality Manual Template)
No transportation
No government funding to support review NLP and NSP
No national curriculum for QMS training
Priority Activities for next year
•
-
Need support
Strengthening a roadmap to
implement a QMS and strengthening
NMMLN opportunity
- Upgrade the (CPA3) to have
microbiology labs capable of bacteria
culture identification and AST,
Develop and build up national
Assessor team and implementation
- Publish and dissemination on Quality
Manual template include National
Laboratory Quality Standard
Support training on lab supervision at
provincial levels
- Support a transportation
- Support budget for annual workshop
on evaluation EQA Program.
•
Need available
-
Provide training courses for basic
laboratories equipment maintenance
Support laboratories assessment in public
and legal private sector
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Thank You