Transcript Role of WHO in policy change and retooling

Retooling Task Force Meeting
15-16 January 2008
Role of WHO in
promoting change and retooling
Lesotho case study
Dr Mario Raviglione
Director
Stop TB Department
World Health Organization
WHO's functions in retooling –
Two phases
1. Norms, standards and policies
• From research and evidence into policy
2. Strategies, guidance towards implementation
• From policy into practice
WHO's functions in retooling –
Phase 1: policy development (1)
1. WHO Strategic and Technical Advisory Group (STAGTB)
2. Before STAG, expert technical consultations
- Selected STAG members and other experts
- Evidence varies: new published, "grey" research
or reviews; proof of principle; large-scale field
trials
- Recommendations made to WHO
3. Based on findings/recommendations, WHO prepares
draft policies/guidelines for STAG review
4. STAG endorses
5. WHO issues final policies/guidelines
WHO's functions in retooling –
Phase 1: policy development (2)
• WHO recommendations disseminated via WHO channels
to Member States (incl. WHA), via website, listserves etc.
• WHO recommendations disseminated also to Global
Fund, UNITAID, World Bank, other agencies and donors
• New technology from research also needs review by
national regulatory agencies and WHO may help
• Operational research to further assess needed
adaptations in different settings and scale-up issues
• Iteration/revision of guidelines as needed
WHO's functions in retooling –
Phase 2: from policy to practice
• Production of Guidelines
• Technical assistance to countries
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Adaptation of guidelines
Human resource assessment
Capacity building and training tools
Adaptation of M&E
Operational research and guideline revision
• Support for scale-up, resource mobilization, and partner
coordination
WHO's functions in retooling
Example of liquid culture
• Key point: focus is on technology, not on
product!!
Example of liquid culture
Phase 1: policy development
Process
• Identification of need
• Review of literature on test performance
• Demonstration projects in different
epidemiological and resource settings
• Expert group meeting to review field data
• Expert report used to prepare STAG proposal
• STAG endorsement
• WHO policy formulation and dissemination
• Development of implementation checklist (RTF)
Example of liquid culture
From Phase 1 to Phase 2
• STAG recommendation on use of liquid culture,
June 2007
• WHO policy announced, October 2007
• In parallel, implementation plan initiated with
FIND, PIH/OSI working with MoH in Lesotho
- Pilot country, small, resources available,
readiness
• Development of performance indicators
• Implementation of external quality assurance
programme with WHO Supranational Reference
Laboratory, SAMRC
• Appointment of country WHO Medical Officer
Example of liquid culture policy:
Phase 2 (1)
• Establishment of Central TB Laboratory,
Nov 2006 – November 2007
1. Renovation & upgrade of laboratory and streamline of work-flow
2. Hire of additional technicians to conduct culture and DST
3. Installation of equipment procured already under GFATM
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Use of external ‘Technical Assistance’ to upgrade and modernize the CTL
Securing of sufficient funding to avoid shortage of consumables and reagents
Country-wide training and EQA for sputum microscopy
Phased approach:
1. Establish quality assured solid culture and DST
2. Establish liquid culture & DST, rapid speciation method
3. Implement rapid molecular methods to diagnose MDR-TB
8. Hire of consultant to reactivate the CTL as per established norms
Example of liquid culture policy:
Phase 2 (2)
• Working in partnership
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FIND appointed a consultant for on-site supervision and technical expertise
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FIND also provided MGIT culture and DST system, and Capilia TB
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MoH&SW and PIH provided all logistics and financial support
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WHO supported
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SAMRC provided external quality assurance (DST proficiency testing)
Renovation of Central TB Laboratory,
Maseru, Lesotho
28thMay to 22ndJune
AFTER Renovation
BEFORE Renovation
3.25m
3.75m
B
S
C
Staining area
Storage of
chemicals, stains
& inspissator
Cntfg
Neg. Air Pressure
BSC
3
3m
Culture room
6
BSC
Refrigerator
Microscopy,
centrifuge,
Incubator
2.5
m
A/C
Culture room
4
Insspi
2m
Media
room
2
5
BSC
Autoclave
Sterilization room
Sin
k
Sink
Office of
Microbiologist
MGIT 960, Fridge &
Incubator
Toilet
Toilet
Specimen receipt
& Microscopy room
1
7
Hand-wash
Entry
Primarily, smear microscopy Laboratory has been upgraded
into Culture & DST setup for immediate needs
Safety cabinets
Culture room
Before
After
Anteroom
Office room shifted and converted into
Microscopy room-work in progress
Glass
partitioning &
creation of a
media room
Painting work &
creation of anteroom
Microscopy room converted to
sterilization room
with on-site autoclave
Before
After
After
Negative air pressure facility
& monitoring
HEPA Exhaust
Magnehelic gauge
HEPA In-flow
Example of liquid culture policy
Lessons learnt in Lesotho
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Benefit of working in partnerships
Rapid introduction of new technology feasible
in the poorest setting
Laboratory strengthening shown to be
affordable
Example of liquid culture policy
Diagnostics retooling challenges
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Extent of laboratory scale-up
Human resource mobilization
Laboratory biosafety
Regular laboratory quality assurance
Regulatory agency on Diagnostics
Laboratory recording and reporting systems
linked with NTP
Sustainability
Funding
WHO's functions in retooling
Retooling of existing technologies
Examples:
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Reduction in number of smears for case
detection
Revised case definition (one positive smear)
Retooling Task Force Meeting
15-16 January 2008
Many thanks for listening
Many thanks to Karin Weyer, Diana Weil, Véronique Vincent, Rachel
Bauquerez who helped prepare this presentation. Many thanks to FIND and
Paramasivan for providing photos and part of the text
Dr Mario Raviglione
Director
Stop TB Department
World Health Organization