‘One Health’ workshop on Lab Systems in Phnom Penh

As part of the SEALAB project Strategy 3 “The laboratory network coordination at the national and international level for human and animal health is active”, it was decided to implement a national ‘One Health’ workshop on human and veterinary laboratory systems to address solutions for filling gaps identified during human and veterinary laboratory systems assessments and to move forward in practical way.

This workshop brought together key stakeholders from Human Health (HH) and Animal Health (AH) sectors who have participated in lab systems assessments conducted by IQLS in 2020.

The 4-day workshop provided participants an opportunity to propose and discuss improvements for lab systems in both sectors guided by two lab experts from IQLS, Dr. Arsen Zakaryan from Canada and Mrs. Vivian Fensham. Mrs. Vivian Fensham has been  in Cambodia for many years and shared her practical local experience helping to better adapt the presentations to a country context.

The main objectives of the workshop were:

• to bring together human and veterinary laboratory professionals,
• to provide theoretical basis on what a laboratory system should be,
• to present gaps identified during both laboratory system assessments,
• to discuss how to move forward in practical way to address these gaps in line with the national strategy.

The discussions focused on critical themes for laboratory systems implementation, coordination and regulations, reference laboratories/tiered level, management (staff, training, equipment, biosafety) and QMS & EQA.

The expected outputs were:

• to propose practical guidelines to draft or update the laboratory national plan in relation with each of these four themes,
• to develop and present a 6-month plan for the implementation of agreed activities to strengthen national laboratory systems,
• to provide documents, procedures, guidelines, training modules to facilitate and speed up implementation activities to strengthen national laboratory systems in the country.

IQLS presented the results of the assessments conducted in December 2020. Discussions were critical for reevaluating the recommendations with the reality in the country and to better correspond to the national strategy. The active participation of the invited lab managers and the involvement of focal persons at BMLS and GDAHP were essential in this process.

The folowing key points were discussed during the workshop:

• Governance: updating and drafting the Laboratory National Plan is challenging in the context of the COVID-19 crisis as all processes were on stand-by during this period. The Working Groups established by BMLS and GDAHP will be central for this work. For the HH sector the first step will be to review the implementation of the 2015-2020 Laboratory Strategic Plan while for the AH sector has to validate strategic objectives before starting to draft the plan.
• Organization & regulations: a concern for both sectors is an integrated transportation system of specimens emerged during COVID-19 pandemic. At present, only vertical programs have developed a transportation system funded by the programs. The SEALAB project has a specific component on this topic. An on-going survey will result in an analysis of the flow of samples in the country to support designing a pilot phase in 3 provinces to provide guidelines for a sustainable system that can guarantee timeliness of delivery and quality of specimens.
• Human resources management: the director of BMLS and the director of NAHPRI emphasized the importance of improving storage and updating of all training materials delivered during various projects, especially the SEALAB and QWArS projects. It was suggested to set up a Knowledge Transfer Platform (Moodle or another open source system) to provide documents, modules and e-learning. The development of this platform will benefit from the experience conducted in Myanmar under the SEALAB project.
• Public Health functions: discussions included the necessity to list the 10 priority diseases, the main concern being the collaboration between HH and AH as zoonotic diseases, involving the private sector in reporting these notifiable diseases, defining the 10 core tests to comply IHR, and to better integrate vertical programs (HIV/TB/Malaria) in the Lab system.
• Equipment and supplies management: inventory and listing specifications of equipment does not seem to be a priority compared to calibration and certification of BSL. SEALAB has delivered a complete training course on preventive maintenance that will be followed by one-on-one support in each lab by the team of Institut Pasteur in Cambodia. Accredited departments for calibration at MoH level is a priority but will likely be long process. The Mérieux Foundation is in discussion with GIZ on implementing another program for strengthening laboratories and plans to jointly initiate a pilot phase by providing a set of calibration (scale/centrifuge/thermometer) to be used by the 5 hospitals for indispensable calibrations. Additionally, the Mérieux Foundation is liaising with US-CDC to employ a national BSC Certifier, NSF-license and a BSC Certifier assistant as BSC certification activities are essential in response to IHR regulation and MoH, in particular in the context of COVID-19 pandemic, to guarantee lab staff safety.
• LQMS: the relevance of providing national EQA schemes to reduce costs and using software to analyze data of EQA was analyzed by the participants. This approach has been developed with the support of NRL for HH. For veterinary sector the priority is to develop a Laboratory Quality Policy and to strengthen participation in international EQA schemes to cover all main priority diseases.

At the end of the workshop, attendees received personalized certificates for their participation and IQLS distributed USB flash drives containing documents and guidelines to support drafting necessary documents.

A 4-day QMS training course for veterinary lab professionals is scheduled from 17 to 20 January 2022. After the training course IQLS will propose a detailed work-plan for the next 6 months inline with requirements expressed during the ‘One Health’ workshop.