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Laboratory services in resource limited areas

By SUSAN LEIB | 03 May, 2014

Dear All,

I am involved with a primary care clinic in southern Belize. We are looking at adding laboratory services to the clinic. Does anyone have any recommendations about types of laboratory services that work well in areas with limited resources? We are hoping to provide basic lab tests including CBCs, electrolytes, LFTs and Hgb A1C. Concerns include ease of use, training, repairs and costs. In particular, does anyone have experience with using World Wide Labs or iStat services? Appreciate any input or suggestions. Thanks.



Maurits van Pelt Replied at 12:12 AM, 4 May 2014

Yes we have experience with laboratory services since these were added in 2010 here in Cambodia as part of "Peer Educator Networks (PEN) for Diabetes and High Blood Pressure, which is facilitating and organizing the availability of these services in remote districts of the country or for patients in poor urban areas. It is a complementary service that must fit with the Prescribing practices of the Physicians and the Revolving Drug Fund for the registered patients with chronic disease. The biochemistry laboratory tests made available by the PEN are biochemistry tests on blood serum: Bloodglucose, Total Cholesterol, HDL, Triglycerides. Potassium, Chloride, ASAT & ALAT, Creatinin, and on whole blood the HbA1c. For serum we use integrated system (machine and reagents from the same german company) and for HbA1c also, but from another company. Many Point of Care machines for HbA1c are not good enough see attached evaluation of some of the well known ones, but perhaps there is a more recent review. Chronic patients are at risk of becoming milkcows of the health system unless we organize the dynamics in such a way that are involved in their own care including the business-economy of their care. That includes the organization of convenient good quality laboratory services for chronic NCD. In 2013 our data base recorded 4000 biochemistry laboratory profiles done for more than 11,000 chronic patients (mostly rural) using these services through the PEN. They pay the full cost as far as they use the services..more at and at After several years of piloting the Cambodian government and Ministry of Health have begun to take over the strategy from the NGO. This opens the road to national scale up, but lots of challenges ahead... Maurits

Attached resources:

Ziad Khatib Moderator Emeritus Replied at 12:12 AM, 4 May 2014

‎Hi Susan,
I worked with MSF as lab tech. WHO has good literature, also MSF.


Anna E. Schmaus Replied at 3:14 AM, 4 May 2014

Dear all,

we support hospitals in remote and rural areas in implementing cytological
laboratories. These laboratories only need basic equipment, no high-end
machines. We train laboratory people how to do the staining. Training also
includes to understand diagnoses. The diagnoses are made in collaboration
with cytologists from the country itself, if available, or with cytologists
from any other country via a web-based telediagnostic platform. We do
blended learning, partly in the country itself, partly by the
telediagnostic platform. This is learning by doing. It is part of CME
(continous medical education) for laboratory people and cytologists in the
remote hospitals. On the web-based platform health personal find lectures
concerning cytology and how to do it.

Members of our NGO are experienced in general cytology but also in cervical
cancer, breast cancer.

Let me know if you would like to know more about building up a laboratory
for cytological analysis.

Anna E. Schmaus-Klughammer (LLB hons)
President of One World Medical Network

2014-05-04 0:03 GMT+02:00 SUSAN LEIB via GHDonline <>:

SYDNEY CHIKUKWA Replied at 3:25 AM, 4 May 2014


I would want to know what is the scale of service you intend to provide and
the limited resources are they technical expertise financial or transport
and communication network.
1. To provide laboratory services basic as in your case you need to know a
few issues to take into consideration in your planning process.
Issues of technical competency, who is going to work in the laboratory,what
is the level of training is required. From the brief information you
supplied it seemed you need at least a technician or technologist with
basic laboratory skills to operate and trouble shoot on instruments. This
also means they will ensure long life span of your analyses as they will
also be in a position to do preventative maintenance. So the next question
will be if i don't have such people what to i do, i would say start the
role out plan on a small scale and if your country has health training
centres then send 6-10 cadres with basic chemistry and biology and
mathematics background for training or ask neighbouring countries for such
courses in biomedical lab sciences or medical lab technology. In the mean
time you can take qualified personal from your national lab to head few
centres you would open at a time while your other people are being trained.
Issue of Quality assurance
We do not have laboratory service for the sake of provision of results, but
we want quality results, a lab machine always give out results and unless
someone has laboratory acumen or unless they are measures to detect and
minimise errors then it will not be lab service for improving clinical
outcomes. So they must be basic quality assurance program that must include
the following, Proficiency testing, external quality assurance, record
keeping, supply chain management, internal quality controls, etc.
The second major issue is choice of instruments, iam currently working in a
developing country Namibia wwhere we have established a comprehensive
laboratory system wholly owned by government but i think its the best in
Africa and some international countries may not be having a system like
that, but it started small. The best option is to lease instruments rather
than to buy the instruments because when you lease instruments services
becomes the vendors responsibility and in case the instruments are outdated
it will be the vendors responsibility to give you modern instruments. But
the other good or bad thing is the amount of your monthly premiums will
depend on the amount of reagents you will purchase from the vendors, the
more you purchase the less you pay, but if you are going to use less then
you would obviously pay more.
When you purchase instrument cash and you don't not have the vendor in your
country the best thing to do is to send 2 or 3 persons to be trained on
operations and service before you start using them vendors usually arrange
If you are leasing you just need to come up with a service plan for each
The third major thing which platforms to lease or buy
I advise you buy small but compact instruments for low volume labs, eg
Coulter ACT 5 diff, for haematology labs with through puts of upto 100 full
blood counts a day. Or cobas C111 for small labs of same size, though it
needs a separate eletrolyte analyser. If your country is vast you may
establish regional labs to do your endocrinology and drugs if its not big
enough then you can have a national reference labs to do endocrinology
viral loads and other special test. I do not know if your country is having
a high burden of HIV you can also buy Pirma point of care CD4 analysers and
gene expert machines for TB diagnosis.
A lot can be said but space and time limit me, note that for your regional
and national labs you can use platforms that combine chemistry and
immunochemistry and high volume throughput systet
For further either inbox me or phone me
00264812329780 and we help you with the planning process as well as the
implementation and M&E
Dr Sydney chikukwa(PhD)

amos oburu Replied at 1:00 PM, 4 May 2014

Dear Anna.

This a great idea an can be much help for developing countries like Kenya where I work.

Currently am involved in clinical trials(drug and vaccine) and I work with KEMRI-Wellcome Trust) in Kenya.

Am interested in such laboratory and will appreciate your collaboration.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.