Reinforcing the capacity of health services in the province of Bolikhamxay

The BoliLab project, supported financially by the Coopération Luxembourgeoise, ended in 2022 after five years of providing support for healthcare services in the province of Bolikhamxay.

Launched in 2018 following the construction of a new provincial hospital, BoliLab was rolled out in close collaboration with local health authorities and the National Center for Laboratory and Epidemiology (NCLE), the leading national laboratory. Having helped to set up the hospital laboratory and introduced new analysis techniques, the Foundation also supported its integration into the national network of laboratories in Laos (with mentoring and training activities). The Foundation also supported the Maria Theresa hospital in the province of Vientiane in renovating its laboratory rooms.

Reinforcing the capacity for dealing with epidemic

Launched in January 2021 with financial support from the Agence Française de Développement (AFD, French Development Agency), the C19-HaïtiLab project aims to reinforce the testing capacity of biomedical analysis laboratories in Haiti’s provinces.

Designed to enable the health system in Haiti to monitor the COVID-19 epidemic, the project aims more globally to strengthen the national laboratory system so that it can play a role of surveillance and control in the event of an epidemic threat.

The project has two main components:

• The reinforcement of peripheral laboratories in association with the National Public Health Laboratory (LNSP), in particular by increasing levels of biosecurity and biosafety, the transport of samples and the transmission of laboratory data.
• Targeted support for GHESKIO centers (Haitian Group for the study of Kaposi’s Sarcoma and other opportunistic infections) to improve the energy performance of their installations.

In 2022, all parts of the project were rolled out: training and practical workshops run in conjunction with the operational project partners, installation of ten microbiological safety cabinets in the different laboratories, energy audit of the GHESKIO building and installation of an air-handling unit.

Expanding access to HIV viral load testing

The Mérieux Foundation has been running the EVAMAD project since 2015 with the support of the Expertise France initiative. This project has two objectives: to expand the geographical coverage of HIV viral load testing and improve the care of people living with HIV/Aids in Madagascar.

Renewed in 2020 for a period of three years, EVAMAD helps to reinforce sampling circuits and provide continuous information for prescribing practitioners, healthcare workers, biologists, and associations.

In 2022, new sampling circuits were added to develop the network in five towns in the north and south of the island. The transfer of routine analysis activities from the Charles Mérieux Center for Infectious Disease (CICM) to the Ministry of Public Health laboratory remains ongoing (half of the needs covered in 2022). The emergency system for dealing with accidental exposure to the virus is currently being set up at the CICM and in a pilot maternity unit on the outskirts of Antananarivo.

Thanks to this project, more than 50% of patients undergoing antiretroviral treatment in Madagascar now have access to viral load testing as part of their follow-up care and more than 75% of patients have recorded virological success.

EVAMAD operates in collaboration with the Ministry of Public Health, the Global Fund, the Charles Mérieux Center for Infectious Disease in Antananarivo, the National AIDS Committee, the NGO MAD’AIDS, UNAIDS and the RESAMAD network of laboratories.

Global program for leadership training in laboratories

Since 2019, the Foundation has actively pursued the development of the GLLP (Global Laboratory Leadership Program). The Foundation was selected by the Global Fund to roll out this program in three countries: Mali, Guinea, and Chad. This is a leadership training program for laboratory staff based on a local mentoring system.

The program is mainly aimed at laboratory professionals working at an intermediate or higher level and with experience in management, leadership, and decision-making. Participants working in the animal and environmental health sectors are also eligible.

The GLLP training program is firmly based on achieving operational results and aims to strengthen the voice of laboratories to enable a community of active leaders to emerge within institutions in the beneficiary countries. The project is based on three main cornerstones:

• Reinforcing the skills of around 10-15 participants per country in four key topics through an interactive, classroom-based course
• Supporting each participant to implement a defined project to improve laboratory services
• Organizing a local mentoring scheme (4 to 6 mentors per country)

In 2022, the selection stages took place in Guinea and in Mali, and training courses were carried out respectively at the National Laboratories Directorate in Conakry and at the Charles Mérieux Center for Infectious Disease in Bamako. The mentor/mentoree pairing process and project planning have begun. In Chad, the call for applications was launched at the end of last year with a view to starting the training courses in the first quarter of 2023.

Project for the detection and surveillance of infectious diseases

Set up in around twenty countries in 2020, IDDS is a project funded by the United States Agency for International Development (USAID) with the objective of reducing global health risks linked to infectious diseases. The Mérieux Foundation USA received a grant to take part in the project in Madagascar and in the Democratic Republic of the Congo in partnership with the Mérieux Foundation.

In Madagascar, the project relies on the RESAMAD network of laboratories, the company ICF, the Charles Mérieux Center for Infectious Disease in Madagascar and the Ministry of Public Health. In 2022, this support was oriented towards strengthening capacities in bacteriology, hematology, and biochemistry. A National Strategic Plan for the development of laboratories was launched in the autumn with a view to improving performance and service quality at all levels of the healthcare system.

In DRC, the Rodolphe Mérieux Laboratory at the National Biomedical Research Institute (INRB) serves as lead laboratory. The project is implemented by staff at the INRB and the Mérieux Foundation in partnership with the companies ICF and Abt Associates, the NGO FHI 360 and the African Society For Laboratory Medicine (ASLM). 2022 achievements include the organization of a nine-day training course for biologists and laboratory technicians from the eastern provinces of the country.

Implementation of a national medical biology policy

The aid supplied to the Guinean Ministry of Health since 2017 by the Agence Française de Développement (AFD, French Development Agency) through the Mérieux Foundation and the Institut Pasteur in Guinea ended in 2022. The support for the network of 39 district and regional laboratories has allowed the laboratories to be modernized, the equipment to be brought up to date, and practices to be harmonized.

Several major milestones have been achieved during this time: connection of buildings to water and electricity supplies, formalization of waste management processes, creation of a national manual of good laboratory practices (conduct of analyses, handling and transport of samples, quality assessments, etc.) and the adoption of software dedicated to laboratory activities (patient data and stock management).

LABOGUI was deployed in close collaboration with the National Laboratory Directorate and the project coordination unit at the Guinean Ministry of Health.

Achievements in 2022 include:

• Renovation of four hospital laboratories and supply of nine vehicles to regional biomedical analysis agents.
• Continuation of training activities for national technical assistants operating in the region and teacher training for staff at the École Nationale de Santé (National Health School) in Kindia, in partnership with Biologie Sans Frontières.
• Establishment of relations between laboratory and hospital staff with the help of regional laboratory managers appointed by the Ministry of Health.
• Installation of the latest version of the LabBook software, introduction of quality documents and launch of a study to measure the impact of the project on the performance of beneficiary laboratories.

Ensuring diagnosis activities in the context of a crisis

The Mérieux Foundation has supported the diagnosis activities of the National Tuberculosis Program (NTP) since 2018, with the objective of guaranteeing patient care despite the increasing fragility of the Lebanese healthcare system.

The Foundation provides operational and strategic assistance with the aim of improving access to diagnosis for vulnerable populations (support for the Rodolphe Mérieux Laboratory in Beirut, help with supervision and with drawing up a National Strategic Plan). Since July 2022, the Foundation has provided logistical support for transporting samples at national level. This project is managed in partnership with the WHO, the Lebanese Ministry of Public Health, and the Faculty of Pharmacy at the Saint Joseph University, and benefits from financial support from the International Organization for Migration (IOM).

Support for the implementation of a quality management system

The Mérieux Foundation’s Quality Initiative aims to reinforce quality management skills as part of a continuous improvement system.

The program provides support for laboratory teams as they adopt a quality management system (QMS), with a view to obtaining ISO15189: 2012 accreditation. This support is based on the WHO LQSI (Laboratory Quality Stepwise Implementation) tool. Two YouTube live streaming events were organized in 2022 on the use of metrology and risk analysis in biosafety. Eight laboratories have joined the Quality Initiative to date and four of these have already been accredited.

Technical support for the national laboratory network

Launched in 2006, the RESAMAD project is a network covering biomedical analysis laboratories in 27 public hospitals in Madagascar with the objective of strengthening their capacities for diagnosis and participation in epidemiological surveillance.

This technical support covers three main priorities: ensuring activities continue over the long term thanks to a process for recovering costs; creating a local infrastructure to improve the proximity of services available to patients; and setting up bacteriology units to meet patients’ needs.

Fifteen years after the RESAMAD network was set up, the Foundation conducted an exercise to find out the lessons learned in order to identify the key factors behind RESAMAD’s success and to demonstrate the added value of the network for laboratory professionals, patients, and public health. The results were published at workshops organized from December 5 to 9, 2022.

Among the lessons learned from this study, several success factors were identified:

• The uniformity of activities thanks to the use of shared standards, participation in training courses, and quality controls;
• The interconnection of laboratories, with multiple positive effects, such as the transfer of skills and the sharing of experiences;
• Progress benefiting all parties involved in the care ecosystem: patients, laboratory professionals, clinicians, and health authorities;
• Appropriation by members of the network, with an extremely active steering committee enabling ties to be strengthened and encouraging a genuine sense of belonging.

RESAMAD is operated in partnership with the Madagascan Ministry of Public Health, the Charles Mérieux Center for Infectious Disease in Madagascar, the Institut Pasteur in Madagascar, IDDS (Infectious Disease Detection and Surveillance).

Development of biomedical services in 7 member countries

Set up in 2009 on the initiative of the Mérieux Foundation, the RESAOLAB regional network of laboratories project entered its third phase in 2019 with the support of the Agence Française de Développement (AFD, French Development Agency). RESAOLAB is the first network of laboratories in West Africa and covers seven French-speaking countries: Benin, Burkina Faso, Guinea, Mali, Niger, Senegal, and Togo.

In close partnership with the respective Ministries of Health, targeted actions focus on two main areas of improvement: the reinforcement of technical capacity in terms of biological diagnosis, and support for the implementation of national medical biology policies through a harmonized regional approach.

In 2022, the actions undertaken in response to the health crisis were finalized in the member countries with the receipt of the last laboratory equipment and the implementation of post-epidemic studies. Training and coordination activities continued: financing of numerous study grants, roll-out of the latest version of the LabBook software, support for the design of high-quality programs, presentation of the 4th edition of the WHO biosafety manual, etc.

As part of this third phase of the project, a review of the operations of the national laboratory networks was drawn up using the LabNet Scorecard assessment system. This status report will serve as the basis for each country to develop an action plan and a second stage will be carried out at the end of the project to measure the evolution of monitoring indicators. At the same time, compiling these works made it possible to gain a cross-sectional overview of the results, revealing the strengths and areas for improvement at a regional level. The Mérieux Foundation helps the countries to define priority initiatives for making improvements.

Improving global health security by reducing the impact of epidemics

Funded by the UK government through the Foreign, Commonwealth & Development Office (FCDO) and led by DAI Global Health, the TDDA (Tackling Deadly Diseases in Africa) program was carried out in six countries in sub-Saharan Africa between 2019 and 2022 (Mali, Ivory Coast, Chad, Cameroon, Uganda, and Niger until 2021).

Its objective was to improve health surveillance and coordination to prevent local outbreaks of diseases leading to epidemics on an international scale.

In Mali, TDDA/ACE was run by the Mérieux Foundation in partnership with the Ministry of Health and Social Development in Mali and the Mérieux Foundation USA. The results were presented at the project closure meeting held in Bamako on September 30, 2022. Progress made during the project included the improvement of surveillance capabilities, the integration of the One Health approach, the deployment of the National Action Plan for Health Security, and better steering of International Health Regulations (IHR).