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Dr. Sau Sokunna Deputy Director of DHS Ministry of Health 30 April 2013

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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Dr. Sau Sokunna Deputy Director of DHS Ministry of Health 30 April 2013

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  1. Cambodian National Work plan for Implementation of IHR Minimum Core Capacities and APSED Priority Areas, 2012-2014Laboratory Dr. Sau Sokunna Deputy Director of DHS Ministry of Health 30 April 2013

  2. Team members Department of Hospital Services/MoH: • Bureau of Medical Laboratory Services (BMLS): • DrSauSokunna, Director • Pharm Sam Sopheap, Chief • Pharm Monipheap, Vice Chief • National Institutes of Public Health(NIPH) • Prof ChuopSokheng, Head of NIPH • National Blood Safety Program (NBTC) • DrHok 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.

  3. Key Components • Accurate laboratory diagnosis • Laboratory support for surveillance and response • Coordination and laboratory networking • Biosafety

  4. 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.

  5. Ongoing activities • Accurate laboratory diagnosis • 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.

  6. IHR Indicators related Laboratory (IHR Core Capacity 8)

  7. Challenges and constraints • 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.

  8. Priority Activities for next year • Need support • 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. • Support available • 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.

  9. Thank you!

  10. APSED 2010 • APSED (2010) • Surveillance, Risk Assessment and Response • Laboratory • Zoonoses • Infection Prevention and Control • Risk Communication • Public Health Emergency Preparedness • Regional Preparedness, Alert and Response • Monitoring and Evaluation • CAREID project • Surveillance, Outbreak Investigation and Response • Emergency Preparedness and Response • Risk Communication • Biosafety, • Quality Management System • Laboratory Networking

  11. Lab diagnostics

  12. Lab diagnostics

  13. Lab diagnostics

  14. Other activities

  15. Achievement 2012 • 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)

  16. 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

  17. 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.

  18. 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 Sept, 2012 Sunway Hotel, CAREID

  19. Achievement in 1st Quarter/ 2013 • 2 times for Sub TWG and 4 times for small group lab services • 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

  20. 1st Quarter/ 2013 Cambodia MOH signed an MOU with TLL on March 2013 at Sunway Hotel On Capability and Capacity Building in lab Biorisk Management and Biosafety Training workshop on EQAS, 15 March, 2013 at Cambodiana Hotel. Supported by WHO

  21. 1st Quarter/ 2013 Meeting of NMMLN, 08 April, 2013 at Sunway Hotel. Supported WHO Workshop on Blood Culture. 21-22 Feb, 2013 at UHS Supported by WHO, DMDP,ITM,FM ,NAMRU-2 AND HSCH

  22. Ongoing 2nd Quarter/2013 • 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

  23. APSED Key milestones, where are we?

  24. IHR Indicators related Laboratory (IHR Core Capacity 8)

  25. Challenges and constraints • 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

  26. 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

  27. Thank You

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