{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:16:41Z","timestamp":1792513001374,"version":"4.5.0"},"reference-count":28,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Laboratories and diagnostics services are critical to universal health coverage and public health response. We assessed the extent of the implementation and functionality of the 2016\u20132023 Eastern Mediterranean Region (EMR) laboratory strategic framework.\n\nIntervention: Documents and reports from World Health Organization country offices were examined between September 2022 and November 2022, supplemented by stakeholder-provided documents, to enhance data collection and reporting across the framework\u2019s five goals. An intervention using a performance evaluation scorecard assessed the progress of EMR Member States (MSs) towards strengthening health laboratory services, with findings validated during the December 2022 regional public health laboratory directors\u2019 meeting in Egypt.\n\nLessons learnt: We analysed results from 21 of 22 MSs. Three (14%) MSs, all high income, had the capacity to implement all indicators, while only one of five low-income (20%) MSs could not demonstrate any capacity across all five goals evaluated. Irrespective of income category, the least implemented domains were: (1) availability of either or both fully implemented laboratory policy, and (2) a fully implemented integrated national laboratory strategic plan, both of which were implemented in only 50% of MSs.\n\nRecommendations: Addressing the identified gaps requires concerted efforts, collaboration, and sustained investment to ensure the delivery of high-quality laboratory services and advance public health outcomes across the EMR. Implementation of laboratory strategies should be coordinated through the specific laboratory department or unit at the Ministry of Health level, above the central public health laboratories and with the support of a national laboratory technical working group.\n\nWhat this study adds: This study revealed substantial gaps in implementing laboratory policies and strategic plans in the EMR, with full implementation achieved by only 50% of MSs. It underscores the necessity for coordinated efforts and sustained investment to enhance laboratory services and promote effective laboratory practices in EMR.\n\nKeywords: laboratory; strategic framework; diagnostic services; health coverage; public health response.<\/jats:p>","DOI":"10.4102\/ajlm.v14i1.2611","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T09:22:52Z","timestamp":1746091372000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Implementation of the laboratory strategic framework to strengthen health laboratory services in Eastern Mediterranean Region, 2016\u20132023"],"prefix":"10.4102","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1319-8434","authenticated-orcid":false,"given":"Fausta S.","family":"Mosha","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01h4ywk72","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization Regional Office for the Eastern Mediterranean"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0401-6603","authenticated-orcid":false,"given":"Rana","family":"Hajjeh","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01h4ywk72","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization Regional Office for the Eastern Mediterranean"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2856-345X","authenticated-orcid":false,"given":"Rachel","family":"Ochola","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01h4ywk72","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization Regional Office for the Eastern Mediterranean"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5382-5782","authenticated-orcid":false,"given":"Amany","family":"Ghoniem","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01h4ywk72","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization Regional Office for the Eastern Mediterranean"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1110-6794","authenticated-orcid":false,"given":"Yvan J.-F.","family":"Hutin","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01h4ywk72","id-type":"ROR","asserted-by":"publisher"}],"name":"World Health Organization Regional Office for the Eastern Mediterranean"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Fleming KA, Horton S, Wilson ML, et al. The Lancet Commission on diagnostics: Transforming access to diagnostics. Lancet. 2021;398(10315):1997\u20132050. https:\/\/doi.org\/10.1016\/S0140-6736(21)00673-5","DOI":"10.1016\/S0140-6736(21)00673-5"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Cornish NE, Anderson NL, Arambula DG, et al. Clinical laboratory biosafety gaps: Lessons learned from past outbreaks reveal a path to a safer future. Clin Microbiol Rev. 2021;34(3):e0012618. https:\/\/doi.org\/10.1128\/CMR.00126-18","DOI":"10.1128\/CMR.00126-18"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Ndihokubwayo J-B, Maruta T, Ndlovu N, et al. Implementation of thwe World Health Organization Regional Office for Africa stepwise laboratory quality improvement process towards accreditation. Afr J Lab Med. 2016;5(1):280. https:\/\/doi.org\/10.4102\/ajlm.v5i1","DOI":"10.4102\/ajlm.v5i1.280"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Peeling RW. Diagnostics in a digital age: An opportunity to strengthen health systems and improve health outcomes. Int Health. 2015;7:384\u2013389. https:\/\/doi.org\/10.1093\/inthealth\/ihv062","DOI":"10.1093\/inthealth\/ihv062"},{"key":"ref4","unstructured":"World Health Organization. International Health Regulations (2005) [homepage on the Internet]. 3rd ed. 2016 [cited 2023 Nov 20]. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789241580496"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Gostin LO, Katz R. The international health regulations: The Governing framework for global health security. Milbank Q. 2016;94(2):264\u2013313. https:\/\/doi.org\/10.1111\/1468-0009.12186","DOI":"10.1111\/1468-0009.12186"},{"key":"ref6","unstructured":"World Health Organization. Regional Office for the Eastern Mediterranean Communicable diseases in the Eastern Mediterranean Region. Prevention and control 2005\u20132009. Cairo: WHO; 2011."},{"key":"ref7","unstructured":"World Health Organization. Regional Office for the Eastern Mediterranean Communicable Diseases in Eastern Mediterranean Region: Prevention and control 2010\u20132011 report. Cairo: WHO; 2012."},{"key":"ref8","unstructured":"World Health Organization. First WHO model list of essential in-vitro diagnostics [homepage on the Internet]. 2019 [cited 2023 Nov 20]. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789241210263"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Nkengasong JN, Yao K, Onyebujoh P. Laboratory medicine in low-income and middle-income countries: Progress and challenges. Lancet. 2018;391(10133):1873\u20131875. https:\/\/doi.org\/10.1016\/S0140-6736(18)30308-8","DOI":"10.1016\/S0140-6736(18)30308-8"},{"key":"ref10","unstructured":"Mosha F, Oundo J, Mukanga D, Njenga K, Nsubuga P. Public health laboratory systems development in East Africa through training in laboratory management and field epidemiology. Pan Afr Med J. 2011;10(Suppl 1):14."},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Masanza MM, Nqobile N, Mukanga, Gitta SN. Laboratory capacity building for the International Health Regulations (IHR [2005]) in resource-poor countries: The experience of the African Field Epidemiology Network (AFENET). BMC Public Health. 2010;10(Suppl 1):S8. https:\/\/doi.org\/10.1186\/1471-2458-10-S1-S8","DOI":"10.1186\/1471-2458-10-S1-S8"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Nkengasong JN, Mesele T, Orloff S, et al. Critical role of developing national strategic plans as a guide to strengthen Laboratory health systems in resource-poor settings. Am J Clin Pathol. 2009;131(6):852\u2013857. https:\/\/doi.org\/10.1309\/AJCPC51BLOBBPAKC","DOI":"10.1309\/AJCPC51BLOBBPAKC"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Ondoa P, Van der Broek A, Jansen C, De Bruijn H, Schultsz C. National laboratory policies and plans in sub-Saharan African countries: Gaps and opportunities. Afr J Lab Med. 2017;6(1):a578. https:\/\/doi.org\/org\/10.4102\/ajlm.v6i1.578","DOI":"10.4102\/ajlm.v6i1.578"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Strasser S, Stauber C, Shrivastava R, Riley P, O\u2019Quin K. Collective insights of public-private partnership impacts and sustainability: A qualitative analysis. PLoS One. 2021;16(7):e0254495. https:\/\/doi.org\/10.1371\/journal.pone.0254495","DOI":"10.1371\/journal.pone.0254495"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Shrivastava R, Fonjungo PN, Kebede Y, et al. Role of public-private partnerships in achieving UNAIDS HIV treatment targets. BMC Health Serv Res. 2019;19(1):46. https:\/\/doi.org\/10.1186\/s12913-018-3744-z","DOI":"10.1186\/s12913-018-3744-z"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Nkengasong JN, Mbopi-Keou F-X, Peeling RW, et al. Laboratory medicine in Africa since 2008: Then, now, and the future. Lancet Infect Dis. 2018;18(11):e362\u2013e367. https:\/\/doi.org\/10.1016\/S1473-3099(18)30120-8","DOI":"10.1016\/S1473-3099(18)30120-8"},{"key":"ref17","unstructured":"World Health Organization. Regional Office for the Eastern Mediterranean. Strategic framework for strengthening health laboratory services 2016\u20132020 [homepage on the Internet]. 2017 [cited 2023 Nov 20]. Available from: https:\/\/applications.emro.who.int\/dsaf\/EMROPUB_2017_EN_19612.pdf"},{"key":"ref18","unstructured":"World Health Organization. Regional Committee for the Eastern Mediterranean, Sixty-third session [homepage on the Internet]. EM\/RC63\/R. 2016 [cited 2023 Sep 22]. Available from: www.WHO.int\/iris\/bitstream\/handle\/10665\/259657\/RC63_Resolutions_2016_R4_19123_EN.pdf"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Meredith LW, Aboualy M, Ochola R, Ozel M, Abubakar A, Barakat A. A phase strengthening of laboratory capacity in the Eastern Mediterranean Region during the COVID-19 pandemic. Influenza Other Respir Viruses. 2024;18(2):e13225. https:\/\/doi.org\/10.1111\/irv.13225","DOI":"10.1111\/irv.13225"},{"key":"ref20","unstructured":"World Health Organization. Regional Office for the Eastern Mediterranean. Summary report on the Fourth intercountry meeting of the directors of public health laboratories in the Eastern Mediterranean Region [homepage on the Internet]. Cairo, Egypt 5\u20137 December 2022. [cited 2023 Sep 22]. Available from: https:\/\/applications.emro.who.int\/docs\/WHOEMLAB395E-eng.pdf"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"World Health Organization. Technical working group consultation on strengthening health laboratory services in the Eastern Mediterranean Region. East Mediterr Health J. 2024;30(1):77\u201378. https:\/\/doi.org\/10.26719\/2024.30.1.77","DOI":"10.26719\/2024.30.1.77"},{"key":"ref22","unstructured":"World Health Organization. Regional Office for the Eastern Mediterranean. Summary report on Meeting of the directors of national laboratory services and partners in the Eastern Mediterranean Region [homepage on the Internet]. Cairo. Egypt 14\u201316 August 2023. [cited 2023 Sep 22]. Available from: https:\/\/applications.emro.who.int\/docs\/WHOEMLAB397E-eng.pdf"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Mulderij-Jansen V, Gerstenbluth I, Duits A, Tami A, Bailey A. Evaluating and strengthening the health system of Cura\u04abao to improve its performance for future outbreaks of vector-borne diseases. Parasit Vectors. 2021;14(1):500. https:\/\/doi.org\/10.1186\/s13071-021-05011","DOI":"10.1186\/s13071-021-05011-x"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Alemnji GA, Zeh C, Yao K, Fonjungo PN. Strengthening national health laboratories in sub-Saharan Africa: A decade of remarkable progress. Trop Med Int Health. 2014;19(4):450\u2013458. https:\/\/doi.org\/10.1111\/tmi.12269","DOI":"10.1111\/tmi.12269"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Alemnji G, Mosha F, Maggiore P, Alexander H, Ndlovu N, Kebede Y et al. Building Integrated Testing Programs for Infectious Diseases. The Journal of Infectious Diseases. published online 12 April 2023.","DOI":"10.1093\/infdis\/jiad103"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Fonjungo PN, Alemnji GA, Kebede Y, et al. Combatting global infectious diseases: A network effect of specimen referral systems. Clin Infect Dis. 2017;64(6):796\u2013803. https:\/\/doi.org\/10.1093\/cid\/ciw817","DOI":"10.1093\/cid\/ciw817"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"GBD Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;399(10341):2129\u20132154. https:\/\/doi.org\/10.1016\/S0140-6736(22)00532-3","DOI":"10.1016\/S0140-6736(22)00532-3"}],"container-title":["African Journal of Laboratory Medicine"],"original-title":[],"link":[{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/viewFile\/2611\/3119","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/viewFile\/2611\/3120","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/viewFile\/2611\/3121","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/viewFile\/2611\/3122","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/view\/2611\/3122","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T07:25:47Z","timestamp":1757489147000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajlmonline.org\/index.php\/ajlm\/article\/view\/2611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,30]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/ajlm.v14i1.2611","relation":{},"ISSN":["2225-2002","2225-2010"],"issn-type":[{"value":"2225-2002","type":"print"},{"value":"2225-2010","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,30]]},"article-number":"a2611"}}