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Evaluation of PEPFAR, a review of the past four years of PEPFAR progress, was released Feb. 20th. Evaluation of PEPFAR, a review of the past four years of PEPFAR progress, was released Feb. 20th. UNAIDS

The PEPFAR Perspective on Laboratory Infrastructure

Effective health laboratories are essential to the scale-up of public health programs targeting diseases like HIV/AIDS or TB, and contribute to the overall coverage and efficiency of national health systems.  In its four-year review, published last month, the President’s Emergency Plan for AIDS Relief (PEPFAR) evaluated its progress in confronting AIDS worldwide, including its efforts to strengthen laboratory systems through training and infrastructure.

PEPFAR was established in 2003 as a major global health initiative of the US Government, and has since partnered with 31 low to middle-income countries worldwide, including Guyana and Haiti, where USAID’s Improving Health Facility Infrastructure (IHFI) project has helped to implement PEPFAR programs.  

The scope of the PEPFAR initiative is multi-faceted and addresses a wide range of issues critical to tackling the AIDS epidemic, including: prevention, counseling, antiretroviral therapy, training and laboratory capacity.  Laboratories in particular play a fundamental role in treatment and patient monitoring, and a lack of proper laboratory expertise, equipment and supporting infrastructure is a major barrier to the scale-up of public health services.

Thus PEPFAR has placed an emphasis on strengthening laboratory capacity to carry out HIV testing and patient monitoring by providing the specialized equipment and laboratory technician training necessary to quickly ramp up the coverage of HIV programs.  These investments in equipment have been coupled with laboratory infrastructure improvements like the backup power and voltage regulation systems that the IHFI project has been implementing in Haiti and Guyana.

The effect of this initiative is demonstrated by the following chart, which shows indicators for PEPFAR’s laboratory activities over this initial scale-up phase.

 

indicator chart

Graph of PEPFAR’s laboratory strengthening indicators. (Image: Evaluation of PEPFAR, Institute of Medicine of the National Academies)

 

While this strategy has proven effective at expanding coverage and offering improved services to people living with HIV, PEPFAR has broadened its approach to laboratory development in recent years.  Rather than rapid capacity and coverage scale-up, PEPFAR is now focusing on the long-term sustainability of public health programs.  This shift has led to a greater focus on national leadership and priority setting, institutional coordination, accreditation, quality assurance, equipment maintenance and training, in addition to a continued commitment to infrastructure improvement.

IHFI has taken a lead in promoting infrastructure sustainability in laboratories and hospitals.  In Haiti, IHFI has trained over 80 hospital facility technicians in the maintenance of energy infrastructure like batteries, inverters and generators.  Program sustainability also requires good administrative support, so IHFI has developed a training program for hospital administrators on the importance of energy systems, technician responsibilities and budgeting for maintenance.  Furthermore, IHFI is working with Haiti’s Ministry of Health and Population to strengthen communication between the Ministry and hospital administrators.

Progress in laboratory capacity and infrastructure has been impressive, but as the PEPFAR evaluation points out, many challenges still exist.  Equipment maintenance is still an issue for many resource-poor laboratories, and much of the advancement made so far has been centered in urban areas, as rural areas face issues of power supply, transportation and worker retention.

This challenge is clear in Guyana, where remote populations must travel long distances over difficult terrain to reach large health facilities.  IHFI is installing small photovoltaic and battery systems in a number of rural health outposts in Guyana.  These systems will support basic laboratory loads, like microscopes, as well as cold chain refrigeration.  While this infrastructure extends the reach of public health services, advanced laboratory capabilities are still limited to urban centers.

As PEPFAR shifts focus towards sustainability and capacity building, through training and maintenance, the IHFI project is applying a similar approach to energy infrastructure.  PEPFAR’s progress to date has shown that health laboratories are essential not only to HIV programs, but to all manner of public health services.  As energy infrastructure, backup and power quality systems, support all other laboratory initiatives, it will be critical to ensure the quality and reliability of those systems in the long run.

Download Evaluation of PEPFAR for free on the Institute of Medicine of the National Academies website.

While this strategy has proven effective at expanding coverage and offering improved services to people living with HIV, PEPFAR has broadened its approach to laboratory development in recent years.  Rather than rapid capacity and coverage scale-up, PEPFAR is now focusing on the long-term sustainability of public health programs.  This shift has led to a greater focus on national leadership and priority setting, institutional coordination, accreditation, quality assurance, equipment maintenance and training, in addition to a continued commitment to infrastructure improvement.

IHFI has taken a lead in promoting infrastructure sustainability in laboratories and hospitals.  In Haiti, IHFI has trained over 80 hospital facility technicians in the maintenance energy infrastructure like batteries, inverters and generators.  Program sustainability also requires good administrative support, so IHFI has developed a training program for hospital administrators on the importance of energy systems, technician responsibilities and budgeting for maintenance.  Furthermore, IHFI is working with Haiti’s Ministry of Health and Population to strengthen communication between the Ministry and hospital administrators.

Progress in laboratory capacity and infrastructure has been impressive, but as the PEPFAR evaluation points out, many challenges still exist.  Equipment maintenance is still an issue for many resource-poor laboratories, and much of the advancement made so far has been centered in urban areas, as rural areas face issues of power supply, transportation and worker retention.

This challenge is clear in Guyana, where remote populations must travel long distances over difficult terrain to reach large health facilities.  IHFI is installing small photovoltaic and battery systems in a number of rural health outposts in Guyana.  These systems will support basic laboratory loads, like microscopes, as well as cold chain refrigeration.  While this infrastructure extends the reach of public health services, advanced laboratory capabilities are still limited to urban centers.

As PEPFAR shifts focus towards sustainability and capacity building, through training and maintenance, the IHFI project is applying a similar approach to energy infrastructure.  PEPFAR’s progress to date has shown that health laboratories are essential not only to HIV programs, but to all manner of public health services.  As energy infrastructure, backup and power quality systems, support all other laboratory initiatives, it will be critical to ensure the quality and reliability of those systems in the long run.

Download Evaluation of PEPFAR for free on the Institute of Medicine of the National Academies website.

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