Detection

Laboratory Systems Strengthening

Since 2007, Baylor Foundation Uganda, with funding from CDC and USAID, has been supporting the Ministry of Health to build a laboratory network with the capacity to provide diagnostic and surveillance services. Baylor Foundation Uganda uses the Strengthening Laboratory Management Towards Accreditation (SLMTA) approach to train labs to implement the Laboratory Quality Management System (LQMS) and attain international accreditation status. Baylor Foundation Uganda also supports laboratory infrastructure refurbishment and equipment procurement, laboratory equipment management through subgrants to two regional laboratory equipment workshops, supply chain management, biosafety and biosecurity, and a robust specimen referral and transportation system. The laboratory capacity-building program is implemented through training, mentorships and quality assurance in collaboration with Uganda MOH’s National Health Laboratory System (UNHLS). Through this capacity, the laboratory network is able to deliver quality results to inform clinical decisions, early detection and response to disease outbreaks.’

• Public health laboratory leadership, coordination and communication: Supported 32 districts in Rwenzori, Bunyoro and Mbale regions to implement district-specific laboratory network plans and district-led diagnostic network improvements.
• LQMS: Trained 1,394 Laboratory staff in LQMS and supported 15/21 lab hubs to attain and sustain international/ISO 15189 accreditation by the South African National Accreditation System. Additionally, one regional laboratory attained microbiology diagnostics accreditation and the Center of Excellence Laboratory at Baylor Foundation Uganda in Kampala attained and sustained the College of American Pathologists (CAP)
• Laboratory infrastructure improvements: Upgraded/refurbished 25 laboratories in 21 districts to optimize testing workflow and enhance biosafety and biosecurity.
• Capacity for the detection of priority diseases: Trained and mentored 2,231 Health care workers from 55 health facilities in 17 districts and 3 cities on COVID-19 RDT use, reporting using electronic laboratory investigation forms, supply chain management, and quality assurance. We further rolled out point of care EID/Viral load and Xpert/MTB Rif testing at 32 health facilities in 21 districts.
• Biosafety and biosecurity: Trained and mentored 394 laboratory personnel in biosafety and biosecurity, creating a pool of personnel to support the implementation of comprehensive and sustainable biosafety and biosecurity procedures and practices at the health facility level.
• Laboratory supply chain management: Trained and mentored 428 laboratory personnel in logistics management to support the purchase and management of diagnostic commodities. We are providing buffer microbiology laboratory reagents for two regional laboratories as a stop-gap measure.
• Specimen referral and transport system: Established mechanisms to ensure that specimens from over 300 health facilities (i.e. >90% of health facilities) are transported to 20 hub laboratories and two national reference laboratories.

Surveillance

Baylor Uganda works in collaboration with the Ministry of Health and other partners to strengthen surveillance systems that are able to detect events of public health significance early to facilitate a timely response. We support surveillance by providing both financial and technical resources for the development and review of national guidelines, support both national and subnational training in surveillance, and second technical staff to both the National Emergency Operation Centre (EOC) and the Department of Integrated Epidemiology, Surveillance and Public Health Emergencies (IES&PHEs) of Ministry of Health. This support is aligned to the IHR core capacity requirements for surveillance including; ensuring a functional surveillance system to identify potential events of concern for public health and health security is in place; the surveillance system is supported by electronic tools, and supporting systematic analysis of surveillance data for action.

 Integrated Disease Surveillance and Response

Since 2020, together with other stakeholders, we have provided technical assistance to the MoH to strengthen surveillance systems. We supported the development of the National Integrated Epidemiology Surveillance and Response Strategic Plan 2021-2025, adaptation and rollout of the 3^rd edition Integrated Disease Surveillance and Response (IDSR) Strategy, a framework for implementing indicator and event-based surveillance.

Event-Based Surveillance

Baylor Foundation Uganda is supporting MoH in the implementation of electronic tools in surveillance in the following ways:

• At the national level, consultants seconded to the Division of Health Information at MoH have provided technical assistance in the development of a Centralised Surveillance Data Warehouse, which is increasing access to available data for analysis, visualisation and use to inform epidemic intelligence;
• Provided capacity building in the implementation of electronic tools for surveillance, including DHIS2, electronic laboratory information system, electronic IDSR and GoData; and
• Supported MoH in development of an event management system.

Sentinel Surveillance

Baylor Foundation Uganda is championing the routine analysis and utilization of data for action including monitoring, evaluating, and improving policies, programs, and services and facilitating the better allocation of resources.

• At the national level, the epidemiologists seconded to the IES&PHEs produce weekly epidemiological reports; the National EOC also produces dashboards and disseminates situation reports of events and ongoing outbreaks.
• The national and regional EOCs produce analyses and disseminate epidemiologic interpretations of all major events at all levels.
• Through the routine analysis of surveillance data at both national and regional levels, the epidemiologists were able to identify bottlenecks to both timeliness and completeness of reporting in Rwenzori, Bunyoro, and Kampala Capital City Authority. The implementation of targeted mentorships has since improved completeness in the three regions to the national target of 80%.

Achievements

• Supported 3^rd edition IDSR adaptation and development of the Integrated Epidemiology, Surveillance and Response Strategic Plan 2021 – 2025.
• Provided technical support in IDSR rollout of in 48/148 districts in 6 Regions (Karamoja, Lango, North Central, West Nile, Rwenzori and Bunyoro) of the country.
• Provided direct support to IDSR rollout in 17 districts and 2 cities in Rwenzori and Bunyoro Regions where 100 IDSR district-based mentors/trainers; 184 health facilities and 600 health workers have been trained.
• Provided technical assistance to MoH in the development of protocols for Acute Febrile Illnesses (AFI) and Severe Acute Respiratory Illness (SARI) Influenza Like Illness (ILI) surveillance, including COVID-19 genomic sequencing and Pan Respiratory Disease Surveillance (PRDS). AFI implementation has begun in Jinja Regional Referral Hospital, while SARI/ILI/COVID19/PRDS protocol is currently under review and approval.
• Developed one health event-based surveillance technical documents (one health priority list, signal list, Event-Based Surveillance (EBS) manual and M&E plan), which are under approval by MoH.
• Developed of one-health EBS training curriculum for national, district, sub-county, facility and community level, under approval by MoH.
• Supported national one health EBS training of trainers, where 56 national trainers were trained.
• Spearheaded development and piloting of the Regional EOC-led one health EBS implementation in Kabarole District and Fort portal City in Rwenzori Region, where:
  1. 22 district based one-health trainers/mentors have been trained in Fort Portal and Kabarole;
  2. 138 sub-county one-health EBS supervisors were trained in Fort Portal and Kabarole;
  3. Surveillance focal persons and Incharges from 26 facilities in Fort Port Portal and 36 in Kabarole were trained in Fort Portal and Kabarole; and
  4. 800 VHTs in Fort Portal and Kabarole were trained.

Uganda Public Health Fellowship Program – Laboratory Leadership Program

Uganda Public Health Fellowship Program – Laboratory Leadership Program (UPHFP-LLP), aligned to Global Laboratory Leadership Program (GLLP) and Uganda Public Health Fellowship Program (UPHFP) structures, is a 2-year post masters fellowship program. It is implemented by Ministry of Health with support from United States Centers for Disease Control and Prevention (US CDC), Association of Public Health Laboratories (APHL), Makerere University School of Public Health (MakSPH) and Baylor College of Medicine Children’s Foundation Uganda (Baylor Uganda). The program is housed at the Uganda National Institute of Public health (UNIPH) and is one of the six tracks at the institute. The other tracks include, Field Epidemiology, Health Informatics, Health Economics (Prevention Effectiveness), Implementation Science, and Monitoring and Evaluation. Currently, it’s Field Epidemiology, Laboratory Leadership and Health Informatics tracks that are fully functional. The UPHFP-LLP aims at developing competent workforce of laboratory leaders able to build and sustain the national laboratory system that effectively and efficiently respond to human, animal, and environmental health challenges in Uganda.

Objectives

1. To build laboratory workforce capacity in the laboratory skills and knowledge to detect and contain public health emergencies in the communities.
2. To establish competent laboratory leaders that can ensure quality laboratory services in response to emerging and re-emerging diseases in Humans, animals and Environmen
3. To produce quality laboratory and field data to guide disease control, planning and policy.

Core competencies for UPHFP-LLP

Deliverables for UPHFP-LLP