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WHO
Collaborative Programme
Health
Laboratory Support and Health Technologies
Back
Situational
Analysis:
The Directorate of Public Health Laboratories (the Central Public Health Laboratory (CPHL)) is headed by a medical director appointed late 1996. This directorate is responsible for the sanitary control of water and food, control of efficacy and safety of drugs, and diagnostis and control of communicable diseases. It is also responsible for proposing regulations related to laboratory services. There are 174 private laboratories registered in Lebanon including private hospital laboratories.
Three working departments exist within the CPHL: Microbiology, Chemistry, Virology; the two remaining pathology department and blood bank department have not been operational for the past 25 years. The rehabilitation process of the CPHL began by appointing the new medical director, reactivation of the exiting working departments, and preparing a global strategy for laboratory services in the country.
CPHL collaborates with the MPH Directorate of Preventive Care for sanitary control of water and food. In addition they are working together on the study of food poisoning and water pollution related cases which are reported from hospitals or health centers.
Other public administrations involved in the work include:
- Ministry of Commerce, in joint surveillance programs of bakeries
- Ministry of Agriculture, in joint surveillance program of zoonosis
- Ministry of Water and Hydraulic Resources, in water analysis of wells
- Ministry of Administrative Reform, in computerization of the laboratory
- LIBNOR, in revision of norms related to food products and water.
Since 1997 WHO has coordinated with the CPHL on several activities to improve the quality of analysis and services. Training sessions were done on water and food analysis. In 1998 a WHO expert conducted two workshops in water chemistry, and a French expert from the French protocol conducted one workshop in water microbiology. More training is needed in water analysis for pesticides and pollutants, in food analysis one food microbiology training activity was conducted by a WHO expert in 1999. More needs to be done in food analysis.
A four months training targetted at medical laboratory technicians was conducted in collaboration with the Italians and a local university.
The French collaborated with the virology department on an audit. The department which is a national referral center for confirmatory testing of sera scored well in relation to the quality of services of HIV testing.
The Swedish provided support to the drug quality control laboratory.
There is an urgent need to develop a quality control system in all areas of the laboratory services.
In 2001 the WHO Lyon Office initiated a training program targeting senior technical laboratory staff from national public health reference laboratories. In relation to the Lyon project a WHO mission in late 2001 assessed the CPHL and the surveillance system in Lebanon. The mission's conclusions and recommendations are as follows:
1. The National surveillance system for epidemic prone diseases is lacking in human resources, transportation, and adequate training. Under reporting, timeliness and lack in data quality are the major problems. There is a need for a national plan for establishing a surveillance system in the country.
2. Food contamination and food poisoning are also an urgent problem to be settled. A close collaboration between human surveillance system and veterinary surveillance system is envisaged.
3. The laboratories at District level need to be improved in terms of equipment and capacity building to allow for a well functioning national laboratory network.
4. Improving the working conditions of laboratory staff is a prerequisite for recruiting qualified personnel.
5. Support to be provided in establishing a quality assurance programme.
6. The logbook for performed test analysis for notifiable diseases does not exist. The MOPH list of notifiable diseases should be distributed to laboratories at all levels.
7. Written protocols are still lacking in the Laboratory. It is proposed that the MOPH develop together with the directors of districts and peripheral laboratories the necessary protocols.
Blood Transfusion Safety:
The CPHL will assume the role of inspection and licensing of hospital blood banks and other blood collection, testing and processing facilities. Discussions are now being made for the review of legislation related to transfusion services, situation assessment and accreditation rules and standards.
There is no local production of equipment or reagents. These are available and purchased through local agents from international firms. The manufacturer is responsible for the quality of the reagents. The reagent user is responsible for the tests performed. The government continues to pay the hospitals for contracted procedures including blood transfusions.
Non-governmental organizations and hospital-based blood banks provide blood transfusion services. Blood is mostly collected from family donors. The overall blood collection in 1996 was 95,312 blood units; of these 16,974 units were collected by the Lebanese Red Cross Blood Centers (eight centers throughout the country). The remaining 78,339 units were collected by the private sector. The existing blood donation system is still mostly dependent on family replacement (90%).
Blood collected is tested for ABO group and Rh type, as well as for any unexpected antibodies that may cause problems in the recipient. This indirect antibody test is carried out only in a few private blood banks. Routine screening tests performed on blood units collected in 1998 for HBsAg, anti-HCV, anti-HIV-1 and 2, and syphilis showed the following prevalence.
HBsAg 1.4%
Anti-HCV 0.3 %
Anti-HIV 1+2 1 case
Syphilis 4 cases
Blood transfusion services staff hold a BS in laboratory technology. The number of female staff is increasing. A blood transfusion course was held in June 1997 in the Chronic Care Center and was attended by the staff of almost all blood transfusion centers in Lebanon. This course was considered as both basic training and a continuing education program.
Internal medical audits are periodically performed in some facilities only to ensure conformity to specifications and compliance with established local transfusion practices.
Problem areas:
· There is an urgent need for the creation of a focal point in the Ministry of Public Health for quality monitoring and enforcement of regulations for blood safety
· Legislation is required to nominate a National Blood Transfusion Advisory Committee (NBTAC). The functions and composition of this committee are being submitted to the Director-General of MPH
· The National Lebanese Red Cross Blood Program which is an autonomous nongovernmental organization must develop its own budget in order to maintain continuity and sustainability of its operations, which is based on a not-for-profit cost-recovery system, and develop more donor recruitment strategy.
· A temporary executive committee for quality monitoring is required urgently to take urgent steps to submit, to the NBTAC, a revision of the existing legislation within 3 months and to use the existing legislation to review the registration of all blood collection facilities in the country, and to provide the basis of permanent office for quality monitoring in transfusion practice, blood collection and laboratory testing and processing procedures.
Finally, emphasis should be made on the following issues:
1. Blood transfusion safety and the revival of the existing department within the CPHL with different tasks mainly related to the revision of legislation and the role of control of blood transfusion services in the country.
2. Quality assurance which is still lacking for laboratory services at a national level, although a coordinator was identified and given facility since 1997 but no concrete work was done in this matter.
Objective:
To strengthen the national capabilities for promoting health laboratory services and controlling the quality and efficacy of drugs and blood transfused, and biological products
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