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National Strategic Plan for Medical Laboratory Services 2010-2015

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NATIONAL STRATEGIC PLANNATIONAL STRATEGIC PLANNATIONAL STRATEGIC PLANNATIONAL STRATEGIC PLAN

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MEDICALMEDICALMEDICALMEDICAL LABORATORY SERVICES LABORATORY SERVICES LABORATORY SERVICES LABORATORY SERVICES

2010 2010 2010 2010 ---- 2015201520152015

Ministry of Health Ministry of Health Ministry of Health Ministry of Health

DeparDeparDeparDepartment of Hospital Services in collaboration tment of Hospital Services in collaboration tment of Hospital Services in collaboration tment of Hospital Services in collaboration with with with with World Health OrganizationWorld Health OrganizationWorld Health OrganizationWorld Health Organization

February February February February 2010201020102010


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TABLE OF CONTENTS

ABBREVIATION..................................................................................................................... 2 PREFACE................................................................................................................................ 3 1: Introduction to the Strategic Plan....................................................................................... 4

1.1 Purpose...................................................................................................................... 4 1.2 Objectives.................................................................................................................. 4 1.3 Organization .............................................................................................................. 4

2: Organization and Management of the MedicLaboratory..................................................... 5 Services..................................................................................................................................... 5

2.1 Strategic objective...................................................................................................... 5 2.2 Planned activities ....................................................................................................... 5

3: Laboratory Services at Health Facility Level.................................................................. 7 3.1 Strategic objective...................................................................................................... 7 3.2 Planned activities ....................................................................................................... 7

4: Human Resources Management and Development....................................................... 10 4.1 Strategic objective.................................................................................................... 10 4.2 Planned activities ..................................................................................................... 10

5: Laboratory Equipment and Equipment Maintenance....................................................13 5.1 Strategic objective.................................................................................................... 13 5.2 Planned activities ..................................................................................................... 13

6: Laboratory Commodity Supply and Distribution System ............................................ 15 6.1 Strategic objective.................................................................................................... 15 6.2 Planned activities ..................................................................................................... 15

7: Laboratory Quality Management System ..................................................................... 17 7.1 Strategic objective.................................................................................................... 17 7.2 Planned activities ..................................................................................................... 17

8: Laboratory Management Information System .............................................................. 19 8.1 Strategic objective.................................................................................................... 19 8.2 Planned activities ..................................................................................................... 19

9: Monitoring and Evaluation of the Medical Laboratory Services ................................... 21 9.1 Strategic objective.................................................................................................... 21 9.2 Planned activities ..................................................................................................... 21

10: Financing and Sustainability of the Medical Laboratory Services................................ 23 10.1 Strategic objective.................................................................................................... 23 10.2 Planned activities ..................................................................................................... 23

11: Laboratory Legal and Regulatory Framework .............................................................. 24 11.1 Strategic objective.................................................................................................... 24 11.2 Planned activities ..................................................................................................... 24

ACKNOWLEDGEMENTS..................................................................................................... 25

TABLE OF CONTENTSTABLE OF CONTENTSTABLE OF CONTENTSTABLE OF CONTENTS


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ABBREVIATION CPA Complementary Package of Activities DHS Department of Hospital Services EQAS External Quality Assessment Scheme MOH Ministry of Health MPA Minimum Package of Activities NEQAS National External Quality Assessment Scheme NBTC National Blood Transfusion Centre NIPH National Institute of Public Health NSP National Strategic Plan NWT National Workshop Team OD Operational District RH Referral Hospital SOP Standard Operating Procedure Sub TWG Sub-Technical Working Group US-CDC United State of Centers for Disease Control and Prevention WHO World Health Organization

ABRAVIATIONSABRAVIATIONSABRAVIATIONSABRAVIATIONS


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PREFACE This National Strategic Plan for the Medical Laboratory Services of Cambodia has been prepared to facilitate the provision of the quality of laboratory services in the country. The document provides appropriates testing for each level of the services. In addition, the National Strategic plan promotes better coordination of activities among the various health programs and institutions, thereby improving quality and communication between all laboratories. The National Strategic Plan systematically outlines the major issues to be addressed in order to provide the quality of laboratory services, including the organization and management structure, human resources, laboratory infrastructure, care and maintenance of equipment, provision of laboratory commodities, and functional information management system. In particular, the National Strategic Plan develops the laboratory network to facilitate the channeling of resources to national priority areas. The National Strategic Plan provides the needed framework for coordinated delivery of quality and accessible laboratory services country-wide. The national laboratory policy developed at the end of 2009. Refer to this policy, the strategic plan have been established. The development of a National Laboratory Strategic Plan is a critical part of the process to improve clinical care. The main objectives of the National Strategic Plan are administrative and technical management structures, provision of standardised quality laboratory services, Laboratory support systems, Laboratory quality management systems, Human resources capacity, Monitor and evaluation systems and Legal and regulatory framework. The MoH strongly support the implementation of this strategic plan in cooperation with all relevant partners. The key challenge to all partners is that the proposed recommendations and arrangements are implemented so that the Cambodian people can benefit through improved laboratory services at all levels. The Ministry of Health hopes that the strategic plan will orient to enhance laboratory quality and to provide laboratory support. The development of this strategy was consulted with many stakeholders and has relied heavily on the input and contributions from members of Sub-technical Working Group for Blood Safety and Laboratory Services. I wish to acknowledge the invaluable support and contribution of the following organizations: DHS, NIPH, NBTC, WHO, US-CDC, Merieux Foundation, who provided both technical and financial support in the development and finalization of this strategy document. I wish, therefore, to appeal to all stakeholders to identify with this strategy and give it the necessary support.

Phnom Penh, 17 February, 2010

Prof. ENG HUOT Secretary of State

PREFACEPREFACEPREFACEPREFACE


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1: Introduction to the Strategic Plan

1.1 Purpose The laboratory plays a crucial role in the diagnosis, care and treatment of patients, in the surveillance of diseases of public health importance and in determining the response to disease outbreaks. The National Strategic Plan for the Medical Laboratory Services of Cambodia 2010 – 2015 has been developed to provide a structure for implementing priority activities for building laboratory capacity mandated in the National Policy for the Medical Laboratory Services of Cambodia. The purpose of the National Strategic Plan is to ensure the delivery of effective, efficient, accessible, equitable and affordable quality laboratory services to the people of Cambodia.

1.2 Objectives The objectives of the Strategic Plan are to reorganize and strengthen:

1. Administrative and technical management structures of the Medical Laboratory Services 2. Provision of standardised quality laboratory services throughout the country 3. Laboratory support systems 4. Laboratory quality management systems 5. Human resources capacity 6. Monitoring and evaluation systems 7. Legal and regulatory framework.

1.3 Organization The National Strategic Plan for the Medical Laboratory Services of Cambodia details priority interventions required to address the following areas of the National Policy:

1. Organization and Management of the Medical Laboratory Services 2. Laboratory Services at Health Facility Level 3. Laboratory Legal and Regulatory Framework 4. Human Resources Management and Development 5. Laboratory Equipment and Equipment Maintenance 6. Laboratory Commodity Supply and Distribution 7. Laboratory Management Information System 8. Laboratory Quality Management Systems 9. Monitoring and evaluation of the Medical Laboratory Services 10. Financing and Sustainability of the Medical Laboratory Services.

1:1:1:1: Introduction to the Introduction to the Introduction to the Introduction to the NNNNational ational ational ational Strategic PlanStrategic PlanStrategic PlanStrategic Plan


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2: Organization and Management of the MedicLaboratory

Services

2.1 Strategic objective Reorganise and strengthen the administrative and technical management structures of the Medical Laboratory Services of Cambodia.

2.2 Planned activities 2.2.1 Provide support to the Bureau of Medical Laboratory Services within the Department of

Hospital Services, Ministry of Health: a. Provide adequate resources for the activities of the Bureau. b. Provide appropriate management training.

2.2.2 The National Public Health Laboratory in the National Institute of Public Health should

be strengthened to provide the needed support to laboratory services country-wide. 2.2.3 Strengthen the Sub-Technical Working Group for Blood Safety and Laboratory Services:

a. Convene ad hoc meetings with relevant technical experts to as required, advice the Sub-Technical Working Group and the two Working Groups on specific technical matters arising from the implementation of the Strategic Plan.

b. Ensure technical representation from the sub TWG for blood safety and laboratory services on the quality improvement bureau.

2:2:2:2: Organization and Management of the Medical Organization and Management of the Medical Organization and Management of the Medical Organization and Management of the Medical

Laboratory ServicesLaboratory ServicesLaboratory ServicesLaboratory Services


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Main Indicators (2)

Baseline

Target level Data

Source

No

Description

(2009) 2010 2011 2012 2013 2014 2015

1

All staff of the lab bureau received

management training

0

All staff

Lab

bureau

2

Number meeting of sub TWG for blood

safety and lab services meetings per year

4

Bimonthly

6

6

6

6

6

Lab

bureau

3

Number of meeting of TWG for blood

safety and medical services laboratory

11

Bimonthly

6

6

6

6

6

Lab

bureau


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3: Laboratory Services at Health Facility Level

3.1 Strategic objective Strengthen provision of standardized quality laboratory services in Cambodia to support clinical services, disease surveillance and response to disease outbreaks.

3.2 Planned activities 3.2.1 Develop a system for assessing the status of national laboratory services:

a. Review and revise existing assessment tools to develop a standard assessment checklist for data collection on laboratory infrastructure, types and numbers of tests performed, equipment status and personnel at each facility.

b. Apply the standard assessment checklist on a regular basis to all laboratories in the country and analyse the reports.

c. Develop an implementation plan for laboratory physical infrastructure rehabilitation , laboratory staff and equipment.

3.2.2 Strengthen diagnostic support to clinical services:

a. Revise essential integrated laboratory test packages to define minimum lab services at every level of health care delivery and integrate into MPA and CPA guidelines.

b. Create template SOP, collect and compile key Standard Operating Procedures for techniques performed in hematology, biochemistry, serology-immunology and microbiology.

c. Ensure Standard Operating Procedures are available in all laboratories. 3.2.3 Strengthen laboratory support for disease surveillance and outbreak:

a. Create five regional to support disease surveillance and response to outbreaks by strengthening selected Referral Hospital laboratories.

b. Establish sample collection and specimen shipment system. c. Develop national guidelines for specimen collection and shipment.

3:3:3:3: Laboratory Services at Health Facility LevelLaboratory Services at Health Facility LevelLaboratory Services at Health Facility LevelLaboratory Services at Health Facility Level


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Main Indicators (3)

Baseline

Target level Sources

No

Description

(2009) 2010 2011 2012 2013 2014 2015

1

Equipment, staff and test performed at

every lab assessed using a standard

checklist

0

yes

yes

yes

yes

yes

yes

Lab

bureau/Report

each lab

2

National plan developed to address

gaps in staff and equipment at every

levels of lab services in Cambodia

0

Draft

Final

plan

Review

plan

Lab bureau

3

Number of integrated labs in

provincial hospitals that effectively

meet the standard in term of staff and

equipment

Unknown

15 Pro

Hosp


9

4

Number of integrated labs in OD RH

that effectively meet the standard in

term of staff equipment

Unknown

2

2

2

2

2

12RHs

5

Key template SOPs for biochemistry,

haematology, sero-immunology and

microbiology are created.

0

All key

SOP

compiled

Key

SOP

revised

Lab bureau

6

Number of regional microbiology labs

effectively supporting outbreak

response

0

1 Kg.

Cham

3 (Kg.

Cham +

Takeo +

BTB)

5 (other

two to be

decided)


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4: Human Resources Management and Development

4.1 Strategic objective Strengthen human capacity development to support quality diagnostic laboratory services.

4.2 Planned activities 4.2.1 Monitor laboratory staffing norms and manpower requirements at all health facility

levels: a. Assess current staffing needs with respect to workload. b. Conduct a job and task analysis and develop Job Descriptions for all laboratory staff. c. Develop plans to ensure availability of adequate and competent laboratory personnel (see

activity 3.2.1). 4.2.2 Strengthen pre-service training of medical laboratory technologists to ensure trained staff

meet the needs of the national laboratory services: a. Establish a system of regular review of laboratory training curricula to meet evolving

needs of medical laboratory technologists. b. Train tutors to ensure competent instruction in medical laboratory training schools c. Increase the number of students in medical laboratory technology training. d. Ensure training schools are adequately supplied with equipment, chemicals and reagents,

and health learning material. e. Develop bachelors and masters degree courses in medical laboratory technology. f. Establish a system for accreditation of laboratory training institutions, including review

of curricula and examinations.

4.2.3 Strengthen in service training for medical laboratory staff and tutors: a. Establish, collect and compile training packages for in service training in hematology,

sero-immunology, biochemistry, microbiology and bio-safety; b. Establish a course in Microbiology at the National Institute of Public Health; c. Establish training packages on laboratory management for laboratory managers and

supervisors; d. Provide further training overseas for selected senior laboratory staff; e. Monitor and evaluate the in service training conducted for each specialty.

4.2.4 Establish an effective support supervisory system:

a. Develop Terms of Reference of the National Laboratory Supervision Team from NIPH, of the National Programs lab supervision teams and of the Provincial Laboratory Supervision Teams (the membership of the provincial lab supervision team should include the head of provincial hospital laboratory).

b. Develop integrated supervisory tools and methods for evaluating laboratory services, including delivery of quality services, personnel, record keeping and problem solving.

c. Ensure on-site mentorship is included in support supervisory activities. d. Review supervisors' job responsibilities and establish a clear supervisory chain of

command.

4:4:4:4: Human Resources Management and DevelopmentHuman Resources Management and DevelopmentHuman Resources Management and DevelopmentHuman Resources Management and Development


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Main Indicators (4)

Base line Target level Funding Sources

No

Description

(2009) 2010 2011 2012 2013 2014 2015

1

Number of labs in RHs where at

least one staff have been trained on

lab management : National level,

CPA3, CPA2, CPA1

Unknown

National

level +

CPA3

CPA2

CPA2

CPA1

CPA1

100%

70%

50%

2

The number of :

-new Medical Laboratory

Technologist and

-new Clinical Pathologist trained

properly per year (preserves training)

Unknown

-60 -10

-120

-20

-120

-20

-120

-20

-120

-20

-120

-20

3

The number of in service training

sessions conducted countrywide

(techniques in haematology, sero-

Unknown

At least

one

training

At least

one

training

At least

one

training

At least

one

training

At least

one

training

At least

one

training


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immunology, biochemistry and

microbiology as well as bio-safety)

for each

specialty

for each

specialty

for each

specialty

for each

specialty

for each

specialty

for each

specialty

4

Number (and %) of CPA 2 and

CPA3 laboratories supervised at

least once a year

Unknown

25%

50%

all

all

all


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5: Laboratory Equipment and Equipment Maintenance

5.1 Strategic objective Ensure availability of functional essential standard equipment in all health facilities.

5.2 Planned activities 5.2.1 Develop a system for coordinating equipment requirements in the country:

a. With the support of the working group for lab, develop and review if needed a standard list of necessary lab equipment at each level of laboratory services;

b. Strengthen mechanisms to ensure effective procurement of appropriate standard lab equipment,

c. Ensure adequate distribution of essential standard equipment. 5.2.2 Improve care and user maintenance of laboratory equipment:

a. Include equipment care and user maintenance in basic laboratory technologist training courses (need advice from Human Resource Development).

b. Include equipment care and user maintenance in all refresher training courses for laboratory technologists.

c. Prepare and provide Standard Operating Procedures on basic Care and Maintenance of Laboratory Equipment.

d. Ensure laboratories have basic items for care of equipment, e.g. covers for microscopes, voltage stabilisers.

e. Ensure all new equipment will be purchased together with maintenance contract. f. Develop a standard biannual report on the status of existing lab equipment for each level

of laboratory services to the lab bureau. 5.2.3 Strengthen the National Workshop Team (NWT) in the Ministry of Health:

a. Provide adequate resources for the activities of the NWT including trained staff, service equipment and spare parts.

b. Ensure adequate funds for regular visits to hospitals for equipment maintenance and calibration.

5:5:5:5: Laboratory ELaboratory ELaboratory ELaboratory Eqqqquipment and Equipment uipment and Equipment uipment and Equipment uipment and Equipment

MaiMaiMaiMainnnntenancetenancetenancetenance


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Main Indicators (5)


No

Description

(2009) 2010 2011 2012 2013 2014 2015

1

Number of NWT visits to the CPA3

(Equipment maintenance)

Unknown

Twice

Twice

Twice

Twice

Twice

Twice

2

Number of labs that have any broken

equipment without fixing (more than 1

months)

Unknown

15% less

10% less

from the

previous

year

10% less

from the

previous

year

10% less

from the

previous

year

10% less

from the

previous

year

10% less

from the

previous

year


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6: Laboratory Commodity Supply and Distribution System

6.1 Strategic objective Ensure availability of essential quality reagents, chemicals and consumables in all health facilities.

6.2 Planned activities 6.2.1 Validate performance of the tests and reagents to be used at all level of laboratory services

a. Develop guideline for testing and validating tests and reagents. b. Ensure that institutions in charge of test validation comply with existing guideline.

6.2.2 Develop a system for strengthening and coordinating supply requirements in the country:

a. Revise the standard lists of essential supplies of reagents and consumables for every health facility level using information from all stake holders and national programmes.

b. Advise the Central Medical Stores on essential supply requirements for the country. c. Establish an electronic link between the Central Medical Stores and the Medical

Laboratory Services Bureau. d. Base annual requirements for laboratory supplies on laboratory workload (lab report and

request). 6.2.3 Strengthen supplies management in hospitals:

a. Train Laboratory Managers in planning, supplies management and logistics. b. Train Laboratory Managers in rational use of laboratory supplies.

6:6:6:6: Laboratory CoLaboratory CoLaboratory CoLaboratory Commodity Supply and Distribution mmodity Supply and Distribution mmodity Supply and Distribution mmodity Supply and Distribution

SystemSystemSystemSystem


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Main Indicators (6)

Base line Target level Sources

No

Description

(2009)

2010 2011 2012 2013 2014 2015

1

Percentage of tests and reagents

procured that have been validated

according to the guideline

50%

70%

80%

90%

Sub sub TWG

2

Percentages of reagents and

consumables that procurement unit

purchased using the recommended

reagents and commodities list

Unknown

80%

85%

90%

95%

Report from

Procurement to Lab

Bureau

3

Percentages of labs in RHs and

National Hospitals that have all

reagents and commodities available to

them in the year

Unknown

50%

60%

70%

80%

85%

90%

Analysis from Lab

bureau based on

Regular reports from

Laboratory services to

Lab bureau


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7: Laboratory Quality Management System

7.1 Strategic objective Strengthen the provision of quality laboratory services throughout Cambodia.

7.2 Planned activities 7.2.1 Ensure internal quality control procedures are implemented in laboratory activities

country wide: a. Ensure quality issues are addressed in all laboratory systems and documents e.g. SOP,

training curriculum, etc. b. Integrate internal quality control issues into existing supervision visit of national and

peripheral laboratories. 7.2.2 Develop and implement a national external quality assessment scheme (NEQAS):

a. Establish and compile national quality assessment schemes to support service and programme needs.

b. Ensure laboratories at all levels are enrolled in appropriate national or international external quality assessment schemes.

c. Use laboratory performance in EQAS to develop appropriate remedial action to improve quality, e.g. refresher training.

d. Ensure that the results of the NEQAS are disseminated on regular basis. 7.2.3 Develop and implement a national laboratory safety programme:

a. Review and update laboratory bio-safety and bio-security guideline. b. Ensure safety issues are addressed in basic training, refresher training and support

supervisory visits.

7:7:7:7: Laboratory Quality Management SystemLaboratory Quality Management SystemLaboratory Quality Management SystemLaboratory Quality Management System


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Main Indicators (7)

Base line Target level Sources

No

Description

(2009) 2010 2011 2012 2013 2014 2015

1

Percentages of supervised CPA3 and

CPA2 labs that effectively conduct

daily Internal quality control testing

for more than 50% of the procedures

during the last 3 months

Unknown

50%

60%

70%

80%

90%

Internal quality

control register

Assessed during

supervision visit

2

Percentages of labs which participate

in EQA for Biochemistry,

Hematology, Sero-Immunology.

Unknown

100%

3

Percentages of CPA3 and CPA2 labs

that practise bio-safety procedures as

described in the guideline.

Unknown

50%

60%

70%

80%

90%

supervision visit


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8: Laboratory Management Information System

8.1 Strategic objective Strengthen the laboratory reporting system to provide accurate data to generate important health information and for planning quality medical laboratory services.

8.2 Planned activities 8.2.1. Strengthen the national Laboratory Management Information System:

a. Determine the information needs of the national laboratory system. b. Develop paper based and electronic data collection tools and procedures, including

quarterly reporting formats. c. Include the laboratory management information system into the lab management training

package.

8.2.2 Strengthen the national data base at the Medical Laboratory Services Bureau: a. Provide adequate resources to manage the Laboratory Management Information System

including staff and electronic equipment. b. Ensure the computer software package is able to provide the required analysis and

generates needed reports. c. Ensure data from all national disease programs are captured in the national data base d. Ensure data is used for national laboratory planning.

8:8:8:8: Laboratory Management Information SystemLaboratory Management Information SystemLaboratory Management Information SystemLaboratory Management Information System


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Main Indicators (8)


No

Description

(2009) 2010 2011 2012 2013 2014 2015

1

Number of National and CPA3 labs

that have laboratory management

information system and transfer data

electronically

Unknown

10

15

20

25

All of

them


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9: Monitoring and Evaluation of the Medical Laboratory Services

9.1 Strategic objective Ensure an effective monitoring and evaluation system to measure performance of laboratory services.

9.2 Planned activities 9.2.1 Develop monitoring and evaluation tools to measure performance of the indicators

defined in this National Strategic Plan. 9.2.2. Conduct a mid-term and end-term review of the National Strategic Plan. 9.2.3. Establish mechanisms for addressing areas requiring support.

9:9:9:9: Monitoring and Evaluation of the Medical Monitoring and Evaluation of the Medical Monitoring and Evaluation of the Medical Monitoring and Evaluation of the Medical

Laboratory ServicesLaboratory ServicesLaboratory ServicesLaboratory Services


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Main Indicators (9)

Base line

Target level Sources

No

Description

(2009) 2010 2011 2012 2013 2014 2015

1

NSP review

Unknown

Yes

Yes

Lab Bureau


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10: Financing and Sustainability of the Medical Laboratory Services

10.1 Strategic objective Ensure adequate financial resources to promote quality laboratory services.

10.2 Planned activities 10.2.1 Develop a budget plan and funding sources to support Medical Laboratory Services and ensure active participation by laboratory managers in laboratory financial planning. 10.2.2 Advocate for increased allocation of funds to support the national laboratory services:

Develop a plan for resource mobilisation.

10:10:10:10: Financing and Sustainability of the Medical Financing and Sustainability of the Medical Financing and Sustainability of the Medical Financing and Sustainability of the Medical

Laboratory SLaboratory SLaboratory SLaboratory Serviceserviceserviceservices


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11: Laboratory Legal and Regulatory Framework

11.1 Strategic objective Strengthen the legal and regulatory framework to support national laboratory policy implementation.

11.2 Planned activities 11.2.1 Establish a regulatory body to accredit institutions and register medical laboratory professional staff.

• Establish a system for inspection and certification of laboratories. • Establish a system for certification of laboratory staff. • Establish a system for taking disciplinary action.

11:11:11:11: Laboratory Legal and Regulatory FrameworkLaboratory Legal and Regulatory FrameworkLaboratory Legal and Regulatory FrameworkLaboratory Legal and Regulatory Framework


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ACKNOWLEDGEMENTS

On behalf of the Ministry of Health we wish to acknowledge the invaluable support, both material and technical, and contributions in the development and finalization of this policy of the following contributors and organizations:

1. Dr. Ung Sam An Director of NIPH and Chairperson of STWG for BS and LS 2. Dr. Nhem Thourk Director of NBTC and Vice-Chairperson of STWG for BS and LS 3. Dr. Sann Sary Director of DHS -MoH 4. Dr. Sok Srun Deputy Director of DHS and Secretary for STWG for BS and LS 5. Dr. Kruy Sun Lay Deputy Director, Pasteur Institute of Cambodia, Member 6. Ph. Buth Sokhal Deputy Director of NIPH and Chairperson of WG on LS 7. Dr. Sau Sokunna Deputy Director of DHS-MoH , Member 8. Dr. Ly Sovann Deputy Director of CDC, Member 9. Dr. Hok Kimcheng Deputy Director of NBTC and Chairperson of WG on BS 10. Dr. Chhorn Samnang Head of Tech. Bureau of NBTC &Vice Chairperson of WG on BS 11. Ph. Chuop Sokheng Head of NPHL and Vice Chairperson of WG on LS 12. Dr. Chap Seakchhay Head of Tech. Bureau of NIPH 13. Ph. Sam Sopheap Head of BMLS, DHS-MoH, Member 14. Ph. Uch Monipheap Vice Head of BMLS, DHS-MoH, Member 15. Ph. Ou Kimsan Vice Head of BMLS, DHS-MoH, Member 16. Dr. Ket Vansith National Pediatric Hospital, Member 17. Ph. Chroeng Sopheap Chief of Laboratory Preah Kossamak Hospital, Member 18. Ph. Ouk Kalyan Chief of Laboratory Section, UHS (TSMC), Member 19. Dr. Sok Panha NCHADS, Member 20. Dr. Pheng Sok Heng Chief of TB Laboratory Section, CENAT, Member 21. Dr. Penh Pouth Chief of Laboratory Khmer-Soviet Friendship Hospital, Member 22. Dr. Nima Asgari Public Health Specialist, CSR team leader, WHO 23. Dr. Nicole Seguy Communicable disease team leader, WHO 24. Dr. Jane Carter African Medical and Research Foundation – Kenya, WHO 25. Dr. Chea Nora Technical Officer for Infection Control & Surveillance,CSR,WHO 26. Mrs. Robyn Devenish Advisor – National Pediatric Hospital 27. Dr. Ly Vanthy Deputy Director, CDC-GAP 28. Dr. Marie Downer Senior Lab Advisor US-CDC 29. Dr. Duncan Blair NCHADS-Clinton Foundation 30. Dr. Francois Xavier Babin Regional Manager Asia/Mérieux Fondation 31. Others Members of Sub-Technical Working Group for BS and LS

ACKNOWLEDGEMENTSACKNOWLEDGEMENTSACKNOWLEDGEMENTSACKNOWLEDGEMENTS

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