Lab scientists from across Africa share their recipes for success in unique 'cookbook'

Dr. Pascale Ondoa, director of science and new initiatives at the African Society for Laboratory Medicine, loves to cook.

Over the past few years, her cookbook has developed a global following – three WhatsApp groups follow the recipes. One particularly ardent follower, Ugandan musician Moses “Supercharger” Nsubuga, was even inspired to write a catchy song with some surprising lyrics: “Security of drugs…development of their labs…knowledge exchange…”

That’s because this cookbook is not for use in a kitchen. And truth be told, most of the recipes are not Dr. Ondoa’s.

Instead, the “recipes” are lessons learned and best practices submitted by laboratory scientists and others working to strengthen the performance and impact of medical laboratories in low and middle-income countries.

The “cookbook” is the product of a very specialized community of practice – the Laboratory Systems Strengthening Community of Practice (LabCoP) – which Dr. Pascale has led since 2017, with support from experts from across the African continent including Dr. Collins Otieno, portfolio lead at the African Society for Laboratory Medicine.

“This is a unique community,” said Dr. Pascale. “Members include highly experienced country teams who share their learnings and present cases to the community to strengthen laboratory systems.”

Each month, a team of laboratory leaders from a different country shares their new “recipe” – lessons and best practices they have identified through their work in labs across the African continent and beyond. The recipes, shared through ECHO (virtual meetings with a specific format aimed at identifying best practices) and via webinar, are eventually condensed and added to the community’s growing cookbook.

“It has helped me to improve my work and better contribute to my country’s health system,” said Nancy Bowen, who leads Kenya’s National HIV Reference Laboratory, which every year processes 1.1 million HIV viral load tests for Kenyans living with HIV. One innovation supported by LabCoP and adopted by Bowen’s network of laboratories: patients can now choose to have their lab results sent to them via SMS text message, eliminating the need to return to the health facility for the lab report.

LabCoP was founded in 2017 by laboratory experts from 11 African countries with an initial focus on supporting country teams to scale up high-quality HIV viral load monitoring and is funded by the Bill & Melinda Gates Foundation. The organization includes representatives from 22 countries, including civil society leaders, clinicians, as well as lab managers and staff, and has expanded its focus to address laboratory issues beyond HIV viral load such as COVID-19 and tuberculosis diagnostics, management of laboratory waste, monitoring and evaluation of testing programs, and diagnostic network optimization. Hundreds of professionals from laboratories around the world join their webinars.

“Our goal is to bring countries together to assess what is working, what is the evidence for a particular approach,” said Dr. Pascale. “Countries can help each other. Even a small lab in a small country has a learning to share. Our goal is to transform these lessons learned and best practices into norms.”

COVID-19 related testing brought laboratory issues and bottlenecks into the spotlight, explained Nadia Rafif, advocacy and influence lead of the International Treatment Preparedness Coalition, which advocates for the health needs of communities. “Ordinary people around the world could suddenly realize how the lab system in their country was struggling to meet demand when they had to wait weeks for tests to be made available or for obtaining test results.”

LabCoP is changing this, helping optimize national laboratory protocols, strategies, and systems. “The foundation of any health care response is diagnostics – you have to know who has what in a timely way,” said Solange Baptiste, who sits on the project oversight committee of LabCoP. “But many public health lab systems do not function optimally as a network at the national level, never mind at the international level.” This means that there might be stockouts of one critical reagent in one lab and stockouts of another in a second, knocking two labs out of commission because the labs don’t efficiently communicate and share resources. Simply connecting these labs can deliver tremendous returns to recipients of care.

In the case of Bowen’s lab system in Kenya, LabCoP helped her change her relationship with the 1.4 million Kenyans who live with HIV and depend on her lab system for life-saving monitoring and diagnosis. “Before we joined the LabCoP, we weren’t involved in the viral load testing demand creation, and we weren’t involved in communities including the community of people living with HIV,” explained Bowen. “But with LabCoP, we’ve recognized that they can help us improve our work and increase our impact.”

LabCoP has also connected Kenya’s lab system with experts who have helped increase the footprint of laboratory services by advising lab managers and ministry officials on the optimal placement of diagnostic instruments and equipment. “The LabCoP helped us understand how to best decentralize our diagnostic services by increasing access to points- of-care testing technology,” said Bowen. “It has also introduced us to best practices for properly disposing of our liquid lab waste.”

Indeed, each of those learnings mentioned above are entries in the LabCoP cookbook and freely available. Other entries include and include: best practices for sample transportation systems, the management of guanidinium thiocyanate containing waste from testing laboratories, and how to decentralize COVID-19 PCR diagnostic capacity to sub-national level. All recipes of the LabCoP cookbook are provided in English, French, and Portuguese.

Additionally, LabCoP hosts monthly webinars where members share their lessons learned. In June, for example, Sindisiwe Dlamini, chief laboratory technologist for Eswatini Health Laboratory Services and her colleague Buyi Simelane, associate director for monitoring & evaluation, shared Eswatini Health Laboratory Services' experience using key performance indicators to track and drive improvements to laboratory performance. In 2022, Professor Jeremiah Seni from the Catholic University of Health and Allied Sciences & Bugando Medical Center, Mwanza, and Reuben Abednego from the National Public Health Laboratory, both from Tanzania, led a session on the country’s success optimizing the use of antimicrobial medicines based on AMR surveillance data.

And when the ministries of health of Sierra Leone and Kenya partnered with community organizations to support the monitoring of viral loads in people living with HIV, LabCoP shined a spotlight on the pilot program and the potential for progress in this challenging area.

“Many of these concepts and challenges faced by national labs are relatively new,” said Bowen. “There are infrastructure, systems, and human resource challenges. The LabCoP is helping us address these challenges, succeed at our work, and meet the UNAIDS 95/95/95 targets.”