2008-01-23-世界卫生组织-The_Maputo_Declaration_on_Strengthening_of_Laboratory_Systems_2页_293kb

The Maputo Declaration on Strengthening of Laboratory Systems Summary

Core Content

The Maputo Declaration on Strengthening of Laboratory Systems was adopted during a Consensus Meeting held in Maputo, Mozambique, from January 22nd to 24th, 2008. The meeting was attended by representatives from governments, multilateral agencies, development partners, professional associations, and academic institutions. The primary goal of the meeting was to address laboratory-related challenges that hinder the expansion of diagnostic and care services for HIV, tuberculosis (TB), and malaria in resource-limited settings.

Main Objectives

The meeting had three key objectives:

• Review and agree on a list of supplies and tests required at each level of an integrated tiered laboratory network.
• Develop a consensus on standardizing laboratory equipment across different levels of the laboratory network.
• Formulate key considerations for maintenance and service contracts of laboratory equipment at various levels.

Key Challenges in Resource-Limited Settings

The declaration highlights several systemic challenges that impede the development of effective laboratory systems in low-resource countries:

• Leadership and advocacy for laboratory systems is lacking.
• Human resources are insufficient, with issues related to training, recruitment, and retention of laboratory personnel.
• National laboratory policies are either absent or not well-developed.
• Strategic planning is hindered by budgetary constraints.
• Physical infrastructure is inadequate.
• Supply chain management is weak.
• Quality management systems are not robust, leading to inconsistent diagnostic outcomes.

Global Health Context

The declaration emphasizes the urgent need for quality-assured laboratory services in the context of global efforts to combat HIV, TB, and malaria:

• HIV: Approximately 33.2 million people are living with HIV, yet only 10% are aware of their status.
• Tuberculosis: Around 8.8 million new cases are reported annually, and the prevalence of drug-resistant TB is rising.
• Malaria: It remains the leading cause of mortality among children, resulting in about 1 million deaths per year globally.

These diseases are interconnected, with co-infection being a significant clinical challenge, especially in regions with high disease burdens.

Funding and Investment

There has been a substantial increase in funding for HIV, TB, and malaria programs. Donors such as the Global Fund, PEPFAR, PMI, World Bank, and the Bill and Melinda Gates Foundation have collectively committed US$10 billion annually to these programs, up from US$1 billion in 2001. However, the declaration stresses that this funding must be directed towards strengthening laboratory systems to ensure effective diagnosis and monitoring.

Key Recommendations

The declaration makes several critical calls to action:

• National Governments should prioritize laboratory systems by:

  • Developing a national laboratory policy within the national health development plan.
  • Establishing a department of laboratory systems within the Ministry of Health.
  • Creating a national strategic laboratory plan that integrates support for HIV, TB, and malaria.

• Donors and Implementing Partners should:

  • Ensure national ownership in laboratory strengthening efforts.
  • Collaborate with each other and with national governments to build a unified, integrated national laboratory network.
  • Support public-private partnerships to enhance laboratory capacity and sustainability.

• Academic Institutions and Research Funders should:

  • Accelerate the development of new diagnostic tools suitable for resource-limited settings.

Conclusion

The Maputo Declaration underscores the critical role of laboratory systems in the fight against HIV, TB, and malaria. It calls for coordinated, integrated, and sustainable approaches to laboratory strengthening, emphasizing the importance of national leadership, adequate funding, and collaboration among all stakeholders. By addressing these challenges, the declaration aims to improve the quality, accessibility, and reliability of laboratory services, thereby enhancing public health outcomes in affected regions.