Building and Rebuilding: The National Public Health Laboratory Systems and Services Before and After the Earthquake and Cholera Epidemic, Haiti, 2009–2015

Abstract

Abstract.Before the 2010 devastating earthquake and cholera outbreak, Haiti’s public health laboratory systems were weak and services were limited. There was no national laboratory strategic plan and only minimal coordination across the laboratory network. Laboratory capacity was further weakened by the destruction of over 25 laboratories and testing sites at the departmental and peripheral levels and the loss of life among the laboratory health-care workers. However, since 2010, tremendous progress has been made in building stronger laboratory infrastructure and training a qualified public health laboratory workforce across the country, allowing for decentralization of access to quality-assured services. Major achievements include development and implementation of a national laboratory strategic plan with a formalized and strengthened laboratory network; introduction of automation of testing to ensure better quality of results and diversify the menu of tests to effectively respond to outbreaks; expansion of molecular testing for tuberculosis, human immunodeficiency virus, malaria, diarrheal and respiratory diseases; establishment of laboratory-based surveillance of epidemic-prone diseases; and improvement of the overall quality of testing. Nonetheless, the progress and gains made remain fragile and require the full ownership and continuous investment from the Haitian government to sustain these successes and achievements.

Prevalence of MDR bacteria in an acute trauma hospital in Port-au-Prince, Haiti: a retrospective analysis from 2012 to 2018

“…Although the laboratory capacity in Haiti has increased dramatically since the 2010 earthquake and cholera outbreak, the main areas strengthened have been molecular testing for TB, HIV, malaria and diarrhoeal and respiratory diseases. 23 Access to quality microbiological diagnostics is still limited, and the guided use of antibiotics through microbiological results and the surveillance of ABR in the country is minimal. Boulos et al 24 reported that not having access to microbiological culture was associated with increased fatality among neonatal sepsis cases in Haiti.…”

Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia

“…These efforts proved fruitful: by 2015, Haiti moved from being ranked the fourth-worst performing country in the Latin American and Caribbean region to the sixth-best in terms of investigating suspected cases of measles and rubella [ 51 ]. However, governance and funding challenges continued to undermine surveillance efforts [ 51 , 53 ].…”

External quality assessment for HIV rapid tests: challenges and opportunities in Haiti

“…The Haitian national laboratory network has grown and improved significantly with the support of PEPFAR. Hospital laboratories were either built or renovated, and the number of facilities with access to automated chemistry, haematology and tuberculosis (GeneXpert) testing tripled after the 2010 earthquake 8. The Global Heath Security Agenda (GHSA) offers another opportunity to strengthen the Haitian laboratory system to support infectious diseases surveillance and outbreaks response.…”

“…LNSP is at the top of the pyramid and serves as a reference laboratory, overseeing and coordinating the activities at the three levels of services. Three regional laboratories are located at teaching hospitals where a comprehensive range of laboratory services are provided and seven laboratories located at departmental hospitals constitute the third and second tier, respectively 8. About 240 primary level, peripheral public healthcare facilities/laboratories form the bottom of the pyramid, where basic laboratory tests are performed.…”