Funding OGAC has defined a budget code for laboratory strengthening activities (see Box 9-1). From FY 2005 to FY 2011, PEPFAR provided more than $1 billion for laboratory strengthening (OGAC, 2005a, 2006b, 2007c, 2008b, 2010b, 2011d,e).

PEPFAR Activities

PEPFAR has supported a wide range of laboratory-strengthening activities that have been described in the published literature and that were reported by country visit interviewees. In several countries PEPFAR supported the development of national laboratory strategic plans (240-21-PCGOV; 331-3-USG; 116-19-PCACA; 396-22-USG) and also guidelines and standard operating procedures (196-10-PCGOV; 116-19-PCACA; 272-13-USG). PEPFAR support for laboratory strengthening has often been aligned with partner country strategic plans, and in many countries, PEPFAR partners have assisted countries with the development of laboratory strategic plans (396-22-USG; 396-55-USG; 240-21-PCGOV; 331-17-USG).

Interviewees confirmed PEPFAR support for the construction and refurbishment of partner country laboratories at multiple levels, including national reference labs (587-7-PCGOV; 587-13-USG; 240-2-USG), provincial or regional labs (240-12-USG; 240-21-PCGOV; 166-11-USG; 934-5-USG), and local labs (461-3-USG). For example, in Ethiopia, PEPFAR has supported the National Laboratory Strategic Plan of the Ethiopian Health and Nutrition Research Institute by renovating and equipping the national reference laboratory, four regional hospitals, and six regional laboratories (Justman et al., 2009). In many countries, PEPFAR has provided lab equipment (240-2-USG; 934-24-PCGOV; 934-28-PCNGO; 396-22-USG; 396-41-PCGOV; 116-19-PCACA; 331-16-USG) and supplies such as reagents, test kits, and consumables (166-11-USG; 240-12-USG; 461-8-PCGOV; 934-2-USG; 934-21-USG; 934-25-USPS; 934-28-PCNGO).

PEPFAR funds several partners to provide TA for laboratory systems across partner countries (ASCP, 2012; BD, 2012; Diallo, 2011). Several interviewees offered descriptions of PEPFAR support for laboratory information systems (331-15-USG; 166-11-USG; 396-22-USG), including numerous reports of PEPFAR efforts to establish quality-management, quality-assurance, and quality-improvement programs (240-19-USACA; 240-21-PCGOV; 166-4-USG; 272-12-USNGO; 461-19-USG; 396-2-USG; 396-22-USG; 934-5-USG). Interviewees in several countries reported participating in PEPFAR’s Strengthening Laboratory Management Towards Accreditation Initiative as well as receiving other PEPFAR support for lab accreditation (116-19-PCACA; 166-11-USG; 934-28-PCNGO; 331-15-USG; 461-18-USG; 396-2-USG; 396-22-USG) (see Box 9-6).

PEPFAR has supported human capacity development for laboratory skills through south-to-south workshops in Nigeria, and the U.S. Centers for Disease Control and Prevention opened the African Center for Integrated Laboratory Training in South Africa (Justman et al., 2009). Interviewees from nearly all of the countries that the committee visited de-



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