RKI and Malagasy researchers analyse public health needs and strengthen laboratory capacities

In August and early September 2023 two teams from the Robert Koch Institute visited Madagascar within the “Assessing and Building Capacities: Madagascar's public health system” (ABCM) project, funded under Global Health Protection Programme (GHPP). One mission was also supported by the project “A Partnership to Strengthen Integrated Genomic Surveillance through Greater Capacities in National Public Health Institutes” funded by the WHO Hub for Pandemic and Epidemic Intelligence.

RKI scientists and Malagasy researchers meet with the Secretary General of the Madagascar Ministry of Health. Photo: RKI

In a joint effort with the Ministry of Health and the National Institute of Public and Community Health (Institut National de Santé Publique et Communautaire, INSPC), a team comprised of researchers from ZIG 2 (Evidence-based Public Health) interviewed 36 key informants. This first round of interviews was designed to map and understand the current status of the public health system in Madagascar. Key informants discussed the essential public health functions (EPHF) as they relate to health systems strengthening and resilience. This was framed around the newly consolidated list of 12 essential public health functions purposed by WHO and the International Association of National Public Health Institutes (IANPHI), with additional attention given to public health laboratory and public health in clinical settings as sub-areas of interest for the country. Key informants included individuals working in each of the EPHF and represented multi-level stakeholders from the central government, international organisations and NGOs as well as local community implementers and experts.

The ultimate goal of the project is to jointly develop a roadmap to strengthen the overall public health system, including the organisation of the public health functions. In parallel, this includes increasing the capacities of the public health system. Through previous and ongoing collaboration, the Robert Koch Institute is supporting building local capacities for detection and surveillance of major vector-borne diseases through a One Health approach. At the request of the Ministry of Health in Madagascar, diagnostic capacities for nationally relevant infectious diseases such as plague, malaria and dengue will be implemented at the Laboratoire d’Analyses Médicales Malagasy (LA2M) in Antananarivo.

Lab experts from two RKI units held a training with the national laboratory in Madagascar in September 2023. Photo: RKI

In order to build molecular diagnostic capacities for plague at LA2M, the unit of Highly Pathogenic Microorganisms at the RKI organised and conducted a one-week workshop with staff of LA2M. The workshop focused on biosafety, biosecurity and molecular diagnostics for Yersinia pestis. This included presentations on the theoretical basics, group work exercises and joint laboratory work resulting in the successful application of an exemplary PCR. The collaboration concluded with a series of discussions to jointly identify the next steps for the implementation of a standardised workflow as well as to identify further needs and topic areas that can be addressed in future project components planned for 2024 and 2025.

To complement the workshop, lab experts from the Centre for International Health Protection (ZIG 4) provided presentations and training on laboratory waste management and a joint session on sample management involving staff from the Directorate of Health Monitoring, Epidemiological Surveillance and Response of the Ministry of Health (Direction de la Veille Sanitaire, de la Surveillance Épidémiologique et Riposte, DVSSER). A detailed workflow from sample collection and transport to the laboratory to final report delivery and reporting to the surveillance system was discussed to identify current gaps.

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