Specialised Toolkit: Laboratory services

Introduction to the laboratories in the public healthcare system

In this section, you will learn:

  • The role of laboratories in the public healthcare system
  • About the organisational structure of laboratory services
  • The flow of laboratory commodities
  • The four commodity categories for laboratory services
  • Role of outsourcing partners in laboratory services

The central role of laboratories on Public Healthcare Systems1,2

Laboratories form an essential part of a country’s public healthcare system by providing timely and reliable test results. They perform core activities including disease prevention and control, screening and surveillance, clinical diagnosis, treatment management and emergency response efforts. Laboratories can be grouped into two broad categories:

  • Public health laboratories provide results primarily for disease control and prevention managed by national departments of public health. They further offer specialised equipment or diagnostic techniques for some infectious diseases.
  • Clinical (or medical) laboratories focus exclusively on providing clinical services to the individual patient for infectious or non-infectious diseases. They are either publicly or privately run.

Both laboratory categories follow similar principles to achieve the safety and quality of reported results. They can also both provide support for clinical research.

The organisational structure of laboratory services3

Laboratories play a central role in national disease surveillance through a three-tier organisational structure. Laboratories perform their core activities across three administrative levels:

  1. Central or national reference laboratories provide all laboratory services possible, including the broadest range of tests available. These serve as sites to which lower-level facilities may refer samples.
  2. Intermediate laboratories, usually located in district or regional hospitals, provide fewer complex services. They serve as links between peripheral and central laboratories and assist in the diagnosis and treatment of patients.
  3. Peripheral laboratories, usually located at health centres and small delivery sites, act as the patients’ first point of contact. They provide basic testing services for common diseases and conditions. Sometimes, peripheral laboratories just collect samples and refer them to higher-level laboratories.

Typically, higher-level laboratory facilities provide supervision, quality control, and technical support to lower-level facilities. This illustration of the flow of laboratory commodities indicates the potential for outsourcing specific laboratory services.

Generic supply chain flow of the retail pharmacy operating model

To optimise the national diagnostic network, specific interventions for outsourcing will be identified for the national strategy. Examples of interventions include all-inclusive pricing schemes, transport services such as third-party logistics.

Characteristics of laboratory commodities4

Laboratory commodities are classified into four categories:

  1. Reagents: chemicals and biological agents. It is essential to ensure the required combination of reagents for each diagnostic process is always available at all laboratory levels.
  2. Consumables: items used once to perform a test and not reused.
  3. Durables: items that can be used for multiple tests.
  4. Equipment: semi-automated or automated machines and instruments used in testing.

Each commodity category has different supply chain considerations, for example:

  • Volume requirements (between 300 to 3,500 required products, depending on the level of laboratory and testing services)
  • Preparations (some are packaged in bulk)
  • Shelf life (some less than three months)

Supply chain considerations

The management of laboratory commodities broadly takes place along four key functional areas:

  1. Forecasting and supply planning: considering data on past consumption, varying sources for commodities, matching test kits to available equipment – standardisation for selected equipment is critical to managing requirements for budgeting, training, and national standard laboratory procedures.
  2. Procurement and strategic sourcing: considering a vast range of products with unique storage requirements, shelf life, standardisation and packaging, strategic procurement of selected equipment, managing varying commodity prices.
  3. Storage and inventory management: considering the number of commodities to manage, storage requirements including cold chain, specialised training of staff, integrated versus parallel disease programmes.
  4. Laboratory testing, sample distribution and clinical diagnosis: considering the return of test results for accurate diagnosis, including the reliability of sample transportation, and managing the expectation of patients, clinicians, laboratory staff, epidemiologists.

The four commodity categories for laboratory services each have unique supply chain considerations. Quality monitoring according to national and international quality standards remains a critical activity across all four functional areas described above.

Role of outsourced partners in laboratory services5

Expertise from outsourced partners can reduce complexity and add value in key functional areas towards optimisation. Outsourcing along the laboratory supply chain can bring the following value-adds:

  • Outsourcing presents an opportunity for national governments or central laboratory departments to leverage external expertise, resources, and quality systems.
  • Gaining access to specialised skills and expertise (staff, information technology, networks etc.).
  • Allowing governments to focus on core competencies along the laboratory services supply chain.
  • Promoting operational efficiency through the redesign of specimen referral networks and information systems.
  • Gaining access to capital investment and innovation.

Outsourcing can assist in optimising selected functions along the laboratory supply chain and improving the delivery of laboratory services, thus facilitating strides towards achieving an optimised diagnostic network (the objective).

1Sources: World Health Organization (WHO). http://www.emro.who.int/health-topics/public-health-laboratories/index.html.

2USAID Deliver Project. Task Order 1. June 2009. Laboratory Logistics Handbook: A Guide to Designing and Managing Laboratory Logistics Systems.

3Source: Interviews for the Toolkit for Outsourcing Laboratories, November 2020

4Source: USAID Deliver Project. Task Order 1. June 2009. Laboratory Logistics Handbook: A Guide to Designing and Managing Laboratory Logistics Systems. Available: https://www.psmtoolbox.org/en/tool/capacity-building/hiv-aids/diagnostics/laboratory-logistics-handbook-a-guide-to-designing-and-managing-laboratory-logistics-systems/

5Sources: Interviews for the Toolkit for Outsourcing Laboratory Services, November 2020. United Nations Commission on Life-Saving Commodities for Women and Children, Technical Reference Team on Supply and Local Markets. December 2015. Private Sector Engagement: A Guidance Document for Public Health Supply

Chains. Available: https://toolkits.knowledgesuccess.org/toolkits/fp-logistics/private-sector-engagement-guidance-document-supply-chains-modern-context