Draft national infrastructure guidelines have been developed to guide the designing, construction, and remodeling of laboratory infrastructure. In the past five years, considerable efforts have been made towards the improvement of laboratory infrastructure in selected hubs and lower-level facilities. The GOU together with development partners has improved infrastructure at National Reference Laboratories (NTRL and CPHL), and the National Referral Hospital (Mulago), Regional Referral Hospitals (50%), General hospitals (11%) have been improved. Despite these achievements, the majority of laboratory facilities are still in need of infrastructure upgrade to meet the nationally recommended infrastructural standards for ideal biosafety and biosecurity practices. Some facilities, especially those that have been recently upgraded from HC II to HCIII and IV, have not realized substantive improvement in their laboratory infrastructure to meet the increased level of service delivery.
From the Facilities Biorisk Management Assessment 2016, Laboratory space was not adequate in all NRHs and HCIIIs as well as 50% of RRHs, GHs, and HCIVs. In 75% of the facilities assessed, the buildings were secure but 80% could not profile the risk of the organisms they were handling. Reporting of incidents and response to chemical exposures was weak at most facilities. Overall, biosafety and biosecurity manuals, policy and guidelines were lacking in most facilities, however, there was improved power supply (80%) and back up (60%).
The enhanced capacity of laboratory hubs to serve as centralized testing points and specimen referral centers has improved the quality of laboratory services delivery in the country, however, the large volume of samples handled at hub laboratories creates greater risks to health workers. This compromises the safety of laboratory personnel, laboratory users and the community.
Biosafety and biosecurity needs have received nationwide attention and support from various stakeholders. Nevertheless, most laboratories, especially at GHs, HCIVs, and HCIIIs, remain inadequate in terms of biosafety and biosecurity systems, occupational health and safety strategies, safe waste disposal mechanisms, and infection prevention and control mechanisms. Biosafety and biosecurity measures in many health facilities are not robust enough to meet requirements for occupational health and safety programs. The GHSA assessment (MOH unpublished report, April 2016) for biosafety biosecurity performance indicated that many facilities were still below average at 41%.
Despite the fact that the national biosafety and biosecurity program has conducted refresher training of over 700 laboratory personnel and 56 trainers of biosafety and biosecurity have been assigned in all health regions, there is still limited knowledge and skills on biorisk management, procurement of safety supplies and equipment, safety auditing of facilities and incident management responses by personnel and managers.