The Freetown Declaration on Developing Resilient Laboratory Networks for the Global Health Security Agenda in Africa
We, country delegates, multilateral agencies, development partners, public health institutions, professional associations, and academic institutions, are gathering for the Regional Global Health Security Consultation for Laboratory Strengthening in Freetown, Sierra Leone, on 15-16 October 2015, and:
- Appreciate that this first-of-its-kind Consultation has brought partners together at the doorstep of the deadliest and costliest Ebola outbreak in history in order to develop strategies to establish the political, legal, and practical frameworks for resilient laboratory networks to address the global health security agenda in Africa.
- Acknowledge that >11,300 lives have been lost in West Africa because of the Ebola Virus Disease outbreak, and that >$2.2 billion in economic growth has been lost in 2015 for Guinea, Liberia, and Sierra Leone as a result of the epidemic.  
- Acknowledge only 1.3% of the world’s healthcare workers are found in Africa, and they care for 25% of the global disease burden. 
- Acknowledge the increase of antimicrobial resistance (AMR) in Africa due to inappropriate use of antibiotics and inadequate capacity to detect resistance. Drug resistant infections may cause 10 million deaths a year and cost up to $100 trillion a year globally by 2050. 
- Recognise the need for multi-sectoral, multi-country, and pan-African strategies for prevention, control, and response to disease outbreaks.
- Recognise the risks posed by the emergence and spread of new and existing microbes; the globalisation of travel and commerce; the rise of drug resistance; and the potential for accidental or deliberate release, theft, or illicit use of biological agents requires the strengthening of public health laboratory networks and surveillance systems.
- Recognise that integrated tiered laboratory networks and surveillance systems are the cornerstone of effective healthcare, and essential to the robust detection and early response to public health threats.
- Recognise the significant progress made in strengthening laboratory networks since the adoption of the 2008 Maputo Declaration for Strengthening Laboratory Systems and Resolution AFR/RC58/R2 at the 58th session of the World Health Organization Regional Committee for Africa (WHO AFRO), both resulting in the scale-up of diagnostic services for HIV, tuberculosis, and malaria.
- Recall the African Society for Laboratory Medicine (ASLM)’s Ministerial Call for Action to Strengthen Laboratory Services in Africa, launched in Cape Town, South Africa in December 2012, and its impact on laboratory services and quality improvement initiatives.
- Acknowledge the key role and need for a standardised monitoring and evaluation framework to measure progress in strengthening laboratory improvements, such as the WHO AFRO Stepwise Laboratory Quality Improvement Process Toward Accreditation (SLIPTA).
- Recognise that emerging threats now require even more responsive, harmonised, and significant integration and alignment of laboratory networks with public health institutes for effective laboratory-based surveillance responses.
- Recognise the functionality of tiered laboratory networks in Africa has significant gaps, the resolution of which must be given high priority in national health systems strengthening efforts.
- Call on national governments to strengthen functional tiered laboratory networks from national reference laboratories down to the primary healthcare level, as an integral part of public health institutes in Africa.
- Call on national governments, nongovernmental organisations, donors, partners, and the private sector to support the implementation of a standardised score card to routinely assess the preparedness and capacity of functional laboratory networks to prevent, detect, and respond to current and future global health threats.
- Call on ASLM and WHO AFRO to help guide countries to revise or establish national laboratory strategic plans and policies that support and strengthen functional tiered laboratory networks for an effective response to disease threats, and a score card to measure progress of implementation and improvements of the networks.
- Call on national governments, nongovernmental organisations, donors, partners, and the private sector to develop innovative strategies for laboratory workforce development to support functional tiered laboratory networks, especially at the primary healthcare level.
- Call on national governments, nongovernmental organisations, donors, and partners to develop a framework for a phased-approach to establish laboratory-based surveillance for monitoring antimicrobial resistance in Africa.
- Call on the African Union, national governments, donors, and partners to develop supranational reference laboratories for each of the regional economic blocs within the framework of the African Centres for Disease Control to enable effective disease surveillance and control in Africa.
- Call on national governments, nongovernmental organisations, donors, and partners to develop and implement guidance on evaluation and regulation of diagnostics, especially in outbreak settings.
- Call on national governments and regional bodies to work collaboratively to streamline regulations governing diagnostic tests to ensure quick, reliable access to services for the more than 1 billion Africans.
- Call on private industry and research and development institutions, with support from national governments, donors, and partners to accelerate development of innovative diagnostic tools for resourced-limited settings.
 United States Centers for Disease Control and Prevention (CDC), 2014 Ebola Outbreak in West Africa – Case Counts. Accessed at http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html on 5 October 2015.
 World Bank Group Ebola Response Fact Sheet, 1 September 2015 briefing. Accessed at http://www.worldbank.org/en/topic/health/brief/world-bank-group-ebola-fact-sheet on 5 October 2015. Shortage of healthcare workers in developing countries–Africa. Naicker S et al. Ethn Dis, 2009 Spring; 19 (1 Suppl 1), S1-60-4. Accessed at http://www.ncbi.nlm.nih.gov/pubmed/19484878 on 5 October 2015. Review on Antimicrobial Resistance: UK Government, Wellcome Trust: 14 May 2015 report. Access at http://amr-review.org/ on 5 October 2015.