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UMMS helps Liberian partners strengthen health care services

Significant progress made in public health laboratories, blood transfusion safety, and infection prevention and control practices

By Megan Bard

UMass Medical School Communications

November 26, 2018
  From left, ACCEL project team members David Chiriboga, MD, MPH; Roseda Marshall, MD; John Oguda, MBA; and Ellen Munemo, MSc

From left, ACCEL project team members David Chiriboga, MD, MPH; Roseda Marshall, MD; John Oguda, MBA; and Ellen Munemo, MSc

Significant progress has been made in the effort to establish certified public health laboratories and safe blood collection and infection prevention and control practices in Liberia, according to David Chiriboga, MD, MPH, assistant professor of medicine, and colleagues, who recently updated the UMass Medical School community on the ongoing work to strengthen health care services in the West African country.

“This is just the latest iteration of how we’re trying to align our best talents with what is needed and the strengths of our Liberian partners. Our sustained friendship and involvement is enriching to all of us,” said Terence R. Flotte, MD, the Celia and Isaac Haidak Professor of Medical Education, executive deputy chancellor, provost and dean of the School of Medicine.

Dr. Chiriboga is the principal investigator for the health care system strengthening project being implemented through the UMMS-led Academic Consortium Combating Ebola in Liberia (ACCEL), in partnership with the Liberia College of Physicians and Surgeons and with funding from the U.S. Centers for Disease Prevention and Control. For the Nov. 19 presentation, Chiriboga was joined by ACCEL project team members Roseda Marshall, MD, project country director; Ellen Munemo, MSc, project programs director; and John Oguda, MBA, project deputy country director.

Since August 2016, the ACCEL project has received $14.7 million in funding from the CDC. The project team works alongside the Liberia Ministry of Health to equip, train and mentor Liberian health care workers to improve their capacity in the wake of the West African Ebola epidemic in 2014. Key focus areas include public health laboratory capacity, safe blood collection and transfusion practices, and infection prevention and control at public health facilities nationwide.

“UMMS engagement in Liberia over a decade has paved the way for the continuation of this project. The project team wants to recognize the contribution of many UMMS faculty and staff, as well as the ongoing UMMS engagement in graduate medical education,” Chiriboga said.

UMMS/ACCEL has provided support and guidance in the strengthening of a tiered public health laboratory by increasing the diagnostic capabilities of laboratories throughout the country. The newly developed capacity improves the capability of identifying diseases with epidemic potential, including Ebola, Lassa fever, meningitis, cholera, shigellosis and salmonellosis. The increased diagnostic capacity was coupled with training and implementation of a comprehensive laboratory quality management system, bringing the Liberian national public health reference laboratory close to international accreditation.

“This is a noteworthy accomplishment notwithstanding the significant structural challenges in the aftermath of the 2014-2015 Ebola outbreak in Liberia,” Chiriboga said.

“Training and mentoring in quality management systems is the basis for the sustainability of the project, as it fosters the adoption of the quality improvement approach to everyday challenges—identifying a problem, performing a root-cause analyses, implementing corrective and preventive actions, and continuously monitoring progress.”

“We are proud to say that as we move forward we know that Liberia, if there is an outbreak, will be able to identify what is the causative agent,” Munemo said.

Dr. Marshall said the labs have enabled doctors to be able to diagnose diseases with epidemic potential faster and without having to send specimens out of country. Local labs are now able to perform bacteriology cultures and drug sensitivity testing, such as diarrheal-diseases, enabling clinical staff in hospitals to practice evidence-based medicine.

A similar approach has been implemented to strengthen the National Blood Safety Program and the hospital blood banks, capped by the recent development and validation of the National Blood Safety policy. Significant strides have been made toward the development of a volunteer, nonpaid blood donation system. Previously, blood being drawn had been typed, but not consistently tested for infectious diseases prior to use, according to Marshall.

“This is a milestone for the country,” Munemo said. The next phase in this process includes development of a five-year strategic plan for blood safety in Liberia.

In the past year, the project has also provided support to the Quality Management Unit from the Ministry of Health to continue strengthening the National Infection Prevention and Control Program, by supporting the implementation of quality improvement projects and the carrying out of focused infection prevention and control interventions.

“There are many logistical challenges derived from the poor road conditions and extended rainy season, as well as from a cash-based economy and low literacy levels in the country, which we need to overcome on a daily basis,” Oguda said.

“It hasn’t been an easy journey, but we are proud to say that we are making progress,” Munemo said.

“We have a committed team of individuals who deeply care about making a difference in Liberia” Chiriboga said.