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The onset of the Ebola outbreak in 2014 originated in Guinea and proceeded to swiftly reach Sierra Leone and Liberia (1). Unfortunately, these nations were critically deficient in their capacity for pathogenic testing and diagnostics, the availability of healthcare workers, and their supply of epidemic prevention materials, thereby impeding their ability to address the outbreak efficiently (2). This grave scenario underscored the need for support from the worldwide community.
At the time, Sierra Leone lacked the domestic capacity for laboratory testing, including that of biosafety level 3 (BSL-3). Recognizing this constraint, the Chinese government hastily dispatched a mobile BSL-3 laboratory and corresponding technicians to Sierra Leone to facilitate testing within the country. Furthermore, the Chinese government expedited the establishment of the Sierra Leone-China Friendship Biosafety Laboratory (BSL-3) within a span of three months, observed to be operational by March 2015. It is important to note that this laboratory also conducted investigations centered on the detoxification of body fluids in Ebola survivors, fueling advancements in the understanding and management of the Ebola virus (3). The laboratory has played a significant role in the prevention and control measures during the Ebola epidemic.
The Ebola outbreak in West Africa underscored a lack of ability to identify and diagnose emerging and re-emerging infectious diseases. While the outbreak has since ended, it underscored the necessity of strengthening the health system to better respond to future public health crises. This was underscored to the government and health practitioners. Sierra Leone, in particular, experienced a high mortality rate due to diseases such as malaria, pneumonia, diarrhea, cholera, Lassa fever, and measles. The nation continues to bear the brunt of public health crises, experiencing significant morbidity and mortality. Consistent international efforts are crucial to building the resilience and capacity of the public health system. To this end, China CDC, in collaboration with the Ministry of Health and Sanitation, Sierra Leone, implemented a multi-year capacity building program that incorporated laboratory operational capacity development and personnel capacity building (4). This article evaluates the performance and outcomes of this program (Table 1).
Framework Laboratory operational capacity building Personnel capacity building Inputs Staff
Technical support
Financial resources
FacilitiesMentors
Short/long-term trainingProcess Developing a laboratory management system
Extending testing capacity
Developing a sentinel surveillance system
Maintaining operation of the labDeveloping a training plan
Mentor instruction
Learning from practice
Encouraging further educationOutcomes Sustained operation of the laboratory
Increased testing scope of pathogens
Enhanced surveillance capacityEstablished professional workforce in the lab
Improved competency of public health personnelTable 1. Framework of the program.
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This multi-year program is focused on providing long-term training in laboratory biosafety, quality management, and testing techniques related to viruses, bacteria, and parasites. A training plan was developed specifically for personnel working in the laboratory, additionally, long-term mentors were dispatched to Sierra Leone. The comprehensive training curriculum covered areas such as pathogen characteristics, specimen collection, data entry, operational standards, personal protection, correct utilization of equipment, materials management, and biosafety. Training was delivered through a combination of lectures, simulation exercises, and practical sessions under the supervision of skilled Chinese technicians.
When operations began in the lab in 2015, a total of five local staff members were recruited for training. Following an eight-year period, 19 local lab technicians have undergone training in the laboratory. Among this group, four have successfully secured scholarships for master’s or doctoral programs outside Sierra Leone. Ongoing training has been used to bolster the competency of local staff in areas such as biosafety and biosecurity, quality management, disease surveillance, and laboratory diagnostics (Table 2). This trained local workforce played a significant role in laboratory testing and diagnostic processes throughout the COVID-19 pandemic. This team ensured that the laboratory was able to conduct tests on a daily basis and report results to the Sierra Leone Ministry of Health and Sanitation within 24 hours of receiving a sample.
Category Ability March 2015 March 2023 Biosafety Operating in biosafety level 3 None Competent Using personal protective equipment properly None Competent Biological waste management & disposal None Competent Biosafety awareness None Acquired Quality management Sample collection, transportation and preservation None Competent Process control None Competent Documents and records None Competent Data management None Competent Disease surveillance Perception of active monitoring None Acquired Process of surveillance None Competent Lab diagnosis Nucleic acid testing None Competent Enzyme-linked immunosorbent assay None Competent Sequencing None In training Table 2. Comparison of laboratory personnel competency in 2015 and 2023.
In the past years, the program successfully conducted or sponsored 37 short-term training courses, collectively reaching 1,061 participants from across the country. This initiative significantly strengthened Sierra Leone’s capacity for pathogenic testing at the district level. The curriculum spanned diverse topics such as pathogen collection, biosafety, surveillance, quality control, pathogenic diagnosis, and disease control. It encompassed diseases such as Ebola, Lassa fever, plague, anthrax, monkeypox, Marburg, malaria, typhoid fever, and SARS-CoV-2, among others (Figure 3).
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