Given the realities of the Caribbean region with respect to geography, small size of countries and limitations of resources, the concept of regional reference nodes has long been a discussion between CAREC and member countries. The concept is one in which laboratories having expertise in specific areas would undertake responsibility for providing laboratory support services in areas of public health importance.
Such reference node services would include the provision of:
- Reference testing
- External quality assessment provider
National Epidemiologists and Laboratory Directors have agreed that such services are critical to support the following specialty areas:
- Cervical cytology (only 4 countries currently do not perform testing)
- HIV services (including care and treatment)
- TB testing services
- Antibiotic resistance
A number of challenges need to be resolved in order to facilitate such arrangements. These include:
- Arrangements for financing of services to ensure that countries undertaking this role are able to sustain their local and regional service needs
- Arrangements for ensuring the quality of services provided. With the advent of the Medical Laboratory Strengthening project and the agreement on implementation of ISO 15189:2003 as the regional standard for laboratories, as well as the planned introduction of a regional accreditation mechanism, the necessary standards and monitoring system should be in place to ensure service quality
- Arrangements for shipping of specimens to the reference nodes labs and arrangements at the reference node labs to manage the receipt of specimens from overseas laboratories (including arrangements with Customs).
- Arrangements to ensure that the data produced by the reference laboratories is collected and fed into the regional information regarding laboratory findings of public health importance.
- Approval of and support for all these arrangements – subject to the decision of national Ministries of Health in the case of public laboratories.
The project undertook a survey of Ministry of Health in late 2005 to determine the laboratories interested in providing reference node services.
The criteria that regional reference nodes will be required to meet were agreed by National Laboratory Directors in 2007. Along with these criteria, the documentation to be provided by the reference node lab to support its application to become a reference node laboratory were also agreed. The issues to be resolved and strategies for moving forward were highlighted. CAREC is expected to take a lead role in moving this initiative forward, informing Ministries of Health and working with countries to achieve this regional reference node network.