The Association of Public Health Laboratories (APHL) is a membership organization comprised of public health laboratory leaders. Its member organizations, with approximately 5,000 professionals, provide a resource of training laboratories and experienced experts to assist and support USG programs and Ministries of Health in strategic planning for national laboratory networks, quality management systems, laboratory policy and safety, training programs, planning and managing renovation projects, laboratory management information systems, procuring equipment and supplies, and providing US-based and in- country advanced mentoring and training for laboratory professionals.

APHL has been a key laboratory partner in Mozambique since the beginning of PEPFAR implementation in this country. The recent award of a new five year headquarter-managed cooperative agreement ensures the continuity of their capacity building efforts in Mozambique. The overarching goal of APHL's activities in Mozambique is to assist the MOH to create and strengthen the tiered public health laboratory network so that quality laboratory services are accessible to all Mozambicans. This goal is directly linked to the Partnership Framework which calls for USG and GOM collaboration to "Strengthen laboratory support services for HIV diagnosis and management" including early infant diagnosis. The PEPFAR II indicators for laboratory (1- Number of labs with capacity to diagnose HIV and perform HIV disease monitoring tests and 2- Number of labs with national or international accreditation) will be important measures of APHL's success in reaching these goals over the life of the agreement.

APHL's activities are not concentrated in one or more geographical areas but instead serve to strengthen the national laboratory network overall. APHL has two in-country technical advisors providing in-country coordination of the entire APHL portfolio of activities as well as on site technical assistance and training for MOH laboratory staff working at all levels of the laboratory network.

A significant portion of APHL's portfolio is aligned to health systems strengthening. In the area of quality assurance, APHL is providing support to the National Immunology and HIV Reference Laboratory to conduct and expand external quality assurance programs for CD4 testing, HIV serology, DNA PCR for early infant diagnosis, and viral load. APHL is building laboratory leadership and management skills in provincial as well as central level laboratory leaders through their Laboratory Management Course. APHL provides support for capacity building to the central level laboratory section to improve the management of functionality of the National Laboratory Section of the MOH. In an effort to systematically improve laboratory quality, Mozambique is embarking on a journey towards laboratory accreditation. As this process requires the specific expertise of a number of laboratory partners, APHL is coordinating activities of the lab coalition partners working in Mozambique and facilitating the logistics of in-country trainings. APHL's in-country staff will play a key role in site supervision and follow up to ensure laboratories being prioritized for intensive quality improvement are meeting their benchmarks and making progress as planned.

In the area of information management, APHL is leading the way to implement and operationalize electronic laboratory information systems to collect, analyze and report laboratory information for data- driven public health decision making. Paper-based LIS is also being implemented with APHL's support to all laboratories across the network that do not have eLIS systems in place. The ultimate goal of LIS is to manage laboratory results and monitor and evaluate the laboratory network. To this end, APHL is building capacity within the central level of MOH to receive and utilize these data.

Increasing the quality and quantity of laboratorians is a critical element to health systems strengthening. APHL is working with MOH to improve the infrastructure of the Health Science Training Institutes to ensure training laboratories are equipped to provide the necessary hands-on training required for appropriate pre-service education. This activity complements USG's investments in the area of pre- service curriculum strengthening and faculty development.

In the next five years, APHL will achieve cost-efficiency improvements by continual quality improvement of its in-country staff and reducing the use of consultants traveling in from the U.S. Specifically, APHL will hire and train specialized workforce positions as well as train local professionals who work in or provide services to the MOH for information technology, quality management systems and laboratory design. This on-going training and mentoring program will set specific objectives for competencies and capabilities each year for selected professionals within Mozambique. In addition, APHL will implement a revised monthly reporting system to include both productivity indicators (such as tests performed, sites provided training, instrumentation and LIS operations) as well as outcomes that measure quality and capabilities (such as successful EQA test results, certification or demonstrated competency by test in laboratory specialties).

APHL performance measures will include the number of testing laboratories supported documenting

progress for critical performance measures that include SOPs completed, testing capacity as measured

by numbers of tests in each category, testing quality as measured by QC and EQA monitoring,

management indicators such as days equipment operational, employee attendance and days when

supplies and reagents are in stock as needed. APHL performance measures will also include specific

monitoring of three laboratories selected for fast-track accreditation noting milestones related to the WHO

accreditation checklist and progress across the laboratory system that relate to the checklist

requirements. APHL will also coordinate withUSG, MOH and laboratory partners to monitor policy and

planning activities related to accreditation such as establishment of national accreditation standards and

training of quality managers. These performance measures will provide accurate information for

forecasting needs for laboratory support.

APHL will provide technical support for at least 25 laboratories throughout Mozambique, including the

Maputo Central Referral Hospital, the National Immunology and HIV Reference Laboratory, Health

Science Institute training laboratories, and clinical laboratories at the Provincial and District level.

APHL will continue to provide management training (Foundations of Laboratory Leadership and

Management) for lab directors and supervisors to strengthen quality for sustainable programs. APHL will

provide QA training for all testing specialties including development of advanced teaching and practice

skills and knowledge for MOH laboratory professionals.

APHL will develop specific performance measures that track development of capabilities in the national

laboratory system that will support cost-effective sustainable laboratory infrastructure. The activities

include: training of local IT support staff, mentoring of provincial quality managers, development of

information systems to track laboratory testing and quality information to support MOH planning and

programs, development of an EQA program for HIV RT, mentoring of laboratory staff and strengthening

of laboratory pre-service training centers.