Africa's ability to detect disease, respond to outbreaks, guide clinical decisions, monitor antimicrobial resistance and protect public health depends fundamentally on the quality of its laboratories. Yet, asks Dr Juliana Ndasi, as countries strengthen their laboratory systems, an important question remains: how do we ensure that quality improvements achieved today are sustained tomorrow?
Ndasi writes:
When a patient is diagnosed, when an outbreak is detected, when food is tested for contamination or when a country tracks antimicrobial resistance, the one thing in common is that someone has to trust the laboratory result.
Africa has made significant progress in strengthening laboratory quality. Across the continent, laboratories have invested in quality management systems, workforce development and preparation for international accreditation. Initiatives such as the Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) have shown that structured improvement can produce real results.
More than 660 laboratories across 29 countries have participated in SLIPTA, with 187 going on to achieve international accreditation.
That progress matters. But it also raises a harder question: what happens after the project ends? A laboratory can achieve accreditation and still struggle to maintain the systems, equipment, workforce and financing needed to sustain that achievement.
The challenge is therefore no longer simply how to improve laboratory quality. It is how to make quality part of the way health and other essential laboratory services operate every day.
Quality cannot depend on projects
Too often, laboratory improvement has been organised around projects with defined start and end dates. Funding arrives, laboratories receive training and mentorship, equipment is purchased, systems are introduced and progress is measured.
Then the project ends. This does not mean that projects have failed. Many have helped laboratories make important gains. The problem is what happens when those gains are not absorbed into national systems.
Quality needs to be reflected in national policies, budgets, regulatory frameworks, workforce plans and institutional accountability. Laboratory managers need the authority and resources to make quality a management priority rather than an additional task. Governments need to see laboratory quality as part of health infrastructure, not simply as a technical issue for laboratories.
This is where the idea of a quality pathway becomes important and is the conversation that Africa needs to have.
Taking cognisance that not every laboratory begins at the same point. Some are already working towards international standards. Others are still establishing basic quality systems.
A practical approach must recognise these differences and allow laboratories to identify their gaps, address them progressively and demonstrate improvement along the way. The goal should not be to create another parallel quality system. It should be to create a realistic route towards sustained competence.
Laboratory quality is bigger than healthcare
There is another reason this conversation needs to move beyond the laboratory community. Testing and calibration laboratories support much more than patient care. They underpin food safety, environmental monitoring, agriculture, animal health, water quality, mining, manufacturing, trade and regulatory systems.
A laboratory result can determine whether a patient receives the right treatment. It can also determine whether contaminated food reaches a market, whether an environmental hazard is detected, whether an industrial product meets a required standard or whether an outbreak in an animal population is identified early.
The quality of that result matters in every case. This makes laboratory quality both a health-security issue and a development issue. It also makes it a One Health issue.
Africa has an opportunity to connect these different parts of the laboratory ecosystem rather than continuing to address them in isolation.
We need to change what we measure
The next phase of laboratory investment should ask different questions. Not only: how many laboratories were trained?
But also: are their quality systems still functioning? Are they improving? Do they have the people and resources to maintain them? Are governments financing quality? And what happens when external support ends?
These questions are less easy to measure than the number of workshops held or laboratories supported. But they tell us much more about whether an investment is likely to last. This also means changing the relationship between governments, development partners, laboratories and industry.
Governments need to move laboratory quality into national policies, budgets and regulatory systems. Development partners should align investments with country-owned pathways and help countries transition towards sustainable financing.
Accreditation and standards bodies have an important role in providing credible routes to demonstrated competence.
Industry, too, has a role to play. Laboratories need reliable equipment, calibration and metrology services, maintenance, digital systems and technical support. The question should not simply be what technology can be supplied, but whether that technology can be maintained and used effectively in the setting where it is deployed.
From accreditation to sustained competence
Accreditation remains important. It provides external recognition that a laboratory meets an established standard.But accreditation should not be where the conversation ends.
The real measure of a strong laboratory system is whether quality becomes part of routine practice and continues when a particular programme, grant or technical assistance project comes to an end.
Africa does not need to choose between quality improvement and accreditation. It needs pathways that connect the two.The opportunity now is to move from a model in which quality improvements are often associated with individual projects to one in which quality is embedded in national laboratory systems
That requires patience, financing, technical support and political commitment. It also requires us to recognise that laboratory quality is not an isolated technical concern. It is part of the infrastructure that allows health systems, economies and societies to function safely.
The question before Africa is therefore no longer whether laboratory quality matters. We already know that it does. The question is whether we are prepared to invest in quality systems that remain strong after the project ends. That is the test of sustainability.
These conversations will begin and take center stage at ASLM2026 Pre-Conference Symposium, Quality Pathways for Sustainable Laboratory Systems in Africa: LQMS, One Health and Accreditation on 6–7 December 2026 in Cape Town, ahead of the ASLM2026 Conference.
Dr Juliana Ndasi is Portfolio Lead at the African Society for Laboratory Medicine, where she works on laboratory systems strengthening and quality
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