How to Get Involved in Global Laboratory Medicine: A Perspective

The practice of laboratory medicine has seen significant advancements over the past several decades. These include an increasingly expansive test menu, technological innovations in automation that enhance operational efficiency, and improved analytical techniques that contribute to greater assay accuracy and precision. These advancements and the knowledge accumulated over the years were put to the test most recently during the COVID-19 pandemic. While many laboratories around the world demonstrated remarkable adaptability and resilience, not all were adequately equipped or could rapidly mobilize resources to do so. In this context, the pandemic exposed and magnified longstanding disparities in access to high-quality laboratory medicine services, particularly in resource-limited settings. According to the World Health Organization (WHO), approximately 84% of the global population resides in low- and middle-income countries, where healthcare systems frequently encounter resource challenges (1). In this article, the authors highlight key challenges commonly encountered by laboratories in such environments, drawing insights from their personal and professional experiences in global laboratory medicine, particularly in Sub-Saharan Africa. They also discuss practical ways in which readers can support the advancement of laboratory medicine in resource-limited settings. Advancements in laboratory medicine have primarily been driven by high-income countries. In addition to this foundational disparity, laboratories in high-income settings benefit from significant advantages over those in resource-limited regions. These include access to cutting-edge technologies, continued professional development, stable funding, laboratory leadership with advanced training, accreditation systems, reliable supply chains, and robust quality assurance programs, all of which contribute to the advancement of patient care. In addition, well-organized professional organizations, often lacking in many resource-constrained countries, contribute tremendously to the advancement of laboratory medicine through advocacy and policy influence. Equally important, effective regulatory frameworks with robust oversight and enforcement mechanisms have been crucial for advancing laboratory medicine in high-income countries. In contrast, quality improvement efforts in low-resource countries often depend on the initiatives of specific institutes and laboratories. Moreover, while laboratories worldwide face shortages of skilled professionals, this issue is particularly acute in resource-limited countries, which already suffers a strained healthcare workforce (1). In Africa, for example, the ratio of healthcare workers is about 1.22 per 1000 people, well below WHO's benchmark of 4.45 per 1000 required to provide basic health coverage (2). This partly stems from a brain drain of skilled healthcare workers, driven by limited career opportunities and poor job satisfaction and returns, and results in shortages of local expertise in crucial areas such as infectious diseases, inborn errors of metabolism (leading to a lack of newborn screening in many places), and genetic disease diagnostics. Sustained gaps in laboratory infrastructure further compound these workforce challenges (3). For instance, unreliable access to electricity and cold chains critically undermines diagnostic capacity by accelerating reagent deterioration and leading to persistent stockouts, since bulk storage is unfeasible (4). Further, well-recognized inherent challenges associated with achieving and maintaining laboratory quality are exacerbated in resource-limited settings. For instance, in these settings, the lack of assay harmonization is acutely felt, with financial constraints and weak regulatory oversight driving procurement decisions. This often compels laboratories to prioritize affordability over quality and consistency, severely impeding local assay harmonization efforts. Beyond these daily challenges, these laboratories, in collaboration with global partners, are in various stages of developing robust preparedness plans and innovative strategies to combat emerging health threats such as antimicrobial resistance (5). This crucial work demands dedicated investment and strategic planning, resources severely limited in regions already battling systemic challenges. In the following section, we will explore ways in which laboratory professionals around the world and relevant partners can support in advancing laboratory medicine practices in low-resource regions. Laboratory professionals can help advance global laboratory medicine by participating in expert groups or technical advisory committees within organizations that shape global health laboratory policies. These include those within the Joint Committee for Traceability in Laboratory Medicine (for harmonization), Association for Diagnostics & Laboratory Medicine (ADLM), College of American Pathologists, International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), and the WHO (6). Laboratory professionals could also share their expertise in education by developing practical quality implementation guidelines, designing or leading open-access courses, and/or providing crucial feedback to enhance existing programs. Excellent platforms for this include OpenWHO (7), the Global Health eLearning Center, the ADLM Learning Lab, and The Canadian Society of Clinical Chemists’ (CSCC) online platform (which offers resources such as biweekly Education Roundtables). The Stepwise Laboratory Quality Improvement Process Towards Accreditation checklist is an example of such useful practical guidelines tackling quality attainment in laboratories in low-resourced areas (8). Another critical contribution involves amplifying the visibility of challenges in laboratory medicine in resource-limited regions. Creating platforms for laboratory professionals to share their experiences is an invaluable way to achieve this. Existing international initiatives—such as Global Medical Laboratory Week, celebrated by organizations such as the American Society for Clinical Pathology, IFCC, and others—already play a crucial role in drawing attention to the indispensable work of the clinical laboratory. Professionals could also support the efforts of numerous nongovernmental organizations that are dedicated to strengthening laboratory quality and capacity in resource-constrained regions. Volunteering or joining these organizations provides direct avenues for impact. Two highlighted organizations are: Pathologists Overseas: This organization has a proven track record, having worked for over 30 years in implementing quality systems [external quality assessment (EQA) programs, laboratory information system (LIS) installation, and continued professional development] in >22 low- and middle-income countries in Asia and Africa (9). Médecins Sans Frontières Labs: Médecins Sans Frontières has innovative initiatives such as the “Mini-Lab” project (10), which designs autonomous, transportable clinical bacteriology laboratories suitable for field interventions in resource-limited settings, directly combating antimicrobial resistance and improving diagnostics. They also support projects such as Antibiogo, an Android app to aid antibiotic susceptibility testing, and DiaTROPIX for rapid diagnostic test development. Institutions, departments, or individual laboratories can contribute to improving global laboratory medicine by participating in “Support-a-Lab” or “Support-a-Professional” schemes. In these programs, an entity effectively “adopts” a laboratory or a laboratory professional in a resource-limited setting for a defined period. They could then provide support, which could include serving as reference laboratories, providing remote consultations, or offering direct hands-on support through on-site visits. For laboratories within academic medical centers, extending virtual participations in conferences such as case presentations or Grand Rounds to their adopted counterparts will provide invaluable access to continuing education. Direct collaboration can profoundly affeact the quality of diagnostics and ultimately transform the lives of thousands of individuals in low-resource regions. Furthermore, it could provide the necessary advanced training opportunities for laboratorians typically lacking in these settings. Institutions can also actively participate in virtual mentorship programs such as the African Society for Laboratory Medicine’s Laboratory Community of Practice. Laboratory Community of Practice actively fosters peer-to-peer learning and quality improvement among African laboratory professionals, providing a structured environment for continuous professional development and knowledge exchange. Professional organizations can significantly support their counterparts in resource-limited settings by establishing organization-to-organization mentorship and consultation programs and offering free or heavily discounted access to their educational programs and memberships, thereby fostering direct knowledge exchange and enabling professionals to access training and networking opportunities in-country, possibly reducing brain drain due to lack of opportunities. Laboratory standard publishers such as the Clinical and Laboratory Standards Institute or International Organization for Standardization could promote adherence to international best practices in low-resource settings by providing free or discounted access to essential guidelines and standards including those targeted toward quality improvement. EQA and Quality Control providers can assist by offering discounted or donated EQA and Quality Control materials vital for laboratories to monitor and improve the accuracy of their testing. For example, the Royal College of Pathologists of Australasia Quality Assurance Programs currently partners with Pathologists Overseas to offer free EQA schemes in >22 laboratories across 9 countries in Sub-Saharan Africa. LIS and document control companies could also support the improvement of laboratory operations in low-resource settings by developing and providing affordable and scalable LIS solutions and document management systems, minimizing the reliance on paper-based documentations and manual quality monitoring processes prevalent in low-resource laboratories. Some companies are already taking these initiatives in partnership with relevant organizations. For example, Pathologists Overseas relies on the donation of LIS software by ComProMed to support laboratories in low-resource settings. Reagent manufacturers should also dedicate resources to overcome the unique logistical hurdles to testing in low-resource settings to serve most of the world’s population. The swift spread of infectious diseases, demonstrated by the recent Ebola epidemic and the COVID-19 pandemic, underscores the indisputable interconnectedness of the global community. This reality means that efforts to enhance laboratory medicine quality and preparedness must adopt a global perspective. As outlined here, the challenges faced by many laboratories and laboratory professionals, particularly in low-resource regions, are complex. However, they also present opportunities for meaningful engagements and knowledge exchanges that consider the broader needs of the global community. Nonstandard Abbreviations: ADLM, Association for Diagnostics & Laboratory Medicine; IFCC, International Federation of Clinical Chemistry and Laboratory Medicine; EQA, external quality assessment; LIS, laboratory information system. Author Contributions: The corresponding author takes full responsibility that all authors on this publication have met the following required criteria of eligibility for authorship: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; (c) final approval of the published article; and (d) agreement to be accountable for all aspects of the article thus ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved. Nobody who qualifies for authorship has been omitted from the list. Catherine L. Omosule (Conceptualization-Equal, Project administration-Lead, Supervision-Lead, Writing—original draft-Lead), Roa Harb (Conceptualization-Equal, Writing—review & editing-Equal), and Merih Tesfazghi (Conceptualization-Equal, Writing—review & editing-Equal) Authors’ Disclosures or Potential Conflicts of Interest: Upon manuscript submission, all authors completed the author disclosure form. Research Funding: R. Harb received funding from the Intramural Research Program of the National Institutes of Health (NIH). The contributions of the NIH author are considered Works of the United States Government. Disclosures: C.L. Omosule, R. Harb, and M. Tesfazghi are affiliated with Pathologists Overseas. C.L. Omosule is a member of the ADLM Society for Young Clinical Laboratorians (SYCL) Core Committee Board, is the 2025–26 SYCL Liaison for The Journal of Applied Laboratory Medicine (JALM), and has received travel support and speaking honoraria from ADLM; has received a speaking honorarium from LetsGetChecked; is a member of the IFCC Committee of Emerging Technology in Pediatric Laboratory Medicine and has received travel support from IFCC; has received research and travel support from the Wellcome Trust Foundation; is a volunteer member of the American Thyroid Association Laboratory Section; is associate editor for the CSCC newsletter, is the section head of clinical chemistry for ASCP, and is involved with the ASCP Clinical Chemistry case series.

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