title: Strengthening systems for communicable disease surveillance: creating a laboratory network in Rwanda.
abstract: BACKGROUND
  The recent emergence of a novel strain of influenza virus with pandemic potential underscores the need for quality surveillance and laboratory services to contribute to the timely detection and confirmation of public health threats. To provide a framework for strengthening disease surveillance and response capacities in African countries, the World Health Organization Regional Headquarters for Africa (AFRO) developed Integrated Disease Surveillance and Response (IDSR) aimed at improving national surveillance and laboratory systems. IDSR emphasizes the linkage of information provided by public health laboratories to the selection of relevant, appropriate and effective public health responses to disease outbreaks.
  
  
  METHODS
  We reviewed the development of Rwanda's National Reference Laboratory (NRL) to understand essential structures involved in creating a national public health laboratory network. We reviewed documents describing the NRL's organization and record of test results, conducted site visits, and interviewed health staff in the Ministry of Health and in partner agencies. Findings were developed by organizing thematic categories and grouping examples within them. We purposefully sought to identify success factors as well as challenges inherent in developing a national public health laboratory system.
  
  
  RESULTS
  Among the identified success factors were: a structured governing framework for public health surveillance; political commitment to promote leadership for stronger laboratory capacities in Rwanda; defined roles and responsibilities for each level; coordinated approaches between technical and funding partners; collaboration with external laboratories; and use of performance results in advocacy with national stakeholders. Major challenges involved general infrastructure, human resources, and budgetary constraints.
  
  
  CONCLUSIONS
  Rwanda's experience with collaborative partnerships contributed to creation of a functional public health laboratory network.
authors.affiliation: Centers for Disease Control and Response, 1600 Clifton Rd,, Atlanta, USA. hap5@cdc.gov.
authors.forename: Senait
authors.initials: S
authors.lastname: Kebede
authors.forename: John B
authors.initials: JB
authors.lastname: Gatabazi
authors.forename: Pierre
authors.initials: P
authors.lastname: Rugimbanya
authors.forename: Therese
authors.initials: T
authors.lastname: Mukankwiro
authors.forename: Helen N
authors.initials: HN
authors.lastname: Perry
authors.forename: Wondimagegnehu
authors.initials: W
authors.lastname: Alemu
authors.forename: Jean B
authors.initials: JB
authors.lastname: Ndihokubwayo
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kramer
authors.forename: Odette
authors.initials: O
authors.lastname: Mukabayire