When the first suspected case of COVID-19 appeared in Nepal on 13 January 2020, there was not a single laboratory in the country capable of conducting an RT-PCR test. Samples had to be shipped overseas which delayed the reporting time. Today, there are 96 laboratories across the country dedicated to the testing and detection of the SARS-CoV-2 virus.
How did Nepal achieve this within a year?
The road leading up to this was difficult and started with a single first step: WHO, Country Office for Nepal, facilitated a partnership between the National Public Health Laboratory (NPHL) and a private research organization which provided COVID-19 RT-PCR primers and probes to NPHL to enable quick COVID-19 testing. On 15 March 2020, NPHL started testing for the virus, becoming the first and only laboratory in the country capable of such testing. Subsequently, WCO Nepal facilitated the supply of COVID-19 RT-PCR reagents to NPHL.
A senior laboratory expert deployed to NPHL by WHO, Country Office for Nepal, through the Global Outbreak and Alert Response Network (GOARN) provided support to develop surge testing plans aimed at increasing the number of samples tested each day, operating the equipment, the procurement of reagents, and allocating staff and work shifts.
WHO, Country Office for Nepal, then supported NPHL in identifying and approving the existing laboratories that were subsequently repurposed to test for COVID-19. With technical support from WCO Nepal, NPHL developed more than 30 COVID-19 diagnostic laboratory Standard Operating Procedures (SoPs), work instructions, assessment and audit reports referring to COVID-19 specificities including the Interim Guidelines for SARS-CoV-2 PCR laboratories in National Public Health Laboratory Network Nepal.
Upon request from NPHL, WHO, Country Office for Nepal, provided direct financial support to engage additional staff in NPHL.
A fundamental aspect in the process of building laboratory capacity for COVID-19 pandemic response was the development of a comprehensive laboratory quality assurance programme for every new laboratory in the country, which WHO coordinated. Also, WHO, Country Office for Nepal, supported the development and implementation of a COVID-19 centralised management information system (MIS) and supported NPHL in data analysis.
Looking back at the process of developing the laboratory network in addressing COVID-19, Nepal has come a long way in terms of preparedness for public health surveillance and pandemic response. Almost all laboratories were performing molecular diagnostic assays (PCR test) for the first time in the first phase, when WHO conducted the laboratory quality assurance programme.
The joint efforts of NPHL and WHO, Country Office for Nepal, ultimately resulted in 96 sites being established. From this expansion, more than 4.1 million tests have been performed. Moreover, the expansion of laboratory capacity also shows how WHO, Country Office for Nepal, worked together with the regional office, WHO Collaborating Centres associated with the WHO Global Influenza Surveillance and Response System (GISRS), Global Outbreak And Response Network and the MoHP, to not only expand physical sites, but to ensure quality of capacity expansion through enabling quality Assurance mechanisms and establishing genome sequencing.
The expansion of laboratory capacity presents many lessons learned. The Government of Nepal, WHO, academia and the private sector came together in support of comprehensive health systems strengthening that enabled the expansion of laboratories to every district and more. Working together, key stakeholders were able to take limited resources and manpower and strengthen the lab capacity and operations so that not only was an expansion undertaken, but it was done so in relatively short time period of less than one year.