Supranational Reference Laboratory Network Business Plan Possible approaches to a public health business plan April 2013
SRLN Business Plan Outline Assumptions Environmental assessment, competitive advantage, market analysis (we are here) Fundamental policies, strategies, and then putting in place a responsive governance: what the organization is and does First steps, piloting and marketing Accountability to assess compliance and performance, and build trust through evaluation, including financial projections Build a technical framework (have for SRL and overlaps GLI) Build financing mechanisms, through partnerships, to achieve stable funding
Possible Goals Analysis of the competition to gain efficiency and leverage Road map that produces stability, including financials Coordination and, where needed, collaboration Rigor, discipline, and higher quality performance, as mapped by TOR and agreements Consistency
External Environmental Assessment Large and well-funded laboratory landscape, which includes TB-related efforts Promotion and value of country ownership, with consequence of funding tied to MOH Sponsors include UNITAID, USAID, Global Fund, PEPFAR, and BMGF, and FIND Implementers include Ministries of Health, WHO, STOP TB Partnership, Union, ASM, APHL, USAID, CDC, ASLM, and SRLs Focus on building systems capacity through consultation from individuals and focused projects Variable verticality of some NTPs and associated national public health laboratories
A Few Possible Assumptions Must recognize history and tremendous efforts of SRLs to date and planned SRL activity varies by site SRL function has changed Previously, SRL Network not in the midst of substantially funded laboratory capacity building efforts and only recently better defined Context is important Scale up of laboratory capacity Sustainability Economic recession Changes to Global Fund
Task Force Recommended Focus of SRLN Quality assurance Support microscopy networks Provide biosafety guidance Assist with development of diagnostic algorithms Programmatic management Long-term partnerships with NRLs
Possible Strategic Choices Focus: developing countries, high burden ones, low and middle income ones, or all UN member nations Target: national TB reference laboratory, national TB laboratory network, or national public health laboratory system Organizational focus: GLI, SRLs, SRL Network, or both Define need for, and value of, the SRL Network Practical breadth of partnership: focused SRL-NRL relationship, facilitate MOH coordination of all external TA for NRL, or network is major player in global coordination
Pilot Survey, Preliminary Look Questionnaire Five broad open-ended questions Electronic with some clarifications by personal conversation Less than 10 surveyed Two-thirds non-laboratory Covered about half of major TB organizations Emphasis on SRL vs. SRLN Role, relationship with other partners
Advantages and Potential (many not repeated) SRLs valuable global capacity Laboratory strengthening is primarily technical in nature Long-term training of NRL staff at SRL Leading role in coordination of external aspects of QA Participate in surveillance and proficiency testing NRL mentorship, lab to lab, not based on just individual experts SRLN Fill in where SRL cannot Support international accreditation of all SRLs Advise WHO Support broader research work
Challenges Persistent identity and fiscal confusion among WHO, GLI, and SRLN Demand outstrips SRLN capacity, funding (recession), and leadership Insufficient interest and capacity to provide inputs to national network program implementation Lack of in-country presence (acceptable) and sufficient programmatic expertise for many SRLs limits overall ability to lead coordination of lab strengthening
Challenges (2) Perception that SRL is a valued designation, but not a guarantee of commitment to delivery TA, and accordingly a sign of weak governance Perceptions of labs talking among themselves without sufficient visibility Maps are a mess; e.g., five SRLs in one country (a good thing) but primary SRL never visited
Suggestions In addition to a core group, insert an independent steering committee of at least half non-laboratory experts Clarify mission beyond lab community, involve NTP managers Take TORs and develop, measure, and show value: funding follows success Assume leadership role in pushing TB community to embrace national lab plans (not TB lab ones) Actively engage ASM, APHL, other professional groups
Global Fund Changes Present Urgent Opportunity SRL needs to be in the midst of entire grant design and proposal development process Can SRL relationship and TA be written into the process as a requirement? New Funding model Transparency and independent review Linkage to National Strategic Plans
A Few Random Tips Raising capital takes time and capital Investors are often added-value investors You should invest your own money in your own venture
Good ideas may attract funding, but not nearly as well as those tied to organizations with highly impressive accomplishments and a solid track record of stellar coordination and project accountability. famous business plan philosopher
Acknowledgements Several anonymous persons interviewed http://publichealthbusinessplanning.org/ Several other websites The views expressed here are those of the author and not necessarily CDC or USPHS