Mapping a Path to Laboratory Surveillance in Bangladesh

In 2024, APHL began working with the US Centers for Disease Control and Prevention (CDC) and the Bangladesh Ministry of Health and Family Welfare to implement a laboratory mapping initiative in Bangladesh. This project focused on designing, developing and implementing a mapping tool to obtain data on the Bangladesh national public health laboratory system. The resulting analysis, summarized in the Bangladesh Health Facility Laboratory Capacity Mapping Report, offers strategic recommendations for the Directorate General of Health Services (DGHS) to utilize in their national strategic plan. The data gathered from 26 laboratory sites across four administrative tiers—National, Division, District and Upazila—revealed that overall network maturity is moderate, defined by significant technical expertise constrained by systemic fragmentation. 

Tiered System of Contrasts

The mapping identified a “dual system” operational model: structured programmatic workflows (e.g., tuberculosis, polio/measles surveillance) operate efficiently, while routine clinical diagnostics often rely on informal manual processes. National laboratories (e.g., Institute of Epidemiology Disease Control and Research (IEDCR), National Tuberculosis Reference Laboratory (NTRL) and Institute of Public Health (IPH)) demonstrate good analytical and procedural standardization. Standardization of testing methods and platforms is high, confirmed by 86% of laboratories across the national list of priority diseases. However, systemic integration is lacking. Sample tracking systems are often informal or limited to specific vertical programs, and the lack of a unified laboratory information system (LIS) increases reliance on manual data transcription. Sub-national tiers (Division, District, Upazila) mapped showed systemic weaknesses in core management areas, such as:

Quality Management (QM) and the Validation Gap. The mapping found an absence of dedicated full-time QM personnel at any sub-national site. This lack of needed QM personnel forces clinical results of validation onto medical technologists, creating a critical quality assurance risk (the "validation gap").

Capacity and Logistics. Procurement systems rely on rigid annual cycles, frequently resulting in stockouts during high-volume testing. This is compounded by the widespread presence of the "one-person lab" model in Upazilas, where a single medical technologist manages the entire complex diagnostic workflow. Sample tracking is informal or non-existent outside vertical disease programs, hindering outbreak investigations and reliable chain-of-custody. For sample transport procedures, 79% of national departments have completely standardized protocols, but three laboratories rely on transport arrangements on an “as needed” basis, and others report non-applicability due to their non-infectious specimen focus (e.g., food samples).

Communication. Post-analytical communication for clinical results remains largely informal (e.g., phone calls), undermining the formal dissemination pathways necessary for integrated public health action.

Strategic Imperatives

The data collected provides DGHS with insights into capacity and communication between the different laboratory tiers. To build a cohesive and resilient network, targeted investments must prioritize: digital integration via a national LIS, creating dedicated full-time quality manager roles and implementing real-time resource planning to ensure sustainable operations at all tiers.

By addressing these, Bangladesh can successfully move toward establishing a truly integrated and responsive national public health laboratory network.