Systems in Resource-Limited Environments

systems (LIMS) have become key components of clinical and public health laboratory infrastructure in developed countries. These systems perform a variety of functions, from ordering tests to documenting the collection of specimens to reporting results to health care providers and to public health programs. Early LIMS were oriented to the business practices of laboratories, but have evolved into a key component of assuring the quality of testing. As health management information systems (HMIS) are developed and as they mature, laboratory data are viewed as key elements of health records. With appropriate integration of surveillance data, LIMS can be utilized (with safeguards to assure appropriate use) by public health systems to monitor disease conditions (chronic as well as infectious diseases) and to evaluate program efficacy. Therefore, LIMS should not be developed as stand-alone vertical systems that focus only on the testing process, but instead, they should be designed to function as integral components of a national health-information system. In resource-limited settings, laboratory data are largely managed by paper-based systems for single-purpose use of data. Electronic LIMS are at the earliest stages of development. However, increasingly, laboratories in many countries are viewed as obvious candidates for implementing information and communication technology (ICT) for better public health outcomes. The need for effective LIMS is increasingly being recognized as important for improving diagnosis, treatment, care, and support for people living with infectious diseases. While there is this perceived need by countries and by international organizations—and while there have been guidance documents developed and standards addressed—there are many barriers to introduction in resource-limited settings. LIMS that are developed by incorporating best practices of health metrics and standards will strengthen larger public health systems and will help assure the use of those data for better public health outcomes