The shortage of skilled human resources at all levels is due to high attrition and turnover of trained personnel. Decentralization has resulted in a gap in human resources for specialized testing at the national level and routine functions at the district and health facility levels. The long distances between some health centers and the national level -in addition to difficult driving conditions in some areas -contributes to a situation where specimens arrive at the NRL in inadequate condition (for example, hemolyzed samples for CD4 and measles IgM testing). Computer and internet access for transmitting data is affected by the erratic supply of electricity. Finally, participants described working within the context of ongoing shortages of vehicles, fuel, laboratory safety equipment, laboratory supplies and reagents. 