We observed examples of collaboration between national disease programs and the national and external reference laboratory systems such as those for polio, measles, and multi-disease resistant TB activities. For example, a key component in many WHO disease eradication or elimination programs (such as the polio eradication activity within the Expanded Programme on Immunization or EPI), is the collaboration between national disease programs and the national and external reference laboratory systems. In the case of polio eradication in Rwanda, the transport of stool specimens from patients with acute flaccid paralysis (AFP) originates at peripheral levels through district hospitals and then to the NRL or to the WHO-EPI program in Rwanda. The NRL or WHO-EPI program in turn ships these specimens to the Ugandan Virus Research Institute in Entebbe, Uganda (UVRI) for confirmation and characterization of the organism. The results are reported back to Rwanda's NRL and EPI offices and then shared with the WHO. The results are communicated to the district health team and health facilities that use the results to inform timely and relevant public health response actions.