Masanza et al. BMC Public Health 2010, 10(Suppl 1):S8 http://www.biomedcentral.com/1471-2458/10/S1/S8 Table 2. Pre and post test performance scores of the equipment calibration training Participant Code Pre test score (%) Post test score (%) Score increase (%) 1. 2. 3. 4. 5. 6. 38 23 10 15 25 40 90 80 75 70 85 90 52 57 65 55 60 50 Challenges and opportunities Challenges Decision-making can be an arduous process in AFENET’s large network because of the multiplicity of players and divergent interests. The limited appreciation of the laboratory as a priority area for capacity building slows down the buy-in for various initiatives by national authorities. One of the major challenges AFENET has encountered is limited funding, which often restricts what can be done or is insuﬃcient to maintain an eﬀort till it has reached a sustainable level. Opportunities AFENET and its partners have done a commendable job, and there are still many opportunities for improving the capacity of the laboratory sector. Available funding has so far enabled AFENET to develop and demonstrate eﬀective approaches; however, most of these programs have yet to be implemented. It is AFENET’s vision that every country in the region should have its own FELTP and enhance peripheral personnel skills through short course training. The SLMTA process is also an oppor- tunity to support more laboratories towards accredita- tion. Laboratory mentoring is also critical especially for improving performance in peripheral laboratories. In addition, gaps still exist in biosecurity and biosafetly, an area in which AFENET is just beginning to build training capacity. Speciﬁcally, there is a need for training on the handling, packaging and shipment of infectious substances. Improving biosecurity is another major opportunity that still exists. Other gaps include programs that build capacity in logistics management, strengthen- ing of national public health laboratory networks, rolling out mid-level manager training and external quality assurance. Conclusions Detection, response, notiﬁcation and monitoring of PHEICs are the key components of the IHR and all require robust laboratory support. Therefore, capacity building for the IHR must by necessity also focus on Page 6 of 7 strengthening the routine laboratory systems within which events are detected and reported. AFENET is purposefully building capacity that runs through the entire laboratory structure from the lowest level to referral facilities by leveraging on the network approach. We believe this approach will build laboratory capacity at lower levels where these events usually occur, and thus ensure timely and adequate laboratory support. With adequate support, AFENET’s approach provides a logical, sustainable and strategic model with a multiplicative eﬀect that can enable countries in resource limited settings attain and sustain the IHR laboratory capacity (core capacity 8). Abbreviations AFENET, African Field Epidemiology Network; AIDS, Acquired Immunodeficiency Syndrome; BLIS, Basic Laboratory Information Systems; BLN, Uganda Medical Laboratory Technology Association; CDC, Centers for Disease Control and Prevention; DTS, Dried tube specimen; EQA, External quality assurance; FELTP, Field Epidemiology and Laboratory Training Program; FETPs, Field Epidemiology Training Program; GHSS, Global Health Systems Solution; HIV, Human Immunodeficiency Virus; IHR, International Health Regulations; ISO, International Organization for Standards; IT, Information technology; LTC, Health Laboratory Technical and Advisory Committee; NGO, Non-government organization; PT, Proficiency Testing; SARS, Severe Acute respiratory syndrome; SLMTA, Strengthening Laboratory Management towards Accreditation; TB, Tuberculosis; UABMS, Uganda Association of Biomedical Scientists; UMLTA, Uganda Association of Biomedical Scientists; WAFELTP, West Africa Field Epidemiology Program; WHO, World Health Organization; WHO AFRO, World Health Organization Regional Office for Africa. Authors’ contributions MMM contributed towards conceptualization, data collection, drafting and final revisions of the version to be published; NN contributed to the technical content of the information presented, conception and design of the projects, drafting and reviewing the article; DM contributed towards the conceptualization, drafting and revising the article it for important intellectual content; SG contributed towards the intellectual content and final revisions of the version to be published. Competing interests The authors declare that they have no competing interests. Acknowledgements We would like to acknowledge the input of Dr. Peter Nsubuga into the design of many of the programs we are reporting about. We appreciate our colleagues at CDC, ministries of health, and other partners who have worked tirelessly to design and implement these programs. We would also like to thank Dr. Monday Busuulwa and Mr. Aloysious Bingi of AFENET for reviewing and making editorial input. This article has been published as part of BMC Public Health Volume 10 Supplement 1, 2010: Disease surveillance, capacity building and implementation of the International Health Regulations [IHR(2005)]. The full contents of the supplement are available online at http://www.biomedcentral.com/1471-2458/10?issue=S1. Published: 3 December 2010 References 1. World Health Organization: International Health Regulations (2005). Second Edition; 2008. 2. Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA: Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 2006, 42(3):377-82. 3. Bates I, Maitland K: Are laboratory services coming of age in sub-Saharan