The recent publication in Lancet Microbe, titled “Bacteriology Testing and Antimicrobial Resistance Detection Capacity of National Tiered Laboratory Networks in Sub-Saharan Africa: An Analysis from 14 Countries” presents a critical assessment of antimicrobial resistance (AMR) detection capabilities in a region that experiences one of the highest burdens of AMR globally. This study identifies key gaps in laboratory infrastructure and operational readiness while offering actionable recommendations for enhancing AMR surveillance systems. 

Uneven Capabilities: The Reality 

Analysing data from 14 countries, the study indicates that among more than 53,000 documented clinical laboratories, only 1% are formally designated to conduct bacteriological testing, with an even smaller amount possessing capacity for antimicrobial susceptibility testing (AST). These findings also reveal notable differences among laboratory tiers. Reference laboratories hold superior resources and exhibit significantly higher readiness scores than district facilities. Meanwhile, district laboratories lack essential infrastructure, such as the availability of certified and functional biosafety cabinets (70% vs 36%).  

Infrastructure Deficiencies 

Resource limitations severely constrain the reliability of bacterial testing. While most laboratories reported access to water (88%) and electricity (87%), only 23% were accredited to ISO15189 standards, which help establish quality and competence benchmarks for medical laboratories. Additionally, only 21% utilised automated methods for pathogen identification and 18% for AST, limiting diagnostic efficiency and scalability. Many laboratories also rely on paper-based data systems, with just 15% employing electronic laboratory information systems (LIMS), hindering effective data management, data quality checks and onward reporting. 

Variability in Access 

Geographical inequities compound the issue. In Kenya, approximately 82% of the population has access to AST, whereas in Sierra Leone, this figure drops to 29%. Across the 14 countries analysed, an estimated 136 million people lack access to essential AST services. These disparities not only hinder timely diagnosis and effective treatment but also increase the risk of unmonitored AMR outbreaks. This lack of coverage poses a key hurdle to formulating integrated national and international AMR strategies. 

Study Recommendations  

Here are some selected recommendations from the authors to improve national laboratory capacity and AMR detection: 

1. Expand access to bacteriology diagnostics, ensuring availability in at least 50% of clinical laboratories or for 80% of the population. 

2. Strengthen infrastructure through targeted investments in quality assurance activities, diagnostics, laboratory equipment, and electronic data systems. 

3. Prioritise bacterial testing and AST in national AMR action plans, with enforced quality management systems (adherence to international AST standards) and adequate resource allocation. 

4. Designate and strategically locate AMR surveillance sites to enhance geographical coverage and improve data representativeness. 

5. Transition from paper-based to electronic laboratory information systems, ensuring consistent and reliable data reporting (esp. into World Health Organization’s Global Antimicrobial Resistance Surveillance System (GLASS)). 

6. Align AMR efforts with broader health system initiatives and engage stakeholders across public and private sectors, whilst strengthening accountability mechanisms. 

Implications 

The results of this study underscore the crucial role of resilient laboratory systems in combating AMR, not only in the studied countries but globally. By investing in local laboratory infrastructure and governance, countries can enhance AMR surveillance, improve healthcare systems, and enable the early detection of public health threats. 

The countries highlighted in this research hold the potential to demonstrate the transformative impact of prioritised, multisector investments in laboratory capacity. If these approaches are scaled globally, they could significantly alter the trajectory of AMR burden, safeguarding effective antibiotics and saving lives. This should serve as another compelling call to action for policymakers, funders, and stakeholders to address these pressing gaps.