Workshop on external competence assessment and national competence assessment for malaria microscopists (ECAMM and NCAMM)

The Workshop on external competence assessment and national competence assessment for malaria microscopists (ECAMM and NCAMM) was convened virtually, from 24 to 25 June 2021. Organized by the Malaria unit, CDS-SEARO, it brought together more than 70 participants from the 10 South East-Asian countries: Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste including  representatives from the national malaria control programmes and head of laboratories; focal points from countries, as well as technical experts and partners to review the current status of microscopy trainings, NCAMMS and ECAMMS and Microscopy QA as a whole. Technical experts and WHO CC shared updates, Standard Operating Procedures and best practices. 

The main discussion points included the microscopy QA status per country, challenges to continue the proficiency trainings given the pandemic since last year, slide banks, external competency assessment (EQA) programme, and set-up of national reference laboratory (NRL) as a pre-requisite to elimination and support from WHO. 

General Objective:

To review the programmes of external competence assessment of malaria microscopists (ECAMM) in South-East Asia Region and national competence assessment for malaria microscopists (NCAMM) in the Member States and plan the way forward 

Specific Objectives: 

1. To review and evaluate the programme of external competence assessment of malaria microscopists (ECAMM) in South-East Asia Region; and of national competence assessment for malaria microscopists (NCAMM) in the Member States; 
2. To review the status and capacities of national reference laboratories in the Member States;
3. To review the uptake and challenges for virtual trainings/ ECAMMS and use of digital technologies for capacity building;
4. To discuss and agree on a new roadmap for ECAMM and NCAMM in the Region including intercountry and regional support for External Quality Assurance (EQA) and reference materials.

Key Findings

• ECAMMS could not be conducted as planned for 2020 and 2021
• SOP’s for virtual ECAMMS are in place but there are challenges (most challenges can be overcome with effective internet and suitable Local Facilitator)

• Extension of certificates of competence is one of stop gap measures done by WHO globally last year. An issue under discussion at GMP HQ in consultation with other regions is whether a maximum of two years’ extension will be allowed.
• The NRLs and good slide banks are not existing/functional in most of countries.
• NCAMMS conducted only in 2 countries in recent years.
• Few refresher trainings were conducted but many deferred.
• Different standards were being followed including accreditation for NRL and NCAMMS, despite access to WHO guidelines on Malaria Microscopy QA and SOPs.
• Funding is generally not an issue, but more technical support is desired by countries.

Way Forward

• Need to recognize that quality microscopy is critical for all countries in line with the malaria elimination framework. National programs should have a short-term and long-term plan for diagnostics quality assurance and setting up the NRL. 
• Capacity building and expertise in microscopy should be available not only the national level but more importantly at the lower levels, since these are the front-line workers delivering the services.
• Identification of qualified local facilitators and networking should be done by countries with guidance from WHO, including the ECAMM Lead Facilitator.
• Regular refresher trainings also need to be conducted by certified resource persons using quality slide panels.
• Organize a training of trainers (ToT) for the national core of trainers of existing L1/L2s that can cascade the training to microscopists at the periphery. 
• WHO and programs should encourage/support countries to conduct regular NCAMMs.
• Use of e-learning platforms needs to be promoted and improved, looking also at local conditions of available information technology.
• Countries should maintain standards and quality of NCAMM, NRL and slide banks with support from WHO including collaborating centres (CC).
• WELCOMM training course needs to be promoted by the National Programme.
• More innovative approaches need to be adopted for continuity of activities related to quality assurance in malaria microscopy (QAMM), including the necessary public health safety measures (PHSM) and IPC given the current pandemic.