Strengthening Malawi’s Measles & Rubella Surveillance—Kamuzu Central Hospital Laboratory Achieves Full WHO Accreditation (2025–2026)

For years, Malawi's Kamuzu Central Hospital (KCH) laboratory has served quietly but decisively as the national hub for confirming measles and rubella cases. Its work underpins the country's immunization programme validating suspected outbreaks, guiding vaccination campaigns, and helping health teams distinguish local transmission from imported cases. Until recently, this essential laboratory operated under provisional WHO accreditation, reflecting both its commitment and the journey still ahead to meet every global standard. In October 2025, that journey reached a pivotal milestone: following a rigorous, on-site assessment by specialists from the WHO Regional Office for Africa and the Regional Reference Laboratory (NICD, Johannesburg), the KCH measles/rubella serology laboratory was fully accredited for the period 2025-2026.

This achievement is more than a technical upgrade, it is a confidence boost for Malawi's health security and a tangible assurance to communities that laboratory-confirmed results are accurate, timely, and actionable. The assessment examined the full spectrum of quality and performance: the physical environment, biosafety practices, equipment calibration and maintenance, staff competencies, adherence to standard operating procedures (SOPs), data systems, internal quality control (IQC), external proficiency testing (PT), and operational coordination with surveillance and EPI teams. KCH scored 94% on the General checklist and 84% on the Serology checklist, both above the ≥80% threshold required for national-level accreditation. In proficiency testing, the "gold standard" for demonstrating reliable results, the laboratory achieved 100% accuracy for measles and 100% accuracy for rubella, matching the reference results from the Regional Reference Laboratory. Turnaround time, a critical measure during outbreaks stood at 84% against an ≥80% target, showing strong performance and room for continued improvement.

Behind these numbers is a human story of dedication and problem-solving. The KCH serology team of five experienced staff with cross-cutting skills has navigated the realities of a compact workspace, shared amenities, and legacy infrastructure. The laboratory is clean, organized, and efficient, but the assessment identified practical needs that will further strengthen safety and performance: a Class II biological safety cabinet for receiving and inspecting fresh specimens, a small autoclave to ensure consistent sterilization, a dedicated fridge for reagents, and desktop/laptop computers to enhance data management and enable the interface between the ELISA reader and the laboratory information system. These investments are not about "nice-to-have" equipment; they are the safeguards that keep staff protected, reduce risk of contamination, and prevent delays or data errors, ultimately ensuring that every test result can be trusted.

Quality systems were a central focus of the accreditation process. The reviewers noted strong technical skills among staff, consistent application of internal quality controls, and good collaboration with EPI and field surveillance teams. They also encouraged targeted improvements in document control and SOP coverage (especially specimen management), streamlining sample reception to reduce congestion, and fully activating the software interface to eliminate manual transfer of test reads. Guidance was provided on-site, and the lab has already taken steps to clarify roles and responsibilities in its organogram to strengthen accountability. These are the kinds of pragmatic changes that donor investments can accelerate; simple, measurable enhancements that compound into better performance week after week, outbreak after outbreak.

For Malawi's immunization and surveillance programmes, the impact is immediate and concrete. Full WHO accreditation means that case confirmations carry internationally recognized quality assurance, enabling faster decisions and more targeted interventions. In practical terms, when a suspected measles or rubella case is reported from a district clinic, the KCH lab can process specimens swiftly, generate validated results, and transmit them to EPI/MoH teams in time to mobilize vaccination, protect health workers, and inform communities. This reliability is especially vital during multi-campaign periods such as the HPV MAC and Mpox responses when system bandwidth is strained and coordination matters. The lab's performance supports verification of elimination progress, provides the evidence base for adjusting strategies, and anchors the trust that communities place in public health guidance.

Donor confidence hinges on stewardship and transparency, and the KCH laboratory brings both. Zero tolerance for quality lapses is embedded through IQC routines and participation in WHO External Quality Assessment (EQA). Equipment calibration procedures are active, and the lab aligns with regional norms via NICD confirmatory testing and WHO proficiency testing. Data reporting to EPI/MoH meets timeliness benchmarks, and the lab collaborates closely with surveillance teams to prioritize testing during outbreak conditions, balancing speed with careful kit management to avoid stock-outs. These operational disciplines reduce waste, limit errors, and extend the life of critical commodities, exactly the kind of value donors seek in health system investments.

The accreditation also clarifies a forward-looking investment roadmap that donors and partners can support:

1. Safety & Infrastructure Upgrades
   • Procure and install a Class II biosafety cabinet, autoclave, and reagent fridge.
   • Improve specimen reception flow and spill-management supplies (broad-spectrum disinfectants, bench mats, dilution tubes, paper towels, handwash stations).
2. Digital & Data Strengthening
   • Equip the lab with desktop and laptop computers and activate the ELISA-LIS interface to eliminate manual data transfer.
   • Enhance database reliability and analytics to support real-time reporting and dashboards for EPI decision-making.
3. Quality Management & SOPs
   • Complete SOPs for specimen management, document control, and data traceability; implement routine audits and refresher training.
   • Continue participation in WHO PT and NICD confirmatory testing; expand internal audits tied to turnaround and accuracy KPIs.
4. Sustainability & Integration
   • Establish a dedicated budget line for essential consumables and maintenance, integrated within MoH/EPI planning.
   • Formalize joint reviews with surveillance and immunization programmes to keep performance aligned with national priorities.

The story of KCH's accreditation is, at heart, a story about people; laboratory professionals working diligently in constrained spaces; surveillance officers coordinating specimen flow from districts; EPI managers using timely results to protect children; and communities relying on the health system to act quickly and decisively. When a mother brings her child to a clinic with rash and fever, the promise of a trusted laboratory result matters. It shapes a clinician's decisions, guides the vaccination team's deployment, and reassures families that the system is responsive. Accreditation turns that promise into a guarantee.

For donors, this milestone signals a high-return investment opportunity: targeted support to a proven, high-performing laboratory that directly strengthens outbreak detection, accelerates immunization impact, and advances Malawi's progress toward measles and rubella elimination. The laboratory now stands on a recognized platform of quality; strategic investments will make that platform broader, safer, and more resilient. As the KCH team continues its work under full WHO accreditation, Malawi's health system is better positioned to detect faster, confirm with confidence, and act sooner, saving resources, preventing outbreaks, and safeguarding lives.

Every accurate test is a step toward prevention. Every timely result is a day saved in response. Every strengthened lab is a stronger shield for Malawi's communities.