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Accreditation is emerging as a preferred framework for building quality medical laboratory systems in resource-limited settings. Despite the low numbers of laboratories accredited to date, accreditation has the potential to improve the quality of health care for patients through the reduction of testing errors and attendant decreases in inappropriate treatment. Accredited laboratories can become more accountable and less dependent on external support. Efforts made to achieve accreditation may also lead to improvements in the management of laboratory networks by focusing attention on areas of greatest need and accelerating improvement in areas such as supply chain, training, and instrument maintenance. Laboratory accreditation may also have a positive influence on performance in other areas of health care systems by allowing laboratories to demonstrate high standards of service delivery. Accreditation may, thus, provide an effective mechanism for health system improvement yielding long-term benefits in the quality, cost-effectiveness, and sustainability of public health programs. Further studies are needed to strengthen the evidence on the benefits of accreditation and to justify the resources needed to implement accreditation programs aimed at improving the performance of laboratory systems.

Expanding health care services for HIV, tuberculosis, and malaria has increased the demand for affordable and reliable laboratory diagnostics in resource-limited countries. Many countries are responding by upgrading their public laboratories and introducing new technology to provide expanded testing services into more regions. This expansion carries the risk of increasing the diversity of an already highly diverse technology and testing platform landscape, making it more difficult to manage laboratory networks across different levels of the health care system. To prevent this trend, countries are recommended to implement policies and guidelines that standardize test menus, technology, platforms, and commodities across multiple laboratories. The benefits of standardization include rational prioritization of resources for capacity development and more efficient supply chain management through volume-based price discounts for reagents and instrument service. Procurement procedures, including specification, prequalification, and contract negotiation, need to align with the standardization policies for maximum benefit. Standardization should be adhered to irrespective of whether procurement is centralized or decentralized or whether carried out by national bodies or development partners.