The Global Fund, in partnership with Zambia’s Ministry of Health, is investing US$21 million to train 11,600 community health volunteers across the country. By participating in community disease surveillance, these health workers play a critical, frontline role in identifying outbreaks, especially in remote and hard-to-reach communities.

In January 2023, a community health volunteer in Zambia’s Chililabombwe District swiftly identified a cluster of children with fever and rash – early signs of measles. By promptly reporting the cases to health authorities, a rapid investigation, community sensitization, and enhanced surveillance activities were triggered. Early action not only helped communities prevent future outbreaks.

In both Kayama and Chirundu Districts, community health volunteers played a pivotal role in strengthening cholera detection and response. In Kayama, community health volunteers identified 40.5% of suspected cases, as they actively engaged in case finding, distributed chlorine and supported rehydration points. In early 2024, as cholera rapidly spread in Chirundu District, community health volunteers provided lifesaving treatment while reaching more than 850 households, 23 schools and multiple churches with education on hygiene practices to help prevent cholera from spreading.

During an anthrax outbreak in 2023, 112 community health volunteers were deployed to prevent the disease from spreading in their communities. Collaborating with traditional leaders and the government’s Department of Veterinary Services, community health volunteers identified suspected cases, traced contacts and reported alerts, becoming the frontline eyes and ears of the outbreak response. By raising awareness among households and enforcing livestock movement restrictions, community health volunteers played a crucial role in the successful containment of the outbreak.

DRC is the second-largest country in Africa. It has few reliable road systems and incredibly challenging terrain. Decades of conflict and displacement, weak health systems and environmental conditions ideal for vector-borne disease all complicate efforts to fight infectious diseases. Over the last decade, DRC has had numerous cholera, Ebola and measles outbreaks, in addition to COVID-19 and mpox.

To ramp up the country's detection of and response to outbreaks and stop them before they spread, the Global Fund, along with other partners, is investing in the government's efforts to digitize the national disease reporting and early alert system.

The system begins in communities, training frontline health workers to use a digital application to compile data on new cases of infectious disease. The data is encoded and transmitted to provincial authorities, who combine it with data from other health districts before it is sent to national health authorities at the Kinshasa-based National Centre for Epidemiological Intelligence.

Before this digital system was established, 2- to 3-weeklong delays in sharing disease surveillance data was common. With the digital system, data is transmitted with the click of a button – allowing health authorities to identify and respond rapidly to potential health threats.

In October 2022, scores of infants were admitted to hospital in Senegal struggling to breathe – health workers couldn't explain what was going on.

This is when the country's Sentinel Syndromic Surveillance System (the 4S Network) kicked into gear.

Clinicians in 38 health facilities designated as sentinel sites across Senegal relayed real-time surveillance data about the increase in infants with respiratory symptoms to a digital platform called WALIP, alerting decision makers and response teams. At the same time, samples were sent to Institut Pasteur Dakar, Senegal's National Reference Laboratory for influenza and respiratory viruses for differential diagnosis. Within 24 hours scientists deduced that the mystery illness was respiratory syncytial virus-B (RSV-B). Officials were able to respond immediately, limiting the number of babies in intensive care, and ultimately saving lives.

Through the West African Regional Laboratory Initiative (WARIL), the Global Fund is working with partners to strengthen and expand disease surveillance and laboratory systems in five new countries across West Africa. This includes establishing selected hospitals as 'Sentinel Sites' to detect emerging health threats early, allowing officials to respond rapidly and prevent disease from spreading further.

In addition to the extensive 4S network in Senegal, the 4S system has been expanded through establishing sentinel sites in Cabo Verde, Gambia, Guinea, Guinea Bissau, Mali, Mauritania, Togo, Sierra Leone, and Benin.

To reinforce regional efforts to detect and respond to emerging health threats and outbreaks in Asia-Pacific, the Global Fund is investing in the Regional Public Health Laboratory Network (RPHLN). The network strengthens national laboratory systems in 14 countries across the region, improving timeliness, accuracy and availability of diagnostic services, which leads to more reliable and faster detection of emerging outbreaks.

This network provides technical assistance and training of trainers to key laboratory experts across the region utilizing regional experts and facilitates the exchange of best practices in delivering diagnostic services through a regional knowledge-sharing platform and peer-to-peer support. The network ensures that timely, high-quality laboratory data is rapidly available to actors across the region, supporting an effective, coordinated and timely response to emerging health threats.

In total, Global Fund investments will support the training of 250 laboratory technicians from 12 countries in Asia-Pacific on diagnostics, sample transportation, laboratory biosafety, biosecurity, biological waste disposal and other essential skills. Once trained, the experts will share this knowledge by training colleagues in their own countries.

Over the past twenty years, Ukraine has made steady progress in the fight against TB, significantly reducing the number of cases. However, even before the full-scale war that began in February 2022, Ukraine still had a high TB burden, including one of the highest rates of drug-resistant TB in Europe.

The result is the reversal of years of progress in TB control in Ukraine – which could lead to an increase in transmission, drug resistance, and mortality across the country, as well as in Europe and beyond. The World Health Organization estimated that TB incidence in Ukraine in 2022 increased by 27% compared to pre-war levels.

In response, the Global Fund is adapting services to prevent the spread of TB in Ukraine. This includes supporting laboratory infrastructure to maintain diagnostic services, providing mobile medicine delivery to people in hard-to-reach communities so they can remain on treatment, and supporting community-based screening to connect people to TB services.

Wastewater testing is used to determine whether a virus or bacteria is spreading in a community before a widescale outbreak occurs. By being able to locate where a pathogen is circulating before people start to get sick, decision-makers can act fast to contain a disease and prevent it from spreading.

In six countries across East and Southern Africa, the Global Fund supports wastewater testing programs for early disease detection, including in Mozambique.

In 2022, with the support of the Global Fund, scientists at Mozambique's National Institute of Health established the Wastewater Environmental Monitoring Program. Through the program, scientists collect and test wastewater samples four times every week in four locations across the country.

Currently, Mozambique is expanding wastewater surveillance through its established integrated diseases surveillance (IDS) initiative. This initiative includes 3 regions and testing for presence of pathogens including SARS-CoV-2, Influenza, Polio, and Cholera will be done using wastewater surveillance.

The Global Fund is supporting Indonesia's Biomedical and Genome Science Initiative, which coordinates genome sequencing, bio-informatics and biobank facilities across the country.

This work includes establishing 40 facilities that can do genome sequencing: a laboratory method that – by analysing an organism's genetic details – helps to fight disease and prepare for future health threats.

The new facilities ensure laboratories across the country get rapid results. For example, before having access to genome sequencing on site, laboratory workers in the city of Batam sent samples 1,100 kilometres away to a laboratory in Jakarta, waiting weeks to get the results.

Now the whole process of preparing the sample, conducting the sequencing and doing the analysis can take as little as three days. This means people receive a diagnosis quickly and can access the treatment they need. It also means that disease outbreaks can be detected and responded to as early as possible.

Genome sequencing played an essential role in fighting COVID-19 in Indonesia; today it is being used to develop more accurate treatment and care to help fight other diseases, including TB. This demonstrates how innovative scientific tools can be used in the fight against today's most persistent and deadly diseases – as well as health threats of tomorrow.

After years of investment, including from the Global Fund, Uganda is now home to one of Africa's most robust and effective national laboratory networks, with proven experience in quickly identifying and responding to disease outbreaks.

In July 2024, Uganda's National Health Laboratories and Diagnostic Services (UNHLDS) deployed a rapid response team equipped with a mobile testing lab to Kasese District, near the border with the Democratic Republic of the Congo. The team confirmed two mpox cases – and Uganda responded rapidly.

Through UNHLDS' vast and interconnected digital network, health workers and patients send samples for testing and receive results almost in real-time. The system can also reach the most remote areas of the country through mobile laboratories. Here, lab technicians are equipped with portable biosafety equipment and can quickly travel to the site of an outbreak to safely test and identify new cases.

Identifying, testing and responding to mpox has been incorporated into health care worker training courses and operating procedures for sample transportation and testing.

Uganda's robust laboratory networks continue to provide a vital foundation for containing the mpox outbreak and keeping people everywhere protected from the disease.

A steady supply of medical oxygen is vital. Oxygen is critical not only in treating acute, chronic and surgical conditions, but also in preventing death during a respiratory disease outbreak.

The COVID-19 pandemic brought this into sharp focus, revealing an acute lack of medical oxygen in many countries around the world – including Bangladesh. In 2020, an assessment revealed that 70% of health facilities in Bangladesh lacked sufficient medical oxygen.

In response, through the COVID-19 Response Mechanism, the Global Fund invested US$15.7 million to transform the country's ability to meet its ongoing medical oxygen needs – as well as increased needs during other health emergencies.

The funding established 29 medical oxygen plants, all installed in newly built plant houses and connected to local medical gas pipeline systems. 153 engineers, technicians, and operators have been recruited and trained to maintain the plants.

In total, this investment will provide 11.5 billion liters of oxygen per year – the equivalent of treating 2 million cases of childhood pneumonia, a disease that kills 24,000 children in Bangladesh annually. When needs rapidly increase during future epidemics or pandemics, these new facilities will also ensure an adequate supply of medical oxygen.

The Philippines was severely impacted by COVID-19, enduring the world's longest lockdown. Like in many countries, health facilities were overwhelmed, oxygen supplies dwindled and families mourned the loss of tens of thousands of loved ones. The pandemic also threatened to unravel decades of progress fighting HIV, TB and malaria.

Through the COVID-19 Response Mechanism, the Global Fund invested US$65.8 million to combat COVID-19 in the country, which has strengthened health systems to protect against outbreaks and future pandemics and mitigated the global pandemic's impact on the fight against HIV, TB and malaria in the Philippines.

These investments have had a profound impact on the country's ability to detect and fight infectious diseases – fortifying the country's defenses against future health threats.

A national network of 14,609 health workers, including those in remote regions, have been trained to detect, report and respond to health threats immediately. National data warehouses and dashboards have been developed to integrate disease-related data from various sources from across the country, better informing decision-makers to understand the emergence of disease and rapidly react when necessary.

And these investments have strengthened laboratory networks. This includes improving diagnostics in regions prone to outbreaks of emerging bacterial and fungal diseases. Through Global Fund investments, the Philippines returned to pre-COVID-19 TB case finding levels by 2023, and is better prepared to respond to the next global health threat, keeping everyone, everywhere safer.