Establishing Zambia's First National Malaria RDT Proficiency Testing Programme: A Model for Strengthening Sustainable Diagnostic Capacity through South-to-South Collaboration

Abstract Background Ensuring the quality of malaria rapid diagnostic testing (mRDT) remains a challenge in many resource-limited settings due to limited capacity to implement External Quality Assessment (EQA) programmes. With support from the East, Central and Southern Africa Health Community (ECSA-HC) as the regional coordinating body, Zambia established its first national malaria RDT proficiency testing (PT) programme through a South–South peer-learning partnership with Uganda’s National Reference Laboratory. Methods A descriptive implementation study was conducted across two PT cycles in 2025 using dried tube specimen (DTS)-based PT panels. Through a structured South–South collaboration facilitated by ECSA-HC, Zambia adapted Uganda’s established malaria EQA framework to its local context. Results Across the two implementation cycles, participation remained high (98% and 94%), with very satisfactory performance maintained above 94% during the expansion of the program. The diagnostic error rates remained low, with community-level testers reporting a higher rate (2.83%) than at the health facility level (0.98%). The median response and shipping turnaround time were 5 days and 13 days, respectively. The programme developed an ISO 17043-aligned quality management framework, standardised documentation and built technical capacity through a cascade Training of Trainers model, creating in - country capacity for malaria diagnostic quality assurance. Conclusions Zambia’s first national Malaria RDT PT programme demonstrates the value of South-South collaboration as a mechanism to accelerate diagnostic capacity strengthening. The partnership enabled the rapid transfer of technical expertise, quality practices, and operational experience within a shared regional context. Collectively, these findings demonstrate that South -South learning models are feasible, scalable, and capable of supporting the development of resilient laboratory systems consistent with the principles of the Africa CDC New Public Health Order.