Setting priorities for which tests a hospital clinical laboratory should perform involves consideration of the expected volume of testing, its clinical impact, the technical skill levels available, the equipment needed, cost benefits, and whether testing can be obtained elsewhere. Most clinical laboratory directors in the US and other developed countries can obtain the above information via the medical literature, fellow laboratorians, specialist colleagues, sales representatives, and reference laboratories. In developing countries, such information may not be readily available and alternative testing sites, such as reference laboratories, may not be available. Here, we relate our experience in acting as a reference laboratory for the country of Eritrea and how this has been used to help set clinical laboratory priorities in Eritrea. Eritrea is situated on the horn of Africa bordering Sudan, Ethiopia, and Djibouti. Its population is currently ~3.5 million. Hominid fossils dating to ~2 million years ago have been found in Southern Eritrea, and human settlement has been dated to 8000 BC. It was part of the Aksumite empire, which dates from around the first century AD. Christianity was established in the area by the fourth century AD and Islam in the seventh century, particularly in the coastal regions of the Red Sea. In more recent times, it was an Italian colony from 1890 until 1941. The United Nations federated Eritrea with Ethiopia in 1950, but Haile Sellassie, emperor of Ethiopia, annexed Eritrea in 1962, which started a movement for independence that was finally successful in 1991 (1). The country of Eritrea was recognized by the United Nations in 1993.