Program activities are designed to increase the supply of safe blood to meet national demand; build local

capacity; and contribute to the prevention of 265,000 new HIV infections in Côte d'Ivoire. These objectives

will be reached through an expansion of the National Blood Transfusion Service's (NBTS) regional blood

collection and distribution network and through improved communication with hospital blood banks.

Decentralizing collection, storage, testing and distribution activities will reduce logistical and personnel

barriers. The decentralized network will allow more blood to reach more patients in a shorter time. Key

emphasis areas are training, infrastructure, quality assurance, community mobilization, policies and

guidelines. Target populations are host country government workers and health care providers, low risk

communities, and the general population.

In FY07 NBTS aims to have 145,000 units of blood and blood products available for distribution.

The NBTS is responsible for recruiting and retaining blood donors, and for collecting, testing, processing,

storing and distributing blood nationwide. NBTS also coordinates training for donor recruiters and clinicians

who prescribe blood. Training will be organized and conducted with Social & Scientific Systems, Inc. (SSS),

the Track 1-funded technical assistance provider for blood safety in Cote d'Ivoire.

FY07 activities:.

• Five blood transfusion centers and 22 blood banks have been reopened after renovations. Four satellite

collection sites have been opened. A major upgrade to the blood tracking software and hardware will have

been completed. Two blood collection vans and one supervisor's vehicle have been procured and put in

service.

• Donor Mobilization. A Knowledge, Attitudes and Practices (KAP) survey will be completed and findings will

be used to inform donor recruitment strategies. 170 new donor clubs were established with FY07 funds.

Other public outreach activities included World Blood Donor Day, June 14.

• Strengthening laboratory testing and QA in all NBTS labs, and the development of a national

hemovigilance system. Accomplishments include: The opening of a national QA lab; expansion of the blood

products unit to reduce physicians' reliance on whole blood; the development of a hemovigilance system.

• Development and dissemination of national policies and guidelines. Work began to draft national policies

on the appropriate use of blood to treat anemia. These guidelines were based, in part, on input from a

conference on the use of blood in FY06. A follow-up conference on the use of blood for the treatment of

hemorrhages was held; input from that meeting will also inform the policy. New blood service legislation was

drafted to reinforce the legal position of NBTS within the Ivorian healthcare system. This step is essential to

ensure continued government commitment to the NBTS budget. Lastly, a laboratory reference manual was

validated and distributed.

• Training. Training from external TA providers (e.g., SSS and the Belgian Red Cross) included instruction

on the operation and maintenance of the PROGESA blood tracking software; laboratory and other stock

management best practices; M&E; blood collection and preparation; blood donor screening and selection;

the appropriate use of blood products for prescribers; and laboratory practices for lab technicians. Training

on PROGESA and other information technologies will facilitate the decentralization of activities and decision

-making to the regional centers. It will also support the QA system. NBTS staff members attended

international conferences, including the WHO Global Consultation on Access to Safe Blood in June 2007.

150 CNTS staff were trained in best practices in blood collection, donor selection, blood testing, production

and storage, and 150 peer educators and 500 prescribers and users of blood products trained in the

appropriate use of blood to treat anemia.

• M&E activities benefited from a strengthened IT network in FY07. The PROGESA blood tracking software

facilitated periodic evaluations of NBTS activities and helped produce reports to inform training as well as

operational and quality assurance decisions. Quarterly, semi-annual and annual reports were prepared and

transmitted to the CDC.

• Sustainability. NBTS implemented the recommendations from a sustainability working group. These

included initiating a process to ensure that technical skills are transferred from the PEPFAR-funded contract

staff (Equipe Projet) to the full-time NBTS staff.

FY08

Most program activities planned for FY08 will be a continuation of those undertaken in FY07. The blood

service's major partners will also remain the same, with the addition of several new blood donor

associations.

Activity 1: Rehabilitation and renovation. Work will be completed or begun on the blood transfusion centers

in Aboisso, San Pedro, Yamoussoukro, Abidjan, Bouaké, Korhogo, Man, Abengourou, Bondoukou, and

Odiénné. (Please note that some renovation projects may be delayed due to continuing levels of political

uncertainty.) Architectural studies will be completed to improve patient flow and access to the blood pick-up

window during non-business hours at the NBTS headquarters. NBTS also plans to establish three new

collection sites, for a total 9 collection sites opened since FY06. An equipment and materials needs

assessment will be performed for each site. These materials will be procured through the standard MOH

procurement system. The NBTS will also restore and equip 30 hospital blood banks in FY08. Key to this

expansion is the procurement of cold chain equipment and the acquisition of information technology to link

these centers to the NBTS network. Cold chain decisions may be informed by a proposed energy

assessment by USAID in calendar year 2007.

Activity 2: Outreach activities will encourage repeat donations from low-risk donors. New strategies based

on the results of a KAP survey will be developed to increase the pool of eligible blood donors and to

encourage these donors to give blood more than once a year. Other recruitment efforts will include radio

and television messages; blood donor clubs; public-private partnerships; and the NBTS website.

In addition, the CNTS will conduct the following public health evaluations:

- A Donor Satisfaction survey. These findings will allow the CNTS to improve customer service and increase

the number of repeat donors.

- A study on "factors of seroconversion among donors". This will allow CNTS to understand donors'

behavioral risk profiles.

Activity Narrative: Activity 3: Testing and quality control activities will include:

1. Develop a laboratory quality control system.

2. Manage the serum bank at the Abidjan center.

3. Diversify blood products according to demands from client hospitals.

4. Implement QA procedures for hospital blood banks.

5. Implement a hemovigilance system for transfused blood products.

6. Implement hygiene and safety protocols.

7. Increase the number of donors who receive their results and appropriate referrals (stigma and

discrimination; increasing gender equity).

NBTS will collaborate with national VCT and treatment centers to establish a referral system for blood

donors who test positive for HIV or other TTI. NBTS will ensure that adequate support is given to the Donor

Follow-up Center.

Activity 4: Policies and guidelines will be disseminated on the prescription and use of blood products for

hemorrhages. A second training program for 500 prescribers and users of blood products will be held. A

third conference is planned to build consensus on national guidelines for the appropriate use of blood.

NBTS will expand the blood products tracking system. New legislation will be finalized to ensure continued

government support for NBTS and safe blood activities nationwide.

Activity 5: Training for FY08 includes:

1. Instruction on the Progesa blood tracking software

2. Stock management and logistics

3. M&E

4. Best practices in blood collection, testing, preparation, and storage

5. Appropriate use of blood for physicians

6. Laboratory practices for screening and the production of blood products

Training will be provided to blood bank staff as new centers become operational. Specialized training in

serology and immunohematology will be organized for senior laboratory technicians in Belgium. A total of

250 CNTS employees and non-CNTS peer educators will be trained in FY08. 500 physicians and other

clinicians will receive training in the use of blood to treat hemorrhage. Selected NBTS staff members will

attend international conferences. In FY06 and FY07, training for laboratory staff has focused on classroom

sessions, with an emphasis on principles. In FY08, NBTS training will include practical, "hands-on", modules

to complement the classroom sessions. NBTS will work with SSS and the TA sub-contractors to identify

instructors to work with classroom instructors and lead the practical sessions. NBTS will also procure

materials needed for the practical sessions.

Activity 6: M&E activities will benefit from improvements to the information technology network. Internet-

connected IT equipment at regional sites will improve communications and record keeping. Upgrades to the

Progesa blood tracking software will improve the speed and accuracy of evaluations and reports. The NBTS

will continue to implement an integrated M&E system. An annual financial audit of the project will be carried

out by an approved auditor.

Activity 7: NBTS will continue to pursue the transfer of skills from TA consultants to NBTS staff. An

analytical accounting system for the NBTS will be developed. NBTS will also continue efforts to diversify

funding sources.