The National Blood Transfussion Service (NBTS), part of the Ministry of Health and Public Hygiene (MSHP)

of Cote d'Ivoire, is responsible for recruiting and retaining blood donors and for collecting, testing,

processing, storing, and distributing blood nationwide. The NBTS also coordinates training for donor

recruiters and clinicians who prescribe blood.

PEPFAR-supported program activities of the NBTS are designed to increase the supply of safe blood to

meet national demand, build local capacity, and contribute to the prevention of HIV infections. These

objectives will be reached through an expansion of the 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 to access to donation and

transfusion. 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, health care providers, low-risk

communities, and the general population. In FY09, the NBTS aims to have 160,000 units of blood and blood

products available for distribution.

FY08 funding is supporting the following NBTS activities:

• Rehabilitation and renovation: Nine blood transfusion centers and 41 blood banks are being reopened

after renovations. Three new satellite collection sites are being opened and equipped, for a total of nine new

sites since 2006. Two blood collection vans and three supervisor vehicle are being procured and put in

service. The software PROGESA is being upgraded to E-PROGESA at the Abidjan NBTS, and hardware is

being purchased.

• Donor mobilization: The findings of a knowledge, attitudes, and practices (KAP) survey will be used to

inform donor recruitment strategies. Sixty new donor clubs are being established. Other public outreach

activities include World Blood Donor Day, a national blood donor day, and NBTS open house events.

• Strengthening of laboratory testing and quality assurance in all NBTS labs and development of a national

hemovigilance system: A new national quality assurance (QA) lab was established and equipped to expand

the capacities of blood product units in Abidjan and Daloa. This will reduce physicians' reliance on whole

blood. The NBTS is developing a hemovigilance system, starting with systems to improve the traceability of

blood products. In addition, an NBTS Quality Management Manual is being prepared.

• Development and dissemination of national policies and guidelines: Work has begun to draft national

policies on the appropriate use of blood to treat anemia. These guidelines are based in part on input from

conferences during FY06-FY08, including a conference on the legal framework of blood transfusion in Côte

d'Ivoire. This groundwork was essential to reinforce the legal position of the NBTS within the Ivoirian health-

care system and to ensure continued government commitment to the NBTS budget. In addition, a reference

manual on the clinical use of blood products was approved and distributed.

• Training: Training from external technical assistance providers (Social and Scientific Systems Inc. (SSS),

Belgian Red Cross) includes instruction on the operation and maintenance of the PROGESA and E-

PROGESA blood tracking software to facilitate the decentralization of activities and decision-making to the

regional centers and to support the QA system. Training is also being conducted in best practices in

laboratory and other stock management, monitoring and evaluation (M&E), blood collection and

preparation, blood donor screening and selection, and the appropriate use of blood products for prescribers.

Training on clients' reception at blood collection and distribution units are being organized, as well as

training of peer educators. NBTS staff capacity is being built through short courses and practical trainings in

France and Belgium as well as international conferences. Altogether, 150 CNTS staff are being trained in

best practices in blood collection, donor selection, and blood testing, production and storage, and 100 peer

educators and 200 prescribers and users of blood products are being trained in the appropriate use of blood

to treat anemia and hemorrhages.

• Monitoring and evaluation: M&E activities are benefiting from an information technology network that was

strengthened with USG support in FY07. The newly installed E-PROGESA blood tracking software

facilitates periodic evaluations of NBTS activities and helps produce reports to inform training as well as

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

transmitted to the PEPFAR country team.

• Sustainability: The NBTS is implementing the recommendations of its sustainability working group,

including developing and implementing a process to ensure that technical skills are transferred from

PEPFAR-funded contract staff ("Equipe Projet") to other NBTS staff.

FY09 funding will support the continuation of FY08 activities, with an emphasis on the sustainability of the

project's activities and on bridging into the PEPFAR Phase 2 blood safety project. The blood service's major

partners will remain the same, with the addition of several new blood donor associations. Altogether, FY09-

funded activities will support 77 service outlets and provide training for 800 people by September 2009.

Specific activities will include:

1. Rehabilitation and renovation: Renovation activities will be completed or launched for blood transfusion

centers in Abengourou, Bondoukou, and Abidjan, increasing the number of blood transfusion centers

nationwide to 11. New blood collection sites will be opened in Ferkéssedougou, Bonoua, and Adzopé,

increasing the number of blood collection sites to 12. Each new center and site will be provided with blood

collection vehicles and supervision vehicles, as well as materials and equipment, procured through the

standard procurement system of the MSHP. The NBTS will also restore and equip 12 hospital blood banks.

Key to this expansion of blood transfusion activities is the procurement of cold-chain equipment and the

acquisition of information technology to link these centers to the NBTS network.

2. Donor recruitment and mobilization: New strategies based on results of a KAP survey will be developed

to strengthen outreach activities and encourage repeat donations from low-risk donors. Partnerships with

donor associations will be reinforced to emphasize community-based activities that will help increase the

pool of eligible blood donors and encourage these donors to give blood more than once a year. Other

recruitment efforts will include radio messages (in partnership with community radio stations), television

messages, a TV series on blood donation, creation of new blood donor clubs, new public-private

partnerships, and information on blood donation through the NBTS Web site. In addition, the NBTS will

Activity Narrative: organize an experts meeting on blood donation, donor mobilization, and donor recruitment.

3. Testing and quality control activities, including:

a. Manage the laboratory quality control system.

b. Manage the inter-laboratory quality control system (NBTS, blood collection centers, and university

hospitals).

c. Diversify blood products according to demand from client hospitals.

d. Implement QA procedures for hospital blood banks.

e. Implement a hemovigilance system, especially a traceability system for transfused blood products,

including information about the proportion of HIV patients receiving blood products.

f. Implement hygiene and safety (H&S) protocols. The H&S standard operating procedures defined for

NBTS units will support this process.

g. Increase the proportion of donors who receive their test results and are given appropriate referrals.

h. Establish agreements with the National HIV/AIDS Care and Treatment Program (PNPEC) for the referral

and treatment of donors who test positive for HIV and other transfusion transmissible infections (TTI). Donor

associations working with the NBTS, in partnership with local/community organizations involved in the care

and treatment of HIV-positive patients, will support this referral system.

i. Establish agreements with the PNPEC for the referral of HIV-negative clients from counseling and testing

(CT) centers to the NBTS as potential donors. Donor associations working with the NBTS will help recruit

HIV-negative clients from CT centers in their communities.

The blood centers in Daloa, Bouaké, Korhogo and Yamoussoukro will be equipped with blood screening

automates. The NBTS will ensure that adequate support is given to the Donor Follow-up Center.

4. Policies and guidelines: National policy documents on the prescription and use of blood products for

anemia and hemorrhages and on the legal framework for transfusion in Côte d'Ivoire will be disseminated

through workshops at the national level to all actors involved in transfusion activities (MSHP, NBTS, hospital

blood banks, prescribers, users, etc). These policies and guidelines will reinforce good clinical use of blood

products and the legal position of the NBTS within the Ivoirian health care system, which will ensure

continued government support for the NBTS and safe blood activities nationwide. A third training program

for 150 prescribers and users of blood products will be held. A consensus conference is also planned to

evaluate the cost of production and the retail prices of blood products. This will allow for better allocation of

government support and for improved financial resources mobilization.

5. Training will cover:

a. Use of the E-Progesa blood tracking software: 40 physicians, pharmacists, computer experts, engineers,

and biotechnologists.

b. Stock management and logistics: 30 pharmacists, physicians, and logistics experts.

c. M&E: 50 physicians, pharmacists, engineers, and computer experts.

d. Best practices in blood collection, testing, preparation, and storage: 150 physicians, pharmacists, nurses,

engineers, and technicians.

e. Appropriate use of blood: 350 physicians, nurses, and technicians.

f. Laboratory practices for screening and production of blood products: 40 physicians, pharmacists, nurses,

engineers, and technicians.

g. Quality assurance: 140 pharmacists, physicians, nurses, engineers, and technicians.

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

serology and immunohematology, quality assurance, and hemovigilance will be organized for senior staff

(physicians, laboratory technicians, etc.) in France and Belgium. Selected NBTS staff members will attend

international conferences. Using FY09 funding, NBTS training will continue to include practical, "hands-on"

modules to complement classroom sessions.

6. M&E: Internet-connected IT equipment at regional sites will improve communications and record keeping.

The purchase of ArcView software will enable the NBTS to establish a cartography of its network of centers,

blood collection sites, and blood banks. Installation of the E-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 and programmatic audit of the project will be carried out by an approved

auditor.

7. Sustainability: The NBTS will continue to implement recommendations from its sustainability working

group, particularly for the mobilization of funds at the national and international levels. The NBTS will

continue the transfer of skills from technical assistance consultants to NBTS staff and will implement

activities such as the development of an analytical accounting system and a final evaluation of the project to

identify areas requiring additional emphasis and support, which will also serve as a justification for renewed

partner commitments.

For the effective implementation of activities with FY09 funding, the NBTS will continue to seek technical

assistance in blood safety and transfusion. Since Track 1 technical assistance provider SSS is phasing out

its project, the NBTS will now contract directly with various national and international technical assistance

providers.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15137

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15137 9707.08 HHS/Centers for Ministry of Health, 7057 4933.08 Track 1 MOH- $4,000,000

Disease Control & Côte d'Ivoire CNTS (Blood

Prevention Safety)

#U62/CCU0236

49

Emphasis Areas

Construction/Renovation

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $400,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety

Total Planned Funding for Program Budget Code: $2,096,851

Total Planned Funding for Program Budget Code: $0

Table 3.3.05: