This is a continuing activity from FY05 and FY06. The partner received 100% of FY06 funds and is on track according to the original targets and work plan. We have increased funding based on the performance and achievements to date, priorities of the Ethiopian Ministry of National Defense and US Department of Defense and previous investments in FY04, FY05, and FY06.

Current Program Context: The NDFE determined established a blood program to support ongoing NDFE blood transfusion requirements and future operational contingencies. The NDFE currently relies on the Ethiopian Red Cross Society (ERCS) for their supply of blood products. However, the ECRS has been unable to adequately supply blood to the military because of commitments to civilian hospitals and the unique nature of military operations. The NDFE has the potential capacity to rapidly mobilize large numbers of blood donors to meet their blood needs. However, aside from infrastructure insufficiencies, there are no standardized guidelines for blood transfusion practice within the NDFE. Implementation of standardized transfusion practice guidelines would further reduce potentially unnecessary transfusions and reduce the potential exposure to blood borne infectious diseases. An initial assessment for the blood program was undertaken from 8-15 Sept 2004 to evaluate the requirements as set forth in the Preliminary NDFE Report, "A Profile of Hospital-Based Blood Bank Establishment Project", of 27 April 2004. Based upon initial discussions with representatives of NDFE, the Director of the ERCS in Addis Ababa, and CDR. Mark of the US Navy Blood Bank, review of the Preliminary Report and proposal with outstanding issues were outlined.

As the United States Military Blood Program consists of strategically located blood collection sites associated with large accessible donor populations, limited testing sites to reduce cost and regulatory oversight risks and a well defined blood distribution program. The NDFE will implement a blood program using components of the United States Military Blood Program as a model. To meet the objectives we will: (1) Establish a central blood collection, processing, and storage facility at the Bella Defense Forces Central Referral Hospital which will also serve as a "center of excellence" for training and also as a template for the establishment by ENDF of additional blood banks at other field referral military hospitals throughout Ethiopia. (2) Perform mobile blood collections from newly accessioned recruits, potentially offering a safer donor pool since recruits are pre-screened from transmissible agents upon entry into the NDFE. Other military personnel are considered as donors if their proximity to blood banks is optimal for their mobilization. (3) Define and establish a realistic safe blood distribution network based upon peacetime, wartime and other national (natural or manmade) emergencies in coordination with the national program or delivery of outreach safe blood transfusion services to communities around military deployment areas. (4) Collaborate with the Ministries of Health, The Ethiopian Red Cross Society and World Health Organization (WHO) to develop and implement guidelines for blood administration, safe transfusion therapy, and an ongoing training and Quality Assurance (QA) program to maintain safety for all aspects of the blood program.

Program Implementation Strategy: Using a phased approach (through FY' 08) build a central military blood bank and a reliable safe blood distribution network/transfusion sights (Total of 6).

The military blood Safety Program is demonstrating a commendable and up to schedule performance: (1) A Program implementation team with US Naval Medical Center San Diego, NHRC, and PEPFAR DOD Ethiopia as participating members: - Efforts on development of SOP for the military blood bank and transfusion centers' staffing and management, - Development of curriculums and conduct of primary hands-on and on-going training, - Development of needed equipment list for the blood collection, processing, storage, distribution and transfusion services; facilitate procurement, delivery, and installation of the equipment at the appropriate sites. - Research and adapt software system to track and control safe blood and blood components. - Work with WHO, MOH, ERCS, and CDC to maintain international and national standards;

and harmonization with the National Program activities.

(2) Accomplished tasks: - Over 70% of the work on the renovation of a building at Bella Military Hospital to serve as a center of excellence for training, for blood collection, blood processing and production of blood components, storing and distribution of safe blood and manufactured components has been accomplished. Completion of the renovation work is planned for end of September, 2006. - Staffing, organization, and SOW proposals have been completed and submitted to the ENDF Health Services Management for comments and subsequent implementation. - Hands on training at the Blood Bank for the Naval Medical Center in San Diego (15 Sept. - 8 Oct., 2006) has been programmed for 3 Ethiopian military Blood Center senior staff members. In country on-going training has also been planned for 30 medical technologists after the initial hands on training at NMCSD. The on-going training for the medical technologists will be done by the 3 trained Ethiopian military Blood Center senior staff members with cooperation and assistance of specialists from NMCSD. - Procurement process of equipment is in progress.

FY04, FY05 and non-PEPFAR Military Health Affairs funding has enabled renovation of a building for the Central Blood Bank at Bella Defense Central Referral Hospital, and also provision of most of the equipment and supplies for this center.

In FY07, additional funding will establish three safe blood outreach sites or hospital based transfusion centers at Mekele, Gondar, and Harar. Provision of consumables for the Bella Central Blood Bank and the hospital's transfusion Center will also be covered.

In FY07, additional funding will establish four safe blood outreach sites or hospital based transfusion centers at Mekele, Gondar, Harar and a TBD location. Provision of consumables for the Bella Central Blood Bank and the hospital's transfusion Center will also be covered.

Infection Prevention Program for the Ethiopian National Defense Forces (ENDF)

Since 2003, with the full participation and technical support from DHAPP, infection prevention measures have been fully established in the initial phase of the activity within three military central referral hospitals (Armed Forces Teaching general Hospital, Bella Defense Central Referral Hospital, and Air force Hospital).

The activities already established are: (1) Questionnaire developed on infection prevention prophylaxis to determine the risk factor among HCW. (2) Infection Prevention training of 275 physicians, HCW and health service rendering facilities support staff. (3) Contaminated waste and sharps collection & disposal units. (4) Infection prevention equipment i.e. disposable & surgical gloves, disposable syringes, respiratory masks, gowns.

Proposed FY07 Activities This activity will be maintained at 7 referral hospitals and expanded to 31 divisional hospitals (i.e. equivalent to health centers) under the referral (Corps-level) hospitals (103rd Corps hospital at Harar, 105th Corps hospital at Kombolcha , 107th Corps hospital at Mekele, 108th Corps hospital at Shire, 109th Corps hospital at Awassa, 110th Corps hospital at Gondar ) and training centers with a total complement of 33 physicians, 1402 nurses, 35 Health Officers, 515 Health Assistants, 626 technicians, 3,613 sanitarians and public health workers, i.e. by the end of FY' 07 we would achieve 6,228 new infections averted and assure qualitative medical service to patients with opportunistic infections (i.e. approximately 40% of all inpatients throughout the military hospitals and health rendering facilities) in a minimal infection risk environment.

DHAPP

In 2002, the Defense HIV/AIDS Prevention Program (DHAPP) assisted the Ethiopian National Defense Health Services in establishing the first VCT services at Armed Forces Teaching General Hospital and Bella Defense Referral Hospital in Addis Ababa, and Air Force Hospital in Debrezeit.

The need to expand the services was realized due to the huge demand of these services within the military, and the disparity of Military Units through wide deployment areas in and around all of the regional states throughout the country. In 2003 and 2004, 6 additional Sites were also established reinforcing existing capacities and providing accessibility of these services to larger numbers of defense civilian employees, active duty and retired servicemen, and their dependants. The general standard set-up of a site is made up of 1 site coordinator nurse, 2 counselors, and 1 laboratory technician. In the year after 2003 the provision of counseling and testing services and availability of ARV for individual service members who could cover the ARV costs made it possible for reorganizing the VCT sites to integrate ARV therapy. The site at the Armed Forces Teaching Hospital is established as one of the models to other VCT services in the country with integrated STI and TB clinics, and ART. The classroom and conferencing facility within this VCT site as also made it the focal place for training of military physicians, nurses, and HCW on counseling, testing and ART management. The issue of provision of HIV Test Kits, standard VCT laboratory equipment and furniture, for the military VCT had, since 2001 through 2004 been resolved through DOD programming. The same has been true in FY05 program implementation, i.e. planning, procuring, and delivery of HIV test kits for all 11 military VCT sites was done through the DOD mechanism, the only to date existing source, for the military program. FY'07, planning considers for provision of HIV Test Kits for 14 sites (9 stationary and 2 already existing mobile and, additional 3 new mobiles under FY06 COP). NB: military VCT is not a Global Fund supported activity.

In FY07, we will within the overhaul MOND VCT make services available for the following number of clients.

The DoD has natural partnerships with uniformed services of host nations, an especially high risk population. It has experience building physical infrastructure, including hospitals and laboratories, and experience providing services to communities around military bases. DoD also has the ability to mobilize quickly to fill gaps on an ad hoc basis.

Military HIV/AIDS and STD Program Management Officer, under the direction of The Security Assistant Officer and within the limits of resources allocated, authorization obtained from the Defense HIV/AIDS Pr evention Program (DHAPP), and provides financial and technical support to The Ethiopian Ministry of National Defense, on its HIV/AIDS prevention and treatment efforts.