ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

1.WITH MOST OF THE COUNTRY'S BLOOD SUPPLY COLLECTED FROM VOLUNTARY DONORS (60%

DURING THE FIRST 6 MONTHS OF 2008) PRIMARILY FROM BLOOD MOBILE DRIVES

3.CONTINUE TO MENTOR AND GUIDE THE NEW LEADERSHIP IN EFFICIENT OPERATIONS AND

MANAGEMENT OF THE NBTS, IN FY08 THERE HAS BEEN SOME CHALLENGES IN MAINTAINING

THE CONSISTENCY OF LEADERSHIP AND DIRECTION FOR THE OPERATIONS OF THE BLOOD

TRANSFUSION SERVICES

Blood safety activities are closely integrated with the Injection Safety and Laboratory Infrastructure program

areas. Blood Safety also has linkages to maternal health aspects of the PMTCT program area; social

mobilization activities in the Condoms and Other Prevention program area; patient referral systems and

confidentiality issues under Counseling and Testing; and data collection and management under Strategic

Information. The project's main objective is to provide a safe and adequate blood supply to people living in

Guyana. All program activities are coordinated by the Ministry of Health's National Blood Transfusion

Service (NBTS). Target Populations: Healthy adults, principally youth, are targeted for recruitment as blood

donors. Women who hemorrhage during and after childbirth, children suffering from anemia, and surgery

and trauma accident plus patients who become anemic as a result of HIV antiretroviral medication will be

the primary beneficiaries of a safe blood supply. Approximately five thousand young potential donors are

expected to be reached thru the give blood save lives campaign, which encompass healthy lifestyle

messages.

The project's main objective is to provide a safe and adequate blood supply to people living in Guyana. All

program activities are coordinated by the Ministry of Health's National Blood Transfusion Service (NBTS).

Emphasis Areas: Information, Education and Communication; Community Mobilization/Participation; Quality

Assurance, Quality Improvement and Supportive Supervision; Development of Network/Linkages/Referral

Systems; Commodity Procurement and Logistics and safe blood as an essential medication.

Target Populations: Healthy adults, principally youth, are targeted for recruitment as blood donors. Women

and children with anemia due to malaria, complications of surgery or childbirth, will be the primary

beneficiaries of a safe blood supply.

The Guyana National Blood Transfusion Service (NBTS) will continue to expand its role as the primary

producer and distributor of blood and blood products in Guyana. In FY09, this expansion is expected to be

underpinned for the first time by legislation outlining the formal oversight responsibilities for the NBTS as an

agency of the Ministry of Health.

As noted in the Program Area Context, the blood system in Guyana is fractured between the public and

private sectors, with most of the country's blood supply collected from voluntary donors (60% during the first

6 months of 2008) primarily from mobile blood drives. Efforts to strengthen laboratory capacity within the

NBTS have been underway since the launch of the PEPFAR initiative. However, progress has been slowed

in past years by systemic and administrative weaknesses in the MOH commodities procurement system.

Bottlenecks in this system - through which the NBTS has been required to work - have led to stock-outs of

test kits and reagents.

In FY08, the NBTS used Emergency Plan funds to procure reagents and other laboratory supplies through

the Partnership for Supply Chain Management (SCMS). SCMS has also provided technical support to

NBTS in the form of needs assessments and the development of a standardized procurement schedule.

To address inconsistencies in blood screening practices, the NBTS will stop routine blood screening at its

regional centers and centralize the screening effort at the NBTS headquarters in Georgetown. The

laboratory centralization policy was implemented in FY07. Also in FY08, the NBTS created three new

"Coordinator" positions to ensure consistent communication between the donor recruitment department, the

blood collection teams, and the laboratory. These coordinators positions were filled and the coordinators will

report directly to the NBTS director, who will provide input from client hospitals on current and future blood

needs.

In FY09 the NBTS will largely continue activities begun in FY07 and continued in FYO8. These include:

1. Strengthen the institutional infrastructure of the NBTS. Special attention will be paid to the new

centralized laboratory screening strategy to ensure that specimens are delivered to the lab and results are

returned to the regions in a timely manner. This activity will be informed by the blood safety legislation which

was passed thru the Health Facility Act in FY08. In addition to the foundation provided by the new

legislation, NBTS will work internally to strengthen the new roles and responsibilities for NBTS employees

under the new "Coordinator" system implemented in FY08. This will include specialized training for the

Coordinators, where appropriate, and team building exercises ensure that communication and supervision

follows the new chain of command. Specialized training will also be provided to the new Director, logistics

personnel and administrators working in the capital and in the regions.

2. Continue to mentor and guide the new leadership in efficient operations and management of the NBTS,

in FY08 there has been some challenges in maintaining the consistency of leadership and direction for the

operations of the blood transfusion services.

3. Continue the relationship with SCMS to procure materials and consumables (e.g., test kits and reagents)

used by the blood service. Working through SCMS has increased the NBTS's ability to manage its

Emergency Plan resources and avoid administrative delays associated with the Ministry of Health's

procurement system. Once capacity is built NBTS should be able to take over this responsibility by the end

of FY09

Activity Narrative: 4.Concurrent with the implementation of the legislative framework for the NBTS, the Service will continue to

implement the Standard Operating Procedures (SOP) for all of the technical activities undertaken by NBTS

staff (e.g., donor registration and notification; phlebotomy; laboratory screening algorithms). These SOP are

based on Caribbean Regional Standards and serve as the foundation for all training and technical

assistance from CDC and PAHO, the TA provider.

5. Continue to strengthen physical infrastructure, where needed, with particular focus on completing the

renovation of the NBTS headquarters and central laboratory, as well as strengthening the compatibility lab

at the Georgetown Public Hospital.

6. Strengthen clinical oversight of the blood service at the Georgetown Public Hospital Corporation. A

Transfusion Committee was established in FY07. Activities in FY09 will continue to focus on routine

surveillance of transfusion activities and technical support to build the Transfusion Committee's

hemovigilance data system.

7. Reduce private hospitals' dependence on hospital-based blood banks. Strengthen the NBTS system to

monitor and predict private hospitals' weekly needs for blood. This will be accomplished through the

development of an active surveillance system to track the use of blood and develop, with hospital directors,

a calendar to predict blood needs for elective surgery and other routine procedures. This calendar will allow

the NBTS to tailor its donor recruitment and collection activities to meet expected demands and to better

anticipate emergency needs. This system will also establish a routine communication mechanism between

NBTS and hospital directors to ensure that, in addition to routine needs, the blood supply can be effectively

triaged in the case of a mass casualty emergency.

8. Build the NBTS social marketing strategy to raise public awareness about the need for blood and to

recruit and retain voluntary, non-remunerated blood donors. The NBTS will receive expert advice and input

from a social marketing firm. This contractual relationship was to be established in FY07, but will be done in

FY09. With the social marketing partner, the NBTS will continue to develop and disseminate a national

information, education and communication (IEC) campaign to address public concerns/fears about blood

donation (key legislative issue: stigma and discrimination) and target low risk donor groups. This campaign

will also include an incentive mechanism to encourage repeat donors to reach landmark and acknowledge

first time donors to become repeat donors. With additional assistance from PAHO, the TA provider, the

NBTS will ensure that the national IEC strategy is informed by the findings of the Knowledge, Attitudes and

Practices (KAP) survey conducted in January 2007.

9. Continue to mobilize partner organizations, including the Guyana Red Cross, to recruit blood donors and

sponsor blood drives. This activity will be coordinated by the NBTS Blood Donor Recruitment Coordinator

(BDRC) who was recruited and hired in FY07. The BDRC will communicate with blood donor partners and

maintain a master calendar of all blood drives scheduled in Guyana. This master calendar will promote

efficiencies in the national blood collection strategy and facilitate the scheduling of blood drives in private

sector offices, factories and other company sites. These partners will benefit from training and will be asked

to sign a formal MOU to outline roles and responsibilities.

The NBTS will also continue to work with the CDC Guyana office to implement and monitor the results of

internal performance evaluations. These evaluations will address issues such as customer satisfaction (e.g.,

wait times for donors), the reasons for transfusions, how blood is routed and tracked from a blood bank to a

ward, and the feasibility of implementing a cost-recovery system.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12717

Continued Associated Activity Information

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

System ID System ID

12717 3185.08 HHS/Centers for Ministry of Health, 6267 5275.08 Track 1 Blood $100,000

Disease Control & Guyana Safety NBTS

Prevention

8063 3185.07 HHS/Centers for Ministry of Health, 5275 5275.07 Track 1 Blood $450,000

Disease Control & Guyana Safety NBTS

Prevention

3185 3185.06 HHS/Centers for Ministry of Health, 3839 3839.06 CDC to MOH $350,000

Disease Control & Guyana Guyana

Prevention

Emphasis Areas

Health-related Wraparound Programs

* Safe Motherhood

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $173,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $22,000

Water

Table 3.3.04: