Linked to Activities 8159, 11057.

SUMMARY: The project's main objective is to provide a safe and adequate blood supply to people living in Haiti's 10 Departments. All program activities are coordinated by the Ministry of Health's National Blood Safety Program (NBSP) through the National Network of Blood Services. BACKGROUND: Since 1986, the Haitian Red Cross (HRC) has been mandated by law to manage the blood transfusion system in Haiti. However, in 2004 only about 9000 units of blood were available for transfusion for a population of approximately 8.5 million. This shortfall indicated a significant need to strengthen the blood service to meet the demand, estimated at between 20,000 and 40,000 units per year. To address this issue, the NBSP was established with PEPFAR support. Within the MOH the National Blood Safety Management Unit was established to administer the program. The National Blood Safety Committee was established to develop national policies and guidelines. The Haitian blood system is comprised of a network of 16 blood collection and distribution centers supported by a central laboratory. The goals of the program include: (1) increase the supply of blood donated by volunteer, non-remunerated donors (VNRD); (2) ensure adequate screening of blood (HIV, HBsAG, HCV, VDRL, and HTLV 1-2); and (3) ensure proper storage, transportation, and distribution of blood. The NBSP has sub-contracts with the HRC to manage the collection, screening and distribution network; with Population Services International (PSI) for donor recruitment support; and with GHESKIO for laboratory QA/QC.

ACTIVITIES AND EXPECTED RESULTS: The following activities will contribute to the PEPFAR 2-7-10 goals by reducing the incidence of transfusion-associated HIV infections. They will also strengthen the health sector through training, QA/QC oversight, and activities to build public trust. Activity 1: Strengthen the Haitian Red Cross's blood screening capacity in Port-au-Prince. This will be accomplished through the renovation and expansion of the current HRC laboratory on Rue des Miracles. Laboratory expansion within the existing building will be made possible by relocating blood collection activities to two satellite blood collection posts. Strengthening and expanding the laboratory will ensure that samples from all blood collected by the network of 16 blood collection centers and mobile collection units will be screened for HIV, HBsAG, HCV, VDRL, and HTLV 1-2 in a timely manner with adequate quality controls. The expanded laboratory will also house a larger area where blood products may be separated (e.g., platelets, fresh frozen plasma) and stored. Strengthening a central blood screening and production center is in line with WHO and CDC safety and sustainability recommendations for blood system laboratory services in resource-constrained settings. Lab procurement costs will be minimized by routing orders through SCMS. Activity 2: Expand the HRC's capacity to attract regular, VNRD to fixed collection sites in the capital. As noted above, the current HRC blood center contains a small collection center with the capacity to collect a maximum of 30 units per day. However, actual volume from this center is much lower due to donors' reluctance to visit the center, which is in a busy commercial zone where parking and security can be problematic. Relocating the HRC's fixed blood collection centers from the Rue des Miracles location to satellite centers will improve donors access and put the centers in closer physical proximity to the communities they serve. One satellite center is currently being renovated at the Canape Vert Hospital; the Blood Safety program will work with the HRC to identify a second site. Emphasis will be placed on selecting a site that increases access for all potential donor communities. PSI's donor mobilization work will be updated to support these new locations. Increasing voluntary donors' access to blood donation centers will result in higher numbers of repeat volunteer donors who have been shown to have a lower risk of infection. Activity 3: Implementation of a QA/QC system throughout the blood collection, testing and distribution network. This system is being developed with FY06 funding. It will include QA/QC procedures and oversight activities for alls aspects of blood collection, screening, storage and distribution. This will include follow up activities to monitor the implementation process and evaluate its effectiveness. The establishment of a functioning QA/QC system with adequately trained staff will ensure that facilities, equipment and staff working in the network of 16 blood collection and banking sites will be properly trained and/or maintained. Activity 4: Continue the development of a National Blood Distribution Network. This

system will improve the management of safe blood stocks, decrease blood wastage (e.g., sites with excess stock of certain blood types will use the network to supply neighboring sites), and improve the public's access to safe blood.. Improved communication will enable relevant stock data to be shared in a timely manner. The MOH will achieve cost efficiencies by reducing the amount of blood lost to spoilage. Patients will benefit from an increased availability of blood throughout the network. Activity 5: Develop and ensure maintenance of the cold chain in the blood services network. The current blood storage systems in most sites are out dated and do not have temperature monitoring and other controls in place. Frequent power outages and lack of fuel for generators often render equipment unusable. Some equipment has been damaged by power surges. Propane back up systems also often lack fuel. In FY07 the NBSP will move toward introducing solar power to blood centers, labs and blood banks. Solar systems will provide reliable electricity for existing electricity-only blood refrigerators or for solar refrigerators. A USAID-sponsored assessment team will supply technical guidance. The cold chain between blood banks and hospital wards will also be strengthened. The NBTS will work with the Haitian Red Cross to ensure that all blood banks are equipped with portable cold boxes. This cold chain system will become even more important as the Blood Network System comes on line and blood is not only transported from blood banks to hospitals but from bank to bank. Introducing solar solutions will reduce operating costs for electricity and ensure blood is not wasted due to breakdowns in the cold chain. Ensuring the cold chain between blood banks and hospitals will address a major barrier to patient access to blood. Activity 6: Implementation of Standard Operating Procedures. The SOP are based on guidelines/procedures that were written and validated but not yet published in 2006. SOPs will introduce economies of scale to the procurement and logistics systems. Activity 7: Continue working with sub-partners to increase the number of units collected, especially from repeat VNRD. The objective is to collect 18,000 units of blood. Recruiting a larger pool of voluntary blood donors who donate several times a year will ultimately reduce mobilization costs. Activity 8: Continue working to establish effective coordination between hospitals and the blood service by training physicians, nurses and other clinical staff (e.g., midwives) in the proper clinical use of blood. This training will focus on staff in the departmental hospitals. Training will also target blood bank managers to ensure that barriers to patient access are addressed and removed. Reducing unnecessary blood transfusions will lessen the strain on the inadequate blood supply. Removing barriers to patient access (e.g., requiring patients to provide cold boxes) will improve the public's trust in the blood service.