INTEGRATED ACTIVITY FLAG:

Blood safety activities are 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 and prevention program area; patient referral systems and confidentiality issues under Counseling

and Testing; and data collection and management under Strategic Information.

SUMMARY:

Overall Activities: WHO/PAHO provides technical assistance and training to the Haitian Ministry of

Health/National Blood Safety Program (MOH/NBSP) and its partners (e.g., the Haitian Red Cross). This

technical assistance covers all areas related to the development and implementation of a safe national

blood system, including strategies for donor mobilization and recruitment, blood collection, laboratory

screening, use of the cold chain to distribute blood and blood products and in clinical use of blood to reduce

risk of unnecessary blood transfusions.

Emphasis Areas: WHO/PAHO provides technical support to the MOH/NBTP in all 17 Emergency Plan

Emphasis areas. In FY08, this support will focus on ensuring quality throughout the blood collection, testing,

processing, distribution, and transfusion system. PAHO will also work with SCMS on appropriate

procurement choices for equipment and consumables. Supervision will place special emphasis on lab

technicians engaged in the fractionation of whole blood into blood products. The NBC laboratory expanded

and renovated in FY07 will allow the NBSP to substantially increase the production of fractionated units.

Primary Target Populations: Training of MOH/NBSP-NBC staff (donor recruitment and mobilization;

laboratory QA/QC laboratory best practices; clinical use of blood; program administration), MOH clinical

staff (clinical use of blood), Community leaders (donor recruitment and mobilization; social marketing) and

the general population for general blood transfusion information,

Coverage Area: Nationwide.

BACKGROUND:

In Haiti, PAHO's Blood Service Program works with the National Blood Safety Program (NBSP), created by

the Ministry of Health in 2004. The NBSP manages the national blood system in conjunction with the Haitian

Red Cross, which currently holds the legislative mandate to supervise blood services activities in Haiti.

PAHO has provided technical assistance to the MOH throughout the development of the NBSP, and

continues to work to strengthen the fledgling blood service's policies, guidelines and systems. PAHO

coordinates its activities with the NBSP and tailors its training activities to respond to needs identified by the

MOH/NBSP. PAHO's training activities are planned, organized and conducted by a PAHO blood transfusion

consultant based in Haiti, in coordination with PAHO headquarters, the NBSP and local partners (e.g.,

Population Services International (PSI), the Haitian Red Cross). When appropriate, international and local

experts are invited to lead these trainings.

The PAHO technical assistance program for blood safety contributes to PEPFAR's broader gender goals in

Haiti through its work to reduce maternal mortality during childbirth. PAHO's training for nurses,

phlebotomists and laboratory technicians also has had a positive impact on the professional development of

Haitian women working in the healthcare field.

ACTIVITIES AND EXPECTED RESULTS:

Activities:

In COP 08, WHO/PAHO will continue to provide technical assistance to the MOH/NBTP in Haiti in the

following areas:

1. Develop and advise on the implementation of new strategies to recruit and retain voluntary, non-

remunerated blood donors (VNRD). The NBSP's goal in this area is to collect 100% of its blood from VNRD

by 2010. (NBSP currently collects approximately 40% of its blood from VNRD, up from 5% in 2004.) PAHO

will work with MOH/NBSP, HRC and PSI to strengthen the network of blood donor recruiters. Recruiters will

be trained in the latest recruitment strategies. This will contribute to the NBSP's goal of collecting 100% of

its blood from VNRD by 2010.

2. Support NBSP policies to ensure free access to blood for patients in public hospitals. PAHO will provide

training and on-site supervision in logistics, stock management and timely delivery strategies to ensure a

stable and consistent blood supply in Haiti. This training will help the MOH/NBSP to establish a national

monitoring system and reduce the number of blood units lost to spoilage or improper storage. The

enhanced system will also improve the delivery of blood to urgent cases and lead to a reduction in mortality

due to a lack of blood, e.g., maternal hemorrhaging during childbirth. The monitoring system will enable

relevant stock data to be shared throughout the NBTP network in a timely manner.

3. Support the development and strengthening of the NBSP's network of blood collection units, blood banks,

and blood transfusion centers. This support will focus on ensuring the efficient transfer of blood samples to

the NBC lab for testing; the return of blood test results to donors; the appropriate collection and

management of patient data; routine and emergency communication between the NBSP headquarters and

the rest of the network; and a strong logistics service that respects international cold-chain requirements for

blood and regents. PAHO will provide technical assistance and advice to the MOH/NBSP to develop and

implement a QA/QC system throughout the NBSP's national network. Monitoring and evaluation (M&E) will

continue for network sites where QA/QC was implemented in 2006. PAHO will work closely with USG

partners and MOH/NBSP to conduct solar electrification assessments throughout the NBSP network to

ensure a sustainable power supply for the blood cold chain.

4. PAHO will continue to play a key role in supervising and strengthening the NBTP's quality management

program nationwide. PAHO will hold quarterly evaluation workshops for MOH/NBSP staff and relevant

partners. The workshops are designed to identify best practices in use in the NBSP network and to address

program areas/activities that may not be sustainable.

5. Training for physicians, nurses and allied healthcare workers in best practices and the appropriate clinical

use of blood. PAHO will conduct training workshops for clinicians on the appropriate use of blood. PAHO

will also support MOH/NBSP efforts to establish effective communication and coordination between

clinicians and blood services.

6. PAHO will provide technical advice, as needed, to ensure renovation work begun in FY07 at the NBC is

completed. PAHO input will include technical advice on the selection of standardized equipment and

materials, especially in the NBC laboratory.

7. PAHO will provide technical input into the development of a national hemovigilance system. The PAHO

consultant will support NBSP staff in the implementation of blood transfusion committees at hospitals

conducting blood transfusion. The consultant will also provide technical assistance to analyze and develop

action plans based on data collected through the hemovigilance system.

8. PAHO will continue its work with the MOH/NBSP/NBC to strengthen Haiti's national sustainability

strategy. This will include working with the CDC project officer in Atlanta to diversify the sources of external

financing available to NBSP.

EMPHASIS AREAS:

Activity Narrative: Training

Network Development

Community Mobilization

Policy and Guidelines

Quality Assurance/Quality Improvement Support Supervision

TARGETS:

Number of service outlets/programs carrying out blood safety activities: N/A

Number of individuals trained in blood safety: 250

TARGET POPULATIONS:

General Population

Host Country Government Workers

Health Care Providers

COVERAGE AREAS:

National