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 a national network of Blood Service outlets. At the end of FY07 this

network consisted of 31 service units nationwide, including the National Blood Center (NBC) in Port-au-

Prince.

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 9,000 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 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 18 blood collection and distribution centers supported by a central laboratory and 12 blood banks

or blood depots (projected end of FY07). The goals of the program include (1) To increase the proportion of

blood donated by volunteer, non-remunerated donors (VNRD); (2) to ensure that 100% of all donated units

are adequately screened for HIV, HBsAG, HCV, syphilis, and HTLV 1-2; and (3) to ensure proper storage,

transportation, and distribution of blood under cold chain conditions. 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

overall health sector through training, QA/QC oversight, and outreach activities to build public trust in the

MOH.

Activity 1: Continue to implement the Quality Management System throughout the national blood service

network and ensure that samples from all blood collected by the 18 blood collection units and mobile blood

drives are screened for HIV, HBsAG, HCV, syphilis (VDRL), and HTLV 1-2 in a timely manner with

adequate quality controls.

Activity 2: Expand the national blood service network from 31 to 38 service units by establishing 7 new

blood depots. These depots will supply blood to local and/or regional hospitals. Increasing the availability of

blood at peripheral hospitals will improve access to blood transfusion services for the community. We

expect greater access to blood transfusion will have a positive impact on patient survival rates, especially

for women and children. Work to expand the network will also include an initiative to strengthen the

logistical network between peripheral sites and the National Blood Center laboratory in Port-au-Prince. All

laboratory testing will continue to be done at the NBC, which was renovated with FY07 funds.

Activity 3: Strengthening the relationships between the Haitian Red Cross, PSI and the MOH's health

promotion department to develop a large network of public "ambassadors" (promoteurs) to assist the blood

service to recruit and retain VNRD. These individuals will help promote voluntary blood donation in their

communities. This work will contribute to the blood service's goal of increasing the proportion of blood

collected from VNRD from 40% to 80%. As the proportion of VNRD increases, the prevalence of HIV and

other transfusion-transmissible infections is expected to continue decreasing from its current rate of 4% (all

TTI).

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Activity 4: Launching the National Blood Distribution Network. This system will improve the management of

safe blood stocks, decrease blood wastage (e.g., sites with low stocks of certain blood types will use the

network to identify excess stocks at nearby sites), and improve the public's access to safe blood. Improved

communication, via conventional voice (i.e., cellular) and new e-mail systems, 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.

The electronic communication network will be phased-in using appropriate technologies (e.g., local internet

service providers instead of VSAT).

Activity 5: Strengthen links with other program areas. This work will ensure that advances in blood safety

contribute to national public health goals. Priority will be given to regions or facilities with high rates of

maternal mortality, as identified by the MOH division of family health. The blood service will also strengthen

its referral system to ensure that donors who test positive for HIV or other infectious markers receive

appropriate follow-up testing (VCT) and/or care and treatment. The blood service will also share guidelines

and experiences with the National Public Health reference laboratory on testing methods and with the

Expanded Program on Immunization (EPI) on ways to strengthen the national blood cold chain.

Activity 6: Begin implementing a solar energy strategy in part of the national blood service network. This

strategy will help address a chronic lack of electrical power throughout the network. Some technical

assistance in the area of solar and other energy options will be provided by USAID.

Activity 7: Increase the number of units of blood collected, especially from repeat VNRD. The goal is to

collect 24,000 units of whole blood. Half of these units will be fractionated into blood products (e.g.,

platelets, fresh frozen plasma). Recruiting a larger pool of voluntary blood donors who donate several times

a year will ultimately reduce mobilization costs and decrease the prevalence of TTI in the donor pool.

Activity 8: Continue training physicians, nurses and other clinical staff (e.g., midwives) in the proper clinical

use of blood. In the first three years of the project, training focused on staff in the departmental hospitals.

The training program will now be expanded to all clinical professionals in the departments who interact with

the blood service. Training will also target blood bank managers to ensure that barriers to patient access

are identified and removed. Additional training will be held within hospitals to strengthen hemovigilence

committees. Reducing unnecessary blood transfusions will avoid unnecessary blood shortages. Removing

barriers to patient access (e.g., requiring patients to provide their own cold boxes) will improve the public's

trust in the blood service.

Activity 9: Monitoring and Evaluation. Information collected via the National Blood Distribution Network

database will be constantly monitored and studied for trends. These data will be used to improve the

program or blood transfusion practices in Haiti. Data will also be used to inform donor recruitment efforts.

Activity 10: Sustainability. Continue to advocate for increased funding from the national treasury.

Diversifying the National Blood Safety Program's funding sources (currently dominated by PEPFAR) will

ensure the long-term sustainability of the safe blood initiative in Haiti, and help Haiti reach its goal of

eliminating patient fees for blood. These fees currently present a barrier to access for many poor Haitians.

The NBSP will also continue to advocate for final passage of the new blood service legislation now before

the Haitian parliament.

EMPHASIS AREAS:

Training

Network Development

Activity Narrative: Community Mobilization

Policy and Guidelines

Quality Assurance/Quality Improvement Support Supervision

TARGETS:

Number of service outlets/programs carrying out blood safety activities: 38

Number of individuals trained in blood safety: 50

TARGET POPULATIONS:

General Population

Host Country Government Workers

Health Care Providers

COVERAGE AREAS:

National