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) trough a national network of Blood Service outlets. At the end of FY08 this network

consisted of 38 service units nationwide, including the National Blood Center 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.

The need would be attained rapidly 50,000 to 80,000 if the Health System improved with some hospital

infrastructures. 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

20 blood banks or blood depots (projected end of FY08). 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 HIV1/2, 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. Since

last year, we began to cooperate with Supplies Chain Management System (SCMS) for purchasing

reagents and materials.

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.

Actvity 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 (Elisa), and HTLV 1-2 in a timely manner with adequate

quality controls.

Activity 2:Ensure that all 38 service units are fully functional particularly the new 20 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.

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. We advocate and lead creation of Voluntary Regular Donors Club around the regions of the

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

from VNRD from 40% to 80%. During all the past period, the rate of ITT stays at 10%, we consider it as a

long diffusion period for promoting voluntary blood donation, now we have to consolidate it and expect that

the rate of ITT decreases at least of 7%.

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 is phased in using appropriate technologies (e.g., local internet

service providers instead of VSAT). We have to realize monitoring and evaluation to maintain its

performance and to ensure that the goal is attained.

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 Programme on Immunization (EPI) on ways to strengthen the national blood cold chain and to

extend immunization against HBV to young regular blood donor as the Club 25 members. We work for

having a strong link with MOH departmental directions and epidemiology services (regional and national).

Activity 6: Continue implementing a solar energy strategy in part of the national blood service network: four

solar freezers are successfully installed in four regions for permitting to have frozen plasma in regions. We

plan for having solar refrigerator in some areas where gas provision is so difficult. 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 27,500 units of whole blood and incorporate in the national network of blood transfusion MSF

(Médecins Sans Frontières) blood activities. Half of these units will be fractionated into blood products (e.g.,

Activity Narrative: red cell, 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 four 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 (regions) 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. Continuing Education appears as an important way to fill some gaps of the professional training

in transfusion practice. 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. We continue to improve blood service

delivery by encouraging delivery from professional to professional as it is done in many regions of the

country.

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

and blood transfusion realization for permitting to MOH authorities to take better decisions in Public Health

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

Negotiation is begun with MOH for increasing national participation funds, the need to have a New National

Blood Transfusion Center is accepted and we expect to have available funds for beginning the building.

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

realizing advocacy for having more funds 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.

Activity 11: Implement a National Hemovigilence System in cooperation with the Quebec National Institute

of Public Health and French blood transfusion services via Martinica. We expect to track blood transfusion

accidents or incidents for improving the service and participating to solve some gaps in the health system

Activity 12: Continue to improve relationship with local representatives of SCMS (System Chain

Management Services) for preventing shortage of reagents and materials and for ensuring a good quality

service to the population.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17196

Continued Associated Activity Information

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

System ID System ID

17196 8160.08 HHS/Centers for Ministre de la 7687 4738.08 Track 1 Blood $2,400,000

Disease Control & Sante Publique et Safety

Prevention Population, Haiti

8160 8160.07 HHS/Centers for Ministre de la 4738 4738.07 Track 1 Blood $2,400,000

Disease Control & Sante Publique et Safety

Prevention Population, Haiti

Table 3.3.04: