Continuing activity with updated targets, target population, and emphasis area.

To strengthen the blood transfusion services and ensure blood safety in Mozambique, the Ministry of Health

(MOH) National Blood Transfusion Program (NBTP) is proposing to conduct the following activities in FY08:

1) The NBTP will assist the MOH in the review process of the National Blood Bank Policy. An

implementation plan will be developed as soon as the final document is approved.

2) Implement National Blood Bank Standards developed in collaboration with the American Association of

Blood Banks (AABB) technical assistance (TA) provider.

3) Develop plants and monitor the construction of the new building for the NBTS and the National

Reference Blood Bank.

4) Continue to improve procurement processes for critical equipment and supplies, and improve process for

the installation, operation, maintenance, calibration, and repair of critical equipment.

5) Implement the newly developed form for data collection, recently piloted in key national centers. The use

of the new form is part of frits steps for moving towards a new and improved system to improve the

Monitoring and Evaluation (M&E), and Quality Management Systems of the operational activities.

6) Conduct baseline Knowledge Attitudes and Perceptions (KAP) survey with TA from the AABB. The

protocol for this survey is being finalized and will be submitted to the US IRB and the Mozambique Bioethics

Committee shortly. Implementation of the study will follow immediately after approval according to a

planned schedule.

7) Conduct training sessions on donor services, donor evaluation, donor registration, and identification,

phlebotomy and blood collection through mobile teams or camps, blood component preparation and

infectious disease testing.

8) Continue supervision visits conducted by central level NBTP staff to blood banks at central, provincial,

and rural hospitals, aiming for supervision visits to be conducted in all 11 provinces, with all central, all

provincial and at least 2 rural hospital blood banks per province being visited during FY08.

9) Strengthen the supervision activities in the three regional blood banks (Maputo, Beira, and Nampula)

through mentorship, in collaboration with Brazilian blood bank experts stationed at the regional blood banks

over extended (3-6 months) time periods.

10) Train and support newly recruited blood donor mobilization staff, and continue support for Information

Education Communication (IEC) interventions to educate donors and promote voluntary blood donation.

11) Implement a national screening assay for detection of anti-HCV antibodies in the country. Roll-out of

Hepatitis C screening will follow the assessment of available regional anti-HCV assays that will be

conducted in partnership with the Immunology Department of the National Health Institute (ID-NHI).

12) Collaborate with the ID-NHI in the effort to increase the number of blood banks participating in the

National External Quality Assessment (EQA) program for HIV and HBV serology.

Continuing activity- PHE with Narrative Update

COP07 Activity ID #: American Association of Blood Banks (AABB)-8194, Ministry of Health (MOH)-8196-

8106

Title: Knowledge, attitudes and practices (KAP) study regarding blood donations in Mozambique

Time and money summary:

FY06 allocations: AABB $20,000; MOH $55,175

FY07 allocations: AABB $75,000; MOH $20,000

Mechanism: Track 1 funding

No additional funding is requested for completion of this study in FY08. It is expected that implementation of

the study will be completed before the end of FY 08.

Local Co-investigators:

Evelina Chambo, Director of the National Blood Transfusion Services (NBTS), MOH Mozambique

Dina Ibrahimo, National Donor Recruitment Coordinator, NBTS, MOH Mozambique

Project Description:

This study is being implemented by the MOH NBTP, with technical assistance (TA) provided by the AABB

team. The study will help identify the level of knowledge among the general public on blood donation;

beliefs, perceptions, attitude and experiences about blood donation; barriers that may limit blood donation;

factors that motivate some people to donate blood; and the most effective communication methods to reach

and motivate the target audience to become regular blood donors for the national blood program of

Mozambique.

It has been recognized that voluntary, non -remunerated, low risk and repeat blood donors are safest in

comparison to those who give their blood only when a member of their family requires it (i.e., family

replacement donors). In Mozambique, despite efforts to improve blood donor recruitment since the

beginning of USG support in 2004, the percentage of blood donations coming from replacement donors has

remained relatively high, and the NBTS remain dependent on family replacement donors whilst the demand

id greater than the current blood supply. Motivating the public to donate blood will require information about

current and potential blood donors, particularly in relation to current knowledge, attitudes, and practices

regarding blood donation-information provided by this study. Study findings will inform and enable the NBTS

staff to further improve blood donor recruitment efforts and to increase the number of blood donors, educate

blood donors on blood donation and reduction of risk behaviors to reduce or prevent risk of HIV

transmission.

Convenience sampling and two data collection techniques - personal interviews and focus group

discussions (FGDs) - will be utilized for implementation of this study. Standardized tools have been

developed for both interviews and FGDs. Approximately one week will be spent in each of six locations, with

at least 200 interviews and 1 FGD conducted in each location. Interviews will be conducted with both

donors and non-donors.

Status of the Study:

A working group composed of MOH NBTS staff, including the Program Director and the Blood Donor

Recruitment Coordinators, a Researcher from the MOH national Health Institute as well as AABB and CDC

technical staff has been established. The study protocol and tools have been developed and are currently

undergoing the last and final review. The study protocol and instruments will be submitted for ethical review

by the Mozambique Bioethics Committee and the appropriate US authority in October 2007. It is anticipated

that the review will be completed by the end of this calendar, and the study be implemented during the first

semester of the calendar year 2008, so that results will be available in June/July 2008 and will be used to

inform planning for further NBTS recruitment activities for FY09.

Lessons Learned:

The collaborative effort and participation of staff and stakeholders from different MOH program or

departments, and different stakeholders and TA providers, means that time is needed for discussion,

several rounds of reviews, submission and approval by senior technical staff, until consensus is reached

and a high-quality protocol produced and submitted.

Regular NBTS activities and emergencies emerging from regular program functioning have at times taken

priority over the review and finalization of the documents. However with finalization of the protocol being

imminent the MOH tam and study working group is committed to move forward with implementation of the

study swiftly as soon as formal approval has been issued.

Information Dissemination Plan:

As customary for studies conducted in Mozambique, the MOH will conduct a formal dissemination workshop

to present study findings and involve various MOH departments and programs as well as other stakeholders

in the discussion of the results and formulation of recommendations to guide further improvements of blood

donor recruitment efforts.

Copies of the final study report will also be shared with provinces and sites that have participated in the data

collection. The report will also be sent to major donor agencies and initiatives in Mozambique, to advocate

for greater support for the program, and donor recruitment activities in particular, as to-date the NBTS is

supported mainly by state and USG funds.

Planned FY08 Activities:

The study protocol and tools will be submitted for ethical review and approval in the US and in Mozambique

in October 2007. It is hoped that approvals will be granted by December 2007, so that preparation for

implementation can take place in January/February 2008, data collection from March to May 2008, data

entry and analysis in June 2008, and report-writing and dissemination in July 2008.

A team of twelve staff and field researchers will be trained from the NBTS staff. AABB will provide a full-time

study coordinator, who will assist with training and supervision for the duration of the study. MOH NBTS,

AABB and CDC staff will collaborate for final data analysis, and preparation of the report and dissemination

event.

Activity Narrative: Budget Justification:

As mentioned above, no new funds are requested for FY08, and funding provided in FY06/07 will be used

for completion of this study.

The budget breakdown for funds provided from previous years will be:

Salaries/fringe benefits: not applicable

Accommodation and per diems for data collectors and supervisors: $55,000

Equipment (Recorders, computers etc.): $10,000

Supplies (Stationary, batteries etc.): $6,500

Reproduction of tools and study report: $7,000

Training: $6,000

Travel for study personnel in-country: $17,000

Travel (incl. return flight from the US), accommodation and per diems for the TA provider: $30,000

Short-term consultancy contracts for data entry and data analysis: $16,000

Translations and transcripts: $9,500

Final dissemination workshop: $3,000

Other: $10,175

Total $170,175