This implementing mechanism seeks to reduce medical transmission of HIV and other transfusion- transmissible infectious disease through technical support to the Mozambican Ministry of Health (MOH) and the National Blood Transfusion Program (NBTP) for the provision of adequate supplies of safe blood to all health care facilities in Mozambique.

The TBD technical assistance to the MOH's National Blood Transfusion Program is for the Rapid Improvement of the Safety and Adequacy of the National Blood Supply that is outlined in four strategic objectives. Under each strategic objective are Intermediate Results in support of the Strategic Objectives.

Strategic Objective #1 - Strengthen infrastructure of national blood program 1.2 Legal framework for national blood program established 1.3 Management Structure defined and implemented 1.4 Appropriate National Standards adopted 1.5 Blood Bank facilities improved and equipped 1.6 Local networks strengthened to ensure sustainability

Strategic Objective #2 - Improve Blood Bank operations through implementation of National Standards: 2.1 Improved Process developed for donor screening 2.2 Improved Process developed for blood collection 2.3 Improved Process developed for preparation of blood components 2.4 Improved Process developed for infectious disease and red cell serology and compatibility testing 2.5 Improved Process developed for the storage, transport, and distribution of blood. 2.6 Effective process to ensure critical equipment is installed, operated, maintained, and serviced properly 2.7 Effective Process for delivery and documentation of training 2.8 Comprehensive Quality program developed

Strategic Objective #3 - Increase collections from voluntary, non-remunerated blood donors: 3.1 Donor Recruitment Activities defined and strengthened 3.2 Strategies developed for recruitment of low-risk voluntary blood donors 3.3 Improved process for mobile blood collection developed 3.4 Improved donor retention strategies developed 3.5 Effective Donor Management system established 3.6 Improved Process for donor counseling and notification developed

Strategic Objective #4 - Improve Transfusion Practice: 4.1 National Guidelines for the appropriate use of blood developed 4.2 Appropriate training and education programs developed for nurses and prescribing physicians

TBD 2010 Proposed Activities: 1) Plan and organize external committee review meeting to include stakeholders form MOH, WHO, TBD, CDC, representatives from other African countries to review and advance the adoption of the legal framework blood legislation, regulation and policy guidelines.

2) Provide focused workshops to provide guidance to NBTS, MOH and hospital clinicians on implementation of national standards related to blood collection, testing and transfusion. 3) Develop organizational structure, job descriptions and training strategy for new reference center to be built 4) Arrange mentorship training for National Quality officer 5) Provide technical assistance to the NBTP to implement and conduct baseline Knowledge, Attitudes and Perception Study. 6) Assist NBTP in developing Information Education Communication materials. 7) Assist the MOH NBTP in identification and establishment of linkages for fellowship opportunities for physicians and nurses in Transfusion Medicine 8) Provide TA to donor recruitment personnel in implementing recruitment strategy 9) Provide TA for revision of Mozambican guidelines for Blood Transfusion 10) Facilitate a workshop on Transfusion Medicine for Medical Students and other health care professionals. 11) Assist NBTP in the development of National Strategic Plan for blood safety 12) Provide key TA to NBTP in the acquisition and implementation of Blood Establishment Computer Software for the management of blood donors and donations. 13) Assess provincial blood bank cold-chain equipment infrastructure. 14) Continue development of Train-of-Trainer (TOT)material 15) Conduct TOT for selected Mozambican blood bank staff.

The implementing mechanism's geographic coverage and target population(s). This implementing mechanism targets blood bank staff and health care workers in transfusion health facilities.

Key contributions to health systems strengthening, if appropriate. At least 100 health care workers will be trained in blood safety through in-service training and continuing education delivered through workshops, on-the-job training, mentoring and symposiums.

A description of the implementing mechanism's cross-cutting programs and key issues: if a cross-cutting attribution is entered or key issue selected it should be described in this narrative. Human Resources for Health: at least 100 health care workers will receive in-servicetraining.

Monitoring and evaluation plans: Monitoring and Evaluation will occur by TBD defined process of submitting Terms of Reference prior to the initiation of an activity to both CDC and NBTP. Once an activity is concluded, the deliverables defined in the Terms of Reference are reviewed before submission to the stakeholders. In addition, all TBD

contracted consultants and/or country coordinators are required to submit a TBD Trip Report that outlines the success of completing the defined objectives and any challenges, limitations or constraints encountered during the performance of the activity. It is the responsibility of the TBD USG PEPFAR Management team to review each of these items for performance indicators and any key issues that need to be addressed with stakeholders.

The TBD technical assistance to the Ministry of Health's National Blood Transfusion Program is for the

Rapid Improvement of the Safety and Adequacy of the National Blood Supply. The TBD TA will take a

multi-pronged approach to improve all aspects of the NBTP. These areas include the recruitment of

voluntary non-remunerated blood donors, collection, processing, distribution and testing of blood.

The TBD will continue with four approaches to achieve these goals: (1) short-term, in-country training; (2)

long term trainings and exchanges abroad; (3) mentorship programs involving 3-6 month stays of visiting

transfusion medicine and/or blood bank professionals working in NBTP sites providing oversight, insight

and repeated mentoring and tutelage of the NBTP staff; (4) long-term management and technical

coaching of NBTP management by TBD Country Coordinators. The goal of these trainings is to

strengthen the capacity of the NBTP and its staff in the aforementioned areas to fulfill the goal of the

NBTP, which is to collect and supply adequate and safe blood to Mozambique.

Plans for this performance period include: data collection from national and provincial blood centers;

Quality Management Systems (QMS) workshop for ten staff as well as a QMS focused long-term

mentorship program in implementing quality systems; in anticipation of implementation of the Blood

Establishment Computer System (BECS), NBTP staff will be sensitized to computerization and receive

training in basic computer skills, an Information Technology (IT) individual will be identified for further

training in IT for NBTP, and blood center buildings will be evaluated for required number of BECS

workstations in Maputo, Nampula and Beira;

TBD TA training methods will promote long term change by increasing the knowledge and skills of the

NBTP and its staff. Simultaneously providing knowledge/skills and creating an internal NBTP

infrastructure to advance best practices and knowledge transfer through Training of Trainer programs;

sustainability of this knowledge and the transfer of knowledge is the ultimate goal. NBTP is a critical

element of the Mozambican health system. The technical capability of the NBTP to identify HIV positive

donors and refer them to appropriate counseling and care is an essential element of prevention and

treatment that adds to other USG funded efforts.