This is a continuing activity from FY 2004, FY 2005, FY 2006, and FY 2007. It supports the Blood

Transfusion Service of Namibia (NAMBTS) to collect, screen, and distribute blood and blood products while

building capacity (through training workshops) and strengthening national policies and frameworks related

to blood safety. It leverages support from WHO (activity 5123.087), CTS Global (activity 7322), ITECH

blood safety training (activity 18275.08), and the Partnership for Supply Chain Management blood safety

procurement activities (activity 18281.08).

The national blood transfusion service in Namibia is operated by the Blood Transfusion Service of Namibia

(NAMBTS) with headquarters in Windhoek. NAMBTS became a recipient of USG support in FY04 through a

direct funding Cooperative Agreement. Prior to 2004, Namibia had no National Blood Policy, no Strategic

Plan to Strengthen the National Blood Program, nor National Guidelines on the Appropriate Clinical Use of

Blood and Blood Products. Since then, National Guidelines on the Appropriate Clinical Use of Blood and

Blood Products have been developed (released June 2006) and a National Blood Policy has been finalised

(accepted July 2007); the 3-Year Strategic Plan and legislative framework will follow. Also before PEPFAR,

i.e. before 2004, there was one blood bank and one fixed site blood collection facility and one testing facility

in Windhoek; and one blood bank facility in the northern region (Oshakati). Collection of blood in the

Oshakati area was discontinued in 2003 due to the high prevalence of malaria, HIV and hepatitis, but

mobile teams collected blood in most other regions of the country. These facilities, as operated at that time,

were inadequate to meet the safe blood supply needs of a country as vast as Namibia.

With USG support, NAMBTS opened a second fixed donor site in Windhoek and a blood bank and donor

clinic facility in Swakopmund; donor clinics in Oshakati were resumed in July 2006 with an improved pre-

donation education programme to assist potential donors in understanding the risk factors that contribute to

a higher risk of transfusion transmitted infections (TTIs). Mobile Teams collect blood from other sites (e.g.

schools and businesses) throughout the country. During FY06, an equipment upgrade for the Windhoek

blood component laboratory improved the quality of the blood components produced and the proportion of

collected units converted into components has increased steadily to its present level of approximately 60%.

In 2005 eight blood transfusion staff were funded by the project. A part-time medical officer was hired, who

has been actively involved in developing the Guidelines for the Appropriate Use of Blood and Blood

Products and developing and conducting training programs to be provided to the medical community on

appropriate use of blood. She has also provided much needed medical backup to the donor clinic in the

selection of donors, to the blood bank in the provision of blood and blood products and to the doctors who

use the products. An officer for quality management and training was hired by NAMBTS in 2005 and

continues to provide and arrange training at all levels. He has been involved in the development of the

National Blood Policy, the Clinical Guidelines for the Appropriate Use of Blood and Blood Products, and the

proposed Standards for the Practice of Blood Transfusion in Namibia. The Quality Management System

and the development of documented policies and procedures, the internal audit program etc. is also

ongoing.

NAMBTS' capacity to supply units of blood increased from 17,853 in 2003 to 18,421 in 2006, Improved

stock management, the more appropriate use of blood and the reduction in discards has enabled NAMBTS

to meet the vast majority of requests for blood and shortages have been reduced considerably over the past

two years. To facilitate the design of more effective donor recruitment and retention campaigns, a KAP

study was done in collaboration with WHO and the University of Namibia in 2005 with support from

NAMBTS and MoHSS.

All donated blood is tested for HIV, syphilis, and hepatitis B and C. This testing is currently carried out by

the South African National Blood Service in Johannesburg, South Africa, on behalf of NAMBTS because it

was determined that this was the most cost-effective method of providing the safest blood possible

(including ID-NAT for HIV, HCV and HBV) to overcome the issues of prohibitive cost for local NAT and the

lack of adequately trained local staff. However, this policy will be reviewed this year. HIV prevalence among

blood donors during 2006, based on the initial screening results was 0.45%.

A survey of blood usage practices in 26 hospitals in Namibia was conducted in collaboration with WHO,

NAMBTS and the MoHSS, to establish present practices and to identify areas for improvement. Appropriate

NAMBTS staff received training in Quality Management, Supervisory/Management skills, pre- and post-

donation counseling, training in cold chain management, general technical training and general donor clinic

training; training is ongoing. The NAMBTS is funded through a system of cost recovery, with majority of the

service fees being paid by the MoHSS since 80% of blood and blood products are supplied to the MoHSS.

NAMBTS will focus on cost control methods to help improve financial sustainability.

The NAMBTS plan of activities for FY08 is largely focused on the implementation of the recently ratified

National Blood Policy, which defines quite far reaching objectives for the strengthening of the National

Blood Programme. These initiatives include -

•the establishment of a National Blood Authority for Namibia,

•drafting of the legislation to control blood transfusion,

•drafting of appropriate Standards for the Practice of Blood Transfusion,

•drafting of formal agreements (memoranda of understanding) between NAMBTS, MoHSS and the Namibia

Institute of Pathology (NIP),

•ongoing surveillance of TTI prevalence in sub-populations of donors in order to identify the safest sub-

groups

•the development of a quality management system for the entire blood programme,

•provision of appropriate reagents and equipment for blood transfusion activities at all hospital blood banks,

•training of hospital blood bank staff on crossmatch techniques, and quality management and cold chain

management,

•the development of a nation-wide haemovigilance programme,

•the strengthening of hospital therapeutic/transfusion committees,

•blood bank and hospital audits to ensure conformity with best practices with regard to the provision of

blood and blood products by the blood banks, and best bedside transfusion practices by the hospitals,

•possible extension of crossmatching services, particularly in northern Namibia. We plan to investigate the

feasibility of opening a NAMBTS blood bank in Rundu, in order to improve the provision of blood and allied

services to the community resident in that area.

•review of the donation testing practices for TTIs. At the present time the testing of blood donations for

Activity Narrative: Transfusion Transmitted Infections is carried out on behalf of The Blood Transfusion Service of Namibia by

the South African National Blood Service in Johannesburg, South Africa. The feasibility of carrying out this

testing in Namibia, without a commensurate loss in sensitivity or unacceptable increase in cost, should be

reviewed from time to time in the light of changing circumstances.