This partners main goal is to manage the safety and adequacy of the Namibian blood supply. NAMBTS is legally mandated to be the sole provider of blood and blood products to Namibian hospitals. NAMBTS collects blood from fixed and mobile sites; all infectious disease testing is performed by the South African National Blood Service through a unique contract mechanism. NAMBTS training in the appropriate use of blood is a health systems strengthening activity that reduces wastage and contributes to improved access to blood transfusion services within the primary healthcare (PHC) system, which is a GHI and PF objective. NAMBTS provides blood to 48 transfusion centers in all 13 regions in Namibia. NAMBTS is a mature partner with a functional cost-recovery system to sustain future operations. Starting in COP12, USG Namibia will begin phasing out funding to NAMBTS through HMBL over a three year period. Limited support to NAMBTS will continue through OHSS and HLAB for cross-cutting activities linked to GHI goals for improving access to PHC services and developing human capacity in blood transfusion laboratory science. As the sole provider of blood to public and private hospitals, NAMBTS has a responsibility to ensure that blood is affordable. Since most transfusions are paid by the Government, cost control is a critical part of the MOHSSs overall sustainability plan. NAMBTS actively seeks private contributions to off-set costs. In 2011 NAMBTS also began selling excess plasma to a South African pharmaceutical company, adding to its cost-recovery revenue stream. The partner maintains a robust electronic data system which contributes information to PEPFAR, WHO and GRN indicators. NAMBTS also operates one of Africas only adverse transfusion reaction surveillance systems.

Building Namibian technical capacity is an essential component in the USG strategy to promote country ownership and the sustainability of services provided by local partners. NAMBTS will work with Polytechnic and UNAM to identify Namibian students in the laboratory science program and the Medical School, and assist them to attain post-graduate qualifications in blood transfusion medicine or blood transfusion laboratory science. NAMBTS currently relies on expatriate experts to fill high-level positions within the blood service and in facility-based blood bank laboratories. The intent of this funding is to build Namibian capacity to fill these senior-level positions. Currently all training in blood transfusion medicine and laboratory science must be conducted outside of Namibia. On this note, NAMBTS is investigating twinning arrangements with universities in the UK and South Africa. If funds are available in the future, this budget code could be used to support curriculum development in these areas at Polytechnic and UNAM. See the HMBL narrative for additional information.

This is the first time the NAMBTS cooperative agreement has been funded through a program area other than HMBL. CDC believes this is an appropriate evolution of the PEPFAR-NAMBTS relationship in light of the sustainability issues described above, and the importance of safe blood transfusion services to maternal and child health, as well as systems strengthening objectives described in the Namibia GHI Strategy.

NAMBTS will continue to implement the comprehensive blood safety program described in prior years. A major change since COP11: 1) In COP12 NAMBTS will absorb the salary and benefit costs all of the employees previously funded by PEPFAR. This absorption is the first step of a three year phase-out plan for blood safety funding under HMBL. Given the continuing systems strengthening needs related to the delivery of safe transfusion services, PEPFAR funding for NAMBTS will continue at a reduced rate under the OHSS and HLAB program areas.

Specific activities will include:

Blood collection: NAMBTS will work to retain current blood donors, expand recruitment activities to schools, and conduct ongoing surveillance of transfusion transmissible infections (TTI) among donors to identify lowest risk sub-groups.

Blood screening: NAMBTS will maintain a contract with the South African National Blood Service (SANBS) for all infectious disease screening. This arrangement is subject to a bi-annual sustainability review, the latest of which occurred in March 2010. NAMBTS has tentatively set a five year goal to return infectious disease screening to Namibia. This objective may be limited by a lack of trained human resources to operate the expanded testing laboratory. To address this barrier, NAMBTS will work with Polytechnic to identify Namibian students in the laboratory science program and assist them to attain blood transfusion qualifications (see NAMBTS narrative in OHSS). This assistance may also include training in nucleic acid testing (NAT) through a twinning arrangement with university blood transfusion medicine programs in South Africa, the US or the UK.

Blood utilization: Equipment procured in COP12 will allow an expansion of blood group compatibility testing to a major hospital in northern Namibia. NAMBTS will also work with the MOHSS Department of Clinical Services and NIP to expand and strengthen the national network of blood banks and compatibility testing laboratories.

Policy and Sustainability: NAMBTS will continue to finance approximately 75% of its operations through an innovative cost-recovery system. Through this system, consumers of blood (the MOHSS, private insurance schemes, individual patients) pay NAMBTS a fixed cost per unit of blood consumed. To increase sustainability, NAMBTS will pursue international accreditation of the NAMBTS laboratory. This will allow NAMBTS to enter into plasma sales and export agreements with pharmaceutical companies in South Africa and elsewhere.