Track 1.0 and 2.0 USAID and HHS/CDC funds are combined for this activity. The Safe Blood for Africa Foundation (SB) is providing technical assistance services in Nigeria in the prevention program area of Medical Transmission/Blood Safety (BS). 100% of SB activities are linked to the National Blood Transfusion Service (NBTS) long term strategy. SB is assisting the NBTS in implementing the primary objective of migrating fragmented hospital-based blood banking services to centralized community-based blood banking services nationwide. A key feature of this program is the development of a voluntary nationwide donor recruitment system. SB has pioneered this system in collaboration with the NBTS. The NBTS zonal centers are maintained by voluntary donors. Capacity building is another key objective of the NBTS strategy. SB has instituted a robust training program that has been integral to the rapid expansion of the NBTS. The NBTS monitoring and evaluation program that SB is assisting to implement in FY07 will significantly improve NBTS regulatory capabilities. It is NBTS's intent to regulate and harmonize blood banking standards and practices on a national basis. This SB program has been designed to assist them to fulfill this objective. Significant changes from 06 to 07 will include the expansion of technical assistance (TA) to the NBTS and the incorporation of a SB assisted NBTS hospital monitoring and evaluation program into the blood banking systems in Nigeria in order to address a more comprehensive BS program in the US Government (USG) supported Nigerian hospitals. SB will incorporate capacity building for blood safety activities at the hospital level, focusing on facilities where other USG implementing partners are located. SB will assist the NBTS in using assessments resulting from this program to help upgrade the safety profile of each hospital blood bank. SB activities will provide support for 19 service outlets and train 180 individuals.. SB has worked with ENHANSE and the NBTS through the mechanism of the National Technical Committee to develop safe blood related policy. The new National Policy which has been approved by the Federal Executive Council clearly states that 100% of all transfused blood nationwide must be screened for HIV. In FY07, emphasis will be on entrenchment of the policy into law and the implementation of the policy throughout the country including setting up a regulatory body and standards for oversight. This is a significant intervention for the prevention of HIV transmission through improved BS practices. SB and the NBTS will introduce the principles of quality management processes with site-specific written Standard operating procedures, proper maintenance logs of equipment, validation of processes and a secure method of record keeping. SB continues to strengthen the technical and managerial capacity of the NBTS through its TA program to ensure sustainability and this has resulted in NBTS operating independently and increasingly taking a leadership role. CONTRIBUTIONS TO OVERALL PROGRAM AREA 100% of SB BS activities will contribute to 07 overall Emergency Plan BS Targets for Nigeria. Activities will improve access to safe blood, increase demand for VNRBD, improve quality of Blood Transfusion Systems and Practices and improve the enabling environment. Planned increases in the number of outlets carrying out BS activities and increasing the number of people trained in BS will improve equity in access to safe blood. SB will ensure that there are linkages and synergies between the outlets where safe blood is available. SB will improve the quality of blood transfusion practices in Nigeria. This activity will be primarily conducted through technical assistance to the NBTS, the hospital certification program and training programs implemented by SB in collaboration with the NBTS. M and E activities will determine the number of outlets adhering to the appropriate use of guidelines and SOPs provided, number of additional outlets established utilizing safe blood standard guidelines and the conduct of regular audits at these outlets at 3 month intervals. LINKS TO OTHER ACTIVITIES SB VNRBD activities have direct links to Counseling and Testing 6702. 100% screening of all donors does result in HIV + donors. SB refers these donors for additional CT at designated USG treatment centers. SB TA activities are linked to policy analysis and system strengthening activities 6774, 6777, 6728. SB also provides technical assistance and support to the other USG partners implementing emergency blood screening activities under this program area. POPULATIONS BEING TARGETED SB assistance activities to the NBTS have target populations associated with increasing supply of HIV free blood by VNRBD. Populations are the low-risk sources including select student groups and select adult men and women. SB will assist the NBTS to engage facilitating organizations that will allow NBTS to access its target populations. These include FBOs, Business/private sector and community and religious leaders. SB training activities and capacity building will target host country government workers and other health care providers. KEY LEGISLATIVE ISSUES ADDRESSED Key issue addressed by SB activities is Volunteers. Development of a robust and sustainable VNRBD base is by definition entirely dependent on recruiting and retaining volunteers, this activity is community based and

focused on the recruitment of suitable low-risk donors to supply centralized blood collection facilities. This will facilitate the migration from hospital based collection systems and allow the hospitals to focus on cross-matching and provision of HIV-free blood to patients. EMPHASIS AREAS This program includes major emphasis on BS training in all areas of the program including the actual training program and the hospital certification program. Emphasis is also being expended in the area of blood policy and oversight. Other emphasis areas include supporting the NBTS in its development and increasing outlets. Community Mobilization/Participation with Quality Assurance and Supportive Supervision will be areas of minor emphasis.

ACTIVITY DESCRIPTION This activity is linked to Blood Safety (#6731) and JSI/MMIS safe injection (#6726) The Safe Blood for Africa Foundation (SB) will provide services in Nigeria in the prevention program area of Medical Transmission/Injection Safety (Injection Safety). SB will work with the relevant government ministries and non-governmental organizations, including the Federal Ministry of Health (FMOH), John Snow Incorporated/Making Medical Injections Safer (JSI/MMIS) and private sector organizations. The SB Injection Safety Program will provide input to JSI/MMIS for the review of the "Do No Harm" facilitator's guide on universal precautions jointly developed by the World Health Organization (WHO)/AFRO and JSI/MMIS. SB will provide information on injection safety and health care waste management specifically related to blood safety activities such as standard operating procedures (SOPs) for phlebotomists and medical laboratory scientists (MLS). During the review, led by the FMOH, proposed SOPs will be examined for possible adaptation into the facilitator's guide. These SOPs would then be incorporated as a training module at all sites that are assessed under the SB hospital monitoring and evaluation program. SB will be training 250 health care workers in injection safety and health care waste management. Prior to program inception JSI/MMIS will support SB donor care staff and MLS with ‘train the trainer' training and supervise the initial SB training sessions to assess standards and ensure quality control. The scope of training will include universal precautions, waste management and behavior change. Staff to be trained include public and private health care workers at all sites in Lagos State and the FCT being assessed under the SB hospital monitoring and evaluation program. Staff from National Blood Transfusion Service (NBTS) will also be trained. For Behavior Change Communication (BCC), SB will review its' blood safety IEC materials to incorporate appropriate universal messages on injection safety and waste management in consultation with JSI/MMIS. These modifications will be incorporated into communications with all voluntary non remunerated blood donors (VNRBD) at all SB outlets. JSI/MMIS will assist SB in recruiting donors by passing the message of VNRBD during their community outreach work in their focal sites. SB will procure ‘safety boxes' from JSI/MMIS which have been found to be suitable for SB post donation counseling clinics. Other needed injection safety supplies will be procured through SB current procurement process. CONTRIBUTIONS TO OVERALL PROGRAM AREA Activities will improve the quality and effectiveness of injections. Planned increases in the number of outlets carrying out injection safety activities will improve equity in access to safe injections. The number of people trained in injection safety practices will also increase access in Nigeria to safe injections. SBFAF will ensure that there are linkages and synergies between the outlets where safe injection programs are implemented. LINKS TO OTHER ACTIVITIES Key link is to Medical Transmission/Blood Safety 3.3.3. SB blood safety activities incorporate injection safety elements in blood collection activities that require existing usage of injection safety commodities and application of universal precautions. POPULATIONS BEING TARGETED Target population is public and private health care providers including doctors, nurses, laboratory workers and waste handlers at sites being supported by SB. KEY LEGISLATIVE ISSUES ADDRESSED Improved injection safety and application of universal precautions will result in a reduction in the stigma and discrimination attached to injection activities as a potential HIV transmission mode. EMPHASIS AREAS This program includes major emphasis on injection safety training. Minor emphasis areas are procurement, community mobilization and policy and guidelines.