The activity narrative combines Track 1 and Track 2 funding. In addition, this activity will be jointly managed

by CDC and USAID.

ACTIVITY DESCRIPTION:

The Safe Blood for Africa Foundation (SBFA) is providing technical assistance services in Nigeria in the

prevention program area of Medical Transmission/Blood Safety (BS). SBFA activities reinforce the National

Blood Transfusion Service's (NBTS) long-term strategy. SBFA assists the NBTS in implementing its primary

objective of migrating fragmented hospital-based blood services to centralized NBTS-based blood services

nationwide. A key feature of this program is the development of a nationwide voluntary donor recruitment

system (VNRD). The NBTS zonal and state centers are primarily supported by VNRD.

Capacity-building is one of the key mechanisms to achieving the objectives of the NBTS long-term strategy.

SBFA is expanding its TA to establish a more appropriate blood safety program in USG supported hospitals

in Nigeria. SBFA has conducted a robust training program that has been fundamental to the rapid

expansion of the NBTS. In FY08, SBFA activities will be primarily focused on: capacity-building for blood

safety activities at USG-supported hospitals in Nigeria; supporting NBTS in developing and implementing a

hospital blood bank exchange and distribution system; and promoting coordinated blood safety activities

across all partners. SBFA will utilize standardized training modules that are appropriate to the various levels

of trainees and approved by NBTS. The facilities will be educated on the use of the blood screening

algorithm and proper diagnostic strategy based on prevalence criteria. SBFA will train nurses and medical

laboratory scientists in USG-supported hospitals and hospitals within NBTS catchment areas to recruit

VNRD from the ranks of current family replacement donors. SBFA will also train these personnel in blood

collection and donor care, as well as in counseling, including appropriate utilization of the NBTS pre-

donation screening questionnaire, leading to improved screening of all donors in all facilities.

SBFA will facilitate the development of an NBTS/hospital blood exchange program through training in

logistics and cold chain management with an emphasis on improved storage and handling. This training

was first introduced in FY07 to NBTS and USG-supported facilities' drivers and medical laboratory

scientists. The NBTS/hospital blood exchange program will put a system in place whereby NBTS will

develop and implement a delivery system with hospitals, including select USG-supported hospitals, which

have appropriate blood banking facilities in place. NBTS will pick up unscreened blood units that the

hospitals have appropriately collected and stored and will transport these units back to NBTS centers where

they will be screened for the 4 transfusion transmissible infections (TTIs) of HIV I and II, hepatitis B,

hepatitis C and syphilis using ELSIA techniques. In addition to collecting unscreened units, NBTS will

deliver to the hospitals their requested order of screened units for blood banking and use at the facilities.

Furthermore, as well as providing screened blood to the facilities, NBTS will also provide monthly feedback

on rates of the 4 TTIs found by ELISA screening of blood units collected by the facility. This will facilitate

improvement of donor prescreening and deferment. This program will be piloted at select facilities with each

USG partner and then expanded as NBTS absorptive capacity improves. The goal will be that 80% of blood

transfusions that occur at these hospitals will be with NBTS-screened blood units, while only 20% will be

emergency transfusions whereby the hospital will screen the donated blood on site using rapid test kits.

Given that only a fraction of facilities will be capable of piloting such an exchange program with NBTS in this

initial year, all facilities will be supported to improve their collection practices and on site lab screening

practices, including utilizing the blood donor setting as another point of service for HCT during pre-donation.

SBFA and NBTS will participate in a University of Maryland led assessment of blood safety evaluation

activities in Nigeria funded in COP07. This operational research will provide insight into rates of TTIs,

including HIV, that go undetected in the current emergency-based transfusion system.

Training on appropriate blood use, dangers of TTIs, and the risks associated with family replacement and

remunerated donors will be maintained. Training will also be conducted on the appropriate clinical use of

blood. Technical support will be given to NBTS to develop IEC materials and job aids. SBFA will work with

other USG IPs to create a referral network whereby suitable donors are referred to nearby NBTS sites for

repeat donation. In cases where donors at NBTS centers are found to be HIV positive, referral will be given

to nearby USG-supported facilities. Referral forms will be jointly developed by SBFA and other IPs through

the USG/IP blood safety group. SBFA will continue to assist the NBTS in its monitoring and evaluation

program. This will significantly improve NBTS regulatory capabilities. It is NBTS's intent to regulate and

institute consistent blood banking standards and practices on a national basis. This SBFA program has

been designed to assist the NBTS to fulfill this objective. SBFA will assist the NBTS in using assessments

resulting from this program to help upgrade the safety standards of each hospital blood bank and will

provide appropriate training and coordination among USG facilities. SBFA activities will provide support for

188 service outlets and will provide 1000 trainee slots that will yield 720 unique individuals trained.

SBFA has worked with ENHANSE and the NBTS through the National Technical Committee to develop safe

blood related policy. In FY08, emphasis will be on entrenching the policy into law and the implementation of

the policy throughout the country including setting up a regulatory body and oversight standards. This is a

significant intervention for the prevention of HIV and other TTIs through improved blood safety practices.

SBFA 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. SBFA will continue to strengthen the technical and managerial capacity of

the NBTS through its TA program to ensure its sustainable, independent operation and increased

leadership role in the safety of Nigeria's healthcare system.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

SBFA BS activities will contribute to COP08 overall Emergency Plan blood safety targets for Nigeria.

Activities will increase VNRD, create an enabling environment, and improve access to quality blood

transfusion systems and practices. Technical support by SBFA in linkages and synergies between the

NBTS and service outlets will improve the quality of blood transfusion practices in Nigeria. The NBTS/USG

supported hospital blood exchange program will also improve access to safe blood. This activity will be

primarily conducted through technical assistance to the NBTS and the hospital monitoring and evaluation

program, as well as through training to facility staff. Monitoring and evaluation activities will determine the

number of blood units screened by NBTS and the number of outlets adhering to the appropriate use of

guidelines and SOPs provided through regular audits at these outlets at 6 month intervals. PEPFAR BS

indicators will be reported.

Activity Narrative: LINKS TO OTHER ACTIVITIES:

SBFA VNRD activities have direct links to Counseling and Testing. SBFA TA activities are linked to policy

analysis and system strengthening activities. SBFA also provides technical assistance and support to other

USG partners implementing emergency blood screening activities under this program area.

POPULATIONS BEING TARGETED:

Low risk populations targeted to become regular VNRD include select youth groups and select cohorts of

adult men and women. SBFA will assist the NBTS to engage with organizations such as FBOs,

business/private sector and community and religious leaders. SBFA training activities and capacity building

will target host country government workers and other health care providers.

EMPHASIS AREAS:

This program focuses on blood safety training in all areas of the program. Efforts are also being expanded

in the area of blood policy and oversight. Community mobilization/participation and supportive supervision

are also a focus of this activity. The program addressed by SBFA activities is based on volunteers.

Development of a sustainable VNRD base is by definition entirely dependent on recruiting and retaining

volunteers. This activity is community based and focuses on the recruitment of suitable low-risk voluntary

donors to supply centralized blood collection facilities.

The Safe Blood for Africa Foundation (SBFA) is providing technical assistance services in Nigeria in the

prevention program area of Medical Transmission/Blood Safety (BS). Activities are linked to the National

Blood Transfusion Service'S (NBTS) long term strategy. SBFA is assisting the NBTS in implementing the

primary objective of migrating fragmented hospital-based blood services to centralized NBTS-based blood

services nationwide. In FY08, SBFA activities under the medical transmission program area will be primarily

focused on: sustainability plans for the NBTS; capacity building for blood safety activities at USG supported

hospitals in Nigeria; supporting NBTS in developing and implementing a hospital blood bank exchange and

distribution system; and promoting coordinated blood safety activities across all partners.

Many challenges have faced the development and institutionalization of the NBTS in Nigeria within the

government. In the second quarter of 2008 the Government of Nigeria (GON) organized a maiden

stakeholders' conference to address some of these challenges. Critical areas requiring additional support

were identified for the progress and sustainability of the NBTS. One of such area is the establishment of an

effective and sustainable Nigerian Blood Service that is a clearly defined Agency which conforms to the

recommendations and guidelines of the World Health Organization (WHO). The successful future of the

NBTS depends on this. NBTS is presently a division under the Federal Ministry of Health and its activities

are limited and restrictive under the bureaucracy of the Ministry. An autonomous status of the NBTS will

give it greater government funding and increased direct access to policy makers and donor agencies. In

FY08 under health policy and system strengthening, SBFAF will work with the Enabling HIV & AIDS, TB

and Social Sector Environment (ENHANCE) for this activity identified as a need for the sustainability of

NBTS. ENHANCE is a Nigeria-USG bilateral project that creates an enabling policy and legislative

environment for health and education programs in Nigeria. This organization played an active role in the

development of the National Health bill and will be part of the Ministerial Steering Committee that will be

constituted to produce an appropriate policy framework and draft the legislative bill to actualize this

objective.

SBFA has worked with ENHANSE and the NBTS through the National Technical Committee to develop

National Blood policy. In FY08, emphasis will be on entrenching the policy into law and setting up a

regulatory body and oversight standards. This is a significant intervention for the prevention of HIV and

other TTIs through improved blood saftey practices. SBFA 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.

Another key area for the successful future of the NBTS will be to develop a blood safety training manual.

This manual is an integral component of the development of sustainable and replicable best practices in

transfusion medicine. Capacity building is one of the key mechanisms to achieving the objectives of the

NBTS long term strategy. SBFA is expanding its TA to establish a more appropriate blood safety program in

US Government (USG) supported hospitals in Nigeria. SBFA has conducted a robust training program that

has been fundamental to the rapid expansion of the NBTS. SBFA will utilize the standardized training

manual to further train a pool of Trainers in Nigeria. Trainers will include all categories of health workers

relevant on blood safety activities he facilities will be educated on the use of the blood screening algorithm

and proper diagnostic strategy based on prevalence criteria. SBFA will train nurses and medical laboratory

scientists in USG supported hospitals and hospitals within NBTS catchment areas to recruit repeat

voluntary blood donors from the ranks of current family replacement donors. SBFA will also train these

personnel in blood collection and donor care, as well as in counseling, including appropriate utilization of the

NBTS predonation screening questionnaire, leading to improved screening of all donors in all facilities.

SBFA will continue to strengthen the technical and managerial capacity of the NBTS through its TA program

to ensure its sustainable, independent operation and increased leadership role in the safety of Nigeria's

healthcare system.