ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

•In COP08, SBFAF will assist the National Blood Transfusion Service (NBTS) to develop a Blood Safety

Training Manual. In COP09, SBFAF will assist the NBTS to train a pool of master trainers in the country.

•Another key activity in COP09 will be SBFAF's active role in the advocacy for the NBTS to achieve the

status of an autonomous agency or commission.

This activity is jointly funded through CDC and USAID. The narrative incorporates the scope of activities in

this joint project, in the two narratives the target for number of people trained is divided in order to avoid

duplication of targets. The Safe Blood for Africa Foundation (SBFAF) is providing technical assistance

services in Nigeria in the prevention program area of Medical Transmission/Blood Safety (BS). SBFAF

activities reinforce the National Blood Transfusion Service's (NBTS) long-term strategy. SBFAF assists the

NBTS in implementing its primary objective of migrating fragmented hospital-based blood services to

centralized national blood services nationwide. A key feature of this program is the development of a

nationwide voluntary donor recruitment system (VNRD - voluntary nonremunerated blood donation). The

NBTS zonal and state centers are primarily supported by VNRD. SBFAF will continue to provide technical

support to NBTS in the VNRD system.

The VNRD system is highly dependent on building a network of repeat donors. Currently, the NBTS has an

aggressive plan to expand the blood collection from the current level of less than 15% of the nation's needs

to over 90% by 2016. The Nigeria Club 25, SBFAF's youth wing in Nigeria, is not currently supported under

the PEPFAR program; however, SBFAF has continued to run the program because of its significance to the

donor pool. Members of Club 25 and youth between 18-25 years of age make up approximately half of the

NBTS donor pool. Additionally, repeat donor members of Club 25 have an HIV prevalence rate of 0.01%

compared to approximately 3.1% in the general public. This is primarily because members of this club have

pledged to donate blood regularly and as such adhere to the club's key messages which include living a risk

-free lifestyle. This same group of young adults aged 18-25, if fully dedicated to the cause, will continue to

be donors for several decades. The World Health Organization (WHO) guidance for blood banks stresses

the need to maintain as large a repeat donor base as possible - it is more reliable, cheaper to maintain, and

safer.

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

SBFAF has conducted a robust training program that has strengthened the NBTS. In COP08, SBFAF

activities have been primarily focused on: capacity-building for blood safety activities at all NBTS centers

and focal USG-supported hospitals in Nigeria; support of NBTS in developing and implementing a hospital

blood bank exchange and distribution system; and promotion of coordinated blood safety activities across

all partners. These activities will be sustained in COP09. SBFAF will utilize standardized training modules

that are appropriate to the various levels of trainees and approved by NBTS. SBFAF 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. SBFAF 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. Training on

appropriate blood use, dangers of TTIs, the risks associated with family replacement/ remunerated donors

and appropriate clinical use of blood will be maintained. SBFAF will continue its TA to establish a more

appropriate blood safety program in USG-supported hospitals in Nigeria in COP09. A total of 720 unique

individuals will be trained in COP09 by the jointly funded project.

SBFAF has facilitated 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 COP07 to NBTS and USG-supported facilities' drivers and medical laboratory

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

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

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

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

they are screened for the 4 transfusion transmissible infections (TTIs) of HIV I and II, Hepatitis B, Hepatitis

C and Syphilis using ELISA techniques. In addition to collecting unscreened units, NBTS delivers to the

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

NBTS also provides monthly feedback on prevalence rates of the 4 TTIs found in the blood units collected

by the facility. This is intended to facilitate improvement of donor prescreening and deferral. This program

has already commenced at selected facilities with each USG treatment partner and will be expanded as

NBTS absorptive capacity improves. The goal is 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 are

capable of piloting such an exchange program with NBTS in the initial year, all other facilities were

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 for deferred blood donors. This support activity will

continue in COP09.

Technical support will be given to NBTS to develop IEC materials and advocacy packages for medical

professionals. The Government of Nigeria has made efforts to increase accessibility to safe blood through

establishment of more NBTS centers. There are presently 11 centers which will increase to 17 in COP09 via

the GON efforts and funding. SBFAF will continue to provide TA in the infrastructural developments of the

new centers to ensure uniform quality nationwide. SBFAF will also continue to work in 33 outlets in Akwa

Ibom State.

SBFAF will continue to assist the NBTS in its monitoring and evaluation program. Bi-annual technical audits

of the NBTS centers will be done to ensure quality of services and laboratory processes. SBFAF 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.

SBFAF has worked with the NBTS through the National Technical Committee to develop a National Blood

Activity Narrative: Policy. In COP09, entrenching the policy into law and advocacy to make the NBTS autonomous will be

pursued in collaboration with other USG policy partners. 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. SBFAF 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: SBFAF blood safety activities will contribute to

COP09 overall Emergency Plan for 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 SBFAF 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 and 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.

LINKS TO OTHER ACTIVITIES: SBFAF VNRD activities have direct links to counseling and testing, human

capacity development and system strengthening activities.

POPULATIONS BEING TARGETED: Low risk populations targeted to become regular VNRD include youth

groups, adult men and women. SBFAF will assist the NBTS to engage with organizations such as faith-

based organizations (FBOs), business/private sector, community and religious leaders. SBFAF training

activities and capacity building will target government health workers and other health care providers.

KEY LEGISLATIVE ISSUES ADDRESSED: Key issue being addressed by SBFAF activities is to entrench

the national blood policy into law and advocacy to make the NBTS autonomous.

EMPHASIS AREAS: This program includes major emphasis on blood safety training in all areas of the

program. Emphasis is also being expended in the area of blood policy and legislation. Community

Mobilization and Supportive Supervision will be areas of minor emphasis.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $122,145

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.04: