CONTINUATION OF ACTIVITY FROM FY 2009

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 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. SBFAF will continue to provide technical support to NBTS in the VNRD system.

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 FY09, SBFAF activities have been primarily focused on: capacity-building for blood safety activities at all NBTS centers and 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.

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 FY07 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 select 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 ELSIA techniques. In addition to collecting unscreened units, NBTS deliver to the hospitals their requested order of screened units for blood banking and use at the facilities. Furthermore, NBTS also provide monthly feedback on rates of the 4 TTIs found by ELISA screening of blood units collected by the facility. This is intended to facilitate improvement of donor prescreening and deferment. This program has already commenced at select 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 FY10. Technical support will be given to NBTS to revise IEC materials to create awareness and promote blood safety and also advocacy packages for health professionals.

The Government of Nigeria has made efforts to increase accessibility to safe blood through establishment of more NBTS centers. There are presently 17 centers which will increase to 19 at the end of FY09. SBFAF will continue to provide TA in the infrastructural developments of the new centers to ensure uniform quality nationwide.

SBFAF will continue to assist the NBTS in its monitoring and evaluation program. 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.

In the past has been worked through the National Technical Committee to develop a safe blood related policy. In FY10, entrenching the policy into law and advocacy to make the NBTS autonomous will be pursued. 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 BS activities for COP10 will contribute to the overall Emergency Plan blood safety targets for Nigeria and will form a bridge to the sustainability

plan for PEPFAR II . 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. 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 centers.

LINKS TO OTHER ACTIVITIES: SBFAF VNRD activities have direct links to counseling and testing and abstinence/be faithful programmes. SBFAF 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. SBFAF will assist the NBTS to engage with organizations such as FBOs, business/private sector and community and religious leaders. SBFAF skills development programmes and capacity building activities will target host country government workers and other health care providers.

KEY LEGISLATIVE ISSUES ADDRESSED: Key issue addressed by SBFAF 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 focused on the recruitment of suitable low-risk voluntary donors to supply centralized blood collection facilities.

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 oversight. Community Mobilization/Participation and Supportive Supervision will be areas of minor emphasis.

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: • In COP10, SBFAF will continue to provide capacity building activities to the NBTS but rather provide classroom type trainings, the technical assistance will be provided through a skills development, hands-on "wet-type" training whereby, the SBFAF technical team and specialists will spend working weeks each and at each time impacting different areas of expertise at each NBTS center. SBFAF will consolidate on all the trainings and prior technical assistance provided to the NBTS and will provide on-site mentoring throughout the fiscal year. SBFAF will provide expertise in various fields that are appropriate to achieve the desired goals of the NBTS. SBFAF will provide extended technical assistance and mentoring in the areas of donor recruitment, blood collection and donor care, pre and post donation counseling, clinical

aspects and appropriate blood use, components production, quality systems, laboratory operational systems and management operational systems. • In COP10, SBFAF and NBTS will approach the hospital linkage programme (HLP) under a re-designed strategy developed by both parties. One pilot hospital will be selected in each of the six geo-political zones and Abuja and the progress of the HLP will be closely tracked by SBFAF. • In COP10, advocacy to make the NBTS autonomous will be conducted. An independent agency/commission status will significantly improve NBTS regulatory capabilities. SBFAF will fund several technical committee meetings to develop a legislative bill to transform the NBTS into an agency or a commission. It is hoped that this document will be passed to the National Assembly for adoption into law. • 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. SBFA will also fund a series of sub-committee meetings to engage all stakeholders involved and utilizing the same methodology as was used for the development of the 'Guidelines for Blood Transfusion Practices in Nigeria' developed in COP 07. The training manual will also be based on this same document.

CONTINUATION OF ACTIVITY FROM FY 2009

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 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. SBFAF will continue to provide technical support to NBTS in the VNRD system.

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 FY09, SBFAF activities have been primarily focused on: capacity-building for blood safety activities at all NBTS centers and 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.

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 FY07 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 select 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 ELSIA techniques. In addition to collecting unscreened units, NBTS deliver to the hospitals their requested order of screened units for blood banking and use at the facilities. Furthermore, NBTS also provide monthly feedback on rates of the 4 TTIs found by ELISA screening of blood units collected by the facility. This is intended to facilitate improvement of donor prescreening and deferment. This program has already commenced at select 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 FY10. Technical support will be given to NBTS to revise IEC materials to create awareness and promote blood safety and also advocacy packages for health professionals.

The Government of Nigeria has made efforts to increase accessibility to safe blood through establishment of more NBTS centers. There are presently 17 centers which will increase to 19 at the end of FY09. SBFAF will continue to provide TA in the infrastructural developments of the new centers to ensure uniform quality nationwide.

SBFAF will continue to assist the NBTS in its monitoring and evaluation program. 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.

In the past has been worked through the National Technical Committee to develop a safe blood related policy. In FY10, entrenching the policy into law and advocacy to make the NBTS autonomous will be pursued. 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 BS activities for COP10 will contribute to the overall Emergency Plan blood safety targets for Nigeria and will form a bridge to the sustainability plan for PEPFAR II . 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. 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 centers.

LINKS TO OTHER ACTIVITIES: SBFAF VNRD activities have direct links to counseling and testing and abstinence/be faithful programmes. SBFAF 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. SBFAF will assist the NBTS to engage

with organizations such as FBOs, business/private sector and community and religious leaders. SBFAF skills development programmes and capacity building activities will target host country government workers and other health care providers.

KEY LEGISLATIVE ISSUES ADDRESSED: Key issue addressed by SBFAF 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 focused on the recruitment of suitable low- risk voluntary donors to supply centralized blood collection facilities.

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 oversight. Community Mobilization/Participation and Supportive Supervision will be areas of minor emphasis.

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: • In COP10, SBFAF will continue to provide capacity building activities to the NBTS but rather provide classroom type trainings, the technical assistance will be provided through a skills development, hands- on "wet-type" training whereby, the SBFAF technical team and specialists will spend working weeks each and at each time impacting different areas of expertise at each NBTS center. SBFAF will consolidate on all the trainings and prior technical assistance provided to the NBTS and will provide on-site mentoring throughout the fiscal year. SBFAF will provide expertise in various fields that are appropriate to achieve the desired goals of the NBTS. SBFAF will provide extended technical assistance and mentoring in the areas of donor recruitment, blood collection and donor care, pre and post donation counseling, clinical aspects and appropriate blood use, components production, quality systems, laboratory operational systems and management operational systems. • In COP10, SBFAF and NBTS will approach the hospital linkage programme (HLP) under a re-designed strategy developed by both parties. One pilot hospital will be selected in each of the six geo-political zones and Abuja and the progress of the HLP will be closely tracked by SBFAF. • In COP10, advocacy to make the NBTS autonomous will be conducted. An independent agency/commission status will significantly improve NBTS regulatory capabilities. SBFAF will fund several technical committee meetings to develop a legislative bill to transform the NBTS into an agency or a commission. It is hoped that this document will be passed to the National Assembly for adoption into law. • 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. SBFA will also fund a series of sub-committee meetings to engage all stakeholders involved and utilizing the same methodology as was used for the development of the 'Guidelines for Blood Transfusion Practices in Nigeria' developed in COP 07. The training manual will

also be based on this same document.