The mission of the National Center for Blood Transfusion (CNTS) is to collect, analyze, and distribute safe blood in adequate quantities and quality to 100% of patients in need in Rwanda. Blood donor activities are based exclusively on voluntary, non-remunerated donations. Transfusion medicine is essential for the appropriate management of different health conditions. Conditions involving blood loss, such as malaria, surgery, obstetrics-gynecology and others cannot be effectively handled without the availability of blood and blood products. Rwanda like other African countries is faced with high morbidity and mortality of

children under 5 years due to malaria. Therefore, the quantity of blood collected should be increased to collect at least 40,000 units of blood to ensure that all national requirements for blood and blood products in both public and private hospitals are attended to and to make sure that there is no shortage of blood and blood products in our centers.

Infrastructure Gihundwe blood transfusion post will be renovated and brought to the level of regional center for blood transfusion (RCBT). This will enable easy accessibility of hospitals to the transfusion facility. This will also solve the problem of hospitals in that region driving long distances to Huye Blood Transfusion Center for blood requests.

Vehicles Following the establishment of new hospitals and an MOH-initiated campaign underway to sensitize people on the importance of early treatment, CNTS expects an increase in the number of people seeking health care, which may trigger a greater need for blood transfusion services. This demand in turn creates a need for more vehicles. In addition, the newly rehabilitated RCBTs will start sensitization, recruitment, blood collection, screening distribution of blood products and blood donor result notification services in FY 2010, activities which will require six additional vehicles.

Equipment RCBT Karongi and Gisenyi will be equipped and staffed with medical equipment and begin functioning like existing RCBTs. Twelve fire extinguishers will be purchased for the newly rehabilitated regional blood centers. In addition incinerators will be installed at four RCBTs for the purposes of waste management. Computerization systems will be installed at newly rehabilitated RCBTs for proper administration of blood and blood components. New medical equipment will be purchased to replace the old or broken machines.

Blood collection In FY 2010 the number of blood collection session at CNTS Kigali will be increased from 20 to24, while the number of blood collection session at CRTS Butare and CRTS Ruhengeri will be increased from eight to ten. The blood collection in these sessions should meet the increasing demand for blood products in health facilities.

Donor recruitment will be strengthened in the eastern province, the western province and Kigali. Secondary schools will continue to be targeted as a potential source of donations. To increase donations CNTS will increase repeat donors from 65% to 66%, continue to provide incentives, strengthen media programming, initiate CLUB-25, introduce haemoglobin testing by use of CuSO4 method, initiate blood

donor notification program for positive tests and purchase consumables.

Blood testing ABO and Rhesus grouping will continue for each blood donation using a fully automated testing system. CNTS will continue to conduct fetal-maternal immunization surveillance and tests for irregular antibodies using a tube indirect antiglobulin test. Standard operating procedures (SOPs) will be written and used for preventive maintenance for laboratory equipments, which will in turn ensure the quality of laboratory results. All blood donations will be routinely screened for HIV, HBV, HCV and syphilis. Quality control and external quality assessments will continue and expand to all areas of testing.

Transfusion and Blood Utilization CNTS will introduce leucoreduced blood components for selected patients and will expand blood components production and quality controls. Furthermore, CNTS will explore the feasibility of viral inactivation of blood units and will work to implement guidelines for the rational and appropriate use of blood products in hospitals. CNTS will also strengthen the implementation of protocols for cold chain management and continue the validation of blood transportation system. There will be increased emphasis on strengthening the inventory management systems for blood components at CNTS and hospitals.

Training CNTS will continue to strengthen laboratory best practices and develop new twinning programs for laboratory technicians in order to improve standards. For the purposes of strengthening the donor notification program, CNTS nurses will receive training in counseling of patients before and after results are given to blood donors. CNTS will continue its program of capacity building and training to ensure sustainability of the program.

Quality assurance In conjunction with technical assistance from AABB, CNTS will implement the twelve quality system essentials for a good quality management program. CNTS will continue external quality assessment for serology and blood grouping with South African and Australian laboratories. To ensure the efficacy and effectiveness of the quality assurance program, the quality assurance officer will receive additional training. CNTS will continue to pursue accreditation/certification by the AABB. CNTS will strengthen a haemovigilance system to ensure the reporting of adverse reaction.

Monitoring and Evaluation Data gathering and analysis will be strengthened and monitoring of blood use in hospitals will be emphasized.

FY 2010 Funding: The mission of the National Blood Transfusion Center (CNTS) is to collect, analyze, and distribute safe blood in adequate quantities and quality to 100% of patients in need in Rwanda. Blood donor activities are based exclusively on voluntary, non-remunerated donations. Transfusion medicine is essential for the appropriate management of different health conditions. Conditions involving blood loss, such as malaria, surgery, obstetrics-gynecology and others cannot be effectively handled without the availability of blood and blood products. Rwanda like other African countries is faced with high morbidity and mortality of children under 5 years due to malaria. Therefore, the quantity of blood collected should be increased to collect at least 40,000 units of blood to ensure that all national requirements for blood and blood products in both public and private hospitals are attended to and to make sure that there is no shortage of blood and blood products in our centers.

Infrastructure Gihundwe blood transfusion post will be renovated and brought to the level of regional center for blood transfusion (RCBT). This will enable easy accessibility of hospitals to the transfusion facility. This will also solve the problem of hospitals in that region driving long distances to Huye Blood Transfusion Center for blood requests.

Vehicles Following the establishment of new hospitals and an MOH-initiated campaign underway to sensitize people on the importance of early treatment, CNTS expects an increase in the number of people seeking health care, which may trigger a greater need for blood transfusion services. This demand in turn creates a need for more vehicles. In addition, the newly rehabilitated RCBTs will start sensitization, recruitment, blood collection, screening distribution of blood products and blood donor result notification services in FY 2010, activities which will require six additional vehicles.

Equipment RCBT Karongi and Gisenyi will be equipped and staffed with medical equipment and begin functioning like existing RCBTs. Twelve fire extinguishers will be purchased for the newly rehabilitated regional blood centers. In addition incinerators will be installed at four RCBTs for the purposes of waste management. Computerization systems will be installed at newly rehabilitated RCBTs for proper administration of blood and blood components. New medical equipment will be purchased to replace the old or broken machines.

Blood collection In FY 2010 the number of blood collection session at CNTS Kigali will be increased from 20 to24, while the number of blood collection session at CRTS Butare and CRTS Ruhengeri will be increased from eight to ten. The blood collection in these sessions should meet the increasing demand for blood products in health facilities.

Donor recruitment will be strengthened in the eastern province, the western province and Kigali. Secondary schools will continue to be targeted as a potential source of donations. To increase donations CNTS will increase repeat donors from 65% to 66%, continue to provide incentives, strengthen media programming, initiate CLUB-25, introduce haemoglobin testing by use of CuSO4 method, initiate blood donor notification program for positive tests and purchase consumables.

Blood testing ABO and Rhesus grouping will continue for each blood donation using a fully automated testing system. CNTS will continue to conduct fetal-maternal immunization surveillance and tests for irregular antibodies using a tube indirect antiglobulin test. Standard operating procedures (SOPs) will be written and used for preventive maintenance for laboratory equipments, which will in turn ensure the quality of laboratory results. All blood donations will be routinely screened for HIV, HBV, HCV and syphilis. Quality control and external quality assessments will continue and expand to all areas of testing.

Transfusion and Blood Utilization CNTS will introduce leucoreduced blood components for selected patients and will expand blood components production and quality controls. Furthermore, CNTS will explore the feasibility of viral inactivation of blood units and will work to implement guidelines for the rational and appropriate use of blood products in hospitals. CNTS will also strengthen the implementation of protocols for cold chain management and continue the validation of blood transportation system. There will be increased emphasis on strengthening the inventory management systems for blood components at CNTS and hospitals.

Training CNTS will continue to strengthen laboratory best practices and develop new twinning programs for laboratory technicians in order to improve standards. For the purposes of strengthening the donor notification program, CNTS nurses will receive training in counseling of patients before and after results are given to blood donors. CNTS will continue its program of capacity building and training to ensure sustainability of the program.

Quality assurance In conjunction with technical assistance from AABB, CNTS will implement the twelve quality system essentials for a good quality management program. CNTS will continue external quality assessment for serology and blood grouping with South African and Australian laboratories. To ensure the efficacy and effectiveness of the quality assurance program, the quality assurance officer will receive additional training. CNTS will continue to pursue accreditation/certification by the AABB. CNTS will strengthen a haemovigilance system to ensure the reporting of adverse reaction.

Monitoring and Evaluation Data gathering and analysis will be strengthened and monitoring of blood use in hospitals will be emphasized.