ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Taking into account that FY 2009 will be the last year of PEPFAR Track 1 funds, it is essential to ensure

that programs implemented by the South African National Blood Services (SANBS) and the Western

Province Blood Transfusion Service (WPBTS) are institutionalized and sustainable. PEPFAR activities will

be sustained by:

(a) Implementing the last phase of the stepwise transfer of all PEPFAR-funded staff positions to the SANBS

and the WPBTS payrolls.

(b) Completing all the outstanding components of the SANBS Transfusion Medicine Training Center

(TMTC), including the accreditation and/or certification of all training and continuing professional

development courses based on distance learning materials; evaluation of the course materials and course

outcomes; and ensuring that the course material is appropriate or could be adapted for use also in the

Southern African Development Community (SADC).

(c) Expanding the data warehouse to capture all blood transfusion activities in terms of quality,

effectiveness, efficiency and cost.

(d) Documenting all standard operating procedures into the quality management system.

(e) Utilizing the data warehouse to optimize the hospital transfusion committees by making available to

individual hospitals, and possibly to individual clinicians and hospital departments, data on the safety and

the appropriate use of blood products.

(f) Refining and institutionalizing the blood safety indicators.

DONOR RECRUITMENT, EDUCATION AND SELECTION:

The programs will be enhanced and expanded by:

(a) Evaluation and measurement of the outcomes of the pilot projects where four fixed donor clinics have

been established in black communities by measuring the demographic profile of the donor population

compared to that of the country.

(b) Further refine the self-exclusion donor health questionnaire to ensure that it is language and culture

specific, and that all donors understand the content of the questionnaire.

(c) Monitor and evaluate donor educational programs and their outcomes on blood safety and blood

sufficiency.

(d) Collaborate with government and NGOs involved in HIV education and testing to identify prospective

blood donors with low-risk life style.

(e) Utilize the blood donor educational youth programs linking safe blood with low-risk blood donation to

spread HIV prevention messages. This will be strengthened by utilizing the Peer Promoter Program as a

component of the youth donor recruitment and education project.

(f) Establish measures and ongoing evaluation of the donor education programs by utilizing the fact that

regular donors are repeatedly tested for HIV and other infections.

(g) Assess and improve the donor loyalty programs and investigate and evaluate the influence of donor

incentives.

HUMAN CAPACITY DEVELOPMENT:

The TMTC will serve as a national and regional facility by:

(a) Accreditation with the relevant South African educational, Health Professions Councils, and

governmental training quality assurance institutions. This will take into account the impact of the pending

restructuring of the statutory educational and training quality assurance systems.

(b) Conduct, with AABB, a comprehensive need assessment for training and human capacity development

in the SADC region to develop and establish systems that will identify potential leaders and ensure optimal

development of blood service personnel.

(c) Establish appropriate links and memoranda of understanding with all stakeholders involved in the

support, training and development of blood service staff in Anglophone African countries. (d) The SANBS

model and materials will be offered to other blood services in the region to develop regional training facilities

and distance and e-learning materials.

PLASMA REPOSITORY AND REGIONAL REFERENCE CENTER:

The regional reference center will be established as a national and regional resource. The quality of the

plasma repository will be enhanced by establishing methods to collect serial samples from seroconversion

donors with low viral loads that had been detected with individual donation nucleic acid test screening. It is a

priority to fully train technical staff in this specialized technology; this training will be at international

reference centers and will ultimately transfer the relevant technology to the SANBS laboratory. It is

envisaged that the plasma repository will be used as the basis for a regional external quality assurance

system. The value of this resource for the region will be maximized by establishing links with international

commercial companies manufacturing test kits and international reference centers such as that of the WHO.

Processes and systems will evaluate the sensitivity and specificity of blood screening tests. The plasma

repository will also be a valuable instrument and could be used to identify HIV strains that may be suitable

for vaccine development.

DATA WAREHOUSE (DW):

The DW will be expanded to include information on the institutions financial management system, human

resource capacity, training and education programs, quality management systems, and blood safety

indicators. The DW will make it possible to use accurate and timely available information to optimize the

management of the blood service, evaluate and measure the outcome and cost-effectiveness of all

programs, manage performance of staff, monitor and refine the quality management system, and document

and evaluate all training programs.

WPBTS:

Activity Narrative: The focus will be on donor recruitment, standardizing all blood safety procedures, training blood service

personnel, aligning the information systems and including national data on the DW.

-------------------------

SUMMARY:

The South African National Blood Service (SANBS) program aims to ensure an adequate supply of safe

blood. This includes expanding the Safe Blood Donor Base by donor education and selection, training donor

and technical staff, logistics management, and appropriate information systems. The major areas of activity

are donor and blood user education and strengthening the technical and information systems infrastructure.

The target population is potential blood donors.

BACKGROUND:

SANBS collects 750,000 units of blood per annum providing blood to eight of the nine provinces. The other

service, Western Province Blood Transfusion Service (WPBTS) collects 120,000 units per year serving the

Western Cape Province. SANBS is a leader of blood transfusion in Africa and supports by training and

technically the blood services of the Southern African Development Community (SADC). The National

Health Act requires a single national blood transfusion service. SANBS, WPBTS and the Department of

Health are discussing how best to comply with legislation. SANBS, utilizing PEPFAR, has shared

educational material with WPBTS, standardized the self-exclusion donor questionnaire, supported the

continuing professional development of staff and developed the PEPFAR indicator tool as a national

measuring system. FY 2008 funding to SANBS will support the merger by strengthening the bonds between

the services in the fields of blood safety, staff training and donor education.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Expanding the Donor Base

The focus of this activity is to expand the donor base by including younger and more demographically

representative population groups. Blood safety is achieved by donor education and self-exclusion of those

at risk of HIV exposure. This activity will consist of several sections: (a) The donor education and

communication materials have been re

vised and included in the donor educator and recruiter training materials. These materials will be made

culture-specific and translated into the indigenous languages to facilitate the expansion and demographic

diversity of the donor base. (b) A donor education guideline for the Muslim community has been approved

by an Islamic fatwa. This will be implemented in FY 2008. (c) A key program focuses on educating and

recruiting young donors. Prospective donors will be exposed to a special scholar donor education program

approved and in harmony with those of the Departments of Education and Health, and the HIV and AIDS

Directorate. Scholars at selected pilot schools will be educated on lifestyle and HIV transmission, including

the role of Abstinence and Be Faithful (AB), and the impact of lifestyle on blood safety. Education also

addresses the importance of blood donation, and the use and need of safe blood. The Club 25 project was

started in FY 2006 and is continually being refined and evaluated. In FY 2007 the program was expanded to

other African countries. The model is based on education of particularly scholars and their commitment to

remaining regular safe blood donors (donate 20 units before the age of 25). The results of laboratory

screening tests will be disclosed to them and the message of safe lifestyle, and the benefits of being a

donor reinforced. This is optimized by one-on-one interviews by trained nursing sister counselors. Trained

donor educators offer course by lectures supported by pamphlets, information leaflets and booklets. In FY

2008 the program will be institutionalized in as many schools as possible. A further 50,000 scholars in FY

2008 will be exposed to the Club 25 program. (d) A donor deferral guideline has been developed for training

of and use by the 100 tele-recruiters allowing them to professionally inform blood donors. (e) A pilot project

to expand the SANBS donor base aims at entering into partnerships with private companies. SANBS has

formed a successful partnership with Daimler Chrysler SA. This initiative will be expanded and new

partnerships fostered in FY 2008. (f) SANBS will continue to refer HIV-infected donors to PEPFAR-

supported ARV sites. SANBS will link with PEPFAR AB partners to optimize the education of the youth on

safe lifestyles. (g) FY 2008 activities will include donor recruitment and educational programs at the four

clinics established in 2007 in black communities. The donor programs will focus on safe lifestyle and the

relationship to safe blood, and the need for blood donors. The results of laboratory screening tests will be

used to reinforce the message of safe lifestyle, the role of AB in avoiding sexually transmitted infections,

and the importance of blood and donors.

ACTIVITY 2: Training

This program focuses on developing training courses and materials for SANBS and WPBTS staff. These

materials will be offered in the seven operational zones of SANBS, and WPBTS. Training focuses on

human capacity development and addressing skills shortages. The 40 technicians enrolled in the program

to qualify as technologists at a tertiary institution will continue in FY 2008. Training programs for technicians,

technologists, and donor education and recruitment staff will be continued. Sixty trainee phlebotomists will

be trained and registered with the Health Professionals Council of SA as Phlebotomy Technicians. Fifteen

trainers from all provinces will be trained in the train-the-trainer program The distance learning material

developed in FY2005-2007 will facilitate in FY 2008 the training of SANBS and WPBTS staff. The distance

learning program is strengthened by the videoconferencing equipment purchased in FY 2007. The national

and regional Training Center commenced in FY 2007 will be fully established in FY 2008 and all aspects of

the program assessed and overseen by a professional educator. SANBS and WPBTS staff will continue to

host seminars, workshops, symposia and lectures in the discipline of transfusion to internal staff and

external health practitioners. As part of the AABB PEPFAR Technical Assistance program, two SANBS staff

members, one each from the donor and technical areas will attend a specialist high-level training course at

Emory University. SANBS in FY 2007 assisted in the development of a certified course in clinical

transfusion medicine at the University of the Free State. SANBS will in FY 2008 participate in the delivery of

the theoretical and practical course material. The course content is suitable for students of other African

Activity Narrative: countries. Central to staff development is job satisfaction leading to better retention of staff. The staff

development program is complemented by performance management and reward with clear career paths.

ACTIVITY 3: Regional Reference Center and Plasma Repository

SANBS annually screens more than 700,000 blood donations for HIV, HCV and HBV. In FY 2007 a plasma

repository of viral positive plasma has been established in a facility funded by SANBS. This will in FY

2008/9 be expanded to a regional reference laboratory. This facility will satisfy the needs of the Southern

African region for an external quality assessment program. The plasma repository will be fully characterized,

and aliquots distributed to participants in an African External Quality Assurance System. Analysis of

performance of blood services will enhance national blood safety. The plasma repository is a unique

resource for African transfusion services and could be used to assess blood screening systems, investigate

the sensitivity and specificity of tests and their impact on the window period, and the identification of new

infectious agents. The technologist who will lead this program in August-October 2007 will be trained at the

Blood Research Institute in San Francisco.

ACTIVITY 4: Data Warehouse

The SANBS data warehouse will be fully operational by end FY 2008. It is an essential component of the

information system and will be used for the management and evaluation of all components of the blood

system. In FY 2008 the data warehouse will include the data of WPBTS. This will make it possible to utilize

the PEPFAR indicator tool to assess and improve the blood system of South Africa.

ACTIVITY 5: Western Province Blood Transfusion Service (WPBTS)

FY 2008 COP activities will be expanded to focus on the merger of SANBS and the WPBTS. Activities will

be implemented for a step-wise incorporation of WPBTS into the SANBS PEPFAR program focusing on

training and personnel development, establishment of a training center, and by developing appropriate

information technology systems for the collection of national data as an indicator of the status of blood

transfusion in South Africa. WPBTS will also utilize PEPFAR funding to expand their base of safe donors by

establishing more mobile clinics. This will be facilitated by acquiring a specially fitted vehicle. WPBTS will

play a key role in the development of the web-based training system and the WPBTS will be incorporated

into the SANBS staff capacity building, on-site training and continuing professional development programs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13813

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13813 3059.08 HHS/Centers for South Africa 6621 511.08 $2,000,000

Disease Control & National Blood

Prevention Service

7394 3059.07 HHS/Centers for South Africa 4399 511.07 $2,000,000

Disease Control & National Blood

Prevention Service

3059 3059.06 HHS/Centers for South Africa 2688 511.06 $350,000

Disease Control & National Blood

Prevention Service

Emphasis Areas

Workplace Programs

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $479,148

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.04: