TITLE: Rapid strengthening of the Blood Safety Program in Tanzania

NEED and COMPARATIVE ADVANTAGE: In the past, blood transfusion services in Tanzania have been

predominantly hospital-based and reliant on replacement donations. This system was susceptible to higher

prevalence of transfusion transmissible infections. Tanzania has since established a centralized

coordinated blood transfusion system that is responsible for collection, processing, storage, and distribution

of blood and blood products to health facilities. This system relies on voluntary, non-remunerated repeat

blood donors (VNRBD). The Ministry of Health and Social Welfare (MOHSW) - National Blood Transfusion

Service (NBTS) is responsible for provision of safe and adequate blood to all Tanzanians.

ACCOMPLISHMENTS: Seven blood transfusion centers have been renovated, equipped, and staffed for

utilization. Of these, four centers have been operational since 2006 and the remaining three were

inaugurated in 2007.

Because of donation protocol, units of blood collected also represent the number of blood donors counseled

and tested for HIV and other TTIs. This component of blood donation significantly contributes toward

attaining the PEPFAR goal for people receiving counseling and testing for HIV/AIDS. Blood collection from

VNRBD has increased from 20% before 2005 to 80% in 2007. Large sensitization campaigns addressing

blood donation stigma are conducted through mass media including television, radio, and newspapers.

A quality systems manual and monitoring and evaluation (M&E) tools (both paper-based and electronic

forms) were developed and are currently being distributed to all implementers. In FY 2006, a computer

system was implemented for management of NBTS information and is operational in one out of the seven

zones in Tanzania. Currently, this system is undergoing implementation in the three additional zones and

plans are underway for provision of nationwide coverage. Utilizing FY 2008 funds, the new centers will be

technologically advanced. MOHSW management is presently in the process of establishing the NBTS as

an executive agency through an act of Parliament.

ACTIVITIES: These activities will be accomplished through bilateral funding to complement Track 1.0

funding.

The Abbott Foundation will renovate 13 regional hospital based blood bank facilities while USG funding will

support NBTS in procuring and installing equipment for storage and distribution in these facilities. This

includes blood testing equipment, refrigerators, and cool boxes..

Access to adequate and safe blood transfusions will be accomplished through increasing opportunities, and

a growing desire by the public, to participate in blood donation. Generating interest will result from a public

sensitization campaign distributing positive messages about donating blood. Mass media, through

information, education, and communication (IEC) material production and distribution, has potential for very

broad coverage of community sensitization messaging. Ten newly procured vehicles will improve logistics

for blood transportation from mobile teams to the zonal center, in addition to improving blood distribution,

mobilization campaigns, and supportive supervision. Phones for health and Personal Digital Assistant

(PDA) equipment will be used by the mobile teams to enter data while in the field, reach donors for recall,

and to send motivational messages to new and repeating donors. NBTS will also develop audio/visual

prevention messages to be used during donor recruitment and sensitization campaigns. This will

necessitate the procurement of audio/visual devices through which each team in the various zones can

relay educational, preventive, counseling, and recruitment messages. Goals are in place to increase the

blood donation rate in the population from 3.3 units per 1,000 to at least 20 units per 1000 people.

The NBTS will equip four of the seven zonal blood banks to perform automated screening for HIV, HBV,

HCV, and Syphilis. This will decrease turn around times for blood, reduce staffing needs for screening, and

reduce the margin of error for testing. Transfusing blood components significantly reduces the physical

need for blood collection. NBTS will also equip four zonal blood transfusion centers with modern

component separation equipment for the production of blood components.

The NBTS, in collaboration with the Tanzania Red Cross, will set up and maintain blood donor clubs in six

additional regions to make a grand 18 regions of Tanzania with donor clubs, paving the way for sustainable

blood stores for the people of Tanzania. With technical assistance from CDC and American Association of

Blood Banks (AABB), the National Blood Transfusion Service (NBTS) will promote rational use of blood in

hospitals by orientating and training physicians, members of the blood committees, and staff at the blood

banks. NBTS will encourage organizations to utilize Government of Tanzania (GoT) and USG procurement

systems (e.g., MSD and SCMS) to ensure a reliable and continuous supply of reagents, test kits, and

supplies for blood collection and processing at zonal centers and regional blood banks. Technical

assistance (TA) from AABB and NBTS will determine the cost of providing one unit of blood and establish

mechanisms for cost recovery.

The NBTS will ensure the quality of services offered at all blood service sites by implementing a quality

management plan, subject to continued review. Additionally, the NBTS will hold regular advocacy meetings

with decision makers from hospitals in order to disseminate updated NBTS policy and guidelines. NBTS

management will provide supportive supervision to monitor the quality of pre-and post-test counseling,

recruitment, testing, blood collection, transportation, storage, and distribution. A standardized tool will be

developed for this purpose and corrective training or advice will be solicited as needed.

In order to assess its quality, impact, efficiency, and effectiveness, the NBTS will implement a three-year

strategic plan and a comprehensive monitoring and evaluation (M&E) plan. Existing data collection and

reporting tools will be reviewed for accuracy and relevance. Feedback will be incorporated into the tools for

improvement of the M&E tools. The NBTS will also formulate a staff retention program to ensure skills-

based management training background for employees. The NBTS will work with the National Malaria

Control Program and President's Malaria Initiative to promote malaria prevention and the use of ITNs

among blood donors, general population, and pregnant women and children under five years of age. NBTS

will also collaborate with the NACP to promote HIV prevention through donor messages.

LINKAGES: The NBTS will link with the National Malaria Control Programme (MACP) and PMI to promote

Malaria prevention messages. The NBTS also intends to collaborate with NACP to promote VCT through

outreach activities. Linkages will also occur in collaboration with private business to devise blood donor

Activity Narrative: incentive and retention.

The NBTS intends to collaborate with Phones for Health and local mobile phone companies for tracking

data, donor notification, and incentives. The NBTS will also directly and indirectly link with the Ministry of

Education and Vocational Training, to ensure that blood safety is included in the training curricula and

advocate that culture and sports become part of blood safety activities, NACP to develop consistent

messages for donor VCT and HIV prevention; the Injection Safety Department, to ensure injection safety

and proper waste disposal; and Haukeland University Hospital, which also provides capacity building and

quality improvement for NBTS.

CHECK BOXES: The blood safety program aims at ensuring adequate numbers of voluntary, non-

remunerated repeating blood donors as a safe source of blood for transfusion. The program will target the

general population.

M&E: The NBTS will collaborate with the AABB to develop an M&E program that will encompass all the key

processes such as collection, processing, distribution, and utilization of blood. Gathering statistics on the

number of annual blood collections reflect the effectiveness of the NBTS to reach goals set by key

stakeholders. In addition, documentation of blood donor recruitment and retention reveals a percentage of

the population who received counseling. These process indicators ensure effectiveness of the quality

management system, the objective of which is to ensure that the NBTS supplies safe and adequate blood.

The required PEPFAR indicators will constitute part of the monitoring tools to ensure planning,

implementation, and effectiveness of project objectives. Qualified M&E personnel will be hired to achieve

the COP 2008 M&E implementation plan and its roll out to the zonal centers.

Gap analyses will be performed to identify potential opportunities for enhancement and improvement.

Subsequently, a model will be developed that incorporates existing NBTS procedures and desired industry

M&E best practices.

SUSTAINAIBLITY: Currently there are plans to institute cost recovery mechanisms for the blood transfusion

services offered by the NBTS. In addition, making the NBTS an executive agency will ensure Government

Fiscal allocations to NBTS for blood safety program activities.