THE ACTIVITY NARRATIVE HAS BEEN COMPLETELY REVISED

TITLE: RAPID STRENGHERNING OF BLOOD SAFETY PROGRAM IN TANZANIA

NEED and COMPARATIVE ADVANTAGE: The National Blood Transfusion Service (NBTS) is a programme

of the Ministry of Health and Social Welfare (MoHSW), established through a cooperative agreement

between Centers for Diseases Control and Prevention (CDC) and the Ministry of Health and Social Welfare

in the year 2004. NBTS is responsible for collection, processing, stocking and distribution of safe blood to

health facilities in Tanzania. NBTS relies on collecting of blood from voluntary non-remunerated repeating

blood donors (VNRBD)

Prior to 2004, blood for transfusion was collected mainly from family and relatives (replacement blood

donors). Currently blood is collected from VNRBD who have lower prevalence of Transfusion Transmissible

Infections (TTIs). NBTS is the sole organization mandated to collect process and supply blood for

transfusion in Tanzania.

The program contributes to USG PEPFAR HIV prevention goals by providing safer blood with low

prevalence of HIV and other TTIs which is necessary for patients with anemia including patients infected

with HIV before and during care and treatment. During mass mobilization and donor recruitment exercises

communities are educated on HIV and other TTI prevention methods. Donors are provided with pre and

post test counseling for safe blood donation and low HIV risk life style skills. Donors who are identified to

be HIV positive are referred to care and treatment services. Repeat donors who are mainly youth are

encouraged to form blood donor clubs where they learn the importance of remaining HIV negative, life skills

and adolescent reproductive health.

ACCOMPLISHMENTS: A total of eight (8) blood transfusion centers including Zanzibar are operational.

From 1st April 2007 - 31st March 2008 a total of 99,341 units of blood were collected from VNRBD which

is 99.34% of the FY07 target.

During the 1st quarter of FYO8 (1st April 2008 - June 30th 2008), 31,211 units of safe blood were

collected, of which 479 units were processed into blood components. The units of blood collected represent

the number of blood donors counseled and tested for HIV and other TTIs. The program conducted mass

sensitizations using TV, Radio and news paper.

Blood collection from VNRBD has increased by 23.8% as compared to FY07. The HIV prevalence amongst

the donors dropped from 3.9% to 2.85% in the same time period, depicting the importance of developing a

larger pool of VNRBD. This achievement is complemented by the increase in the proportional of VNRBD

from 5% in 2005 to 20% in 2007. With FY07 funds NBTS trained 74 out of 173 trained staff. In FY08

NBTS had hoped to train 120 individaul but due to dealys in funding this figure was not achieved.

Guidelines and IEC materials on appropriate use of blood and blood products were distributed to hospitals

at different levels.

A Quality System Manual was reviewed and training on quality manual conducted to 70 NBTS staff.

Monitoring and evaluation paper based tools were reviewed and distributed to all zones for field testing and

comments, feedback will be incorporated in FY09.

In the process of establishing NBTS as a semi-autonomous institution a team of MOHSW high level

management officials, CDC and AABB visited Zimbabwe and South Africa National blood transfusion

services to learn about semi-autonomous operations. Following the visit, a report with recommendations

was presented to MOHSW management for action. The legal framework is being prepared by the Ministry

through a consultancy which will enable NBTS to become semi-autonomous institution. NBTS blood

collection activities are undertaken jointly with Tanzania Red Cross Society (TRCS) who do mass

mobilization and blood collection in hard to reach areas and Tanzania Peoples' Defense Forces (TPDF)

which runs military hospitals serving both the military and civilian communities within its areas of operation.

TPDF mobilizes and collects blood within these areas some of which are hard to reach.

ACTIVITIES:

With FY09 funds NBTS aims at increasing blood collection from the FY08 target of 120,000 units to 150,000

units, and to ensure post test counseling for HIV and other TTI to 50,000 donors. In order to achieve these

goal , the following activities will be implemented:-

1.Expand access to adequate and safe blood transfusion services as well as blood components throughout

the country by increasing blood collection.

a)Continuing blood collection in the current eight (8) blood zonal centers using existing mobile donation

teams and add 25 new (satellites) fixed blood collection sites to scale up blood collection while decreasing

high expenses related to adding more mobile donation teams.

b)Advocacy and mass mobilization will be strengthened by increasing activities for donor and public

sensitization during blood donation campaigns, through designing, producing and distributing more

innovative IEC materials to recruit more donors, mass medias campaigns and utilization of audio visual

equipment at new satellite blood collection sites. The existing audio visual equipment and program will be

improved.

c)Hospital management and transfusion committees will continue being trained using technical assistance

from the American Association of Blood Banks (AABB) in order to engender appropriate utilization of blood

and blood products

d)Training of existing staff to be multi skilled to enable them to perform different tasks in different blood

transfusion processes so as to minimize the number of new staff to be recruited.

e)Recruit additional skilled staff to support the automated centralized blood testing implemented with FY08

funds and to operationalize the new satellite blood collection sites. Multi-skilling will be one of the key

selection criteria for new hires.

f)Procure cold chain equipment for satellite sites through Regional Procurement Support Office (RPSO)

g)Following centralization of TTI testing and blood grouping at Eastern zone centre in FY08, an effective

and efficient transportation system of samples from all the zones to Eastern zone is mandatory. This will be

effected through hiring of reliable courier services. Blood collection from donation sites and distribution of

safe blood to different facilities will be strengthened through close linkage with regional and district

Activity Narrative: management teams. Additional transportation of blood from satellite centers to zonal centers will be hired.

h)Laboratory space at all zonal centers will be expanded to cater for scaled up component production.

This will follow the centralized testing at Eastern zone accomplished in FY08.

i)Advocacy campaigns and orientation to policy and decision makers from national to district levels on

NBTS policy and guidelines will be enhanced. This activity will include Regional Health Management Teams

and Council Management Teams (RHMTs) and (CHMTs) to ensure planning and budgeting for safe blood

requirements within regional and district budgets.

j)Timely availability of adequate reagents and supplies will be ensured through MSD and back up supplies

will be procured from Supplies Chain Management Systems (SCMS) to enhance efficient and effectiveness

of blood transfusion processes.

k)In order to increase the current donor pool, existing blood donor clubs in eighteen (18) regions will be

maintained and new ones will be established in the eight (8) remaining regions, to bring the donor club

coverage to 26 regions of Tanzania. Donor clubs Training of Trainers (TOT) and updating of training

materials will be undertaken in collaboration with AABB.

2.) NBTS will ensure the quality of service offered by:

a) Strengthening Planned Preventive Maintenance (PPM) for the NBTS equipment by procuring service

contracts and end users' training,

b) establishing NBTS facilities preventive maintenance,

c) Maintain External Quality Assurance for HIV, HBV, HCV and Syphilis for all NBTS zonal centers to attain

International Standards Organization accreditation for the NBTS processes.

b) Continue implementing quality management plan. This will entail training staff in different departments

on quality management systems based on the quality plan, updating documents and records including

standard operational procedure (SOP) and to implement good manufacturing practice (GMP).

3.) Implement M&E Plan to maintain quality, efficiency and effectiveness by:

a) Reviewing, printing and distribution of paper based M&E tools for blood collection, processing and

distribution.

b) Procuring, installing and training of users on the commercial blood banking software. Following the

initiative to improving data collection by use of personal digital assistant (PDA) in FY08, additional PDAs

will be procured for satellite blood collection sites in FY09. Maintenance of PDAs and users training will be

undertaken through consultation services.

b) An electronic information system will be maintained to link with the PDA data collection tools, automated

testing and blood banking system.

c) In Fy08 Eastern zone started communicating through SMS messages to blood donors facilitated by

Phone for Health initiative. This service will be expanded to three 3 additional zones in Fy09 and staff will be

trained on the electronic short messaging system (SMS) in these zones.

d) Currently NBTS internet connectivity is not reliable due to use of shared connectivity, with FY09 money

connectivity will shift to dedicated bandwidth which is more reliable and allows continuous internet

connectivity. This is important to support SMS Phones for Health initiative as well efficiency in information

transfer of sample test results which will be pooled to Eastern zone for centralized testing. Monthly Virtual

Private Network (VPN) connectivity fee will be paid to enhance data linkages from all zones to the NBTS

headquarter servers.

4.Strengthen linkages with other programs -

a) NBTS will continue working in collaboration with HIV prevention programs for blood donors and staff,

proper waste management, prevention of malaria and anemia, and safety at the workplace. NBTS will link

with other HIV/AIDS programs to develop consistent audio visual prevention messages to be used during

donor recruitment and mass mobilization.

b) NBTS will enhance collaboration with NACP to promote HIV prevention by encouraging voluntary

counseling and testing (VCT) and other prevention among the VNRBD, donor clubs and general population.

This collaboration will provide information that encourages HIV negative VCT clients to become blood

donors while the clients who are positive to refrain from donation and use the VCT centers as platforms for

notifying donors of HIV and other TTIs test results.

c) NBTS will expand donor recall and incentives through SMS communication in collaboration with Phones

for Health and private local companies to cover expenses.

d) NBTS will advocate for operational research. A Knowledge Attitude and Practice (KAP) study will be

undertake under AABB TA in relation to voluntary and repeating blood donation in Tanzania including

Zanzibar. It is expected that the outcome from this syudy will assist NBTS to develop strategies to develop a

pool of safe donors.

e) NBTS will partner with Ministry of Education and Vocational Training to incorporate blood safety

education in schools and institution curricula.

f) Maintain collaborations with the National Malaria Control Programme (NMCP) and PMI for protection of

children fewer than five years, pregnant mothers and blood donors against malaria.

g) NBTS will strength Public Private Partnership (PPP) in blood donor recruitment and retention by working

with local organizations were donating blood voluntarily before NBTS establishment.

h) Strengthen collaboration with Haukeland University Hospital (Bergen, Norway) for Technical Staff

capacity building and Quality improvement within NBTS.

M&E:

With FY09 funds M&E officer at national level is to be recruited and data collection and transfer enhanced

through use of an electronic blood transfusion software system, PDAs and SMS. Paper based M&E strategy

and tools will be reviewed to incorporate inputs from users. The NBTS will collaborate with the AABB to

develop an M&E program that will encompass all the processes such as collection, processing, distribution,

and utilization of blood. Gathering statistics on the numbers 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 and blood products.

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

Activity Narrative: implementation, and effectiveness of project objectives.

SUSTAINAIBLITY:

In FY07 the Government of Tanzania provided US$ 650,000.00 for reagent and supplies and US$

100,000.00 to support NBTS operations.

NBTS staffs (108) of medical cadres were absorbed in the Government payroll scheme.

In FY08 funds are planned to undertake a blood costing exercise in collaboration with AABB. This activity

will enable NBTS to know the cost of a unit of blood, which will assist NBTS to implement the cost recovery

plan. Once this plan is implemented it will contribute towards sustainability.

The MoHSW is working on the recommendations from the team that went for a study tour to Zimbabwe and

South African National Blood Service (SANBS) to transform NBTS into semi autonomous organization.

MoHSW is also working on the legal framework that will speed up this process.

Under semiautonomous operations NBTS plans to recover funds for collection, processing and supplying to

the government and private hospitals through health insurance scheme. KAP study will assist NBTS to

develop strategies for developing sustainable donor pool

New/Continuing Activity: Continuing Activity

Continuing Activity: 13523

Continued Associated Activity Information

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

System ID System ID

13523 8720.08 HHS/Centers for Ministry of Health 6540 4920.08 Track 1.0 $3,500,000

Disease Control & and Social

Prevention Welfare, Tanzania

8720 8720.07 HHS/Centers for Ministry of Health 4920 4920.07 MOHSW Track $3,500,000

Disease Control & and Social 1.0

Prevention Welfare, Tanzania

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $300,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.04: