Blood transfusion is an essential life-saving intervention; 3 out of 4 transfusions in Uganda are given to

children suffering from malaria- associated anemia and mothers with post-partum hemorrhage. An

increasing number of transfusions are being given to patients on ART. Provision of safe blood is an

essential component of the minimum health care package of the Ministry of Health (MOH) and essential to

attaining the key outcomes of the Uganda's Health Sector Strategic Plan II (2006-2011) including reduction

of the infant mortality rate and maternal mortality as well as HIV/AIDS prevention and care. These outcomes

have a direct relevance to the attainment of the Millennium Development Goals (MDG) 4, 5 and 6.

The Uganda Blood Transfusion Service (UBTS) is the national blood service responsible for all blood safety

activities for the entire country with the following: Vision ‘To be a national, efficient, effective, well-resourced,

accountable and sustainable organization' and Mission ‘To achieve a safe, efficient and sustainable national

blood transfusion service, based on healthy volunteer donors and able to meet the needs of Uganda's

health care system while promoting a good blood transfusion system'. An adequate supply of safe blood

screened and processed in a quality assured manner by the UBTS eliminates the risky donor selection,

incomplete laboratory testing, and inadequate processing that occurs with hospital collections. The UBTS

with their sub partner, the Uganda Red Cross Society (URCS) recruits voluntary blood donors through the 7

regional blood banks to obtain adequate blood for transfusion to supply over 166 health facilities. The

PEPFAR program provides about 75% support to the UBTS operating budget; the MOH contributes the

remainder of the operating budget in addition to UBTS personnel costs. URCS are responsible for about

40% of the activities in blood donor recruitment and provision of post-test counseling to blood donors.

Established as an act of Parliament in 1936, URCS has been involved in blood donor recruitment in Uganda

since 1954. Ten blood donor recruiters and 14 professional blood donor counselors from URCS work on

teams that regularly visit schools, workplaces and churches for blood collection and post-test counseling.

Activities during FY 2008 fell under the following areas: infrastructure development, blood collection and

testing, promotion of appropriate clinical usage of blood, quality assurance, training, monitoring and

evaluation, and sustainability.

The UBTS operates 7 regional blood banks, of those, only 2 are purpose built with adequate space. The

new regional blood bank in the east, at Mbale was commissioned and another one in the southwest, at

Mbarara has also been completed. The national reference centre in Kampala, at Nakasero is now too small

to conduct all activities, with FY 08 funding it is being expanded and renovated. The refurbishment of these

administrative headquarters and reference laboratory at Nakasero blood bank will soon begin following the

selection of a consultant and contractor by the Regional Procurement Support Office (RPSO). Two more

regional blood banks will be constructed in FY2008 in the west, at Fort Portal and north, at Gulu to enable

improved functioning of these regional blood banks. Laboratory equipment and back-up generators will be

purchased and installed in these units. Another two regional blood banks will be constructed in northwest,

at Arua and central, at Masaka in FY 2009. Procurement of laboratory equipment and reagents has been

finalized; vehicles for use in blood donor recruitment and collection will also be received following

completion of the procurement process.

Current work on blood donor registers for new and repeat donors, and donor clubs is being finalized, as well

as continued mobilization, recruitment, retention and care of voluntary non-remunerated repeating blood

donors. These are continuing activities, and are expected to lower the HIV sero-prevalence among blood

donors from the current 1.4% to 1.2%, as well as result in a 10% decrease in the prevalence of hepatitis B,

C and syphilis in the blood donor population. The main objective of pre-donation counseling is selection of

low-risk healthy blood donors, whereas post-donation counseling (donor notification) gives opportunity to

blood donors to learn their health status, make informed decisions about their lives, continue donating

blood, as well as preventing infected blood donors from donating again. This will be continued during

FY2009 to ensure that at least 70% of all blood donors receive post-donation (donor notification)

counseling.

Repeat voluntary blood donors in Uganda are encouraged to join blood donor clubs, which are an

equivalent of "Club 25" elsewhere. Members of donor clubs have the lowest infection risk and are

particularly valuable for providing safe blood during school holidays. In FY2009, existing clubs will be

encouraged to recruit more members and more clubs will be formed.

Blood units collected amount to 135,000 which constitute 75% of the FY 2008 target. All the blood was

collected from voluntary, non-remunerated donors, half of whom are repeat blood donors. More than 80% of

the blood is collected by mobile blood collection teams, who travel to communities after blood donor

recruitment officers have visited the communities to mobilize, educate and provide IEC materials to groups

of blood donors. UBTS has a network of 20 such mobile teams in the whole country. Further

improvements in the efficiency of blood collection in FY 2009 will be achieved. The number of blood units

collected in FY 2009 is expected to increase by 15%; from a projected annual collection of 150,000 to

172,500 units of blood. Effective use of text messages to mobile phone by recall centers, are expected to

contribute significantly in the increased contact with repeat donors. Using these and already established

strategies the proportion of repeat blood donors is expected to increase to 58% from the current 52%. The

UBTS collaboration with the URCS in donor mobilization will continue in FY 2009. Other valuable partners

include CDC Uganda, USAID, corporate bodies, institutions of learning and churches. Other organizations

have shown willingness to collaborate in blood donor mobilization including the ROTARY clubs in Uganda.

These opportunities will be further pursued in FY 2009 to ensure effective blood donor mobilization across

the country.

All blood units collected from donors continue to be tested for HIV, Hepatitis B and C, and syphilis, using the

most effective testing algorithm recently adopted by the reference laboratory at Nakasero. All regional

blood bank laboratories operate an algorithm that includes use of a screening ELISA test and a confirmatory

ELISA for high titer positive samples. Indeterminate and borderline samples are referred to the reference

laboratory for further testing and confirmation. The reference laboratory has automatic laboratory

equipment for high throughput and uses chemilunescen based testing technology. Specialized blood

processing into components that was previously only conducted at Nakasero, has been initiated in the new

regional blood bank facilities at Mbale, and in the near future at Mbarara, following the availability of suitable

premises at those regional blood banks. This allows for the provision of appropriate blood components for

transfusion to match the requirements of patient treatment, rather than the indiscriminate use of whole

blood, implying better patient management. In order to ensure the appropriate utilization of blood in

hospitals, establishment of hospital transfusion committee will continue to cover at least 50% of the district

hospitals. UBTS will support the revision and distribution of national clinical transfusion guidelines on

Activity Narrative: appropriate clinical use of blood and blood products. Further improvement in documentation will enhance

haemovigilance in hospitals.

UBTS will continue to offer its expertise as a reference laboratory for other organizations involved in HIV

counseling and testing (HCT) activities in the country, and will also continue to play a significant role in the

care and support of HIV/AIDS patients who require blood transfusion, and malaria patients, especially

children. Similarly, UBTS will continue to collaborate with the reproductive health departments to ensure

timely management of emergencies in childbirth by providing sufficient blood needed to save mothers' lives.

Through provision of safe blood, UBTS will continue to play a significant role in reduction of mother-to-child

transmission of HIV/AIDS.

The quality assurance program was developed with collaboration of the Sanguin Consulting Services (SCS)

and this will continue in FY 2009. Quality assurance manuals have been finalized, and a program of

training in their application, especially the standard operating procedures (SOPs) is on going. Emphasis on

use of standard operating procedures, as well as operating an effective quality control system are expected

to further ensure the safety of blood supplied by UBTS. A blood banking information system (BBIS) was

developed by the CDC Uganda office, and launched in September 2008. This BBIS will greatly support the

computerization of testing and processing blood, data analysis and reporting. It is currently operational at

the Nakasero headquarters, and the new regional blood bank facilities in Mbale and Mbarara. The

monitoring and evaluation program is currently being developed, (taking advantage of the new BBIS) and is

expected to be fully implemented in FY2009 to ensure further efficient and effective implementation of the

blood safety activities, and ultimately provision of a safe blood in the country.

The Ministry of Health continues to provide funds for the UBTS staff salaries. Following the approval of the

staff structure by the Ministry of Public Service, a full contingent of staff will have been appointed by the end

of 2008. Deployment of staff and filling of the staff structure for the entire blood safety services has been a

major activity to provide the necessary human resource and ensure sustainability of the organization.

UBTS has developed and implements training courses for all cadres of staff in the service. Important

training activities included a seminar for 30 clinicians, training course for 15 senior technologists and short

course for various cadres of staff which are still ongoing. UBTS staff benefit from counselor courses

conducted by The AIDS Support Organization and the AIDS Information Center; it is expected that more

blood donor counselors will be trained by those institutions. An extensive training program will be

implemented in FY 2009 for all staff using a national training document that is already in place. Two

regional blood bank directors have enrolled for the Masters Degree in Management of Transfusion Medicine

(MMTM) in FY 2008 and 2 more will register in FY 2009. UBTS collaborates with training schools including

clinical officers" schools at Fort Portal, Mbale and Gulu to teach clinical blood transfusion in these schools.

These arrangements will continue in FY 2009. Plans by UBTS and Sanquin Consulting Services to develop

a blood safety course for integration in the curricula of medical schools in the country will be finalized in FY

2009.

The approval of a national policy on blood transfusion, the staff structure, and the recently granted self-

accounting status to the UBTS are important steps towards making the organization fully autonomous. A

decision on the autonomy of the UBTS is expected in FY 2009. This will be a significant step in enhancing

sustainability.

Priority activities in FY 2009 include:

1. Improvement of the infrastructure through provision of adequate premises at Nakasero Blood Bank, Fort

Portal and Gulu regional blood banks (through RPSO) and provision of essential equipment, supplies and

vehicles to support effective implementation of the program.

2. Effective mobilization, recruitment, retention and care of voluntary, non-remunerated repeating blood

donors to ensure a consistent, adequate and safe blood supply.

3. Improved efficiency for collection, testing, storage and distribution of blood and blood products, to ensure

that need for blood for transfusion is adequately met.

4. Continued collaboration between UBTS and Uganda Red Cross Society (URCS) and other departments

in the health sector as well as development partners in the development of a sustainable, safe and cost-

effective service for the people of Uganda.

5. Work with the Ministry of Health to accomplish activities leading to UBTS autonomy

New/Continuing Activity: Continuing Activity

Continuing Activity: 13320

Continued Associated Activity Information

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

System ID System ID

13320 4014.08 HHS/Centers for Uganda Blood 6442 1250.08 Rapid $3,000,000

Disease Control & Transfusion Strengthening of

Prevention Services Blood

Transfusion

Services

8368 4014.07 HHS/Centers for Uganda Blood 4817 1250.07 $3,000,000

Disease Control & Transfusion

Prevention Services

4014 4014.06 HHS/Centers for Uganda Blood 3175 1250.06 $1,800,000

Disease Control & Transfusion

Prevention Services

Table 3.3.04:

Provision of safe blood is an essential component of Uganda's Health Sector Strategic Plan (2006-2011) as

indicated in the minimum health care package of the plan. It is also one of the main strategies of the

country's HIV/AIDS prevention and care. PEPFAR support to the Uganda Blood Transfusion Service

(UBTS) and sub-partner, the Uganda Red Cross Society (URCS) has enabled them to maintain and

increase the supply of safe blood to 166 hospitals in the country by 45.6% and reduce the HIV prevalence

among the blood donor population from 1.7% in 2004 to 1.36% in 2006 (a reduction of 20%). It is estimated

that over 21,000 new HIV infections have been prevented through provision of safe blood since the

beginning of the PEPFAR support to UBTS; 75% of these infections would have occurred in children and

pregnant women who receive most of the blood transfusion.

In FY08 existing blood donor clubs will be encouraged to recruit more members, and new donor clubs will

be formed. The URCS plays a key role in the blood donor recruitment, counseling activities as well as

overseeing and maintaining the blood donor clubs. The main objective of pre-donation counseling is

selection of low-risk healthy blood donors, whereas post-donation counseling (donor notification) gives

opportunity to blood donors to learn their health status and make informed decisions about their lives, be

encouraged to continue donating blood, as well as preventing infected blood donors from donating once

again. UBTS and URCS collaborate with several AIDS Support Organizations in the country and refer

identified HIV positive blood donors for care and support. During FY08 the percentage of blood donors who

receive post-donation counseling will increase from the current 70% to at least 80%. Currently, 100% of

donors in Uganda are voluntary, non-remunerated individuals; this trend will be maintained in FY08. For

every 100 persons that receive HIV health education aimed at recruiting blood donors, only 10 donate

blood.

Although HIV counseling and testing is not the main activity for the Blood Safety program, but key to the

provision of adequate amounts of safe blood, UBTS and URCS indirectly contribute to this program area.

UBTS and URCS have to provide health education to 1,300,000 individuals in order to obtain 100,000 blood

donors. These donors will receive HCT; most of them are young people above 17 years in education

institutions, and others in rural communities and urban work places. Through the blood donor mobilization

and recruiting activities, UBTS/URCS reach large numbers of individuals as far as HIV prevention campaign

is concerned.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13321

Continued Associated Activity Information

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

System ID System ID

13321 8585.08 HHS/Centers for Uganda Blood 6442 1250.08 Rapid $0

Disease Control & Transfusion Strengthening of

Prevention Services Blood

Transfusion

Services

8585 8585.07 HHS/Centers for Uganda Blood 4817 1250.07 $0

Disease Control & Transfusion

Prevention Services

Table 3.3.14: