The Rapid Strengthening of Blood Transfusion Program is a national program aimed at scaling-up blood transfusion activities to ensure efficient, effective, equitable, and affordable access to safe blood transfusion services throughout Zambia. The program is supported by the President's Emergency Plan for AIDS Relief (PEPFAR) with a 5-year grant that ends in March 2010. As part of the national program the ZNBTS is building a boold satefy program within the scope of the government sustainability framework.

The overarching goal of the program is to establish an efficient and effective nationwide system for safe blood transfusion in Zambia and to prevent transfusion-related transmision of HIV, Hepatitis, Syphilis, and other blood borne infections. A continuation from fiscal year (FY) 2005/06, the program has sought to ensure equity of access to safe blood and blood products and to promote ethics in the collection, testing, and rational use of blood and blood products. The main focus has been to significantly improve blood donor retention, through increasing reliance on voluntary non-remunerated donors to over 95% and increase the proportion of repeat donors from 26% to 60%, and by doing so, reduce HIV prevalence in donated blood from 5% to 3%.

Zambia has a comprehensive national blood transfusion program aimed at ensuring equity of access to safe and affordable blood throughout the country. Blood transfusion needs in Zambia are currently estimated at 100,000 units (450 mls each) of blood per year. Since the initiation of PEPFAR funding, August 2004, mobile collection sites have increased from 9 to 21 while blood collection has increased drastically from the baseline of 8,715 in 2004 to 18,476 the quarter ending March 2006 bringing the current operation to 93,000 units per year of exceeding 88,500 target by 6%. About 40-45% of the collected blood are transfused in children under the age of five years and 20% in complicated pregnancies. With support from PEPFAR, transfusion sites have increased from 81 to 115 sites covering all the nine provinces and operates in most of the 72 districts. Previous funding has allowed for expansion of collection sites from 81 to 115, purchase of 18 vehicles and five trailers for transporting blood, nine large blood storage refrigerators for the nine provincial sites and 81 small blood storage refrigerators for the blood transfusion sites. About 595 providers have been trained on safe blood operations. There is strong collaboration between the ZNBTS and other donors such as World Bank and the Global Fund to ensure funding for blood safety are coordinated and streamlined for efficiency.

These achievements have been accomplished through various activities; hiring and maintaining appropriate project staff to supplement the inadequate permanent staff, developing an appropriate database and locator system to ensure that effective contact with donors is maintained, enhancing donor counseling services to help convert first time donors into repeat donors, and procuring all the necessary supplies including refrigerators and vehicles for mobile collection sites and to transport blood and for frequent program monitoring.

Currently, ZNBTS has a total of 9 large blood bank refrigerators, which have been allocated to each of the provincial blood banks. Each of these blood banks has only one big refrigerator. This has created a problem as some of these centers are using the same refrigerator for storage of both the tested and unscreened units of blood. The practice is considered unsafe and hence the request for additional refrigerators. The procurement of these additional refrigerators will make it possible for each center to have two large refrigerators, and provide for separation of the storage of tested blood from untested blood.

At the time of procuring the small blood bank refrigerators, ZNBTS was only servicing 81 district hospital-based blood banks, and hence a total of 81 small refrigerators were procured and distributed to these centers. These refrigerators are used for storage of already screened units of blood supplied by the regional blood banks. However, since that time, the number of hospital-based blood banks/transfusion outlets, has increased to 112 and are expected to soon reach 115.

Fiscal year 2007 funding will support continuation of the current established activities. The funding will also be used to procure an additional nine new large refrigerators for nine regional sites and 34 small blood bank refrigerators, which will be distributed to blood banks which do not have refrigerators at the moment.

In FY 2006, ZNBTS developed a MS Access database for blood donor tracing system. However, problems such as inaccuracies associated with manual capturing of data occur using this data entry system. The 2007 funding will also be used to procure and distribute 21 laptop computers to each of the 21 blood collection teams at all provincial blood banks, which will enable them to capture data and consult the database for donor counseling on site during blood collection sessions. A referral mechanism will be established to ensure that all blood donors testing positive for HIV will be referred to the appropriate HIV services for screening for eligibility for ART and entry into an HIV care program, including preventive therapy according to national guidelines.

In FY 2006, ZNBTS started establishing linkages with health facilities which offer voluntary counseling and testing services. Strengthening of these links will be a major focus during this funding period. Such linkages would benefit the blood transfusion service in two ways: 1) blood donors who test positive to HIV would be referred, with their consent, to selected reputable health facilities for further counseling and advice on how to live positively and, can also provide free antiretroviral therapy if necessary; and) 2. Persons who test negative for HIV at voluntary counseling and testing (VCTs) would be encouraged to visit ZNBTS blood banks and become repeat blood donors, hence reducing the percentage if infected and discarded blood.