The rapid strengthening of the Zambia National Blood Transfusion Services (ZNBTS) 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

United States Government (USG) President's Emergency Plan for AIDS Relief (PEPFAR) with a five-year

cooperative agreement that ends in March 2010.

Safe blood transfusion is an essential life-saving medical intervention for treatment of various conditions

requiring supplementation of blood and/or blood products. It is also one of the most effective strategies for

prevention of transfusion transmissible infections (TTIs), particularly HIV, HBV, HCV, and syphilis, and is

also considered as one of the important strategies for achieving the Millennium Development Goals

(MDGs), particularly those related to maternal and child health, and to combating HIV, TB, and malaria.

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

120,000 units of blood per year (the volume of one unit of blood is 450 milliliters). Approximately 40% of the

patients transfused are children under the age of five years, largely due to anemia secondary to malaria,

and about 20% are mothers due to complicated pregnancies. Since the commencement of PEPFAR

support in August 2004, the blood transfusion system has been restructured into a nationally coordinated

system with the national coordinating center in Lusaka and nine provincial blood transfusion centers

responsible for donor recruitment, collection, testing, and distribution of blood. Blood collections have

drastically increased from the baseline of approximately 8,000 units per quarter in 2004 to 22,798 units for

the quarter ended June 2008 and the projected collections for the year ending March 2009 is 90,000 units.

Transfusion outlets have increased from 90 to 128 hospitals, as of August 2008, and include public, faith-

based, and private hospitals, which provide clinical transfusion services to patients in all nine provinces and

72 districts. Trends towards reductions in discards due to TTIs have also emerged, with total discards

reducing from the baseline of 15% in 2004 to 11.7% for the year ended March 2008, and HIV discards from

6% to 3.8% during the same periods.

PEPFAR funding has facilitated significant scaling-up of blood collections, procurement of appropriate

equipment and transport, strengthening of blood testing protocols, standard operating procedures and

technologies, scaling-up of training and capacity building in blood safety, and appropriate clinical use of

blood and blood products. With the US $20,000 provided in the FY 2008 COP within the Srategic

Information program area, ZNBTS was able to review and redesign the blood request form and procedures,

and conduct training on proper ways of capturing and recording data on requesting, cross-matching and

usage of blood. A total of 203 hospital and blood transfusion staff, including nurses and laboratory

personnel were trained. This training is expected to greatly improve the capturing of data on transfusion

requests and outcomes.

ZNBTS is determined to sustain all the achievements already made, further scale-up blood safety

operations towards meeting national transfusion needs and scale-up activities aimed at ensuring long-term

sustainability of the national blood safety program. To support these objectives, ZNBTS is requesting and

USG/Zambia supports the request of US $769,855 in the FY 2009 COP.

One of the key activities that will be supported is the strengthening of blood donor retention, as the key

strategy for ensuring sustainable increases in blood collections and reductions in discards attributable to

TTIs. Recruitment and retention of reliable regular repeating voluntary non-remunerated blood donors from

low-risk population groups is the main foundation for any successful blood safety program. Even though

ZNBTS has made significant progress in promoting dependency on voluntary, non-remunerated blood

donors, converting these donors into regular repeating donors has continued to be a major challenge. The

proportion of voluntary, non-remunerated blood donors increased from 72% in 2004 to 99.59% in 2007.

However, dependency on regular repeating blood donors remained at approximately 30%. In view of this

situation, ZNBTS intends to further scale-up blood donor retention, which is expected to lead to an increase

in the pool of reliable regular repeating voluntary blood donors and in-turn result in increases in blood

collections and reductions in discards attributable to TTIs, on a consistent and sustainable basis. The

activities that this funding will support are procurements of appropriate blood donor appreciation tokens,

which will include: t/shirts, key holders, ball-point pens, donor sensitization materials, and membership

cards.

The target is to convert 5,000 first time blood donors into regular repeating donors. The current level of

repeat donors is at 30% and the overall target for the year is to increase this to 50%, an increase by 20%.

This proposed activity is expected to contribute approximately 8% to this increase, while the balance of 12%

will be achieved through the activities included in the main action plan for the year. Apart from the expected

benefits of increasing blood collections and reducing discards, the proposed activities will greatly contribute

to the strengthening of counseling and behavior change, through the messages aimed at ensuring that

repeat donors live safe lives and remain negative.

Further, over the past year, ZNBTS has been considering establishing linkages with health facilities which

offer voluntary counseling and testing (VCT) services. Even though ZNBTS has initiated discussions with

the relevant VCT centers, this strategy has not yet been implemented. Such linkages would benefit the

blood transfusion service in two ways: 1) blood donors who test positive for HIV would be referred, with their

consent, to selected reputable health facilities for further counseling and advice on how to live positively and

access free antiretroviral therapy if necessary; and 2) persons who test negative for HIV at VCT centers

would be encouraged to visit ZNBTS blood banks and become blood donors. Funding for this activity will

be used for establishing linkages with reputable VCT centers, including sensitization of donors.

Another critical area of focus will be that of ensuring long-term sustainability of the national safe blood

Activity Narrative: transfusion services. A number of activities are being implemented aimed at providing for long-term

sustainability, including: 1) finalization of the development of an appropriate policy and legislation, which

will include clauses aimed at increasing government funding and commitment; 2) organizational

restructuring and strengthening; 3) systems strengthening; 4) infrastructure development and procurement

of equipment; 5) staff training and capacity building; and 6) efforts towards increasing government funding

and broadening international support. Funding requested for this purpose will support: 1) facilitating

stakeholder consultations on the draft policy and legislation, which is a requirement; 2) procurement of

appropriate equipment to strengthen TTIs testing and blood components preparation at Lusaka and Kitwe;

and 3) establishment of hospital blood transfusion committees, to ensure effective clinical use of blood, help

establish past blood utilization trends, and also assist in establishing appropriate demand patterns and

stock levels for their respective regions.

All the activities proposed are in-line with the objectives and strategies which formed the original proposal.

ZNBTS will ensure that all the activities included in this proposal are incorporated into the annual action

plan.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15605

Continued Associated Activity Information

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

System ID System ID

15605 3607.08 HHS/Centers for Zambia National 7196 578.08 ZNBTS - Track $3,500,000

Disease Control & Blood Transfusion 1-

Prevention Service U62/CCU02368

7

9049 3607.07 HHS/Centers for Zambia National 5026 578.07 ZNBTS - Track $3,800,000

Disease Control & Blood Transfusion 1-

Prevention Service U62/CCU02368

7

3607 3607.06 HHS/Centers for Zambia National 2952 578.06 Technical $1,500,000

Disease Control & Blood Transfusion Assistance

Prevention Service

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Estimated amount of funding that is planned for Education $10,000

Water

Table 3.3.04: