Ethiopia National Defense Force Safe Blood Program

The Ethiopia National Defense Force (ENDF) determined that there was a need to establish a blood

program to support present, ongoing, ENDF blood-transfusion requirements and future operational

contingencies. The ENDF currently relies on the Ethiopian Red Cross Society (ERCS) for its supply of blood

products. However, the ECRS has not been able to adequately supply blood to the military because of

commitments to civilian hospitals and the unique nature of military operations. Nor have there been

standardized guidelines for blood-transfusion practice within the ENDF. Implementation of standardized

transfusion practice guidelines will further reduce potentially unnecessary transfusions and reduce the

potential exposure to blood borne infectious diseases. The ENDF with the support of the US Navy Blood

Program has started implementing a safe blood program using components of the United States Military

Blood Program as a model. To meet the objectives, this activity will:

1) Establish a central blood collection, processing, and storage facility at the Bella Defense Forces Central

Referral Hospital which will also serve as a "center of excellence" for training and a template for the

establishment by ENDF of additional blood banks at other field referral military hospitals throughout Ethiopia

2) Provide facilities to perform mobile blood collections from newly accessioned recruits, potentially offering

a safer donor pool since recruits are pre-screened for transmissible agents upon entry into the ENDF. Other

military personnel are considered as donors if their proximity to blood banks is optimal for their mobilization.

3) Define a realistic, safe, blood-distribution network that takes into account peacetime, wartime, and other

national (natural or manmade) emergencies, in coordination with the national program on delivering safe-

blood transfusion services to communities around military deployment areas

4) Define an organizational structure with recommended assignments, standard operating procedures

(SOP), and forms for blood administration, safe transfusion therapy, and an ongoing training and Quality

Assurance (QA) to maintain safety for all aspects of the blood program.

Program Implementation Strategy:

The DOD Blood Safety Program has been using a phased approach (FY04-FY08) to build one central blood

-collection, processing, and storage facility with a strategically located distribution network, and a total of

four reliable, safe, hospital-based blood banks. Throughout the implementation process of the program, it

will ensure performance of tasks in order to validate and build capacity within the ENDF to assume total

operational sustainability of the program.

1) Accomplished tasks:

The FY06 Program implementation team (i.e., US Naval Medical Center San Diego, DOD HIV/AIDS

Prevention Program at Naval Health Research Center, Bella Hospital Director, and PEPFAR DOD Ethiopia)

was established and collaborated by way of weekly teleconferencing and meetings. With FY04-FY06

funding resources, the following was accomplished:

1) Renovation of a building at Bella Military Hospital. This building will serve as a center of excellence for

training, for blood collection, blood processing, production of blood components, storing and distribution of

safe blood and manufactured components

2) All medical equipment for the central blood collection, processing, storage, and distribution facility and

also the Bella Hospital-based blood bank has been delivered, installed, and validated

3) SafeTrace Program Software and Wyndgate Computer terminals have been purchased for the blood-

and blood-products management computer system to track and control safe blood and blood-component

products. Ten desktop computers for the program have been acquired from CDC Ethiopia on a one-year

loan. Preparation of local networking of the computers is underway and in progress.

4) Structural organization, staffing, and Scope of Work proposals have been completed and submitted to

the ENDF Health Services Management for comments and subsequent implementation.

5) Hands-on training (15 Sept. - 8 Oct., 2006), for two Ethiopian military Blood Center senior staff members

was conducted at the Naval Medical Center Blood Bank in San Diego, CA.

6) Training for 11 Ethiopian core staff personnel assigned to the Bella blood center was conducted between

the periods 29 May - 15 June 2007. The Core Staff has been trained on the following topics:

--Component processing for red-cell, fresh frozen plasma, and storage requirements for both

--Equipment calibration for the component processing equipment

--Donor registration process, vital signs (blood pressure, pulse, temperature, hemoglobin, arm check, and

weight screening), confidential interview, confidential unit exclusion, bag issue, and collection process

--Testing process and quality control

--Once-a-week functionality training at the International Testing Laboratory in Addis Ababa for the Senior

Medical Technologist

--Lectures on transfusion safety and adverse reactions were delivered to the medical staff at the Bella

Defense Referral Hospital, the Armed Forces General Hospital, and the Defense College

--Delayed delivery of some essential equipment and consumables has made it impossible for the blood-

safety technical team to complete the program of training in its entirety and certify full operability of the

center by the core staff. For this reason, a second visit by the technical team has been scheduled for

October 2007.

By the end of FY07 plan implementation, three more military-hospital-based blood banks at Mekele,

Gondar, and Harar will be established. Provision of consumables for the Bella Blood Center and the four

hospital-based blood banks will also be covered.

In FY08 all logistical support for consumables and a supply-management system for the centrally

established blood collection, processing, storage, and distribution facility at Bella and four hospital-based

blood banks will be realized. Computers replacing those on loan from the CDC will be provided. A visit by a

US Navy Blood Safety Technical Team in order to evaluate existing quality assurance standards and

management of all PEPFAR-established military facilities for blood safety would have been accomplished.

Testing of existing systems and addressing challenges will enable the partner to create a solid base for its

future ability to sustain the program.

Ethiopian National Defense Force Injection Safety Program

In 2003,with the full participation and technical support from Defense HIV/AIDS Prevention Program

(DHAPP), infection-prevention measures were fully established within three military central referral hospitals

(Armed Forces Teaching General Hospital, Bella Defense Central Referral Hospital, and Air Force

Hospital). This was the initial measure of a phased approach to the program, which has since then been

gradually expanding.

The activities already established are:

•Questionnaire developed on infection-prevention prophylaxis to determine the risk factor among healthcare

workers (HCW)

•Infection-prevention training of 275 physicians, HCW, and support staff in health-service facilities

•Provision of contaminated waste, sharps collection, and disposal units

•Provision of infection-prevention equipment (e.g., disposable and surgical gloves, disposable syringes,

respiratory masks, gowns)

In FY08, this technical support will be maintained in two central referral hospitals, one teaching hospital,

seven field referral hospitals, and 31 health centers, with a total complement of 33 physicians, 1,402 nurses,

35 health officers, 515 health assistants, 626 technicians, and 3,613 sanitarians and public health workers.

Support provided through this activity improves the quality of services delivered in Ethiopian National

Defense Force (ENDF) medical facilities. Approximately 40% of all inpatients throughout the military

hospitals and health-rendering facilities are people living with HIV/AIDS. Providing infection-control supplies

minimizes the risk for nosocomial infection.

All hospital staff, from physicians to janitors, are trained on an ongoing basis using previously developed

protocols and curricula. The training is self-sustained by the ENDF with consumables provided by PEPFAR.