Blood safety activities are closely integrated with the Injection Safety and Laboratory Infrastructure program

areas. Blood Safety also has linkages to maternal health aspects of the PMTCT program area; social

mobilization activities in the Condoms and Other Prevention program area; patient referral systems and

confidentiality issues under Counseling and Testing; and data collection and management under Strategic

Information. The project's main objective is to provide a safe and adequate blood supply to people living in

Guyana. All program activities are coordinated by the Ministry of Health's National Blood Transfusion

Service (NBTS). Target Populations: Healthy adults, principally youth, are targeted for recruitment as blood

donors. Women who hemorrhage during and after childbirth, children suffering from anemia, and surgery

patients will be the primary beneficiaries of a safe blood supply.

The project's main objective is to provide a safe and adequate blood supply to people living in Guyana. All

program activities are coordinated by the Ministry of Health's National Blood Transfusion Service (NBTS).

Emphasis Areas: Information, Education and Communication; Community Mobilization/Participation; Quality

Assurance, Quality Improvement and Supportive Supervision; Development of Network/Linkages/Referral

Systems; Commodity Procurement and Logistics.

Target Populations: Healthy adults, principally youth, are targeted for recruitment as blood donors. Women

and children with anemia due to malaria, complications of surgery or childbirth, will be the primary

beneficiaries of a safe blood supply.

The Guyana National Blood Transfusion Service (NBTS) will continue to expand its role as the primary

producer and distributor of blood and blood products in Guyana. In FY08, this expansion is expected to be

underpinned for the first time by legislation outlining the formal oversight responsibilities for the NBTS as an

agency of the Ministry of Health.

As noted in the Program Area Context, the blood system in Guyana is fractured between the public and

private sectors, with most of the country's blood supply collected from family/replacement or paid donors

(65% during first 6 months of 2007)) in hospital based blood centers. This structure is inefficient and difficult

to regulate, especially in the area of laboratory screening. The collection of blood from replacement donors,

combined with a lack of standardized testing algorithms, has historically placed recipients of blood

transfusions in Guyana at a much greater risk contracting transfusion transmissible infections (TTI),

including HIV. Efforts to strengthen laboratory capacity within the NBTS have been underway since the

launch of the PEPFAR initiative. However, progress has been slowed in past years by systemic and

administrative weaknesses in the MOH commodities procurement system. Bottlenecks in this system -

through which the NBTS has been required to work - have led to stock-outs of test kits and reagents.

In FY07, the NBTS used Emergency Plan funds to procure reagents and other laboratory supplies through

the Partnership for Supply Chain Management (SCMS). SCMS has also provided technical support to

NBTS in the form of needs assessments and the development of a standardized procurement schedule.

To address inconsistencies in blood screening practices, the NBTS will stop routine blood screening at its

regional centers and centralize the screening effort at the NBTS headquarters in Georgetown. The

laboratory centralization policy will be fully implemented by the end of FY07. Also in FY07, the NBTS will

create three new "Coordinator" positions to ensure consistent communication between the donor

recruitment department, the blood collection teams, and the laboratory. These coordinators will report

directly to the NBTS director, who will provide input from client hospitals on current and future blood needs.

In FY08 the NBTS will largely continue activities begun in FY07. These include:

1.Strengthen the institutional infrastructure of the NBTS. Special attention will be paid to the new

centralized laboratory screening strategy to ensure that specimens are delivered to the lab and results are

returned to the regions in a timely manner. This activity will be informed by the new blood safety legislation

which NBTS anticipates will be passed by the end of FY07. If the law is still pending, NBTS will continue its

advocacy efforts to win passage in FY08. In addition to the foundation provided by the new legislation,

NBTS will work internally to strengthen the new roles and responsibilities for NBTS employees under the

new "Coordinator" system implemented in FY07. This will include specialized training for the Coordinators,

where appropriate, and team building exercises ensure that communication and supervision follows the new

chain of command. Specialized training will also be provided to logistics personnel and administrators

working in the capital and in the regions.

2.Continue the relationship with SCMS to procure materials and consumables (e.g., test kits and reagents)

used by the blood service. Working through SCMS has increased the NBTS's ability to manage its

Emergency Plan resources and avoid administrative delays associated with the Ministry of Health's

procurement system.

3.Concurrent with the implementation of the legislative framework for the NBTS, the Service will continue to

develop and deploy Standard Operating Procedures (SOP) for all of the technical activities undertaken by

NBTS staff (e.g., donor registration and notification; phlebotomy; laboratory screening algorithms). These

SOP will be based on Caribbean Regional Standards and serve as the foundation for all training and

technical assistance from CDC and PAHO, the TA provider.

4.Continue to strengthen physical infrastructure, where needed, with particular focus on completing the

renovation of the NBTS headquarters and central laboratory, as well as strengthening the compatibility lab

at the Georgetown Public Hospital.

5.Strengthen clinical oversight of the blood service at the Georgetown Public Hospital Corporation. A

Transfusion Committee will be established in FY07. Activities in FY08 will focus on routine surveillance of

transfusion activities and technical support to build the Transfusion Committee's hemovigilance data

system.

6.Reduce private hospitals' dependence on hospital-based blood banks. Strengthen the NBTS system to

monitor and predict private hospitals' weekly needs for blood. This will be accomplished through the

development of an active surveillance system to track the use of blood and develop, with hospital directors,

Activity Narrative: a calendar to predict blood needs for elective surgery and other routine procedures. This calendar will allow

the NBTS to tailor its donor recruitment and collection activities to meet expected demands and to better

anticipate emergency needs. This system will also establish a routine communication mechanism between

NBTS and hospital directors to ensure that, in addition to routine needs, the blood supply can be effectively

triaged in the case of a mass casualty emergency.

7.Build the NBTS social marketing strategy to raise public awareness about the need for blood and to

recruit and retain voluntary, non-remunerated blood donors. The NBTS will receive expert advice and input

from a social marketing firm. This contractual relationship will be established in FY07. With the social

marketing partner, the NBTS will continue to develop and disseminate a national information, education and

communication (IEC) campaign to address public concerns/fears about blood donation (key legislative

issue: stigma and discrimination) and target low risk donor groups. This campaign will also include an

incentive mechanism to reward repeat donors and attract first time donors. With additional assistance from

PAHO, the TA provider, the NBTS will ensure that the national IEC strategy is informed by the findings of

the Knowledge, Attitudes and Practices (KAP) survey conducted in January 2007.

8.Continue to mobilize partner organizations, including the Guyana Red Cross, to recruit blood donors and

sponsor blood drives. This activity will be coordinated by the NBTS Blood Donor Recruitment Coordinator

(BDRC) who will be recruited and hired in FY07. The BDRC will communicate with blood donor partners

and maintain a master calendar of all blood drives scheduled in Guyana. This master calendar will promote

efficiencies in the national blood collection strategy and facilitate the scheduling of blood drives in private

sector offices, factories and other company sites.

The NBTS will also continue to work with the CDC Guyana office to implement and monitor the results of

internal performance evaluations. These evaluations will address issues such as customer satisfaction (e.g.,

wait times for donors), the reasons for transfusions, how blood is routed and tracked from a blood bank to a

ward, and the feasibility of implementing a cost-recovery system.