Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 12493
Country/Region: Uganda
Year: 2010
Main Partner: Not Available
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: HHS/CDC
Total Funding: $0

The goal of the National Blood Transfusion Services (NBTS) is to achieve a safe, efficient and sustainable national blood transfusion service based on healthy volunteer blood donors and able to meet the needs of Uganda's health care system. The specific objectives include:

1. To expand the blood transfusion infrastructure

2. To increase the annual blood collection necessary to meet the blood requirements of all patients in the transfusing health units throughout the whole country.

3. To test all blood for transfusion-transmissible infections (TTIs) and operate an effective, nationwide Quality Assurance Programme that ensures safety of the entire blood transfusion process

4. To ensure continuous education and training in Blood Safety.

The NBTS contributes to the fulfilment of PEPFAR goals of reducing transmission of HIV, Uganda's Health Sector goals and the United Nations Millennium Development Goals [MDG] (in particular MDG4: reduce child mortality, MDG5: combat HIV/AIDS, malaria and other diseases and MDG6: improve maternal health).

The estimated hospital blood requirement is 200,000 units of blood annually to be able to handle all emergencies that need blood. 140,000 units of blood were collected in FY09 and distributed to 220 health facilities. 50% of all these collections were transfused to children; 25% to pregnant women and 25% to accidents and surgical/medical cases.

The NBTS has an important task of meeting the increased demand for safe blood transfusion especially at Health Centre IVs located in rural areas where most of the population lives. This will involve expanding the blood transfusion service including community education, recruitment of low risk voluntary non-remunerated blood donors, and infrastructure. The NBTS aims to increase blood collection to 6 units per 1,000 population per year, and by 20% in subsequent years. In a quality assured manner 100% of collected blood will be tested for HIV, hepatitis B surface antigen, hepatitis C antibodies and syphilis.

The NBTS operates through a network of seven regional and six blood collection centers. While the national blood bank at Nakasero prepares all blood components including fresh frozen plasma, platelets and cryoprecipitate other blood banks are only able to prepare paediatric packs of blood concentrates and issues all blood for treatment of adult patients.

To support appropriate use of blood, clinical guidelines will be disseminated to hospital blood transfusion committees and clinicians, and documentation of blood use will be enhanced. Training in all areas of blood safety will continue to be a key activity.

Monitoring & evaluation activities will implemented. Support supervision through regular visits to regional facilities and collection centres will be conducted. The use of reports and forms designed to capture required data has been institutionalized. The data management unit at the national office will analyze the information and compile it into a quarterly reporting format. Feed back will be provided as basis for subsequent planning, training, and improving performance.

Some of the challenges the NBTS continues to face include:

Relatively high level of TTIs in collected blood especially Hepatitis B and C causing a significant quantity of blood to be discarded.

Small, restricted premises at five of the seven regional blood banks that negate efficiency.

The cost of blood collection and testing supplies continues to rise in the bckdrop of level funding. This will severely restrict efforts to increase blood collections.

Reliance on PEPFAR as the main funding agency restricts operations, and does not foster ownership and sustainability of the program

This mechanism will also support the UBTS in attaining autonomy status with an adequate government financed budget, necessary legislation and regulation, management team, responsibility and authority for blood transfusion services.

Funding for Biomedical Prevention: Blood Safety (HMBL): $0

The purpose of the Blood Safety program is to reduce HIV transmission through the transfusion of safe blood and decreasing the HIV prevalence among blood donors. The grantee will support the National Blood Transfusion Service (NBTS) in the provision of safe and adequate supply of blood and blood products to health facilities in Uganda. Under PEPFAR I the Blood Safety Program was implemented by the Uganda Blood Transfusion Service (UBTS) in partnership with the Uganda Red Cross Society (URCS). This will continue under PEPFAR II through a single eligibility mechanism to the Uganda Blood Transfusion Service (UBTS) as it is the mandated body responsible for the blood transfusion services nationally.

The UBTS has an established network with national coverage comprising 7 regional blood banks and 6 blood collection centers with oversight from the administration, program and referral laboratory headquarters in the capital city, Kampala. The UBTS with URCS recruits voluntary non-remunerated blood donors (VNRD) through this blood banking network to obtain blood for transfusion to supply over 220 health facilities in the country. In particular, the UBTS will support activities to improve blood donations from regular VNRD; ensure safety through a centralized testing system; promote appropriate use of blood and blood components among the main beneficiaries, of which persons with HIV/AIDS are a part.

In order to increase awareness of blood safety activities, blood donor mobilization, education and motivation the program will improve and explore innovative information, education and communication (IEC) with the blood donor community and general public. This is intended to help expand the pool of low-risk, repeat VNRD beyond educational institutions, and retain them through improved donor motivation, screening, recruitment & retention and communication strategies. Priorities for blood collection include: development and support for the sustainability of blood donor clubs, provision of a standard package for HIV prevention; ensure safe blood collection procedures including donor selection and deferral, donor care and confidentiality; and improve the efficiency of post donation counseling services and referrals, by developing, implementing and sustaining a donor notification program for provision of test results and initiate linkages to HIV/AIDS care and treatment and other referrals for those with reactive results.

The mechanism will continue to ensure adequate supplies for maintenance of cold chain as well as blood processing, storage and transportation, particularly as new purpose built infrastructure is completed at all the regional blood banks. Additionally screening of all donated blood for transfusion transmissible infections (TTIs), including HIV, hepatitis B and C viruses and syphilis will be maintained. Existing protocols for the testing, selection and evaluation of appropriate screening assays are to be revised and reviewed to accommodate current best practices in blood safety.

This mechanism will ensure an efficient logistics management system for the timely procurement, supply, central storage and distribution of reagents and materials for continuity in blood testing and processing at the UBTS laboratories. Supplies for this mechanism will be purchased under the established national procurement regulations and supply chain, with the Ministry of Health continuing to provide for blood bags.

To realize the above, the UBTS will ensure adequate numbers of well trained staff to support blood collection, processing, storage and distribution activities. Under PEPFAR I, the UBTS and URCS maintained a fleet of vehicles for donor mobilization, blood collection, pre and post- donation counseling activities. Funds will be budgeted to ensure this continues, and the necessary vehicle replacements are made. The provision of adequate infection control, post-exposure prophylaxis and waste management will continue, particularly as the UBTS attains improved purpose built infrastructure throughout the country. The required training to support these activities will be planned for and implemented.

This mechanism will support the establishment of autonomy status of the UBTS with which it is envisioned the organization will be better positioned to advocate for and obtain funds from multiple sources for blood safety activities in the country. The UBTS will also explore other potential funding sources, including cost recovery within the health sector. Additionally, the UBTS will advocate for government commitment through an incremental direct and continuous financial and budgetary allocation, and foster development and implementation of its own budgeting and finance system to ensure a sustainable blood safety program through annual budget allocation. ? The UBTS will also promote sustainability through developing a plan for continued, high-quality interventions and services; and implement a robust program monitoring and evaluation system, using the results for ongoing improvement of program performance.

Other key priorities include coordination with key partners in policy development, technical assistance, reporting, support supervision, M&E (MOH departments, District Health Systems, HMIS); establishment and promotion of linkages among all stakeholders in Blood Safety including local, regional and international partners and donor agencies; and strengthen collaborations with HHS/CDC, other U.S. government agencies and their implementing partners (Injection Safety, President's Malaria initiative, Maternal& Child health, Laboratory, Infrastructure, HIV/AIDS Care and treatment programs) to address gaps in blood transfusion services and develop strategies for the blood safety program.

Subpartners Total: $0
To Be Determined: NA