Access to a safe and sufficient supply of blood and related products and services, including blood transfusion, is a critical element of any health system. Unfortunately, many people who need transfusions — especially those who live in low- and middle-income countries around the world — do not have timely access to safe blood.
According to the World Health Organization (WHO), activities related to blood collection, testing, processing, storage, and distribution should be coordinated at the national level through effective organization and integrated blood supply networks. Furthermore, national blood systems should be governed by national blood policies and legislative framework to promote uniform implementation of standards and consistency in the quality and safety of blood and blood products. As a result, there is a need in many low- and middle-income countries for expert technical assistance to strengthen the rapid implementation of safe blood programs and precautions against the transmission of HIV and other transfusion transmitted infections.
Although safe blood is a recognized priority and a key element in the fight against HIV/AIDS and efforts to achieve global Sustainable Development Goals, the overall regulatory framework for health, including the lack of clear legal and political accountability, is still evolving in many countries. This poses a particularly serious challenge for effectively addressing blood safety.
AIHA has provided technical guidance, clinical training and mentoring, and expert advice to enhance blood safety and improved transfusion practices. We have also worked closely with our local partners to help prepare them for accreditation in accordance with international standards. More information on our projects can be found below.
Twinning Center Blood Safety Project (Ukraine) under PEPFAR
The main objectives of the project were accreditation of the blood establishments of Ukraine, strengthening the national blood system through the provision of TA to the PHC, provision of TA to the Blood Safety Coordination Working Group of Experts at the Ministry of Health of Ukraine, and training and ensuring the sustainability of the proper clinical use of blood components and the organization of transfusion care in health care institutions.
In the context of active health system reforms in Ukraine, including in the blood service sector, AIHA has managed to successfully respond to 100% of requests for technical assistance made by the MoH of Ukraine and PHC as major partners in project implementation at the national level. To read more on this project, click here.
Technical Assistance Support for the Strengthening of Blood Transfusion Services in Selected Countries Under the President’s Emergency Plan for AIDS Relief (PEPFAR)
In December 2012, AIHA launched a project designed to improve access to a safe supply of blood in selected countries in Asia and Eurasia. This five-year technical assistance project was funded through a cooperative agreement with the U.S. Centers for Disease Control and Prevention (CDC) in support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
Through this project, which concluded in March 2018, AIHA provided technical assistance to strengthen the implementation of safe blood programs and precautions against the medical transmission of HIV, thereby ensuring a safe and adequate blood supply. AIHA delivered expert guidance and technical assistance to the ministries of health and national blood transfusion services (NBTS) in Kyrgyzstan, Kazakhstan, Tajikistan, Ukraine, and Cambodia. Two key areas of focus were the development and implementation of national safe blood programs and development of sustained local capacity to continue these programs after the project’s conclusion.
The project’s success was directly linked to close partnerships AIHA developed with CDC / Atlanta; CDC offices in each country targeted for technical assistance; and ministries of health, NBTS, and other country-level implementing organizations. Technical expertise was provided by transfusion medicine and blood bank professionals and in collaboration with ID Consulting for International Development of Transfusion Medicine (IDTM), Global Healing, and the Australian Red Cross (AuRC).
Our team of experts conducted assessments in each country as a first step toward developing work plans that zeroed in on key areas requiring improvement. A common deficiency in all countries was the absence of a quality management system (QMS), which is critical for ensuring the availability of safe blood for all patients needing transfusions. This was a primary area of focus throughout the project and included both theoretical and skills-based training. Local stakeholders developed templates for quality plans and other quality processes that could then be customized by each institution. Other operational areas for capacity building included recruitment of volunteer non-remunerated blood donors (VNRBD), blood collection and donor care, laboratory processing and manufacturing, storage and distribution of blood components, and the clinical use of blood for transfusion.
AIHA conducted more than 80 training workshops over the course of the project, delivering these to some 2,753 participants. We contributed to the development of at least eight national guidelines or prikaz on topics pertaining to organizational infrastructure, VNRBD recruitment, quality and technical standards, and clinical use of blood – all of which contribute to blood safety and accessibility.
AIHA bolstered the knowledge and skills of a team of local blood safety experts in Ukraine who have been recognized by the Ministry of Health and empowered to promote ongoing sustainability of the project’s efforts at the national level. Similarly, in Kyrgyzstan we trained a group of local experts from the Republican Blood Center on the clinical use of blood who in turn trained physicians in rural parts of of the country. Additionally, several project deliverables were recognized as best practices in the region and have been replicated in other countries through the project. In 2016, for example, AIHA developed the National Guideline on the Clinical Use of Blood in Kyrgyzstan with technical assistance from international experts. AIHA later worked with stakeholders in Cambodia, Tajikistan, and Ukraine to adapt, contextualize, and implement this guideline, further contributing to better standards for blood safety in the region.
Another exciting outcome of the project was the early development of a regional network for the national blood systems in Central Asia, which greatly facilitated the sharing of best practices. The NBTS Quality Manager in Kazakhstan, for example, visited the NBTS in Kyrgyzstan to provide advice on accreditation, while the Head Physician from the same project site in Kazakhstan provided physician training on the clinical use of blood in Tajikistan.
Why Building Sustainable Local Capacity in Blood Safety Matters
In some of the countries, transfusion of infected blood or blood products is a serious concern because the prevalence of HIV and hepatitis B and C in the blood donor populations is higher than the prevalence in the global donor population. Screened blood units have higher rates of most transfusion transmitted infections (TTIs) than the general global donor population and, according to CDC reports, the presence of TTIs remains the primary reason for discarding donated blood. Lack of safe blood has also been directly implicated in HIV transmission in Central Asia and other countries. Safe blood is also a recognized priority in target countries and a key element in their fight against HIV/AIDS and efforts to achieve Sustainable Development Goals, but the overall regulatory framework for health, including the lack of clear legal and political accountability, is still evolving in each country. This poses a particularly serious challenge for effectively addressing blood safety.
Preventing HIV/AIDS and Hepatitis B and C in Moldova Project
The Preventing HIV/AIDS and Hepatitis B and C Project (PHHP) began in June 2006 and was planned as a four-year, $6.2 million effort in Moldova. USAID contracted the Emerging Markets Group to implement PHHP with assistance from two subcontractors — AIHA and Pathfinder International.
AIHA’s role was to spearhead efforts to ensure the safety of Moldova’s blood and blood products, as well as to facilitate the strengthening of laboratory capacity needed both to diagnose HBV and HCV and to improve epidemiological surveillance capabilities.
USAID/Moldova was forced to curtail funding in October of 2008 in response to a funds directive from USAID/Washington. Subsequently, the PHHP was reorganized into a two-and-a-half year program. Despite a shorter-than-anticipated implementation period, PHHP was successful in meeting most of its targets, and in its efforts to support and strengthen ongoing programs of Moldova’s Ministry of Health, the National AIDS Center, the National Blood Transfusion Center, the Center for Preventive Medicine, and other key government agencies.
To read more on the project, click here.