Technical Assistance Support for the Strengthening of Blood Transfusion Services in Selected Countries Under PEPFAR
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.
WHO reports that in 2017, of the 117.4 million blood donations collected globally, 42 percent of these are collected in high-income countries, home to 16 percent of the world’s population. Additionally, some 62 percent of countries have specific legislation on safety and quality standards for blood transfusion, ranging from 81 percent of high-income countries down to just 44 percent of low-income countries. There is also a marked difference in the level of access to blood between low- and high-income countries, as evidenced by the whole blood donation rate, which ranges from a median of 36.8 donations per 1,000 population in high-income countries to 11.7 in middle-income countries and 3.9 in low-income countries. And, while WHO reports an increase of 11.6 million blood donations from voluntary unpaid donors between 2008 and 2015, 58 countries collect more than half of their blood supply from family, replacement, or paid donors rather than voluntary unpaid blood donors.
Clearly, 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, hepatitis, malaria, and other blood-borne infections.
AIHA’s Blood Safety Program
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 provided technical guidance, clinical training and mentoring, and expert advice to enhance blood safety and improved transfusion practices. We also worked closely with our local partners to help prepare them for accreditation in accordance with international standards.
From December 2012 through March 2018, AIHA implemented a five-year technical assistance project to improve access to a safe supply of blood in selected countries in Asia and Eurasia under 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). We provided technical assistance to strengthen the implementation of safe blood programs and precautions against the medical transmission of HIV, delivering 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.
Selected Program Results
- In Cambodia, AIHA supported an ongoing collaboration between the Ministry of Health and the National Blood Transfusion Centre and technical experts from the Australian Red Cross. Together, they are strengthened Cambodia’s blood safety infrastructure, including development of national blood policies and clinical guidelines for transfusion in Phnom Penh, as well as providing laboratory training in the capital region. The team adopted a multidisciplinary technical assistance approach to build capacity and capability across the Cambodian blood banking sector. Through training and guidance the technical team improved blood service safety and delivery across the country, which resulted in improved clinical practice. They strengthened national policy and legislation for blood services and ensured integration with the wider health system – for example with maternal health program, national HIV programs national education. The technical support team also focused on program management, monitoring and evaluation, business, finance, communications; developed tools and systems for blood service delivery; and promoted the effective use and management of other donor funding (e.g., Global Fund) through robust, integrated project work plans and partner coordination. Click here to learn more about the project’s strong collaboration with multiple stakeholders.
- In Kazakhstan, AIHA provided technical assistance supporting the development of user requirement specifications for bidding a national computer system; delivered a quality management training curriculum; provided technical assistance on cost-accounting and financial management systems; and reviewed national prikaz on clinical use of blood, making recommendations for revisions. We also worked with leading national experts to develop a postgraduate course on the clinical use of blood, which — once finalized and officially approved — was introduced to medical school faculty and clinicians across in the country during a two-week training workshop. Similar work was done for a postgraduate quality management course for specialists from the national blood service.
- AIHA’s work in Kyrgyzstan commenced with a national needs assessment and resulting recommendations for blood service reform. We conducted a series of quality management trainings with follow-up mentoring in all six oblasts and worked with local stakeholders to develop quality and technical standards that were submitted to the Ministry of Health and approved as a national prikaz. In addition, the AIHA team developed national clinical guidelines for the use of blood components that also were approved by the Ministry as national policy. We provided technical assistance on blood service financing and implemented donor recruitment training for partners from the Republican Blood Center, the Red Crescent Society, and Club 25, as well as to representatives of the mass media. The project also supported a national blood safety conference in October 2014.
- AIHA began working in Tajikistan in 2015, providing a series of trainings on clinical use of blood for more than 100 blood service professionals. We also provided technical assistance to the Republican Blood Center and facilitated a round table discussion in late 2016 with key stakeholders to review the National Guideline on the Clinical Use of Blood; provided technical assistance on finalizing the guideline in early 2017; and printed and distributed 1,000 copies of the final guideline to the national blood service in June 2017. The guideline – available in both Russian and Tajik – is a formative document for Tajikistan on the storage, transportation, and clinical use of blood and its components.
- In Ukraine, the AIHA team provided a series of quality management trainings that resulted in marked improvements in practice, as well as the development of a core group of blood safety professionals officially recognized by the Ministry of Health as national experts (click here to read more). We provided training on the costing of blood, participated in a scientific conference sponsored by the Association of Blood Services in Ukraine, and worked with State Services to develop a plan for a new computer information management system for which we coordinated training and development of user requirement specifications. Through the project, AIHA collaborated with the National Medical Academy of Postgraduate Education to develop a transfusiology curriculum and assisted with harmonization of local policies with European Union directives for blood services. We also provide trainings in proper venipuncture techniques, donor care, component preparation, and validation of equipment.