CIDRZ enrolls 14,376 patients on Health Post, FastTrack DSD models for ART dispensation

Drugs being transport from Matero Referral Hospital to Chimwemwe Health Post

With the scale up of Antiretroviral therapy (ART), most district health facilities in Zambia began experiencing increased congestion. Patients face significant challenges to retention including transportation costs, time away from work, long clinic waiting times, and competing life priorities with greater need to develop strategies to cater for the different needs and situations of ART patients.

In July 2017, CIDRZ through its Pharmaceutical Services Department with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partnership of U.S Centers for Disease Control and Prevention (CDC) developed differentiated service delivery models (DSD) of care among others, namely Health Post and Fast Track (Static) for ART dispensation.

The models which are in line with WHO and 2016 Ministry of Health (MoH) ‘Zambia Consolidated Guidelines for Treatment and Prevention of HIV Infection are being implemented in 16 main facilities ,21 Health posts and 7 static sites with a total of 14, 376 patients enrolled between October 2017 and February 2018.

Sr Masupa Chimwemwe Health Post

The objectives of the models are to decongest main facilities by aligning bi-annual medicine refills with clinical visits, reduce the cost and distance a patient is required to travel to pick up drugs and reduce pharmacy waiting time for patients at the facility. The models target stable patients with CD4 >=200/µl and viral load suppression of <1000 copies/ml.

Three months’ supply of drugs for patients on the Health Post model are delivered weekly to health posts closer to their homes to ensure a steady and uninterrupted supply of drugs. Drugs for patients on the Fast Track model are delivered to a separate dispensing location within the facility where stable patients pick up their three months’ supply of drugs.

Matero Reference clinic is among the facilities where the two models have been highly accepted by both patients and the facility staff. Enrollment at the health facility started on 26th October 2017 and to date 6,014 stable patients have been enrolled into both Health Post and Fast Track Models.

Grace Pumulo collecting her drugs from CIDRZ Treatment Supporter, Sabrina at Chimwemwe Health Post

Grace Pumulo, a beneficiary of the Fast Track model is elated with the model;

 “I have been on ART since 2007.In all these years before enrolment on the model, I spent long hours queuing up to receive ART services such as clinician appointments, laboratory tests and even getting drugs. With this model, I just walk in here and within a short time, I am attended to and go back home to do other things”.

Pharmacy Technologist at Matero Reference Clinic, Tinda Mbewe shared her experience;

“Before the introduction of the DSD program, we used to attend to 300 stable and unstable patients in a day. With two pharmacists working on that number of patients’ files and dispensing drugs, one would only imagine the amount of stress that comes with it. However, after the introduction of Fast Track, there is reduced workload as we only see 100 patients a day”.

Sabrina Sakala, a Treatment Supporter at Matero Reference clinic said;

“Matero Ref alone has enrolled 6,014 stable patients on Fast Track. On average, we attend to 150 patients per day with each patient spending about 10 minutes. What this means for the client is that they spend less time here at the facility and are able to go back to attend to their daily activities. Some patients say that the model guarantees them more confidentiality as they do not have to queue up just to receive their drugs.”

Sr Masupa Chimwemwe Health Post

Another Treatment Supporter, Estella Ngowani had this to say;

“What we are now experiencing are overwhelming requests from patients once we go to the main pharmacy at Matero to sensitize them about the program. This simply shows that patients have understood the aims differentiated service delivery models want to achieve”.

Helen Bwalya Mulenga, Head of Pharmacy at CIDRZ explains;

 “I am excited to lead and drive the team in the implementation of Differentiated Service Delivery for ART, these models will provide improved patient adherence and retention and enable us to positively contribute to decongesting ART clinics, reducing patient wait times and reducing patient costs by offering them an opportunity to collect drugs near their homes”.

CIDRZ shares research results at first 2018 MoH Scientific Research Meeting

Research in any country is vital especially in finding lasting solutions to health needs and more so is it more effective if its done in close partnership with the government and the communities as addressing health challenges becomes much easier and faster.

Through continued generous support from funders such as the United States (U.S) National Institutes of Health (NIH), Division of AIDS (DAIDS), Centers for Disease Control and Prevention (CDC), and other partners that include Bill & Melinda Gates Foundation, Aeras, TB REACH, Global Alliance for TB Drug Development; CIDRZ has been conducting locally relevant research aimed at improving the quality of health care in Zambia.

By working in close collaboration the Zambian Ministry of Health, CIDRZ aims to be a permanent resource to the government by answering locally relevant health questions using latest methodologies to generate high quality evidence to inform policy.

It in this regard that CIDRZ participates in the National Health Research Authority (NHRA) organized scientific research meetings, a national platform for dissemination of research information and research results.

The first 2018 scientific meeting was held at the UTH Paediatric Center of Excellence where CIDRZ shared research results from three projects namely:

  • A Rapid Qualitative Assessment Before, During and After the 2nd-dose OCV Campaign in Bauleni, Chawama and Kanyama compounds in Lusaka;
  • Costing and Cost Effectiveness Analysis of the Oral Cholera Vaccine (OCV) Campaign in Lusaka, Zambia in 2016, and
  • Recounting the numbers: Policy proposal to Reinforce Routine HIV Testing and Treatment among children in Zambia

 “There is need for all stakeholders involved in research to support research work if we are to improve the quality of health care in Zambia. We as CIDRZ look forward to listening to research work being done by other researchers as this meeting provides a platform to learn from each other,” CIDRZ CEO Dr Izukanji Sikazwe said.

Dr Sikazwe further added “The presentations CIDRZ is making today on cholera is driven by past outbreaks and through support from donors, we are looking at possibilities of how future outbreaks could be averted. One particular such study CIDRZ is carrying out is a cholera vaccine trial in the Lukanga Swamps. Another presentation will look at HIV in children and how to improve HIV interventions among children”.

Dr Anjali Sharma presented research findings on A rapid qualitative assessment before, during and after
the second-dose OCV campaign in Bauleni, Chawama and Kanyama compounds in Lusaka, a project that was aimed at  understanding community and healthcare worker perspectives and experience regarding both the reactive and preemptive OCV campaigns.

Taniya Tembo, presented on Costing Cholera Illness, Vaccine Delivery and Vaccination Campaigns in Zambia while Dr Mwanza Wa Mwanza presented on Routine HIV Testing and Treatment for Children and how the intervention can increase testing update for children.

 

CIDRZ screens 741, Initiates 15 on TB treatment during TB week in George Compound

CIDRZ staff screening at during the community drive campaign

CIDRZ with support from the Stop TB Partnerships/TB REACH and working with the Ministry of Health through the Lusaka District Health screened patients for TB treatment during the TB week.

With current statistics indicating that Zambia ranks 7th among 30 highest tuberculosis (TB) burden countries in the world, a lot of effort needs to be channeled towards ending the spread of TB.

As the world commemorated World TB Day this year, under the theme; Wanted: Leaders for a TB-Free World. You can make history. End TB, CIDRZ celebrated this year’s event with a TB screening drive in Lusaka’s George compound where close to 300 people were screened for TB as well as tested for HIV on a daily basis.

Matero Sub District TB Coordinator, Mercy Mwale said “in 2017, of 1693 patients on TB treatment,1451 are male and 242 female and from our observations men are at high risk of TB due to poor diet and excessive alcohol intake”.

Matero Sub District TB Coordinator Mercy Mwale during the commemoration

“CIDRZ has supported us with a mobile X- Ray machine and an X-pert machine, resulting in quick turnaround time for results of all TB tests we conduct and detection of 10 MDR (Multi Drug Resistant) TB cases. This has elated the community going by the demand for TB screening services. Through TB drives such as this one, we are able to reach out to as many as 300 people in a day and this is all through CIDRZ support”.

Catherine Nalumbwe, a former TB patient shared her experience, “through the TB services offered by CIDRZ, I was quickly linked to care after being screened and found with TB. Throughout the six months I was on medication, I received support from the health care providers and today I stand before you to tell you that early TB detection saves lives. I wish to thank Stop TB Partnership and TB REACH because without their support, a lot of lives could have been lost to TB”.

Ag Lusaka District Health Director, Dr. Khozya Zyambo

And acting Lusaka District Health Director Kozya Zyambo says “all stakeholders need to come on board and participate towards ending TB. The community needs to be informed about the symptoms of TB and engage with health facilities to access treatment. Early detection and screening is the surest way to prevent TB.”

CIDRZ Director of TB Programmes, Dr Monde Muyoyeta emphasized the importance of community involvement in the fight against TB.

Dr. Monde Muyoyeta, CIDRZ Director of TB Programmes

“Without the collaboration of the Community Volunteers, this work would not have been possible. Working with them and equipping them with knowledge about TB has resulted in increased case detection. We need to continue sensitizing people and encouraging them to screen for TB. Lastly I wish to thank our funders Stop TB Partnership/ TB REACH for their continued support in this drive to end TB”

CIDRZ begins offering Pre Exposure Services to at risk populations

 

PrEP Champions during the training workshop conducted by CIDRZ

According to UNAIDS, since 2010, the annual global number of new HIV infections among adults (15 years and older) has remained static, at an estimated 1.9 million with key populations accounting for 45% of all new HIV infections in 2015.

In some countries and regions, infection rates among key populations are extremely high. HIV prevalence among sex workers varies between 50% and 70% in several countries in southern Africa.

In Zambia, National AIDS Strategic Framework (NASF) reports that there are 46, 000 new infections in 2016 with most new infections happening among this population. With these statistics, several strategies such as condom use and treatment as prevention have been promoted among key populations.

However, HIV prevention needs change during a person’s lifetime and that a combination of interventions targeted at key populations are needed to halt the HIV epidemic.

CIDRZ with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and U.S Centers for Disease Control and Prevention (CDC) has moved a step up in its effort to ensure everyone has equal access to quality health care especially HIV services by introducing Pre Exposure Prophylaxis (PrEP) services to HIV uninfected Key populations.

CIDRZ Olipa Tembo is one of the key drivers of this initiative

The programme that started in February 2018 under the Pharmacy unit intends to initiate 236 people on PrEP in 2018 in Lusaka and 1197 for Lusaka and Western Provinces in 2019.

Muhau Mubiana of CIDRZ explains, “Introduction of PrEP in Zambia is yet another step towards achieving the 90-9-90 strategy. PrEP is a program that brings a paradigm shift from focusing only on HIV positive clients but also on the HIV negative at substantial risk of HIV infection”.

“High numbers of new infections become a motivating factor for Health care providers like me to drive and support implementation of new innovations intended to reduce HIV infection in our country. In my own words, PrEP is not only for the socially acceptable community but the marginalized population. It is an Extended Service Delivery that touches the lives of marginalized communities. The program comes as a restoration of the right to health care to the vulnerable and marginalized population. Everyone has the right to be prevented from HIV infection provided they are considered to be at substantial risk”.

In order to reach out to these at risk populations, CIDRZ conducted a training targeting 55 health care providers and 28 PrEP beneficiaries. For health care providers, the training was to impart them with the necessary skills to offer friendly services to key populations.

For PrEP beneficiaries, the training was to equip them knowledge as advocates for good health behavior and act as linkages to facility care among their peers in their respective communities. The beneficiaries will be involved as PrEP Champions after having being  on  PrEP for the past one month.

Carol 33, a PrEP Champion shared her experience “When I first learnt Pre Exposure Prophylaxis(PREP), I had my fears that probably if I accepted to be initiated on the drug after testing negative for HIV, it would turn out as a way of actually infecting me with HIV.  However, after intensified counseling and learning of the benefits and how that I was actually protecting myself from contracting HIV, I decided to agree to be initiated on PREP.”

“It is a good initiative to involve us the direct beneficiaries, because sex work is a job that is stigmatized and that makes it hard to go to the health facility and access services. Therefore, using a sex worker to reach out to another sex worker will create demand and uptake of services such as HIV testing and PrEP. To many, this will seem like a way to promote careless behavior but I tell you that our work really puts us at risk and we too need to have access to quality health care just like anybody else who is not doing our kind of business”

CIDRZ Clinical Care Specialist – Prevention, Dr Natalie Vlahakis during the training sessions

And Lwazo Akunfuna, a Clinical Officer at Kabwata health facility had this to say “This is a good initiative as the demand for the service is already there and will greatly impact on the fight against HIV. Key populations have the highest HIV rates in the country but the most difficult to reach and to see that CIDRZ has even managed to get some to access HIV services and become champions is commendable. These are people that we live with in our communities and offering them these services contributes to the well being of the community and Zambia as a whole and subsequently reduce the prevalent rate of HIV”.

New Grant: Elton John AIDS Foundation Awards CIDRZ a £750,000 Grant

CIDRZ receives a Two and half year grant from Elton John Foundation for Building capacities of the Zambia Correctional Service to provide holistic and integrated health services to juvenile offenders.

The Elton John Foundation has awarded CIDRZ a £750,000 to provide comprehensive, juvenile-appropriate health services including recreational and legal services.

The grant will focus on incarcerated juveniles owing to their vulnerability, marginalisation and increased risk of sexual exploitation and discrimination, hence, increased risk of HIV infection especially those incarcerated in adult holding facilities..

This grant will provide comprehensive interventions tailored to the needs of incarcerated juveniles aimed at reducing risk of HIV and other STI infections subsequently morbidity and mortality due to HIV and TB, and improve the quality of life of incarcerated juveniles.

In addition, the grant will initiate adolescent friendly health and social services, support legal services and advocate for judicial reform to expedite case disposal thereby reducing time of detention without trail.

For more information on this project, you can contact  the Principal Investigateor, Dr Monde Muyoyeta, CIDRZ Director of TB programme (monde.muyoyeta@cidrz.org); or Clement Moonga, the Programme Manager (clement.moonga@cidrz.org).

Differentiated Models of Care: Encouraging ART Patient Retention into Care

 

Nessia Tembo on her way to Matero Main Clinic to collect her medication

Community based ART delivery models have been shown to reduce the burden and strain on the local health system. These models have shown improved outcomes that include better patient retention in care, reduced clinic congestion, and patient satisfaction.

Nessia Tembo of Matero was one of the over 400 participants  who took part in the CIDRZ Fast Track Model, one of the four differentiated models of care implemented during the Community ART for Retention in Zambia study through funding from the Bill and Melinda Gates Foundation. The other three were Community Adherence Group(CAG), Urban Adherence Group (UAG) and Streamlined ART Initiation (START).

Nessia shared her experience, “I was working part time and usually getting leave from work to go the health facility would be a challenge and for fear of losing my job, I would default going for my clinical  appointment just to keep my job. The hours I would spend from having my file pulled to collecting my drugs were long. When the Fast Track model was introduced, I spent less time at the health facility during my ART visits giving me enough time to go back to work and even attend to other family engagements.”.

Nessia receiving her ARV’s from the Pharmacist at Materos Main Clinic

“It is sad that the study has come to an end. If only those of us that took part in the study could be trained and mentored, we would form groups to ensure continuity of the model”.

The Zambian Ministry of Health had authorised  implementing partners to pilot different models of community-based ART service delivery to determine best models of dealing with retention into care of HIV positive clients.

This was in response to the challenges that the health sector was facing. Under the Community ART Study (CommART), CIDRZ conducted a study whose objectives were:

  1. To determine the acceptability, appropriateness, and feasibility of a differentiated care system in Zambia.
  2. To evaluate the effectiveness, efficiency, and health care quality of a differentiated care system that includes targeted models of care.
  3. To develop a “methodologic” toolkit for assessment of local needs and preferences and for implementation during scale-up of differentiated care models in this and in other contexts.

Four models were piloted: one Community model and three facility models. These were the Community Adherence Groups (community model), and the Urban Adherence Groups, FastTrack and Streamlined ART Initiation (facility models).

CIDRZ calls for assessment of the duration of protection of One-dose cholera vaccine

 [CAPE TOWN] A dose of oral vaccine provides effective short-term protection against the cholera during an outbreak, a study in Zambia shows.

According to researchers, because of a shortage of global stockpile of cholera vaccines, an outbreak in Lusaka, Zambia, in February 2016 necessitated a need for single-dose vaccination.

An emergency single-dose oral vaccination campaign was implemented in April 2016, around Lusaka, targeting more than 500,000 people in the city’s overcrowded township areas.

Francisco Luquero, a co-author of the study and an expert in preventable diseases at the France-based Epicentre, the research arm of the Médecins Sans Frontières (MSF) or Doctors without Borders, says that studies have already proved that one oral cholera vaccine dose works, but they were conducted in countries that had recently experienced cholera.

The 2016 outbreak happened when Zambia had not reported a case of cholera in four years.

“Our results show that people vaccinated can be protected against cholera a few days after receiving one dose.”

Francisco Luquero, Médecins Sans Frontières (MSF)

Between 25 April 2016 and 15 June 2016, researchers enrolled 66 patients with confirmed cholera and 330 people without the disease but who were neighbours of the patients, and determined the effectiveness of the single-dose cholera vaccine.

According to the study published last month (8 February) in the New England Journal of Medicine, the effectiveness of the single dose vaccination was about 90 per cent.

“Our results show that people vaccinated can be protected against cholera a few days after receiving one dose, which is important in outbreaks because we need to protect people quickly, Luquero says.

Oral cholera vaccines are emerging as a new tool for cholera control and have been used in past years to successfully prevent outbreaks in complex emergencies, to curb cholera epidemics or to reduce burden in countries which are endemic but there is a current global shortage, MSF says.

The Lusaka outbreak ended quickly after the implementation of the vaccination campaign, thus limiting the number of cases recruited, Luquero explains.

The Ministry of Health offered a second vaccine eight months later in December 2016.

The WHO estimates that globally cholera infects one to four million people a year, resulting in 21 000 to 143 000 deaths, with countries in Sub-Saharan Africa at increased risk.

“This is an important study because it suggests that the world could face the challenges of cholera outbreak with a single dose,” says Roma Chilengi, chief scientific officer, Centre for Infectious Disease Research in Zambia, adding a single-dose vaccine is cheaper and could help countries with limited financial ability to control the disease.

But Chilengi tells SciDev.Net, “It would be helpful to be clear about the potential duration of the protection the single dose offers.”

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.

References

Eva Ferreras and others Single-dose cholera vaccine in response to an outbreak in Zambia(New England Journal of Medicine, 8 February 2018)

Original Article: https://www.scidev.net/sub-saharan-africa/medicine/news/one-dose-cholera-vaccine-protection.html

Breaking the Barriers: CIDRZ reaches to Nc’wala Ceremony Attendees with Health Messages

Nc’wala Ceremony attendees at the CIDRZ stand

To ensure that quality health care reaches to as many as possible in all the sites where CIDRZ has presence, working with the local leadership has been one of the strategies the organisation uses to reach out to many people with health information.

We engage with traditional leaders to discuss health issues that concern their people and we take advantage of every opportunity to do so. We talk about cervical cancer, Voluntary Medical Male Circumcision, Prevention of Mother to Child Transmission of HIV, Tuberculosis and best ways to link HIV positive people to care.

And we have always found positive attitude with our traditional leaders and have received support for our work.

This is why during this year’s Nc’wala ceremony, CIDRZ with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partnership from the U.S Centers for Disease Control and Prevention (CDC) During this year’s ceremony, sensitised a total number of 2131 people voluntary male medical circumcision, condom use, Prevention of Mother to Child Transmission of HIV (PMTCT) and cervical cancer.

Messages on the importance of HIV testing, male circumcision for HIV negative partners and cervical cancer prevention and management were disseminated to individuals as well as groups of people. We conducted two onsite circumcision procedures.

CIDRZ also provided HIV testing services of which 578 people got tested with six people found HIV positive were linked to care.

Nc’wala Traditional Ceremony is an annual event of the Ngoni-Speaking People of Eastern Province and takes  at Mtenguleni in Chipata District, Eastern Province to celebrate the first harvests of the year.

Better Drug Storage Conditions Equals Quality Medication for Patients

Aircon installed at Katoba RHC in Chongwe

Even though there were adequate drugs to supply the patients, facilities in Chongwe district faced challenges in ensuring appropriate storage conditions for drugs.

The Centre for Infectious Disease Research in Zambia (CIDRZ) is currently supporting 29 facilities in Chongwe District. All the facilities including the district pharmacy had no functional air conditioners in the pharmacy store rooms to maintain appropriate temperatures for storage of drugs at the time CIDRZ started supporting Chongwe District. The few facilities with room thermometers recorded temperatures of above 35˚C to 40˚C especially in the hotter seasons. This is above the recommended temperature range of 15˚C to 30˚C. This exposure of drugs to uncontrolled temperatures is a risk to reduced potency of drugs, hence lowering their efficacy. Some facilities opted to ordering and storing fewer drugs so as to reduce on the period of exposure to the unfavorable storage conditions.

“I just notice color change in some drugs and guess that heat has damaged the product,” said the nurse at Katoba Rural Health Center.

The solution to this challenge was not to reduce stored quantities, but to have an effective temperature control system – air conditioners accompanied by room thermometers and temperature charts for daily monitoring of room temperatures.

In November 2017, CIDRZ, through the Pharmaceutical Services Department began an air conditioner installation exercise in Chongwe District. The District was supported with 14 air conditioners paired with installation accessories. This activity was done in close collaboration with the Chongwe district medical office whose technician was the installer.  In February 2018, we also distributed room thermometers and temperature charts to 10 facilities in Chongwe district.

Facility staff are confident that the improved storage conditions will help maintain drug’s effectiveness during the shelf life. This came with mentorship on the use of the equipment, temperature monitoring and maintaining the pharmacy store room in order. They gave an assurance of taking care of the items given to them.

“Temperature will be maintained in appropriate range all year round! I will no longer feel guilty when dispensing drugs because they were kept within recommended temperature range as I am assured of safety and efficacy.” said pharmacy technologist Ngwerere Main Clinic.

“The community of Katoba will no longer complain of coming across discoloured brittle-tearing latex male condoms.” said a peer based at Katoba Rural Health Center.

“Facilities can now keep adequate quantity of stock without worrying on the products deteriorating during its storage period.” said the district pharmacist.

Based on the success of improving storage conditions, the district medical office also supported 2 facilities with air conditioners. The status for storage now stands at 58% of facilities installed with air conditioners, 73% have room thermometers all with temperature logs and 86% have the store room arranged in appropriate order.

CIDRZ has in its plan to continue improving storage conditions of drugs to ensure that quality drug product is dispensed to the patient for desired therapeutic outcomes. It is planned that by the end of 2020, 90% of CIDRZ supported facilities in Chongwe adhere to recommended storage guidelines. This is one of the organisations ways to improve access to quality healthcare in Zambia.

CIDRZ employees donate blood

Dr Mulenga, Medical Director

The importance of blood in one’s life could never be overemphasized. The billions of cells in our bodies need a steady supply of oxygen to function properly, a function critical to blood.

Zambia for example collects an average of 115,742 units of blood annually (based on 1% of national population) currently short the 150,000 units the country needs to service everyone in need of this life saving fluid.  With high and rapidly increasing demand for blood and blood products, the annual units of blood needed are estimated at 300,000 units.

To support the Zambia National Blood Transfusion Service (ZNBTS), CIDRZ in collaboration with ZNBTS conducted a blood drive for its employees to donate blood to the blood bank, with 21 employees donating blood.

CIDRZ CEO, Dr Izukanji Sikazwe commended ZNBTS; “we appreciate the efforts of ZNBTS in saving the lives of millions of Zambian in need of blood. CIDRZ has benefited from your services because barely two weeks ago, one of our staff members life was saved through blood transfusion and as an organisation, we thought it would be prudent to support ZNBTS’s efforts through the blood donation drive we are having today”.

And Dr Joseph Mulenga, Medical Director at ZNBTS highlighted some of the challenges being faced by the blood bank in meeting its annual targets.

“Countrywide Scale up of cancer treatment, cardiac surgery, renal treatment, increased hospital bed space through the upgrading of hospitals and newly built hospitals country wide, high prevalence of HIV and Hepatitis B Virus in the general population, lack of a cost recovery or re-imbursement scheme to fill the financing gap and reliance only on government for funding are some of the challenges faced by ZNBTS”.

Dr Mulenga said added to the challenges is lack of Nucleic Acid Amplification Testing (NAT) to complement serologic tests for testing of blood for Transfusion Transmissible Infections such as HIV, Hepatitis B Virus and Hepatitis C Virus  and capacity for Apheresis, Stem Cell collection and processing, Leucodepletion and Gamma Irradiation of products, HLA, Tissue Typing and Pathogen Inactivation procedures.

To mitigate these challenges ZNBTS has established Provincial Blood Transfusion Centre in all the 10 provinces to mobilize and recruit more voluntary non remunerated blood donors, conduct blood donor counseling, implement blood donor retention programmes & promote repeat blood donations.

Other measures include collecting 300,000 blood units (2% of estimated national population) per year, scale up blood component production, implement Apheresis procedures at 10 Centre’s, collect Platelets, FFP, plasma, 2-RBCs, source plasma, granulocytes, HLA typing, Irradiation, leucodepletion stem cell harvesting, implement ID-NAT testing procedures, promotion of rational use of blood & blood products and introduction of a partial cost recovery programme.