Global Advisory Panel on Corporate Governance and Risk Management of Blood Services in Red Cross and Red Crescent Societies

Tools

GAP Manual (English)
Development of Safe and SustainableNational Blood ProgrammesManualAugust 20141Inside cover:Global Advisory Panel (GAP) on Corporate Governanceand Risk Management of Blood Services in Red Crossand Red Crescent Societies, 2011GAP SecretariatL1, 69 Walters DriveOsborne Park WA 6017AustraliaCopies of all or part of this document may be made fornon-commercial use, providing the source isacknowledged. GAP would appreciate receiving detailsof its use. Requests for commercial reproduction shouldbe directed to GAP at gapsecretariat@redcrossblood.Telephone: +61 8 6213 5909Telefax: +61 8 6213 5949Email: gapsecretariat@redcrossblood.org.auorg.au2ContentsPreface ............................................................................................................................................. 5Acknowledgements ........................................................................................................................ 51. Introduction .............................................................................................................................. 62. Overview of National Society involvement in blood programmes........................................ 82.1 Levels of National Society engagement .............................................................................. 82.2 Promoting a safe and sustainable blood system ............................................................... 163. Fundamental Principles ......................................................................................................... 173.1 Promoting voluntary, non-remunerated blood donation (VNRBD) ..................................... 173.2 Ensuring safety for donors and recipients ......................................................................... 183.3 Promoting equity of access to blood and blood products .................................................. 183.4 Serving the community and patient interest ...................................................................... 194. Blood programme management............................................................................................ 204.1 Organizational models ...................................................................................................... 204.2 Governance ...................................................................................................................... 214.3 Corporate management .................................................................................................... 224.4 Financial management ...................................................................................................... 224.5 Risk management ............................................................................................................. 244.6 Balanced decision-making ................................................................................................ 255. Building a sustainable donor base ....................................................................................... 265.1 Voluntary, non-remunerated blood collection .................................................................... 265.2 Attracting and retaining donors ......................................................................................... 275.3 Long-term donor commitment ........................................................................................... 275.4 Donor health and counselling ............................................................................................ 286. Blood Safety ........................................................................................................................... 306.1 Strategy development ....................................................................................................... 306.2 Programme implementation .............................................................................................. 316.2.1 Minimum screening requirements.............................................................................316.2.2 Additional screening test requirements ..................................................................... 326.2.3 Testing algorithms ....................................................................................................336.2.4 Test systems ............................................................................................................336.2.5 Quality system..........................................................................................................336.2.6 Result, donor and product management................................................................... 346.2.7 Emergency provision of blood ..................................................................................347. Quality management .............................................................................................................. 357.1 The quality system ............................................................................................................ 357.2 Good manufacturing practice (GMP) ................................................................................. 367.3 Standards ......................................................................................................................... 387.4 Auditing............................................................................................................................. 388. Partnerships ........................................................................................................................... 398.1 Government ...................................................................................................................... 398.2 Community engagement ................................................................................................... 408.3 Blood sector networks....................................................................................................... 408.4 Hospitals and clinicians ..................................................................................................... 418.5 National Societies ............................................................................................................. 429. Sustainability .......................................................................................................................... 439.1 Adoption of new technologies and practices ..................................................................... 439.2 Contingency planning and disaster preparedness ............................................................. 439.3 Environmental sustainability .............................................................................................. 4510. Transition and exit strategies................................................................................................ 46Appendices ................................................................................................................................... 51Appendix 1: International Federations blood policy ..................................................................... 51Appendix 2: National Society blood risk summary........................................................................ 57Appendix 3: Framework of a Memorandum of Understanding..................................................... 58Appendix 4: ISBT Code of Ethics ................................................................................................ 61Appendix 5: Blood Safety, WHO Aide-Mmoire for National Blood Programmes ......................... 623Appendix 6: The Clinical Use of Blood, WHO Aide-Mmoire for National Health Programmes .... 64Appendix 7: Quality Systems for Blood Safety, WHO Aide-Mmoire for National BloodProgrammes ................................................................................................................................ 64Appendix 8: Safe Blood Components, WHO Aide-Mmoire for National Health Authorities ......... 664PrefaceThe safety and integrity of a nations blood supply is fundamental to a secure health system. People inall societies should have the right to expect that the blood and blood products supplied to them aregathered and provided in a safe and sustainable way. While the World Health Organization (WHO)recognizes that it is the responsibility of governments to ensure a safe and adequate supply of blood 1,the International Federation of Red Cross and Red Crescent Societies (IFRC) expects its memberNational Societies that are involved in blood programmes to meet these obligations to the community.0FThis manual supercedes the IFRC 1998 Blood Programme Development Manual and is informed by theexpertise of the Global Advisory Panel (GAP) on Corporate Governance and Risk Management of BloodServices in Red Cross and Red Crescent Societies. It identifies the features of an effective andsustainable blood programme and directs member societies to relevant resources on blood programmemanagement.By developing this manual the GAP seeks to support National Societies to manage their involvement inblood programmes in accordance with the International Federations blood policy and principles and inthe best interests of donors and recipients.This publication describes the Red Cross Red Crescent minimal requirements and international bloodservice standards that National Societies need to meet in order to maintain a blood programme. It alsoincludes generic guidelines to assist them in assessing the risks of blood service provision, and intransitioning to a lesser involvement in blood programme delivery if this is considered appropriate.Ultimately, it is the responsibility of individual societies involved in blood programmes to ensure that theyestablish sound governance and their programmes comply with the safety and quality requirements andthe necessary risk management mechanisms described in this manual and the GAP Self-assessment. Itis important that National Societies are aware of their responsibilities and exposure to risk that arise withundertaking blood service activities.AcknowledgementsThe members of the GAP (the blood services of the American Red Cross, Australian Red Cross, RedCross Society of China (Hong Kong), Ethiopian Red Cross Society, Finnish Red Cross, Honduran RedCross, Japanese Red Cross Society, Magen David Adom in Israel, Swiss Red Cross and the Thai RedCross Society) would like to thank the IFRCs Health Department for their collaboration in thedevelopment and publication of this Manual. The International Federations contribution of expertise involuntary blood donor recuitment, and their support with translations and funding assistance aregratefully acknowledged.The GAP would also like to express its thanks to both the International Society of Blood Transfusion(ISBT) and the World Health Organization (WHO) for their important work in supporting national bloodprogrammes as well as their specific contributions to this manual. ISBTs helpful feedback on the draftdocument has enabled the GAP to develop a better, more useful Manual for the use of NationalSocieties, while the GAP would like to thank WHO for allowing us to reference their excellent materials.Finally, the members would like to thank the Singapore Red Cross for their valuable assistance inbringing a blood donor recruitment perspective to appendix 3.1Aide-Mmoire: Blood Safety. Geneva, WHO, 200251.IntroductionThe International Federations mission is to improve the lives of vulnerable people by mobilizing thepower of humanity. The IFRC recognizes that health security is fundamental to global, national andindividual development and is committed to capacity building and promoting sustainability. 2 Priorities inits Global Agenda are to improve local, regional and international capacity to respond to disasters andpublic health emergencies; scale up actions with vulnerable communities in health promotion, diseaseprevention and disaster risk reduction; and to significantly increase HIV/AIDS programming andadvocacy.1FThe safety and integrity of national blood supplies are fundamental to health security. Blood and bloodproducts are vital for health care and the achievement of the United Nations Millennium DevelopmentGoals to:1. reduce child mortality (Goal 4)2. improve maternal health (Goal 5)3. combat HIV/AIDS, malaria and other diseases (Goal 6)Recognizing that voluntary, non-remunerated blood donation (VNRBD) 3 provides the foundation for safeand sustainable blood systems, the International Federation has partnered with WHO to create a globalframework for action for 100 per cent voluntary blood donation 4. Approximately 60 nations, includingresource-limited countries, have now achieved a national blood supply sourced from voluntary donors.The aim of the global framework is to eliminate paid or family replacement donation and help shift theresponsibility for the provision of blood from patients relatives (in the case of family replacementdonation) to the health care system.2F3FThe International Federation through the GAP supports the establishment of safe and sustainable bloodsystems through leadership, advocacy and guidance to National Societies and their blood programmes.This manual has been developed by the GAP with the assistance of IFRCs health department. Since itsestablishment in 2001, the GAP has provided advice to member societies on corporate governance andriskmanagement.ItFundamental Principlespromotes the adoption of(Chapter 3)best practice, knowledgeManagementSustainabilityRequirementsexchangeandthe(Chapter 9)(Chapter 4)Safe andmobilization of resourcesSustainable Bloodacross blood services. TheBlood SectorSustainable DonorPartnershipsBaseProgrammeareas highlighted in this(Chapter 8)(Chapter 5)publication, as illustrated inQuality AssuranceBlood Safetythe diagram on the right, are(Chapter 7)(Chapter 6)based on feedback fromNational Societies and their partners.2Health policy adopted at the XV Session of the IFRC General Assembly, Seoul, November 2005.Voluntary, non-remunerated blood donors are persons who give blood, plasma or other blood components of their ownfree will and receive no payment for it, either in the form of cash, or in kind which could be considered a substitute formoney. This includes time off work, other than reasonably needed for the donation and travel. Small tokens, refreshmentsand reimbursement of direct travel costs are compatible with voluntary, non-remunerated donation. Decision 34 of the VIIISession of the IFRC General Assembly, Budapest, 19914For the purposes of this manual, any reference to voluntary blood donors or voluntary blood donation assumes thedonation is non-remunerated, as per the description in the footnote above.36The International Federations blood policy (appendix one) states that National Societies must implementthe GAP Self-assessment and adhere to the requirements set out in this manual. National Societiesoperating full blood transfusion services (Level A) should find all sections of the manual relevant. Forthose societies involved only in promotion and advocacy of voluntary blood donation (Level C), Chapter3 on the fundamental principles underpinning involvement in blood activities will be of particular interest.It is worth noting here that for the purposes of this manual, any reference to voluntary blood donors orvoluntary blood donation assumes the donation is non-remunerated.National Societies that are also involved in the systematic recruitment of voluntary blood donors shouldespecially focus on the sections covering sustainability of the donor base (Chapter 5), tracking ofdonations for safety and quality assurance (Chapters 6 and 7), partnerships to support a culture ofvoluntary blood donation and to share best practice in donor recruitment (Chapter 8), and transitionstrategies (Chapter 10).The GAP and the International Federation are mindful that member societies are at different stages ofdevelopment in their blood programmes and acknowledges their efforts to date towards meeting theirobligations. This manual is intended to serve as a resource to assist members in achieving a safe andsustainable blood system, maintaining the high standing and trust that the community places in RedCross and Red Crescent societies.72.Overview of National Society involvement in bloodprogrammesThe extent of National Society engagement in blood programmes ranges from non-involvement throughto extensive responsibility for blood collection and supply. Around a quarter of member societies havesome responsibility for blood service delivery in their national blood programmes, while around 63 percent are engaged in either systematic blood donor recruitment activities or advocacy and promotion ofVNRBD. 54F2.1Levels of National Society engagementA. Full Blood Service ProvisionB. Systematic Blood Donor RecruitmentC. Advocacy for VNRBDPromotional campaignsEducation and awarenessInvolvement in WBDDDonor recruitmentPromotional campaignsEducation and awarenessInvolvement in WBDDGovernanceAdvocacy for appropriate useProduct distributionLaboratory testingComponent preparationCollection services/donor careDonor recruitmentPromotional campaignsEducation and awarenessInvolvement in WBDDThe greater the level of engagement and responsibility that National Societies have in relation to bloodprogrammes, the more extensive are their requirements, obligations and level of risk.Most National Societies are best suited to contribute towards predisposing the community to donateblood, such as through education programmes and advocacy campaigns. Feedback from manygovernments also suggests that support for their blood services from a society and its volunteers can beof most assistance in this area. The GAP regards this level of involvement as presenting the lowest riskfor any National Society.National Societies at all levels are not encouraged to expand their existing blood programme activitiesunless they have received a mandate from the appropriate government authority, and have sufficientresources, capacity and expertise to do so. Should National Societies wish to move between levels,undertake more extensive involvement in donor recruitment, or significantly increase or reduce theirinvolvement in Level A activities, it is recommended that advice be sought from the GAP at the outset.Considerations include the capacity of a National Society to undertake additional blood programmeactivities, the provision of sufficient government funding, access to suitable training and personnel, anappropriate governance structure and risk management expertise.To assist National Societies in understanding the extent of their commitment and associatedrequirements, an overview of recommendations for each level of engagement in blood programmeactivities is provided on the following pages for their consideration. A list of the minimal conditionsrecommended for undertaking a National Society blood programme can also be found in the GAP Selfassessment under key issue one. 65F5Global Mapping of Red Cross/Red Crescent involvement in blood programmes 2009/2010 (updated August 2011), GAP,2011; p. 3. For more information contact the GAP secretariat (gapsecretariat@redcrossblood.org.au)6The latest GAP Self-assessment questionnaire is available on the IFRCs internal web site https://fednet.ifrc.org8Level A: Full blood service provisionNational Societies involved in providing blood collection, storage and distribution services require stronggovernance and risk management structures. These societies can reinforce positive attitudes to blooddonation through excellent service, recognition and valuing of the donor gift. Those involved at Level Amust also meet the requirements set out for Level B and C.National Societyblood servicechecklistFundamentals Adherence to IFRC blood policy and the minimal conditions described in theGAP Self-assessment (Level A). The blood service is integrated as part of a national health policy and plan. The blood service operates under a quality assurance programme andadheres to a national regulatory framework or, if necessary, an internationalregulatory framework. For example, the AABBs Standards for Blood Banksand Transfusion Services, or the Council of Europes Guide to the preparation,use and quality assurance of blood components'. The blood service is based upon voluntary, non-remunerated blooddonation. Roles and responsibilities between the blood service, the National Society, thegovernment and other stakeholders are formally documented in a serviceagreement, and are being adhered to. Government protection/indemnity and/or appropriate insurance cover havebeen secured for blood service activities, including clinical advice. (Please referto the GAP Self-assessment for the types of insurance cover required). The blood service has a long-term and sustainable source of revenue. The blood service has sufficient facilities, supplies, equipment and trainedstaff and volunteers to meet operational and regulatory requirements. Training programmes are in place to develop and maintain operational skillsfor all staff. The donor is treated ethically and his or her privacy and confidentiality areassured.Blood programme management There is a separate corporate governance structure for the blood service,including a professional blood service board with the appropriate skills andknowledge to manage corporate governance effectively. There is a well-defined system of delegation that provides clarity on authorityand accountability between the: National Society council and blood service board blood service board and blood service management A policy is in place to ensure there are no conflicts of interest for boardmembers, senior staff and major suppliers. The blood service is under the direction of an appropriately qualifiedprofessional who has authority over the necessary resources. A separate corporate structure for the administration of the blood service hasbeen established. There is a nationwide organizational model for the blood service.9 The blood service has a clear vision and mission, and a strategic plan thatmeets the needs of donors, recipients and clinicians. Performance goals and key performance indicators have been establishedto monitor progress against the strategic plan. Training programmes are in place to develop and maintain management andleadership skills.Financial management The blood service has an independent budget with a service level agreementfor the transfer of funds between the National Society and the blood service.Risk management There is a risk management framework in place to identify, prioritize andmanage risks relevant to the local environment. The framework should includeregular completion of the GAP Self-assessment. Systems are in place to identify emerging threats to the safety of the bloodsupply relevant to the local environment. Mechanisms are in place for supporting recipients of infected blood,including record-keeping policies for potential future claims. If undertaking fractionation, the appropriate risk management measuresdescribed in the GAP Self-assessment are in place.Donor care and counselling The health and well-being of the donor and recipient are paramount. The blood service maintains donor records and a donor register. National donor selection and deferral criteria are defined and a deferralsystem relevant to the local environment has been implemented. A counselling system for donors, especially those that have been deferred, isin place.Blood Safety A national screening strategy is developed and implemented by the bloodservice that: reflects international good practice and takes into account localvariables and national regulations; describes minimal requirements for pre-donation screening (includingdonor eligibility), laboratory testing and product management; ensures 100% of blood donations are tested and only those foundnegative for specified transfusion transmitted infections (TTIs) arereleased; and includes a system to manage the disposal of at risk product inaccordance with national regulations for bio-hazardous wasteQuality assurance The blood service adheres to a national regulatory framework, or there isnational acknowledgement that an international regulatory framework (suchas AABB, Council of Europe) should be applied. The blood service adheres to quality assurance standards and goodmanufacturing practice (GMP) to ensure the quality and safety of blood andblood components in accordance with WHO and international or local regulatoryrequirements.10 Systems of quality assurance, monitoring, evaluation and accountabilityare in place for all aspects of blood service provision, including collection,preparation, testing, storage and distribution. Staff are continually trained in all aspects of quality assurance.Stakeholder partnerships The blood service participates with government in the development of nationalregulatory standards. A system is in place for performing a cost-benefit analysis, with government,on all safety-enhancement proposals. The government is educated on the importance of adequately funding bloodsafety. A national system is established to report Haemovigilance/serious adverseevents to the National Society blood programme where a donor might beimplicated. If there is no national system, hospital-based reporting should beencouraged. There are systems in place to educate the public on the safety of the bloodsupply and the risks of blood transfusion. Clinicians are educated on the appropriate use of blood and bloodcomponents, the risks of blood transfusion and relevant aspects of PatientBlood Management Hospitals are encouraged to develop a system that monitors and works towardsreducing wastage and advocates appropriate blood product use. The blood service has formal agreements with end users (e.g., hospitals) oninventory holdings, ordering and supply systems. Hospitals are encouraged to set up multidisciplinary transfusioncommittees. The blood service has developed a supply plan with stakeholders (includingend users) to ensure that recruitment and collection activities produce sufficientblood and blood components to meet the needs of the health system.Sustainability A clear disaster preparedness and contingency plan is in place. The blood service has an appropriate environmental and hazardous wastemanagement policy.Level of RiskHigh (refer to Chapter 4, Appendix 2, and the GAP Self-assessment Level A).Key Resources forLevelAblood7programmes Promoting Safe and Sustainable Blood Systems Policy (draft). Geneva, IFRC,2011 (see Appendix 1).6F GAP Self-assessment Level A. GAP, current version. WHA 63.12, Availability, safety and quality of blood products. Sixty-Third WorldHealth Assembly, Geneva, 21 May 2010, Geneva, WHO 2010 (also WHA 28.72and WHA 63.12). Aide-Mmoire: Blood Safety. Geneva, WHO, 2002 (attached as Appendix 5)7GAP recommends that National Societies and their blood services keep a copy of all key resources with the GAP manualfor easy reference11 Aide-Mmoire: The Clinical Use of Blood. Geneva, WHO, 2003 (attached asAppendix 6) Aide-Mmoire: Developing a National Blood System, Geneva, WHO, 2011 Aide-Mmoire: Good Policy Process for Blood Safety and Availability. Geneva,WHO, 2008 Aide-Mmoire: Quality Systems for Blood Safety. Geneva, WHO, 2002(attached as Appendix 7) Aide-Mmoire, Safe Blood Components. Geneva, WHO, 2005 (attached asAppendix 8) Aide-Mmoire: Safe health-care waste management. Geneva, WHO, September2000 Blood Cold Chain: Selection and Procurement of Equipment and Accessories.Geneva, WHO, 2002. Costing Blood Transfusion Services. Geneva, WHO, 1998. Manual on the Management, Maintenance and Use of Blood Cold ChainEquipment. Geneva, WHO, 2005 Screening Donated Blood for Transfusion-Transmissible Infections. Geneva,WHO, 2009 Safe management of wastes from healthcare activities. Geneva, WHO, 1999 Code of Ethics for Blood Donation and Transfusion. International Society ofBlood Transfusion (ISBT), General Assembly, 12 July 2000; amended by theISBT General Assembly, 5 September 2006 (attached as Appendix 4). Australian Code of Good Manufacturing Practice for Human Blood and Tissues.Canberra, Therapeutic Goods Administration, 2000 Guide to the Preparation, Use and Quality Assurance of Blood Components.European Directorate for the Quality of Medicine (EDQM), Council of Europe,current edition. Standards for Blood Banks and Transfusion Services. AABB, current edition Making a difference...Recruiting voluntary, non-remunerated blood donors.Toolkit, Geneva, IFRC, 2008 Towards 100 per cent voluntary blood donation: A global framework for action.Geneva, WHO/IFRC, 2010Please note: References relevant to the content in each manual chapter arelisted under the Resources heading found at the end of most sections.12Level B: Systematic recruitment of voluntary blood donorsSome National Societies support their domestic blood programme and blood services by recruitingblood donors and providing access to blood donation centres. These societies act in partnership with ablood service, actively promote non-remunerated donation, and motivate donors through information andrecruitment campaigns. National Societies at Level B need to enter into a dialogue with the bloodservices to which they recruit donors to ensure that the blood service has the appropriate standards indonor care and quality assurance.National SocietyVNRBDRecruitmentprogrammechecklistFundamentals Adherence to the IFRCs blood policy and the minimal conditions described inthe GAP Self-assessment (Level B). Ensuring that the blood service the National Society recruits blood donors tomeets local regulatory requirements and/or WHO and international standardsrecommended for national blood programmes (see Level A information on pages8-11). The blood donor recruitment programme is based on VNRBD. Roles and responsibilities between the National Society and government havebeen clarified and there is a documented service agreement for VNRBDrecruitment activities. A long-term and sustainable source of revenue for the donor recruitmentprogramme has been secured. The donor recruitment programme is evaluated regularly to assess whether a) itis meeting demands or b) it is grossly exceeding requirements. The donor is treated ethically and his or her privacy and confidentiality areassured. The IFRC toolkit Making a differenceRecruiting VNRBD is used.Blood donor recruitment programme management There is a clear vision, mission and strategic plan for the donor recruitmentprogramme. Performance goals and key performance indicators have been established tomonitor progress against the strategic plan. The programme is under the direction of a professional director with authorityover the necessary resources, who is part of the National Societys seniormanagement team. The director organizes, manages, trains, monitors and evaluates the staff,volunteers and procedures involved in blood donor recruitment and retention. Staff are continually trained in all aspects of blood donor recruitment andretention.Donor care and counselling A donor register and records are maintained. The National Societys donor recruitment and deferral practices reflect nationaldonor selection and deferral criteria. Counselling for donors, especially those that have been deferred, is provided by13the National Society or blood service, as appropriate. Good customer service and donor care is the responsibility of all staff members. Staff performance is subject to monitoring and evaluation.Promotion A community education programme develops positive attitudes to VNRBD. Donor populations at low risk of transfusion-transmitted infections (TTIs) aretargeted. The worth of blood donations and blood donors is recognized. The National Society works with clinicians (through education, awareness, etc.)to promote VNRBD.Sustainability There is a risk management framework in place to identify, prioritize andmanage risks relevant to the local environment. A clear disaster preparedness and contingency plan is in place.Level of RiskMedium (refer to Chapter 4, Appendix 2, and the GAP Self-assessment Level B).Key Resources Promoting Safe and Sustainable Blood Systems Policy (draft). Geneva, IFRC,2011 (see Appendix 1). GAP Self-assessment Level B. GAP, current version. Towards 100 per cent voluntary blood donation: A global framework for action.Geneva, WHO and IFRC, 2010. Making a differenceRecruiting voluntary, non-remunerated blood donors.Toolkit, Geneva, IFRC, 2008. Developing a Voluntary Blood Donor Programme for Blood Safety (DONOR).Geneva, WHO and IFRC. Aide-Mmoire: Blood Safety. Geneva, WHO, 2002. Aide-Mmoire: Safe Blood Components. Geneva, WHO, 2005. New blood for the world, DVD and leaflet. Geneva, IFRC, 2009. Proceedings of the international colloquia on the recruitment of VNRBD.Making the most of World Blood Donor Day. WHO/IFRC/FIODS/ISBT,http://www.who.int/worldblooddonorday/resources/making_the_most_of_wbdd.pdfPlease note: References relevant to the content in each manual chapter are listedunder the Resources heading found at the end of most sections.14Level C: Motivation and advocacy for voluntary, non-remuneratedblood donationMany National Societies report they play a significant role in promoting VNRBD for blood programmes intheir countries and in generating positive attitudes to blood donation through volunteer networks,education programmes and advocacy campaigns. These activities predispose a population to donateblood. All National Societies are encouraged to be involved at this level, if practicable and appropriate.National SocietyExpectationsBring to public attention the role of voluntary blood donors in meeting the needs ofthe most vulnerable.Undertake occasional, broad-based community education and awarenessprogrammes.Participate in World Blood Donor Day events (14 June).Level of RiskLow.Basic ChecklistNational Societies involved in the occasional promotion and advocacy of blooddonation should: have a general agreement with national and local government authorities touse World Blood Donor Day, 14 June, as an opportunity to pay tribute tovoluntary blood donors remind its own membership about the need for securing a safe blood supplythrough voluntary and unpaid blood donation have clarified its roles and responsibilities and those of other stakeholders insetting up viable Club 25 Programmes, whereby youth assist by giving blood ona regular basis and also help with peer education in health promotion explore with the government ways to phase out family replacement donationand move towards 100 per cent voluntary blood donationKey Resources Promoting Safe and Sustainable Blood Systems Policy. Geneva, IFRC, draft.(see Appendix 1). GAP Self-assessment Level C. GAP, current version. Making a differenceRecruiting voluntary, non-remunerated blood donors.Toolkit, Geneva, IFRC, 2008. Towards 100 per cent voluntary blood donation: A global framework for action.Geneva, WHO and IFRC, 2010. Developing a Voluntary Blood Donor Programme for Blood Safety (DONOR).Geneva, WHO and IFRC, 2010. New blood for the world, DVD and leaflet. Geneva, IFRC, 2009.Making the most of World Blood Donor Day. WHO/IFRC/FIODS/ISBT,http://www.who.int/worldblooddonorday/resources/making_the_most_of_wbdd.pdfPlease note: References relevant to the content in each manual chapter are listedunder the Resources heading found at the end of most sections.152.2Promoting a safe and sustainable blood systemAll National Societies, irrespective of whether they are directly or indirectly involved in the administrationof their national blood programmes, can contribute towards the development of a safe and sustainablenational blood system. Advocacy and promotion of VNRBD builds the foundations of global blood safety,which ultimately saves lives.National Societies with no formal involvement in blood programmes (Level C) can support the process ofchanging attitudes and beliefs towards blood donation in their countries through advocacy, educationcampaigns and participating in blood donor recognition events, notably World Blood Donor Day on 14June each year. Also, community health programmes supported by the International Federation and itsmember societies, such as strategies to prevent AIDS or hepatitis and to control diseases such asmeasles or cholera, promote healthy lifestyles in local communities and provide the basis for a low-riskblood donor population.Societies involved in blood donor recruitment activities (Level B) can further build participation involuntary blood donation through campaigns and providing access to donation centres. Thoseextensively involved in blood services (Level A) can promote a culture of donation by valuing andrecognizing the commitment of donors, and can encourage regular donation by providing effective,accessible services to donors.Level AFULL BLOOD SERVICE(INCLUDING BLOOD COLLECTION)Reinforcing a culture of donationLevel BSYSTEMATIC RECRUITMENTEnabling voluntary blood donationLevel CMOTIVATION AND ADVOCACYPredisposing the population to voluntary blood donation163.Fundamental PrinciplesThe International Federation expects that National Societies engaging in blood programmes adhere toand promote the Fundamental Principles of humanity, impartiality, neutrality, independence, voluntaryservice, unity and universality. National Societies are also expected to demonstrate and uphold IFRCcore values when engaging with blood service partners and the community. These are:the protection of life, health and human dignityrespect for the human beingnon-discrimination on the basis of nationality, race, gender, religious beliefs, class or politicalopinionsmutual understanding, friendship, cooperation and lasting peace among peopleservice by volunteersThese principles and values are reflected in the following commitments that underpin safe, equitable andsustainable national blood programmes. National Societies should also comply with the InternationalSociety of Blood Transfusion (ISBT) Code of Ethics for Blood Donation and Transfusion (2006), whichhas been adopted by WHO and is included in this manual as appendix four. The Code is available indifferent languages on the ISBT web site (www.isbtweb.org).3.1Promoting voluntary, non-remunerated blood donation (VNRBD)VNRBD has been viewed as critical to the international health effort since the 1975 World HealthAssembly (WHA) resolution 8 called for member states to promote the development of national bloodservices based on voluntary, non-remunerated donation of blood, a principle reasserted by the WHA in2005. 9 Voluntary, non-remunerated blood donors, particularly those who donate blood regularly, providethe foundation for a safe, sustainable blood supply that can meet the needs of all patients requiring bloodtransfusion. The International Red Cross and Red Crescent Movement has been a strong advocate forVNRBD and continues to work towards this objective internationally.7F8FA number of studies have shown that blood derived from altruistic, voluntary donors is safer than thatsourced from paid donors or family replacement donors, with the lowest rates of transfusiontransmissible infection among regular donors. 10 The recognition of donor contribution to the well-being ofothers, rather than payment, supports the integrity of the blood system and maintains human dignity.Sourcing blood from voluntary blood donation will help eliminate paid and family replacement donationand support universal and equitable access to safer blood transfusion.9FA safe and sustainable blood supply is underpinned by programmes aimed at recruiting and retainingvoluntary blood donors from low-risk populations. Many countries have achieved the transition from paidand family replacement donation to VNRBD and, as illustrated overleaf, many others have madesignificant progress towards this objective.8 WHA 28.72, Utilization and supply of human blood and blood products. Twenty-Eighth World Health Assembly, 13-30May 1975. Geneva , WHO, 19759 WHA 58.13, Blood safety: proposal to establish World Blood Donor Day. Fifty-Eighth World Health Assembly, Geneva,WHO, 200510 Towards 100 per cent voluntary blood donation: A global framework for action. Geneva, WHO/IFRC, 2010, p. 18.17Developing (Low HDI) Countries Progression towards VNRBD2003Paid donation, 8%2008VNRBD, 31%Paid donation, 2%Family replacement, 30%VNRBD, 69%Family replacement, 61%Source: World Health Organization Global Data Base, 20093.2Ensuring safety for donors and recipientsThose National Societies involved in blood donor recruitment, collection or service delivery are entrustedby their community and government to act as good stewards of the blood supply and to safeguard itsintegrity. This requires mechanisms for oversight of blood management and processes that ensure highstandards of safety and quality, as will be outlined in subsequent chapters.National Societies have a responsibility to maintain the well-being of both donors and the recipients ofblood products. To meet this obligation, recruitment should focus on attracting low-risk donors, witheffective donor screening and deferral processes. Donor welfare should be supported througharrangements for donor health and counselling. The quality and safety of blood and blood componentsis further ensured by laboratory testing of donated blood, systems to trace and recall potentiallycontaminated blood components; standards for inventory storage, handling and distribution; andguidelines and training for appropriate clinical use.3.3Promoting equity of access to blood and blood productsBlood transfusion is a life-saving function that should be available in a first-referral level of a health carefacility providing comprehensive emergency obstetric and newborn care. 11 Access to safe blood for allpatients reduces morbidity and mortality, supporting the International Federations global agenda goalsand the Millennium Development Goals. The timely availability of safe blood and blood products isessential for blood transfusion in emergency situations, such as from road accidents or haemorrhageduring childbirth. Haemorrhage accounts for over 25 per cent of the 530,000 maternal deaths each year.Almost all of these are in the developing world. Access to safe blood could help prevent up to a quarterof maternal deaths. 12 A large proportion of traffic accident victims need blood transfusion during the first24 hours of treatment. Road accidents are projected to become the third largest contributor to the globalburden of disease. 13 Children under the age of five suffering from life-threatening anaemia, often as aresult of malaria or malnutrition, also require transfusion support. 1410F11F12F13F11Towards 100 per cent voluntary blood donation: A global framework for action. Geneva, WHO/IFRC, 2010, p. 9.Ibid13 Ibid14 Towards 100 per cent voluntary blood donation: A global framework for action. Geneva, WHO/IFRC, 2010, p. 9.1218It is important that all patients have access to life-saving blood on the basis of their clinical need. Insystems supported by an established voluntary donor base, patients generally have improved access tosafe blood transfusion in both routine and emergency situations. Hospitals, patients and patient familiesshould not be placed under pressure to find blood donors. Family replacement donors do not provide forthe communitys blood supply needs and hospitals dependent on such donors usually have insufficientinventory to administer transfusions when needed.It is more appropriate that the community takes ownership for the blood system through voluntary, nondirected donations. With altruistic blood donation, patients experience a sense of being cared for byothers in the community, which can generate a reciprocal spirit of generosity and engagement. AVNRBD system supports equity of access by providing a regular, reliable supply of safe blood.3.4Serving the community and patient interestA strong commitment to humanity is the basis of National Society involvement in blood programmeactivities. Engagement in blood services and promotion of safe blood donation provides tangible andoccasionally life-saving benefits to members of the community.Humanitarian values also motivate individuals to generously and unconditionally donate their blood. Thishumanitarian spirit is core to the International Federations work and is reflected by the many volunteerswho give freely of their time. Societies have an obligation to respect this commitment by recognizing andvaluing the gift of blood donation. For those societies directly involved in blood programme delivery,serving the patient and community interest also requires maintaining the integrity of donated blood byensuring its quality and safety, and striving to make best use of scarce blood to achieve the bestoutcomes for patients.Chapter resourcesA Code of Ethics for Blood Donation and Transfusion. International Society of Blood Transfusion (ISBT),2000, amended 2006.194.Blood programme management4.1Organizational modelsBlood programmes can be national, regional or hospital-based. National Societies can range from beingthe sole provider of the national blood programme to undertaking large or small-scale blood collection ata regional or district level, or providing support to the national blood service through the recruitment ofdonors or the promotion of VNRBD. Regardless of the structure of blood service delivery arrangements,the IFRC and GAP support WHO recommendations that blood service provision be guided by nationalregulations and a national blood policy to promote consistency in practice, accessibility and equity ofaccess. 1514FWHO recommends that a national blood system should be organized and coordinated to ensure themost efficient and cost effective use of all resources 16. A centralized structure supports a safe andsustainable blood supply by improving safety and quality, ensuring a consistent, regular blood supplywhich is less dependent on local contingencies, and providing flexibility when responding to emergencysituations. Centralization of blood processing and testing provides for increased cost-efficiency anduniformity of standards.15FBlood transfusion services should be coordinated at national regional and provincial levels, with criticalactivities such as blood screening and processing consolidated in strategic locations 17. The GAPrecommends that, where possible, National Society blood programmes should function under anationwide operational model 18 in which district and regional services form part of a central blood servicemanaged by a national blood service director. The director should be responsible for ensuring the bloodservice adheres to national standards in quality assurance and good manufacturing practice (GMP) andfor setting internal organizational policies and procedures in line with national regulations.16F17FWhatever model is used, it is important that the blood service has a clear organizational structure, andthat the roles and responsibilities at national, regional and district level (if applicable) are clear, andaccountabilities between the different levels, if any, are clearly defined. Individual Blood TransfusionServices (BTS) should be structured, staffed and managed in accordance with national regulations withsuitable medical, technical and quality processes for the provision of safe blood and blood componentsto patients. BTSs should be accessible and sustainable with:suitable premises that comply with GMPsufficient numbers of appropriately trained staffspecialized equipment for blood collection, processing, testing, storage and transportation and apreventative maintenance systema reliable supply of blood collection bags and reagents 1918FThe GAP can facilitate collaboration with partners such as WHO and government health agencies andprovide guidance to National Societies on which organizational structure may be most appropriate. Thiswould be informed by a situation analysis that looked at the local context, availability of resources, andso on.15Aide-Mmoire: Safe Blood Components. Geneva, WHO, 200516Aide-Mmoire: Developing a National Blood System. Geneva, WHO, 201117Ibid18Key Issue two: GAP Self-assessment Level A. GAP, current version.19 Aide-Mmoire: Safe Blood Components. Geneva, WHO, 200520Resources Aide-Mmoire: Safe Blood Components, Geneva, WHO, 2005 Aide-Mmoire: Developing a National Blood System, Geneva, WHO, 2011 GAP Self-assessment Level A. GAP, current version4.2GovernanceNational Societies are expected to apply principles of good corporate governance in respect of their bloodprogrammes. Blood programme management is complex and requires specialist medical, technical, andfinancial expertise. The GAP recommends that National Societies delivering blood programmes establish aseparate, professional board that comprises members with blood sector, clinical and businessmanagement experience. The separate board should have delegated responsibility to govern the bloodprogramme, including the appointment of the director of the blood programme and authority over dedicatedblood programme resources. There should be clearly defined roles and accountability between the bloodservice director and the blood service board.The chairman of the blood service board and the majority of its members should be independent of theblood service management team. The boards role includes to:ensure the blood service has an effective system of corporate governance and that the board alsooperates in accord with corporate governance standardsestablish the strategic direction and ensure sufficient resources are available for the blood serviceto achieve its strategic objectivesmonitor performance and approve budgets, new business proposals and major items of capitalexpenditureoversee operations and ensure effective managementensure major policies are established with appropriate support systemsensure procedures for risk management, internal control and compliance are adhered toappoint and monitor the performance of the director of the blood programme and developsuccession planningensure that the blood service has appropriate interaction with external stakeholders 2019FThe functions of a blood service board can be supported by the establishment of more specializedoversight committees, such as finance, audit and risk, and clinical governance committees. Eachcommittee should comprise the relevant managers responsible for that function of the blood service andboard members with appropriate experience and technical expertise. 2120FWhile a separate board can provide National Societies with additional expertise with which to manageblood service risks, National Societies may still be exposed to financial and reputational risks. It isimportant that there are clearly defined lines of authority and accountability between the NationalSocietys blood service board and the societys governing council. A National Society might alsoconsider establishing an advisory committee to provide independent advice to the blood service boardon medical, scientific and research matters and to provide assurance to the governing council that highstandards are being maintained.ResourcesGAP Self-assessment Level A. GAP, current version.2021Informed by the official description for an Australian Red Cross blood service board member, November 2008Informed by the Australian Red Cross blood services terms of reference for their advisory committees, 2008-2009.214.3Corporate managementThe GAP recommends that a National Society blood service has a separate corporate structure for theadministration of the blood programme, with an independent budget. The roles and responsibilities ofthe National Society and the blood service should be discussed and clarified, and then documented andrespected. A service level agreement should be in place for the transfer of funds between the NationalSociety and blood service, and measures established so the National Society does not have access tofinancial contributions (unless prior approval from donors has been given) and personal information fromblood donors.A blood service director should be appointed who is well qualified to manage the blood service andaccountable to the National Society, the board and the wider community. The blood service director shouldbe accountable nationally for ensuring that all blood service operations are carried out properly andcompetently, as required by the relevant health acts, regulations and standards. He or she could besupported by a management committee comprising the managers of the various departments includingclinical, donor recruitment, quality, finance, risk and audit, etc.Staff roles and responsibilities should be clearly defined in job descriptions and there should be sufficientstaff to meet regulatory requirements and support the organization and its activities. Blood service staffshould have the appropriate experience and training for their positions. 2221FA clear vision and mission should be in place for the blood service or blood donor recruitmentprogramme and stakeholders should be consulted in the development of a strategic plan. Performancegoals and key performance indicators need to be established to measure progress against the strategicplan, which should be reviewed regularly to ensure that it remains relevant.Resources:GAP Self-assessment Levels A and B. GAP, current versions.4.4Financial managementNational Societies involved in blood programmes at any level should develop and implement a financialmanagement system. It should be appropriately costed, effectively managed, supported by governmentand ensure the ongoing financial sustainability of their blood programme. WHO in its Aide-Mmoire onBlood Safety notes that the responsibility for adequately funding the blood service to ensure a safe andadequate supply of blood rests with the government. 23 It is critical that there should be transparentfinancial arrangements, including a service level agreement for the transfer of funds, between theNational Society and blood service so the government or other funding body is assured that the fundsare being used for relevant blood programme activities.22FThe WHO and IFRC Global Framework 24 provides National Societies operating Level B or C bloodprogrammes (recruitment and motivation only) with information and action points to secure sustainablefinancing for their blood programmes. National Societies operating at Level A may also use this resourceto help in budgeting for their donor recruitment activities.23FOne of the key challenges for National Society blood services is advocacy to funders around the cost of22Aide-Mmoire: Blood Safety. Geneva, WHO, 200223Ibid.Towards 100 per cent voluntary blood donation: A global framework for action. Geneva, WHO/IFRC, 2010, pp. 40-41.2422blood. The time and resources that inform the final cost of blood are often not known or misunderstoodby funders, and therefore they can be unwilling to support fully the seemingly high cost of blood.Therefore, it is very important that National Societies actively engage and advocate with funders on theissue of sustainable blood service funding.National Societies may seek sustainable financing for their blood services either through cost recovery orannual budget allocation. Whatever the method of financing, in order to be sustainable the level offunding must cover capital and recurrent costs 25 and the financial model must allow for potential futureincreases in the cost of blood service delivery (for example, the introduction of new tests, staff increases,building renovations, inflation, devaluation, etc.). The WHO Blood Costing Model is an example of a toolthat can be used by National Societies with full blood programmes for costing their blood services. 2624F25FNational Societies should seek to develop and implement a funding agreement with their government (orother funder) which outlines the financing arrangements for their blood service, including reportingrequirements, and which allows for regular renegotiation of future funding levels should the blood servicecost increase.It is recommended that there should be a dedicated resource person (chief financial officer) for bloodservice financial management who is accountable to the blood programme director. Blood services mayalso wish to establish a finance and audit committee, which may comprise the chief financial officer andsuitably qualified members of the blood service board and also provides for oversight of financialpractice. National Societies should aim to conduct regular audits (either annually or in line withgovernment requirements) to demonstrate transparency to funders and as an opportunity to reviewfinancial practices to identify areas for improvement.Minimum checklist for financial management of blood services: Advocate to potential funders (e.g., government) on the resources required for blood transfusionservices, and the associated costs. Develop a realistic costing of blood service activities the WHO model is recommended. Negotiate an agreement with government for the ongoing provision of blood service financing (costrecovery or budget allocation). Establish a service level agreement for the transfer of funds between the National Society and theblood service, including overhead costs if applicable. Implement an appropriate financial management model, with a focus on transparency andsustainability, in line with any government requirements. Implement regular (at least annually, or as required by government) financial reporting to the funderand other appropriate authorities (e.g., the National Society and the blood service board). Appoint a dedicated financial manager, responsible to the blood service director. Undertake annual budgeting, including a review of blood service costs capital and recurrent. Undertake an annual audit of the financial management systems, including expenditure.ResourcesCosting Blood Transfusion Services. Geneva, WHO, 199825Capital costs are those incurred during start-up, expansion or improvement phases of a blood programme, such as forbuildings, vehicles, equipment, furniture, and also training costs. Recurrent costs include staff remuneration, heating andlighting, insurance, travel, consumables and administration.26 Costing Blood Transfusion Services. Geneva, WHO, 1998234.5Risk managementThere are inherent risks in collecting and supplying blood and blood components. Blood services need toensure the health of donors, to manage the risk of transfusion-transmitted infection and other transfusionrelated complications, to ensure blood and blood components are stored and handled appropriately, andthat they are delivered in time and to order. Communities also expect National Societies to operate withprofessional integrity and to maintain high ethical standards. Appropriately managing risks involved in thedelivery of blood programmes results in improved consequences for donors or recipients, and has apositive impact on the reputation and financial stability of a National Society.A brief list of the main risks facing National Societies involved in blood services (Level A) and VNRBDrecruitment (Level B) can be found in Appendix 2, while a more exhaustive checklist can be found in theGAP Self-assessments. It should be recognized, however, that while compliance with the standardsdescribed in the GAP Self-assessment and this manual will significantly reduce National Societiesexposure to risk, securing government indemnity and/or adequate insurance cover is essential in theeventuality of compensation or other legal claims arising from blood service delivery.GAP recommends that National Societies consult with local legal experts to clarify the risk managementbenefits of securing government assurance for its blood programme activities, particularly against bloodborne disease liabilities, or acquiring appropriate insurance cover as a last resort. Any recommendationsmade as a result of those consultations should be implemented by the National Society as a matter ofpriority.It is important that National Societies establish systems for the identification, prioritization andmanagement of risks that are relevant to the local context. ISO 31000 provides generic principles andguidelines for risk management. These recommend a risk management framework that integrates riskmanagement into the culture of the organization, including governance, planning, decision-making andreporting. A risk management framework promotes understanding of the context in which theorganization operates, sets out a risk management policy and processes to address and manage risk,and assign responsibilities and accountability. There should be consultation with management, staff andexternal stakeholders when identifying actual and potential risks. These risks can then be assessed andplans developed to manage them. Risk management processes and decisions should be welldocumented. As with other quality assurance processes, a National Societys approach to riskmanagement needs to be monitored and reviewed for continuous improvement.To illustrate, a risk framework might begin with workshops attended by board members and seniormanagement to determine the blood services risk tolerance and its key strategic risks. 27 A risk matrixcan then be developed to categorize risks, and criteria agreed for which type of risk would need to beescalated for the attention of senior management and the board. Strategic risks are passed on to theappropriate operational areas, which are responsible for ensuring actions are in place to manage eachrisk. The risks are then prioritized and recorded on an organizational risk register, which is monitoredaccording to agreed risk and control indicators. High-risk actions would be included in business planningprocesses and progress against actions regularly monitored.26FThe GAP provides information and advice to National Societies on appropriate risk managementstructures and processes. The GAP Self-assessment questionnaire includes a checklist to guideNational Societies in understanding their exposure to potential risks and to signal areas requiringattention. It enables National Societies to ascertain:27This example is informed by the Australian Red Cross Blood Services risk management framework.24their own performance against international benchmarkswhere they are performing well and where improvements can be madewhether it is appropriate they continue their involvement in blood service activities (see Chapter10)National Societies engagement should in general be aimed for long-term provision and support. Anyconsiderations to reduce the National Societies level of involvement in blood activities should clearlyfollow the recommendations detailed in Chapter 10 (transition and exit strategies). GAP Selfassessments are available for National Societies involved at all levels of blood programme activity.Participating Level A blood services receive an individual feedback report from the GAP that analysestheir Self-assessment results and provides them with specific risk management recommendations.Depending upon the number of Self-assessments received by the GAP, blood services may receive anadditional report comparing their Self-assessment results with those of other Level A blood services intheir region. Level B National Societies may complete the Self-assessment and receive a feedbackreport upon request, according to the GAPs capacity.It should be noted that only the National Society that completed the Self-assessment is identified in itsindividual report - the anonymity of other participating National Societies is maintained to encourageaccurate self-reporting.The GAP endeavours to respond to the many requests for corporate governance and risk managementassistance received from National Society blood services. However, specific technical support can onlybe offered to two or three societies a year. Those seeking assistance should first contact the GAPsecretariat to discuss what assistance is required before submitting a written request from their secretarygeneral to the GAP chair.Resources GAP Self-assessment, Level A, B and C. GAP, current version International Standard ISO 31000 Risk Management Principles and Guidelines. InternationalOrganization for Standardisation (ISO), 2009. Available from the ISO web site, www.iso.org Aide-Mmoire: Good Policy Process for Blood Safety and Availability. Geneva, WHO, 20084.6Balanced decision-makingThere is a public expectation that blood services not only respond to established risks to blood safety butalso anticipate potential or emerging risks and act accordingly. Under the precautionary principle, wherethere is reason to believe that a potential threat to public health may occur, preventative action should beundertaken and not delayed until definitive evidence is available.Balanced decision-making encompasses both evidence-based and precautionary approaches to guideinvestment and safety decisions. This is supported by engagement with blood sector decision-makers,regulators and the community to ascertain blood-related risks and inform decisions on investmenttowards safety, taking into account all relevant scientific, financial and social considerations and ensuringthat a balance is maintained between safety and cost. Increased blood safety should be weighed upagainst any potential costs, for example a decrease in the availability of blood or blood products.Resources GAP Self-assessments Level A, B and C. GAP, current versions Aide-Mmoire: Good Policy Process for Blood Safety and Availability. Geneva, WHO, 2008255.Building a sustainable donor baseThe capacity of a blood programme to provide sufficient blood and blood products is ultimatelydetermined by the availability and commitment of healthy, regular VNRBD donors and the appropriateuse of blood and blood products by the clinical community. In building a sustainable donor base, bloodservices need to establish a positive, long-term relationship with donors that recognizes theircommitment, promotes good donor health, fosters repeat donation and encourages referrals ofcolleagues, family and friends.5.1Voluntary, non-remunerated blood collectionVoluntary, non-remunerated donors who regularly give blood are the foundation of a safe and adequateblood supply. Blood collection with well-selected voluntary donors from low-risk populations provides thefirst line of defense in minimizing the risk of transfusion-transmitted infection. 2827FThe International Federation shares the belief of WHO that it is morally unacceptable for health care tobe based on the purchase of body parts, including blood. Blood services have an obligation to safeguardthe health of donors and no coercion should be brought to bear upon an individual to donate. 29 Peoplewho give blood for monetary reward or in response to pressure from others may conceal information thatwould otherwise cause them to be deferred, either temporarily or permanently. For people in thesecircumstances, donation may not only be potentially harmful to a recipient, it may also have negativehealth consequences for the donors themselves.28FA system of voluntary, non-remunerated blood donation can reduce the risk of patient exposure tocontaminated blood and blood products. Non-paid blood donors invariably have a lower prevalence oftransfusion-transmissible infection than paid donors because they have no reason to withhold anyinformation about their health status that may make them unacceptable as donors.The International Federation is working in partnership with WHO to promote a global framework foraction in achieving VNRBD blood programmes internationally. 30 The global framework outlinesstrategies for progressing towards this goal in each of the areas illustrated in the figure below.29FGoal AGoal BCreate an enablingenvironment for100% VNRBDFoster a culture ofvoluntary donationGoal CGoal DBuild and maintain asafe, sustainablevoluntary donor baseProvide quality donorservice and care28Screening Donated Blood for Transfusion-Transmissible Infections. Geneva. WHO, 2009, p. 6.29Towards 100 per cent voluntary blood donation: A global framework for action. Geneva, WHO/IFRC, 2010, p. 14.30Ibid.265.2Attracting and retaining donorsTo provide for even the most basic blood supply requirements a country needs at least 1 per cent of thepopulation to donate, with requirements in most countries far exceeding this. 31 WHO asserts that regulardonation by suitable donors requires effective donor recruitment, call-up and retention strategies. This issupported by national donor selection and deferral criteria that factor in the maintenance of donor health,and blood collection targets informed by clinical demand. 3230F31FBlood services are encouraged to appoint an officer responsible for the national blood donor programmeto lead a group trained in relevant aspects of donor education, motivation, recruitment and retention. Aregister of VNBRD donors should be established and efforts made to identify and attract donorpopulations with low risk of transfusion-transmitted infection. It is also appropriate to monitor transfusiontransmitted infection in the donor population. 3332FThe IFRC toolkit Making a differenceRecruiting voluntary, non-remunerated blood donors presentspractical international examples to inform all aspects of blood donor recruitment. The toolkit coversplanning and implementation of education and social marketing programmes, recruiting and retainingtarget groups, engaging young people, approaches to quality service provision, and national and globalpartnerships in support of donor recruitment.Resources Making a differenceRecruiting voluntary, non-remunerated blood donors. Toolkit, Geneva, IFRC,2008 Towards 100 per cent voluntary blood donation: A global framework for action. Geneva,WHO/IFRC, 2010 Aide-Mmoire: Safe Blood Components. Geneva, WHO, 2005 Aide-Mmoire: Blood Safety. Geneva, WHO, 20025.3Long-term donor commitmentRepeat donors are generally safer than new donors because they are better informed about theimportance of low-risk behaviour and understand the need for self-deferral should their donationpotentially be harmful to a recipient. Testing for transfusion transmissible infections like HIV, HCV andHBV of repeat donors at each donation additionally decreases the risk for recipients of bloodcomponents. It is also more cost-effective to retain existing or former donors than to recruit first-timedonors. The retention of existing donors is therefore crucial to achieving an adequate, safe andsustainable blood supply.Quality management starts with blood donor recruitment and donor care. This includes valuing andcaring for donors and considering how their needs can better be met. Opening times and locations ofdonor centres and mobile sites should be convenient for donors while ensuring that adequate staffing isavailable. Surveys of donors can provide feedback on convenience and customer service. Bloodservices should also have a mechanism to receive and address customer complaints.A customer service ethos should be reflected in: the mission statement of the blood service job descriptions of every employee31Towards 100 per cent voluntary blood donation: A global framework for action. Geneva, WHO/IFRC, 2010, p. 10.32Aide-Mmoire: Safe Blood Components. Geneva, WHO, 2005Aide-Mmoire: Blood Safety. Geneva, WHO, 20023327an effective quality system, including standard operating procedures for each processstanding agenda items for staff meetingssystematic monitoring and evaluationsacknowledgement and rewards for staff that provide the best customer servicecommunication with the publicThe higher the quality of interaction between a blood service and its donors, the more likely it is tosucceed. Expectations of customer service need to be clearly communicated to staff and volunteers.Staff motivation is a primary factor in the provision of excellent service to donors. A good workingenvironment, job security, opportunities for promotion, regular training and appropriate remuneration allcontribute to job satisfaction, which will support positive attitudes towards customer service.5.4Donor health and counsellingBlood services should have in place a counselling and support system for their donors. Counselling ofdonors includes the provision of information before an individual registers to donate, a donor interviewbefore donation, making available blood collection and testing information during blood donation, andproviding post-donation information, counselling and referral when appropriate. 3433FCounselling is particularly important when a donor is found to be ineligible to donate because of atemporary deferral, as this can affect a donors morale and potentially discourage future donation.Particular care must be taken in post-donation counselling of donors whose screening tests areconfirmed positive for a transfusion-transmitted infection or where they have been implicated in atransfusion reaction. Temporary and permanently deferred donors require professional and sympatheticattention from an appropriately trained staff member. The health needs of a deferred donor should beaddressed through referral to a medical practitioner or a counselling service.Integral to the trust relationship between blood services and donors is an understanding that the resultsof blood tests and any information they divulge will be regarded as strictly confidential. Donor interviewsshould be conducted in an environment in which the conversation cannot be overheard. Donor recordsneed to be kept secure. This confidentiality is critical so that donors are truthful about their health statusor recent behaviours that might contribute to an increased risk to blood safety, and so deferred donorsare not subjected to victimization from their community.Minimum checklist for blood donor counselling: 3534F Provide counselling to individuals who are temporarily or permanently deferred from blood donationunder national donor selection criteria. Provide oral or simple written pre-donation information that educates donors about donor selection,testing, deferral/referral and self-deferral. Give as a first step with the medical questionnaire.o Give donors that have medical conditions information on healthy lifestyles and/or encouragethem to see their doctors.o Ensure donors are given a forward appointment at the end of the deferral period to motivate theirreturn. Provide pre-donation counselling just before blood donation. Blood service staff should conduct aconfidential interview with the donor to ensure they have and understand the pre-donationinformation, go over the medical questionnaire, allow the donor to ask questions and secure theirinformed consent to donate. Measure blood donors blood pressure and haemoglobin.3435Implementation Guidelines on Donor Counselling. Geneva, WHO-CDC-IFRC, 2012Ibid.28o Advise donors deferred for low haemoglobin how to improve their haemoglobin levels.o Refer donors deferred for anaemia for medical treatment and review their donation frequency.o Encourage donors that have been permanently deferred to advocate VNRBD to others. Provide the donor with information on the type of screening tests conducted during the blooddonation and the fate of components should any of the tests show abnormal results. Offer post-donation counselling to all donors that return positive results. Counselling should:o be handled tactfully, with understanding and empathyo be conducted as soon as results are availableo be conducted one-on-one by a trained and knowledgeable staff membero be held in privacy and the donor assured that his or her information will be kept confidentialo discuss the test results and the implications for the donors healtho be conducted at a reasonable and understandable pace and offer the donor the opportunity toask questions and clarify doubts and concernso explore risk behaviour and reinforce cessation/prevention of unsafe behaviour refer the donor toan appropriate medical specialist for further management, care and treatmento advise the donor to inform contacts that might be at risk of infection so they can be tested andtreatedo be used to identify any weaknesses in the pre-donation screening process i.e. the donorquestionnaire and interviewResources Implementation Guidelines on Donor Counselling. Geneva, WHO-CDC-IFRC, 2012 Screening Donated Blood for Transfusion-Transmissible Infections. Geneva, WHO, 2009 (Section6.3)296.Blood SafetyThis section discusses the principles and requirements for screening of donated blood to ensure thesafety of the blood supply. Transfusion of an incompatible blood product or a blood product carryingtransfusion-transmissible infections (TTIs) has the potential for significant harm to the recipient, and alsoprovides significant reputational and financial risk to the National Society providing the blood service.National Societies should implement rigorous donor and donation screening strategies into bloodprogrammes to minimize these risks.A primary aim of blood safety screening is to safeguard recipients of blood and blood components fromthe risk of TTI. Effective blood safety screening strategies target the identification and exclusion of riskfrom the blood supply through screening of both the donor and the donation. Blood safety screeningbegins with the recruitment of voluntary, non-remunerated blood donors from low risk populations, andcontinues with the pre-donation assessment of prospective donors against established selection criteria.Provision for the voluntary and confidential self exclusion of blood donors either at the time ofassessment or post donation is an important safeguard to exclude donations with a previously undisclosed risk factor. Finally donated blood is laboratory tested for markers of transfusion-transmissibleinfections prior to release.Blood Safety strategies should also target the processes and tests that safeguard recipients from the riskof transfusion with incompatible blood. Appropriate strategies include testing of all blood donations forspecified blood groups and screening for the presence of antibodies, prior to their release. Furtherlaboratory testing with the intended recipient is conducted pre-transfusion to confirm the appropriatenessof the selected donor unit for transfusion, and exclude incompatibility between the intended recipient anddonor blood.6.1Strategy developmentTo ensure the provision of safe blood to the community, an overall blood safety screening strategy tomanage blood safety and specifically reduce the risk of TTIs must be developed and implemented. Thestrategy should: Be nationally consistent and described in national policy and regulations Reflect international good practice (WHO, Council of Europe, AABB etc) and take into accountlocal variables Ensure the ethical assessment and management of blood donors including appropriate donorcounseling (in accordance with WHO recommendations) Identify the mandatory screening requirements for blood donations and any additional or selectivescreening requirements. Prescribe the universal screening of all donations for TTIs. Be based on appropriate risk assessment and analysis. The risk assessment must consider thegeographic epidemiology, incidence and prevalence of blood borne infection in the country and theresidual risk estimates for the local donor population. Be reviewed periodically. Changes in the epidemiology of current TTIs and the potential foremergence of new TTIs may require the strategy to be updated to ensure its ongoing effectivenessand appropriateness. Clearly define the responsibilities for pre-transfusion compatibility testing (hospital or bloodservice).30Resources Screening Donated Blood for Transfusion-Transmissible Infections. Geneva WHO, 2009 Aide-Mmoire: Blood Safety. Geneva, WHO, 2002 Aide-Mmoire: Safe Blood Components. Geneva, WHO, 20056.2Programme implementationThe effectiveness of the screening strategy depends upon the consistent implementation of all aspectsof the strategy into blood programmes at the local level. During the implementation process NationalSocieties must ensure that:All prospective donors, including repeat donors, complete a pre-donation assessment100% of blood donations are screened and only those found negative for TTIs are releasedblood screening programmes are operated within the context of a well supported and wellmanaged quality systemthe screening programme incorporates all blood screening requirements specified in countryspecific regulations/standards (where these exist) or other internationally recognized regulations/standards, and must also address the minimum screening requirements outlined in 6.2.1.where pre-transfusion compatibility testing occurs outside of the National Society, actively promotethe use of relevant testing standards to ensure the blood safety pre-transfusion testing isconducted appropriately.ResourcesThe resources listed below apply to all the remaining sections of this chapter (6.2.1-6.2.7). Additionalresources are listed at the end of each section, where applicable. Screening Donated Blood for Transfusion-Transmissible Infections. Geneva, WHO, 2009 Guide to the Preparation, Use and Quality Assurance of Blood Components. European Directoratefor the Quality of Medicine (EDQM), Council of Europe, current edition. Standards for Blood Banks and Transfusion Services. AABB, current edition Australian Code of Good Manufacturing Practice for Human Blood and Tissues. Canberra,Therapeutic Goods Administration, 2000 Aide-Mmoire: Blood Safety. Geneva, WHO, 2002 Aide-Mmoire: Safe Blood Components. Geneva, WHO, 2005 Aide-Mmoire: Quality Systems for Blood Safety. Geneva, WHO, 20026.2.1 Minimum screening requirementsa.) Pre-donation screening Donor AssessmentAll prospective blood donors must undergo a pre-donation assessment including completion of a donorquestionnaire, confidential interview and medical assessment against established donor selectioncriteria. If not already in place, national standardised selection and deferral criteria should be developedthat reflect international best practice (e.g. Council of Europe, AABB guidelines) as well as national andlocal epidemiological data on infectious diseases, prevalent risk behaviours and other local variables 36.35FThe donor questionnaire must be designed to obtain the donors medical and travel history, and anybehaviours that may result in increased risk to blood safety. The donor selection criteria must bedesigned specifically to identify and manage donors with risk factors that could indicate infection with atransfusion transmissible agent. Donors unable to fulfill the donor selection criteria must be excludedfrom blood donation via permanent or temporary deferral and appropriately counselled.36Towards 100 per cent voluntary blood donation: A global framework for action. Geneva, WHO/IFRC, 2010; P10231b.) Laboratory screening of blood donationsTesting for markers of transfusion-transmissible infections:The blood screening programme must ensure that 100% of blood donations are screened by appropriatelaboratory screening test systems for at least one marker for each of the following TTIs: HIVHIV-1 and HIV-2 Antibody or combination antigen-antibody assay (test) HCVHCV antibody or combination HCV Antigen-antibody assay HBVHepatitis B surface antigen (HBsAg) Syphilis Screening for specific antibodies to tremonema pallidumTesting for blood group and antibody screeningEvery blood donation must be typed for ABO and Rh(D) blood groups.All first time donors must be tested for clinically significant irregular red cell antibodies.The ABO and Rh(D) typing result on each donation must be verified with the historicallydetermined blood type for repeat donors. For first time donors, the ABO and Rh(D) typing must bebased on two independent ABO and Rh(D) tests.Pre-transfusion compatibility testing with intended recipient (this testing may occur outside theblood service in hospital transfusion laboratories)ABO and Rh(D) typing of both the donation and recipient red cells.Recipient serum or plasma tested for irregular antibodies.Compatibility testing of donation red cells and recipient plasma for all cases with irregular red cellantibodies.6.2.2 Additional screening test requirementsAll National Society blood services should adhere to the minimum screening requirements listed insection 6.2.1 however additional screening tests may also be applied depending on local risk profilesand blood safety management strategies (or donor selection guidelines). Consideration should be givento extending the screening programme beyond the minimum requirements for TTIs based on the localincidence and prevalence of blood borne disease in the country and the associated risk of theseinfections to the blood supply.In some countries, additional screening for Trypanosoma cruzii [Chagas disease], West Nile virus,HTLVI/II and malaria may be considered. For example, in malaria endemic areas, it would beappropriate to consider the implementation of malaria-specific donor selection and deferral guidelinesaimed at identifying donors at least risk of malaria infection, in addition to the implementation oflaboratory screening of donations for parasitaemia.The practice of additional pre-donation testing of prospective blood donors for TTIs should be consideredcarefully as pre-donation testing is generally not cost-effective (except in some countries where theprevalence of TTIs is extremely high), and the associated inconvenience to the donor and increased riskof stigmatization may undermine the development of a base of regular VNRBD donors, all of which canadversely affect the sustainability of the blood programme 37. Post donation screening (as per theminimum screening requirements) is essential to allow release labeling of the final product.36F37Screening donated blood for transfusion transmissible infections. Geneva, WHO, 2009, section 5.8326.2.3 Testing algorithmsNational testing algorithms should be developed to describe the specific process of testing and resultmanagement for each individual TTI. These algorithms ensure consistency in blood screening and resultinterpretation by describing:the precise sequence of testing (i.e. initial screening, repeat testing, and any additionalsupplemental or confirmatory testing) the resulting component fate depending on the test result outcomeThey should also describe actions to be undertaken regarding donor management (i.e. donor deferral,notification, counseling and, where applicable re-instatement testing), again to ensure consistency ofapplication.6.2.4 Test systemsThere are a number of considerations that should be taken into account when selecting a test system forblood screening including effectiveness, cost, availability and ease of use. Assays selected must bedesigned specifically for blood donor screening, and must have both high sensitivity and specificity.Screening assays must be adequately validated prior to use to ensure that the test system consistentlyperforms as intended in the local environment where it will be used, and systems must be used inaccordance with the manufacturers instructions.The use of rapid/simple assays is not recommended for large scale blood screening as they aredesigned for the immediate and rapid testing of small numbers of samples, mainly for diagnosticpurposes, and in general have inferior sensitivity compared to assays optimised for blood screening.Apart from the technical assay specifications (including rates of biological false positives and period ofdetection), other factors such as availability of ongoing supply of associated test kits/reagents, as well ascomplexity and the level of operator expertise required to use the system should also be considered.Regardless of the type of screening test system selected, having an adequate number of suitably trainedoperators with the appropriate level of technical expertise to perform the required testing and resultinterpretation in accordance with the national testing algorithms and procedural instructions is essential.6.2.5 Quality systemThe blood screening programme must be supported by, and operated within a well managed qualitysystem. Quality system oversight of the screening programme provides assurance that the bloodscreening processes are implemented as intended and are regularly monitored for their effectiveness.Quality assurance in blood screening processes should include:the implementation of good laboratory practice,the appropriate use of internal quality control processes in addition to the use of external orreference controls for the purpose of monitoring testing performance (eg from national referencelaboratories),the participation in independent quality assurance panels.Quality systems are discussed in further detail in section 6.336.2.6 Result, donor and product managementOnly blood donations that have been screened and found negative for TTIs are suitable for release forsupply and ultimately transfusion. The blood service must implement systems of quarantine andsegregation to ensure that components/donations cannot be released until the full complement ofscreening tests have confirmed that the unit is negative for known TTIs and the required testing for bloodgrouping and antibody screening is complete.Blood donations found to be reactive or indeterminate as a result of the screening test should beconsidered to be infectious and immediately quarantined, to prevent accidental release. Quarantinedblood donations must be easily identifiable, be physically segregated from the blood inventory, andshould wherever possible be safely discarded without delay. Disposal of quarantined units must be inaccordance with national regulations for bio-hazardous waste and should reflect the WHOrecommendations on healthcare waste management 38.37FStaff should be safeguarded from risk from handling potentially infectious blood through theestablishment of appropriate training in universal/standard precautions and the implementation of GoodLaboratory Practices.Screening test results must remain confidential and the blood service should have systems in place toensure that access to this information is highly restricted. Only nominated individuals within the bloodservice should be permitted access to the donor screening records.Processes for ethical donor management should be established including donor confirmatory testing andcounseling and, where appropriate, processes for undertaking lookback (i.e. tracing/testing recipients ofblood components from donors with TTI positive results).Additional resources Safe management of wastes from healthcare activities. Geneva, WHO, 1999 Aide-Memoire: Safe health-care waste management. Geneva, WHO, 20006.2.7 Emergency provision of bloodThe blood screening strategy should include provision for the emergency release of blood under reducedscreening arrangements in response to specific defined emergency conditions. The types of emergencyconditions should be agreed in consultation with relevant regulatory authorities, governments andstakeholders, and be based on appropriate risk assessment where failure to provide blood would resultin greater adverse health outcomes than the risk of issuing partially, or in extreme circumstances, whollyunscreened blood. In such circumstances, the use of rapid test systems and individual labelingspecifying the limitations of testing may be appropriate. Blood samples of any units issued under theemergency provisions must be tested as soon as possible by appropriate blood screening tests, and theresults communicated to the recipients treating physician.38Safe management of wastes from healthcare activities. Geneva, WHO, 1999347.Quality managementNational Societies engaged in the provision of blood services should have a quality managementframework in place which ensures that the blood and blood components produced are fit and safe forclinical use.An effective quality management framework ensures that a blood service produces blood and bloodcomponents that are safe and clinically effective in a way that does not cause harm to patients, donorsor staff. The framework should meet regulatory and legal requirements and allow opportunities forimprovement in quality and safety to be identified.There are three essential aspects that must be considered by a blood service when implementing aquality management framework:the quality systemgood manufacturing practicestandards7.1The quality systemWHO recommends that a quality system should cover all aspects of blood service activities and ensuretraceability, from donor recruitment through to the transfusion of blood and blood components topatients, and should take into account the structure, needs and capabilities of the blood service. 39 Itshould be guided by a quality policy (preferably national) and operate under the direction of a nationalmanager.38FAn effective system should ensure that policies and procedures are in place to define and control allactivities that have the potential to affect the quality of blood components and the safety of donors, staffand patients. For each activity, procedures should be in place covering:establishment of specificationsmanagement of resourcesmonitoring and analysis of activities against specifications to confirm quality and identifyimprovementsidentifying and resolving situations where the required standards are not metmanagement responsibility for reviewing the effectiveness of the quality system and drivingcontinuous improvementThe quality policy and procedures should form the basis of a manual which sets out the system structureand clear accountability. The manual should be read and understood by all staff.There are a number of resources that are available to guide National Societies in the implementation of aquality system, including the International Organization for Standardizations ISO 9001 Standard which isgeneric to all industries. The AABB, the Council of Europe, and the Australian Therapeutic GoodsAdministration (TGA) have regulatory frameworks for blood services. It is important that a NationalSociety, if it does not have local regulatory requirements in place or they are not up to internationalstandards, selects and adopts one of these international standards for its blood service.39Aide-Mmoire: Quality Systems for Blood Safety. Geneva, WHO, 200235Resources Aide-Mmoire: Quality Systems for Blood Safety., Geneva, WHO, July 2002 Aide-Mmoire: Safe Blood Components. Geneva, WHO, 2005 ISO 9001 Quality Management Systems Requirements. ISO, 2008. Available from the ISO website, www.iso.org Guide to the Preparation, Use and Quality Assurance of Blood Components. European Directoratefor the Quality of Medicine (EDQM), Council of Europe, current edition. Standards for Blood Banks and Transfusion Services. AABB, current edition Australian Code of Good Manufacturing Practice for Human Blood and Tissues. Canberra,Therapeutic Goods Administration, 20007.2Good manufacturing practice (GMP)The blood service quality system should be based on good manufacturing practice (GMP). Thisincorporates all activities performed by the blood service that ensure a finished component or deliveredservice consistently meets the required specifications.GMP requirements are usually set out in Codes ofGMP that are developed by blood services in conjunction with regulatory or government authorities orare adopted from any existing documents. With respect to blood service-related activities, Codes ofGMP include a very strong emphasis on checking and controlling all steps of manufacturing and controlto show that the component or service is suitable for its intended use i.e., fit for purpose and that thiscan be repeated. Principles of GMP should apply to the whole manufacturing process, from donorselection to release of blood components for use. Key requirements include: Implementation (or introduction) of a quality system: Quality system structures and proceduresshould be in place and a quality manager who is independent of the manufacturing process shouldbe appointed. Monitoring the effectiveness of the quality system: An internal audit programme should be inplace to review existing activities regularly and a system be set up to identify, report, monitor andanalyse incidents when errors occur or the final component or service is not fit for use (i.e., acontinuous improvement system to monitor non-conforming components and services). Management review: The staff within the senior management level should regularly review theresults of activity monitoring such as internal audits, corrective actions, non-conformances andcustomer complaints or adverse event reports to identify improvement opportunities. Staff training and performance: Staff should be trained in and be able to follow the quality systemrequirements and GMP principles applicable to their role, and their work performance evaluatedregularly. This should be documented and the records should be made available to staff and foraudit or monitoring purposes. Lines of accountability should be clearly documented and understoodby all staff, including senior management. Suitable premises: Buildings should be suitable for the activities performed by the blood service.All areas, especially those used for production and manufacturing, should be constructed andorganized in a way that reduces errors and allows for easy cleaning. The working environment (e.g.,air temperature, humidity, etc.) should be appropriate for the activities and, where critical, should bemonitored and alarmed. Equipment suitable for intended use: Equipment important (or critical) to any blood serviceactivity, from recruitment through to distribution, should be fit for its purpose and validated (i.e.,tested to make sure it performs as expected) before use. A regular maintenance programme shouldbe in place, including testing of equipment performance against known standards (calibration),especially for refrigeration and bar code equipment. Document control: There should be a system for controlling the content of documents (a documentcontrol system) to ensure that instructional documents, such as standard operating procedures, arealways current. The system should make sure there is a regular review and update of the36documents and that obsolete documents are removed from use. A copy should be kept for archivingpurposes.Record management: The blood service should establish specifications for the storage, retention,archiving and disposal or destruction of any records holding information on the blood servicesmanufacturing activities, including determining which records to keep. The retention period shouldbe based on regulatory or legislative requirements.Control of materials: Materials used in the manufacturing chain should be purchased from reliablesuppliers wherever possible and assessed against specifications for their performance and qualityprior to release for use. Critical materials should be traceable to components in the event of a recalldue to defective material. Suppliers of critical materials should be audited regularly to ensurecompliance with quality requirements.Donor recruitment, selection, collection and testing: Donors should be assessed for suitabilityaccording to defined donor selection criteria that are appropriate for the local environment andensure the safety of the donor, the staff and the patient or recipient. Records should exist todemonstrate full traceability of the steps taken from donor to component, and each donation shouldbe screened for infectious agents. The donor selection criteria and testing/screening requirementsare stipulated in the standards adopted by the blood service.Quality control monitoring and process control: Procedures should be established to ensurethat all activities, processes, materials, equipment, etc. are tested or validated before beingimplemented for use. Blood components should be regularly monitored by a quality control testingprogramme and the results checked against the agreed specifications of the quality system. Anychanges to established systems should be managed via a change control process that includesany re-validation or re-testing that needs to occur before the change is implemented. The status ofmaterials, equipment and blood components should be clearly demonstrated by status labelling orphysical location where status could mean fit for use, in quarantine, not tested, failed test results,under-validation, etc. Where possible, physical segregation is best and any non-conformingmaterial or blood components that have not been assessed as fit for use should be securelysegregated. There should be documented procedures for the release of blood components by anauthorized person where the component has been assessed as fit for use and rapid recall ofreleased components if required.Storage and Transport: Materials and blood components should be stored and transported inequipment or facilities that maintain the required storage conditions (temperature, etc.). Thereshould be clear differentiation between in process/unfinished/quarantined/non-conformingcomponents and finished fit for use components. Transport containers should be validated for thecomponent type, the temperature at which they are to be transported, and the distance or time oftransport. Where possible, the transport should also be monitored, using a data logger.Computer systems: Computer systems, where used in the blood service operations, should bevalidated to demonstrate that they perform as required. Strict data control should be applied tocomputer records.Contracted suppliers: Where services are sub-contracted, there is a responsibility to ensure thatthe sub-contractor follows all the relevant standards that apply to the blood service and providesservices as detailed in a contract.The World Health Organization has established GMP guidelines and provides training workshops andseminars on the assessment of compliance with GMP at manufacturing sites, details of which can beprovided by local or regional WHO offices.37Resources: As per Section 7.1, plus: WHO Guide to Good Manufacturing Practice (GMP) Requirements. Geneva, WHO, 1997 Quality Assurance of Pharmaceuticals: A Compendium of Guidelines and Related Materials,Volume 2, Good Manufacturing Practices and Inspection. Geneva, WHO, 2007 Blood Cold Chain: Selection and Procurement of Equipment and Accessories. Geneva, WHO,2002 Manual on the Management, Maintenance and Use of Blood Cold Chain Equipment. Geneva,WHO, 2005 Safe Blood and Blood Products Distance Learning Material. Geneva, WHO, 2002 Principles of Good Manufacturing Practice in Respect of Medicinal Products for Human Use andInvestigational Medicinal Products for Human Use. European Commission Directive 2003/94/EC7.3StandardsWhile the adoption of GMP can provide confidence that a blood services blood components will meetspecifications, Codes of GMP generally do not set out the required specifications for those components.These are contained in Standards.Standards detail the minimum acceptable specifications or criteria for the most important (or critical)steps in the blood services activities, and for the services and finished blood components provided bythe blood service. Standards can either be used as guidelines for practice, or set as minimum regulatoryrequirements that must be met depending on the regulatory and legislative requirements of the country.Standards are often seen as the minimum requirement and a blood service may chose to exceed themin practice.Appropriate Standards for blood and blood components should be selected by the National Society, theregulator or government authority, or both in consultation, and may include the selection of an existingIndustry Standard such as the AABB Standards for Blood Banks and Transfusion Services or Council ofEurope Guide to the preparation, use and quality assurance of blood components, or the development ofa set of locally specific Standards.Resources: As per Section 6.2, plus:Screening Donated Blood for Transfusion-Transmissible Infections. Geneva, WHO, 20097.4AuditingAn internal audit programme should be established to review periodically the operation and effectivenessof the quality system. The audit programme should ensure that all activities and manufacturing steps arecovered, and that the level of compliance with internal and regulatory requirements is assessed. Internalaudits also provide opportunities to identify areas that need improvement. External audits may also beconducted by a regulatory agency or a third party.There should be a procedure that describes the frequency and the requirements for conducting internalaudits, including time frames for reporting and responding to audits. The scope of each audit should beclearly defined and the audit conducted by a trained auditor who is independent of the activity beingaudited. Corrective action taken in response to audit outcomes should be reviewed and verified beforeclosing out the audit.Audit outcomes should be regularly reviewed as part of management review.Resources: ISO 19011: Guidelines for quality and/or environmental management systems auditing. ISO, 2002.Available from the ISO web site, www.iso.org388.PartnershipsFostering global partnerships and collaboration is a United Nations Millennium Development Goal.There are limits to the capacity of individual organizations to generate a culture of voluntary donation andbuild sustainable blood systems. Achieving a safe and sustainable blood system requires thecooperation and assistance of government, as well as communication and engagement with other bloodservices and National Societies.8.1GovernmentAs blood transfusion services are an essential part of modern health care provision, governments have astrong interest in maintaining a healthy, sustainable, self-sufficient national blood programme. WHOrecognizes that it is ultimately the responsibility of the Ministries of Health to ensure a safe and sufficientsupply of blood and blood products and their safe and rational use. Even if this responsibility has beendelegated to a nongovernmental blood service organization, governments should provide effectiveleadership and governance and sufficient resources to establish and maintain a sustainable nationalblood system 40. This should include:39F providing adequate financial resources with which to develop and maintain a viable bloodprogramme formalising government support and commitment to the blood programme enabling the blood transfusion service to operate with a discrete budget, separate managementand appropriately trained staff establishing appropriate support systems and structures for the national blood system, including anational blood policy and strategic plan which emphasizes the principle of VNRBD 4140F developing a legislative and regulatory framework based upon international standards toencourage and enforce appropriate blood service standards and behaviour (if not in place) supporting national clinical guidelines for blood transfusion creating a broadly representative national blood commission 42 or national blood authority withexecutive functions 4341F42FNational Society blood services and voluntary blood donor recruitment activities should, therefore, befully integrated into the governments health plans. Any roles and responsibilities delegated to a NationalSociety by a government should be defined in a legal agreement 44 such as a service agreement orMemorandum of Understanding that also defines the source of financial support and the cost-recoverysystem. An example framework for a Memorandum of Understanding is included as Appendix 3. Anyagreement for blood service provision should also include government indemnity or protection for theNational Societys blood service activities acknowledging that there are risks associated with undertakinga blood programme.43FNational Societies and their blood services have a responsibility to practice humanitarian diplomacy 45 toensure that the government appreciates the role that safe blood and a sufficient supply of such bloodand blood products play in national health security, and the benefits to public health that will come from44F40Aide-Mmoire: Developing a National Blood System. Geneva, WHO, 2011Processes for effective blood policy and policy considerations are outlined in Aide-Mmoire: Good Policy Process forBlood Safety and Availability. Geneva, WHO, 200842Aide-Mmoire: Blood Safety. Geneva, WHO, 200243Aide-Mmoire: Developing a National Blood System. Geneva, WHO, 201144Ibid45IFRC Humanitarian Diplomacy Policy, adopted by the 19th session of the IFRC Governing Board in Paris, May 2009.4139appropriately funding and supporting the national blood programme. National Society communicationsand interactions with government should stress the need for a national policy of VNRBD, action tominimize risk in blood services and the importance of adequately funding blood safety measures, theneed for balancing blood safety and accessibility, and the importance of donor care and donor andrecipient safety. Governments should also be reminded of their responsibilities in maintaining a nationalblood system that is fully integrated into the health care system (as described by WHO in Aide-Mmoirefor Ministries of Health, Developing a National Blood System 46).45 FBecause of their strong ties to the community and their extensive volunteer networks, some NationalSocieties may find that the government would like them to increase their engagement in bloodprogramme activities, particularly blood donor recruitment. Any increase in blood activities comes with anincrease in risk to the National Society, so it is recommended that any society considering a change toits level of engagement in its national blood programme first contacts the GAP and/or the InternationalFederation for advice.Resources Aide-Mmoire: Developing a National Blood System. Geneva, WHO, 2011 Aide-Mmoire: Good Policy Process for Blood Safety and Availability. Geneva, WHO, 2008 Aide-Mmoire: Blood Safety. Geneva, WHO, 2002 Blood Transfusion Safety, Information Sheet for National Health Authorities. Geneva, WHO,current version8.2Community engagementBlood services are encouraged to engage with government health, education and community agencies,the media, other voluntary and educational organizations and the business community in promotingVNRBD and community support for the national blood programme. These networks and channels ofcommunication can improve public understanding of the role of blood in health care, influence attitudesto blood donation, and convey the importance of blood safety. Government and business employers canalso support blood services by providing opportunities for their employees to donate blood and byforming corporate donor groups.Resources Towards 100 per cent voluntary blood donation: A global framework for action. Geneva,WHO/IFRC, 20108.3Blood sector networksInternational collaboration supports resilience in blood systems and the capacity of blood services toadapt in response to uncertainty and change. Collaboration assists national blood services in emergencypreparedness and pandemic planning. Sharing of best practice examples, emerging technologies andinvestments in safety supports blood services in pursuing continuous improvement. It can also informdiscussions with government on investment in new technology and appropriate safety measures.National and regional blood services recognize that there are significant benefits in engaging in bloodsector networks such as the international Alliance of Blood Operators (ABO), the European BloodAlliance (EBA), Asia-Pacific Blood Network (APBN), AABB, ISBT, the International Plasma FractionationAssociation (IPFA), the International Haemovigilance Network (IHN), the International Society ofThrombosis and Haemostasis (ISTH), and the International Federation of Blood Donor Organizations46Aide-Mmoire: Developing a National Blood System. Geneva, WHO, 201140(FIODS). Blood sector networks support performance improvement and operational efficiency throughbenchmarking, the exchange of knowledge, and the development of consistent policies, standards andprocesses across countries and regions.Benchmarking operational performance against other comparable blood services provides identificationof best practice, quality assurance and continuous improvement. Blood services affiliated with ABOparticipate in an annual Balanced Scorecard that allows for comparison of performance and practice inthe areas of donor attraction and retention, blood component demand and issue rates, clinic efficiency,collection and processing efficiency, and workforce turnover. The scorecard gives participating bloodservices a clear indication of where they are positioned relative to other (non-identified) countries in eachaspect of blood service delivery. Data from the benchmarking informs discussions among networkmembers on best practice and collaborative approaches such as sharing information.Information from the ABO and APBN Balanced Scorecards is shared among participating blood services.National Societies interested in learning more about benchmarking using a scorecard are advised tocontact the ABO or the APBN secretariats.The Global Blood Safety Network (GBSN) forum, convened by WHO, involves internationalorganizations, agencies and experts from developing and developed countries in sharing expertise insupport of global blood safety. The forum promotes information exchange, consensus on appropriateblood safety standards and practices, and fosters cooperative arrangements between institutions tosupport the safety of blood donors and recipients in all countries. Further information on the aims andoutcomes of the GBSN is available on the WHO web site.8.4Hospitals and cliniciansThe implementation of appropriate patient blood management (PBM) systems during blood storage,handling, use and administration by hospitals is important in ensuring that the quality and safety of bloodand blood components is maintained and that scarce blood resources are used to best effect withrespect to patient outcome. While National Society blood services may not have any direct involvementin the treatment of patients by blood transfusion, they do have a responsibility to patients to ensure thatblood is collected while maintaining both the quality and safety of the units, and to their blood donors toensure that donated blood is not wasted and that it is used appropriately.Blood services should have in place formal agreements for the supply of blood to hospitals that includeprovisions such as: a commitment from the hospital that it adheres to WHO recommendations on the clinicaltransfusion process and patient safety 47 and PBM 48 the appropriate levels of stock systems for ordering and supply monitoring and reporting of appropriate use and wastage and expiry monitoring and reporting of patient adverse events46F47FIt is recommended that blood services engage with transfusion medicine experts, hospital administrators,and government stakeholders (e.g., military representatives and national contingency or disastermanagement teams) to establish a national or local inventory management and supply plan. This shouldbe aimed at ensuring sufficient supplies to meet routine demands and respond to surges if additionalblood is required, for example in emergency situations (see Section 9.2), while minimizing wastage from47Aide-Mmoire: Clinical Transfusion Process and Patient Safety. Geneva, WHO, 201048Aide-Mmoire: The Clinical Use of Blood. Geneva, WHO, 200341expiry and inappropriate use. It is recommended that blood services and hospitals also establisharrangements for priority supply and transportation.Blood services should encourage hospitals to establish multidisciplinary transfusion committeesresponsible for implementing the national policy and guidelines in a local context and monitoring howblood components are being used, as described by WHO in its Clinical Use of Blood, Aide-Mmoire forNational Health Programmes (2003). Blood services should work with hospital transfusion committees indetermining current and anticipated blood supply needs, and in promoting leading transfusion practice.National Society blood services should work to educate clinicians as well as medical and nursingstudents on aspects of blood transfusion safety, the risks of blood transfusion, alternatives andprevention strategies, the importance of appropriate product use, and the benefits of voluntarily donatedblood. Level B and C National Societies could also focus on hospitals and clinicians in their advocacyefforts to change family replacement donation to 100 per cent VNRBD.Resources Aide-Mmoire: Clinical Transfusion Process and Patient Safety. Geneva, WHO, 2010 Aide-Mmoire: The Clinical Use of Blood. Geneva, WHO, 2003 Aide-Mmoire: Safe Blood Components. Geneva, WHO, 2005 WHA 63.12, Availability, safety and quality of blood products. Sixty-Third World Health Assembly,Geneva, 21 May 2010, Geneva, WHO 20108.5National SocietiesThe GAP supports cooperation between National Societies involved in blood programme deliverythrough regional meetings and the establishment of twinning or buddying relationships between bloodservices.GAP regional meetings allow National Society blood services to discuss issues arising from the GAPSelf-assessment and provide societies from similar environments the opportunity to share corporategovernance and risk management experiences, challenges and successful approaches. The GAPszonal coordinators can also hold in-depth discussions with societies seeking priority assistance with theorganization of their blood programme.Upon request the GAP and/or the International Federation can help National Societies establish twinningor buddying relationships with other National Societies that have expertise and experience in areas ofneed, and can also provide them with direct advice as to the appropriate level of engagement in theirnational blood programme (see Chapter 10).The International Federation encourages National Societies involved in donor recruitment to share theirexperiences and some zones and regions hold regular meetings for societies involved in bloodprogramme activities, including VNRBD recruitment. National Societies should contact their Federationzone office for more information.429.Sustainability9.1Adoption of new technologies and practicesBlood services benefit from shared learning with other blood services on best practice in bloodmanagement, testing, manufacturing and distribution. This includes evaluations of new technologies andequipment, and comparisons of operational approaches and performance. Information exchange canoccur through blood sector networks, visits to other blood services, attending conferences or engaging inpartnering arrangements.Equipment needs to be appropriate to the defined task and meet specified standards. In determining thesuitability of new equipment, blood services should consider factors such as performance in localconditions, operating requirements (e.g., power, water), staff training and maintenance. Coordinatingequipment purchases across a blood service can assist in standardization, provide for economies ofscale, and simplify processes for training, maintenance and support.When considering receipt of donated equipment it is important to assess how the equipment willintegrate with the existing system, whether trained operators are available, and if replacement parts andmaintenance services are obtainable.The transition to new technologies or systems should be planned to minimize disruption, with a processof monitoring, evaluation and review. Time should be allowed to ensure appropriate training of staff usingthe equipment. Blood services should also consider whether outmoded equipment that still operates tospecified standards might be of use to other National Society blood services. Equipment shouldotherwise be appropriately disposed of.9.2Contingency planning and disaster preparednessDisruption of blood services as a result of a natural disaster, pandemics, war or terrorism can potentiallyimpact upon the lives of patients in need of blood transfusion. After a disaster, demand for blood maysuddenly escalate at the same time as blood collection sites become unusable and the publics responseand willingness to donate increase. A significant issue will be managing the influx of donors. Power cutsmay cause stored blood and blood products to become unsafe as they fall outside of prescribed storagetemperatures. A crisis situation may also be caused by publicity concerning contaminated bloodproducts. Delivery of blood services entails responsibility to ensure an adequate and timely supply ofblood and blood components. A lack of preparation and contingency for adverse events could result in aloss of confidence and reputational damage to a National Society. A disaster plan is therefore essentialto manage a response, so that blood service staff and other partners are clear on what should be done,by whom, and in what order.A comprehensive plan for disaster management includes actions for mitigation, preparedness, responseand recovery. Mitigation actions might include relocating facilities to alternate sites or designing facilitiesto reduce the impact of recurring natural disasters. Preparedness addresses the risks that cannot besufficiently reduced by mitigation strategies and involves a risk analysis of potential disasters and thoseareas of operation most likely to be adversely affected. Preparatory actions should be routinely reviewedto ensure that they address these risks and, where possible, a test run or exercise included to monitorpreparedness and the accuracy of key information such as contact numbers.43Response during a disaster includes critical actions initiated by staff to protect life and property but thesafety of staff must be the primary consideration. These actions include establishing internal andexternal communication, conducting emergency evacuations, and re-establishing operations at analternate site (if required). This requires clearly defined, understood and practised processes,emergency operating procedures, and a leadership succession plan. Recovery operations focus on therestoration of critical infrastructure to re-establish important functions, such as communications, power,water, sewage and transportation. Identifying areas that may require additional mitigation actions in theevent of future disasters is also an aspect of recovery.Contingency and disaster planning involves identifying recurring natural disasters and events that areendemic to the region e.g., earthquakes and seasonal disease patterns. Information regarding manmade threats can also be provided by government agencies responsible for health, defence and utilities,or from the private sector. A National Societys blood service disaster plan should be integrated with anynational disaster plan and should detail: membership of the crisis management team with their roles and responsibilities names, roles and contact information of key contact persons plus back-up personnel internal communication management for staff and volunteers external communication management, including names and roles of official spokespersons andresponsibilities for communication with donors, the media, and other stakeholders (e.g., hospitals) information on alternative collection sites information on alternative finished product storage sites (e.g., have established agreements withhospitals to increase on-site stock should blood service storage equipment fail) information on alternative supplies of equipment and consumables information and procedures for recruitment, collection, processing, testing, storage and distributionactivity continuation in the event of a disaster names, addresses and contact details for all staff responsibilities of individual staff in relation to contingency and disaster planning arrangements for back-up storage of all donor and sponsor records arrangements for computer back-up systems, where in useThe disaster plan needs to be well practiced, so that staff know exactly what to do and can actimmediately in assuming their designated role. Disaster management responses should be rehearsed ona regular basis as part of staff training.Resources Maintaining a Safe and Adequate Blood Supply during Pandemic Influenza: Guidelines for BloodTransfusion Services. WHO, July 2011. Pandemic Influenza Planning for Blood Organizations. European Blood Alliance EmergencyPlanning Action Group, 2009 Disaster Operations Handbook: Coordinating the Nations Blood Supply during Disasters andBiological Events. AABB, 2008. Available from the AABBs web site, www.aabb.org The John Hopkins and Red Cross Red Crescent Public health guide in emergencies. John HopkinsBloomberg School of Public Health and IFRC, 2008, second edition.449.3Environmental sustainabilitySound environmental management helps to minimize the impact of blood service operations upon theenvironment and public health. It not only supports compliance with regulatory standards but alsodemonstrates to the public and employees that their National Society is acting in an environmentallyresponsible way. Good environmental management practices can also deliver savings through lowerenergy usage, less consumption of materials, and reduced waste management and distribution costs. 4948FThe requirements and guidelines for an environmental management system are set out in the ISO 14000Standards, which complement the ISO Standards for quality management (ISO 9000). ISO 14000provides a holistic framework with which blood services can develop an environmental policy and plans.An effective management system will enable the blood service to manage hazardous waste, identify andcontrol environmental impacts, set environmental objectives and targets, plan actions to achieve these,and continually improve environmental performance.A blood services environmental approach should be conveyed in an environmental policy madeavailable to the government, suppliers, contractors and the community. This will:comply fully with all applicable environmental and hazardous waste management laws andregulations, and reflect international good practice, including WHO recommendations on healthcare waste managementseek to minimize or control (to the extent possible) environmental impacts from operationsset objectives and targets for continuous improvement in environmental performancepromote staff awareness of environmental objectives and responsibilities, and their activeinvolvementcommunicate the environmental policy and environmental requirements to contractors andsuppliers and seek to influence, as far as possible, their environmental practices 5049FResources ISO 14000, Environmental Management. ISO, 2007. Available from the ISO web site, www.iso.org Safe management of wastes from healthcare activities. Geneva, WHO, 1999 Aide-Memoire: Safe health-care waste management. Geneva, WHO, September 20004950See ISO web site, www.iso.org.These areas are informed by the environmental policy of the Hong Kong Red Cross blood transfusion service.4510. Transition and exit strategiesAs previously highlighted, involvement in blood service delivery (Level A) entails a high degree ofresponsibility and compliance to manage National Society exposure to blood-related risks. These riskscan be reduced through adherence to the standards outlined in this document (refer to the tables inSection 2.1). If a National Society involved in blood programmes determines that it has insufficientcapacity to manage the associated risks or if the government is prepared to take over the bloodprogramme, it could consider reducing its level of involvement in blood activities, as in the diagrambelow.A. Full Blood Service ProvisionB. Systematic, Voluntary BloodDonor RecruitmentHigher RiskC. Advocacyfor VNRBDLower RiskNational Societies that are considering either building their capacity and ability to operate their bloodservices in a safe and sustainable manner or withdrawing to a lesser involvement in blood activities areencouraged to contact the GAP or the International Federation for advice. Decisions to reduceinvolvement in blood programmes are not made lightly, and it is important to consider and mitigate theconsequences to the community of a National Societys withdrawal from blood service provision.It is important that the National Society engages key stakeholders (the government, the InternationalFederation, WHO, the GAP and others) before it initiates action to exit from its blood service. The resultof the negotiations might be that an alternative provider is identified, making it easier for the NationalSociety to withdraw strategically from its blood service activities. However, in some cases thegovernment might decide to increase resources to the National Society and, with technical support frominternational agencies such as the GAP or WHO, the blood service can improve its operations to meetthe required standards and remain the national blood programme provider.The following pages present generic guidelines for blood service National Societies contemplating atransition from Level A to a lesser degree of involvement. The guidelines are broad, so they can beadapted to local circumstances and conditions.The guidelines may also serve as a tool for engagement with government regarding the requirements foran effective and sustainable national blood programme. Blood services cannot function effectivelywithout adequate financing and appropriate infrastructure. The GAP can provide guidance to NationalSocieties when engaging with government and other stakeholders regarding the extent of theirinvolvement in blood programme activities.46Exit Strategy FrameworkThis framework and its guidelines are designed to assist National Societies that have decided that theirbest course of action is to exit from their blood service activities. It includes strategies to ensureappropriate consultation and processes are undertaken during the transition phase, when the bloodservice transfers from the National Society to another entity (as determined by the appropriategovernment body). The following phased change plan is recommended:Introductory phase:Engaging all stakeholdersFeasibility phase:Assessment and development of the exit strategyProgramme phase:Implementing the exit strategyMonitoring and evaluation phase:Follow up with reporting to all stakeholders on progressThe following guidelines are intended to assist National Societies designing an effective exit or transitionplan. It includes objectives, considerations and potential activities.Phase 1: Introductory phaseObjective: To facilitate the gradual implementation of an exit strategy by consulting key stakeholdersand identifying requirements for effective transition.Activities:Hold discussions between a) the National Society blood service and the ministry of health, b) theNational Society blood service, the ministry of health and the appropriate GAP zonal coordinator(focal point), if necessary.Share information arising from the GAP Self-assessment report.Clarify the new role of the National Society (Level B or C).Discuss options and a time frame for the exit strategy/change plan (recommended minimum oftwo years).Appoint a project team involving all stakeholders and establish its terms of reference, taking intoconsideration any additional fund-raising that might be needed to manage the implementation ofthe exit strategy.Phase 2: Feasibility phaseObjective: To develop a project/exit plan for the handover of blood service activities that ensures: Asmooth transition to the new authority, security for the blood service and its stakeholders, and themaintenance of optimal blood safety and levels of donor care.47ActivitiesPerform a detailed risk analysis of the impacts of the National Societys exit from blood servicesin the local situation (see Section 4.5).The project team (including government authorities) should develop a project/exit plan thatensures:oa clear governance regime for the handover, and for each area of blood service operationsthe following are identified: what is required to properly effect a handover who is responsible how those tasks will be done by the responsible party when those tasks will be done by the responsible partyothe following are incorporated as areas for attention (as applicable): the operational transition of products and services. May include: transfer of assets,equipment, hardware and software, personnel, knowledge exchange/training, transfer ofdatabases, provision of statement of third party contracts, and insurance information blood service functions. May include: donor management and recruitment, collections,testing, processing, inventory management and distribution, operations support,transfusion medicine, research and development, corporate support and planningothe safety of blood donors and blood recipients through the application of the fundamentalprinciples of VNRBD and equity in access to blood and blood products (see Section 3)othe integration of international standards in quality assurance and good manufacturingpractice (GMP) (see Section 6) into national regulations as recommended by WHOoblood donors are aware of and confident in the transition process, so they continue todonate bloodoa costing analysis is completed to ensure that the future blood programme operation isfinancially sustainable (see Section 4.2)oappropriate compensation is given to the National Society for the transfer of any assetsorisks are identified and managed throughout the process of transition and beyond (seeSection 4.5)osufficient resources are put towards communicating with government, key stakeholders (e.g.,media, regulators, suppliers, hospital staff and clinicians), donors and the general publicoa contingency plan is in place to manage either: lack of preparedness to exit according to the initial time frame a local disaster which may result in the necessity to re-establish the National Society bloodservice temporarily to deal with the crisisAgree on a Memorandum of Understanding that clarifies each partys role and responsibilitiessubsequent to the handover (see Appendix 3).A GAP review 51 of the project/exit plan proposal with recommendations to ensure that anypossible risk management issues for IFRC have been considered (e.g., reputational risk).5150FSubject to the availability of resources48Phase 3: Programme phaseObjective: To implement the project/exit plan within the agreed time frame while maintaining a servicethat meets all the needs of both the donor and patient populations.Activities:Implementation of the project/exit plan and Memorandum of Understanding with scaling down ofNational Society involvement during the transition, ensuring:othe systematic transfer of blood service functions and operational products and servicesothe establishment of national regulations for the blood programme based upon internationalstandards, if they are not in place alreadyoblood safety is maintained through the application of quality assurance and GMP systems(as per WHO recommendations)oprogress is being made towards 100 per cent VNRBDoongoing collaboration with partners, patient organizations, professional societies and otherstakeholders to ensure supply plans are set up to meet the nations need for bloodo the supply of blood and blood products is on a non-for-profit basisochanges and updates are communicated to stakeholders through key spokespersonsoa system and process is established to manage the ongoing requirement for donor lookbackand counselling once the exit is completeIf withdrawing to Level B or C, in parallel, the National Society should consider:oappointing a team with a focus on donor recruitment or community education and settingup training programmes based on: the IFRC toolkit Making a differenceRecruiting voluntary, non-remunerated blood donors the workshop materials compiled jointly by WHO and IFRC, entitled DONOR Towards 100 per cent voluntary blood donation: A global framework for action the requirements basic checklists found in this manual in Section 2.1 (pages 12-14)oestablishing a sub-committee to address legal responsibilities to blood donors and bloodrecipients in order to comply with World Health Assembly recommendation 28.72, which callsfor member states to enact effective legislation governing the operations of blood services andto take any other necessary action to protect and promote the health of blood donors andrecipients 5251Foproviding ongoing capacity building and mentoring to the new blood service operatorLiaise with WHO to ensure requirements are being met in all areas of blood service operations andto secure access to the full Basic Operational Framework for Blood Transfusion Safety.52Subsequent WHA resolutions (WHA58.13, 2005 and WHA60.18, 2007) have called upon all member states to establishor strengthen systems for the recruitment of voluntary, non-remunerated donors and the implementation of stringentcriteria for donor selection.49Phase 4: Monitoring and Evaluation phaseObjective: To report on a regular basis on all matters of accountability to the new services donors,the funding agencies, users of blood and blood products, and the community at large.Potential activities:Report on agreed targets (e.g., blood donation, blood component production).Review the new systems impact, if any, on wider health and care priorities (maternal health,child mortality).Benchmark progress with key partners (see Section 7.3). Access to safe blood and bloodcomponents cannot be achieved without cost but an unsafe or inadequate blood supply is evenmore costly in both human and economic terms. Benchmarking with key partners can assist inquality improvements at all levels of service delivery and is a useful tool for monitoring progress ina cost-efficient way.Report back to the GAP with full case study details for the benefit of other National Societies andministries of health.Conduct a Learning Review to identify what:owas done well and would be done againowas not done well and would be improved on next timeThe review could report back to the GAP for the benefit of other National Societies and ministriesof health.50AppendicesAppendix 1: International Federations blood policyPOLICYPromoting Safe and Sustainable National Blood SystemsIntroduction:Blood safety is a critical underpinning for safe blood transfusion and health systems. People in allcountries have a right to expect that the blood and blood products supplied to them are gathered,produced and provided in a safe and sustainable way that supports their communities and their healthsystems.The International Federation recognises that health security is a fundamental and indispensableprerequisite to global, national and individual development 53 and it supports the advancement of globalhealth security by promoting voluntary non-remunerated blood donation (VNRBD), and advocating forthe safe provision of blood and products 54.While the World Health Organisation (WHO) recognises that it is the responsibility of governments toensure a safe and adequate supply of blood 55, Red Cross/Red Crescent Societies in many countries, asauxiliaries to their governments, play an important role in promoting safe and sustainable bloodprogrammes. National Society activities range from the provision of the national blood service, tosystematic recruitment of voluntary blood donors, to promotion of blood donation and advocacy forVNRBD, for example annual participation in World Blood Donor Day.52F53F54FScope of policyThis policy sets out the International Federation and member National Societies position on advancinghealth security through safe and sustainable blood systems.Importance of blood servicesSustainable and quality blood services play a critical role in the health of any society, and in terms ofdisaster preparedness the existence of a quality blood service is critical. While the availability of bloodcould be a major concern in the event of a disaster, the safety is also always of paramount concern toany emergency/disaster response. Blood is used for a multitude of life saving purposes including:assisting patients undergoing surgery; treating diseases including anaemia and malaria; caring forpatients on chemotherapy; supporting women with complications during childbirth (postpartumhaemorrhage) and patients on Antiretroviral (ARV) treatments. The unavailability of safe blood can leadto serious health consequences such as death from haemorrhage or the transmission of life threateninginfections HIV/AIDS, hepatitis B and C, syphilis and other infections.There should be preparedness plans to provide rapid response to emergency situations and for postdisaster reconstruction of blood transfusion services.The availability of safe blood contributes directly to three of the United Nations MillenniumDevelopment Goals:4. the reduction of child mortality;5. the improvement of maternal health; and6. combating HIV/AIDS, malaria and other diseases.53Health Policy adopted at the 15 session of the General Assembly of the IFRC, Seoul, November 2005.Strategy 2020, p 15, IFRC55Blood Safety, Aide-Memoire for National Blood programme, WHO, 20025451It is recognised that a sufficient supply of safe blood and blood components based on voluntarynonremunerated blood donation (VNRBD), and the security of that supply, are important national goalsto prevent blood shortages and meet the transfusion needs of the patient population 56.VNRBD is a critical component in ensuring a safe and sustainable blood supply that meets the needs ofall recipients. VNRBD was enshrined as a fundamental principle of blood service when the 1975 WorldHealth Assembly (WHA) resolution called for member states to promote the development of nationalblood services based upon voluntary non-remunerated donation of blood 57.Patients must have equitable access to safe transfusion on the basis of their clinical needs, and thesafety of the donor and patient must be considered paramount. The International Federation and itsmember National Societies promote equity, access, quality and safety of blood and blood componentsso that citizens can have confidence in the security and integrity of their blood system.While the benefits of blood transfusion are widely acknowledged, there are also some risks inherent inthe blood transfusion process, including accidental exposure to transfusion transmitted infections suchas HIV. To secure the safety of the blood supply, blood services must ensure that appropriate donorscreening and quality management processes are in place, and that they remain vigilant against newthreats to the blood supply.55F56FCharacteristics of well-functioning RC/RC blood programmesWhile it is the responsibility of a countrys government to ensure an adequate and safe blood supply,many National Societies play an important role in supporting their government to achieve that objective.National Societies may be involved in blood-related activities at three levels:A: Full blood services (collecting, testing, processing, distribution)B: Systematic recruitment of blood donors to a blood serviceC: Promotion and advocacy of blood donationThese levels are reflected in the figure below.Figure 1: Red Cross/Red Crescent role in blood activitiesEach level of National Society involvement in blood services is characterised by different requirementsregarding capacity and risk management. While Level A requires the most resources and has thehighest level of risk, a well run National Society blood service can contribute enormously to the healthand well-being of the community in which it is based. However, all National Societies can contribute5657WHA resolution 63.12.WHA resolution 28.72 This principle was reasserted again by the WHA in 2005 (WHA58.13) and 2010 (WHA28.72)52towards the development of a safe and sustainable blood system through the advocacy and promotion ofVNRBD.For a full description of the characteristics of each level, please refer to the Global Advisory Panel onCorporate Governance and Risk Management of Blood Services in Red Cross and Red CrescentSocieties (GAP) blood manual Development of Safe and Sustainable Blood Programmes. A summaryof the main characteristics of a well-functioning level A or B blood programme is provided below.For both Levels A and B: Systems are in place to ensure that the health and well-being of the donor and recipient areprotected There is national blood policy in place which reflects WHO recommendations, including VNRBD, andit is supported by a legislative framework The blood programme is integrated as part of a national health policy and plan The allocation of roles and responsibilities between the Government , the blood programme, and theNational Society reflect the overall responsibility of the Government to ensure an adequate and safeblood supply and are formally documented in a service agreement Long-term and sustainable funding allows the blood programme to:o meet operational and regulatory requirements with regards to facilities, supplies, equipmentand trained staff and volunteers; ando implement appropriate donor care and risk management systems leading to high quality, safeand effective blood products. The blood programme is nationally coordinated to ensure uniformity of standards and cost efficiency Donor selection criteria are in place to identify low risk donors and counselling is provided in cases ofdeferral There is a risk management framework in place, to identify, prioritise and manage risksAt Level A: The National Society has secured government protection/indemnity and/or insurance cover for itsblood service activities, including clinical advice. The National Society should assure that adequate external assessments are conducted regularly toensure that the Blood services operate under the necessary quality assurance programme andadheres to a national regulatory framework based upon internationally recognised standards. The blood service is involved in collaborations and partnerships to ensure a safe and adequate bloodsupply and appropriate product use.At Level B: The blood service to which the National Society recruits donors operates under a quality assuranceprogramme and adheres to a national regulatory framework based upon internationally recognisedstandards. There are agreements in place whereby the roles and responsibilities of the National Societies andthe Blood Service are clearly defined.It is therefore important that National Societies consider carefully the level of blood activity which is mostappropriate for their engagement. The global burden of disease due to unsafe blood can be eliminated orsubstantially reduced through an integrated approach to blood safety, requiring, The establishment of a nationally coordinated blood service Formalization of government commitment and support. Contribute where appropriate to the Development of National blood policy and plans. Advocacy of necessary legislation/regulation for the Blood Transfusion Service . Establishment of nationwide quality systems, including guidelines, standard operating procedures,accurate records, monitoring and evaluation aligning to Government policy. Collection of blood only from vnrbd from low risk populations53Haemovigilance system for monitoring, reporting and investigating adverse events.Trained staff and continuing professional development and upgrading for latest technology as aprerequisite.Ensure efficient and good laboratory practices in screening for transfusion transmissible infections,blood grouping, compatibility testing, blood component production, storage and transportationReduction of unnecessary transfusions through effective clinical use of bloodBut a National Society needs to consider carefully all aspects of a sustainable and qualityprogramme, and if it is contemplating a commitment to undertake activities at Level A the NationalSociety:1. Should have a clear mandate from their government to do so;2. Should have the capacity to adhere to regulatory requirements and implement appropriateblood safety measures;3. is able to manage any legal liabilities, possibly by considering whether a separate legal entityis required to separate the assets of the National Society from the blood business.Independence with its own director, board of management and budget may also lead toincreased public trust and confidence, crucial to a successful national blood programme.Framework of support to RC/RC blood programmesTogether with WHO the IFRC is committed to the achievement of 100 per cent voluntary blooddonation, in keeping with our Fundamental Principles, and we have a long history of collaboration inthe area of blood safety and availability. The strength of the partnership lies in its complimentary andsynergistic approach at national as well as global level. Three key milestones have marked ourstrategic collaboration, each providing a global framework of support:(1) the designation of Blood Safety as the theme of WHOs World Health Day 7 April 2000,supported by IFRC(2) the foundation and establishment of World Blood Donor Day in 2004-5 which is nowcelebrated each year on 14 June to raise awareness of the importance of blood donationand recognize the contribution of voluntary non-remunerated blood donors in saving livesand improving health.(3) the 2009-10 release of the WHO/IFRC Global Framework for action-towards 100 per centvoluntary blood donationThe International Federations main toolkit, designed to assist key stakeholders in best practice, indonor recruitment and advocacy for 100 per cent vnrbd is the package Making aDifferencerecruiting voluntary, non-remunerated blood donors. This is a self-help manualempowering personnel in the field to motivate, recruit and retain vnrbd and to phase-out anydependence on family/replacement donors.National Societies and the International Federation have created an experts group (GAP) togenerally assist and advise National Societies on the governance and risk management issuesrelevant to blood services, as resources allow. GAPs main tool in working with National Societies isthe Self-assessment, a questionnaire that: enables National Societies to identify potential problem areas where their blood programmeactivities may be exposing them to risk; and offers strategies for improving corporate governance and risk management.54Meanwhile, as ongoing support to sister societies and in accordance with the spirit of theInternational Federation, the sharing of best practice between National Societies is encouraged inorder to maintain and expand on the competitive advantage which the International Federation andits member National Societies have in this specialized field of health care.It is clearly acknowledged and understood that each National Society is fully responsible for its ownblood activities. The support provided by either the International Federation, GAP or assistingNational Societies does not in any way dilute or transmit this responsibility.Specific Responsibilities arising out of this policy:The International Federation, GAP and National Societies engage to:support and advocate the principle of voluntary, non-remunerated blood donation (VNRBD)advocate a balanced decision-making approach to blood safety that addresses both evidence-basedconsiderations and the precautionary principle promote and uphold high ethical standards, integrity and accountability consistent with the Code ofEthics for Blood Donation and Transfusion of the International Society of Blood Transfusion, asadopted by the International Conference of Red Cross and Red Crescent Societies, 1981, andsupported by the World Health OrganizationNational Societies have a responsibility to:work to ensure their Governments accept their responsibility to ensure a safe and adequate bloodsupply within their jurisdictionsidentify their role in the overall strategy of blood service delivery in their country in accordance withtheir capacity, technical know-how, available resources, local priorities and in liaison with governmentpromote safe, sustainable and equitable practices in the development and administration of bloodprogrammesensure their blood programme has an adequate governance structure with a well-defined system fordelegation of authority and accountability.support the aspiration of national self-sufficiency, including ensuring adequate blood and bloodproducts to meet domestic health needsundertake Humanitarian Diplomacy as necessary to seek government action to minimise risk in bloodservices and to help ensure that Government alerts the public to any reasonably preventableinadequacy in blood service delivery which places them at riskimplement the GAP Self-assessment and adhere to the Development of Safe and Sustainable NationalBlood Programmes Manual, which may necessitate a more detailed analysis, assessment anddevelopment of an exit strategyrespect the confidentiality and privacy of all information relating to blood donors and blood donationadminister any blood programmes in compliance with this position; inform all staff, volunteers andblood sector partners participating in blood programmes of this positionwhere practical, provide support to other National Societies and blood services in achieving a safe andsustainable blood system in ways that enable self-empowerment and long-term sustainabilitytake steps in consultation with GAP and other partners to ensure that appropriate risk managementmeasures are implemented; this includes ensuring that its senior management and governing leadersare alerted to any material risks and that appropriate action is subsequently takenensure that all blood programmes comply with this policyThe International Federation has a responsibility to:focus on the promotion of voluntary blood donor recruitment and to liaise and work in closecollaboration with GAP, WHO and other partners in implementating the WHO/IFRC Global Frameworkfor action-towards 100 per cent voluntary blood donationshare knowledge and exchange information with GAP at a strategic, regional and country level.55ensure this policy is reviewed after five yearswork with the GAP membership to help ensure necessary GAP resourcingkeep through the International Federation Secretary General International Federation Governanceappropriately informed of major material risks for the International Federation it becomes aware ofThe GAP has a responsibility to:share knowledge and provide advice to National Societies on governance and management of riskassociated with blood programmes, as resources allowensure any lessons learned from the implementation of the GAP manual Development of Safe andSustainable National Blood Programmes are incorporated into an update of the manual at same timeas the policy reviewinform both the International Federation Secretariat and the concerned National Societies of majormaterial risks for the International Federation discovered through the GAP National Society selfassessment program in blood service delivery and any other GAP workReview and Reference:This policy was drawn up in 2010 and it is designed to replace the previously established policy onQuality Provision in Blood Services. IFRC will ensure this policy is reviewed after five years, withany proposed amendments to be submitted to the Federation for approval. The review is to beinitiated no later than 30 Dec 2014.This policy is submitted to Governing Board Dec 2010 for its approval and submission to the GeneralAssembly in Nov 2011.Further Reference Texts:Decision 34, 8th session of the General Assembly, Budapest, 25-28 Nov 1991.Voluntary nonremuneratedblood donors are persons who give blood, plasma or other blood components of theirown free will and receive no payment for it, either in the form of cash, or in kind which could beconsidered a substitute for money. This includes time off work, other than reasonably needed for thedonation and travel. Small tokens, refreshments and reimbursement of direct travel costs arecompatible with voluntary, non-remunerated donationCode of Ethics for Blood Donation and Transfusion. International Society of Blood Transfusion,General Assembly, Montreal, 1980 and XXIVth International Conference of the Red Cross, Manila,1981.Code of Ethics for Blood Donation and Transfusion. International Society of Blood Transfusion,General Assembly, 12 July 2000; amended by the ISBT General Assembly, 5 September 2006.Decision 36, Blood Quality Programme. Seville, Spain: 11th Session of the General Assembly,November 1997.Melbourne Declaration 2009, arising from WHO/IFRC global consultation on 100 per cent vnrbdwhereby participants (more than 65 experts in transfusion medicine, policy makers, government andnon-government representatives from 38 countries across WHO/IFRC regions) agreed, inter alia, towork in collaboration in international efforts to promote safe and sustainable vnrbd programmes thatfoster community engagement and benefit the recipients of blood and blood products.Decision, World Health Assembly, 2010, Availability, safety and quality of blood products(WHA63:12)56Appendix 2: National Society blood risk summaryThere are a number of risk issues facing Level A and Level B National Societies. For a full list of riskmanagement recommendations, see the GAP Self-assessment.Main risks for National Society blood services (Level A)Below is a list of the main risk issues the GAP has identified for National Society blood services (Level A)in order of priority:Risk issueConsequenceLack of government protection and/orappropriate insurance cover for bloodborne disease transmissionExposes the National Society to financial risks beyond itscapacity to resolve should an incident occurThe inability to meet either regulatory ornational standardsShould be minimum requirements of any blood service blame for a lack of achievement can be clearly laid at thefeet of the National SocietyLack of funding and resourcesFundamental risk management and donor and productsafety systems/processes are prejudicedThe lack of systematic identification,analysis, evaluation and prioritization ofrisks and their managementLack of appreciation of risks and therefore identification ofthose which are the most imperative to reduceIneffective governanceSignificant risks in lack of assurance and leadershipLack of systems of monitoring emergingthreats to the blood supplyLack of risk management measures in place to dealwithblood-borne diseasesFailure to provide meaningful, practicalsupport for victims of blood-bornedisease transmissionRisks the very reputation of Red Cross Red Crescent as ahumanitarian organizationMain risks for National Societies involved in blood donor recruitment (Level B)Without clear Memoranda of Understanding with either the ministry of health or blood service, theNational Society may recruit to a blood service without appropriate standards to ensure bloodsafety and blood donor care and safety.Without adequate knowledge of the criteria for blood donor selection, there is a risk of mobilizinggroups of people, some of whom may not be eligible to donate blood, which could result in theNational Society being criticized as unprofessional.With pressure from government, some societies may participate in recruiting donors to potentiallyunsafe blood services and expose themselves to potential risks including a) victims of bloodborne diseases seeking meaningful and practical support from the societies due to theirinvolvement in the recruitment of the donor and b) a donor seeking compensation from thesocieties for injuries related to blood donation at the blood service.57Appendix 3: Framework of a Memorandum of UnderstandingWhen a National Society agrees to undertake the provision of part (Level B) or all (Level A) of a nationalblood programme on behalf of the government or health authority, GAP recommends that this issupported by a Memorandum of Understanding (MoU) or service agreement between the two parties. AMoU provides clarity on respective roles and responsibilities and facilitates a cooperative workingrelationship based on expectations that have been agreed to by both parties. It can also be used todocument and reaffirm the governments responsibility to assist the National Society in managing itsblood programme risks both financially and with regards to assurance.MoUs are established for a clearly specified period (such as 1-3 years) however they should bereviewed annually. It is in the interest of both parties that a formal contract be negotiated each year(perhaps as an addendum to the MoU) that specifies the volume/number of products to be provided andthe funding that will be provided by, or funding arrangements that are supported by, the government.MoU formats may vary but generally they will include the following:A title which describes clearly the parties and the purpose of the MoU, for example: Memorandum ofUnderstanding (MoU) between [the Country government or health authority] and [the NationalSociety/blood service] for the [Specific programme of work e.g. implementation of the national bloodprogramme/provision of the blood donor recruitment programme]I.Mission/ObjectiveA preamble which includes a brief description of the missions of both the National Society/bloodservice and the government, and the area which the partnership will promote e.g. the adequatesupply of safe blood and blood products to patients, through a national blood programme based onvoluntary blood donation.II.Purpose and ScopeA description of the intended results that both parties hope to achieve in forming the partnership,and the area(s) that the specific activities listed later will cover.Delegations could be covered in this section. If a National Society is delegated as the nationalblood service, the National Society should seek an assurance that it will have autonomy andindependence in the technical management of the programme. Funding arrangements and theprovision of assurance could also be covered here.III. ResponsibilitiesA list of the specific responsibilities and/or tasks of each party, and any joint obligations, that havebeen agreed as part of the negotiation process including annual operations and budget plans withagreed Key Performance Indicators. Below is a list of government and National Societyresponsibilities that could be considered for inclusion in a MoU for a Level A blood programme.Government obligations: The implementation of a clear blood policywhich spells out the agreed roles and functionsof all parties, including the National Society, andestablishes VNRBD as the basis for the nationalblood programmeGovernment obligations (cont.):58National Society/blood service obligations: Comply strictly with all laws, regulations andguidelines issued by government Provide the population with access to the safestpossible blood and blood products, equitablyand appropriatelyNational Society/blood service obligations (cont.): The provision of an appropriate legislativeframework for the blood programme andregulatory oversight The provision of sufficient resources to enablethe National Society to undertake the task at therequired level of quality and competencewithout compromising standards or diminishingits own resources The provision of an adequate level ofprotection/assurance to the National Society forundertaking the blood programme on its behalf,particularly regarding incidents of no faulttransfusion transmitted infection. Recruit VNRB donors, provide appropriatedonor care, and collect, test, process anddistribute blood and blood components Retaincompetentstaff,includinganappropriatelyskilleddirectorwiththeresponsibility and authority for planning,coordinatingandmanagingthebloodprogramme Provide a technical, financial and administrativestructuretoensuretheappropriatemanagement of the blood programme Maintain an appropriate quality managementsystem for its activities and productionprocesses Submit agreed financial and quality reports tothe government in a timely mannerA number of the examples above could also apply for Level B National Societys entering intopartnership with a blood centre. Additional suggestions are included below:Government/Blood Centre obligations: The implementation of appropriate donor caresystems and of quality standards in thecollection, testing and processing anddistribution of blood and blood components toensure the population has access to the safestpossible blood and blood products, equitablyand appropriately The provision of professional expertise for thedevelopment ofthepublic awarenessprogramme, in liaison with those responsible fordonor recruitment programme (includingRC/RC) Assistance in the orientation and training ofRC/RC volunteers Management of a dedicated budget for theblood service allocating appropriate resourcesto those responsible for donor recruitment(including RC/RC)59NationalSociety/blooddonorrecruitmentprogramme obligations: Work in partnership with Blood Centre to ensurean adequate supply of safe blood Recruit and build a team to implement the blooddonorrecruitmentandmanagementprogramme, implementing wherever possiblethe IFRCs standard toolkit Making a Differencerecruiting voluntary , non-remunerated blooddonors Develop and implement a continuous nationalawareness programme to heighten theimportance of blood donation Develop and manage education, publicity andpromotion activities to promote, recruit andretain blood donors to the level as agreed withthe blood service. Develop recognition programmes for regularblood donors, in partnership with the bloodservice, including World Blood Donor Day on 14June. Motivate and enlist the support of thecommunity to organize and host blood mobilesessions and to coordinate the activities for theblood mobile drives with the blood service. Recruit, train and manage a pool of volunteersto maximize the impact of the donor recruitmentprogrammeIV. Terms of UnderstandingDescribes the terms of length for the MoU and the effective date from which the agreement will start(usually when it is signed). A review period, usually annually, should be included to ensure that theMoU is meeting its purpose and that any necessary revisions can be made. The option to extendthe MoU upon mutual agreement could also be written into this section.The process for termination of the MoU and for resolving disputes should be clarified. Aconfidentiality clause could also be incorporated to ensure that information and documents receivedor acquired are treated as strictly confidential.The MoU should end with the signatures of the duly authorised representatives of both the governmentand National Society and the date upon which the document was signed. The signatures of at least twowitnesses, one from each party, should also be included.GAP may be able to assist in providing example MoUs for National Societies to consider. Pleasecontact the GAP Secretariat or the IFRC, if further information is required.60Appendix 4: ISBT Code of EthicsA CODE OF ETHICS FOR BLOOD DONATION AND TRANSFUSIONThe objective of this code is to define the ethical principles andrules to be observed in the field of Transfusion Medicine.Blood Centers: donors and donation1. Blood donation including haematopoietic tissues fortransplantation shall, in all circumstances, be voluntaryand non-remunerated; no coercion should be brought tobear upon the donor.A donation is considered voluntary and nonremunerated if the person gives blood, plasma orcellular components of his/her own free will andreceives no payment for it, either in the form of cash,or in kind which could be considered a substitute formoney. This would include time off work other thanthat reasonable needed for the donation and travel.Small tokens, refreshments and reimbursements ofdirect travel costs are compatible with voluntary, nonremunerated donation.The donor should provide informed consent to thedonation of blood or blood components and to thesubsequent (legitimate) use of the blood by thetransfusion service.2. A profit motive should not be the basis for theestablishment and running of a blood service.3. The donor should be advised of the risks connectedwith the procedure; the donors health and safety mustbe protected. Any procedures relating to theadministration to a donor of any substance forincreasing the concentration of specific bloodcomponents should be in compliance withinternationally accepted standards.4. Anonymity between donor and recipient must beensured except in special situations and theconfidentiality of donor information assured.5. The donor should understand the risks to others ofdonating infected blood and his or her ethicalresponsibility to the recipient.6. Blood donation must be based on regularly reviewedmedical selection criteria and not entail discriminationof any kind, including gender, race, nationality orreligion. Neither donor nor potential recipient has theright to require that any such discrimination bepracticed.7.Blood must be collected under the overall responsibilityof a suitably qualified, registered medical practitioner.8. All matters related to whole blood donation andhaemapheresis should be in compliance withappropriately defined and internationally acceptedstandards.9. Donors and recipients should be informed if they havebeen harmed.10. Blood is a public resource and access should not berestricted.11. Wastage should be avoided in order to safeguard theinterests of all potential recipients and the donor.Hospitals: patients12. Patients should be informed of the known risks andbenefits of blood transfusion and/or alternative therapiesand have the right to accept or refuse the procedure. Anyvalid advance directive should be respected.13. In the event that the patient is unable to give priorinformedconsent, the basis for treatment bytransfusion must be in the best interests of the patient.14. Transfusion therapy must be given under the overallresponsibility of a registered medical practitioner.15. Genuine clinical need should be the only basis fortransfusion therapy.16. There should be no financial incentive to prescribe ablood transfusion.17. As far as possible the patient should receive only thoseparticular components (cells, plasma, or plasmaderivatives) that are clinically appropriate and affordoptimal safety.18. Blood transfusion practices established by national orinternational health bodies and other agencies competentand authorised to do so should be in compliance with thiscode of ethics.The Code has been elaborated with the technical support and adopted by the WHO.Adopted by General Assembly of ISBT, July 12, 2000Amended by the General Assembly of ISBT, September 5, 200661Appendix 5: Blood Safety, WHO Aide-Mmoire for National BloodProgrammes6263Appendix 6: The Clinical Use of Blood, WHO Aide-Mmoire for NationalHealth Programmes6465Appendix 7: Quality Systems for Blood Safety, WHO Aide-Mmoire forNational Blood Programmes6667Appendix 8: Safe Blood Components, WHO Aide-Mmoire for NationalHealth Authorities6869
GAP Global Mapping 2018
Global MappingRed Cross / Red Crescent National Societyinvolvement in country blood programs2018GAP Global Mapping - 2018Red Cross / Red Crescent National Society involvementin country blood programswww.globaladvisorypanel.orgThank you to all National Societies andBlood Services for your valuable contributionto this project and reportGlobal Advisory Panel - 2018Every effort has been made to verify the accuracy of the information contained in this report. Allinformation was believed to be correct as of March 2018.Nevertheless, GAP cannot acceptresponsibility for the consequences of its use for other purposes or in other context.If you would like to reference this document, please use the following citation:Global Advisory Panel on Corporate Governance and Risk Management of Blood Services in RedCross and Red Crescent Societies. Global Mapping - Red Cross / Red Crescent National Societyinvolvement in country blood programs, 2018.ForewordAbout the Global Advisory Panel (GAP)The Global Advisory Panel on Corporate Governance and Risk Management of Blood Services inRed Cross and Red Crescent Societies (GAP) is global network of Red Cross and Red Crescentblood services.The Global Mapping projectIn order for GAP to be able to best assist Red Cross / Red Crescent National Societies with theirblood banking activities, from 2015-2018 a global mapping survey was undertaken to determine thelevel of involvement of all Red Cross / Red Crescent National Societies in the blood programs of theirrespective countries.The level of involvement of a National Society may be:Level A: Full blood service provisionGAP provides advice and support to National Societies and their affiliated blood services in mattersconcerning corporate governance and risk management of National Society blood programs.Governance Advocacy for appropriate use Product distribution Laboratory testing Component preparation Collection services/donor care Donor recruitment Promotional campaignsEducation and awareness Involvement in WBDDLevel B: Systematic blood donor recruitmentDonor recruitment Promotional campaigns Education and awareness Involvement in WBDDGAP advocates and supports the establishment of safe and sustainableblood systems, promotes the adoption of best practice, and facilitatesresource mobilization and knowledge transfer between blood servicesLevel C: Advocacy for VNRBDPromotional campaigns Education and awareness Involvement in WBDDNil: No involvementKey objectives of GAP:Provide technical advice in terms of corporate governance and risk management to NationalSociety blood programs;Promote knowledge sharing, networking and partnership among and between Red Cross andRed Crescent blood services and external partners;Develop and provide tools and guidelines and country support to National Society blood servicesmost in need;Coordinate assistance to National Society blood services post-disaster including blood programrecovery;Influence global blood policy in conjunction with partners;Provide advocacy and support to National Society blood services and the IFRC on issuesaffecting blood programs.Further information on GAPs activities, including our in-country programs,can be found on the GAP website - www.globaladvisorypanel.orgAll 190 National Societies were invited to participate in the global mapping survey and, of those, 185responded (97%). The following report provides a global, regional and country specific overview ofRed Cross / Red Crescent involvement in blood programs, based on the information provided in thesurvey responses and also obtained from public sources.The country reports include information on:Level of engagement (and details where relevant) of the National Society in the blood program oftheir country (A, B, C or Nil)National context (e.g. size of country, population, economy, health system)National blood program overviewWhile attempts were made to maintain consistency in the country reports, there was considerablevariation in the type of information available for each countrys national blood program. Referenceshave been provided for all information used, however where a reference is not noted, data has beenprovided by the National Society, their blood service or non-Red Cross blood services in the globalmapping survey.History of the Red Cross / Red Crescent in blood185919211948in 1859, Henry Dunant noticedhow few people there were totake care of the injured soldiers,and even then, only for those fromtheir own side.In witnessing this, Dunantenvisioned a neutral organisationthat would provide aid andprotectiontotheaffected;thus founding the Red CrossMovement on both a legal(Geneva Conventions) and a(para)medical footing.The provision of safe blood for lifesaving transfusion later becamepart of that tradition/movement.The British Red Cross establishedthe first Red Cross bloodtransfusion service, with theAustralian and Netherlands RedCross following shortly after.1The League of the Red Cross(later renamed IFRC) adopted aresolution recommending NationalSocieties to take an active part inblood transfusion and co-operatewith their respective governmentsin establishing blood transfusioncentres, or organizing these centresthemselves. They also endorsedthat where possible, blood shouldbe free and universally applied.1THE RED CROSS WASESTABLISHMENT OF THEFOUNDED BY HENRY DUNANT FIRST RED CROSS BLOODIn observing the battle of Solferino TRANSFUSION SERVICELEAGUES RESOLUTION TOTAKE AN ACTIVE PART INBLOOD WITH GOVERNMENT1973By the mid 1970s, the RedCross was active in thenational blood programin approximately 95% ofcountries. The majorityof these were involved inblood donor recruitmentand education.11ROLE OF VOLUNTARY NON-REMUNERATEDBLOOD DONATION (VNRBD)As a result of an increase in the instances of paidcommercial blood donation globally, the InternationalConference of the Red Cross affirmed that a bloodservice based on voluntary non-remunerated blooddonation (VNRBD) and motivated by humanitarianprinciples is the safest and most effective way ofsupplying blood needs.They urged the Governments of all nations to adoptthe highest standards for a safe blood service totheir citizens and formulate those standards on theconcept of VNRBD, and recommended the two worktogether to obtain national blood services based onthe broad voluntary participation of the people.2HISTORY OF RED CROSS / RED CRESCENT IN BLOOD1997IFRC RE-EXAMINED ITS ROLE IN BLOODFollowing a number of highly visible incidentsand legal liabilities surrounding the HIV epidemicarising in the 1980s, the IFRC were concernedabout the potential risk posed by National Societyparticipation in blood and the very threat to theexistence of the organisation as a whole. Thedecision was made to focus on promotion ofvoluntary blood donor recruitment.At this time, the IFRC also decided to set upan experts group to share knowledge and toprovide advice to National Societies on theproper management of risk associated with bloodprograms; and to invite the experts group fromtime to time to inform it of the results of its work.As a reaction to this, Red Cross / Red CrescentNational Societies involved in blood banking,self-organised.1998IDENTIFICATION OF KEY REQUIREMENTSFOR NATIONAL SOCIETIES: BLOODGOVERNANCE & MANAGEMENTDuring a G24 meeting in Sydney, a sessionwas organised for all National Societiesactively involved in blood program activitiesas an opportunity to share experiences andfundamentals in regard to the ethical, social,legal and financial environment facing theblood programs.The following year in Bonn, it was agreedthat any new program should focus on bloodgovernance and management issues as corerequirements.Given the challengesexperienced by so manycountries in achievinga safe and sustainablesupply of blood for theirpopulation, the RedCross / Red CrescentMovement, as a universaland neutral organisation,has a significant role ininternational cooperationand promotion of voluntaryblood donation.1999GAP WAS CONVENEDWith all of these preceding activities at theforefront, GAP was convened following a seminaron blood program governance and managementwhich was co-organised by the IFRC and theFinnish Red Cross in Helsinki, Finland.The seminar was attended by 14 NationalSocieties, the IFRC, as well as speakers fromSanquin, National Blood Authority (England) andthe European Plasma Fractionation Association(EPFA).HISTORY OF RED CROSS / RED CRESCENT IN BLOOD22000THE GLOBAL ADVISORY PANEL WASESTABLISHEDA small network of Red Cross blood serviceCEOs established the new program, knownas the Global Advisory Panel on CorporateGovernance and Risk Management of BloodServices in Red Cross and Red CrescentSocieties (GAP).20022011The inaugural GAP meeting was held inVancouver where the first 6 critical issues ofblood program governance and managementwere identified. This formed the foundation forthe GAP Self-assessment as the fundamentalguidance tool for National Societies.The Policy on Promoting Safe and SustainableNational Blood Systems acknowledges thecritical role that the Red Cross / Red Crescentplays in health care systems and in advancinghealth security through safe and sustainableblood systems; including the need for a sufficientsupply of safe blood based on VNRBD.INAUGURAL GAP MEETINGThe founding members includedAustralia, America, Finland,Switzerland, Japan and Thailand.RATIONALE & ROLE OF THE RED CROSS / REDCRESCENT IN BLOODThe reason the Red Cross / Red Crescent, as a volunteer-drivenorganization, became so heavily involved in blood donation is explained bythe added safety (low transfusion transmissible disease rates) of voluntarynon-remunerated blood donation as compared to paid or family replacementdonations, and the ethics surrounding paying people for substances ofhuman origin.Perhaps underpinning all of the Movements impetus in becoming involvedin blood transfusion, Hantchef (1961 page 370) affirmed that above all,every programme of transfusion requires, as a fundamental prerequisite,the active participation and support of the population. Experience hasproved that such participation depends on how well the programme isunderstood by the public creating and promoting a disinterested spirit ofco-operation, free from all prejudice and fear.That is why the Red Cross, which has a very high moral influence withthe public, is perhaps the ideal organization and the most logical, throughwhich the recruitment of donors can be made all over the world.1IFRC BLOOD POLICY WAS DEVELOPEDThe blood policy outlines the responsibilitiesfor National Societies, GAP and the IFRCwith respect to management and governanceof blood programs. In particular, NationalSocieties have a responsibility to implement theGAP Self-assessment and adhere to the GAPManual and take steps in consultation with GAPand other partners to ensure that appropriaterisk management measures are implemented.2012GAP BECAME A LEGAL ASSOCIATIONGOVERNED BY SWISS LAWTen years after its inaugural meeting, GAPbecame a legal entity governed by Swiss Law.Per its statutes, GAPs mandate is to provideadvice to National Red Cross and Red CrescentSocieties, and their affiliated blood services, inmatters concerning Corporate Governance andRisk Management of National Society bloodprogrammes, as well as to the IFRC Secretariatand relevant IFRC bodies.GAP - 2018GOOD GOVERNANCE, SAFE BLOODWith a membership of 13 National Societies involved in operating a blood service, GAP continuesto deliver its core program of work, which centres upon providing assistance to Red Cross / RedCrescent National Societies to identify any potential risks associated with their involvement in ablood programme, and provide specialist support to help address any risk areas.GAP interacts with all 190 Red Cross / Red Crescent National Societies, as well as the IFRC, and fitssquarely within the medical foundation of the Red Cross / Red Crescent Movement.In 2018, GAP member countriesaccount for approx 26% of the worldspopulation and collect approx 18% ofall blood donations globally each yearGAP would like to acknowledge the following articles by Hantchef which assisted in the development of this historical timeline:1. Z. S. Hantchef (1961). The gift of blood and some international aspects of blood transfusion. International Review of the Red Cross, 1, pp 355-370 doi:10.1017/S00208604000097242. Z. S. Hantchef (1974). The Red Cross and new developments in blood transfusion. International Review of the Red Cross, 14, pp 337-343 doi:10.1017/S00208604000189943HISTORY OF RED CROSS / RED CRESCENT IN BLOODHISTORY OF RED CROSS / RED CRESCENT IN BLOOD4Why Global Mapping?Determining the level of involvement of all National Societies in their countrys bloodprogram through the Global Mapping survey is a precursor to the GAP Self-assessmentprocess and is also used to inform GAPs disaster response management protocols.This enables rapid assessment of the potential impact of a disaster on a NationalSociety blood program, and to determine the extent of support that may be required ifthe blood service is affected.Blood program riskIn August 2009, GAP was asked by the IFRC to provide a review of the risks associated with NationalSociety blood service activities. GAPs analysis of the Self-assessment results received since 2003revealed that significant risks existed in many of the responding National Societies across the tenspecific issues canvassed by the Self-assessment and that the highest level of risk was faced byNational Societies operating full blood services (Level A).The blood risk review report submitted to the IFRC concluded that there were seven areas of significantrisk facing National Society blood service (and IFRC):1. A lack of government protection for blood borne disease transmission and/or appropriate insurance cover to reduce financial risk2. The inability to meet either regulatory or national standardsGAP Self-assessment3. A lack of funding and resources which affected National Societys ability to put in place riskmanagement and donor and product safety systems/processesGAPs main tool when working with National Society Blood Services is the Self-assessment4. A lack of systems for the identification, analysis, evaluation, prioritisation and management of risksquestionnaire. The aim of the Self-assessment is to assist National Societies to ensure that appropriate5. Ineffective governance leading to significant risks in lack of assurance and leadershipsteps are taken to support the long term stability and sustainability of their blood service without6. A lack of appropriate systems to monitor emerging threats to the blood supplyexposing the National Society to any unnecessary risks. It is considered critical to understanding aNational Society Blood Services operations and allows them to:Measure their own performance against international benchmarks;Identify where they are performing well and where improvements can be made; andIdentify whether it is appropriate that they continue their involvement in blood service activitiesIt is a National Societys responsibility to manage the risks associated with its blood service activities.National Society Blood Services that participate in the Self-assessment receive a feedback reportthat:Provides the blood services with an individual analysis of their Self-assessment results, highlightingpotential corporate governance and risk management issues which may need to be addressed,andOffers recommendations and strategies for the consideration of the blood service that it canincorporate into its organisational and risk management planning.7. A failure to provide meaningful practical support for victims of blood borne disease transmission which goes to the very reputation of the Red Cross / Red Crescent as a humanitarian organisationGAP continues to monitor these risks through its Self-assessment process and through individualsupport to National Societies most in need.GAPs tools and resources, including the Self-assessmentquestionnaire and GAP Manual, can be downloaded from theGAP website - www.globaladvisorypanel.orgGAP ManualIn addition to the Self-assessment, in 2010 GAP developed and released a Blood Program ManualSubject to whether GAP receives sufficient Self-assessments from a region to adequately de-identifyas guidance for National Societies to use in risk management and governance of their blood services.the participants, blood service may also receive a regional Self-assessment report which will allowThe GAP Manual supports National Societies to manage their involvement in blood programs inthem to compare their results with other unidentified blood services. The regional report also identifiesregional themes and shared challenges.The GAP Self-assessment has been acknowledged by National Societies involved in blood servicesto be an extremely useful tool for their blood service risk management.5WHY GLOBAL MAPPING?accordance with the International Federations blood policy and principles and in the best interestsof donors and recipients. Its chapters include guidance and recommendations on blood programmanagement, building a sustainable donor base, blood safety, quality management, partnerships andsustainability, and provides reference to supporting materials.WHY GLOBAL MAPPING?6Role of blood in disasters - GAPs perspectiveNepal earthquake - April 2015In countries where the National Society runs the blood program, GAP has an agreed role with IFRCFollowing the devastating earthquake in Nepal in April 2015, the Nepal Red Cross Society (NRCS)to provide coordination assistance to the affected National Society Blood Service for the recovery ofrequested that GAP take on an advisory role for the rebuild and recovery of the NRCS National Bloodtheir blood program in the event of a disaster. This includes assessment of need and coordination ofTransfusion Service (NBTS)bilateral Partner National Society support programs to minimise duplication of effort.This advisory and technical coordination role supports the NRCS NBTS development in conjunctionA disaster situation for a blood service may include a natural disaster (e.g. earthquake, flood, cyclone,with the associated partner National Societies, facilitating the optimal use of available funds in Nepalfire); a disease outbreak (e.g. Ebola); or a major equipment malfunction or supply shortage; and mayand providing transparency of multiple partner programs to ensure there is no duplication of activityimpact the blood service in a number ways.or investment.Immediate impacts for a blood service post disaster may include:Direct loss or damage to facilities, equipment or other health care infrastructure;Loss of key personnel, for example through loss of life or conflicting priorities in the post disaster situation;Breakdowns in the blood supply chain and/or shortages of critical consumables;Changes to immediate supply needs;The need to manage a higher than normal number of blood donors who want to help and donate when additional blood donations may not actually be required.!If your National Society Blood Service is directly impacted by adisaster event and you require assistance or support, contact GAPwithin 24 hours - gapsecretariat@redcrossblood.org.auAfter the initial disaster response phase is over, blood services may continue to be affected bythe disaster through changes to their regular blood demand profile, for example as a result of:Increased foreign medical support in health care driving changes to demand, including new blood component requests and/or increasing volume of orders,Post disaster disease outbreaks (e.g. Dengue) driving new product requirements.GAP members providing support to the NepalRed Cross Blood Service as part of the GAPPost-earthquake recovery programIn the longer term, the capacity of staff and the blood service to provide an adequate andsustainable blood service may require ongoing technical support, including:Consolidation of lessons learned from the disaster response and development of a disaster preparedness plan for blood, for improved response / management in future disaster situations.Governance and management support for coordination of the national blood program with a focus on strengthening the central blood service first, and then cascading to regional sites as part of a hub and spoke model. This model supports sustainability of blood services in a country.Training across functional areas, including quality assurance, SOPS etc.The rebuilding of new permanent facilities.Support for the purchase, installation and training for required critical equipment and materials.7ROLE OF BLOOD IN DISASTERS - GAPS PERSPECTIVEROLE OF BLOOD IN DISASTERS - GAPS PERSPECTIVE8Level of involvement of all National Societies by regionGlobal Mapping results summary60All 190 National Societies were invited to participate inthe GAP global mapping survey between 2015 - 2018.of National Societies providedinformation for the surveyNumber of Countries97% (185 of 190)50403020100AfricaAmericasAsia Pacific161723123713100191412No ResponseNilLevel CLevel BLevel AEurope &Central Asia01410209MENA23454No Response 5 NS (3%)Level A (full blood service - collection, processing, testing, distribution)Nil27 NS (14%)Level B (regular recruitment of voluntary blood donors)Level A36 NS (19%)National Society (NS) involvementin blood programs by level(total number NS = 190)Level C (promotion of voluntary non-remunerated blood donation - VNRBD)Nil (no involvement)No response to the global mapping surveyLevel C47 NS (25%)Level B75 NS (39%)9GLOBAL MAPPING RESULTS SUMMARYGLOBAL MAPPING RESULTS SUMMARY10National Society involvement in blood programsLevel A (full blood service - collection, processing, testing, distribution)Level B (regular recruitment of voluntary blood donors)Level C (promotion of voluntary non-remunerated blood donation - VNRBD)Nil (no involvement)No response to the global mapping surveyNo National Society11GLOBAL MAPPING RESULTS SUMMARYGLOBAL MAPPING RESULTS SUMMARY12Focus on Level A National Society Blood ServicesThere are 36 Level A National Society Blood Services globallyLevel A National Society Blood Services may be involved in the following activities:Blood service governanceAdvocacy for appropriate use of blood productsBlood product distributionLaboratory testingBlood component preparationBlood collection services/donor careBlood donor recruitmentPromotional campaignsEducation and awarenessInvolvement in World Blood Donor DayMENA1Number of National Societieswho have achieved 100% VNRBD0No. of National Societies thatcollect 100% countrys supplyAMERICA4IsraelSuriname, America,El Salvador, Guatamala2EUROPE & CENTRAL ASIA9of the worlds population issupported by Level A NationalSociety Blood Services>22 millionunits of whole blood arecollected by Level A NationalSocieties worldwide each year3No. of National Societies thatcollect 100% countrys supplySuriname, HaitiNumber of National Societieswho have achieved 100% VNRBDAustria, Belgium, Finland,Germany, Italy, Luxembourg, Spain,Switzerland, Turkey>1 billionNumber of National Societieswho have achieved 100% VNRBDEurope &Central Asia= 9 (25%)MENA=4(11%)AFRICAAmericas= 10 (28%)No. of National Societies thatcollect 100% countrys supplyAsia Pacic *= 12 (33%)1Number of National Societieswho have achieved 100% VNRBDBeninFinland, Luxembourg, SwitzerlandAfrica = 1 (3%)0No. of National Societies thatcollect 100% countrys supplyASIA PACIFIC1322% (8/36)53% (19/36)of Level A National SocietyBlood Services provide 100% ofthe blood supply in their countryof Level A National Society BloodServices have achieved 100%voluntary blood donationFOCUS ON LEVEL A NATIONAL SOCIETY BLOOD SERVICES4Number of National Societieswho have achieved 100% VNRBDAustralia, Japan,South Korea, Thailand3No. of National Societies thatcollect 100% countrys supplyAustralia, Japan, Laos* Does not include the Hong Kong Red Cross (Branch of the Red Cross Society of China):Hong Kong Red Cross also operates a Level A National Society Blood Service which collects100% of Hong Kongs blood supply and has achieved 100% VNRBD.FOCUS ON LEVEL A NATIONAL SOCIETY BLOOD SERVICES14CONTENTSHistory of the Red Cross / Red Crescent in blood1Why Global Mapping?...5Role of blood in disasters GAPs perspective7Global Mapping Results Summary 9Focus on Level A National Society Blood Services13AFRICAREGIONAL SUMMARY ................................................................................................................ 15AFRICA - LEVEL ABenin ............................................................................................................................................ 17AFRICA - LEVEL BBotswana ...................................................................................................................................... 20Burkina Faso................................................................................................................................. 22Burundi ......................................................................................................................................... 24Cameroon ..................................................................................................................................... 26Central African Republic ............................................................................................................... 28Chad ............................................................................................................................................. 30Congo, Democratic Republic of the ............................................................................................... 32Congo, Republic of ....................................................................................................................... 34Cte d'Ivoire .................................................................................................................................. 36Ghana ........................................................................................................................................... 38Guinea .......................................................................................................................................... 40Guinea-Bissau .............................................................................................................................. 42Kenya ........................................................................................................................................... 44Liberia ........................................................................................................................................... 46Madagascar .................................................................................................................................. 48Malawi .......................................................................................................................................... 50Rwanda ........................................................................................................................................ 52Sao Tome and Principe................................................................................................................. 54Sierra Leone ................................................................................................................................. 56South Sudan ................................................................................................................................. 58Tanzania ....................................................................................................................................... 60Togo ............................................................................................................................................. 62Uganda ......................................................................................................................................... 64AFRICA - LEVEL CCape Verde (Cabo Verde) ............................................................................................................ 66Comoros ....................................................................................................................................... 68Djibouti.......................................................................................................................................... 69Ethiopia ......................................................................................................................................... 71Gabon ........................................................................................................................................... 73Gambia ......................................................................................................................................... 75Lesotho ......................................................................................................................................... 77Mauritania ..................................................................................................................................... 79Mozambique ................................................................................................................................. 81Niger ............................................................................................................................................. 83Nigeria .......................................................................................................................................... 85Senegal ........................................................................................................................................ 87Seychelles .................................................................................................................................... 89Somalia ......................................................................................................................................... 91Sudan ........................................................................................................................................... 93Zambia.......................................................................................................................................... 95Zimbabwe ..................................................................................................................................... 97AFRICA - NIL (NO INVOLVEMENT)Angola ........................................................................................................................................ 100Mali ............................................................................................................................................. 102Mauritius ..................................................................................................................................... 104Namibia ...................................................................................................................................... 106South Africa ................................................................................................................................ 108Swaziland ................................................................................................................................... 110AFRICA - NO RESPONSEEquatorial Guinea ....................................................................................................................... 112AMERICASREGIONAL SUMMARY .............................................................................................................. 113AMERICAS - LEVEL AColombia .................................................................................................................................... 115Dominican Republic .................................................................................................................... 117Ecuador ...................................................................................................................................... 119El Salvador ................................................................................................................................. 122Guatemala .................................................................................................................................. 124Haiti ............................................................................................................................................ 126Honduras .................................................................................................................................... 128Mexico ........................................................................................................................................ 130Suriname .................................................................................................................................... 132United States of America ............................................................................................................ 134AMERICAS - LEVEL BAntigua and Barbuda .................................................................................................................. 137Belize .......................................................................................................................................... 139Chile ........................................................................................................................................... 141Costa Rica .................................................................................................................................. 143Cuba ........................................................................................................................................... 145Dominica ..................................................................................................................................... 147Guyana ....................................................................................................................................... 149Jamaica ...................................................................................................................................... 151Nicaragua ................................................................................................................................... 153Paraguay .................................................................................................................................... 155Peru ............................................................................................................................................ 157Saint Lucia .................................................................................................................................. 159Saint Vincent and the Grenadines ............................................................................................... 161AMERICAS - LEVEL CArgentina .................................................................................................................................... 163Bahamas .................................................................................................................................... 165Bolivia ......................................................................................................................................... 167Brazil........................................................................................................................................... 169Panama ...................................................................................................................................... 171Trinidad and Tobago ................................................................................................................... 173Uruguay ...................................................................................................................................... 175AMERICAS - NIL (NO INVOLVEMENT)Barbados .................................................................................................................................... 177Canada ....................................................................................................................................... 179Saint Kitts and Nevis ................................................................................................................... 181AMERICAS - NO RESPONSEGrenada...................................................................................................................................... 183Venezuela ................................................................................................................................... 185ASIA PACIFICREGIONAL SUMMARY .............................................................................................................. 187ASIA PACIFIC - LEVEL AAustralia ...................................................................................................................................... 189Bangladesh ................................................................................................................................. 192Hong Kong .................................................................................................................................. 195India ............................................................................................................................................ 198Indonesia .................................................................................................................................... 201Japan .......................................................................................................................................... 204Laos ............................................................................................................................................ 207Nepal .......................................................................................................................................... 209Pakistan ...................................................................................................................................... 212Philippines .................................................................................................................................. 215South Korea (Republic of Korea) ................................................................................................ 218Thailand ...................................................................................................................................... 221Vietnam ...................................................................................................................................... 225ASIA PACIFIC - LEVEL BChina .......................................................................................................................................... 227Cook Islands ............................................................................................................................... 230Fiji ............................................................................................................................................... 232Kiribati......................................................................................................................................... 234Malaysia ..................................................................................................................................... 236Micronesia, Federated States of ................................................................................................. 239Mongolia ..................................................................................................................................... 241Palau .......................................................................................................................................... 244Samoa ........................................................................................................................................ 246Singapore ................................................................................................................................... 248Solomon Islands ......................................................................................................................... 251Timor-Leste................................................................................................................................. 254Tonga ......................................................................................................................................... 256Tuvalu ......................................................................................................................................... 258ASIA PACIFIC - LEVEL CAfghanistan ................................................................................................................................. 260Brunei Darussalam ..................................................................................................................... 262Cambodia ................................................................................................................................... 264Maldives ..................................................................................................................................... 267Myanmar (formerly Burma) ......................................................................................................... 269North Korea (Democratic Peoples Republic of Korea) ................................................................ 271Papua New Guinea ..................................................................................................................... 273Sri Lanka .................................................................................................................................... 275Vanuatu ...................................................................................................................................... 277ASIA PACIFIC - NIL (NO INVOLVEMENT)New Zealand ............................................................................................................................... 279EUROPE AND CENTRAL ASIAREGIONAL SUMMARY .............................................................................................................. 281EUROPE AND CENTRAL ASIA - LEVEL AAustria ........................................................................................................................................ 283Belgium....................................................................................................................................... 285Finland ........................................................................................................................................ 288Germany ..................................................................................................................................... 291Italy ............................................................................................................................................. 294Luxembourg ................................................................................................................................ 296Spain .......................................................................................................................................... 298Switzerland ................................................................................................................................. 301Turkey......................................................................................................................................... 303EUROPE AND CENTRAL ASIA - LEVEL BAlbania ........................................................................................................................................ 306Azerbaijan ................................................................................................................................... 308Bosnia and Herzegovina ............................................................................................................. 310Croatia ........................................................................................................................................ 312Cyprus ........................................................................................................................................ 314Czechia (Czech Republic) ........................................................................................................... 316Georgia ....................................................................................................................................... 318Hungary ...................................................................................................................................... 320Kazakhstan ................................................................................................................................. 322Latvia .......................................................................................................................................... 324Liechtenstein............................................................................................................................... 326Macedonia .................................................................................................................................. 328Montenegro................................................................................................................................. 330Norway ....................................................................................................................................... 332Poland ........................................................................................................................................ 334Russia......................................................................................................................................... 336Serbia ......................................................................................................................................... 338Slovakia ...................................................................................................................................... 340Slovenia ...................................................................................................................................... 342Uzbekistan .................................................................................................................................. 344EUROPE AND CENTRAL ASIA - LEVEL CAndorra ....................................................................................................................................... 346Belarus ....................................................................................................................................... 348Bulgaria ...................................................................................................................................... 350Estonia........................................................................................................................................ 352Kyrgyzstan .................................................................................................................................. 354Malta ........................................................................................................................................... 356Moldova, Republic of .................................................................................................................. 358Romania ..................................................................................................................................... 361Tajikistan .................................................................................................................................... 363Ukraine ....................................................................................................................................... 365EUROPE AND CENTRAL ASIA - NIL (NO INVOLVEMENT)Armenia ...................................................................................................................................... 367Denmark ..................................................................................................................................... 369France ........................................................................................................................................ 371Greece ........................................................................................................................................ 373Iceland ........................................................................................................................................ 375Ireland......................................................................................................................................... 377Lithuania ..................................................................................................................................... 379Monaco ....................................................................................................................................... 381Netherlands, the ......................................................................................................................... 383Portugal ...................................................................................................................................... 385San Marino ................................................................................................................................. 387Sweden ....................................................................................................................................... 389Turkmenistan .............................................................................................................................. 391United Kingdom .......................................................................................................................... 393MIDDLE EAST AND NORTHERN AFRICA (MENA)REGIONAL SUMMARY .............................................................................................................. 395MENA - LEVEL AEgypt .......................................................................................................................................... 397Israel ........................................................................................................................................... 400Jordan......................................................................................................................................... 403Lebanon ...................................................................................................................................... 405MENA - LEVEL BAlgeria ........................................................................................................................................ 408Bahrain ....................................................................................................................................... 410Iran ............................................................................................................................................. 412Iraq ............................................................................................................................................. 415Morocco ...................................................................................................................................... 417MENA - LEVEL CLibya ........................................................................................................................................... 419Qatar........................................................................................................................................... 421Tunisia ........................................................................................................................................ 423Yemen ........................................................................................................................................ 425MENA - NIL (NO INVOLVEMENT)Palestinian Occupied Territory .................................................................................................... 427Saudi Arabia ............................................................................................................................... 429Syria ........................................................................................................................................... 431MENA - NO RESPONSEKuwait ......................................................................................................................................... 433United Arab Emirates .................................................................................................................. 435APPENDIX 1- Global Mapping Survey ..................................................................................... 437AFRICANATIONAL SOCIETY (NS) INVOLVEMENT IN BLOODPROGRAMS BY LEVELNo response1 NS (2%)Level A1 NS (2%)Nil6 NS (13%)Level C17 NS (35%)Level B23 NS (48%)TOTAL NUMBER NS = 4815AFRICAAFRICAFOCUS ON LEVEL A NATIONAL SOCIETY BLOOD SERVICESIN THE REGIONThere is only one Level A country in the regionBENINVNRBD rate is 100%The NSBS provides 35% of the national blood supplyAFRICA16AFRICA LEVEL ABENINRed Cross of Benin:Level A (undertakes full blood service provision)35% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationWestern AfricaGeographical size ranking1103rdPopulation (world ranking)111 million (82nd)Median age118.2Political system1Presidential republicGDP per capita (worldranking)1$2,200 (204th)HDI Index (world ranking)20.485 - low (167th)Health Expenditure14.6% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Moderate: 1.5-3.5%Population prevalence HIV51.00% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe blood program in Benin falls under the governments Ministry of Health and consists of theNational Blood Transfusion Service, Departmental Blood Transfusion Services, blood banks, andhealth facility transfusion posts.6 Approximately 86.5% of the national blood product demand is metwhen there are blood products available.6Data from 2013 indicates that there are approximately 40 blood centres in the country (6 stand-aloneand 34 hospital-based).7The number of whole blood donations in 2013 was 77,510 which included 74,016 VNRBD donorsand 3494 family/replacement donations.7 The majority of blood transfused nationally is whole blood.7The Benin national blood program has7:17a specific unit within the Ministry of Health responsible for monitoring blood activitiesa system of blood cost recoverynational standards for the collection, testing, processing, storage and distribution of bloodproductsnational guidelines on the clinical use of bloodAFRICAAFRICA LEVEL AAccording to the 2016 World Health Organisation (WHO) Global Status Report on blood safety andavailability, the national blood transfusion service received international agency financial or technicalsupport during the period of 2011-2013 from the following agencies7:Agence Belge de DveloppementAPEFE (Association pour la Promotion de lEducation et de la Formation lEtranger),WBI (Wallonie-Bruxelles International)Bavarian Red CrossWHO 7NATIONAL SOCIETY (RED CROSS OF BENIN)The Red Cross of Benin (CRBe):operates two blood banks (in Parakou and Porto-Novo)annually collects 13,000-15,000 units of whole blood (2017)collects 35% of the national blood supply (65% is collected by the National Blood TransfusionAgency)processes collected blood into componentsconducts screening testing of blood for infectious disease and blood groupingconducts cross-matching for transfusionforwards plasma to a fractionation facilitydoes perform transfusionsis working towards accreditationdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the country (support from the German Red Cross ended in 2014)is not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, solid organs and corneasis planning to expand its current level of involvement in blood-related activitiesBlood donor recruitment and retention activities are coordinated nationally, through the districts andlocally by the National Society. They are funded by the government, National Society, blood serviceand privately. Paid staff and volunteers are used to undertake recruitment programs, such as school/university and corporate programs.The CRBe provides technical, material and logistical support to the blood banks and technicalsupport to blood donor associations (for training and graduation). They are a member of the BloodBank Management Committee and there is an agreement between the Ministry of Health and CRBefor the management of blood banks in Benin.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bn.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-bAFRICA18AFRICA LEVEL A4Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Republic of Benin, Ministry of Health General Secretariat, Directorate of Planning & Forecasting. National HealthDevelopment Plan (2009-2018) [Internet] Republic of Benin [cited 2018 Feb 01] Available from:http://www.nationalplanningcycles.org/sites/default/files/country_docs/Benin/benin_pnds_20092018_last_year_version_-_en_1.pdf7 World Health Organization. The 2016 Global Status Report on Blood Safety and Availability. [Internet] World HealthOrganization 2017 [cited 2018 Feb 01] Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf?ua=119AFRICAAFRICA LEVEL BBOTSWANABotswana Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking149thPopulation (world ranking)12.2 million (145th)Median age124.5Political system1Parliamentary republicGDP per capita (worldranking)1$18,100 (96th)HDI Index (world ranking)20.698 - medium (108th)Health Expenditure15.4% of GDPPopulation prevalencehepatitis BNo current data availablePopulation prevalencehepatitis C3Low Moderate: 1.0% <2.0%Population prevalence HIV421.9% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Service (NBTS) falls under the responsibility of the Ministry of Healthand is the single provider of blood and blood products in Botswana.5 Botswana has a national policyon blood transfusion principles based on 100% VNRBD.5 There is no cost to patients receiving ablood transfusion as the Botswana government supports all associated costs.6There are two centres operating under the NBTS the National Blood Transfusion Centre inGaborone and the Francistown Regional Blood Transfusion Centre.5Each centre consists of 5:Blood Donor Section Responsible for recruitment, counselling, collection, apheresis anddonor relationsLaboratory Section Responsible for testing, grouping, components and dispatchQuality Section Responsible for quality, safety health and environment, and trainingcoordinationDecentralization of blood collection started in August 2013 with collections being undertaken inMolepolole, Mahalapye, Serowe-Palapye and Maun.5AFRICA20AFRICA LEVEL BIn 2013, there were 20,207 blood donations5, though the Ministry of Health states the minimumrequirement for blood is 40,000 units annually.6There are approximately 8,000 donors who have donated in the last two years.6The Blood Donor Relation Unit recalls donors through SMS and email.5Every blood donation is tested for HIV, Hepatitis B and C and Syphilis.6NATIONAL SOCIETY (BOTSWANA RED CROSS)Blood donor recruitment and retention activities are coordinated nationally by the National Society.However, there is no longer funding for recruitment and retention activities which the Botswana RedCross Society was integrating into its service.Volunteers are used for recruitment, with technical assistance from staff. Recruitment programsinclude school/university programs and Club 25.Botswana Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis planning to expand its current level of involvement in blood-related activities to help meetthe countries requirement of 40,000 pints of blood annually, through:o expanding to other branches which did not register with the Society for betterrecruitment from the communityo partnering with schools and youth clubs in villages, to plan together and see how theycan assist each othero working more on the pledge 25 as it is preventing further infectionshas not previously been involved in blood at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bc.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c4 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html5Ministry of Health. Botswana. National Blood Transfusion Service Overview.http://www.moh.gov.bw/Publications/Overview%20of%20Blood%20Transfusion%20Services.pdf6 Republic of Botswana. Ministry of Health. National Blood Transfusion Service (NBTS) [Internet] Government ofBotswana 2011 [cited 2018 Feb 01]. Available from:http://www.gov.bw/en/Ministries--Authorities/Ministries/MinistryofHealth-MOH/Tools--Services/Services--forms/WorldWar--II-WWII-Veterans-Allowance/21AFRICAAFRICA LEVEL BBURKINA FASOBurkinabe Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationWestern AfricaGeographical size ranking176thPopulation (world ranking)120.1 million (59th)Median age117.3Political system1Presidential republicGDP per capita (worldranking)1$1,900 (209th)HDI Index (world ranking)20.402 - low (185th)Health Expenditure15% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV50.8% among adults aged 15 to49NATIONAL BLOOD PROGRAMThe CNTS (Centre National de Transfusion Sanguine-National Blood Transfusion Centre) in BurkinaFaso provides 53% of the national blood supply.6 The remaining 47% is produced by independenthospital blood banks.6 In 21.4% of non-CNTS sites, blood donation is restricted to replacement(family) donors.6In 2010 98.4% of blood was separated into components. 7 Donations are tested for HIV, HBV, HCVand syphilis.7In 2013 there were a total of 100,716 blood donations nationwide with 68,032 coming from voluntarydonors.8AFRICA22AFRICA LEVEL BNATIONAL SOCIETY (BURKINABE RED CROSS)GAP records for Burkina Faso indicate that the Burkinabe Red Cross Society (CRBF) werepreviously involved at Level A (2008).The CRBF actively promotes blood donation through awareness-raising activities in severalbranches. Volunteers also contribute to mobile blood collection in collaboration with the regionalblood transfusion centres through donor mobilisation and campaign coordination. All blood bankactivities are managed by the Ministry of Health, though the CRBF is present on the board ofdirectors for the National Blood Transfusion Centre.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/uv.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Nbi K1, Ouattara S, Sanou M, Kientega Y, Dahourou H, Ky L, Kienou K, Diallo S, Bigirimana F, Fretz C, Murphy EL,Lefrre JJ., Poor procedures and quality control among nonaffiliated blood centers in Burkina Faso: an argument forexpanding the reach of the national blood transfusion center. Transfusion 2011 Jul: 51(7 Pt2).https://www.ncbi.nlm.nih.gov/pubmed/217365827 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2017 October 31]. Available from:http://www.afro.who.int/sites/default/files/2017-06/status-of-blood-safety-in-the-who-african-region.pdf8 World Health Organization. The 2016 Global Status Report on Blood Safety and Availability. [Internet] World HealthOrganization 2017 [cited 2018 Feb 01] Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf?ua=123AFRICAAFRICA LEVEL BBURUNDIBurundi Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AfricaGeographical size ranking1147thPopulation (world ranking)111.4 million (78th)Median age117.0Political system1Presidential republicGDP per capita (worldranking)1$800 (228th)HDI Index (world ranking)20.404 - low (184th)Health Expenditure17.5% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0 - <1.5%Population prevalence HIV51.1% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn Burundi, blood transfusion is provided by the National Blood Transfusion Centre (CNTS)supported by the four Regional Blood Transfusion Centres (CRTS) and 30 blood banks (2009 data).6Though it falls under the Ministry of Public Health, it operates autonomously.7Difficulties faced by the CNTS in the past are generally those seen commonly in similarly placedcountries, and include insufficient human resources and expertise, lack of infrastructure, lack oftraining resources, current standard operating procedures and guides and a lack of computerisedsystems all of which are compounded by limited funds being available.6 Blood safety is alsothreatened by the high prevalence of HIV / AIDS and other blood borne diseases in the population.6Burundi reported having achieved 100% VNRBD in 2008.8 A resurgence of malaria increased thedemand for blood in 2009 which resulted in 53 replacement donors (0.18%) being accepted with theremainder of blood collected from voluntary donors. 6In 2014, budget cuts and bureaucracy were blamed for blood shortages and led to calls for anoverhaul of the transfusion system.9 To collect a minimum average of 4,000 units of blood per month,the CNTS needs an annual US$775,000 to function properly but only received US$370,000 in2014.9,10AFRICA24AFRICA LEVEL BNATIONAL SOCIETY (BURUNDI RED CROSS)The Burundi Red Cross is heavily involved in the recruitment of voluntary donors and conductsoutreach / community education on the voluntary blood donation. It also provides logistical supportduring the blood collection.Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by government or Ministry of Health and by the National Society.The Burundi Red Cross:uses volunteers for donor recruitment programs, such as Club 25does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level Asigned an agreement in 1988 with the Burundian Government through its Ministry for Healthto define the responsibilities of each in relation to the blood serviceis responsible for raising awareness and community mobilization for voluntary blooddonation, while the Burundian Government is responsible for the collection, processing anddistribution of blood to the recipientdoes not plan to expand or scale back its level of blood related activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/by.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Centre National de Transfusion Sanguine- Rapport annuel 2009. (2009 Annual Report of the National TransfusionCentre in Burundi in French). Available from https://www.minisante.bi/index.php/Programs/cnts.7 Republique du Burundi. Centre National de Transfusion Sanguine (CNTS) [Internet] Republique du Burundi 2018 Jan12 [cited 2018 Feb 01]. Available from: https://www.minisante.bi/index.php/programmes/cnts8 World Health Organization. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organization 2011 Jun [cited 2018 Feb 01]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=19 IRIN. Blood woes in Burundi. IRIN News [Internet] 2017 Aug 27 [cited 2018 Feb 01]. Available from:http://www.irinnews.org/report/100544/blood-woes-burundi10 Cavallaro A. Burundis blood shortage. Borgen Magazine. [Internet] 2014Sept 18 [cited 2018 Feb 01]. Available from:http://www.borgenmagazine.com/burundis-blood-shortage/25AFRICAAFRICA LEVEL BCAMEROONCameroon Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AfricaGeographical size ranking155thPopulation (world ranking)124.9 million (53rd)Median age118.5Political system1Presidential republicGDP per capita (worldranking)1$3,400 (188th)HDI Index (world ranking)20.518 - low (153rd)Health Expenditure14.1% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV53.8% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Program (NBTP) was created by a Prime Ministerial order on 18March 2013 and is the responsibility of the Ministry of Public Health.6 Through the US PresidentsEmergency Plan for AIDS Relief (PEPFAR) program, the U.S. Government has been providingfinancial and technical support for increased blood collection using mobile collection units and alsoincreasing the capacity and infrastructure of blood services to store, test, treat, distribute andtransfuse blood and blood products that are safe.7From 2016, PEPFAR started to transition the responsibility of blood donor mobilisation, advocacyand blood collection back to the Government of Cameroon.7 By end of 2017, it was planned thatanother 15 blood banks were transitioned back to the government, as the Ministry of Health regainedfiscal responsibility for them.7AFRICA26AFRICA LEVEL BNATIONAL SOCIETY (CAMEROON RED CROSS)In 2016, 3961 people donated blood with the assistance of the Cameroon Red Cross Society, anincrease from 180 the year before.8Blood donor recruitment and retention activities are nationally coordinated by the National Society,and are funded by the government and National Society.The Cameroon Red Cross Society:use volunteers for donor recruitment programs (school / university, corporate programs, Club25 still in experimentation)does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Awith financial support it is planning to expand its level of involvement in blood related activitiesto make blood available for treatment of diseases such as malaria, cancer, childbirthcomplications, accidents and disasters1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from:. https://www.cia.gov/library/publications/the-world-factbook/geos/cm.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 World Health Organisation Africa, Cameroon. National Blood Transfusion Program [Internet] World Health Organization2013 [cited 2018 Feb 01]. Available from: http://www.afro.who.int/news/national-blood-transfusion-program7 United States Department of State. Cameroon Country/Regional Operational Plan COP/ROP 2015 Strategic DirectionSummary [Internet] 2015 Aug 07 [cited 2018 Feb 01]. Available from:https://www.pepfar.gov/documents/organization/250280.pdf8 The International Federation of Red Cross and Red Crescent Societies. Cameroon Red Cross Society [Internet] TheInternational Federation of Red Cross and Red Crescent Societies 2016 [cited 2018 Feb 01]. Available from:http://data.ifrc.org/fdrs/societies/cameroon-red-cross-society27AFRICAAFRICA LEVEL BCENTRAL AFRICAN REPUBLICCentral African Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AfricaGeographical size ranking146thPopulation (world ranking)15.6 million (115th)Median age119.7Political system1Presidential republicGDP per capita (worldranking)1$700 (229th)HDI Index (world ranking)20.352 - low (188th)Health Expenditure14.2% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV54% among adults aged 15 to49NATIONAL BLOOD PROGRAMThe National Centre of Blood Donation in the Central African Republic is run by the HealthDepartment. Central African Republic reported having achieved 100% VNRBD in 2008 6, but a rate of68% was reported in 2010. 7In 2010, 100% of blood was separated into components.7NATIONAL SOCIETY (CENTRAL AFRICAN RED CROSS)The Central African Red Cross has a close relationship with the Ministry of Health (MoH), recruitingblood donors from the population and Red Cross volunteers (12,000)In 2015, 333 people donated blood with the assistance of the Central African Red Cross Society,this was a decrease from 460 in 2014.8Donor recruitment activities include educational campaigns, media and local communications intowns.AFRICA28AFRICA LEVEL B1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Availablefrom:https://www.cia.gov/library/publications/the-world-factbook/geos/ct.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 14].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 14] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 14] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] 2011 [cited 2018 Feb 14]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=17 Tapko JB, Toure B, Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2018 Feb 14]. Available from: http://www.afro.who.int/sites/default/files/201706/status-of-blood-safety-in-the-who-african-region.pdf8 The International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and ReportingSystem. National Society Profiles - Central African Red Cross Society [Internet] 2016 [cited 2018 Feb 14]. Available from:http://data.ifrc.org/fdrs/societies/central-african-red-cross-society29AFRICAAFRICA LEVEL BCHADRed Cross of Chad:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AfricaGeographical size ranking122ndPopulation (world ranking)112 million (75th)Median age117.8Political system1Presidential republicGDP per capita (worldranking)1$2,400 (199th)HDI Index (world ranking)20.392 - low (185th)Health Expenditure13.6% of GDPPopulation prevalencehepatitis B311.8%Population prevalencehepatitis C4High: 5%Population prevalence HIV51.3% among adults aged 15 to49NATIONAL BLOOD PROGRAMChadina National Blood Transfusion Center was established in 1972. 6 In 2016, the voluntarydonation rate was reported as 14% for the capital NDjamena, and 5% for the whole country.6In 2013, there was a total of 69,265 blood donations, with 4,310 of those from voluntary donors(approximately 6% VNRBD).7NATIONAL SOCIETY (RED CROSS OF CHAD)In 2016, 500 people donated blood with the assistance of the Red Cross of Chad. 8Blood donor recruitment and retention activities are coordinated nationally and funded by theNational Society.The Red Cross of Chad:uses volunteers for donor recruitment programs such as Club 25does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved in blood at Level Ais planning to expand its level of involvement in blood-related activitiesAFRICA30AFRICA LEVEL B1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/cd.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Bigna JJ, Amougou MA, Asangbeh SL, Kenne AM, Noumegni SR, Ngo-Malabo ET, Noubiap JJ. Seroprevalence ofhepatitis B virus infection in Cameroon: a systematic review and meta-analysis BMJ Open [Internet]. 2017 [cited 2018Feb 01]; 7:e015298. Available from: http://bmjopen.bmj.com/content/7/6/e015298 D.O.I: 10.1136/bmjopen-2016-0152984 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 UN staff launch blood donation campaign. News Ghana [Internet] 2016 Oct 21 [cited 2018 Feb 01]. Available from:https://www.newsghana.com.gh/un-staff-in-chad-launch-blood-donation-campaign/7 World Health Organization. The 2016 Global Status Report on Blood Safety and Availability. [Internet] World HealthOrganization 2017 [cited 2018 Feb 01] Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf?ua=18 The International Federation of Red Cross and Red Crescent Societies. Red Cross of Chad [Internet] The InternationalFederation of Red Cross and Red Crescent Societies 2016 [cited 2018 Feb 01]. Available from:http://data.ifrc.org/fdrs/societies/red-cross-of-chad31AFRICAAFRICA LEVEL BCONGO, DEMOCRATIC REPUBLICOF THERed Cross of the Democratic Republic of the Congo:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AfricaGeographical size ranking112thPopulation (world ranking)183.3 million (16th)Median age118.6Political system1Semi-presidential republicGDP per capita (worldranking)1$800 (227th)HDI Index (world ranking)20.435 - low (176th)Health Expenditure14.3% of GDPPopulation prevalencehepatitis B3High Intermediate: 5% - 7%Population prevalencehepatitis C4High Moderate: 2.0% - <5.0%Population prevalence HIV50.7% among adults aged 15to 49NATIONAL BLOOD PROGRAMA national blood transfusion policy is in place and the Ministry of Health coordinates transfusionactivities in each province through their national technical office.Error! Bookmark not defined.From 2001 to 2012, there was major progress made in blood transfusion safety and activities 112,882 volunteer blood donors were mobilized; more than 80% of blood products were checked forsafety; all blood needs were covered; and 7560 people were trained in blood transfusion.Error!Bookmark not defined.AFRICA32AFRICA LEVEL BNATIONAL SOCIETY (RED CROSS OF THE DEMOCRATIC REPUBLIC OF THECONGO)The Red Cross of the Democratic Republic of the Congo is involved in blood donor recruitmentthrough the mobilization of donors, coordinated from the Red Cross headquarters.They organise voluntary donation campaigns for the various blood banks in Kinshasa wherevolunteers and members of the public come to donate, as well as undertaking recruitment activitiesin various other provinces of DRC. They also work closely with the National Blood TransfusionCentre to do this.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb05]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/cg.html2United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 05]. Available from: http://hdr.undp.org/en3Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 05] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 05] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb05]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html33AFRICAAFRICA LEVEL BCONGO, REPUBLIC OFCongolese Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AfricaGeographical size ranking165thPopulation (world ranking)14.9 million (122nd)Median age119.7Political system1Presidential republicGDP per capita (worldranking)1$6,700 (162nd)HDI Index (world ranking)20.592 - medium (135th)Health Expenditure15.2% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV53.1% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe French government contributed to the costs of establishing the National Blood TransfusionCentre (Centre National de Transfusion Sanguine) in Brazzaville, a regional centre in Pointe-Blackand eight transfusion posts at outlying regional sites.6As part of the countrys efforts to address the spread of HIV/AIDS, the World Bank renovated theNational Blood Transfusion Centre and presented it to the Congolese government in September2003.7In 2010 35.5% of donations were VNRBD, and 20.5% of donations were separated intocomponents.8Ebola virus has been present in the northern region of the country.9NATIONAL SOCIETY (CONGOLESE RED CROSS)The Congolese Red Cross works with the National Centre for Blood Transfusion in the Congo andis the primary source for mobilizing blood donors through their volunteers.Improving blood donor supply and educating donors on healthy, risk-free behaviours was one of thelong term planning outputs for 2012-2015 for the Congolese Red Cross.10AFRICA34AFRICA LEVEL B1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb05]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/cf.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 05]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 05] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 05] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb05]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 IFC Against AIDS Partnerships list. Congo Brazza [Internet] IFC Against AIDS 2003 May 08 [cited 2018 Feb 05].Available from:http://allafrica.com/download/resource/main/main/idatcs/00010431:4c66711496c657de397e42a34f47310f.pdf7 IRIN. Congo: World Bank rehabilitates Brazzaville blood transfusion centre. IRIN [Internet] UN Office for theCoordination of Humanitarian Affairs 2003 [cited 2018 Feb 05]. Available from: https://reliefweb.int/report/congo/congoworld-bank-rehabilitates-brazzaville-blood-transfusion-centre8 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2017 October 31]. Available from:http://www.afro.who.int/sites/default/files/2017-06/status-of-blood-safety-in-the-who-african-region.pdf9 Revol D. Fighting superstition in Congoos Ebola zone. International Federation of the Red Cross and Red CrescentSocieties [Internet] 2003 Apr 08 [cited 2018 Feb 05]. Available from: http://www.ifrc.org/en/news-and-media/newsstories/africa/congo-republic-of/fighting-superstition-in-congos-ebola-zone/10 International Federation of the Red Cross and Red Crescent Societies. Central Africa 2012-2015 Long Term PlanningFramework 2014 Annual Report [Internet] International Federation of the Red Cross and Red Crescent Societies 2015April 30 [cited 2018 Feb 05]. Available from: http://adore.ifrc.org/Download.aspx?FileId=7994735AFRICAAFRICA LEVEL BCTE D'IVOIRERed Cross Society of Cte d'Ivoire:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collection.NATIONAL CONTEXTLocationWestern AfricaGeographical size ranking170thPopulation (world ranking)124.1 million (54th)Median age120.9Political system1Presidential republicGDP per capita (worldranking)1$3,900 (181st)HDI Index (world ranking)20.474 - low (171st)Health Expenditure15.7% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High Moderate: 2.0% <5.0%%Population prevalence HIV52.70% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Service (NBTS) is responsible for all blood related activitiesincluding donor recruitment and retention, collection, testing, processing, storing and distributingblood and products across the country to over 200 hospitals.6 It performs these tasks as per WHOguidelines.6The national blood system is comprised of a large central blood bank in Abidjan which undertakescollection of blood, testing and distribution.7 There are also another two collection and testing sitesin Daloa and Yamoussoukro.7 In addition, there are 19 collection sites throughout the country and110 blood bank storage units in hospitals.7The NBTS ability to meet the national demand for safe blood has been achieved with the support ofthe US Presidents Emergency Plan for AIDS Relief (PEPFAR) in the following ways6:the acquisition of cold-chain equipmentrehabilitation of laboratories and blood collection sitesexpanding technology for tracking use of blood and blood productsprovision of reagents and other key commodities for testing blood unitssupport for the validation of national blood transfusion guidelines and updating of trainingmodules for health care professionals.6AFRICA36AFRICA LEVEL BThe NBTS is also now able to separate whole blood into blood products and to collect blood directlyinto paediatric-size bags. 6100% VNRBD was reported in Cote d Ivoire in 2008.8 NBTS donor recruitment activities includeestablishing donor groups in schools, churches, and in the workplace. Rigorous pre-screeningquestionnaires are in place to ensure the most low-risk donors are recruited.6Blood shortages and lack of equipment have been reported in some regions.9NATIONAL SOCIETY (RED CROSS OF CTE D'IVOIRE)The Cte d'Ivoire Red Cross supports the Ministry of Health National Blood Transfusion Servicethrough blood donor recruitment and registration, and the organisation of blood collection days.10According to the GAP global mapping survey, the National Society acknowledged that Cte d'Ivoirehas not yet achieved a self-sufficient blood supply and the Red Cross Society would like to contributeto achieving this goal.Community education activities are coordinated nationally and through local branches. They arefunded by the National Society (local branches are self-funding).The Cte d'Ivoire Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis planning to expand its current level of involvement in blood-related activities to developand retain voluntary donor networks through Club 25According to the IFRC Federation-wide databank and reporting system (FDRS), in 2015, 455people donated blood with the assistance of the Red Cross Society of Cte d'Ivoire.111Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/iv.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 PEPFAR Cote dIvoire Operational Plan Report [Internet] 2012 [cited 2017 August 22]. Available from:www.pepfar.gov/documents/organization/145716.pdf7 Delaney, Meghan (Medical Director, Childrens National Health System, Washington DC). Cote dIvoire blood program.Message to: GAP Secretariat (WA). 2017 Nov 28 [cited 2018 Feb 23]. [about 1 screen].8 World Health Organization. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organization 2011 Jun [cited 2018 Feb 01]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=19 Blood shortages causing deaths in the West. IRIN. [Internet]. 2012 January 4 [cited 2017 August 22]. Available from:http://www.irinnews.org/feature/2012/01/04/blood-shortages-causing-deaths-west10 Croix-Rouge Cote DIvore. Don de sang [Internet] Croix-Rouge Cote DIvore 2017 [cited 2017 June 20]. Availablefrom: http://www.croixrougeci.org/don-de-sang/11 The International Federation of Red Cross and Red Crescent Societies. Red Cross Society of Cote dIvoire [Internet]The International Federation of Red Cross and Red Crescent Societies 2016 [cited 2017 August 22]. Available from:http://data.ifrc.org/fdrs/societies/red-cross-society-of-cote-d-ivoire37AFRICAAFRICA LEVEL BGHANAGhana Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collection.NATIONAL CONTEXTLocationWestern AfricaGeographical size ranking183rdPopulation (world ranking)127.5 million (49th)Median age121.1Political system1Presidential republicGDP per capita (worldranking)1$4,600 (173rd)HDI Index (world ranking)20.579 - medium (140th)Health Expenditure13.6% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV51.6% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Ghana National Blood Service is overseen by the Ghana Ministry of Health6. Its directive is asper WHO guidelines for blood safety and to ensure blood products are available to all public andprivate patients in a timely manner, and that they are accessible and affordable6.The National Blood Service coordinates all blood related activities, including processing and supplyof blood and blood products, developing a national haemovigilance system and conducting relevantresearch to promoting 100% VNRBD, developing and implementing a national quality system,monitoring and evaluation of activities and implementing an appropriate information system.6 In 2013,122,943 units were collected; 33% of blood donations are VNRBD; and 67% were fromfamily/replacement donors.7AFRICA38AFRICA LEVEL BNATIONAL SOCIETY (GHANA RED CROSS)In 2013, 800 people donated blood with the assistance of the Ghana Red Cross Society. The GhanaRed Cross Society coordinates donor recruitment and retention activities by district/chapter.Activities are funded by private organisations.The Ghana Red Cross Society:1uses both paid staff and volunteers for donor recruitment programs (youth clubs, Club 25and corporate programs)does not receive technical assistance or financial support for VNRBD activities fromoutside the countryhas not previously been involved at Level Ais not planning to expand their current level of activityCentral Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/gh.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6National Blood Service, Ghana. Service Charter [Internet] National Blood Service 2016 June [cited 2018 Feb 05]. .Available from: http://nbsghana.org/wp-content/uploads/2010/08/NBSG-Service-Charter-08.06.16.pdf7 Mamaye Factsheet on Ghanas blood services 2014 www.mamaye.org/sites/default/files/Blood%20factsheet_2014.pdf39AFRICAAFRICA LEVEL BGUINEARed Cross Society of Guinea:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationWestern AfricaGeographical size ranking180thPopulation (world ranking)112.4 million (74th)Median age118.9Political system1Presidential republicGDP per capita (worldranking)1$2,000 (208th)HDI Index (world ranking)20.414 - low (183rd)Health Expenditure15.6% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV51.5% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn Guinea, there is one National Center for Blood Transfusion (CNTS) and four existing regionalcentres with screening of blood only performed in Conakry, as the only centre to have adequateequipment and trained staff.6 The Ministry of Health did have plans in 2015 to refurbish the bloodcentres.6Before the Ebola outbreak in 20147, 10% of collected blood in the country came from voluntary nonremunerated donors, after the outbreak, those donations went down to 4% and the blood systemwas on the verge of collapse.6After the discovery of treating Ebola patients with blood and plasma transfusions and the increasein associated funding, WHO issued guidance and recommendations to promote plasma collectionand processing8 and there is now hope the limited capacity blood service could be improved withnew equipment and training for plasma collection being received from the Bill and Melinda GatesFoundation.6AFRICA40AFRICA LEVEL BNATIONAL SOCIETY (RED CROSS OF GUINEA)The Red Cross Society of Guinea Health Department is a partner of the CNTS, and performsmobilisation of the community for blood donation. The volunteers of the Guinea Red Cross areengaged in recruitment of candidates for blood donation, CNTS staff perform the actual bloodcollection. This socialization is performed throughout the country by Red Cross volunteers, who alsohelp in the decentralized centres.The Red Cross Society of Guinea organizes three or four blood collection sessions per year, withabout 60 to 150 units of whole blood collected per session. Donor recruitment activities are restricteddue to budget.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/gv.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 World Health Organization. Improved blood systems in Ebola-affected countries expected to be positive outcome[Internet] World Health Organization 2015 Apr [cited 2018 Feb 12]. Available from:http://www.who.int/features/2015/blood-plasma-ebola-context/en/7 Centers for Disease Control and Prevention. 2014-2016 Ebola Outbreak in West Africa [Internet] Centers for DiseaseControl and Prevention 2016 Oct 21 [cited 2018 Feb 05]. Available from: https://www.cdc.gov/vhf/ebola/outbreaks/2014west-africa/index.html8 Delamou A, Haba NY, Mari-Saez A, Gallian P, Ronse M, Jacobs J, Camara BS, Kadio KJ, Guemou A, Kolie JP, DeCrop M, Chavarin P, Jacquot C, Lazaygues C, De Weggheleire A, Lynen L, van Griensven J. Organizing the Donation ofConvalescent Plasma for a Therapeutis Clinical Trial on Ebola Virus Disease: The Experience in Guinea. Am.J.Trop.Med.Hyg [Internet]. 2016 [cited 2018 Feb 05];95(3);647-653. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014273/pdf/tropmed-95-647.pdf41AFRICAAFRICA LEVEL BGUINEA-BISSAURed Cross Society of Guinea-Bissau:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationWestern AfricaGeographical size ranking1138thPopulation (world ranking)11.8 million (152nd)Median age120Political system1Semi-presidential republicGDP per capita (worldranking)1$1,800 (213th)HDI Index (world ranking)20.424 - low (178th)Health Expenditure15.6% of GDPPopulation prevalencehepatitis B3High: >8%Population prevalencehepatitis C4Moderate: 1.5-3.5%Population prevalence HIV53.10% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn 2013, 28% of donations were VNRBD, 4,006 units of whole blood were issued for transfusion, andsome paid donations were also accepted.6 A campaign was organised for World Blood Donor Dayat the National Blood Service at the National Hospital Simo Mendes to address low emergencyblood stock shortages and encourage people who were afraid to donate due to lack of informationor cultural reasons.7The National Red Cross supports the national blood service.8NATIONAL SOCIETY (RED CROSS OF GUINEA-BISSAU)The Red Cross Society of Guinea-Bissau coordinates donor recruitment and retention activities at anational level and by district/chapter. Activities are funded by the government and Ministry of Health.AFRICA42AFRICA LEVEL BThe Red Cross Society of Guinea-Bissau:uses volunteers for donor recruitment programs (school/university programs and corporateprograms)does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved at Level A, however the National Society could not maintain thecapacity to continue at that levelis planning to expand their current level of activity1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 31]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/pu.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 World Health Organization. The 2016 Global Status Report on Blood Safety and Availability. [Internet] World HealthOrganization 2017 [cited 2018 Feb 12] Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf?ua=17 UNIOGBIS. News. Blood Donor Day: Guinea-Bissau Hospitals Short of Blood, People Afraid to Give [Internet] 2015June 12 [cited 2017 October 31]. Available from: https://uniogbis.unmissions.org/en/blood-donor-day-guinea-bissauhospitals-short-blood-people-afraid-give8 World Health Organization. Current Status on Blood Safety and Availability in the WHO African Region, Report of the2013 Survey. [Internet] World Health Organization Regional Office for Africa, Brazzaville 2017 [cited 2018 Feb 12).Available from: http://www.afro.who.int/sites/default/files/2017-06/9789290233480-eng.pdf43AFRICAAFRICA LEVEL BKENYAKenya Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationEastern AfricaGeographical size ranking150thPopulation (world ranking)147.6 million (30th)Median age119.7Political system1Presidential republicGDP per capita (worldranking)1$3,500 (187th)HDI Index (world ranking)20.555 - medium (146th)Health Expenditure15.7% of GDPPopulation prevalencehepatitis B3High Intermediate: 5% - 7%Population prevalencehepatitis C4Low: 1.0-<1.5%Population prevalence HIV55.4% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Kenya National Blood Transfusion Services (KNBTS) was established by the Ministry of Health(MOH) in 2000, and entrusted with the responsibility of managing the blood collection and transfusionnationally in Kenya.6 KNBTS is situated at National Public Health Labs grounds in Kenyatta NationalHospital Nairobi, with six Regional Blood Transfusion Centres and fourteen Satellite Centres aroundthe country.6 The first blood policy and guidelines were initiated in 2001, and the country now alsohas National Blood Transfusion Standards, a haemovigilance manual for hospitals and guidelinesfor appropriate use of blood and blood products.6 The KNBTS is in the process of implementing avein to vein blood bank management system in all centres.6The core components of KNBTS include:specific unit within MOH for coordination, program management and monitoring of the bloodsystem throughout the countryadvisory body bringing together major stake holders formulating policy and plans, settingstandards and advising on key issuesAFRICA44AFRICA LEVEL BBTS involved in donor recruitment, collections, testing, processing, storage and distributionof blood and blood productshospital blood banks - clinical transfusion services and hospital transfusion committees(HTCs) for timely provision of compatible blood and its safe and appropriate useKenya has reported 100% VNRBD since 2011.7In 2015, 155,000 units of blood were collected, with the national requirement estimated to be 400,000units. 8 80% of blood donors are between 16 and 25 years.8NATIONAL SOCIETY (KENYA RED CROSS)To ensure safety, quality accessible and timely availability of blood and blood products KRCSfocuses on blood donor recruitment and mobilization. The activities of focus include:advocacy campaigns, sensitization and public education through blood donor awarenesscreation for potential blood donor mobilizationtaking the lead in mobilization of blood donors during emergency situationspolicy, strategy and guidelines development and dissemination of blood donor services.recruitment of blood donors through community activities such as increasing emphasis ofthe Pledge 25 and social media mobilization through the Kenya Red Cross applicationsupporting data feedback to DHS, which will guide policy formulations in haemovigilanceand strengthen laboratory systems to enhance qualitysupport in branding and marketing of blood donation and rolling out static sites for blooddonation within the major towns and within the counties. Promotion of walk in donors to dropin collection centres in high traffic areas in major cities in the country.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 12]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Ministry of Health. Kenya National Blood Transfusion Service [Internet] Kenya National Blood Transfusion Service 2016[cited 2018 Feb 12]. Available from: http://www.nbtskenya.or.ke/7 World Health Organization. The 2016 Global Status Report on Blood Safety and Availability. [Internet] World HealthOrganization 2017 [cited 2018 Feb 12] Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf?ua=18 Odhiambo, Rhoda. Blood donations fail to meet required target. The Star [Internet] 2016 Jun 14 [cited 2018 Feb 12].Available from: http://www.the-star.co.ke/news/2016/06/14/blood-donations-fail-to-meet-required-target_c136930845AFRICAAFRICA LEVEL BLIBERIALiberian Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationWestern AfricaGeographical size ranking15thPopulation (world ranking)14.6 million (125th)Median age117.8Political system1Presidential republicGDP per capita (worldranking)1$900 (226th)HDI Index (world ranking)20.427 - low (177th)Health Expenditure110% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV51.6% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe National Blood Safety Program falls under the responsibility of the Ministry of Health and SocialWelfare.6 Their mandate follows WHO guidelines to provide a safe, sufficient and timely supply ofblood and blood products and to also transition from paid donors to voluntary donors, which prior tothe Ebola outbreak of 2014, composed only 10% of donations.6Following the Ebola outbreak, the delicate blood service systems which ensured the provision ofsafe blood for hospitals, maternal and child health and emergencies in Liberia were destroyed.7 Allblood available was used during the epidemic, and now the country is uniting with Grifos and theUniversity of Massachusetts to revitalise the blood program with new infrastructure.7NATIONAL SOCIETY (LIBERIAN RED CROSS)Blood donor recruitment and retention activities are coordinated nationally, at the district/chapter aswell as at the community level by the National Society. They are funded by government or Ministryof Health and by private organisations.AFRICA46AFRICA LEVEL BThe Liberian Red Cross Society:uses paid staff and volunteers for donor recruitment programs, such as school/universityprograms and programs in communitiesdoes not receive technical assistance or financial support for VNRBD activities from outsidethe country, however the government doeswas previously involved in blood at Level A - during the civil war the laboratory wasvandalized and all the equipment including the blood bank freezer was lootedis planning to partner with the blood safety program to create sensitization and awarenesson voluntary donation in the communities, utilising volunteers in the 15 counties all the waydown to the community level. The Ministry of Health is taking the lead through the BloodSafety Department, with support from an international NGO (ACCEL), however there is nostructure in place for blood donor drives or campaigns.There is a long term development plan for the construction of a blood bank / training facility, but nodecision on the strategy that will be used in terms of running it.The National Society would not consider including a focus on recruitment and collection of bloodfrom recovered Ebola patients for convalescent plasma.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/li.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 01]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb01]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Ministry of Health Republic of Liberia. 2014 Annual Report [Internet] Ministry of Health and Social Welfare 2015 [cited2018 Feb 12]. Available from:http://reliefweb.int/sites/reliefweb.int/files/resources/MOHSW%20Annual%20Report%202014_Revised.pdf7 World Health Organization. Improved blood systems in Ebola-affected countries expected to be positive outcome[Internet] World Health Organization 2015 Apr [cited 2018 Feb 12]. Available from:http://www.who.int/features/2015/blood-plasma-ebola-context/en/47AFRICAAFRICA LEVEL BMADAGASCARMalagasy Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking148thPopulation (world ranking)125 million (52nd)Median age119.7Political system1Semi-presidential republicGDP per capita (worldranking)1$1,600 (218th)HDI Index (world ranking)20.512 - low (158th)Health Expenditure13% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2% - 4%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.2% among adults aged 15to 49NATIONAL BLOOD PROGRAMOne of the priority strategies of the Madagascar Action Plan 20072012 was to ensure there wereblood banks in all 22 regions, to combat the spread of HIV and AIDS.6In 2013, 23,075 units of blood were collected with 4,294 (18.6%) units from voluntary donors.7There is a national blood policy, clinical transfusion guidelines and national standards in place anda unit within the Ministry of Health responsible for oversight of the blood transfusion activities. 7 Thereare approximately 47 blood centres and 110 hospitals performing blood transfusions inMadagascar.7NATIONAL SOCIETY (MALAGASY RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter of the NationalSociety and are funded by the National Society.Both paid staff and volunteers are used for donor recruitment and the donor recruitment programutilises the volunteer network.AFRICA48AFRICA LEVEL BThe Malagasy Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis planning to expand its current level of involvement in blood-related activities, to increaseawareness of blood donation in the communityhas not previously been involved in blood at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ma.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 12]. Available from: http://hdr.undp.org/en3Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6Republic of Madagascar. Madagascar Action Plan (MAP): 2007-2012 [Internet] International Monetary Fund 2007 [cited2018 Feb 12]. Available from: https://www.imf.org/external/pubs/ft/scr/2007/cr0759.pdf7 World Health Organization. The 2016 Global Status Report on Blood Safety and Availability. [Internet] World HealthOrganization 2017 [cited 2018 Feb 12] Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf?ua=149AFRICAAFRICA LEVEL BMALAWIMalawi Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking1101stPopulation (world ranking)119 million (61st)Median age116.5Political system1Presidential republicGDP per capita (worldranking)1$1,200 (224th)HDI Index (world ranking)20.476 - low (170th)Health Expenditure111.4% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV59.2% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Malawi Blood Transfusion Service (MBTS) was established in 2003, through joint funding by theMinistry of Health and the European Union.6 Prior to this blood was collected through the combinedefforts of hospitals and the Malawi Red Cross.6Although there was no legislation in place to regulate blood transfusion in Malawi in 2015, there wasa national blood policy, guidelines for safe blood transfusion and guidelines for the clinical use ofblood and blood products.7Malawi reported having achieved 100% voluntary non-remunerated blood donation in 2008. 8However, by 2014, the proportion of VNRBD donors had fallen to just 65% with the remaining donorsbeing family replacement donors.8 MBTS utilises Club 25 as the main strategy to collect blood fromyoung people as it has over 500 active members.9Malawi collects one third of the blood required nationally, with 66% of blood recipients being womenand children.10AFRICA50AFRICA LEVEL BNATIONAL SOCIETY (MALAWI RED CROSS)Blood donor recruitment and retention activities are coordinated nationally and by district/chapter bythe National Society.The Malawi Red Cross Society:uses volunteers for donor recruitment programs, such as school/university programs andcommunity membersdoes not receive technical assistance for VNRBD activities from outside the countryreceives funding support for VNRBD activities from The Swiss Red Crosswas not previously involved in blood at Level Aplans to scale up in four more areas, mainly cities, to support more collection of blood by theMBTS1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/mi.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 12]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Malawi Blood Transfusion Service. Addressing blood shortage the corporate way [Internet] Malawi Blood TransfusionService 2018 [cited 2018 Feb 12]. Available from: http://www.mbtsmalawi.com/index.php/centre/press/79-bloodshortage/85-addressing-blood-shortange-the-corporate-way7 Njlomole SE, Mbaya B, Ndhlovu D, Mfune T, Yonamu F, Phiri P, Kalonjeka B. Post Baseline Situational Analysis ofBlood Safety in Malawi 2015. Malawi Blood Transfusion Service 2017 Jul [cited 2018 Feb 12]. Available from:http://www.mbtsmalawi.com/images/publications/Post%20Baseline%20Situational%20Analysis%20of%20Blood%20Safety%20in%20Malawi%202015.pdf8 World Health Organization. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organization 2011 Jun [cited 2018 Feb 12]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=19 Malawi Blood Transfusion Service. About Club 25 [Internet] Malawi Blood Transfusion Service 2018 [cited 2018 Feb12]. Available from: http://www.mbtsmalawi.com/index.php/club-2510 Mamaye! Maternal and Newborn Health Factsheet Malawi [Internet] Mamaye! 2017 [cited 2018 Feb 12]. Availablefrom: http://mamaye.org/sites/default/files/docs/mamaye-factsheet-2017-mw-web-3_0.pdf51AFRICAAFRICA LEVEL BRWANDARwandan Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AfricaGeographical size ranking1149thPopulation (world ranking)111.9 million (76th)Median age119Political system1Presidential republicGDP per capita (worldranking)1$2,100 (205th)HDI Index (world ranking)20.483 - low (163rd)Health Expenditure17.5% of GDPPopulation prevalencehepatitis B3High Intermediate: 5% - 7%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV53.1% among adults aged 15to 49NATIONAL BLOOD PROGRAMA national policy on blood transfusion promoting VNRBD was accepted in 2006, and the NationalCenter for Blood Transfusion (NCBT) in Kigali was established.6 Regional blood centers have beenestablished in all five provinces of Rwanda to increase access to blood for transfusion.6The NCBT has introduced vein to vein safety by implementing procedures to improve VNRBD safety,automated testing, computerised record management and guidelines for the rational use of blood.7The NCBT collected 53,439 units in 2015, an increase from 42,788 units in 2014.8Rwanda reported having achieved 100% VNRBD in 2008.9NATIONAL SOCIETY (RWANDAN RED CROSS)Rwanda Red Cross is involved in the blood program, but only in blood donor mobilisation.Rwanda Red Cross provided a Level A global mapping response in 2008.AFRICA52AFRICA LEVEL B1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/rw.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 12]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Senyana F. Reorganisation of Blood Transfusion Services after the 1004 genocide to enhance access to blood andblood products in Rwanda. Paper presented at: African Society for Blood Transfusion International Congress; 2012 June04-07; Mauritius. PowerPoint Presentation available from:www.afsbtedu.org/mauritius2012/usb/day2/talk2/ppt.pdf7 Florent S, Gasana M. P318: Safety of blood products in Rwanda. Antimicrob Resist Infect Control 2013;2(Suppl1):P318. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3688304/8 Atieno L. Blood bank calls for donation. The New Times [Internet] 2016 Jan 09 [cited 2018 Feb 12]. Available from:http://www.newtimes.co.rw/section/article/2016-01-09/195945/ .9 World Health Organization. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organization 2011 Jun [cited 2018 Feb 12]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=153AFRICAAFRICA LEVEL BSAO TOME AND PRINCIPESao Tome and Principe Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AfricaGeographical size ranking1185thPopulation (world ranking)1201 thousand (184th)Median age118.4Political system1Semi-presidential republicGDP per capita (worldranking)1$3,200 (192nd)HDI Index (world ranking)20.574 - medium (142nd)Health Expenditure18.4% of GDPPopulation prevalencehepatitis B3High: >8% (central Africa)Population prevalencehepatitis C4Moderate: 1.5-3.5% (centralAfrica)Population prevalence HIVCurrent data not availableNATIONAL BLOOD PROGRAMIn Sao Tome and Principe there is only one blood bank, located at the Central Hospital. 5 In 2006, anational policy for blood transfusion and a strategic plan was developed, but a lack of humanresources, technical capacity and equipment have caused difficulties with implementation. 5 In 2013,there was a total of 919 blood donations with 600 (65.3%) from voluntary donors, the remainder werereplacement donors.6 There are national standards for collection and testing of blood and clinicalguidelines for the appropriate use of blood and blood products available.6In 2010, Sao Tome and Principe applied for funding from the Global Fund to implement HIVprevention strategies including the promotion of VNRBD and screening of donations for HIV, HBV,HCV and syphilis.5 The proposal noted:blood bank facility is in poor conditionthe proportion of family/replacement blood donors was still very highthe service is operated by technicians with low haemotherapy knowledgethe hospital lacks a haemotherapy committee and surveillance of transfusion adversereactionsphysicians do not follow good practices on haemotherapy6Efforts to move towards voluntary blood donation are performed by UNDABESA, an NGO thatsupports the blood bank educating the public, motivating and recruiting them as donors.6AFRICA54AFRICA LEVEL BNATIONAL SOCIETY (SAO TOME AND PRINCIPE RED CROSS)The Sao Tome and Principe Red Cross:uses volunteers for donor recruitment (school/university programs and communitymobilisation)blood donor recruitment and retention activities are coordinated both nationally and by thedistrict/chapterblood donor recruitment activities are funded by the Blood Service, the National Society,government and another funder (OMS)does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis not planning to expand or scale back its current level of involvement in blood-relatedactivitieshas not previously been involved in blood at Level A.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/tp.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 12]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 The Global Fund To Fight AIDS, Tuberculosis and Malaria. Proposal Form Round 10 [Internet] 2010 Oct 01[cited 2018Feb 13]. Available from: https://info.undp.org/docs/pdc/Documents/STP/STP-R10-HA_Proposal_0_en.pdf6 World Health Organization. The 2016 Global Status Report on Blood Safety and Availability. [Internet] World HealthOrganization 2017 [cited 2018 Feb 12] Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf?ua=155AFRICAAFRICA LEVEL BSIERRA LEONESierra Leone Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationWestern AfricaGeographical size ranking1120thPopulation (world ranking)16.2 million (109th)Median age119.0Political system1Presidential republicGDP per capita (worldranking)1$1,800 (212th)HDI Index (world ranking)20.420- low (179th)Health Expenditure111.1% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV51.7% among adults aged 15to 49NATIONAL BLOOD PROGRAMAccording to the National Strategic Plan for Blood Safety (2011-2014) 6, blood centres in SierraLeone are mostly hospital based, with 90% of blood coming from replacement donors and only 10%from voluntary donors.6 The blood policy was launched in February 2006 but was only partiallyimplemented in 2010. 6 A National Blood Advisory Committee was created with members appointedfrom the MOHS and SLRCS.6 26 hospitals conduct blood collections this is comprised of 18government hospitals, one military hospital, six missionary hospitals and one private hospital.6 TheBlood Program has initiated a cost recovery system and charges are Le 10,000 and Le 5,000 perunit of blood issued to the private and public sector hospitals respectively. 6 The national qualitymanagement program is yet to be fully implemented. 6After the Ebola virus outbreak in Western Africa, the strengthening of national blood transfusionsystems became a priority in countries such as Sierra Leone. 7 Plans were developed in Sierra Leoneto strengthen blood transfusion systems and ensure safe blood became available.7 The Blood bankat the Connaught Hospital in Freetown was upgraded in 2015 by the Ebola Convalescent PlasmaConsortium funded by The Welcome Trust and The Bill & Melinda Gates Foundation. 8AFRICA56AFRICA LEVEL BThe Blood Bank was fully refurbished and refitted with modern equipment to enable the productionand donation of blood and plasma.8A continuous power supply is also provided to the hospital to ensure critical equipment is keptrunning at all times.8 Training and reagents have been provided by experts from the English NHSBlood and Transplant Service and Public Health England who have visited the Blood Bank.8In 2010 9.7% of donations were VNRBD.9NATIONAL SOCIETY (SIERRA LEONE RED CROSS)In 2014, 1,300 people donated blood with the assistance of the Sierra Leone Red Cross Society, adecrease from 2,950 in 2013. 10The Sierra Leone Red Cross Society was said to have provided support to Blood Programs bypromoting voluntary blood donation, in the National Strategic Plan for Blood Safety (2011-2014).6The Sierra Leone Red Cross was involved in blood activities until 2003 (with the support of theGerman Red Cross), at which time the Ministry of Health took over. VNRBD is a key activity ofvolunteers during their training and 97% of blood donors (>2000) are Red Cross volunteers.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/sl.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 14].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 14] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 14] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 National Strategic Plan for Blood safety (Revised) (2011-2014). Government of Sierra Leone. Ministry of Health andSanitation. [Internet] 2010 Sept [cited 2018 Feb 14]. Available from: https://mohs-portal.net/wpcontent/uploads/2017/06/National-Strategic-Plan-for-Blood-Safety-2011-2014.pdf7 WHO strengthens capacities of national blood transfusion systems in Ebola-affected countries. World HealthOrganisation. Regional Office for Africa. [Internet] 2015 Jun 2 [cited 2018 Feb 14]. Available from:http://www.afro.who.int/news/who-strengthens-capacities-national-blood-transfusion-systems-ebola-affected-countries8 Freetown Blood bank Strengthened by Ebola Research Study. Clinical Research Management Inc. [Internet] 2017[cited 2018 Feb 14]. Available from: http://www.clinicalrm.com/freetown-blood-bank-strengthened-by-ebola-researchstudy/9 Tapko JB, Toure B, Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2018 Feb 14]. Available from: http://www.afro.who.int/sites/default/files/201706/status-of-blood-safety-in-the-who-african-region.pdf10 The International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and ReportingSystem. National Society Profiles - Sierra Leone Red Cross Society [Internet] 2016 [cited 2018 Feb 14]. Available from:http://data.ifrc.org/fdrs/societies/sierra-leone-red-cross-society57AFRICAAFRICA LEVEL BSOUTH SUDANSouth Sudan Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationEast-Central AfricaGeographical size ranking143rdPopulation (world ranking)113 million (73rd)Median age117.3Political system1Presidential republicGDP per capita (worldranking)1$1,500 (220th)HDI Index (world ranking)20.418 - low (181st)Health Expenditure12.7% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV52.7% among adults aged 15to 49NATIONAL BLOOD PROGRAMA relatively new country (independence was declared in 2011), South Sudans first blood bank andthe National and Regional Public Health Laboratories were launched on 8 July 2014.6 Developed bythe United Nations Development Program (UNDP) through the Global fund, the facilities cost US$1.5million and serve to improve the countrys health system.6The blood bank was urgently needed after it was reported in 2012 that lack of blood was the maincause of mortality at the countrys teaching hospital. 7 Blood is directly donated by family, andtherefore only available for that specific patient.7 Cultural taboos and lack of awareness also makevoluntary blood donations challenging.7NATIONAL SOCIETY (SOUTH SUDAN RED CROSS)The South Sudan Red Cross officially became a member of the IFRC in November 2013.8Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the National Society and supported by the Swiss Red Cross Society.AFRICA58AFRICA LEVEL BBoth paid staff (MoH) and volunteers are used for donor recruitment. Seconded staff from MoHensure sustainability and capacity building. Volunteers are only given cost recovery payment for foodand transport.Recruitment programs include school/university programs, corporate programs and publiccampaigns in markets and during national events.The South Sudan Red Cross Society:receives technical assistance from the World Health Organisation (WHO), UNDP & Centersfor Disease Control and Prevention (CDC) - mainly for blood services, policies and guidelinesdoes not receive financial support for VNRBD activities from outside the countryis planning to expand its current level of involvement in blood-related activities by recruitingstaff for VNRBD, assessing the possibility of expanding to two other states, and becominginvolved in road safetyhas not previously been involved in blood at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb13]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/od.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 13]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 13] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 C Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 13] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb13]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 UNDP. South Sudans first blood bank and public health laboratories established in Juba. News Centre [Internet] 2014Jul 08. United Nations Development Program Geneva 2018 [cited 2018 Feb 13]. Available from:http://www.europe.undp.org/content/geneva/en/home/presscenter/articles/2014/07/08/south-sudan-s-first-blood-bankand-public-health-laboratories-established-in-juba.html7 Why the beleaguered hospitals of South Sudan are out for blood. The Guardian [Internet]. 2012 Jan 31 [cited 2018 Feb23]. Available from: https://www.theguardian.com/global-development/2012/jan/31/south-sudan-hospitals-blood8 South Sudan Red Cross. Annual Operations Report 2013 [Internet] South Sudan Red Cross 2014 [cited 2018 Feb 13].Available from: http://data.ifrc.org/fdrs/societies/south-sudan-red-cross59AFRICAAFRICA LEVEL BTANZANIATanzania Red Cross Society:Level B - involved in the systematic/regular recruitmentnon-remunerated blood donors but with no involvement in blood collectionofvoluntaryNATIONAL CONTEXTLocationEastern AfricaGeographical size ranking132ndPopulation (world ranking)153.9 million (26th)Median age117.7Political system1Presidential republicGDP per capita (worldranking)1$3,300 (191st)HDI Index (world ranking)20.531 - low (151st)Health Expenditure15.6% of GDPPopulation prevalencehepatitis B3High Intermediate: 5% - 7%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV54.7% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Tanzania National Blood Transfusion Service (TNBTS) was established in 2004.6 It is workingwith the Ministry of Health and Social Welfare to transform itself into an autonomous body. 7 Anational blood policy was developed in 2005 and a legislative framework was in development in2015.7 Guidelines on the clinical use of blood and blood products have been developed.8The TNBTS received Level 2 accreditation with the African Society for Blood Transfusion (AfSBT) inlate 2017.9The percentage of blood from VNRBD donors reduced to 80% in 2014 with 4% being fromreplacement donors6 with the total number of voluntary blood donors standing at 199,000 in 2017.9The estimated demand for blood is 400,000 450,000 units annually.6One of the biggest challenges to the blood system in Tanzania is insufficient supply of blood.Although the TNBTS has more than tripled the total collection of blood units from 52,000 in 2005 to162,000 in 2014, only 30% of all blood need is currently being met.7NATIONAL SOCIETY (TANZANIA RED CROSS)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the blood service, the government or Ministry of Health and by privateorganisations.AFRICA60AFRICA LEVEL BBoth paid staff and volunteers are used for donor recruitment programs such as school/universityprograms, Club 25 and corporate programs.The Tanzania Red Cross Society: receives both technical assistance and financial support - AABB (through CDC) providedtechnical assistance in development and use of standard operating procedures at all levelsof blood donor recruitment, collection and retention including management of donor clubsand mentorship is planning to expand its current level of involvement in blood-related activities, to reach thetarget which was set to ensure all transfusing facilities in the regions of operations havesufficient safe blood - funds are required to implement this planwas until recently involved in blood at Level A - the National Society was involved in bloodcollection through the funding from CDC under the US Presidents Emergency Plan for AIDSRelief (PEPFAR), which ended in 2015. The collected blood was centrally processed by theNational Blood Transfusion ServiceThe Tanzania Red Cross Society indicated that prior to 2016, they were operating at Level A(involved in operating a full blood service). The Blood Service:collected 100% VNRBDannually collected 5,000 units of whole blood (2015)supported a population of 4,500,000processed collected blood into componentsconducted screening testing of blood for infectious diseases and blood groupingdid not conduct cross-matching for transfusiondid not perform transfusionswas not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, solid organs and corneas forwarded plasma to a fractionation facilityProviders of the nations blood were: Ministry of Health 65% Army 10% Tanzania Red Cross Society 25%1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/tz.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 13]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 13] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 13] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb13]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Ambassadors for Safe Blood and Life Association. National Blood Transfusion Service [Internet] ASBLA 2017 [cited2018 Feb 13]. Available from: http://www.safebloodtanzania.com/national-blood-transfusion-service/7 Mama Ye! Evidence for action. Factsheet on Tanzanias blood services: 2015 [Internet] 2014 Jun [updated 2015 Jun.Cited 2018 Feb 13]. Available from: http://mamaye.org/sites/default/files/blogfiles/TZ%20blood%20factsheet_2015.pdf8 Mama Ye! Evidence for action. Tanzanias blood services: Factsheet 2017 [Internet] Mama Ye!2014 Jun [updated 2017Jun. Cited 2018 Feb 13]. Available from:http://mamaye.org/sites/default/files/docs/tanzania_wbdd_factsheet_2017_final.pdf9 Lugongo B. Tanzania: Relief Beckoning As Blood Services Set for Betterment. Tanzania Daily News [Internet] 2017Dec 12 [cited 2018 Feb 13]. Available from: http://allafrica.com/stories/201712120443.html61AFRICAAFRICA LEVEL BTOGOTogolese Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationWestern AfricaGeographical size ranking1127thPopulation (world ranking)17.9 million (99th)Median age119.8Political system1Presidential republicGDP per capita (worldranking)1$1,600 (217th)HDI Index (world ranking)20.487 - low (166th)Health Expenditure15.2% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV52.1% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe national requirement for blood in Togo is approximately 70,000 units per annum.6Togo reported having achieved 100% VNRBD in 2008.7A report in 2012 stated the National Centre for Blood Transfusion (CNTS) was struggling with debt.8NATIONAL SOCIETY (TOGOLESE RED CROSS)Blood donor recruitment and retention activities are coordinated nationally and by district/chapter bythe National Society. They are funded by the blood service and the National Society.Volunteers are used for donor recruitment programs, including school/university programs, Club 25and community education/awareness programs.AFRICA62AFRICA LEVEL BThe Togolese Red Cross:does not receive technical assistance for VNRBD activities from outside the countryreceived financial support for VNRBD activities from IFRC, but for 2013/14 onlyis planning to expand its current level of involvement in blood-related activities to increasenew donor recruitment by 50% in three yearswas previously involved in blood-related activities at Level A, but has not had any funding topay staff since 1987In 2014, the Togolese Red Cross recruited 1666 blood donors, however this decreased steadily to310 in 2016.9The 2015 Annual Report states the Togolese Red Cross mobilised 475 blood donors and collected2,039 units of blood10 as part of the national blood donation campaign. Members of 14 Club 25groups were educated on nutrition and healthy lifestyle for blood donation.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb13]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/to.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 13]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 13] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 13] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb13]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Vicarmelo. Togo/Health: National Blood Transfusion Center observes World Blood Donor Day. Togo Portail [Internet]2017 Jun 14 [cited 2018 Feb 13]. Available from: http://www.togoportail.net/2017/06/togosante-le-centre-national-detransfusion-sanguine-observe-la-journee-mondiale-du-don-de-sang/7 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] 2011 [cited 2018 Feb 13]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=18 Godson K. Togo: National Center for Blood Transfusion, Finances in the Red and Shortage of Reagents and BloodStocks. 27avril.com [Internet] 2012 Aug 10 [cited 2018 Feb 13]. Available from: http://www.27avril.com/blog/culturesociete/sante/togo-centre-national-de-transfusion-sanguine-finances-dans-le-rouge-et-penurie-de-reactifs-et-de-stockde-sang9 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Togolese Red Cross. [Internet] 2016 [cited 2018 Feb 13]. Available from:http://data.ifrc.org/fdrs/societies/togolese-red-cross10 Croix-Rouge Togolaise Togolese Red Cross. Rapport DActivites 2015 [Internet] Croix-Rouge Togolaise 2016 [cited2018 Feb 13]. Available to download from: http://data.ifrc.org/fdrs/societies/togolese-red-cross63AFRICAAFRICA LEVEL BUGANDAUganda Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationEast-Central AfricaGeographical size ranking182ndPopulation (world ranking)140 million (34th)Median age115.8Political system1Presidential republicGDP per capita (worldranking)1$2,400 (200th)HDI Index (world ranking)20.493 - low (163rd)Health Expenditure17.2% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV56.5% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Uganda Blood Transfusion Service (UBTS) is an independent, centrally coordinatedorganization in the Ministry of Health servicing all regions of the country.6 Serving as a referencecentre for the provincial blood banks as well as other public and private hospitals, the blood bankheadquarters is located in Nakasero.6 Blood safety is recognized by the 1999 National Health Policyas an essential component of the Ministry of Health's Minimum Health Care package and an effectiveHIV preventive measure.6The UBTS aims to maintain an adequate and safe blood supply through voluntary blood donationsin Uganda.6 UTBS works closely with the Uganda Red Cross Society (URCS) which recruitsvoluntary blood donors a relationship which has been formalized through a Memorandum ofUnderstanding.6UBTS includes seven Regional Blood banks at Arua, Fort- Portal, Gulu, Kitovu, Mbale, Mbarara andNakasero and six blood collection centers in Hoima, Jinja, Kabale, Rukungiri, Lira and Soroti.6 UBTSis planning to turn collection centers into blood distribution centers as well.6The percentage of VNRBD gradually increased to 85% in 1999 and currently stands at 100%.6Uganda is one of the countries that have reported having achieved 100% VNRBD in 2008.7Annual blood collections at the UBTS increased from 106,996 units in 2004 to 202,939 units in 2011.8AFRICA64AFRICA LEVEL BIn 2010/11, 173,735 units of blood were supplied to 200 health facilities9:86,867 units (50%) to anaemic children (anaemia is induced by malaria)52,120 units (30%) to pregnant mothers34,748 units (20%) for other reasons9An improved donor selection process has led to HIV sero-prevalence among blood donors reducingfrom 1.99% in June 2004 to 0.97% in April 2009 considerably lower than the HIV prevalence in thegeneral population.10NATIONAL SOCIETY (UGANDA RED CROSS)Activities provided by the Uganda Red Cross Society include:community mobilisation and motivationrecruiting and retaining 100% VNRBD blood donors to the Ministry of Health contributing toover half of the national blood collectionspre- and post-donation counselling (i.e. after receiving positive results to infectious diseasescreening)Blood donor recruitment and retention activities are coordinated nationally by the National Society,and are funded by the funding partners: Centers for Disease Control and Prevention (CDC) and theUS Presidents Emergency Plan for AIDS Relief (PEPFAR).Both paid staff and volunteers are used for donor recruitment programs, including school/universityprograms, corporate programs, Club 25 and blood donor clubs.The Uganda Red Cross Society:receives technical assistance for VNRBD activities from outside the countryis planning to expand its current level of involvement in blood-related activities, but not toLevel Ahas not previously been involved in blood at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 14].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 14] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 14] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Uganda Blood Transfusion Service. About us. [Internet] 2018 [cited 2018 Feb 14]. Available from:http://www.ubts.go.ug/about-us.html7 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] 2011 [cited 2018 Feb 14]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=18 Centers for Disease Control and Prevention. Global health initiative Executive Director opens CDC-supported UgandaBlood Transfusion Service Headquarters. [Internet] 2010 Aug 4 [cited 2018 Feb 14]. Available from:http://www.cdc.gov/globalaids/success-stories/uganda-blood-transfusion.html9 Our blood is safe, says Kyeyune. New vision. Ugandas Leading Daily. [Internet] 2013 Aug 17 [cited 2018 Feb 14].Available from: http://www.newvision.co.ug/new_vision/news/1329371/blood-safe-kyeyune10 Centers for Disease Control and Prevention. Global HIV/AIDS. Improving blood safety in Uganda. [Internet] 2010 Aug4 [cited 2018 Feb 14]. Available from: http://www.cdc.gov/globalaids/success-stories/blood-safety.html65AFRICAAFRICA LEVEL CCAPE VERDE (CABO VERDE)Red Cross of Cape Verde:Level C: National Society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationWestern African islandsGeographical size ranking1176thPopulation (world ranking)1561 thousand (173rd)Median age125.4Political system1Parliamentary republicGDP per capita (worldranking)1$6,900 (160th)HDI Index (world ranking)20.648 - medium (122nd)Health Expenditure14.8% of GDPPopulation prevalencehepatitis B3High: >8%Population prevalencehepatitis C4Moderate: 1.5-3.5%Population prevalence HIV50.8% among adults aged 15 to49NATIONAL BLOOD PROGRAMCape Verde increased the percentage of VNRD from 32% in 2004 to 80.8% in 2011. 6In 2010, 87.1% of blood was separated into components. 7NATIONAL SOCIETY (RED CROSS OF CAPE VERDE)1,500 people donated blood with the assistance of the Red Cross of Cape Verde in both 2014 and2015. 8Blood donor recruitment and retention activities are coordinated nationally and funded by theNational Society.AFRICA66AFRICA LEVEL CThe Red Cross of Cape Verde:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywere previously involved at Level B, recruiting blood donors in hospitals and continuous blooddonation campaignsare planning to expand their level of involvement in promotional and educational campaignsare looking to strengthen National Society activities in blood donation activities at all levels,taking into account the magnitude and frequency of disasters in the area1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/cv.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 14].Available from: http://hdr.undp.org/en3 Jia J. Global Epidemiology of HBV and HCV infection. Paper presented at: Capital Medical University; 2015 Sept 02;Glasgow (UK). PowerPoint presentation available from: http://www.worldhepatitissummit.org/docs/default-source/defaultdocument-library/2015/resources/state-of-the-art-epidemiological-overview.pdf?sfvrsn=44 Health Protection Surveillance Centre. Infectious disease assessment for migrants hepatitis C [Internet] 2015 July [cited2018 Feb 14]. Available from: http://www.hpsc.ie/A-Z/SpecificPopulations/Migrants/Guidance/5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Towards Self-Sufficiency in Safe Blood and Blood Products based on Voluntary Non-Remunerated Donation. Globalstatus 2013. World Health Organisation [Internet] 2013 [cited 2018 Feb 14]. Available from:http://www.transfusion.ru/2014/02-26-2.pdf7 Tapko JB, Toure B, Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2018 Feb 14]. Available from: http://www.afro.who.int/sites/default/files/201706/status-of-blood-safety-in-the-who-african-region.pdf8 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Red Cross of Cape Verde. [Internet] 2016 [cited 2018 Feb 14]. Available from:http://data.ifrc.org/fdrs/societies/red-cross-of-cape-verde67AFRICAAFRICA LEVEL CCOMOROSComoros Red Crescent:Level C: National Society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern African islandsGeographical size ranking1180thPopulation (world ranking)1808 thousand (163rd)Median age119.6Political system1Federal presidential republicGDP per capita (worldranking)1$1,600 (219th)HDI Index (world ranking)20.497 - low (160th)Health Expenditure16.7% of GDPPopulation prevalencehepatitis B3High: >8%Population prevalencehepatitis C41%Population prevalence HIV3<0.5% among adults aged 15 to49NATIONAL BLOOD PROGRAMBlood collection in Comoros is undertaken by the Ministry of Health.In 2010, 15.7% of donations were VNRBD.5NATIONAL SOCIETY (COMOROS RED CRESCENT)In 2013, 450 people donated blood with the assistance of the Comoros Red Crescent. 6Participation in World Blood Donor Day (WBDD) is noted in the 2013 Annual Report6. The RedCrescent has approximately 5,000 volunteers who are called on to donate in a crisis.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/cn.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2017 October 30].Available from: http://hdr.undp.org/en3 Travel Medicine Inc. Destination Guide Comoros Islands [Internet] 2017 [cited 2017 October 30]. Available from:https://www.travmed.com/pages/comoros-islands4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clinical Microbiology and Infection [Internet] 2011 Feb [cited2017 October 30];17(2):107-115. Available from: http://www.sciencedirect.com/science/article/pii/S1198743X146164875 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2017 October 30]. Available from:http://www.afro.who.int/sites/default/files/2017-06/status-of-blood-safety-in-the-who-african-region.pdf6 The International Federation of Red Cross and Red Crescent Societies. The Comoros Red Crescent [Internet] 2016[cited 2017 October 30]. Available from: http://data.ifrc.org/fdrs/societies/the-comoros-red-crescentAFRICA68AFRICA LEVEL CDJIBOUTIRed Crescent Society of Djibouti:Level C: National Society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern AfricaGeographical size ranking1151stPopulation (world ranking)1865 thousand (162nd)Median age123.9Political system1Semi-presidential republicGDP per capita (worldranking)1$3,600 (186th)HDI Index (world ranking)20.473 - low (172nd)Health Expenditure110.6% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV51.3% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe blood transfusion system in Djibouti is based on a family donor system.6 Spontaneous donationsfrom the police and military staff make up about 20% of the 2500 units collected annually. 6Screening amongst 9006 volunteer blood donors at the National Blood Bank from 1998 to 2000found the prevalence of transfusion transmissible infections was low in comparison withneighbouring countries.7NATIONAL SOCIETY (RED CRESCENT OF DJIBOUTI)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the CICR (Comit International de la Croix-Rouge) with the logistical support ofthe Ministry of Health.69AFRICAAFRICA LEVEL CThe Red Crescent Society of Djibouti:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved as a Level A or Level Bis planning to expand through volunteers and communities at a national level, to promoteVNRBD on World Blood Donor Day1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/dj.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 14].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 14] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 14] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 14]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Osaro E and Charles AT. The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: theneed for the development of alternatives to allogenic blood. J Blood Med. [Internet] 2011 Feb 6 [cited 2018 Feb 14]:2.Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262349/7 Dray X, Dray-Spira R, Bronstein JA and Mattera D. Prevalences of HIV, hepatitis B and hepatitis C in blood donors inthe Republic of Djibouti. Med Trop (Mars) [Internet] 2005 [cited 2018 Feb 14]:65(1). Available from:http://www.ncbi.nlm.nih.gov/pubmed/15903075AFRICA70AFRICA LEVEL CETHIOPIAEthiopian Red Cross Society:Level C: National Society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern AfricaGeographical size ranking128thPopulation (world ranking)1105.4 million (12th)Median age117.9Political system1Federal parliamentaryrepublicGDP per capita (worldranking)1$2,100 (206th)HDI Index (world ranking)20.448 - low (174th)Health Expenditure14.9% of GDPPopulation prevalencehepatitis B3High Intermediate: 5% - 7%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV51.1% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Service Centre (NBTS) in Ethiopia is located in Addis Ababa andhas been funded by the US Presidents Emergency Plan for AIDS Relief (PEPFAR). 6 The centreserveS to increase access to blood transfusion services across Ethiopia, as well as beingresponsible for6:screening donated blood for HIV, HBV, HCV and syphilisblood typingprocessing blood components (concentrated red cells, fresh frozen plasma, platelets andcryoprecipitate)issuing blood to hospitals6Responsibility for the NBTS was transferred from the Ethiopian Red Cross Society to the FederalMinistry of Health in 2010, for the purpose of improving efficiency, access to blood and quality ofservice. 7 Previously the NBTS had been heavily reliant on family replacement donors, could only beaccessed by hospitals in the regional capitals, and did not perform universal testing of blood.771AFRICAAFRICA LEVEL CAs a result of this changeover, the number of hospitals accessing safe blood increased from 48% in2012 to >90% in 2014.7 The proportion of voluntary blood donation increased and HIV prevalencein blood donors dropped.7Ethiopia currently has 24 regional blood banks and one national centre in Addis Ababa.8The 25 blood banks serve 8 to 12 hospitals each, allowing approximately 90% of hospitals accessto a safe blood supply.7 In 2014 there were 31 mobile blood collection teams working throughout thecountry, up from 4 in 2012.7According to WHO, VNRBD rates have increased from 10% in 2011 to over 98% in 2016. 8 It hasbeen reported that the national requirement for blood in Ethiopia is 80,000-120,000 units per year,however only 43% of this need is met through collections.9The Ethiopian Red Cross Society along with health associations such as the Ethiopian Public HealthAssociation, Ethiopian Society of Obstetricians and Gynaecologists and Ethiopian MidwivesAssociation promote blood donation in collaboration with the FMoH and other internationalorganisations such as WHO and CDC.9NATIONAL SOCIETY (ETHIOPIAN RED CROSS)Level A blood services in Ethiopia were provided by the Ethiopian Red Cross Society from 1969 to2010 through its 12 regional blood banks covering the requirements of 52% of the hospitals in thecountry.The Ethiopian Red Cross Society currently:coordinates community education activities at a national levelcommunity education is funded by the blood service and the NSpreviously received technical assistance for VNRBD activities from CDCplans to expand activities in collaboration with the National Blood Bank Service in terms ofdonor mobilization, awareness creation and different campaigns1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/et.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 13].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Ethiopia to get its first National Blood Transfusion Service Centre. African News Agency. [Internet] 2016 May 5 [cited2018 Feb 14]. Available from: https://www.enca.com/africa/ethiopia-to-get-its-first-national-blood-transfusion-servicecentre7 World Health Organisation. Ethiopia Country Office. Update Ethiopia. Blood Safety Progress in 2014. [Internet] 2015Mar [cited 2018 Feb 14]. Available from: http://www.afro.who.int/sites/default/files/2017-05/ethiopia_update-sheet-onblood-safety_2014_final.pdf8 World Health Organization. Regional Office for Africa. Policy-makers in Ethiopia had a Forum to ensure an effectiveNational Blood Transfusion System [Internet] 2017 July 19 [cited 2018 Feb 14]. Available from:http://www.afro.who.int/news/policy-makers-ethiopia-had-forum-ensure-effective-national-blood-transfusion-system9 Arage G. Ibrahim S. Adimasu E. Blood donation practice and its associated factors among health professionals ofUniversity of Gondar Hospital, Northwest Ethiopia: a cross sectional study. BMC Res Notes [Internet] 2017 July 19 [cited2018 Feb 14]:10(1). Available from: https://www.ncbi.nlm.nih.gov/pubmed/28724447AFRICA72AFRICA LEVEL CGABONGabonese Red Cross Society:Level C: National Society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationCentral AfricaGeographical size ranking178thPopulation (world ranking)11.8 million (153rd)Median age118.6Political system1Presidential republicGDP per capita (worldranking)1$19,300 (91st)HDI Index (world ranking)20.697 - medium (109th)Health Expenditure13.4% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV53.6 % among adults aged15 to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Centre (CNTS) of Gabon is housed in the University Hospital ofLibreville.6 30% of donations are VNRBD.6The CNTS uses a medical questionnaire and tests for HIV, HCV and HBV antibodies and surfaceantigens in order to select blood donors.7NATIONAL SOCIETY (GABONESE RED CROSS)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the government or Ministry of Health.The Gabonese Red Cross:73does not receive financial support for VNRBD activities from outside the countryreceives technical support in the form of trainingwas not previously involved in blood at Level A or Bis not planning to expand or scale back its current level of involvement in blood-relatedactivitiesAFRICAAFRICA LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/gb.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 13].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Gabon Blood bags: URGENT The TSSA seeks donors! GL9News. [Internet] 2016 May 11 [cited 2018 Feb 13].Available from: http://www.gabonlibre.com/Gabon-Poches-de-sang-URGENT-Le-CNTS-cherche-donneurs-_a31638.html7 Rerambiah LK, Rerambiah LE, Begone C, Djoba Siawaya JF. The risk of transfusion-transmitted viral infections at theGabonese National Blood Transfusion Centre. Blood Transfus. [Internet] 2014 Jul [cited 2018 Feb 23];12(3). Availablefrom: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111813/AFRICA74AFRICA LEVEL CGAMBIAGambia Red Cross Society:Level C - National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationWestern AfricaGeographical size ranking1166thPopulation (world ranking)12 million (146th)Median age121Political system1Presidential republicGDP per capita (worldranking)1$1,700 (216th)HDI Index (world ranking)20.452 - low (173rd)Health Expenditure17.3% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High moderate: 2.0% - <5.0%Population prevalence HIV51.7% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Services collected 11,513 units of blood in 2014 and 12,054 unitsin 2015.6 25% is collected from VNRBD. 7Health has been given top priority in the governments development agenda, including the NationalBlood Transfusion Policy and Strategic Plan (2014-2020). 8NATIONAL SOCIETY (GAMBIA RED CROSS)Gambia Red Cross Society:75is involved in occasional community awareness and education programs to help promotevoluntary non-remunerated blood donationcommunity education activities are coordinated nationally and are funded by privateorganisationsAFRICAAFRICA LEVEL Cdoes not receive technical assistance or financial support for VNRBD activities from outsidethe countryplans to expand its current level of involvement in blood-related activities and operate asLevel A by constructing a blood bank and training volunteers in blood managementhas not previously been involved in blood at Level Aconducts sensitization activities on the importance of blood donations and promotes Club 259In 2013, 423 people donated blood with the assistance of the Gambia Red Cross Society10. Thestrategic work plan 2013-17 includes the establishment of a Blood Bank at the Gambia Red Crossheadquarters, with a timeline of 2013-1410.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 02]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ga.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 01].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 01] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2017 October 02] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 02]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Faal M. Senghore S. Gambia: Donor Conference to Support Blood Transfusion Services Held. The Daily Observer(Banjul) [Internet] 2017 May 30 [cited 2017 October 02]. Available from: http://allafrica.com/stories/201705300946.html7 Singateh S C. More Blood Donors Needed as Gambia Commemorate World Blood Donor Day. Foroyaa Newspaper[Internet] 2015 June 23 [cited 2017 October 02]. Available from: http://www.foroyaa.gm/archives/57788 Colley JP. Camara L M. Gambia: Health PS Highlights Significance of Blood Transfusion. The Daily Observer [Internet]2014 January 31 [cited 2017 October 02]. Available from: http://allafrica.com/stories/201401311287.html9 Marenah S. Media Practitioners Sensitised on Blood Donation. The Point. [Internet] 2009 Mar 16 [cited 2018 Feb 13].Available from: http://thepoint.gm/africa/gambia/article/media-practitioners-sensitised-on-blood-donation10 The International Federation of Red Cross and Red Crescent Societies. The Gambia Red Cross Society [Internet]2016 [cited 2017 October 02]. Available from: http://data.ifrc.org/fdrs/societies/the-gambia-red-cross-societyAFRICA76AFRICA LEVEL CLESOTHOLesotho Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking1142ndPopulation (world ranking)12 million (148th)Median age124.2Political system1Parliamentary constitutionalmonarchyGDP per capita (worldranking)1$3,900 (180th)HDI Index (world ranking)20.497 - low (160th)Health Expenditure110.6% of GDPPopulation prevalencehepatitis B3High Intermediate: 5% - 7%(Southern Africa)Population prevalencehepatitis C4Low moderate: 1.5% - 2.0%Population prevalence HIV525% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn accordance with set national and international standards the Lesotho Blood Transfusion Service(LBTS), established in 1984 and under the Ministry of Health, is entrusted with supplying all hospitalsof Lesotho with sufficient, cost effective and safe blood when required.6Blood banks are located in Maseru, Leribe and Mohaless Hoek.7The United States Government has provided support to the Government of the Kingdom of Lesothoto strengthen and expand safe blood transfusion services since 2010 through the US PresidentsEmergency Plan for AIDS Relief (PEPFAR) under a cooperative agreement with the CDC inLesotho.6A large proportion of the blood collected in Lesotho is from school children.8 In 2016 the LBTS facedan acute blood shortage due to the temporary suspension of the school blood donation program. 8The suspension was a result of an outcry from the parents of the school children because theirconsent had not been sought to collect blood from their children.8 Without the donations from the77AFRICAAFRICA LEVEL Cschool children, most blood is donated by people who are doing so to assist a family member inneed of a blood transfusion. 8This form of donation is not encouraged, as the majority of donors who are giving blood for a relativeneglect to divulge their medical conditions. 8 Negotiations to develop guidelines for school blooddonations are in progress. 8In 2010, 93.8% of donations were VNRBD.9NATIONAL SOCIETY (LESOTHO RED CROSS)Lesotho Red Cross Society (LRCS) invites the National Blood Bank to LRCS events such as WorldRed Cross Day so that they can promote blood donations. Community education activities aretherefore conducted by extenstion, and not by LRCS themselves.The community education activities are funded by the blood service and by the National Society.The Lesotho Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level Bis not planning to expand or scale back its current level of involvement in blood-relatedactivities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/lt.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 13].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Seebregts S. Implementation of the Blood Safety Informaiton System Donor Management Module at the Lesotho BloodTransfusion Service. Jembi Health Systems. [Internet] 2016 Apr 25 [cited 2018 Feb 13]. Available from:http://www.jembi.org/implementation-blood-safety-information-system-donor-management-module-lesotho-bloodtransfusion-service/7 Adults reluctant to donate blood. Lesotho Times. Pressreader. [Internet] 2015 Dec 31 [cited 2018 Feb 13]. Availablefrom: https://www.pressreader.com/lesotho/lesotho-times/20151231/2815737647045738 Kabi P. Patients at risk as blood bank runs dry. Lesotho Times. [Internet]. 2016 Mar 19 [cited 2018 Feb 13]. Availablefrom: http://www.lestimes.com/patients-at-risk-as-blood-bank-runs-dry/9 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2017 October 31]. Available from:http://www.afro.who.int/sites/default/files/2017-06/status-of-blood-safety-in-the-who-african-region.pdfAFRICA78AFRICA LEVEL CMAURITANIAMauritanian Red Crescent:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationWestern AfricaGeographical size ranking130thPopulation (world ranking)13.75 million (129th)Median age120.3Political system1Presidential republicGDP per capita (worldranking)1$4,300 (175th)HDI Index (world ranking)20.513 - low (157th)Health Expenditure13.8% of GDPPopulation prevalencehepatitis B3High: >8%Population prevalencehepatitis C4Moderate: 1.5-3.5%Population prevalence HIV50.50% among adults aged 15to 49NATIONAL BLOOD PROGRAMA national strategy for the safety of blood transfusions has been implemented.6 Thirteen regionalblood banks have been established to ensure systematic blood control.6 A national blood transfusioncentre has also been established and facilitates the network of blood banks with the provision oftrained personnel, management tools and coordinates a regular supply of reagents andconsumables.6Donor loyalty and blood collection are promoted thorugh organised activities.6 Active campaigningresulted in an increase in blood donors from 6,802 in 2004 to 10,584 in 2008.6While all donations are tested for hepatitis B, hepatitis C, syphilis and HIV, the majority of rejecteddonations are due to syphilis and hepatitis B. With improved donor selection and donor loyalty, thisnumber is decreasing.6In 2010, 31% of donations were VNRBD.779AFRICAAFRICA LEVEL CNATIONAL SOCIETY (MAURITANIAN RED CRESCENT)In 2013, 60 people donated blood with the assistance of the Mauritanian Red Crescent (MRC).8Red Crescent volunteers donate blood when required.programs and public campaigns.The MRC also undertakes education1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 30]. Availablefrom:https://www.cia.gov/library/publications/the-world-factbook/geos/mr.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2017 October 30].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2017 October 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2017 October 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 List of issues and questions in relation to the combined fourth and fifth periodic reports of Mauritania. Addendum,Replies of Mauritania [Internet] 2014 March 13 [cited 2017 October 30]. Available from:http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2FPPRiCAqhKb7yhsgOTxO5cLIZ0CwAvhyns%2ByL73Se1Ck34GffsZTuUoU4oJU6LE7D7G7KKP2CkjtexbivY9DTfBpEkn7DHIHmB8g53ICVChCMhEhCxMjk4Jr%2B8MkOnO6zxFXBHjSJ4sWYJlQ%3D%3D7 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2017 October 30]. Available from:http://www.afro.who.int/sites/default/files/2017-06/status-of-blood-safety-in-the-who-african-region.pdf8 The International Federation of Red Cross and Red Crescent Societies. Mauritanian Red Crescent [Internet] 2016[cited 2017 October 30]. Available from: http://data.ifrc.org/fdrs/societies/mauritanian-red-crescentAFRICA80AFRICA LEVEL CMOZAMBIQUEMozambique Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouth-eastern AfricaGeographical size ranking136thPopulation (world ranking)126.6 million (50th)Median age117.2Political system1Presidential republicGDP per capita (worldranking)1$1,300 (222nd)HDI Index (world ranking)20.418 - low (181st)Health Expenditure17% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV512.3% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Program (PNTS) was established in Mozambique by the Ministry ofHealth in 1975. 6 In 2011 the National Blood Service (SENASA) was created by the Ministry ofHealth.6 SENASA is responsible for ensuring an adequate blood supply, and that quality standardsare met.6There are now 149 blood banks distributed across the country in central, provincial, general anddistrict hospitals and health centres.6 Working together with the Mozambique Red Cross, the PNTScollects, processes, stores and issues blood to public and private health facitilies.6Since 2004, PNTS has tested all blood for transfusion transmissible infections (TTIs).6In 2014 a National Blood Reference Centre in Maputo was established using funds provided by theUS government via US Presidents Emergency Plan for AIDS Relief (PEPFAR), which now totalUS$13 million.7 The Mozambican health service is still severely short of blood despite the increasein donations over the last ten years.756% of blood donations are from family replacement donors.881AFRICAAFRICA LEVEL CNATIONAL SOCIETY (MOZAMBIQUE RED CROSS)Community education activities are coordinated nationally and funded by the National Society.The Mozambique Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level A the National Society previously operated ablood service which collected blood from donors, and may also have been involved inprocessing blood into components and screening donations for infectious disease, howeverceased involvement ten years ago due to limited skills and capacityis not planning to expand or scale back its current level of involvement in blood-relatedactivities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/mz.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 13].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 2012 Global AIDS Response Progress Report. National AIDS Council. Republic of Mozambique. [Internet] 2012 [cited2018 Feb 13]. Available from:http://files.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_MZ_Narrative_Report[1].pdf7 National Blood Centre Inaugurated. AIM Reports. Mozambique News Agency. [Internet] 2015 Jan 6 [cited 2018 Feb13]. Available from: http://www.poptel.org.uk/mozambique-news/newsletter/aim498.html#story88 Strengthening Blood Transfusion Services in the Republic of Mozambique under the Presidents Emergency Plan forAIDS Relief (PEPFAR). Division of Global HIV/AIDS. Centre for Global Health. Centres for Disease Control andPreventation. [Internet] 2014 [cited 2018 Feb 23]. Available from: https://www.cdc.gov/globalaids/global-hiv-aids-atcdc/fy2015/CDC-RFA-GH15-1559.pdfAFRICA82AFRICA LEVEL CNIGERRed Cross Society of Niger:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationWestern AfricaGeographical size ranking123rdPopulation (world ranking)119.2 million (60th)Median age115.4Political system1Semi-presidential republicGDP per capita (worldranking)1$1,200 (223rd)HDI Index (world ranking)20.353 - low (187th)Health Expenditure15.8% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV50.4% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe National Centre or Blood Transfusion is the only structure authorised by the health authoritiesto have a blood bank to collect and distribute blood to all health facilities, including privateorganisations.In 2010, 36% donations were VNRBD and 7.2% of donations were separated into components.6NATIONAL SOCIETY (RED CROSS OF NIGER)The Red Cross Society of Niger is involved in the motivation and mobilisation of blood donors towarddonating blood at the National Centre for Blood Transfusion (CNTS) on the celebration of theInternational Day of the Red Cross and Red Crescent Movement (8th May). The National Societymobilises nearly 50 volunteers each year to donate blood at this centre.In 2013, 168 people donated blood with the assistance of the Red Cross Society of Niger. 7The Red Cross Society of Niger conducts blood donation activities at the CNTS in Niamey, Agadez,Diffa and Tillabry.883AFRICAAFRICA LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ng.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 13].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 13] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 13]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Tapko JB, Toure B, Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2018 Feb 13]. Available from: http://www.afro.who.int/sites/default/files/201706/status-of-blood-safety-in-the-who-african-region.pdf7International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Red Cross Society of Niger. [Internet] 2016 [cited 2018 Feb 13]. Available from:http://data.ifrc.org/fdrs/societies/red-cross-society-of-niger8 Activity Report (2010-2013). Nigerian Red Cross National Executive Board General Assembly. [Internet] 2014 Jan[cited 2018 Feb 13]. Available from: http://data-api.ifrc.org/documents/NE/AR_Niger_2010-2013_FR.docAFRICA84AFRICA LEVEL CNIGERIANigerian Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationWestern AfricaGeographical size ranking133rdPopulation (world ranking)1191 million (7th)Median age118.4Political system1Federal presidential republicGDP per capita (worldranking)1$5,900 (164th)HDI Index (world ranking)20.527 - low (152nd)Health Expenditure13.7% of GDPPopulation prevalencehepatitis B43High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV52.9% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn 2006 Nigeria established a National blood transfusion policy. 6 It outlined the structure of the bloodtransfusion services as follows6:the National Blood Transfusion Service (NBTS), responsible for blood donor recruitmentregional blood service centres, responsible for the processing of bloodlocal and state government blood service centres, responsible for the appropriate use ofbloodarmed forces blood service, responsible for personnel and human resource developmentprivate and other NGO health establishments6The NBTS operates a number of donor centers around the country but is not located in all areas ofthe country. 7 Their long term plan is to be the blood service for the entire country but resourcescontinue to be scarce and funding is limited.7Nigeria has made little progress over the years with voluntary donor recruitment, with only 5% ofblood donated from voluntary donors. 8 The rest is donated by paid and family replacement donors.885AFRICAAFRICA LEVEL CWhether for cultural or religious reasons, there are opinion leaders in Nigeria who are against blooddonation. 9 This combined with ignorance and scepticism around blood donation directly contributesto the lack of a voluntary blood donation culture.910% of worldwide maternal casualties are attributed to Nigeria, which has one of the highestmaternal mortality rates in the developing world. 10 Health professionals predict that an improvedblood bank system will dramatically decrease the 23% of maternal deaths caused by haemorrhage.10NATIONAL SOCIETY (NIGERIAN RED CROSS)Community education activities are coordinated both nationally and by district/chapter by theNational Society. They are funded by the government or Ministry of Health.The Nigerian Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level B. It ceased involvement due to limited or no supportfrom government and other agencies on VNRBDis planning to increase its current level of involvement in blood-related activities. The NRCShas held talks with the National Blood Transfusion Service to resume community mobilisationfor VNRBD but requires technical and financial support to return to a level B and ensure thelong term sustainability of their VNRBD activities in Nigeria3,402 people were donating blood at or with the assistance of the Nigerian Red Cross Society in2013 (up from 2,120 in 2012).111Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ni.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Aneke J. Okocha CE. Blood Transfusion Safety; current status and challenges in Nigeria. Asian Journal of TransfusionScience [Internet]. 2017 Jan-Jun [cited 2018 Feb 12]; 11(1). Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345273/7 Schall, Tom. Re: question. Message to: Vandekerckhove, Philippe (GAP President) 2016 Mar 22 [cited 2018 Feb 14].8 Benedict N, Augustina AO, Nosakhare BG. Blood Donation in Nigeria: Standard of the Donated Blood. J LabPhysicians. [Internet] 2012 Jul-Dec [cited 2018 Feb 14]:4(2). Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574505/9 Nigeria: Why blood donation is essential for Nigerians. This Day. [Internet] 2014 Feb 20 [cited 2018 Feb 14]. Availablefrom: http://allafrica.com/stories/201402200162.html10 Obinna C. Robust blood bank systemll reduce maternal mortality. Vanguard. [Internet] 2015 May 20 [cited 2018 Feb14]. Available from: http://www.vanguardngr.com/2015/05/robust-blood-bank-systemll-reduce-maternal-mortality/11 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Nigerian Red Cross Society. [Internet] 2016 [cited 2018 Feb 13]. Available from:http://data.ifrc.org/fdrs/societies/nigerian-red-cross-societyAFRICA86AFRICA LEVEL CSENEGALSenegalese Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationWestern AfricaGeographical size ranking189thPopulation (world ranking)114.7 million (71st)Median age118.8Political system1Presidential republicGDP per capita (worldranking)1$2,700 (197th)HDI Index (world ranking)20.494 - low (162nd)Health Expenditure14.7% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV50.4% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn Senegal, there is a national blood bank which is responsible for all activities.In 2012, there were 53,000 blood donations. 6 24,000 of these donations were collected at theCentre for Blood Transfusion.6Senegal reported having achieved 100% VNRBD in 2008 7, but this dropped to 79.4% in 2010. 8In 2010, 20.5% of donations were separated into components. 8NATIONAL SOCIETY (SENEGALESE RED CROSS)The Red Cross organizes blood donor clinics from time to time with the technical support of the bloodbank. In this regard, the Red Cross prepares and implements awareness-raising activities in thepopulation and in the media.87AFRICAAFRICA LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/sg.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Fall H. Business of blood in Senagal. World Newsde Harouna. [Internet] 2013 Mar 14 [cited 2018 Feb 12]. Availablefrom: http://fallharouna.blogspot.com.au/2013/03/buisness-of-blood-in-senegal.html7 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] 2011 [cited 2018 Feb 12]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=18 Tapko JB, Toure B, Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2018 Feb 12]. Available from: http://www.afro.who.int/sites/default/files/201706/status-of-blood-safety-in-the-who-african-region.pdfAFRICA88AFRICA LEVEL CSEYCHELLESSeychelles Red Cross:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationIndian OceanGeographical size ranking1199thPopulation (world ranking)194 thousand (198th)Median age135.4Political system1Presidential republicGDP per capita (worldranking)1$28,900 (68th)HDI Index (world ranking)20.782 - high (63rd)Health Expenditure13.4% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Very low: 0 - <1.0%Population prevalence HIV50.4%NATIONAL BLOOD PROGRAMThe Blood Transfusion Unit (BTU) of the Ministry of Health is responsible for blood transfusion inSeychelles.6In 2014, the Seychelles Ministry of Health received its first mobile blood donor van provided by theWorld Health Organisation.6Each year, 1500 units of blood are donated in the Seychelles about half of the countrysrequirement.6 The BTU relies heavily on family replacement donations, which make up the majorityof the total donations.7 In case of emergency, an emergency group of donors made up of membersof the army, police, fire brigade and other forces may be called. 8 There is also a list of about 250regular donors who may be called in case of emergency.889AFRICAAFRICA LEVEL CNATIONAL SOCIETY (SEYCHELLES RED CROSS)The Red Cross Society of Seychelles (RCSS) provides some assistance to the Ministry of Health forthe promotion of blood donation, despite limited resources.9 In 2006 the RCSS launched a programto train Blood Donor Recruitment Officers from various organisations to help educate and motivatepotential blood donors. 10Community education activities are coordinated nationally by the National Society. They are fundedthrough projects submitted to donor organisations.The Seychelles Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryindicated in their survey response that they had not previously been involved in blood at LevelA or B, however in previous GAP global mapping (2010) they were Level Bis not planning to expand or scale back its current level of involvement in blood-relatedactivities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/se.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Schweitzer A, Horn J, Mikolajczyk R, Krause G, Ott J. Estimations of worldwide prevalence of chronic hepatitis B virusinfection: a systematic review of data published between 1965 and 2013. The Lancet. [Internet] 2015 Jul 28 [cited 2018Feb 12];386(10003). Available from: https://www.sciencedirect.com/science/article/pii/S014067361561412X?via%3Dihub4 World hepatitis Day July 28 2014 Hepatitis: Think Again. Seychelles Nation. [Internet]. 2014 Jul 26 [cited 2018 Feb12]. Available from: http://www.nation.sc/article.html?id=2424575 Bovet P, Gdon J, Louange M, Durasnel P, Aubry P, Gazre BA. Situation and health issues in the Seychelles in2012. Tropical Medicine and Health. [Internet] 2013 Nov [cited 2018 Feb 12];23(3). Available from :https://www.researchgate.net/publication/258954058_Health_situation_and_issues_in_the_Seychelles_in_20126 Arrigo A. Give blood, save lives: Seychelles moving out to meet blood donors halfway. Seychelles News Agency.[Internet] 2014 Jun 15 [cited 2018 Feb 12]. Available from:http://www.seychellesnewsagency.com/articles/738/Give+blood,+save+lives+Seychelles+moving+out+to+meet+blood+donors+halfway7 World Blood Donor Day. Seychelles Nation. [Internet] 2017 June 23 [cited 2018 Feb 14]. Available from:http://www.nation.sc/article.html?id=2545808 Bodwell A. Interview with Prosper Kinabo, Head of Laboratory Services at the Ministry of Health. Today in Seychelles.Facebook. [Internet] 2014 Dec 23 [cited 2018 Feb 12]. Available from:https://www.facebook.com/todayinsey/posts/762142723823540:09 Annual Report 2015. Seychelles Red Cross Society. [Internet] 2016 [cited 2018 Feb 14]. Available from: http://dataapi.ifrc.org/documents/SC/AR_Seychelles_2015_EG_Draft.pdf10 Red Cross to launch blood donor recruitment programme. Seychelles Nation. [Internet] 2006 Sept 28 [cited 2018 Feb14]. Available from: http://www.nation.sc/article.html?id=214757AFRICA90AFRICA LEVEL CSOMALIASomali Red Crescent Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern AfricaGeographical size ranking145thPopulation (world ranking)111 million (83rd)Median age117.9Political system1Federal parliamentary republicGDP per capita (worldranking)1$400 (230th)HDI Index (world ranking)2n/aHealth Expenditure1n/aPopulation prevalencehepatitis B3High Intermediate: 5-7%Population prevalencehepatitis C4Moderate: 1.5-3.5%Population prevalence HIV50.40% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn 2013, over 26,000 units of blood were donated through the blood transfusion networks supportedby the World Health Organization in Somalia. 6 There are four blood banks and 25 blood transfusionunits, mainly confined to urban areas.6 There is a lack trained staff, proper equipment, routinesupplies and basic amenities such as water in existing transfusion units.6 Mothers account for almost70% of donated blood used.6A youth group in Mogadishu, the Somali blood donor volunteers, provides critical support to hospitalsin the city handling emergency medical cases. 7 The group has 5,000 registered members, includinguniversity and high school students, football players, businessmen, teachers, journalists andhumanitarian workers.7 600 members have donated blood since the group formed in November2015.7 Contact details and blood groups of members are registered with local hospitals, who cancall them in case of emergency.791AFRICAAFRICA LEVEL CNATIONAL SOCIETY (SOMALI RED CRESCENT)In the 1990s the Red Cross was involved in the blood program however following the collapse ofthe central government, there was no longer an active blood program. The hospital blood banking isbased on family replacement donors and few volunteers. The Somali Red Crescent Society currentlyhas a strategy to have regular mobilisation of donors within the hospitals (both public and RedCrescent volunteers), as well as calling for donors in a crisis.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017October 30]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/so.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 October 30]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 October 30] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectiousdiseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 October 30] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectiousdiseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017October 30]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 World Health Organisation, Somalia, Mothers in Somalia need more blood donations [Internet] World HealthOrganisation 2014 June 14 [cited 2017 October 30]. Available from: http://www.emro.who.int/som/somalianews/mothers-in-somalia-need-more-blood-donations.html7 Taysir C. Youth blood donors giving critical support to Somali hospitals. Radio Ergo. [Internet] 2016 July 04 [cited 2017October 30]. Available from: https://www.radioergo.org/en/blog.php?article_id=2215AFRICA92AFRICA LEVEL CSUDANSudanese Red Crescent:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationNorth-eastern AfricaGeographical size ranking117thPopulation (world ranking)137.3 million (37th)Median age119.9Political system1Presidential republicGDP per capita (worldranking)1$4,600 (174th)HDI Index (world ranking)20.490 - low (165th)Health Expenditure18.4% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.2% among adults aged 15to 49NATIONAL BLOOD PROGRAMSudan has a National Blood Transfusion Centre, and 49% of blood is VNRBD.6A group of young people have developed an online database which helps to match patients withdonors. 7 The blood is collected at the National Public Health Laboratory in Khartoum.7NATIONAL SOCIETY (SUDANESE RED CRESCENT)Community education activities are coordinated nationally and by district/chapter by the NationalSociety. They are funded by the blood service, by the National Society, by government or Ministryof Health and by private organisations. Campaigns are held as required, focusing more on raregroups.The Sudanese Red Crescent:93does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas not previously involved in blood at Level A or Bis planning to expand its current level of involvement in blood-related activities if it receivesfunding to do soAFRICAAFRICA LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/su.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 01] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 World Health Organisation. Sudan. Heads of UN agencies and development partners lead blood donation in Sudan.[Internet] 2012 Jun 12 [cited 2018 Feb 12]. Available from: http://www.emro.who.int/sdn/sudan-news/blood-donation.html7 Middle East Extra Sudan Blood. AP Archive. [Internet] Khartoun: AP Television; 2015 Feb 7 [cited 2018 Feb 12].Videocast about 6 minutes. Available from: http://www.aparchive.com/metadata/Middle-East-Extra-SudanBlood/57fcaaf060ea1e604afc7a629350d462?query=MIDDLE+EAST+EXTRA&current=14&orderBy=Relevance&hits=34&referrer=search&search=%2Fsearch%3Fquery%3DMIDDLE%2520EAST%2520EXTRA%26allFilters%3DSudan%3ALocations&allFilters=Sudan%3ALocations&productType=IncludedProducts&page=1&b=50d462AFRICA94AFRICA LEVEL CZAMBIAZambia Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking140thPopulation (world ranking)116 million (69th)Median age116.8Political system1Presidential republicGDP per capita (worldranking)1$4,000 (179th)HDI Index (world ranking)20.579 - medium (139th)Health Expenditure15% of GDPPopulation prevalencehepatitis B3High Intermediate: 5% - 7%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV512.4% among adults aged15 to 49NATIONAL BLOOD PROGRAMZambia National Blood Transfusion Service (ZNBTS) is the government unit, mandated by MOH toensure the safety and adequacy of blood and blood products throughout Zambia.6The ZNBTS is responsible for7:blood donor recruitment, selection and blood collectioncare for blood donors including counsellingscreening for infectious agents, serological blood grouping and storage of blood unitsthe processing of blood componentssupplying blood to hospital blood banks 7The proportion of VNRBD has increased from 73% in 2004 to 100% since 2007.6109,000 units were collected in 2014, which is below the required number of 140,000 (68% of donorsare male). 8In 2010, 2% of donations were separated into components. 995AFRICAAFRICA LEVEL CNATIONAL SOCIETY (ZAMBIA RED CROSS)Community education activities are coordinated nationally and by district/chapter by the NationalSociety. They are funded by the blood service and by private organisations.The Zambia Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryindicated in their survey response that they had not previously been involved in blood at LevelA or B, however in previous GAP global mapping (2010) they were Level Bis planning to expand its current level of involvement in blood-related activities - dependanton funds being made available, the Zambia Red Cross plans to come up with systematicblood recruitment programs to support the collection of blood by the ZNBTS1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/za.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Muyinda G. Strategy for Accelerated Establishment of Hospital Transfusion Committees in Zambia. Presented at:AfSBT Congress; 2012 Jun 4-7; Mauritius. Powerpoint presentation available from:http://www.afsbtedu.org/mauritius2012/usb/day3/talk6/ppt.pdf7 University Teaching Hospital. Ministry of Health. Government of the Republic of Zambia. Blood bank and ZambiaNational Blood Transfusion Service. [Internet] 2015 [cited 2018 Feb 12]. Available from:http://www.uth.gov.zm/?page_id=15138 Malama B. World blood day: time to demystify blood donation. Zambia Daily Mail [Internet] 2015 Jun 14 {cited 2018Feb 12]. Available from: https://www.daily-mail.co.zm/?p=330709 Tapko JB, Toure B, Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2018 Feb 12]. Available from: http://www.afro.who.int/sites/default/files/201706/status-of-blood-safety-in-the-who-african-region.pdfAFRICA96AFRICA LEVEL CZIMBABWEZimbabwe Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking162ndPopulation (world ranking)113.8 million (72nd)Median age120.0Political system1Semi-presidential republicGDP per capita (worldranking)1$2,300 (201st)HDI Index (world ranking)20.516 - low (154th)Health Expenditure16.4% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low moderate: 1.5% <2.0%Population prevalence HIV513.5% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Service (NBTS) was formed and registered as a non-profit makingorganization in May 1989 following the amalgamation of the existing Bulawayo Districts BloodTransfusion Service and the Harare Districts Blood Transfusion Service. 6 The Service has aconstitution that governs its operations as embodied in the Memorandum and Articles ofAssociation.6 In 2006, the organization was renamed the National Blood Service Zimbabwe (NBSZ).6The organisational objectives6 are:to increase accessibility and consistency of safe blood suppliesto enhance financial management and funding mixto enhance marketing, brand awareness and customer satisfactionto build blood management capacity and appropriate use of productsto increase organizational effectiveness and promote researchto improve waste management, Quality and Safety6NBSZ is geographically located in five areas, with the main site at Harare and regional centres inBulawayo, Masvingo, Mutare and Gweru. 697AFRICAAFRICA LEVEL CThe NBSZ developed its quality management system based on the ISO 9001:2008 standard and iscertified to it by the Standards Association of Zimbabwe (SAZ). 7 NBSZ is working towardsaccreditation to the Africa Society for Blood Transfusion standards.8NBSZ operates under a National Blood Policy and Standards for blood donation, processing andclinical transfusion.9 The National Blood Policy aims to ensure access, affordability, quality andsafety of blood, blood products and services to all who are in need in conformity with the InternationalSociety for Blood Transfusion (ISBT) Code of Ethics for Blood Transfusion Services. 9NBSZ maintains an activity based cost recovery model designed to implement full cost recoverybased pricing policy.6International Funding has been received by NBSZ from NGOs including10:the Swiss Red Crossan AIDS prevention organizationseveral corporations10NBSZ invested over $4 million in infrastructure, staff development and equipment between 2010 and2013, with the funds provided by the US Presidents Emergency Plan for AIDS Relief (PEPFAR).8Zimbabwe achieved 100% VNRBD in 2008.11In 2015, NBSZ collected 59,837 units, but faced shortages, particularly of group O blood.7In 2015 the following components were produced:46527 red cells388 paediatric red cells7057 plasma4075 platelets83 single donor platelets collected on demand1832 whole blood259 paediatric whole blood214 cryoprecipitate7Most Club 25 youth blood donation programs around the world are based on the NBSZ Pledge25, which began in 1989.12 NBSZ asked students to pledge 25 blood donations before they turned25, as it identified that most HIV infections were transmitted from unprotected sex under the age of25.12 The pledge encouraged students to conduct healthy a lifestyle, which included safe sexpractices.12 Pledge 25 was a great success: 70% of blood collected in Zimbabwe is from students.12While the HIV infection rate amongst the sexually active population was over 20% in 2005, HIVinfection rates among blood donors was as low as 0.35%, down from 4.45% in 1989. 12 Pledge 25club collections contributed 13.19% of collections in 2015.7NATIONAL SOCIETY (ZIMBABWE RED CROSS)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the National Society.The Zimbabwe Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level Bis not planning to expand or scale back its current level of involvement in blood-relatedactivitiesAFRICA98AFRICA LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Availablefrom:https://www.cia.gov/library/publications/the-world-factbook/geos/zi.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 National Blood Service Zimbabwe. Historical Background [Internet] 2018 [cited 2018 Feb 12]. Available from:http://www.nbsz.co.zw/about7 National Blood Service Zimabwe. Annual Report 2016. [Internet] 2016 [cited 2018 Feb 20]. Available from:http://www.nbsz.co.zw/annual-reports8 National Blood Service Zimbabwe. Annual Report 2015. [Internet] 2015 [cited 2018 Feb 12]. Available from:http://www.nbsz.co.zw/annual-reports9 National Blood Service Zimbabwe. National Blood Policy of the Republic of Zimbabwe. [Internet] 2011 [cited 2018 Feb20]. Available from: http://www.nbsz.co.zw/sites/all/themes/corlate/images/PDF/nbp.pdf10 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.11 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] 2011 [cited 2018 Feb 12]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=112 Club 25: Reaching young blood donors. World Blood Donor Day. World Health Organisation. [Internet] 2006 [cited2018 Feb 26]. Available from: http://www.who.int/worldblooddonorday/campaignkit/WBDD_Club25_English.pdf99AFRICAAFRICA NIL (NO INVOLVEMENT)ANGOLAAngola Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking124thPopulation (world ranking)129.3 million (46th)Median age115.9Political system1Presidential republicGDP per capita (worldranking)1$6,800 (161st)HDI Index (world ranking)20.533 - low (150th)Health Expenditure13.3% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV51.9% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Ministry of Health (MOH) is the organisation responsible for blood safety in Angola. 6 Within theMOH, the National Blood Centre (NBC) is responsible for developing national policies and guidelinesfor the delivery and implementation of blood safety interventions.6 The NBC is the only officialnational safe blood service provider in Angola.6In 2013 the blood services remain disjointed.6 To improve the blood supply, the MOH/NBC togetherwith the United States Government and private organisations are working to train blood service andmedical staff in the areas of:quality management of blood donorsmaterials handlingtesting for transmittable infections6The US Presidents Emergency Plan for AIDS Relief (PEPFAR) Angola will be supporting thatprocess providing on-ground technical support to help develop standardizations across bloodcentres and insure all blood centres are operating under the same regulations and guidelines.6AFRICA100AFRICA NIL (NO INVOLVEMENT)In 2011, Angolas National Blood Centre used family replacement donors for 90% of transfusionsnationally. 7 In the nations capital, there are 8,000 VNRBD donors covering only 25% of transfusionrequirements, whereas in the other provinces there are fewer VNRBD. 7 A lack of blood in Luanda,Angola, has led to an underground market for blood, where doctors and nurses contact people whowill donate blood for money.8Collaborative efforts between the US CDC and Angola Blood Services have focused on evaluationof the current system of donor recruitment, blood collection and storage, and testing of the blood forpathogen contaminants.6 Recommendations have been made to expand the number of unitscollected; the proportion collected from voluntary, non-remunerated donors versus familyreplacement; the ability to fractionate units into components; and the testing of all units for HIV,Hepatitis B and C, and syphilis in a quality-assured manner.6NATIONAL SOCIETY (ANGOLA RED CROSS)Angola Red Cross Society is not involved in any blood related activities. It was previously involvedin blood at Level C: Individual branches had previously raised small amounts of funding that allowedfor community outreach to encourage people to donate blood in Cabinda, Luanda and Benguelaprovince. This was done as recently as 2015. There has since been no financing for this activity.In 2013, 308 people were donating blood at or with the assistance of the Angola Red Cross. 9 In2012 the number was 1,698.91Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ao.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Angola Operational Plan Report. FY 2013. Presidents Emergency Plan for AIDS Relief. [Internet] 2014 [cited 2018 Feb12]. Available from: http://www.pepfar.gov/documents/organization/222150.pdf7 Radio Ecclesia. Centro Nacional de Sangue com reduo de sangue (National Blood Centre with reduced blood).[Internet] 2011 Aug 28 [cited 2018 Feb 12]. Available from:http://www.radioecclesia.org/index.php?option=com_flexicontent&view=items&cid=195:angola&id=7231:centro-nacionalde-sangue-com-reducao-de-sangue-&Itemid=715#.Vz7Owvl97RY8RA Sociedade. Venda clandestina de sangue em Luanda (Clandestine sale of blood in Luanda). [Internet] 2015 May 31[cited 2018 Feb 12]. Available from: http://www.redeangola.info/venda-clandestina-de-sangue-em-luanda/9 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Angola Red Cross. [Internet] 2016 [cited 2018 Feb 12]. Available from:http://data.ifrc.org/fdrs/societies/angola-red-cross101AFRICAAFRICA NIL (NO INVOLVEMENT)MALIMali Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationInterior Western AfricaGeographical size ranking125thPopulation (world ranking)117.9 million (64th)Median age115.8Political system1Semi-presidential republicGDP per capita (worldranking)1$2,200 (203rd)HDI Index (world ranking)20.442 - low (175th)Health Expenditure16.9% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High: 5%Population prevalence HIV51% among adults aged 15 to49NATIONAL BLOOD PROGRAMThe Centre National de Transfusion Sanguine (CNTS) provides blood transfusion services to thepeople of Mali. 6 The CNTS headquarters are located in Bamako but there are services available inall regions under the regional hospitals.6The Safe Blood for Africa Foundation (SBFA) completed Blood Safety Assessments and planningevents in Mali since 2012.6 This organisation is committed to improving blood services so they aresustainable and adhere to the guidelines and recommendation of WHO.6 Funding to address longterm needs is provided through the US Presidents Emergency Plan for AIDS Relief (PEPFAR) undera Cooperative Agreement with the US Centers for Disease Control and Prevention (CDC). 6In 2010, 30.4% of donations were VNRBD and 30.4% of donations were separated intocomponents.7NATIONAL SOCIETY (MALI RED CROSS)There is no recent data available on people donating blood with the assistance of the Mali Red CrossSociety. 8There is no mention of blood related activities in the 2015 Mali Red Cross Annual Report.9AFRICA102AFRICA NIL (NO INVOLVEMENT)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ml.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Safe Blood for Africa Foundation. Mali [Internet] 2017 [cited 2018 Feb 12]. Available from:http://www.safebloodforafrica.org/index.php/mali7 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2018 Feb 12]. Available from: http://www.afro.who.int/sites/default/files/201706/status-of-blood-safety-in-the-who-african-region.pdf8 The International Federation of Red Cross and Red Crescent Societies. Mali Red Cross [Internet] 2016 [cited 2018 Feb12]. Available from: http://data.ifrc.org/fdrs/societies/mali-red-cross9 Croix-Rouge Malienne. Rapport Annuel DActivities. [Internet] 2015 [cited 2018 Feb 12]. Available from:http://data.ifrc.org/public/documents/ML/AR_Mali_2015_FR.pdf103AFRICAAFRICA NIL (NO INVOLVEMENT)MAURITIUSMauritius Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationSouthern African islandGeographical size ranking1181stPopulation (world ranking)11.4 million (156th)Median age134.8Political system1Parliamentary republicGDP per capita (worldranking)1$21,600 (86th)HDI Index (world ranking)20.781 - high (64th)Health Expenditure14.8% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C3Moderate: 1.5% - 3.5%Population prevalence HIV41.2% among adults aged 15to 49 (2012)NATIONAL BLOOD PROGRAMNational Blood Transfusion Service of Mauritius is a department of the Central Health Laboratory,Ministry of Health and Quality of Life, and is situated within the Victoria Hospital, Candos. 5 It providesblood and blood components to all public and private health care institutions in Mauritius.5 Blood iscollected at fixed sites as well as through a system of mobile blood collection throughout the island.5The fixed points of blood collection are found at Blood Banks attached to the four regional hospitals:AG Jeetoo Hospital in Port LouisSSRN Hospital in the NorthFlacq HospitalJawaharlal Nehru Hospital in Rose Belle South5Regional Blood Banks are attached to the regional hospitals.5 Their main activity is to collect bloodfrom the blood donors and to store and issue blood to the hospitals after pre transfusion testing. 5Currently, 85% of blood donations are VNRBD.6AFRICA104AFRICA NIL (NO INVOLVEMENT)Unlike mainland Africa where burden of infectious diseases is still high, non-communicable diseasessuch as diabetes and cardiovascular diseases are emerging as a major challenge for Mauritius. 7Almost 30% of the blood supply presently goes to treat anemia in end stage and renal failurepatients.7The Mauritian Blood Transfusion service has managed to keep pace with increased demands asreflected in the steady increase in the number of blood units collected, from 20 000 in 1998 to morethan 45 000 in 2011.7In 2010, 47.6% of donations were separated into components.8A Blood Donor Association (NGO) is responsible for blood collections and educational campaigns.NATIONAL SOCIETY (MAURITIUS RED CROSS)In 2013 no people donated blood with the assistance of the Mauritius Red Cross Society. 9There is no mention of blood related activities in the 2012-2016 Mauritius Red Cross SocietyStrategic Plan 2013-2016.101Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 31]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/mp.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2017 October 31].Available from: http://hdr.undp.org/en3 Ministry of Health and Quality of Life. Health Statistics Report 2014 Island of Mauritius and Island of Rodrigues[Internet] 2015 [cited 2017 October 31]. Available from:http://health.govmu.org/English/Statistics/Health/Mauritius/Documents/annual%20report%202014.pdf4 UNICEF. At a glance: Mauritius [Internet] 2013 [cited 2017 October 31]. Available from:https://www.unicef.org/infobycountry/mauritius_statistics.html5 Mauritious Blood Transfusion Service [Internet] 2017 [cited 2017 October 31]. Available from:http://bts.health.govmu.org/English/Pages/default.aspx6 Blood Donors Association (Mauritius) http://www.bdamauritius.com/home.php7 National Computer Board News. Mauritius hosts 6 th Internationsl Congress of Africa Society for Blood Transfusion 5June 2012. http://www.ncb.mu/English/News/Pages/Mauritius-Hosts-6th-International-Congress-of-Africa-Society-forBlood-Transfusion.aspx8 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2017 October 31]. Available from:http://www.afro.who.int/sites/default/files/2017-06/status-of-blood-safety-in-the-who-african-region.pdf9 The International Federation of Red Cross and Red Crescent Societies. Mauritius Red Cross Society [Internet] 2016[cited 2017 October 31]. Available from: http://data.ifrc.org/fdrs/societies/mauritius-red-cross-society10 Mauritius Red Cross Society. Strategic Plan 2013-2016 [Internet] [cited 2017 October 31]. Available from:http://data.ifrc.org/public/documents/MU/SP_Mauritius_2013-2016_eng.pdf105AFRICAAFRICA NIL (NO INVOLVEMENT)NAMIBIANamibia Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking135thPopulation (world ranking)12.5 million (142nd)Median age121.2Political system1Presidential republicGDP per capita (worldranking)1$11,500 (134th)HDI Index (world ranking)20.640 - medium (125th)Health Expenditure18.9% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low moderate: 1.5% <2.0%Population prevalence HIV513.8% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Southwest Africa Blood Transfusion Service was formed in 1963, and renamed as the BloodTransfusion Service of Namibia (NAMBTS) on 1 January 1987 after Namibia declaredindependence.6 NAMBTS is a fully operational blood transfusion service with four fixed donationcentres - two in Windhoek, one of which is the head office, Swakopmund and Walvis Bay. 6 Mobiledonation teams visit 147 different venues annually.7Every donation is tested for HIV, Hepatitis B and C, and Syphilis.6In 2012 approximately 25,000 units of blood were collected from less than 12,000 active blooddonors.8A National Blood Policy was developed in 2007, which includes that all blood must be obtained fromVNRBD.9 Namibia achieved 100% VNRBD in 2008.10NATIONAL SOCIETY (NAMIBIA RED CROSS)The Namibia Red Cross is not involved in blood activities.AFRICA106AFRICA NIL (NO INVOLVEMENT)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/wa.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Namibia Blood Transfusion Service. About Us. [Internet]. 2018 [cited 2018 Feb 20]. Available from:http://www.bts.com.na/about-us7 Namibia Blood Transfusion Service. Donation Clinics. [Internet] 2018 [cited 2018 Feb 12]. Available from:http://www.bts.com.na/8 Radiowave. Charity of the Month. June 2013 Namibian Blood Transfusion Service (NAMBTS). [Internet] 2013 [cited2018 Feb 12]. Available from: http://www.radiowave.com.na/charityofthemonth/119-2013-cotm/871-june-2013-namibianblood-transfusion-service-nambts9 National Blood Policy. Republic of Namibia. Ministry of Health and Social Services. World Health Organisation.[Internet] 2008 Sept [cited 2018 Feb 12]. Available from:www.who.int/entity/bloodsafety/transfusion_services/NBPolicyNamibiaApril09.pdf10 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] 2011 [cited 2018 Feb 12]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=1107AFRICAAFRICA NIL (NO INVOLVEMENT)SOUTH AFRICASouth African Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking126thPopulation (world ranking)155 million (25th)Median age127.1Political system1Parliamentary republicGDP per capita (worldranking)1$13,400 (116th)HDI Index (world ranking)20.666 - medium (119th)Health Expenditure18.8% of GDPPopulation prevalencehepatitis B3High Intermediate: 5-7%Population prevalencehepatitis C4Low moderate: 1.5% - <2.0%Population prevalence HIV518.9% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe South African National Blood Service (SANBS) operates across all of South Africa with theexclusion of the Western Cape which is serviced by the Western Province Blood Transfusion Service(WPBTS). 6 7Both services are independent not for profit organisations and are accredited by the South AfricanNational Accreditation System.8 9SANBS has 84 blood banks in eight provinces. 8 In the period 1 April 2014 to 31 March 2015, 484,498donors gave 807,563 donations.8 There were 1,971 apheresis red cell and 27,344 apheresis plateletcollections.8WPBTS has blood banks in the three teaching hospitals in Cape Town, each regional branch, at aprivate hospital in Somerset West, and 90 emergency blood banks throughout the Western Cape. 9In the period 1 April 2014 to 31 March 2015, 71,620 donors gave 154,451 donations.9 There were3,603 adult apheresis platelet and 1,522 infant apheresis platelet collections.9AFRICA108AFRICA NIL (NO INVOLVEMENT)South Africa has plasma fractionation facilities at the National BioProducts Institute (NBI). 10 NBI isa private not-for-profit pharmaceutical manufacturer of human plasma-derived medicinal products.10Approximately 157,000 litres of plasma from whole blood was sold to NBI in 2013.11NATIONAL SOCIETY (SOUTH AFRICAN RED CROSS)The South African Red Cross is not involved in blood activities, and according to the results of thesurvey has not previously been involved in blood at any level, however GAP records for the SouthAfrican Red Cross indicate that they were previously involved in Level C (2010).The South African Red Cross may look at working with the South African Blood Transfusion Serviceand advocating for blood collection in the future.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/sf.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 South African National Blood Service. About Us. [Internet] 2016 [cited 2018 Feb 12]. Available from:http://www.sanbs.org.za/7 Western Province Blood Transfusion Service. Home. [Internet] 2015 [cited 2018 Feb 12]. Available from:http://www.wpblood.org.za/8 Annual Report 2015. South African National Blood Service [Internet] 2015 [cited 2018 Feb 12]. Available from:https://sanbs.org.za/wp-content/uploads/2016/09/SANBS_AR2015_DRAFT-82.pdf9 Annual Report 2014/15. WP Blood Transfusion Service. [Internet] 2015 [cited 2018 Feb 12]. Available from:http://www.wpblood.org.za/sites/default/files/WP_5690_Annual%20Report_e-version_16C.PDF10 National Bioproducts Institute South Africa. Profile. [Internet]. 2018 [cited 2018 Feb 12]. Available from:http://www.nbisa.org.za/index.php/our-profile11 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.109AFRICAAFRICA NIL (NO INVOLVEMENT)SWAZILANDBaphalali Swaziland Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationSouthern AfricaGeographical size ranking1159thPopulation (world ranking)11.5 million (154th)Median age121.7Political system1Absolute monarchyGDP per capita (worldranking)1$9,900 (140th)HDI Index (world ranking)20.541 - low (148th)Health Expenditure19.3% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low moderate: 1.5% <2.0%Population prevalence HIV527.2% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Swaziland National Blood Transfusion Services supplies blood to 12 hospitals across the fourregions of the country. 6 Each year, between 10,000 and 11,000 units of blood are collected.6 Theestimated requirement is 15,000 to 18,000 units of blood annually.6The countrys National Blood Transfusion Service Policy was drafted in 2010 and indicates that theMinistry of Health will establish the Swaziland National Blood Transfusion Service to administer thenational blood program in accordance with the statutes of the Kingdom of Swaziland. 7 The Servicewill be a semiautonomous department with its own identity, structure, building, staff and budget.7Swaziland was reported as having achieved 100% VNRBD in 2008. 8Being one of the most HIV affected countries, blood transfusion safety is a priority and the followingmeasures are undertaken6:HIV low risk group blood donors are targeted, particularly school childrenDonor education, confidential exclusion process and screening for HIV, hepatitis C, hepatitisB and syphilisCreation of a database of regular donors6In 2010, 100% of donations were separated into components. 9AFRICA110AFRICA NIL (NO INVOLVEMENT)NATIONAL SOCIETY (BAPHALALI SWAZILAND RED CROSS)The Baphalali Swaziland Red Cross Society is not involved in any blood related activities. It waspreviously involved in blood at Level A and C. The NS had funding from the Swiss Red Cross from1991 to 2000. The funding covered staffing, volunteers, and office costs as well as general officerunning costs.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Availablefrom:https://www.cia.gov/library/publications/the-world-factbook/geos/wz.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 12].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 01] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Feb 12] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Feb 12]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Swaziland Government. Ministry of Health. The National Blood Transfusion Services. [Internet] 2018 [cited 2018 Feb12]. Available from: http://www.gov.sz/index.php?option=com_content&view=article&id=567&Itemid=5797 Swaziland Government. National Blood Transfusion Service Policy. A Draft. [Internet] 2010 Nov 30 [cited 2018 Feb 12].Available from: https://www.k4health.org/sites/default/files/SWaziland_National_Blood_Transfusion_draft_policy.pdf8 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] 2011 [cited 2018 Feb 12]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=19 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2018 Feb 12]. Available from: http://www.afro.who.int/sites/default/files/201706/status-of-blood-safety-in-the-who-african-region.pdf111AFRICAAFRICA NO RESPONSEEQUATORIAL GUINEARed Cross of Equatorial Guinea did not respond to the GAP Global Mapping survey.Information available indicates that it is involved in blood activities, but it is not clear at which level.NATIONAL CONTEXTLocationCentral AfricaGeographical size ranking1146thPopulation (world ranking)1778 thousand (164th)Median age119.6Political system1Presidential republicGDP per capita (worldranking)1$34,900 (56th)HDI Index (world ranking)20.592 - medium (135th)Health Expenditure13.8% of GDPPopulation prevalencehepatitis B3High Intermediate: 5-7%Population prevalencehepatitis C4Moderate: 1.5-3.5%Population prevalence HIV56.20% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Equatorial Guinea Health System has two regional and four provincial centres for bloodtransfusions.6In 2010, 942 units were collected, none of which were VNRBD.7NATIONAL SOCIETY (RED CROSS OF EQUATORIAL GUINEA)In 2015, 20 people donated blood with the assistance of the Red Cross of Equatorial Guinea, thiswas a decrease from 28 people in 2014.81Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ek.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2017 October 30].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2017 October 30] Availablefrom:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2017 October 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Andeme Ela MC. Equatorial Guinea Health System Powerpoint Presentation available from:www.egindc.com/presentations/8-8-14/3.pdf7 Tapko, JB Toure, B Sambo LG. Status of blood safety in the WHO African Region Report of the 2010 Survey. WorldHealth Organization [Internet] 2014 [cited 2017 October 30]. Available from:http://www.afro.who.int/sites/default/files/2017-06/status-of-blood-safety-in-the-who-african-region.pdf8 The International Federation of Red Cross and Red Crescent Societies. Red Cross of Equatorial Guinea [Internet] 2016[cited 2017 October 30]. Available from: http://data.ifrc.org/fdrs/societies/red-cross-of-equatorial-guineaAFRICA112AMERICASNATIONAL SOCIETY (NS) INVOLVEMENT IN BLOODPROGRAMS BY LEVELNo response2 NS (6%)Nil3 NS (9%)Level A10 NS (29%)Level C7 NS (20%)Level B13 NS (37%)TOTAL NUMBER NS = 35113AMERICASAMERICASFOCUS ON LEVEL A NATIONAL SOCIETY BLOOD SERVICESIN THE REGION4 out of 10 NSBS have achieved 100% VNRBD100%90%80%% VNRBD70%60%50%40%30%20%10%0%* Information unknown2 out of 10 NSBS provide 100% of the national blood supply100%% of national supply90%80%70%60%50%40%30%20%10%0%* Information unknownAMERICAS114AMERICAS LEVEL ACOLOMBIAColombian Red Cross Society:Level A (undertakes full blood service provision)15% of the national total blood collection76% VNRBDNATIONAL CONTEXTLocationNorthern South AmericaGeographical size ranking127thPopulation (world ranking)147.7 million (29th)Median age130Political system1Presidential republicGDP per capita (worldranking)1$14,500 (113th)HDI Index (world ranking)20.727 - high (95th)Health Expenditure17.2% of GDPEfficiency of Healthcare347th of 51 countriesPopulation prevalencehepatitis B4Low intermediate: 2% - 4%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.4% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn 2013, Colombia had 87 collection centres and 87 processing centres with an average annualprocessing per bank of 8,507 units.7The major providers of blood in Colombia are:Colombian Red Cross (collects 15.5% of the national blood supply)Colombian Haematology Foundation (22%)Hemolife Blood Bank (7.1%)In 2012/13, a responsible unit and a national policy and quality assurance program was in place,however a specific law, budget and national plan are yet to be implemented.7Blood collection in Colombia is somewhat uncoordinated, with most donations coming from voluntarydonors and the rest being collected from replacement donors.8 Hospital blood banks perform themajority of the collections, however there is an increasing number of for-profit organisationscollecting blood by offering various incentives to the donors.8 There are concerns that donors maybe unaware of the commercial interests of these new organisations.8115AMERICASAMERICAS LEVEL ANational statistics show that in 2013, 86.7% of blood units were from voluntary donors and the restfrom family/replacement donors.7 In 2015, the Colombian Red Cross Blood Service reported theirlevel of VNRBD as 76%.7Hospitals and blood centres do not appear to promote repeat donations, prompting concerns thatmost donations are collected from first-time donors.8In 2013, a total of 740,173 units of blood were collected in Colombia.7The proportion of wastage was high: 40.8% for whole blood, 66.3% for FFP and 99.6% for frozenplasma.7NATIONAL SOCIETY (COLOMBIAN RED CROSS)The Colombian Red Cross:annually collects (2015):o 109,000 units of whole bloodo 14,000 units of blood collected by apheresissupplies blood to 148 hospitals/clinicsdoes not perform transfusionsis not accrediteddoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis not involved in cord blood stem cells, peripheral stem cells, bone marrow stem cells orbone/solid organ transplantsis involved in the collection, processing or testing of corneasBlood donor recruitment and retention activities are coordinated via district/chapter by the NationalSociety. They are funded by the blood service and the National Society. Paid staff are used toundertake school/university programs and other programs. Each blood service creates a differentstrategy for blood collection. A national strategy for blood collection is in development by theCoordination Network Blood Banks.The Colombian Red Cross Blood Service does not forward plasma to a fractionation facility.The Colombian Red Cross Blood Service is planning to consolidate the different blood banks withinthe Red Cross in order to improve market share and become more effective.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/co.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 25].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 25]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25]. Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25]. Availablefrom:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pan American Health Organization (PAHO). Supply of Blood for Transfusion in Latin American and CaribbeanCountries 2012 and 2013 [Internet] 2015 [cited 2018 Jan 25]. Available from:http://www.paho.org/hq/index.php?option=com_content&view=article&id=1466%3Adocumentos-tecnicospublicaciones&catid=1163%3Ahss-blood-services-&Itemid=2163&lang=en8 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.AMERICAS116AMERICAS LEVEL ADOMINICAN REPUBLICDominican Red Cross:Level A (undertakes full blood service provision)NATIONAL CONTEXTLocationCaribbeanGeographical size ranking1132ndPopulation (world ranking)110.7 million (86th)Median age128.1Political system1Presidential republicGDP per capita (worldranking)1$17,000 (104th)HDI Index (world ranking)20.722 - high (99th)Health Expenditure14.4% of GDPEfficiency of Healthcare343rd of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV61% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2013, the Dominican Republic had 66 collection centres and 66 processing centres with anaverage annual processing of 1,678 per bank.7In 2013 a specific law, responsible unit, national policy, national plan and a quality assurance policywas in place. However, there was no specific budget.7In 2013, a total of 110,780 units of blood were collected in the Dominican Republic.7 Of these,15.97% were from VNRBD donors, 2.85% from paid donors and the remainder (81.15%) fromfamily/replacement donors.7NATIONAL SOCIETY (DOMINICAN RED CROSS)The Dominican Red Cross (DRC) is the major supplier of blood to the health care system, and intendto supply 100% of donation needs within the next four years. 8 This amounts to approximately400,000 units per year.8 The DRC performs collection, testing and distribution of blood to hospitals.8Data provided to IFRC for 2013 indicates that 32,622 people were donating blood at or with theassistance of the Dominican Red Cross.9117AMERICASAMERICAS LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/dr.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 25].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 25]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 25]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2708 Vanderkerckchove, Philippe (GAP President). Dominican Republic. Message to: GAP Secretariat (WA). 2016 Sep 7[cited 2018 Feb 1].9 International Federation of Red Cross and Red Crescent Societies. Dominican Republic Year Report 2012. [Internet]2013 [cited 2018 Jan 25]. Available from http://adore.ifrc.org/Download.aspx?FileId=44781AMERICAS118AMERICAS LEVEL AECUADOREcuadorian Red Cross:Level A (undertakes full blood service provision)63% of the national total blood collection96% VNRBDNATIONAL CONTEXTLocationWestern South AmericaGeographical size ranking175thPopulation (world ranking)115.9 million (68th)Median age127.7Political system1Presidential republicGDP per capita (worldranking)1$11,200 (136th)HDI Index (world ranking)20.739 - high (89th)Health Expenditure19.2% of GDPEfficiency of Healthcare313th of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.3% among adults aged 15 to 49NATIONAL BLOOD PROGRAMIn 2013, Ecuador had 21 collection centres and 21 processing centres with an average annualprocessing per bank of 10,906 units.7 In 2012/13 a specific law, a responsible unit, a specific budget,a national policy and a national quality assurance program was in place. 7 However, a national planis not in place. 7The Ecuador Red Cross is the main provider of blood services in Ecuador, collecting 63% of thenations blood. Other providers are:Social Security and Minister of Health (5 blood banks) (15.53% of blood collected)Solca and Junta de Beneficiencia (NGOs) - 4 blood banks (15.97% of blood collected)Private 5 blood banks in clinics and Hospitals (7.79% of blood collected)In November 2012, the first national blood centre was established by the Ecuadorian Red Cross andfunded by the Ministry of Public Health at a cost of 3 million dollars. 8 The blood bank is a parent toother blood banks and is located in Carapung, north of the Capital8. It is committed to deliver 16,660units of blood annually.8119AMERICASAMERICAS LEVEL AIn 2013, a total of 229,018 units of blood were collected in Ecuador. 7 Of those, 57.05% wereVNRBD and the rest from family/replacement donors. 7NATIONAL SOCIETY (ECUADORIAN RED CROSS)The Ecuadorian Red Cross has been delivering blood to hospitals and clinics since 1947.9The Ecuador Red Cross Blood Service:annually collects (2015):o 165,978 units of whole bloodo 324 units of blood by apheresissupplies blood to 300 hospitals/clinicssupports the national populationprocesses collected blood into componentsconducts screening testing of blood for infectious diseases and blood groupingconducts cross-matching for transfusionforwards plasma to a fractionation facilitydoes not perform transfusionsis accredited to ISO9001-2008does not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, solid organs or corneasBlood donor recruitment and retention activities are coordinated nationally and by district/chapter bythe National Society. They are funded by the blood service. Paid staff and volunteers are used toundertake school/university programs, Club 25, corporate programs, programs at parks, commercialcentres, fairs, events etc.The Ecuadorian Red Cross Blood Service has changed its functional model from 29 blood banks ofdifferent size, capacities, costs and technologies to an integrated model of centers with differentlevels of processing:14 centres that only collect volunteer blood donors and distribute blood componentsfive centres that collect, process and distributetwo blood banks that collect, process, screen and distribute - one of these is a blood centre(Hemocentro) that performs the screening for infectious diseases (molecular biology NATand serological) and immunological screening of all donors of the Red Cross Blood System.This Hemocentro processed 96,000 donors and conducted more than a million screeningtests in 2015The April 2016 earthquake destroyed Portoviejos Red Cross building, which provided blood servicesin the province of Manabi.10 With increased support from the Ecuadorian people, makeshift donationcentres were set up in Guayaquil and received plenty of blood.10 The Ecuadorian Red Cross NationalBlood Centre coped well in the days following the earthquake, with many voluntary blood donorsbeing turned away when demand was fully met.11AMERICAS120AMERICAS LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ec.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 25].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 25]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 25]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2708 Latin America. Current events and news. Red Cross opens first national blood bank in Quito Ecuador. [Internet] 2012Dec 9 [cited 2018 Jan 25]. Available from: http://latinamericacurrentevents.com/red-cross-opens-first-national-bloodbank-in-quito-ecuador/24898/9 International Federation of Red Cross and Red Crescent Societies. Ecuador: Nationwide blood drive on World BloodDonor Day. [Internet] 2013 Jun 14 [cited 2018 Jan 25]. Available from:http://www.ifrc.org/en/what-we-do/health/blood-services/world-blood-donor-day/ecuador-nationwide-blood-drive-onworld-blood-donor-day-62514/10 Ecuadorians show solidarity with earthquake victims. Al Jazeera News. [Internet] 2016 Apr 19 [cited 2018 Jan 25].Available from: http://www.aljazeera.com/news/2016/04/ecuadoreans-show-solidarity-quake-hit-victims160418204017877.html11 International Federation of Red Cross and Red Crescent Societies. Ecuadorian Red Cross Blood Bank Holding Steadyin Aftermath of Earthquake. [Internet] 2016 Apr 27 [cited 2018 Jan 25]. Available from: http://www.ifrc.org/en/news-andmedia/news-stories/americas/ecuador/ecuadorian-red-cross-blood-bank-holding-steady-in-aftermath-of-earthquake72171/121AMERICASAMERICAS LEVEL AEL SALVADORSalvadorian Red Cross:Level A (undertakes full blood service provision)19% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationCentral AmericaGeographical size ranking1153rdPopulation (world ranking)16.2 million (108th)Median age127.1Political system1Presidential RepublicGDP per capita (worldranking)1$8,900 (144th)HDI Index (world ranking)20.680 - medium (117th)Health Expenditure16.8% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.6% among adultsaged 15 to 49NATIONAL BLOOD PROGRAMThe major providers of blood in El Salvador are:Ministry of Health 53%Salvadoran Social Security Institute 26%Salvadorian Red Cross Society 19%Military Hospital 2%El Salvador has substantially reduced its number of collection and processing centres.6 Whilst in2012, there were 42 collection centres as well as 42 processing centres in El Salvador with anaverage annual processing of 2,250 per bank, by 2013, the numbers had reduced to 27 collectioncentres and 16 processing centres with an average annual processing of 6,131 per bank.6In 2012/13 a responsible unit, national policy, national plan and national quality assurance programwere in place, however there was no specific law, no specific budget and no quality assurancepolicy.6In 2013, a total of 98,079 units of blood were collected in El Salvador, of these, 14.3% were fromVNRBD donors and the remainder (85.7%) from family/replacement donors.6AMERICAS122AMERICAS LEVEL ANATIONAL SOCIETY (SALVADORIAN RED CROSS)In 1975, the Salvadorian Red Cross (SRC) became involved in the promotion of VNRBD, and in1981, the National Blood Program and Blood Centre at the SRC was established.7The Salvadorian Red Cross:annually collects 8000 units of whole blood (2016)processes collected blood into componentsconducts screening of blood for infectious diseases and blood groupingconducts cross-matching for transfusiondoes not forward plasma to a fractionation facilitydoes not perform transfusionsis not involved in cord blood stem cells, peripheral stem cells, bone marrow stem cells,bone/solid organ transplants or corneassupports the national and private hospitalssupplies blood to 80 hospitals and clinicsis in the process of obtaining accreditationdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryBlood donor recruitment and retention activities are coordinated at a national level. They are fundedby the blood service and the National Society. Paid staff and volunteers are used to undertakerecruitment activities at schools, universities, club 25 and for corporate programs.The SRC is planning to expand its current level of participation in activities related to blood.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/es.html2 United Nations Development Program. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 25]. Availablefrom: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25]http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 25]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 Salvadoran Red Cross. What is the blood center? [Internet] 2017 [cited 2018 Jan 25]. Available from:http://www.cruzrojasal.org.sv/seccion.php?seccion=2&cat=21123AMERICASAMERICAS LEVEL AGUATEMALAGuatemalan Red Cross:Level A (undertakes full blood service provision)100% VNRBDNATIONAL CONTEXTLocationCentral AmericaGeographical size ranking1108thPopulation (world ranking)115.5 million (70th)Median age122.1Political system1Presidential republicGDP per capita (worldranking)1$8,200 (152nd)HDI Index (world ranking)20.640 - medium (125th)Health Expenditure16.2% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.5% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2013, Guatemala had 61 collection centres and 61 processing centres with an average annualprocessing of 1,998 per bank.6The major providers of blood in Guatemala are:National Hospital 63%Guatemalan Red Cross 37% (of total national VNRBD collections)In 2012/13, a specific law for blood, a responsible unit, a specific budget and a national plan were inplace.6 A national policy was partially in place.6 However, there was no quality assurance policy ornational quality assurance program.6In 2013, a total of 121,921 units of blood were collected in Guatemala.6 Of these, just 4.81% werefrom VNRBD donors, with the remainder from family/replacement donors.6AMERICAS124AMERICAS LEVEL ANATIONAL SOCIETY (GUATEMALAN RED CROSS)The Guatemalan Red Cross:annually collects 2500 units of whole blood (2016)does not process collected blood into componentsdoes not conduct screening of blood for infectious diseases and blood groupingdoes not conduct cross-matching for transfusiondoes not forward plasma to a fractionation facilitydoes not perform transfusionsis not involved in cord blood stem cells, peripheral stem cells, bone marrow stem cells,bone/solid organ transplants or corneassupplies blood to 25 to 30 hospitals/clinicsis not accrediteddoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryThe draft Promotion of Voluntary Blood Donation supported by the Ministry of Public Health andSocial Assistance is currently being implementedBlood donor recruitment and retention activities are coordinated nationally. They are funded byGovernment or MOH. Paid staff / volunteers are used to undertake club 25 programs.The Guatemalan Red Cross is not planning to expand or scale back the current level of involvementin blood-related activities.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/gt.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 25].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 25]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270125AMERICASAMERICAS LEVEL AHAITIHaiti Red Cross Society:Level A (undertakes full blood service provision)100% of the national total blood collection48% VNRBDNATIONAL CONTEXTLocationCaribbeanGeographical size ranking1148thPopulation (world ranking)110.6 million (88th)Median age123Political system1Semi-presidential republicGDP per capita (worldranking)1$1,800 (214th)HDI Index (world ranking)20.493 - low (163rd)Health Expenditure17.6% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV52.1% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2012/13 a specific law for blood, a responsible unit, a specific budget, a national policy and anational plan were in place.6 However, there was no quality assurance policy and a national qualityassurance program was partially in place.6In 2004, annual blood collections increased from less than 10,000 units to over 30,000 units in 2012due to support from the Global Fund to Fight AIDS, Malaria and Tuberculosis and the US PresidentsEmergency Plan for AIDS Relief (PEPFAR).7 In 2013, a total of 27,478 units of blood were collectedin Haiti.6 Of these, 59.16% were from VNRBD donors, with the remainder from family/replacementdonors.6The American Red Cross has supplied blood to Haiti on at least two recent occasions - after theearthquake in 2010 (5305 units), and in 2015 (1000 units) after its automated blood testingequipment failed.8AMERICAS126AMERICAS LEVEL ANATIONAL SOCIETY (HAITIAN RED CROSS)There has always been a strong focus on promoting voluntary blood donation since the Haitian RedCross Society was established in 1932. 9 In 1986, the Haitian state assigned a national directive tothe Haiti Red Cross to maintain a well-stocked and secure blood bank.9The Haiti Red Cross:annually collects 27,752 units of whole blood (2015)processes collected blood into componentsconducts screening of blood for infectious diseases and blood groupingconducts cross-matching for transfusiondoes not forward plasma to a fractionation facilitydoes not perform transfusionsis not involved in cord blood stem cells, peripheral stem cells, bone marrow stem cells,bone/solid organ transplants or corneassupports the national populationsupplies blood to 92 hospitals/clinicsis accreditedreceives technical assistance and financial support for VNRBD and blood service activitiesfrom outside the country (Technical - PAHO/WHO, Swiss Red Cross: Financial USPresidents Emergency Plan for AIDS Relief (PEPFAR), Global Fund, Swiss Red Cross,American Red Cross)Blood donor recruitment and retention activities are coordinated nationally. They are funded by theMinistry of Health, with specific projects funded by PEPFAR, Global Fund, Swiss Red Cross andAmerican Red Cross. Paid staff / volunteers are used to undertake school/university, club 25,corporate and church programs.The Haiti Red Cross is planning to expand activities by extending the number of donor sites andextension of club 25.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ha.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 25].Available from: http://hdr.undp.org/en3Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 25]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 World Health Organisation. World Blood Donor Day. Blood donation success stories from countries. Haiti. Youngpeople rise to the challenge. [Internet] 2012 [cited 2018 Jan 25]. Available from:http://www.who.int/worldblooddonorday/media/success_story/en/index1.html8 American Red Cross. Red Cross working across borders to ensure Haitis blood supply. [Internet] 2015 Feb 25 [cited2018 Jan 25]. Available from: http://www.redcross.org/news/article/Red-Cross-Working-across-Borders-to-Ensure-HaitisBlood-Supply9 International Federation of Red Cross and Red Crescent Societies. Saving lives every day in Haiti through blooddonation. [Internet] 2014 Jun 24 [cited 2018 Jan 25]. Available from: http://www.ifrc.org/en/news-and-media/newsstories/americas/haiti/saving-lives-every-day-in-haiti-through-blood-donation-66207/127AMERICASAMERICAS LEVEL AHONDURASHonduran Red Cross:Level A (undertakes full blood service provision)50% of the national total blood collection30% VNRBDNATIONAL CONTEXTLocationCentral AmericaGeographical size ranking1104thPopulation (world ranking)19 million (94th)Median age122.6Political system1Presidential republicGDP per capita (worldranking)1$5,500 (170th)HDI Index (world ranking)20.625 - medium (130th)Health Expenditure18.7% of GDPPopulation prevalencehepatitis B3Not availablePopulation prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.40% among adultsaged 15 to 49NATIONAL BLOOD PROGRAMThe Honduran Red Cross Blood Service is the main provider of blood services in the country,collecting 50% of the nations blood (but testing more than this figure). The remaining 50% arecollected by the Ministry of Health hospitals.In 2013, Honduras had 25 collection centres and 19 processing centres with an average annualprocessing per bank of 3,636 units.6A responsible unit and a specific budget are in place, but there is no specific law and no nationalplan or quality assurance program.6 A national policy is partially in place.6In 2013, a total of 69,082 units of blood were collected in Honduras.6 Of those, 15% were VNRBD,0.9% remunerated and 84.1% from family/replacement donors.6Malaria is endemic in much of rural and regional Honduras.7 Combined with frequent outbreaks ofdengue, up to 60% of donors may be deferred by history7 in hospital blood banks.Blood demand has been increasing due to trauma from car accidents and violence, and improvedaccess to health services, leading to shortages of blood.7AMERICAS128AMERICAS LEVEL APlasma not transfused is discarded, as there are no fractionation facilities.7 In 2013, 24.2% of plasmawas discarded nationally.6 The discard rate was 6.6% for packed red blood cells and 25.8% forplatelets.6NATIONAL SOCIETY BLOOD PROGRAM (HONDURAN RED CROSS)The Honduran Red Cross Blood Service:annually collects 39,000 units of whole blood (2015)supplies blood to over 70 hospitals/clinicsprocesses collected blood into componentsconducts screening testing of blood for infectious diseases and blood groupingconducts NAT testing for HIV, HBV and HCV since 2011does not conducts cross-matching for transfusion this is conducted by hospitals, with theexception of special casesdoes not perform transfusionsdoes not forward plasma to a fractionation facilityis accredited to AABB (since 2005)7receives technical assistance from the Swiss Red Cross to develop an adequate governancestructure, increase voluntary blood donation and improve blood cold chaindoes not receive any additional financial support for VNRBD or blood service activities fromoutside the countryis not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, solid organs or corneasThe Blood Service is planning to expand it is working to assume a mandate for 100% of all unitscollected in the country. The Blood Service is already testing units collected by most hospitals fromthe Ministry of Health (Approximately 7000 units a year).Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the blood service. Paid staff are used to undertake school/university programs,Club 25, corporate programs and programs at churches.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 03]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ho.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2017 October 03].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2017 October 03] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2017 October 03] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2017 October 03]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2017 October 03].Available from: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.129AMERICASAMERICAS LEVEL AMEXICOMexican Red Cross:Level A (undertakes full blood service provision)1% of the national total blood collection65% VNRBDNATIONAL CONTEXTLocationNorth AmericaGeographical size ranking115thPopulation (world ranking)1125 million (11th)Median age128.3Political system1Federal presidential republicGDP per capita (worldranking)1$19,500 (89th)HDI Index (world ranking)20.762 - high (77th)Health Expenditure16.3% of GDPEfficiency of Healthcare312th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.3% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn both 2012 and 2013, Mexico had 556 collection centres.7The majority of these were hospital based with the public sector responsible for most of thecollections.8The major providers of blood in Mexico are:Mexican Institute of Social Security 38%National Blood Transfusion Centre (State Centres) 20%Health Secretary 15%Mexican Red Cross 1%National policies and regulations are developed by the National Blood Transfusion Center (CNTS),which forms part of the National Institutes of Health in Mexico.8 The largest public cord blood bankin Mexico, CordMX, is managed by the CNTS.8In 2012/13, there was a specific law for blood, a responsible unit, a specific budget, a national policy,a national plan, a quality assurance policy and a national quality assurance program in place.7AMERICAS130AMERICAS LEVEL AIn order to try and increase the quality of blood, the Mexican Ministry of Health released newregulations in December 2012.8 These also incorporated new rules for donor screening.8In 2013, a total of 1,364,395 units of blood were collected in Mexico a 23% reduction over theprevious year (1,768,862 units).7 Of these, just 3.06% were from VNRBD donors the lowest levelin Latin America.7 The remainder of blood was from family/replacement donors.7The proportion of Mexicans who donated yearly was approximately 1.5%. 8Deferral rates were as high as 33% for replacement donors and 25% for voluntary donors. 7NATIONAL SOCIETY (MEXICAN RED CROSS)The Mexican Red Cross:annually collects (2017):o 14,269 units of whole bloodo approximately 250 units by apheresisprocesses collected blood into componentsconducts screening of blood for infectious diseases and blood groupingconducts cross-matching for transfusiondoes not forward plasma to a fractionation facilityperforms transfusions for internal and makeup by patients onlyis not involved in cord blood stem cells, peripheral stem cells, bone marrow stem cells,bone/solid organ transplants or corneassupports mainly trauma / accident patientssupplies blood to 180 hospitals/clinicsis not accrediteddoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryBlood donor recruitment and retention activities are coordinated by district/chapter. They are fundedby the blood service and National Society. Paid staff and volunteers are used to undertakeschool/university and corporate programs.The Mexican Red Cross is planning to expand its current level of participation in activities related toblood by regaining the national coordination of transfusion medicine for national project development.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/mx.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 25].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 25]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 25] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 25]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2708 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.131AMERICASAMERICAS LEVEL ASURINAMESuriname Red Cross:Level A (undertakes full blood service provision)100% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationNorthern South AmericaGeographical size ranking193rdPopulation (world ranking)1600 thousand (172nd)Median age129.8Political system1Presidential republicGDP per capita (worldranking)1$13,900 (114th)HDI Index (world ranking)20.725 - high (97th)Health Expenditure15.7% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2-4%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV51.02% among adults aged 15 to49NATIONAL BLOOD PROGRAMSuriname Red Cross is the sole provider of blood services in the country with 100% of blood fromVNRBD.In 2013, Suriname had just one collection centre and one processing centre.6In 2012/13 a specific law, responsible unit, specific budget, national policy and national plan were inplace, however the quality assurance policy was only partially implemented.6NATIONAL SOCIETY BLOOD PROGRAM (SURINAME RED CROSS)The National Blood Bank of the Suriname Red Cross:annually collects 10,521 units of whole blood (2014)supplies blood to five hospitals/clinicshas one fixed site collection centrecollects 11% of blood supply from its four mobile sitesprocesses collected blood into componentsAMERICAS132AMERICAS LEVEL Aconducts screening testing of blood for infectious diseases and blood groupingdoes not conduct cross-matching for transfusion this is conducted by hospitalsdoes not perform transfusionsdoes not forward plasma to a fractionation facilityis working towards accreditation using the Guide to the preparation, use an quality assuranceof blood components (European Committee)receives technical assistance from a twinning facility with Sanquin Consulting Services 2014 2016. 7 The Twinning facility Suriname-Nederland UTSN is a foundation funded by theMinistry of Foreign Affairs of the Netherlands.7 This Twinning project is designed to buildcapacity and educate blood bank employees.7 It includes building of a sustainable trainingprogram for NBB to improve quality of blood products and services.7does not receive financial support for VNRBD or blood service activities from outside thecountryis not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, solid organs or corneasBlood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the blood service. Paid staff and volunteers are used to undertakeschool/university programs, Club 25 and corporate programs.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ns.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 Sanquin. Twinning project capacity building Suriname Red Cross Blood Bank [Internet] 2017 Jul 31. [cited 2018 Jan29]. Available from: https://www.sanquin.org/products-and-services/consulting-services/projects-andconsultations/suriname133AMERICASAMERICAS LEVEL AUNITED STATES OF AMERICAAmerican Red Cross:Level A (undertakes full blood service provision)41% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationNorth AmericaGeographical size ranking14thPopulation (world ranking)1327 million (3rd)Median age138.1Political system1Constitutional federalrepublicGDP per capita (worldranking)1$59,500 (20th)HDI Index (world ranking)20.920 - very high (10th)Health Expenditure117.1% of GDPEfficiency of Healthcare344th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.29% (2013)NATIONAL BLOOD PROGRAMIn 2013, American Red Cross and American Blood Centres were collectively responsible for thecollection of 13.1 million units, or 96.1% of the supply.7 The remaining 3.9% of units were collectedby hospitals.7 This represents a significant decline of 12.1% from 2011.7American Blood Centres operate as a trade organisation, representing 67 independent blood centreswith more than 600 blood donation collection sites, providing approximately half of the nations bloodsupply.8 American Red Cross Biomedical Services collects and processes approximately 40% ofthe blood supply.9The Department of Defence has a separate blood collection system. 10 The Armed Services BloodProgram consists of approximately 20 blood banks and blood centres in the US and around theworld.10AMERICAS134AMERICAS LEVEL AAccording to their website 11 , the US Food & Drug Administration (FDA) Center for BiologicsEvaluation and Research (CBER) is responsible for regulating the following aspects of the bloodservices:the collection of blood and blood components used for transfusionthe manufacture of pharmaceuticals derived from blood and blood components, such asclotting factorsestablishes standards for the products themselves11FDA also regulates related products that are used to prepare blood products or to ensure the safetyof the blood supply.11 FDA develops and enforces quality standards, inspects blood establishmentsand monitors reports of errors, accidents and adverse clinical events.11NATIONAL SOCIETY (AMERICAN RED CROSS)The American Red Cross began an early blood processing program in World War II in order to beable to supply blood on a large scale.9 This program became a civilian blood program after the war.9Today, the American Red Cross is the only major supplier of blood and blood products in the UnitedStates, responsible for the collection, processing and distribution of approximately 41% of the bloodsupply for use in transfusion centres nationwide.9The American Red Cross operates in a competitive environment for fresh blood product donors(whole blood and apheresis). It also operates in a competitive environment for plasma forfractionation/source plasma with organisations that compensate/renumerate donors.In the 2015/16 financial year, 2.8 million people donated approximately 4.8 million units of blood.9The American Red Cross:annually collects (2015/16)o 4.1 million units of whole bloodo 700,000 units of blood collected by apheresissupplies blood to approximately 2,500 hospitals/clinicsprocesses collected blood into componentsconducts screening testing of blood for infectious diseases and blood groupingconducts cross-matching for transfusion this is also conducted by hospitalsdoes not perform transfusionsforwards plasma to a fractionation facilityis accredited to FDA and AABBdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis involved in the collection, processing or testing of peripheral stem cells and bone marrowstem cellsis not involved in the collection, processing or testing of cord blood stem cells, bone, solidorgans or corneasThe American Red Cross is not planning to expand or scale back activities.Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the blood service. Paid staff and volunteers are used to undertakeschool/university programs and corporate programs.135AMERICASAMERICAS LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/us.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 29]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 HIV Surveillance Report Volume 26. Diagnoses of HIV Infection in the United States and Dependent Areas, 2014.Centers for Disease Control and Prevention; 2015 [cited 2018 Jan 29]. Available from:http://www.cdc.gov/hiv/library/reports/surveillance/7 Whitaker B, Rajbhandary S, Harris A. The 2013 AABB Blood Collection, Utilisation, and Patient Blood ManagementSurvey Report. AABB; 2015 Dec 18 [cited 2018 Jan 29]. 88p. Available from:http://www.aabb.org/research/hemovigilance/bloodsurvey/Documents/2013-AABB-Blood-Survey-Report.pdf8 American Blood Centres. What We Do. [Internet] 2018 [cited 2018 Jan 29]. Available from:http://www.americasblood.org/9 American Red Cross. About Us. [Internet] 2018 [cited 2018 Jan 29]. Available from: http://www.redcrossblood.org/10 Armed Services Blood Program. History. [Internet] 2018 [cited 2018 Jan 29]. Available from:http://www.militaryblood.dod.mil/default.aspx11 U.S. Food & Drug Administration. Blood & Blood Products. [Internet]. 2018 [cited 2018 Jan 29]. Available from:http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/default.htmAMERICAS136AMERICAS LEVEL BANTIGUA AND BARBUDAAntigua and Barbuda Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCaribbeanGeographical size ranking1201stPopulation (world ranking)195 thousand (197th)Median age131.9Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$26,300 (76th)HDI Index (world ranking)20.786 - high (62nd)Health Expenditure15.5% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4Approx. 0.8% in theCaribbeanPopulation prevalence HIV50.61% (2014)NATIONAL BLOOD PROGRAMThe country has only one blood bank, which is located at Mount St Johns Medical Centre.6In 2010, there were two collection centres in Antigua and Barbuda.7In 2010 no specific law for blood, responsible unit, specific budget, national policy, national plan ornational quality assurance program was in place.7In 2010, a total of 1,321 units of whole blood were collected in Antigua and Barbuda.8 5% were fromVNRBD donors with the remainder from family/replacement donors.8NATIONAL SOCIETY (ANTIGUA AND BARBUDA RED CROSS)Blood donor recruitment and retention activities are coordinated and funded nationally by theNational Society. Volunteers are used for donor recruitment. The NS has a locally tailored programwhich piggy-backs off of the Club 25 principle.137AMERICASAMERICAS LEVEL BThe Antigua and Barbuda Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryreceived financial support which has now come to an end - the ABRC launched a localinitiative to promote a culture of voluntary blood donations to support the lone Public Hospital,which continues to operate at a huge deficit when it comes to blood demand and supply. Thisinitiative was made possible by the Australian High Commission-Direct Aid Program out ofTrinidad for the 2015 Calendar year. The Program is dubbed Club Life and the blood donorsare identified as heroes.6has not previously been involved at Level Ais planning to scale back its current level of involvement in blood-related activities now it hasreached the end of the one year financial assistance - activities will be scaled backsignificantly as local support is minimal1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ac.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 UNAIDS. Country Progress Report. Antigua and Barbuda January 2014 December 2014. [Internet] 2015 [cited 2018Jan 29]. Available from: http://www.unaids.org/sites/default/files/country/documents/ATG_narrative_report_2015.pdf6 Joseph K. Red Cross initiates drive to boost blood banks supplies. The Daily Observer. [Internet] 2014 Dec 29 [cited2018 Jan 29]. Available from: https://antiguaobserver.com/red-cross-initiates-drive-to-boost-blood-banks-supplies/7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2010 and 2011. [Internet] 2013 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=22468&Itemid=2708 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS138AMERICAS LEVEL BBELIZEBelize Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AmericaGeographical size ranking1152ndPopulation (world ranking)1360 thousand (177th)Median age122.7Political system1Parliamentary democracy undera constitutional monarchyGDP per capita (worldranking)1$8,300 (151st)HDI Index (world ranking)20.706 - high (103rd)Health Expenditure15.8% of GDPPopulation prevalencehepatitis B3Low intermediate: 2% - 4%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV51.8% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn 2013, Belize had seven collection centres and one processing unit.6In 2012/13 a responsible unit was in place, but there was no specific law, specific budget, nationalpolicy, national plan or quality assurance policy.6In 2013, a total of 5,120 units of whole blood were collected in Belize.6 13.8% were from VNRBDdonors with the remainder from family/replacement donors.6NATIONAL SOCIETY (BELIZE RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the National Society. Volunteers are used for donor recruitment. Withthe support of the Ministry of Health and the Blood Bank, the branch makes public calls for blooddonations and on pre-scheduled days, along with the Blood Bank, carries out collections.139AMERICASAMERICAS LEVEL BThe Belize Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to expand. Presently advocacy is the focus of initiatives in blood collection. Oneof 8 branches more actively conducts events to recruit blood donors at least quarterly. TheNS hopes to expand these events to every branch in the country.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/bh.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS140AMERICAS LEVEL BCHILEChilean Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouthern South AmericaGeographical size ranking139thPopulation (world ranking)117.8 million (65th)Median age134.4Political system1Presidential republicGDP per capita (worldranking)1$24,600 (80th)HDI Index (world ranking)20.847 - very high (38th)Health Expenditure17.8% of GDPEfficiency of Healthcare317th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low moderate: 1.5% - <2.0%Population prevalence HIV60.5% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn 2007, there were 59 public organizations collecting, processing and testing blood in Chile. 7 Eachorganization relied predominantly on replacement donors.7 The Ministry of Health (MINSAL) createda National Blood Commission (NBC) to support the national health authorities in establishing aNational Service for Blood and Tissues.7By 2013, Chile had 46 collection centres and 19 processing centres with an average annualprocessing of 12,100 per bank.8Chile is one of the countries identified by PAHO as setting an example for the organization of bloodservices.8 In 2012/13 a responsible unit, specific budget, national policy, national plan and a qualityassurance policy were in place.8 A specific law was partially in place.8A 2010 journal article9 provides further insight into recent history of the National blood program inChile: In recent years, the Chilean Health Ministry has developed a strategy in order to improve thesafety and opportunity of the blood supply through the creation of a nationally coordinated bloodtransfusion service, centralizing collection management, production and testing in three BloodCenters along the country and promoting voluntary, regular, blood donation.141AMERICASAMERICAS LEVEL BIn 2013, a total of 229,911 units of blood were collected in Chile.8 Of these, 23.5% were from VNRBDdonors, with the remainder from family/replacement donors.8NATIONAL SOCIETY (CHILEAN RED CROSS)Blood donor recruitment and retention activities are coordinated and funded by the National Society.The Chilean Red Cross:uses volunteers for donor recruitment programs (school and university programs, Club 25and corporate programs)does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved at Level A (15 years ago)is planning to expand into social media if there is enough financial support.collected or assisted in the collection of blood from 334 people in 2015, up from 280 in 2014101Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ci.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 29]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Contreras M, Martnez C, Larrondo M and Crdenas C. The steps taken for establishing a blood service in Chile. ISBTScience Series. [Internet] 2012 July [cited 2018 Jan 29];7(1):10-11. Available from:http://onlinelibrary.wiley.com/doi/10.1111/j.1751-2824.2012.01591.x/abstract8 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2709 Herrera C, Martnez C, Armanet L, Crcamo A, Boye P, Lyng C. Blood donation in Chile: Replacement and volunteerdonors. Biologicals [Internet] 2010 Jan;38(1):36-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1992630310 The International Federation of Red Cross and Red Crescent Societies. Chilean Red Cross [Internet] 2016 [cited 2018Jan 29]. Available from: http://data.ifrc.org/fdrs/societies/chilean-red-crossAMERICAS142AMERICAS LEVEL BCOSTA RICACosta Rican Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AmericaGeographical size ranking1130thPopulation (world ranking)14.9 million (123rd)Median age131.3Political system1Presidential republicGDP per capita (worldranking)1$17,200 (101st)HDI Index (world ranking)20.776 - high (69th)Health Expenditure19.3% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.4% among adultsaged 15 to 49NATIONAL BLOOD PROGRAMIn 2013, Costa Rica had 33 collection centres and 30 processing units with an average annualprocessing of 2,273 units (or 8.74 per working day).6In 2012 there was no specific blood law, responsible unit, specific budget, national policy, nationalcommission or quality assurance policy or program in place.6The Costa Rican Seventh-day Adventist Church received acknowledgement from the National BloodBank in 2013 for successfully organising the most blood donations.7In 2013, a total of 68,209 units of whole blood were collected in Costa Rica. 6 Approximately 68%were from VNRBD donors with the remainder from family/replacement donors.6NATIONAL SOCIETY (COSTA RICAN RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the government or Ministry of Health.Paid staff, volunteers and the community in general are used for donor recruitment at NS level incoordination of the National Blood Bank.143AMERICASAMERICAS LEVEL BThe Costa Rican Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to maintain its level of activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/cs.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 Cernas M. Costa Rica: Church recognised for outstanding contribution in obtaining blood donations. Seventh-dayAdventist Church. Inter-American Division. [Internet] 2013 Jul 31 [cited 2018 Jan 29]. Available from:http://www.interamerica.org/2013/08/05/costa-rica-church-recognized-for-outstanding-contribution-in-obtaining-blooddonations/AMERICAS144AMERICAS LEVEL BCUBACuban Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral American IslandGeographical size ranking1107thPopulation (world ranking)111 million (80th)Median age141.5Political system1Communist stateGDP per capita (worldranking)1$11,900 (132nd)HDI Index (world ranking)20.775 - high (66th)Health Expenditure111.1% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.4% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2013, Cuba had 120 collection centres and 46 processing centres with an average annualprocessing per bank of 8,946 units.6In 2012/13 a specific law, a responsible unit, a national policy, a national plan and a national qualityassurance program were in place.6 However, there was no specific budget for blood relatedactivities.6In 2013, a total of 411,545 units of blood were collected in Cuba.6 All (100%) of these were fromVNRBD donors.6NATIONAL SOCIETY (CUBAN RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety, however these are not funded. Volunteers are used for donor recruitment. Club 25 andworkplace recruitment programs are used.145AMERICASAMERICAS LEVEL BThe Cuban Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to maintain its level of activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/cu.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS146AMERICAS LEVEL BDOMINICADominica Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral American IslandGeographical size ranking1189thPopulation (world ranking)174 thousand (202nd)Median age133.5Political system1Parliamentary republicGDP per capita (worldranking)1$12,000 (130th)HDI Index (world ranking)20.726 - high (96th)Health Expenditure15.5% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4Approx. 0.8% in theCaribbeanPopulation prevalence HIV50.75%NATIONAL BLOOD PROGRAMIn 2013, Dominica had one collection centre and one processing centre.6In 2012/13 there was no specific law for blood, responsible unit, specific budget, national policy,national plan or national quality assurance program in place.6In 2013, a total of 1,071 units of blood were collected in Dominica.6 8.68% of these were from VNRBDdonors, with the remainder from replacement donors.6NATIONAL SOCIETY (DOMINICA RED CROSS)Blood donor recruitment and retention activities are coordinated nationally and funded by theNational Society. Paid staff and volunteers are used for donor recruitment programs (Club 25).The Dominica Red Cross Society:147does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to maintain its level of activities.AMERICASAMERICAS LEVEL B1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/do.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Males dominate HIV infection in Dominica. Dominica News Online. [Internet] 2013 Feb 27 [cited 2018 Jan 29].Available from: http://dominicanewsonline.com/news/homepage/news/health/males-dominate-hiv-infection-in-dominica/6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS148AMERICAS LEVEL BGUYANAGuyana Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationNorthern South AmericaGeographical size ranking186thPopulation (world ranking)1738 thousand (166th)Median age126.2Political system1Parliamentary republicGDP per capita (worldranking)1$8,300 (150th)HDI Index (world ranking)20.638 - medium (127th)Health Expenditure15.2% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV51.6% among adults aged 15 to49NATIONAL BLOOD PROGRAMGuyanas National Blood Transfusion Service (NBTS) was established in 1990 with the mainobjectives of ensuring the safety of blood through comprehensive screening and testing forrecognized infectious agents and to encourage regular voluntary donations towards ensuring theadequacy of blood and blood products, with the goal of eliminating the spread of HIV and otherinfectious diseases through blood and blood products. 6 This first stand-alone blood bank was setup in partnership with the World Health Organisation (WHO) and the European Union (EU). 6Prior to 1990, there were several blood banks at Georgetown Hospital, four regional hospitals andfour private hospitals.6 By 2013, Guyana had five collection centres and one processing centre.7In 2012/13 a responsible unit and a specific budget were in place, and a national plan was partiallyin place.7 However, there was no specific law, national policy, national plan or quality assurancepolicy.7In 2013, a total of 11,148 units of blood were collected in Guyana.7 Of these, 95.79% were fromVNRBD donors, with the remainder from replacement donors.7149AMERICASAMERICAS LEVEL BNATIONAL SOCIETY (GUYANA RED CROSS)Guyana Red Cross provided two sets of responses to the global mapping survey.20152016Blood donor recruitment and retentionactivities are coordinated nationallyBlood donor recruitment and retentionactivities are coordinated By district/chapterThey are funded by the National Society, thegovernment or Ministry of Health and byprivate organisationsThey are funded by the National SocietyVolunteers are used for donor recruitmentprograms (Club 25)Both paid staff and volunteers are used forrecruitment programs, such asschool/university programs, Club 25, corporateprograms and other (individuals, as well ascurrent participants in Red Cross regulartraining programs).The National Society receives both technicalassistance and financial support for VNRBD orblood service activities from outside thecountryThe National Society received neither technicalassistance nor financial support for VNRBD orblood service activities from outside thecountryThe Guyana Red Cross Society:has not previously been involved at Level Ais planning to expand its level of involvement in blood related activities - the National Societyhas been requested to increase the number of VNRBD, and hopes to widen the Club 25aspect as well as reaching out to new groups of donor locations1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/gy.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Guyana poised to attain 100% voluntary blood donation by 2012. Kaieteur News online. [Internet] 2011 Oct 16 [cited2018 Jan 29]. Available from: http://www.kaieteurnewsonline.com/2011/10/16/guyana-poised-to-attain-100-voluntaryblood-donation-by-2012/7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS150AMERICAS LEVEL BJAMAICAJamaica Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCaribbeanGeographical size ranking1167thPopulation (world ranking)13 million (138th)Median age126Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$9,200 (143rd)HDI Index (world ranking)20.730 - high (94th)Health Expenditure15.4% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2-4%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV51.7% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2013, Jamaica had ten collection centres6,7 and three processing centres with an average annualprocessing per bank of 10,226 units.6 In 2015, a mobile blood collection unit was added to theNational Blood Transfusion Service to allow access to donors unable to reach collection centres.8In 2012/13 a specific budget for blood related activities and a national policy were in place.6 Howeverthere was no specific law, responsible unit, national plan or national quality assurance program.6In 2013, a total of 30,679 units of blood were collected in Jamaica.6 16.58% of these were fromVNRBD donors with the remainder from replacement donors.6NATIONAL SOCIETY (JAMAICA RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the National Society. Paid staff are used for donor recruitment programs(Club 25 and JRC Care Program).151AMERICASAMERICAS LEVEL BThe Jamaican Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to expand its level of involvement in blood related activities by revamping the JRCCare Program to recruit additional blood donors and enhancing the Club 25 Program ininstitutions where it exists and seek to implement in other institutions going forward1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/jm.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 National Blood Transfusion Service Government of Jamaica. Collection Centres. [Internet] 2018 [cited 2018 Jan 29].Available from: http://nbts.gov.jm/collection-centres/8 The Ministry of Health Government of Jamaica. The National Blood Transfusion Service receives a much neededMobile Blood Collection Unit. [Internet] 2015 Jan 3 [cited 2018 Jan 29]. Available from: http://moh.gov.jm/the-nationalblood-transfusion-service-receives-a-much-needed-mobile-blood-collection-unit/AMERICAS152AMERICAS LEVEL BNICARAGUANicaraguan Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AmericaGeographical size ranking199thPopulation (world ranking)16 million (111th)Median age125.7Political system1Presidential republicGDP per capita (worldranking)1$5,800 (165th)HDI Index (world ranking)20.645 - medium (124th)Health Expenditure19% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.2% among adultsaged 15 to 49NATIONAL BLOOD PROGRAMUntil February 2016 and since 19866, the Nicaraguan Red Cross was the national and sole providerof blood services in the country, utilising 100% of blood from voluntary donors.6 In 2012/13 a specificlaw, a specific budget, a national policy, a national plan and a national quality assurance programwere in place.7From 2016, the Ministry of Health (MINSA) assumed the responsibility of the blood service at its fivelocations in accordance with Law 369 on transfusion safety.6 8 All centres, staff and equipment weretransferred to MINSA under the agreement, and the National Blood Service no longer operates underthe name and emblem of the Nicaraguan Red Cross.6The Nicaraguan Red Cross continues to support and cooperate with MINSA to promote andencourage voluntary blood donation at the National Blood Service.8NATIONAL SOCIETY (NICARAGUAN RED CROSS)The Nicaragua Red Cross Blood Service responded to the GAP Global Mapping survey as Level Ain 2015, however since completing the survey has moved to Level B involvement.153AMERICASAMERICAS LEVEL BBlood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the blood service and by the government of MoH. Both paid staff andvolunteers are used to undertake school/university programs, Club 25 and corporate programs.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 October31]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/nu.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 October 31]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 October 31] Available from:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 October 31] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectiousdiseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 October31]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Torres C. Nicaraguan Blood Banks to move from the Red Cross to the Ministry of Health. La Prensa/Nationals [Internet]2016 Jan 27 [cited 2018 Feb 08]. Available from: https://www.laprensa.com.ni/2016/01/27/nacionales/1976380-banco-desangre-de-nicaragua-pasa-de-la-cruz-roja-al-ministerio-de-salud7 Pan American Health Organization (PAHO). Supply of Blood for Transfusion in Latin American and Caribbean Countries2012 and 2013 [Internet] Pan American Health Organization 2015 [cited 2017 October 03]. Available from:http://www.paho.org/hq/index.php?option=com_content&view=article&id=1466%3Adocumentos-tecnicospublicaciones&catid=1163%3Ahss-blood-services-&Itemid=2163&lang=en8 Red Cross Nicaraguense realizes transfer of the Banco Nacional de Sangre al MINSA. Ministerio de Salud [Internet]Managua 2016 Jan 27 [cited 2018 Feb 08]. Available from: http://www.minsa.gob.ni/index.php/105-noticias-2016/2405cruz-roja-nicaragueense-realiza-traspaso-del-banco-nacional-de-sangre-al-minsaAMERICAS154AMERICAS LEVEL BPARAGUAYParaguayan Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral South AmericaGeographical size ranking161stPopulation (world ranking)16.9 million (104th)Median age128.2Political system1Presidential republicGDP per capita (worldranking)1$9,800 (141st)HDI Index (world ranking)20.693 - medium (110th)Health Expenditure19.8% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4Low moderate: 1.5% - <2.0%Population prevalence HIV50.5% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn 2013, Paraguay had 12 collection centres (down from 46 in 2012) and 7 processing centres (upfrom 5 in 2012) with an average annual processing of 12,293 units per bank.6In 2012/13, there was a specific law for blood, a responsible unit, a specific budget, a national policy,a national plan, a quality assurance policy and a national quality assurance program in place.6In 2013, a total of 86,056 units of blood were collected in Paraguay.6 9.2% of the blood was collectedfrom VNRBD donors, with the remainder from family/replacement donors.6NATIONAL SOCIETY (PARAGUAYAN RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. Currently donor recruitment is done through the subsidiary Itapa, sub -subsidiary ofFernando de la Mora and through the Reina Sofa Hospital, accompanying the work of the Ministryof Health and Welfare.The Sub subsidiary of Fernando de la Mora has implemented the Club 25 in its activities, to carryout activities concerning the recruitment of voluntary blood donors.155AMERICASAMERICAS LEVEL BBlood donor recruitment and retention activities are funded by the National Society. Volunteers atItapa and Fernando de la Mora and paid staff at the Reina Sofa Hospital are used for donorrecruitment programs.The Paraguayan Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to expand recruitment and retention activities at Reina Sofia Hospital, to expandClub 25 to more districts within Itapa, and train more volunteers regarding these activitiesin Fernando de la Mora.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/pa.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom:. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS156AMERICAS LEVEL BPERUPeruvian Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationWestern South AmericaGeographical size ranking121stPopulation (world ranking)131 million (43rd)Median age128Political system1Presidential republicGDP per capita (worldranking)1$13,300 (118th)HDI Index (world ranking)20.740 - high (87th)Health Expenditure15.5% of GDPEfficiency of Healthcare336th of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.3% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn 2013, Peru had 89 collection and processing centres with an average annual processing of 2,300units per bank.7In 2012/13, there was a specific law for blood, a responsible unit, a specific budget, a national policya quality assurance policy and a national quality assurance program was partially in place.7 Therewas no national plan.7In 2013, a total of 204,871 units of blood were collected in Peru.7 4.56% of the blood was collectedfrom VNRBD donors, 0.005% from paid donors and the remainder (95.43%) from family/replacementdonors.7Deferral rates for paid donors were 79% with just 10 of the 47 interviewed accepted to donate. 7 Incomparison, deferral rates for both voluntary and replacement donors were still a high 30%. 7157AMERICASAMERICAS LEVEL BNATIONAL SOCIETY (PERUVIAN RED CROSS)Blood donor recruitment and retention activities are coordinated nationally and at district;/chapterlevel by the National Society. They are funded by the National Society.The Peruvian Red Cross:uses volunteers for donor recruitment programs (school and university programs, Friends ofBlood Red Cross)does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas previously been involved at Level Ais planning to expand activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/pe.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 29]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS158AMERICAS LEVEL BSAINT LUCIASaint Lucia Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCaribbeanGeographical size ranking1193rdPopulation (world ranking)1165 thousand (187th)Median age134.8Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$13,500 (115th)HDI Index (world ranking)20.735 - high (92nd)Health Expenditure16.7% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4Very low: <1.0%Population prevalence HIV50.58%NATIONAL BLOOD PROGRAMIn 2012, Saint Lucia had two collection centres and one processing centre with an average annualprocessing per bank of 2,276 units.6In 2012/13 a quality assurance policy was partially in place, however there was no specific law,responsible unit, specific budget, national policy or national plan.6In 2013, a total of 2,174 units of blood were collected in Saint Lucia.6 62.11% of these were fromVNRBD donors with the remainder from replacement donors.6NATIONAL SOCIETY (SAINT LUCIA RED CROSS)The National Society joins the National Blood Service of the Ministry of Health to assist witheducation, donor recruitment and blood collection. All technical staff are from the National BloodService.159AMERICASAMERICAS LEVEL BBlood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the government or Ministry of Health. Volunteers are used for donor recruitmentprograms (Club 25 and other).The Saint Lucia Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais not planning to expand or scale back its level of involvement in blood related activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/st.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from:. http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clinical Microbiology and Infection. [Internet] 2011 Feb [cited2018 Jan 29]; 17(2). Available from: http://www.sciencedirect.com/science/article/pii/S1198743X146164875 Hamilton M and Musau S. Sustaining the HIV and AIDS Response in St. Lucia: Investment Case Brief. USAID. Health,Finance & Governance. 2014 Nov [cited 2018 Jan 29]. Available from: https://www.hfgproject.org/sustaining-hivaidsresponse-st-lucia-investment-case/6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS160AMERICAS LEVEL BSAINT VINCENT AND THEGRENADINESSaint Vincent and the Grenadines Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCaribbeanGeographical size ranking1205thPopulation (world ranking)1103 thousand (195th)Median age133Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$11,600 (133rd)HDI Index (world ranking)20.722 - high (99th)Health Expenditure18.6% of GDPPopulation prevalencehepatitis B31.5%Population prevalencehepatitis C42.1% in the CaribbeanPopulation prevalence HIV50.6% (2012 est.)NATIONAL BLOOD PROGRAMIn 2013, Saint Vincent and the Grenadines had one collection centre and one processing centre: theblood bank at Milton Cato Memorial Hospital in Kingstown.6In 2013 there was no specific law, responsible unit, specific budget, national policy, national plan orquality assurance policy in place.6In 2013, a total of 1,161 units of blood were collected in Saint Vincent and the Grenadines.6 Of these,13.8% were from VNRBD donors, with the remainder from replacement donors.6NATIONAL SOCIETY (SAINT VINCENT AND THE GRENADINES RED CROSS)In a conversation with O. House, GAP delegate (IFRC General Assembly and Statutory meeting inTurkey, Nov 2017) a representative of the Saint Vincent and the Grenadines Red Cross Societyindicated that they provide assistance to the Ministry of Health by mobilising the public and Red161AMERICASAMERICAS LEVEL BCross volunteers to donate (this occurs regularly but on a small scale) and also by providing VNRBDeducation programs in schools.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/vc.html2 United Nations Development Program. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30]. Availablefrom: http://hdr.undp.org/en3 PKIDS Online. Parents of Kids with Infectious Diseases. Hepatitis B. Global infection rates. [Internet] 2006 [cited 2018Jan 30]. Available from: www.pkids.org/files/pdf/phr/02-09globalhbv.pdf4 Hanafiah K, Groeger J, Flaxman A and Wiersma S. April 2013. Global epidemiology of hepatitis C virus infection. Newestimates of age-specific antibody to HCV seroprevalance. Hepatology [Internet] [cited 2018 Jan 30];57(4):1333-1342.Available from: http://onlinelibrary.wiley.com/doi/10.1002/hep.26141/full5 Pan American Health Organisation. Antiretroviral Treatment in the Spotlight: A Public Health Analysis in Latin Americaand the Caribbean 2012 [Internet] 2012 [cited 2018 Jan 30]. Available from:http://apps.who.int/medicinedocs/documents/s20145en/s20145en.pdf6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 30]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS162AMERICAS LEVEL CARGENTINAArgentine Red Cross:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern South AmericaGeographical size ranking19thPopulation (world ranking)144 million (31st)Median age131.7Political system1Presidential republicGDP per capita (worldranking)1$20,700 (87th)HDI Index (world ranking)20.827 - very high (45th)Health Expenditure14.8% of GDPEfficiency of Healthcare332nd of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low moderate: 1.5% - <2.0%Population prevalence HIV60.4% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn 2013, Argentina had 160 processing centres with an average annual processing of 6,038 unitsper processing centre.7In 2012/13 there was a specific law, a specific budget, a responsible unit, a national plan, a nationalpolicy and a national quality assurance program in place.7In 2013, a total of 966,059 units of blood were collected in Argentina.7 Of these, 38% were fromVNRBD donors, with the remainder from replacement donors.7NATIONAL SOCIETY (ARGENTINE RED CROSS)Community education activities are coordinated by district / chapter by the National Society. Theyare funded by the National Society.163AMERICASAMERICAS LEVEL CThe Argentine Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas previously been involved at Level Bis planning to expand its level of involvement in blood related activities - a relationship hasbeen established with the National Blood Program of the Ministry of Health to assist in thepromotion of voluntary blood donation1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ar.html2 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 29]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS164AMERICAS LEVEL CBAHAMASBahamas Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationCentral American IslandsGeographical size ranking1161stPopulation (world ranking)1330 thousand (179th)Median age132Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$25,100 (79th)HDI Index (world ranking)20.792 - high (58th)Health Expenditure17.7% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV53.3% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2013, The Bahamas had three collection centres and three processing centres with an averageannual processing of 2,405 units per processing centre.6In 2012/13 there was a national plan and a quality assurance policy in place, however there was nospecific law, no responsible unit or specific budget.6 A national policy was partially in place.6In 2013, a total of 7,214 units of blood were collected in The Bahamas.6 Of these, 41.93% were fromVNRBD donors, with the remainder from replacement donors.6NATIONAL SOCIETY (BAHAMAS RED CROSS)The Bahamas Red Cross takes part in World Blood Donor Day as a partner of the localtelecommunications company that promotes a blood drive.165AMERICASAMERICAS LEVEL CThe Bahamas Red Cross provide volunteers to assist blood donors to complete their donationquestionnaires. The community education activities are funded by the BahamasTelecommunications Corporation.The Bahamas Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level A or Bis planning to expand its level of involvement in blood related activities. The National Societyis exploring the possibility of forming a club of donors1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/bf.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30].Available from: http://hdr.undp.org/enCentres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Available from:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 30]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS166AMERICAS LEVEL CBOLIVIABolivian Red Cross:Level C: National society is involved in occasional community education/ awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationCentral South AmericaGeographical size ranking129thPopulation (world ranking)111.1 million (81st)Median age124.3Political system1Presidential republicGDP per capita (worldranking)1$7,500 (155th)HDI Index (world ranking)20.674 - medium (118th)Health Expenditure16.3% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.3% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn 2013, Bolivia had 17 collection centres and 17 processing centres with an average annualprocessing of 6,009 units per processing centre.6In 2012/13 there was a specific law, a responsible unit, a specific budget, a national policy, a nationalplan and a quality assurance policy in place.6In 2013, a total of 102,146 units of blood were collected in Bolivia.6 Of these, 45.23% were fromVNRBD donors, with the remainder from replacement donors.6NATIONAL SOCIETY (BOLIVIAN RED CROSS)Community education activities are coordinated nationally and by district/chapter by the NationalSociety. They are funded by the National Society, the government or Ministry of Health and by privateorganisations.167AMERICASAMERICAS LEVEL CThe Bolivian Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously at Level B, when there was a Club 25 Project (2009-2010)is not planning to expand or scale back its current level of involvement in blood-relatedactivities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/bl.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 30]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS168AMERICAS LEVEL CBRAZILBrazilian Red Cross:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern South AmericaGeographical size ranking16thPopulation (world ranking)1207 million (5th)Median age132Political system1Federal presidential republicGDP per capita (worldranking)1$15,500 (107th)HDI Index (world ranking)20.754 - high (79th)Health Expenditure18.3% of GDPEfficiency of Healthcare350th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low moderate: 1.5% - <2.0%Population prevalence HIV60.6% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn 2012 (latest available data), Brazil had 544 collection centres and 530 processing centres with anaverage annual processing of 6,293 units per processing centre.7Blood collection centres across Brazil vary in their level of complexity, numbering as follows:32 of greater complexity65 of medium complexity302 of low complexity175 hospitals.8In 2012/13 there was a specific law, a responsible unit, a specific budget, a national policy and aquality assurance policy in place.7 However, there is no national plan.7The national network of blood banks together form SINASAN the National System of Blood,Components and Derivatives.8 Through SINASAN and under the Unified Health System (SUS) anational blood policy was established in 2001.8169AMERICASAMERICAS LEVEL CIn 2013, a total of 3,335,035 units of blood were collected in Brazil.7 Of these, 59.52% were fromVNRBD donors, with the remainder from replacement donors.7The Brazilian Enterprise for Blood Products and Biotechnology (Hemobrs) received funding fromthe Brazilian Ministry of Health in 2012 to increase fractionation capacity to half a million litres.8 Thiswas to be achieved by building a new factory in the state of Pernambuco near Recife, howevercompletion has been delayed past the expected operational date of 2014.8In February 2016, two cases of Zika infection through blood transfusion in Brazil were reported.9NATIONAL SOCIETY (BRAZILIAN RED CROSS)Community education activities are coordinated nationally and by district/chapter by the NationalSociety. They are funded by the National Society and through agreements with health authorities.The Brazilian Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously at Level Bis planning to expand its level of activities to promote Club 25 education for blood donation1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/br.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 30]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Available from:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 30]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2708 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.9 Zika virus update: 2 cases of Zika infection through blood transfusion in Brazil. Parent Herald [Internet] 2016 Feb 4[cited 2018 Jan 30]. Available from:http://www.parentherald.com/articles/19380/20160204/zika-virus-blood-transfusion.htmAMERICAS170AMERICAS LEVEL CPANAMARed Cross Society of Panama:Level C: National society is involved in occasional community education / awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationCentral AmericaGeographical size ranking1119thPopulation (world ranking)13.8 million (130th)Median age129.2Political system1Presidential republicGDP per capita (worldranking)1$24,300 (81st)HDI Index (world ranking)20.788 - high (60th)Health Expenditure18% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.8% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2012, Panama had 27 collection centres and the same number of processing centres with anaverage annual processing of 2,141 units per bank.6In 2012/13 a specific law for blood was in place, however there was no responsible unit, specificbudget, national policy, national plan, quality assurance policy or national quality assuranceprogram.6In 2013, a total of 53,414 units of blood were collected in Panama (Hospital San Miguel Arcngeland Centro Mdico Paitilla not included).6 This compares with 55,083 units in 2012, where therewere no exclusions.6 In 2013, 5.79% of the blood was collected from VNRBD donors, 8.09% frompaid donors and 85.90% from family/replacement donors.6NATIONAL SOCIETY (RED CROSS OF PANAMA)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the National Society and private organizations.171AMERICASAMERICAS LEVEL CThe Red Cross Society of Panama:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously at Level Bis not planning to expand its level of participation in activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/pm.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 30]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=270AMERICAS172AMERICAS LEVEL CTRINIDAD AND TOBAGOTrinidad and Tobago Red Cross Society:Level C - National society is involved in occasional community education / awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationCentral AmericanIslandsGeographical size ranking1174thPopulation (world ranking)11.2 million (160th)Median age136Political system1Parliamentary republicGDP per capita (worldranking)1$31,200 (62nd)HDI Index (world ranking)20.780 - high (65th)Health Expenditure15.9% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4High moderate: 2.0% <5.0%Population prevalence HIV51.2% among adultsaged 15 to 49NATIONAL BLOOD PROGRAMIn 2012, Trinidad and Tobago had six collection centres and one processing centre with an averageannual processing per bank of 21,300 units.6The National Blood Transfusion Unit (NBTU), Ministry of Health is the only authorized bloodcollection agency.7In 2012/13 there was no specific law, responsible unit, specific budget, national policy, qualityassurance policy or national plan in place.6In 2013, a total of 21,300 units of blood were collected in Trinidad and Tobago. 6 According to theMinistry of Health and WHO recommendations, approximately 65,000 units of blood are requiredannually for the size of the country.7In 2012, 100% of the blood collected was from family/replacement donors,6 despite a VNRBD systembeing introduced in 2010.7 VNRBD data was not reported to PAHO in 2013.6173AMERICASAMERICAS LEVEL CNATIONAL SOCIETY (TRINIDAD AND TOBAGO RED CROSS)In a conversation with O. House, GAP delegate (IFRC General Assembly and Statutory meeting inTurkey, Nov 2017) a representative from Trinidad and Tobago Red Cross indicated that they do notundertake any regular recruitment activities, however a small group of volunteers donate bloodoccasionally when required.The Trinidad and Tobago Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis planning to expand its level of involvement to level Aenjoys a very good partnership with the Ministry of Health1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/td.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29].Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clinical Microbiology and Infection. [Internet] 2011 Feb [cited2018 Jan 29]; 17(2). Available from: http://www.sciencedirect.com/science/article/pii/S1198743X146164875 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 Government of the Republic of Trinidad and Tobago. Ministry of Health. National Blood Transfusion Unit. [Internet]2018 [cited 2018 Jan 29]. Available from: http://www.health.gov.tt/sitepages/default.aspx?id=184AMERICAS174AMERICAS LEVEL CURUGUAYUruguayan Red Cross Society:Level C - National society is involved in occasional community education / awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern South AmericaGeographical size ranking192ndPopulation (world ranking)13.36 million (133rd)Median age135Political system1Presidential republicGDP per capita (worldranking)1$22,400 (84th)HDI Index (world ranking)20.795 - high (54th)Health Expenditure18.6% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C4Low moderate: 1.5% - <2.0%Population prevalence HIV50.6% among adults aged 15 to49NATIONAL BLOOD PROGRAMBy 2013, Uruguay had 61 collection centres and 51 processing centres with an average annualprocessing of 1,944 per bank.6In 2012/13 a specific law for blood was in place.6 It was not recorded whether there was a responsibleunit, a specific budget, a national policy, a national plan, a quality assurance policy or a nationalquality assurance program.6In 2013, a total of 99,151 units of blood were collected in Uruguay. 6 Of these, 46.48% were fromVNRBD donors, with the remainder from family/replacement donors.6NATIONAL SOCIETY (URUGUAYAN RED CROSS)The Uruguayan Red Cross Societys 2014/15 Annual report indicates that the National Society hasa strategic alliance with the National Blood Service for voluntary and altruistic donation of blood, isinvolved in activities on World Blood Donor Day and conducts blood donation campaigns, particularlytargeting youth groups. 7The Uruguayan Red Cross occasionally supports State Government blood donor recruitmentcampaigns, however this is not a regular activity of the National Society.175AMERICASAMERICAS LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/uy.html2 United Nations Development Program. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 29]. Availablefrom: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 29] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 29]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 29]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 Cruz Roja Uruguyaya, Memoria Annual 2014-15 [Internet] 2015 [cited 2018 Jan 29]. Available from:http://data.ifrc.org/public/documents/UY/AR_Uruguay_2014-2015_Spanish.pdfAMERICAS176AMERICAS NIL (NO INVOLVEMENT)BARBADOSBarbados Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationCaribbeanGeographical size ranking1202ndPopulation (world ranking)1292 thousand (180th)Median age138.3Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$17,500 (98th)HDI Index (world ranking)20.795 - high (54th)Health Expenditure17.5% of GDPPopulation prevalencehepatitis B31.4%Population prevalencehepatitis C42.1% in the CaribbeanPopulation prevalence HIV51.30% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2009 (no reports appear to have been made to PAHO for 2010-2013), Barbados had one collectioncentre. 6 The Barbados National Blood Collecting Centre is located in St. Michael.6In 2009 a national policy was in place; however there was no specific law for blood, responsible unit,specific budget, national plan or quality assurance policy.6A total of 4,781 units of blood were collected in Barbados in 2009.6 15% of these were from VNRBDdonors, with the remainder from replacement donors.6In 2012, a website and Facebook page called Red Donor was set up as a social enterprise toconnect individuals in need of blood to blood donors in the Caribbean community.7 Blood donorsdonate for specific patients.7 Requests for blood for specific patients also appear on the Red DonorFacebook page and in the national news.8NATIONAL SOCIETY (BARBADOS RED CROSS)The Barbados Red Cross Society is not involved in any blood related activities.177AMERICASAMERICAS NIL (NO INVOLVEMENT)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/bb.html2 United Nations Development Program. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 25]. Availablefrom: http://hdr.undp.org/en3 Schweitzer, A, Horn J, Mikolajczyk R, Krause G and Ott J. 2015. Estimations of worldwide prevalence of chronichepatitis B virus infection: a systematic review of data published between 1965 and 2013. The Lancet. Volume 386, No.10003, p15461555, 17 October 2015. http://www.thelancet.com/action/showFullTextImages?pii=S01406736%2815%2961412-X4 Hanafiah K, Groeger J, Flaxman A and Wiersma S. Global epidemiology of hepatitis C virus infection: New estimates ofage-specific antibody to HCV seroprevalance. Hepatology [Internet]. 2013 Feb 4 [cited 2018 Jan 25];57(4). Availablefrom: http://onlinelibrary.wiley.com/doi/10.1002/hep.26141/full5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 25]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Pan American Health Organization (PAHO). Supply of Blood for Transfusion in Latin American and CaribbeanCountries 2010 and 2011 [Internet] 2015 [cited 2018 Jan 25]. Available from:http://www.paho.org/hq/index.php?option=com_content&view=article&id=1466%3Adocumentos-tecnicospublicaciones&catid=1163%3Ahss-blood-services-&Itemid=2163&lang=en7 Red Donor. About. [Internet] 2013 [cited 2016 March 30]. Available from: http://www.reddonor.com/about.8Red Donor Facebook page. [Internet] 2013 [cited 2016 March 30]. Available from:https://www.facebook.com/RedDonor/timeline.AMERICAS178AMERICAS NIL (NO INVOLVEMENT)CANADACanadian Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationNorth AmericaGeographical size ranking13rdPopulation (world ranking)135.6 million (38th)Median age142.2Political system1Federal parliamentarydemocracy under aconstitutional monarchyGDP per capita (worldranking)1$48,100 (34th)HDI Index (world ranking)20.920 - very high (10th)Health Expenditure110.4% of GDPEfficiency of Healthcare321st of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.21% (2014 est.)NATIONAL BLOOD PROGRAMCanadian Blood Services (CBS) are a not-for-profit organisation that provides 77% of Canadasblood supply. 7 Qubec has its own separate blood system operated by Hma-Qubec (HQ),supplying 23% of Canadas blood.7 CBS replaced the Canadian Red Cross as the operator ofCanadas blood system in 1998.7Blood safety and blood-borne pathogen monitoring is managed by the Canadian Ministry of Health.7Canadian Blood Services (CBS):In 20142015 CBS received 850,218 blood donations from 409,000 active blood donors. 8 CBSsupplied over one million units of blood and blood-derived products to 700 hospitals and clinicsnationwide.8Canadian Blood Services is responsible for manufacturing, acquiring and distributing about $500million worth of plasma protein products annually.8179AMERICASAMERICAS NIL (NO INVOLVEMENT)CBS also operates Canadas OneMatch Stem Cell and Marrow Network (operates in all areasoutside of Qubec7), which had 360,000 registrants.8 There were 1,150 organ donors (from 555living donors and 595 deceased donors) in Canada in 2014.8The provinces and territories of Canada (outside Qubec) provide funding to the CBS based on theirpopulation and product usage.7 Blood is provided to the hospitals at no charge.7Hma-Qubec (HQ):Hma-Qubec is a not-for-profit organisation founded in 1998. 9 HQ is responsible for9:recruiting donors, collecting blood, testing and processing them and delivering the finishedproducts to hospitalscollecting, processing and distributing human tissues such as corneas, skin, bones, heartvalves and tendons and represents the largest human tissue bank in Canadathe Stem Cell Donor Registry for Qubec (60,243 donors registered as of 2016-17)the first and largest Public Cord Blood Bank in operation in Canadathe only Public Mothers Milk Bank in Qubec.9HQ donation statistics (2016/17)9:176,633 registered donors for all types of donation.205,201 donations. All blood donations are tested for HIV, HCV, HBV, HTLV and syphilis.Positive results in donations were rare and have not changed significantly over the years,with 0 positive results for HIV, 13 for HCV, 10 for HBV, 1 for HTLV and 17 for syphilis.212,705 red blood cells delivered to hospitals.60,243 registered stem cell donors.95,881 litres of plasma sent for fractionation. This provided 21% of Qubecs need forintravenous immunoglobulin (IVIg).9NATIONAL SOCIETY (CANADIAN RED CROSS)The Canadian Red Cross was previously involved in blood at Level A. The Canadian Red Crossstopped managing all blood services on September 28, 1998. The Royal Commission of Inquiry onthe Blood System in Canada was established in 1993 to investigate concerns about blood-bornediseases like HIV/AIDS and Hepatitis C and the contamination of the blood system. As a result theresponsibility for blood services was transferred over to two new agencies.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ca.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30].Available from:. http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 30]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 CATIE. Canadas source for HIV and hepatitis C information. The epidemiology of HIV in Canada. [Internet] 2017 [cited2018 Jan 30]. Available from: http://www.catie.ca/en/fact-sheets/epidemiology/epidemiology-hiv-canada7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.8Canadian Blood Services Annual Report 20142015. Canadian Blood Services. [Internet] 2015 [cited 2018 Jan 30].Available from: http://itsinyoutogive.ca/Annual/2015/pdfs/cbs_ar2015_en.pdf9 Hma-Qubec Annual Report 2016-2017. Hma-Qubec. [Internet] 2017 [cited 2018 Jan 30]. Available from:http://www.hema-quebec.qc.ca/userfiles/file/media/anglais/publications/AR_2016-2017_EN.pdfAMERICAS180AMERICAS NIL (NO INVOLVEMENT)SAINT KITTS AND NEVISSaint Kitts and Nevis Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationCaribbeanGeographical size ranking1212thPopulation (world ranking)153 thousand (207th)Median age135Political system1Federal parliamentarydemocracy under aconstitutional monarchyGDP per capita (worldranking)1$26,800 (74th)HDI Index (world ranking)20.765 - high (74th)Health Expenditure15.1% of GDPPopulation prevalencehepatitis B32% (2006 est.)Population prevalencehepatitis C42.1% in the CaribbeanPopulation prevalence HIV50.9% among adults aged15 to 49 in 2010NATIONAL BLOOD PROGRAMIn 2013, Saint Kitts and Nevis had two collection centres and two processing centres with an averageannual processing of 166 units per processing centre.6The St. Kitts/Nevis Blood Bank Service is responsible for all blood collected in the federation.7 Thereare two blood bank areas, one is located in Nevis at the Alexandra hospital and the other located inSt. Kitts at the Joseph N France hospital.7 Both are attached to the hospitals' Pathology Laboratoryand also operate through the Ministry of Health.7The blood bank practises quality control measures and is involved in external quality assuranceprograms. The blood bank has become more visible to the public by organising blood drives andmedia appearances for public education on VNRBD.In 2012/13 there was no specific law, responsible unit, specific budget, national policy or nationalplan in place.6 A quality assurance policy is partially in place.6 A national blood policy is in place.In 2013, a total of 331 units of blood were collected in Saint Kitts and Nevis.6 Of these, 21.45% werefrom VNRBD donors, with the remainder from replacement donors.6All blood was screened in 2013 for HIV, HBsAg and HCV.6181AMERICASAMERICAS NIL (NO INVOLVEMENT)Due to a high demand for blood and blood products, a voluntary blood donor database is currentlybeing developed.NATIONAL SOCIETY (SAINT KITTS AND NEVIS RED CROSS)The Saint Kitts and Nevis Red Cross Society is not involved in any blood related activities. Theywere previously operating at Level B, but this ceased 20 years ago.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/sc.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30].Available from: http://hdr.undp.org/en3PKIDS Online. Parents of Kids with Infectious Diseases. Hepatitis B. Global infection rates. [Internet] 2006 [cited 2018Jan 30]. Available from: www.pkids.org/files/pdf/phr/02-09globalhbv.pdf4 Hanafiah K, Groeger J, Flaxman A and Wiersma S. Global epidemiology of hepatitis C virus infection: New estimates ofage-specific antibody to HCV seroprevalance. Hepatology [Internet]. 2013 Feb 4 [cited 2018 Jan 30];57(4). Availablefrom: http://onlinelibrary.wiley.com/doi/10.1002/hep.26141/full5 Pan American Health Organization. Antiretroviral treatment in the spotlight: A public health analysis in Latin Americaand the Caribbean. Saint Kitts and Nevis. [Internet] 2012 [cited 2018 Jan 30]. Available from:http://www.paho.org/hq/index.php?gid=18082&option=com_docman&task=doc_download6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 30]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 Archibald, Keita (Sasskya) (Red Cross volunteer and lab technician at JNF General Hospital). RE: FWD: GlobalMapping Americas Saint Kitts and Nevis Red Cross Society. Message to: GAP Secretariat (WA). 2015 Nov 4 [cited2018 Feb 1].AMERICAS182AMERICAS NO RESPONSEGRENADAGrenada Red Cross Society did not respond to the GAP Global Mapping survey.Information available indicates that it is probably not involved in blood activities.NATIONAL CONTEXTLocationCaribbeanGeographical size ranking1208thPopulation (world ranking)1111 thousand (190th)Median age130.9Political system1Parliamentary democracyGDP per capita (worldranking)1$14,700 (112th)HDI Index (world ranking)20.754 - high (79th)Health Expenditure16.1% of GDPPopulation prevalencehepatitis B3Nil reportsPopulation prevalencehepatitis C42.1% in the CaribbeanPopulation prevalence HIV50.57% (2009 est.)NATIONAL BLOOD PROGRAMIn 2012, Grenada had one collection centre and one processing centre.6 This could be the bloodbank at St. Georges General Hospital, which has a modern blood banking and haematologydepartment and a mobile blood bank.7In 2012 there was no specific law for blood, responsible unit, specific budget, national policy ornational plan in place.6 It was not recorded whether there was a quality assurance policy.6In 2012, a total of 1,365 units of blood were collected in Grenada.6 Of these, 38.83% were fromVNRBD donors, with the remainder from family/replacement donors.6In 2010, all blood was screened for HIV, HBsAg and HCV.6NATIONAL SOCIETY (GRENADA RED CROSS)It appears that the Grenada Red Cross Society is not involved in blood.Grenada Red Cross is a very small organisation with just three paid staff members.8There is no data available regarding people donating blood with the assistance of the Grenada RedCross Society. 8183AMERICASAMERICAS NO RESPONSE1Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/gj.html2 United Nations Development Program. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30]. Availablefrom: http://hdr.undp.org/en3 Schweitzer, A, Horn J, Mikolajczyk R, Krause G and Ott J. 2015. Estimations of worldwide prevalence of chronichepatitis B virus infection: a systematic review of data published between 1965 and 2013. The Lancet.[Internet] 2015October 17 [cited 2018 Jan 30];386(10003):1546-1555. Available from:http://www.thelancet.com/action/showFullTextImages?pii=S0140-6736%2815%2961412-X4 Hanafiah K, Groeger J, Flaxman A and Wiersma S. April 2013. Global epidemiology of hepatitis C virus infection. Newestimates of age-specific antibody to HCV seroprevalance. Hepatology [Internet] 2013 February 04 [cited 2018 Jan30];57(4):1333-1342. Available from: http://onlinelibrary.wiley.com/doi/10.1002/hep.26141/full5 Minister of Health, Grenada. Grenada National HIV/AIDS Strategic Plan 2012-2016. [Internet] 2012 February 15 [cited2018 Jan 30]. Available from:http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/grenada/grenada_nsp_20122016_1.pdf6 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 30]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2707 Ministry of Health. Government of Grenada. The General Hospital. [Internet] 2016 [cited 2018 Jan 30]. Available from:.http://health.gov.gd/index.php?option=com_content&view=article&id=170&Itemid=601&lang=en.8 The International Federation of Red Cross and Red Crescent Societies. Grenada Red Cross Society [Internet] 2016[cited 2018 Jan 30]. Available from: http://data.ifrc.org/fdrs/societies/grenada-red-cross-societyAMERICAS184AMERICAS NO RESPONSEVENEZUELAVenezuelan Red Cross did not respond to the GAP Global Mapping survey.Information available indicates that it is involved in blood activities, but it is not clear at which level(A or B).NATIONAL CONTEXTLocationNorthern South AmericaGeographical size ranking134thPopulation (world ranking)131.3 million (42nd)Median age128.3Political system1Federal presidential republicGDP per capita (worldranking)1$12,400 (126th)HDI Index (world ranking)20.767 - high (71st)Health Expenditure15.3% of GDPEfficiency of Healthcare339th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low Moderate: 1.5% - <2.0%Population prevalence HIV60.6% among adults aged 15 to 49NATIONAL BLOOD PROGRAMVenezuelas blood system is facilitated by hospital based centres collecting approximately 60% ofthe nations supply. 7 The remaining 40% comes through private for-profit, social security, andcharitable hospitals.7In 2012, Venezuela:185had 319 collection centres and 316 processing centres with an average annual processingof 1,411 per bankhad a total of 445,957 units of blood collected. Of these, 6.62% were from VNRBD donors,with the remainder from family / replacement donorshad a specific law for blood, a specific budget and a national plan in place; a responsible unit,a quality assurance policy and a national quality assurance program were partially in place;however there was no national policy for bloodscreened 93.38% of blood units for disease markers HIV, HbsAg and HCVdid not screen a total of 29,531 units of blood for infectious disease markers. 7AMERICASAMERICAS NO RESPONSEFractionation is performed within Venezuela, with the facility supplying the countrys plasma proteinrequirements, with the exception of recombinant factor VIII concentrate.7Hospitals share excess supply and though the actual red blood cell use and wastage is unknown,blood officials believe that blood demands are being met. 7NATIONAL SOCIETY (VENEZUELAN RED CROSS)The Venezuelan Red Cross is involved in blood, but it is not clear at which level.The number of people donating blood at or with the assistance of the Venezuelan Red Crosswas 580 in 2013 and 520 in 2012.8The 2015 Annual Report notes 1,285 blood donations, two blood banks, and celebration ofWorld Blood Donor Day.9The 2014-19 strategic plan includes consolidation of the volunteer blood donor network,promotion and awareness of VNRBD through the Club 25, and community awareness ofVNRBD. 10The Hospital Carlos J Bello is included on the Venezuelan Red Cross Website. The hospitalincludes a Blood Bank. 111Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/geos/ve.html2 United Nations Development Program. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 30]. Availablefrom: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2014 [cited 2018 Jan 30]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 30] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] 2013 [cited 2018 Jan 30]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pan American Health Organization. World Health Organisation. Regional Office for the Americas. Supply of Blood forTransfusion in Latin American and Caribbean Countries 2012 and 2013. [Internet] 2015 [cited 2018 Jan 30]. Availablefrom: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=31435&Itemid=2708 The International Federation of Red Cross and Red Crescent Societies. Venezuelan Red Cross [Internet] 2016 [cited2018 Jan 30]. Available from: http://data.ifrc.org/fdrs/societies/venezuelan-red-cross9 Sociedad Venezolana de la Cruz Roja. Informe Anual 2015 [Internet] 2016 [cited 2018 Jan 30]. Available from:http://data.ifrc.org/public/documents/VE/AR_Venezuela_2015_Spanish.pdf10 Cruz Roja Venezolana. Plan Estratgico de Desarrollo (2014-2019) [Internet] 2014 [cited 2018 Jan 30] Available from:http://data.ifrc.org/public/documents/VE/SP_Venezuela_2014-2019_Spanish.pdf11 Cruz Roja Venezolana. Hospital Carlos J Bello [Internet] 2012 [cited 2018 Jan 30]. Available from:https://www.cruzrojavenezolana.org/hospital.phpAMERICAS186ASIA PACIFICNATIONAL SOCIETY (NS) INVOLVEMENT IN BLOODPROGRAMS BY LEVELNil1 NS (3%)Level C9 NS (25%)Level A*12 NS (33%)TOTAL NUMBER NS = 36Level B14 NS (39%)187ASIA PACIFIC*Does not include the Hong Kong Red Cross, whichoperates a Level A Blood Service, but is a branchof the Red Cross Society of ChinaASIA PACIFICFOCUS ON LEVEL A NATIONAL SOCIETY BLOODSERVICES IN THE REGION5 out of 13 NSBS have achieved 100% VNRBD100%90%80%% VNRBD70%60%50%40%30%20%10%0%* The Hong Kong Red Cross is a branch of the Red Cross Society of China, and operates a Level A National Society Blood Service4 out of 13 NSBS provide 100% of the national blood supply100%90%% of national supply80%70%60%50%40%30%20%10%0%* The Hong Kong Red Cross is a branch of the Red Cross Society of China, and operates a Level A National Society Blood ServiceASIA PACIFIC188EUROPE ANDASIA PACIFICLEVELCENTRALAASIAAUSTRALIAAustralian Red Cross:Level A (undertakes full blood service provision)100% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationOceaniaGeographical size ranking17thPopulation (world ranking)123.2 million (56th)Median age138.7Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$49,900 (28th)HDI Index (world ranking)20.939 - very high (2nd)Health Expenditure19.4% of GDPEfficiency of Healthcare36th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low Moderate: 1.5% - <2.0%Population prevalence HIV60.1% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn Australia, a statutory agency within the Australian Government, called the National Blood Authority(NBA), manages and coordinates the arrangements for the supply of blood and blood products andservices on behalf of the Australian Government and state and territory governments.7 A Deed ofAgreement exists between the NBA and the Australian Red Cross specifying the Australian RedCross Blood Service (the Blood Service) as the organisation that will undertake these activities.8The Australian Red Cross has been the sole provider of blood components for transfusion inAustralia since its establishment as a hospital transfusion service in 1929.9 In 1996, individual stateand territory blood transfusion services operated by local Red Cross chapters amalgamated to formthe Australian Red Cross Blood Service.9 As an operation under the Australian Red Cross, the BloodService has a separate Board that reports to the Australian Red Cross Board, which has oversightand responsibility to appoint all Board members.10189ASIA PACIFICASIA PACIFIC LEVEL AThe Therapeutic Goods Administration (TGA) is the regulatory body which licenses the BloodService to manufacture blood and blood components in Australia and is responsible for administeringthe provisions of the Therapeutic Goods Act 1989.8The Blood Service has four processing centres where processing and testing occur, and 96 blooddonor centres (both fixed and mobile) across the country.11 Mobile donor centres comprise selfcontaied vehicles, or community venues.11In 2015-16, the Blood Service supplied:1,008,831 fresh blood products to customers, including:o 646,014 units of red cells (equivalent adult doses)o 130,877 units of platelets (equivalent adult doses)o 113,014 units of clinical fresh frozen plasma (equivalent adult doses)601.2 tonnes of plasma to CSL Behring for fractionation into plasma products.7Australia has experienced a reduction in red cell demand in the past decade; red cell supply hasreduced from 801,296 in 2011-12 to 646,014 in 2015-16, a drop of over 19 per cent.7NATIONAL SOCIETY (AUSTRALIAN RED CROSS)The Australian Red Cross Blood Service is responsible for all blood collection in the country, of which100 per cent is voluntary non remunerated blood donation. In 2015-16 1.3 million individualdonations were made in blood donor centres.The Blood Service: annually collects (2015-16):o 716,453 units of whole bloodo 548,285 units of plasma and 31,651 units of platelets by apheresis supplies blood to 401 approved health providers (including hospitals) supports the entire Australian population of 23.2 million with blood components fortransfusion processes collected blood into components conducts viral and serological blood donor screening forwards plasma for fractionation to a local fractionation facility is accredited by the Australian Governments Therapeutic Goods Administration to theAustralian Code of Good Manufacturing Practice for human blood and blood components,human tissues and human cellular therapy products and the Council of Europe Guide to thePreparation, Use and Quality Assurance of Blood Components coordinates, delivers and funds nationally, all blood donor recruitment and retention activitiesusing existing, paid staff is involved in the collection, processing or testing of cord blood stem cells, peripheral stemcells, bone marrow stem cells, bone, tissue and solid organs is seeking out new opportunities in research and development with potential expansion of itscurrent level of involvement in blood-related activities, as well as exploring opportunities tocontribute more broadly into healthcare that leverages our expertise and infrastructure. 11ASIA PACIFIC190EUROPE ANDASIA PACIFICLEVELCENTRALAASIAUnlike some other blood operators in other parts of the world, the Blood Service: does not conduct cross-matching for transfusion this is conducted by hospital laboratories does not perform transfusions does not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the country is not involved in the collection, processing or testing of corneas1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/as.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Feb 16].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Feb 16].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Australian Red Cross Blood Service. Australian Red Cross Blood Service Annual Report 2015/16 [Internet] AustralianRed Cross Blood Service 2016 [cited 2018 Feb 16] Available from:http://www.donateblood.com.au/sites/default/files/Annual%20Report%202015%20Online%20211215.pdf8 National Blood Authority Australia. What Blood Products are Supplied - National Product List [Internet] Commonwealthof Australia. [updated 2017 Jan 01; [cited 2018 Feb 16] Available from: https://www.blood.gov.au/national-product-list9 Australian Red Cross Blood Service. History [Internet] Australian Red Cross Blood Service 2016 [cited 2018 Feb 16]Available from: http://www.donateblood.com.au/page/history10 Australian Red Cross Blood Service. People [Internet] Australian Red Cross Blood Service 2016 [cited 2018 Feb 16]Available from: http://www.donateblood.com.au/about/board11 Australian Red Cross Blood Service. Australian Red Cross Blood Service Annual Report 2016/17 [Internet] AustralianRed Cross Blood Service 2017 [cited 2018 Feb 16] http://www.donateblood.com.au/sites/default/files/Annual-Report2016-2017.pdf191ASIA PACIFICASIA PACIFIC LEVEL ABANGLADESHBangladesh Red Crescent Society:Level A (undertakes full blood service provision)11% of the national total blood collection31% VNRBD1NATIONAL CONTEXTLocationSouthern AsiaGeographical size ranking295thPopulation (world ranking)2158 million (8th)Median age226.7Political system2Parliamentary republicGDP per capita (worldranking)2$4,200 (177th)HDI Index (world ranking)30.579 - medium (139th)Health Expenditure22.8% of GDPPopulation prevalencehepatitis B4Low Intermediate: 2% - 4%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV6<0.01% among adults aged15 to 49NATIONAL BLOOD PROGRAMBlood Transfusion Services were established in Bangladesh in 1950 at the Dhaka Medical CollegeHospital.7 8 In 1952 a Blood Transfusion Service Committee was established which acted as anadvisory panel on donor selection criteria, blood safety matters and technical issues such asmandatory testing of blood,9 and in 1976 the National Council of Blood Transfusion was set up.7 Bothwere re-organised and re-formed in 1995 along with updates to the country by-laws.10Until 2000, most of the countrys blood supply was obtained by professional donors (47%).9 In 2000the Bangladesh government, in collaboration with the United Nations Development Program (UNDP),began a blood screening program (the National Safe Blood Transfusion Program) in 97 centresaround the country.8 9 10 This program led to the Safe Blood Transfusion Act being introduced aslegislation in April 2002, and enforced from August 2004 as the regulatory law for blood transfusioncenters.10 As well as introducing testing for transfusion transmissible infections, it also encouragedcapacity building, provided training for medical staff and technicians and encouraged the promotionof voluntary non-remunerated blood donation (VNRBD) through improved donor motivation andpromotional campaigns.9 10ASIA PACIFIC192EUROPE ANDASIA PACIFICLEVELCENTRALAASIAThe Safe Blood Transfusion Act-2002, sets out the legal requirements for blood safety includingsetting up centres, management, blood collection, storage, testing and transfusion.9 10 Under thisframework all Blood Transfusion Services in Bangladesh (public and private) are managed andregulated by the Ministry of Health and Family Welfare (MoH & FW).9 10 After the Act was introduced,the National Safe Blood Transfusion Council (NSBTC) was formed.1 Safe Blood Transfusion Rules2008 were gazetted on 17June 2008 and the National Safe Blood Transfusion Expert Committee(NSBTEC) was formed under these rules.1 A National Blood Policy was approved in November 2013.Despite the active legislations, there is no centralised blood collection system at a national level andno organisation that specifically supports and coordinates VNRBD.10The major providers of blood in Bangladesh are:Government / private hospital based blood banks 80%Bangladesh Red Crescent Society 11%Shandhani, Medical college based voluntary organization 5%Quantum and Badhan, private organization 4%According to the Blood Transfusion Society of Bangladesh, approximately 600,000 units of bloodare required annually.8 70% of these donations come from family relative donors, 30% from voluntarydonors, with no paid donors.8NATIONAL SOCIETY (BANGLADESH RED CRESCENT)The Bangladesh Red Crescent Society Blood Service:annually collected 62,152 units of whole blood (2016)supplies blood to 332 hospitals/clinics, distributing approximately 75150 units of blood andcomponents (2016)supports a regional population of 10 million peopleprocesses collected blood into componentsconducts screening of blood for infectious diseases and blood group testingconducts cross-matching for transfusionis not accreditedreceives technical assistance for VNRBD and blood service activities from GAP and IFRCreceives financial support for VNRBD and blood service activities from Global Fund and IFRCis not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, solid organs or corneasdoes not forward plasma to a fractionation facilitytransfuses washed cells to thalassemia patients in its four blood centres in Dhaka, Sylhet,Chittagong and JessoreThe eight centres have their own blood donor recruitment and retention processes which arecoordinated by the BDRCS blood program director.Donor recruitment activities are funded by the blood service, the National Society, government orMoH and private organisations. Both paid staff and volunteers are used to undertakeschool/university programs and corporate programs.The BDRCS is planning to expand its current level of involvement in blood-related activities bydeveloping a five year strategic plan which will include increasing VNRBD, and establishing newcentres, quality management and GMP.193ASIA PACIFICASIA PACIFIC LEVEL A1Mehedi T. Bangladesh Global Mapping Report (review of). Global Advisory Panel (GAP) on Corporate Governance andRisk Management of Blood Services in Red Cross and Red Crescent Societies; 2017 Jul. 3p.2 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bg.html3 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 16]. Available from: http://hdr.undp.org/en4 Centres for Disease Control and Prevention.CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention.CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Blood Transfusion Society of Bangladesh. History [Internet] Blood Transfusion Society of Bangladesh 2017 [cited 2018Feb 16]. Available from: http://btsbd.org/history/8 Blood Transfusion Society of Bangladesh. Activity [Internet] Blood Transfusion Society of Bangladesh 2017 [cited 2018Feb 16]. Available from: http://btsbd.org/activity-2/http://btsbd.org/activity-2/9 Islam MB. Blood transfusion services in Bangladesh. Asian J Transfus Sci. 2009 Jul [cited 2018 Feb 16]:3(2):108-110.).Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920470/ DOI: 10.4103/0973-6247.53880https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920470/10 Mayr W, Wsolak M. GAP Preliminary Visit Report. Perth (WA): Global Advisory Panel (GAP) on CorporateGovernance and Risk Management of Blood Services in Red Cross and Red Crescent Societies; 2014 Dec 11. 8p.ASIA PACIFIC194EUROPE ANDASIA PACIFICLEVELCENTRALAASIAHONG KONGHong Kong Red Cross (Branch of the Red Cross Society of China):Level A (undertakes full blood service provision)100% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationEastern AsiaGeographical size ranking1184thPopulation (world ranking)17.2 million (100th)Median age144.4Political system1Presidential limiteddemocracy; a specialadministrative region of thePeoples Republic of ChinaGDP per capita (worldranking)1$61,000 (18th)HDI Index (world ranking)20.917 - very high (12th)Efficiency of Healthcare32nd of 51 countriesPopulation prevalencehepatitis B4High Intermediate: 5% - 7%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.12%NATIONAL BLOOD PROGRAMThe Hong Kong Red Cross Blood Transfusion Service (BTS) is the sole provider of blood to all publicand private hospitals nationwide.7 Since 1991 the BTS has been managed by the Hospital Authority7, a public organisation which provides health services to public hospitals.8The BTS first launched its blood program in 1952.9 All donations are received from non-remunerateddonors.9 Currently the BTS operates:nine donor centrestwo university campus donor centresfour mobile blood collection teamsone medi-coach9To adequately supply blood to all hospitals of Hong Kong the BTS requires 1,100 donors per day. 9The BTS estimates that the need for blood will continue to increase due to an aging population andthe opening of several public and private hospitals.9195ASIA PACIFICASIA PACIFIC LEVEL ATo meet this demand the BTS is proactively expanding its service network to recruit blood donorsand strengthen the overall blood collection capacity.9 Young donors are being encouraged to donateregularly in an effort to stabilise the long term blood supply.9NATIONAL SOCIETY (HONG KONG RED CROSS: BRANCH OF THE RED CROSSSOCIETY OF CHINA)The Hong Kong Red Cross Blood Transfusion Service (BTS) is responsible for collection, processing,testing and distribution of all blood donated by 100% voluntary non-remunerated donors in HongKong.In 2005, the BTS implemented a Quality-Environmental Management System which incorporatesthe principles of ISO9001, ISO14001 and cGMP (Code of Good Manufacturing Practice for Bloodand Components) standards.7The Hong Kong Red Cross Blood Transfusion Service:annually collects (2016):o 250,554 units of whole bloodo 7,668 units by apheresis10supplies blood to 30 hospitals/clinicssupports a regional population of 7.2 million peopleprocesses collected blood into componentsconducts screening testing of blood for infectious diseases and blood groupingdoes not conduct cross-matching for transfusionis accredited by US AABBdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis involved in the collection, processing or testing of cord blood stem cells and peripheralstem cellsis not involved in the collection, processing or testing of bone marrow stem cells, bone, solidorgans or corneasthe Public Cord Blood Bank was established in 1998 and the Hong kong Bone Marrow DonorRegistry in 2005forwards plasma to a fractionation facilityBlood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the blood service. Paid staff are used to undertake school/university programsand corporate programs.The Hong Kong Red Cross Blood Transfusion Service is planning to expand its current level ofinvolvement in blood-related activities, but only to increase the volume of activities to meet increasingdemand.ASIA PACIFIC196EUROPE ANDASIA PACIFICLEVELCENTRALA1ASIACentral Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/hk.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 16]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Feb 16].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Department of Health. The Government of Hong Kong Special Administrative Region. Virtual AIDS office of Hong Kong.HIV surveillance and epidemiology [Internet] Department of Health 2007 [updated 2017 Aug 29] [cited 2018 Feb 16].Available from: http://www.info.gov.hk/aids/english/surveillance/latest_stat.htm.7 Hong Kong Red Cross. Hong Kong Red Cross Blood Transfusion Service. History and Background. [Internet] 2013[cited 2018 Feb 16]. Available from: http://www5.ha.org.hk/rcbts/enarticle.asp?bid=1&MenuID=1#.WoZR8dJlIuU8 Hospital Authority Hong Kong. About Us. Introduction. [Internet] 2018 [cited 2018 Feb 16]. Available from:http://www.ha.org.hk/visitor/ha_visitor_index.asp?Parent_ID=10004&Content_ID=10008&Ver=HTML9 Concern over the continuously low level of blood stock in Hong Kong and excessively long waiting time for organtransplant. Annex II. Central and Western District Council. Committees Meetings Discussion Papers. [Internet] 2016[cited 2018 Feb 5]. Available from:http://www.districtcouncils.gov.hk/central/doc/2016_2019/en/committee_meetings_doc/clsac/10123/20160922_CLSAC_Paper_29_2016_Annex_II.pdf10 Hong Kong Red Cross. Hong Kong Red Cross Blood Transfusion Service. 2016 Key facts in Blood Collection andUsage [Internet] Hong Kong Red Cross 2017 [cited 2017 Oct 03]. Available from:http://www5.ha.org.hk/rcbts/enarticle.asp?bid=86&MenuID=3#.WdMMgtIUm70197ASIA PACIFICASIA PACIFIC LEVEL AINDIAIndian Red Cross Society:Level A (undertakes full blood service provision)Provide approximately 10% of the national supply1Approximately 90% VNRBD1NATIONAL CONTEXTLocationSouthern AsiaGeographical size ranking28thPopulation (world ranking)21.28 billion (2nd)Median age227.9Political system2Federal parliamentaryrepublicGDP per capita (worldranking)2$7,200 (157th)HDI Index (world ranking)30.624 - medium (131st)Health Expenditure24.7% of GDPPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very Low: 0-<1.0%Population prevalence HIV60.3% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe national blood system in India is decentralised; there are 27607 blood banks which are run by8:Ministry of Health (49.1% total collections)Private/commercial sector (32.4% total collections)NGO/not-for-profit (18.5% total collections).8A national blood policy was adopted in India in 2002 which was followed with an Action Plan forBlood Safety to address priorities and objectives as stated in the blood policy.8Licensing of blood banks is under the Drug Controller General of India (Drug & Cosmetics Act 1945).9 To hold a license, blood banks must adhere to national minimum standards for operationwhich are defined by the Act as well as standards issued by the National AIDS Control Organisation(NACO).9The National Blood Transfusion Council (NBTC) was formed in 1996; each state also has a StateBlood Transfusion Council (SBTC).10 The NBTC formulates policy relating to all matters of bloodcentre operations, coordinates the SBTCs and ensures involvement of other government ministriesand health programs.10ASIA PACIFIC198EUROPE ANDASIA PACIFICLEVELCENTRALAASIANACO, a division of the Indian Ministry of Health, has been largely responsible for making sure thereis an adequate safe blood supply for use across the country since 1992.10 NACO set the servicecharge for blood components, also specifying that blood must be provided free for particular patientsincluding those with thalassemia and haemophilia.11 NACO provides support to 1131 blood banksthrough the provision of blood bags, reagents and testing kits.10In 2015-2016, the number of units collected by NACO supported blood banks was 6,385,000 units(well below the national annual requirement of approximately 12.8 million units)10, 79% of thesecollections were from voluntary blood donors.10Between 2007 and 2014-2015 the incidence of HIV sero-positivity in donors declined from 1.2% to0.2% in NACO supported blood banks.12Blood bank accreditation is conducted by the National Accreditation Board for Hospitals andHealthcare Providers (NABH), their assessment includes compliance to NABH and NACO standardsand guidelines.13Plasma fractionation in India is undertaken by a PlasmaGen Biosciences, a private facility inBangalore (Karnataka) with a capacity of up to 60,000L annually14; and Reliance Life Sciences inMumbai (Maharashtra).15 NACO also plans to set up a government run plasma fractionation centrein Chennai (Tamil Nadu) with a capacity of 150,000L of plasma per year.10NATIONAL SOCIETY (INDIAN RED CROSS)The Indian Red Cross Society started the first blood bank in the country in 1942 in Calcutta (WestBengal); the National Headquarters in New Delhi were opened in 1977.16The Indian Red Cross Society has 166 blood banks which all operate independently, at a state basedlevel, and provide approximately 5-10% of the national blood supply (approx. 800,000 units peryear).17The number of blood banks and the level of blood supply in each state is very variable, 14 states inthe country have IRCS blood banks which provide a full blood service (collection, processing,distribution of blood).17 In the remaining states, the Indian Red Cross assists with promotion ofvoluntary blood donation and recruitment of donors.17The IRCS National Headquarters blood bank in New Delhi (one of the largest IRCS blood banks inthe country) provides approximately 40,000 units of blood per year to the Delhi area.17 VNRBD ratesfor this blood bank are 96%.18The activities of the Indian Red Cross blood banks vary significantly across the country.18 As well asprocessing and distribution of blood, some blood banks conduct cross-matching and undertaketransfusions (primarily for thalassaemia patients) within their facilities. 18 In addition, some bloodbanks are accredited by the National Accreditation Board for hospitals and some forward plasma toa fractionation facility.181Strategic Development Plan (2014-2017). Indian Red Cross Society. Available from:http://www.indianredcross.org/publications/strategic-development-plan.pdf2 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/in.html3 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 16]. Available from: http://hdr.undp.org/en4Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b199ASIA PACIFICASIA PACIFIC LEVEL A5Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 National AIDS Control Organisation (NACO) Assessment of NACO Supported blood banks A Preliminary Report 2016[Internet] NACO 2016 [cited 2018 Feb 16]. Available from:http://naco.gov.in/sites/default/files/Assessment%20of%20NACO%20supported%20BBs%20in%20India.pdf8 National AIDS Control Organisation (NACO) Rapid Situation Assessment of Blood Transfusion Services in India[Internet] 2014 [cited 2018 Feb 16]. Available from:http://naco.gov.in/sites/default/files/Rapid%20Situation%20Assessment%20of%20BTS%20in%20India%20pdf%20%281%29.pdf9 Central Drugs Standard Control Organisation, India. Regulatory Requirements of Blood and/or its ComponentsIncluding Blood Products [Internet] Central Drugs Standard Control Organisation 2014 [cited 2017 Oct 17]. Availablefrom: http://www.cdsco.nic.in/forms/list.aspx?lid=1813&Id=110 National AIDS Control Organization [Internet] NACO 2017 [Cited 2017 Dec 11]. Available from:http://www.naco.gov.in/blood-transfusion-services11 National AIDS Control Organization, Guidelines for Recovery of Processing Charges for Blood and BloodComponents-reg [Internet] NACO 2017 [Cited 2017 Dec 8]. Available from:http://www.naco.gov.in/sites/default/files/guidelines.pdf12 NACO Annual Report 2015-2016. Department of AIDS Control. Ministry of Health & Family Welfare, Government ofIndia. [Internet] NACO 2016. [cited 2017 Oct 16]. Available from:http://naco.gov.in/sites/default/files/Annual%20Report%202015-16_NACO.pdf13National Accreditation Board for Hospitals & Healthcare Providers. Quality Indicators for Blood Banks [Internet]National Accreditation Board for Hospitals & Healthcare Providers 2017 [updated 2017 Apr 29] [cited 2017 Oct 16].Available from: http://www.nabh.co/bloodbank.aspx14 PlasmaGenBiosciences Pvt. Ltd. Who We Are [Internet] PlasmaGenBiosciences 2017 [cited 2017 Dec 11]. Availablefrom: http://plasmagen.in/about-us.php15 Reliance Life Sciences All Rights Reserved. Biopharmaceuticals [Internet] Reliance Life Sciences 2009 [cited 2017Dec 11]. Available from: http://www.rellife.com/biopharmaceutical.html16 The International Federation of Red Cross and Red Crescent Societies. Indian Red Cross Society annual report 201516 [Internet] The International Federation of Red Cross and Red Crescent Societies 2016 [cited 2017 Oct 16]. Availablefrom: http://data.ifrc.org/public/documents/IN/AR_India_2015_English.pdf17 House O. GAP Visit Report: India. Perth (WA): Global Advisory Panel (GAP) on Corporate Governance and RiskManagement of Blood Services in Red Cross and Red Crescent Societies; 2015 Oct 13.18 House O. GAP Visit to India Sep 2015, Perth (WA): Global Advisory Panel (GAP) on Corporate Governance and RiskManagement of Blood Services in Red Cross and Red Crescent Societies; 2015 Sept 21.ASIA PACIFIC200EUROPE ANDASIA PACIFICLEVELCENTRALAASIAINDONESIAIndonesian Red Cross Society (Palang Merah Indonesia PMI):Level A (undertakes full blood service provision)90% of the national total blood collection90% VNRBD (average for all centres)NATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking116thPopulation (world ranking)1261 million (4th)Median age130.2Political system1Presidential republicGDP per capita (worldranking)1$12,400 (125th)HDI Index (world ranking)20.689 - medium (113th)Health Expenditure12.8% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Very Low: 0 - <1.0%Population prevalence HIV50.4% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn Indonesia, 90% of the blood is supplied by the Indonesian Red Cross (PMI) with the remaining10% being supplied by government run blood centres. 6While the majority of blood collected from PMI is from voluntary donors, government run hospitalcollections are predominantly replacement donations.7 In addition, government hospitals transfusemostly whole blood.7A number of national guidelines are in place in Indonesia, including a national blood policy forVNRBD and national technical standards for blood centres (including GMP).6Blood is sold to hospitals on a fee-for-service basis; the patients are charged for the blood but theymay claim the cost from government or private insurance.7 The Ministry of Health (MoH) mandatesthe cost recovery model which was approximately USD$30 for a unit of blood in 2016. 6Currently in Indonesia, 80% of plasma is discarded each year across all PMI centres nationally.6Plasma products are imported by hospitals from overseas suppliers.6 In 2019/2020, the IndonesianMoH is planning to open a plasma fractionation facility with the plasma supplied by the IndonesiaRed Cross.6 The MoH has appointed PT Biofarm to construct this facility.6201ASIA PACIFICASIA PACIFIC LEVEL AIn 2015, the government released regulations specific for plasma fractionation which requires PMIblood centres to be GMP accredited prior to providing plasma for fractionation.6NATIONAL SOCIETY (INDONESIAN RED CROSS)In 1873, the Dutch colonial government established the Red Cross organization in Indonesia withthe name Het Rode Kruis Nederland-Indiche (NIRK). 8 The organisation was recognised by theInternational Committee of Red Cross in 1950.8The Indonesian Red Cross Society:has 212 semi-autonomous blood centres. In addition, PMI has a number of blood banks(blood storage centres) in MoH hospitals.6collects (2015):o 2,776,202 units of whole blood annuallyo 8,844 units of blood collected by apheresiscollects 62% of the blood via mobile sitestransfuses 84% components, 16% whole blood (average across all centres)6supplies blood to 3,880 hospitals/clinicsprocesses collected blood into componentsconducts screening testing of blood for infectious diseases and blood groupingconducts cross-matching for transfusiondoes not perform transfusionsis not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, solid organs or corneas.Some centres are working to become accredited to WHO GMP Blood establishment.6Funding for the PMI blood program is provided by the national government (5-10%), localgovernments and the National Society.6 PMI does not receive financial support from internationalpartners; however the blood service has received technical support from the Australian Red Crossto assist with the implementation of a quality system since 2012.6Nationally, 85% of PMI blood centres use ELISA and 15% use a rapid test for infectious diseasescreening. In the capital Jakarta, the local government funds NAT screening for the PMI bloodcentres in this area.6Blood donor recruitment and retention activities are coordinated by the National Societydistrict/chapter and are funded by the blood service. Both paid staff and volunteers coordinateschool/university and corporate donor recruitment programs.Indonesia Red Cross is planning to expand its current level of involvement in blood-related activitiesby establishing or participating in a blood network with its neighbouring country.ASIA PACIFIC202EUROPE ANDASIA PACIFICLEVELCENTRALA1ASIACentral Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/id.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 16]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 House O. GAP Visit to Indonesia. Perth (WA): Global Advisory Panel (GAP) on Corporate Governance and RiskManagement of Blood Services in Red Cross and Red Crescent Societies; 2016 Sep 6p.7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.8 Palang Merah Indonesia. About us. History PMI. [Internet] Palang Merah Indonesia; 2011 Sep 10 [cited 2017 Dec 11].Available from (select English): http://www.pmi.or.id/index.php/tentang-kami/sejarah-pmi.html203ASIA PACIFICASIA PACIFIC LEVEL AJAPANJapanese Red Cross Society:Level A (undertakes full blood service provision)100% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationEastern AsiaGeographical size ranking163rdPopulation (world ranking)1126 million (10th)Median age147.3Political system1Parliamentaryconstitutional monarchyGDP per capita (worldranking)1$42,700 (41st)HDI Index (world ranking)20.903 - very high (17th)Health Expenditure110.2% of GDPEfficiency of Healthcare34th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.01%NATIONAL BLOOD PROGRAMThe Japanese Red Cross Society (JRCS) is the sole collector and provider of blood for transfusionsin Japan. The donated blood from VNRB donors are supplied to medical institutions as bloodproducts for transfusion after testing and manufacturing. Source plasma is collected and providedfrom JRCS to three domestic manufacturers for processing into plasma derivatives.National regulatory standards are established and administered by the Ministry of Health, Labourand Welfare, and the Pharmaceutical and Medical Devices Agency.Legal framework on blood program in Japan is governed by laws as follows: The Law on Securing a Stable Supply of Safe Blood Products - came into effect in 2003 withthe basic principle of achieving domestic self-sufficiency. Act on Securing Quality, Efficacy and Safety of Pharmaceuticals, Medical Devices,Regenerative and Cellular Therapy Products, Gene Therapy Products, and Cosmetics(revised from amendments of Pharmaceutical Affairs Law) - came into full effect in 2005 viaa new organization called the Blood Service Headquarters of JRCS, which was set up inkeeping with the provisions of these laws and regulations, and was inaugurated in October2004. 7ASIA PACIFIC204EUROPE ANDASIA PACIFICLEVELCENTRALAASIANATIONAL SOCIETY (JAPANESE RED CROSS)JRCS collects all of the nations blood, which is from VNRB donors, and supports the entire Japanesepopulation with blood components for transfusion.The Japanese Red Cross Blood Service:recruit and retain blood donors nationally with the support of volunteersannually collects (2015):o 3,526,005 units of whole bloodo 775,664 units of Platelet Rich Plasma for Platelet Concentrateso 581,918 units of Platelet Poor Plasmaprocesses donated blood into blood products for transfusionconducts screening of blood for infectious diseases and blood groupingdoes not conduct cross-matching for transfusion this is conducted by hospitalssupplies blood to more than ten thousand hospitals/clinicsforwards plasma to a fractionation facility. Japan Blood Products Organization (JBPO) wasestablished in 2012 as a non-profit general incorporated association7does not perform any transfusionsis involved in collection, processing and testing of cord blood stem cells, peripheral stem cellsand bone marrow stem cellssupplies blood to 10,363 approved hospitals/clinicsis not accredited to international standardsdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryThe structure of the Blood Service is at three levels as follows:8National Headquarters of the JRCS (Blood Service Headquarters) Oversight of all servicesBlock Blood Centres - Seven locations nationwide and directly controlled by the nationalheadquarters; responsible for testing, preparation and supply-demand managementBlood Centres comprising 47 blood centres nationwide supervised by each prefecturalChapter of the JRCS but belonging to the respective Block Blood Centres; responsible forpromoting blood donations, collecting blood, and supplying productsDonor recruitment and retention activities are coordinated nationally and funded by the blood serviceusing paid staff and volunteers. Recruitment programs include school/university programs andcorporate programs. Promotional strategies include:commercials on TV, radio & cinema screenradio program & live events with musicianswebsite, Facebook, Twitter, YouTube & pamphletsdelivery seminar on life and/or blood donation for high school studentson-site learning at blood centres and collection rooms for primary school pupilsThere are no plans to either expand or scale back the current level of involvement in blood relatedactivities.205ASIA PACIFICASIA PACIFIC LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ja.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 16]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 September 18 [cited2018 Feb 16]. Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-theworld.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 UNAIDS. Report to UNAIDSHIV/AIDS Trends In Japan [Internet] UNAIDS 2016 Ap [cited 2018 Feb 16]. Availablefrom:: http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2016countries/7 Japan Blood Products Organization. The purpose of establishment [Internet] Japan Blood Products Organization 2012[cited 2017 May 23] Available from: http://jbpo.or.jp/english/company/index.html8 Japanese Red Cross Society. Blood Services 2017 [Internet] Japanese Red Cross Society 2017 [cited 2017 Dec 18].Available from: http://www.jrc.or.jp/english/pdf/Blood_Services_2017_web.pdfASIA PACIFIC206EUROPE ANDASIA PACIFICLEVELCENTRALAASIALAOSLao Red Cross:Level A (undertakes full blood service provision)100% of the national total blood collection92% VNRBDNATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking185thPopulation (world ranking)17.1 million (101st)Median age123Political system1Communist StateGDP per capita (worldranking)1$7,400 (156th)HDI Index (world ranking)20.586 - medium (138th)Health Expenditure11.9% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.3% among adults aged 15to 49NATIONAL BLOOD PROGRAMA National Blood Policy was entered into legislation in Laos in 1995, the same year that the Lao RedCross Blood Transfusion Centre was created to manage the national blood service.6 7 The NationalTransfusion Committee was created three years later, the to oversee the blood program.7There are branches of the National Blood Transfusion Centre in all 17 regions of Laos, with the mainheadquarters situated in Vientiane.6 7The National Blood Transfusion Centre is responsible for7:recruiting blood donorscollecting bloodprocessing and testingstorage and distribution of blood to hospitalsencouraging the safe and efficient use of blood products7The blood transfusion service has progressed rapidly since the 1990s, with an increase in totaldonations from 500 in 1995 7 to 45,735 in 2017. VNRBD has reached almost 100% VNRBD at centrallevel (92%) and 52% at the regional level (2017). Mobile blood collections are the main source of207ASIA PACIFICASIA PACIFIC LEVEL Ablood donations6, with mobile units frequenting schools, universities, government offices, the armyand other businesses.7Mandatory testing is performed on each donation, including ABO and Rh blood groups and antibodyscreening and testing for TTIs (HIV, HBV, HCV and syphilis).7 This testing is performed based onthe World Health Organisation (WHO) guidelines.7NATIONAL SOCIETY (LAO RED CROSS)The Lao Red Cross:annually collects 45,735 units of whole blood (2017)processes collected blood into componentsconducts screening of blood for infectious diseases and blood groupingconducts cross-matching for transfusiondoes not forward plasma to a fractionation facilitydoes not perform transfusionsis not involved in cord blood stem cells, peripheral stem cells, bone marrow stem cells,bone/solid organ transplants or corneassupports the National / Regional populationsupplies blood to 49 hospitals/clinicsis not accredited to an international standardreceives technical assistance from IFRC, WHO, Swiss Red Cross (SRC) and Japanese RedCross Society (JRCS), and financial support for VNRBD activities from the Global Fund.Blood donor recruitment and retention activities are coordinated nationally. They are funded by theBlood Service, Government of MOH and private organisations. Paid staff and volunteers are usedto undertake school/university, club 25 and corporate.The Lao Red Cross is planning to expand its activities by conducting more blood campaigns incommunities and government offices, with Youth Donor Club (YDC) and donor recruiter training.The Lao Red Cross Blood Service is expecting to reach 100% VNRBD and collect 65,000 units ofblood by 2020.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/la.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 16]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 World Health Organisation. Biregional Workshop on Blood Donor Management Meeting Report [Internet] WHO 2010Jun 14-16 [cited 2017 Dec 19]. Available from:http://www.wpro.who.int/health_technology/documents/docs/MeetingReportBiregionalMeetingonBlooodDonorManagement.pdf7 Lao Red Cross. National Blood Service. [Internet] Laos Red Cross 2015. [cited 2018 Feb 16]. Available from:http://www.laoredcross.org.laASIA PACIFIC208EUROPE ANDASIA PACIFICLEVELCENTRALAASIANEPALNepal Red Cross Society:Level A (undertakes full blood service provision)90% of the national total blood collection85% VNRBDNATIONAL CONTEXTLocationSouthern AsiaGeographical size ranking196thPopulation (world ranking)129.4 million (45th)Median age124.1Political system1Federal parliamentaryrepublicGDP per capita (worldranking)1$2,700 (196th)HDI Index (world ranking)20.558 - medium (144th)Health Expenditure15.8% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low Moderate: 1.5% <2.0%Population prevalence HIV50.2% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 1991, when the National Policy for Blood Safety was first approved, the government of Nepalmandated the Nepal Red Cross Society as the sole authority in conducting blood programs in Nepal.67 13The National Blood Policy has since been revised in 2006 and 20127, providing the regulationsfor ensuring the people of Nepal have access to a safe and adequate supply of blood and bloodproducts.There is a National Technical Advisory Committee (NTAC) which provides advice on blood technicalmatters, and falls under the National Steering Committee, part of the Ministry of Health andPopulation (MoHP).7 Under the MoHP, the National Public Health Laboratory (NPHL) functions asthe reference centre and encourages all aspects of blood safety (policy, guidelines, protocols andSOPs).8Voluntary blood collection was introduced in 1982.6 The central Blood Transfusion Service (BTS) inKathmandu reached 90% VNRBD in 2009.13209ASIA PACIFICASIA PACIFIC LEVEL AThe blood service consists of:a central BTS centre (BTSC)four regional BTSC22 district BTSC37 emergency BTSC36 hospital units9On the 25th April, 2015 a devastating earthquake hit Nepal, with aftershocks continuing for severalweeks after the initial damage.7 10 The earthquakes caused significant damage to the blood servicethroughout Nepal, both in Kathmandu and 14 districts.11 One staff member and two volunteers losttheir lives while involved in a mobile blood collection at the time.12 In Kathmandu, the Central BloodTransfusion Service building was considered unsafe due to the damage and the current temporaryarrangements are inadequate to support even a rudimentary level of operation (in terms of collection,processing and testing capacity).7 Several externally funded projects are underway to support theBlood Transfusion Service re-establish itself.NATIONAL SOCIETY (NEPAL RED CROSS)The Nepal Red Cross Society was established in 1963 and three years later, in 1966, its BloodTransfusion Service was founded.13 The service began for the people of Kathmandu but has sincebeen extended to 68 locations in the 48 districts of the country6 (though since the 2015 earthquake,12 centres have been fully damaged and 19 centres partially damaged).7The Nepal Red Cross Society:currently operates 105 Blood Transfusion Services in 72 of the 75 districts of Nepal14supplies blood to 200 hospitals/clinicssupports a regional population of 30 millioncollected a total of 310,623 units of blood between 2016-201714indicates blood donation to be at 85% VNRBD and 15% family replacement donation withthe rate of national increase at 13% per year14does not perform transfusionsdoes not forward plasma to a fractionation facilityis not accreditedreceives technical support from Red Cross Partner National Societies (Finnish Red Cross,Japanese Red Cross, Belgian Red Cross Flanders, Danish Red Cross, British Red Cross,American Red Cross, Australian Red Cross, Thai Red Cross and GAP), and also receivescapacity support from bilateral partners, Sanquin Netherlands, for quality managementreceives financial support for VNRBD and blood service activities, with partial and intermittentsupport from WHOreceives support for post-earthquake recovery from GAPis not involved in the collection, processing or testing of cord stem cells, peripheral stem cells,bone marrow stem cells, bone, solid organ or corneaBlood donor recruitment and retention activities are coordinated nationally by the National Societyand they are currently undertaking school/university, Club 25 and corporate programs. Donorrecruitment activities are funded by the National Society. Paid staff are utilised for donor recruitment.Nepal Red Cross is planning to expand its current level of involvement in blood related activities byincreasing collections and commencing an apheresis program.ASIA PACIFIC210EUROPE ANDASIA PACIFICLEVELCENTRALA1ASIACentral Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/np.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 16]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Nepal Red Cross Society. Blood Services [Internet]. Nepal Red Cross Society 2017 [cited 2017 May 30]. Availablefrom: http://www.nrcs.org/program/blood-services7 Rajkarnikar, M. Blood management post earthquake 25th April 2015. Transfus Apher Sci [Internet] 2016 [cited 2017 Dec19];55;184-185. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27692604. doi:10.1016/j.transci.2016.09.0068 Department of Health Services Nepal. National Guidelines on Management of Blood Transfusion in Nepal. 2008 Dec.Revised 2012 Nov. 41pp9 Rajkarnikar M (NRCS Central Blood Transfusion Service, Nepal). The Blood Program in Nepal. Paper presented at theAustralian Red Cross Blood Service; 2015 Feb 1-5; Brisbane.10 World Health Organization. Nepal Earthquake 2015 Country Update and Funding Request [Internet] 2015 [cited 2017Dec 19]. Available from: http://www.who.int/emergencies/nepal/nepal-donor-may.pdf11 World Health Organization. Humanitarian crisis after Nepal earthquakes 2015 [Internet] 2015 May [cited 2017 Dec 19]Available from: http://www.searo.who.int/entity/emergencies/phra_nepal_may2015.pdf?ua=112 Global Advisory Panel on Corporate Governance and Risk Management of Blood Services in Red Cross and RedCrescent Societies. Nepal [Internet] Global Advisory Panel on Corporate Governance and Risk Management of BloodServices in Red Cross and Red Crescent Societies 2017 [cited 2017 Dec 19]. Available from:http://www.globaladvisorypanel.org/about-gap/activities/priority-country-activities/nepal13 World Health Organisation. Biregional Workshop on Blood Donor Management Meeting Report [Internet] WHO 2010Jun 14-16 [cited 2017 Dec 19]. Available from:http://www.wpro.who.int/health_technology/documents/docs/MeetingReportBiregionalMeetingonBlooodDonorManagement.pdf14 Rajkarnikar M. Blood Transfusion Country Report Nepal. Nepal Red Cross Society Blood Transfusion Service 2017[cited 2018 Jan 25] 3pp211ASIA PACIFICASIA PACIFIC LEVEL APAKISTANPakistan Red Crescent Society:Level A (undertakes full blood service provision)<1% of the national total blood collection98% VNRBD1NATIONAL CONTEXTLocationSouthern AsiaGeographical size ranking237thPopulation (world ranking)2204.9 million (6th)Median age223.8Political system2Federal parliamentaryrepublicGDP per capita (worldranking)2$5,400 (171st)HDI Index (world ranking)30.550 medium (147th)Health Expenditure22.6% of GDPPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5High: 5.0%Population prevalence HIV60.1% among adults aged15 to 49NATIONAL BLOOD PROGRAMPakistan has a fragmented blood transfusion system with mostly hospital-based transfusion services,approximately 15% of donations are VNRBD and 85% replacement/family donations.7 It is estimatedthat the annual blood collection in Pakistan is 3.5 million units.8The National Blood Policy and Strategic Framework 2008-2012 stated there were nearly 170 publicand approximately 450 private/NGO blood banks in the country.9 However, other reports indicatethat there may be up to 1800 blood centres in Pakistan, including many that are unregulated.10The Safe Blood Transfusion Program (SBTP), a Pakistan national government program supportedby the German government (GIZ), was established in 2010.11 SBTP performs the role of centralcoordinating body to oversee policy planning, provide strategic guidelines, set standards, monitorand evaluate programs, liaise with development partners and report on international commitmentsto contribute to the improvement in blood safety standards in the country.7ASIA PACIFIC212EUROPE ANDASIA PACIFICLEVELCENTRALAASIAOperational Documents on the SBTP website include:National Blood Donor Policy (which recommends VNRBD)Standards and Guidelines for Blood Banks and Transfusion Services. These include BloodDonor Selection, Blood Component Preparation and Storage, Testing of Blood Donations(including mandatory requirements for infectious disease testing and pre-transfusiontesting).12These are considered essential minimum standards for licensing of blood centres in Pakistan.12The Islamabad Blood Transfusion Authority (IBTA) is an autonomous organisation established in2005 and revived in 2013, to guide the development of blood transfusion services and regulate thesystem on internationally accepted models and providing technical advice.13In 2015 in Islamabad there were 19 licensed blood banks including the Pakistan Red CrescentSociety Blood Donor Centre.13 Blood Transfusion Authorities were then established in otherprovinces, including Punjab, Sindh, Khyber Pakhtunkhwa, Azad Jammu and Kashmir andBalochistan. Their role includes registration and inspection of blood banks, issuing licenses that fulfilminimum criterial, inspections, haemovigilance, surveillance, compliance and data management.14NATIONAL SOCIETY (PAKISTAN RED CRESCENT)The Pakistan Red Crescent (PRCS) Blood Transfusion Service has seven centres: four in Punjab,two in Sindh and one at Islamabad.The PRCS Blood Donor Centre, National HQ, Islamabad:collects 3,075 units of whole blood annually (2015)supplies blood to more than 40 hospitals/clinicssupports a population of 5 million of the cities of Rawalpindi & Islamabadprocesses collected blood into componentsconducts screening testing of blood for infectious diseases and blood groupingdoes not conduct cross-matching for transfusiondoes not perform transfusionsdoes not forward plasma to a fractionation facilityis licensed by the IBTA15does not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, solid organs or corneas.The Blood Service is planning to expand its activities to include a thalassaemia treatment centre.Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the blood service. Paid staff undertake school/university programs andcorporate programs.1Aslam U (Pakistan Red Crescent Society, RBDC). Donor Recruitment and Care, The Pakistani Donors Realities. Paperpresented at: The Eighth Red Cross and Red Crescent Symposium on Blood Programs in the Asian Region SecuringStable Supply of Safe Blood (III); 2017 Oct 18-20; Bangkok.2 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/pk.html213ASIA PACIFICASIA PACIFIC LEVEL A3United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Zaheer H. Waheed U. Blood safety system reforms in Pakistan Blood Transfus. 2014 Oct:12(4);452-457. doi:10.2450/2014.0253-138 Government of Pakistan. National Blood Banks Data Collection Report 2016 [Internet] Safe Blood TransfusionProgramme 2016 [cited 2018 Jan 22] Available from: http://www.sbtp.gov.pk/media/7176/national-report__blood-banksdata-collection-2016.pdf9Government of Pakistan. National Blood Policy & Strategic Framework 2008-2012 For Blood Transfusion Services inPakistan [Internet] National AIDS Control Programme Ministry of Health 2008 [cited 2018 January 22]. Available from:http://www.nacp.gov.pk/repository/howwework/Technical%20Guidelines/Blood%20Transfusion/National%20Blood%20policy%20&%20strategic%20framework-BT.pdf10 Government of Pakistan. Standard and Guidelines for Blood Banks and Transfusion Services [Internet] Safe BloodTransfusion Programme 2013 [cited 2018 January 22]. Available from:http://sbtp.gov.pk/media/1306/5-standards-and-guidelines-for-blood-banks-and-transfusion-services1.pdf11 Deustche Gesellschaft fur Internationale Zusammenarbeit (GIZ). Safe blood transfusion in Pakistan [Internet] GIZ2017 [cited 2017 May 23] Available from: https://www.giz.de/en/worldwide/18027.html12 Government of Pakistan. Safe Blood Transfusion Programme. [Internet] Safe Blood Transfusion Programme 2018[cited 2018 January 22]. Available from: http://www.sbtp.gov.pk/13 Zaheer H.A. Regulation of Blood Transfusion Services in Pakistan. 2015. Powerpoint presentation available from:http://www.tmi.ac.ir/_DouranPortal/documents/Regulation%20of%20BTS%20in%20Pakistan_Prof.%20HAZ.pdf14 Islamabad Blood Transfusion Authority. Provincial Blood Transfusion Authorities [Internet] Islamabad BloodTransfusion Authority 2013 [cited 2018 January 22]. Available from: http://www.ibta.gov.pk/Provincial_BTAs.html15 Islamabad Blood Transfusion Authority [Internet] Islamabad Blood Transfusion Authority Islamabad 2013 [cited 2017May 23]. Available from: http://www.ibta.gov.pk/index.htmlASIA PACIFIC214EUROPE ANDASIA PACIFICLEVELCENTRALAASIAPHILIPPINESPhilippine Red Cross:Level A (undertakes full blood service provision)52% of the national total blood collection94% VNRBD1NATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking274thPopulation (world ranking)2104.3 million (13th)Median age223.5Political system2Presidential republicGDP per capita (worldranking)2$8,200 (153rd)HDI Index (world ranking)30.682 - medium (116th)Health Expenditure24.7% of GDPPopulation prevalencehepatitis B4Low Intermediate: 2% - 4%Population prevalencehepatitis C5Very Low: 0% - <1.0%Population prevalence HIV60.1% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn the Philippines, blood is collected by:the Philippine Red Cross (52%)government hospitals (20%)Philippine Blood Centre (13%)private hospitals (15%).Blood donation in the Philippines is regulated under the Republic Act No. 7719 (RA 7719), alsoknown as the National Blood Services Act of 1994, which promotes voluntary blood donation for afree and safe blood supply and regulates blood banks.7 The Philippines Department of Healthwebsite7 outlines five goals for the National Voluntary Blood Services Program (NVBSP):215Development of a fully voluntary blood donation system.Strengthening of a nationally coordinated network to increase efficiency by centralized testingand processing of blood.Implementation of a quality management system including Good Manufacturing Practice andManagement Information System.Maximum utilization of blood.Sustainable management and funding for the nationally coordinated blood network.7ASIA PACIFICASIA PACIFIC LEVEL AIn 2016, 920,000 units of blood were collected throughout the country, with Philippine Red Crossproviding nearly half the supply (407,000 units), this however, falls below the WHO recommendationof blood donation from 1% of the total population.8Many people turn to online groups to ask for direct blood donations to avoid being chargedprocessing fees twice for blood coming to the hospitals from other collection centres, as allowedunder RA 7719.8NATIONAL SOCIETY (PHILIPPINE RED CROSS)The Philippine Red Cross:annually collects (2015):o 355,000 units of whole bloodo 2,500 apheresis unitsprocesses collected blood into componentsconducts screening tests of blood for infectious diseases and blood grouping.does not conduct cross-matching for transfusiondoes not forward plasma to a fractionation facilitydoes not perform transfusionsis not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells, bone marrow stem cells, bone, cornea or solid organssupplies 70-100 hospitals and dialysis unitsNational Blood Centre is accredited to ISO 9001:2008 and other PRC facilities are workingtowards accreditationdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryDonor recruitment and retention activities are coordinated nationally and by district/chapter. Donorrecruitment activities are funded by the blood service and the National Society. Both paid staff andvolunteers are used for donor recruitment.Current recruitment programs include school/university programs, Club 25, corporate programs, RC143 community donor recruitment, police, military, media, civic organization and the church.RC 143 stands for one leader + 43 members. The RC 143 volunteers in the Red Cross BloodProgram are asked to become regular and standby donors when needed, recruit voluntary unpaidblood donation, and organise voluntary mass blood donations as required.9ASIA PACIFIC216EUROPE ANDASIA PACIFICLEVELCENTRALA1ASIASentones H. Country report, Philippines. In: The Eighth Red Cross and Red Crescent Symposium on Blood Programsin Asian Region Securing Stable Supply of Safe Blood; 2017 Oct 18-20; Bangkok, Thailand.2 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/rp.html3 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Feb 16]. Available from: http://hdr.undp.org/en4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Feb 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Feb16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Republic of the Philippines. Department of Health. Blood Donation Program [Internet] 2017 [cited 2018 Feb 16]Available from: http://www.doh.gov.ph/blood-donation-program8 Francisco, K. Blood needed: With PH blood supply below target, patients seek help online. Rappler [Internet]. 2017 Sep03 [cited 2018 Jan 29]. Available from: https://www.rappler.com/newsbreak/in-depth/180446-blood-donation-onlinenetworks-philippine-red-cross9 The Philippine Red Cross. Red Cross 143 Basic Training Course. Paper presented at Manila 2011 August [cited 2018Jan 29] Powerpoint presentation available from: http://www.slideshare.net/coached23/from-philippine-red-crossbtcmodule-1217ASIA PACIFICASIA PACIFIC LEVEL ASOUTH KOREA (REPUBLIC OFKOREA)Republic of Korea National Red Cross:Level A (undertakes full blood service provision)93% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationEastern AsiaGeographical size ranking1110thPopulation (world ranking)151.2 million (27th)Median age141.8Political system1Presidential republicGDP per capita (worldranking)1$39,400 (45th)HDI Index (world ranking)20.901 - very high (18th)Health Expenditure17.4% of GDPEfficiency of Healthcare35th of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2% - 4%Population prevalencehepatitis C5Very Low: 0% - <1.0%Population prevalence HIV6<0.1%NATIONAL BLOOD PROGRAMUntil 2002, the Republic of Korea Red Cross (KRC) was the sole blood service provider in the country.7At this time, the government allowed the establishment of non-Red Cross blood centres.7 The KRCundertakes 93.2% of the countrys blood collection. 8 Other providers of blood in Korea are theHanmaeum Blood Centre (6.5%) and hospital blood banks such as the Jungang University Hospital(0.3%).9VNRBD commenced in 1960 and a national policy of 100% VNRBD was implemented, eliminatingpaid blood donation, in 1974.9 The national rate of VNRBD in Korea is now 100%8, however donorsmay receive a small gift. Donors can choose a donation voucher equivalent to the value of the gift,one in 20 donors chose the donation voucher over the gift in 2014.9 To increase retention, Koreaalso provides a thank you card to first time donors and a gift to first time donors who return within sixmonths.9ASIA PACIFIC218EUROPE ANDASIA PACIFICLEVELCENTRALAASIAThe Korea Centres for Disease Control and Prevention (KCDC) Division of Human Blood SafetySurveillance is responsible for the evaluation of blood establishments and investigation of transfusionassociated infections.10The Division of Bioethics Policy at the Ministry of Health and Welfare (MoHW) is responsible for thenational blood program 11 including overall blood supply-demand management, permission ofestablishment of blood centres and the determination of the price of blood products.10 11The Ministry of Food and Drug Safety is responsible for plasma fractionation management. 10 11NATIONAL SOCIETY (REPUBLIC OF KOREAN NATIONAL RED CROSS)The Korean Red Cross Blood Centre was established in 1958 and in 1981 was given the mandateby the government for the provision of the national blood supply.9 This was removed in 2002.7 In1994, the Korean Red Cross was also entrusted by the government with management and supplyof plasma fractionation products, and management of bone marrow donations.9 12In 2002, the KRC Blood Service Headquarters opened and they began simultaneous testing for HIVantigen/antibody.10 Additional NAT testing for Hepatitis B commenced in 2012.12The Korean Red Cross Blood Services operates:Blood Service headquarters15 blood centres138 blood donation centresa Blood Transfusion Research Institutethree blood laboratory centresa plasma fractionation plant.12The Korean Red Cross:annually collect (2016):o 1,986,173 units of whole bloodo 659,008 units of blood by apheresis9supplies blood to 2,717 hospitals/clinicsdoes not perform transfusionsis accredited to ISO-9001does not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis not involved in cord stem cells, peripheral stem cells or bone/solid organ/cornealtransplantsrecruits approximately 7,000 donors a year to the Korea Marrow Donor Program.7Blood donor recruitment and retention activities are coordinated nationally by the National Societyand they are currently undertaking school/university and corporate programs. Donor recruitmentactivities are funded by the blood service and the government. Both volunteers and paid staff areutilised for donor recruitment.In 1991, the Blood Components Research Centre (now known as the Plasma Fractionation Centre)was opened.8 9 Operated by the Korean Red Cross, products are then sold to the Green Cross andSK Chemicals.7 In 2015, South Korea anticipates to be fully self sufficient to meet the national supplyof plasma, with the exception of hyperimmune globulin products.9219ASIA PACIFICASIA PACIFIC LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ks.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 September 18 [cited2017 May 23]. Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-theworld.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 World Health Organization: World Health Statistics 2011 [Internet] France 2011 171p. [cited 2017 May 23]. Availablefrom: http://www.who.int/gho/publications/world_health_statistics/en/7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.8 Korean Red Cross. Blood Service Introduction. Key Figures [Internet] Korean Red Cross 2011 [cited 2018 Jan 29].Available from:https://www.redcross.or.kr/eng/eng_activity/activity_blood_introduction.dohttps://www.redcross.or.kr/eng/eng_activity/activity_blood_keyfigures.do9 Korean Red Cross Blood Services. Annual Report (2015). Seoul, Republic of Korea 2015 39p. Available from:https://www.redcross.or.kr/eng/eng_activity/activity_blood_resource.do10Korean Red Cross Blood Services. 2014. Powerpoint presentation available from:http://fondzdrav.ru/upload/Korean%20Blood%20Services.pdf11 Sinyoung K, Hyun Ok K, Moon Jung K, Sang Won L, Young Hack S, Young Sil C, Dong Han L. Performance review ofthe National Blood Safety Improvement Project in Korea (2004-2009). Blood Res [Internet]. 2013 Jun 25 [cited 2018 Jan29];48(2):139-44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698400/pdf/br-48-139.pdf12 Korean Red Cross. Blood Service Introduction [Internet] Seoul, Republic of Korea 2011 [cited 2017 May 29]. Availablefrom: https://www.redcross.or.kr/eng/eng_activity/activity_blood_introduction.doASIA PACIFIC220EUROPE ANDASIA PACIFICLEVELCENTRALAASIATHAILANDThai Red Cross Society:Level A (undertakes full blood service provision)40% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking152ndPopulation (world ranking)168.4 million (20th)Median age137.2Political system1Constitutional monarchywith interim military-rungovernment since May2014GDP per capita (worldranking)1$17,800 (97th)HDI Index (world ranking)20.740 - high (87th)Health Expenditure16.5% of GDPEfficiency of Healthcare328th of 51 countriesPopulation prevalencehepatitis B4High Intermediate: 5% - 7%Population prevalencehepatitis C5High Moderate: 2% - <5%Population prevalence HIV61.1% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 1966, the Thai Government assigned the Thai Red Cross Society the task of initiating a NationalBlood Program.7 With assistance from the French Government, the National Blood Centre of theThai Red Cross Society commenced operations in 1969.7 Tasks performed included:recruitment of blood donorscollection of bloodABO typing and transmissible disease screeningstorage and distribution of blood.7Initially the focus was on was on blood donor recruitment, establishment of regional blood services,and conversion of existing paid donors into non-remunerated ones.7 By the late 1980s and into theearly 1990s, non-remunerated blood collections had strengthened and a pilot project was initiated221ASIA PACIFICASIA PACIFIC LEVEL Ato fractionate plasma.7 Blood was being processed into specialised products for clinical use, andfractionated plasma products were regularly manufactured and issued for use.7The first version of the National Blood Policy was established in 1989 and it has since been updatedto the second version in 1989, third version in 2010 and a new version was due to be released in2017.The National Blood Centre of the Thai Red Cross currently collects approximately 30% of the nationsblood supply with the remainder being collected by government (60%), university and metropolitanhospitals (remaining 10%).8The Ministry of Public Health has tasked the Thai Red Cross National Blood Centre with8:preparation and supply of collection bags and venepuncture sets for use in the countrypreparation and supply of blood group reagentssupply of blood and blood components for hospitals in Bangkok and nearby provincesmanufacture of albumin and immunoglobulin from human plasmareference laboratory for clinical problemssetting up national guidelines/standards for blood collection and quality controla training centre for laboratory techniques.8NATIONAL SOCIETY (THAI RED CROSS)The Thai Red Cross became a member of the IFRC in 1921.9 The Thai Red Cross Blood Servicecommenced in 1952 and the National Blood Centre was established in 1969.8 The Thai Red CrossBlood Centre started making plasma-derived products since 1979 in a small-scale plasmafractionation plant, which produced albumin, HBIG, HRIG, heat treated dried cryoprecipitate anddried plasma. It imports products from other countries when required to make up any shortfall.10Since 2015, the Thai Red Cross Society has been operating a new Plasma Fractionation Plant withindustrial scale capacity of 200,000L of plasma annually for albumin, IVIG and Factor VIIIproductions. The plant was the first of its kind in all of South-east Asia.10The responsibilities of the National Blood Centre are outlined in a five year Thai Red Cross StrategicPlan (2017-2021) with targets set as:Increase whole blood collections for blood supplied by the Thai Red Cross from 55.5%(1,081,400) in 2017 to 57.5% (1,164,040) in 2021Increase supply and coverage of plasma derived medicinal products from 55% in 2017 to60% in 2021Increase the number of unrelated stem cell registered donors with HLA typing from 160,434in 2017 to 84434 in 2021The National Blood Centre, Thai Red Cross Society:anually collects (2015):o 908,413 units of whole blood (925,440 collected by the National Blood Centre and its12 regional blood centres, from 100% VNRBD)o 17,027 units by apheresissupplies blood to 757 hospitals/clinicssupports the entire population of Thailandprocesses 100% of collected blood into componentsASIA PACIFIC222EUROPE ANDASIA PACIFICLEVELCENTRALAASIAwith the 12 Regional Blood Centres conduct screening testing of blood for infectious diseases,NAT and blood grouping for 90% share of blood screening, the remainder are tested inuniversity hospitals and some high level tertiary government hospitalsconducts cross-matching for transfusion in specific cases with complicated problemsis accredited by official Thai regulatory agencies for ISO and GMPdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis involved in the collection, processing or testing of cord blood stem cells, peripheral stemcells, bone marrow stem cells and solid organsis not involved in the collection, processing or testing of bone or corneasforwards plasma to a fractionation facilitydoes not perform transfusionsongoing expansion of blood collections and testing facilities in its Regional Blood Centresis not planning to expand or scale back its level of involvement in blood-related activitiesBlood donor recruitment and retention activities are coordinated nationally by the National Societyand are funded by the National Society. Paid staff undertake school/university programs, Club 25and corporate programs.Other professional activities include: manufacture and supply of collection bags and venepuncture sets for use in the National andRegional Blood Centres manufacture and supply blood testing reagents such as ABO, Rh blood grouping reagents,standard red cell and panel red cell reagents and some monoclonal antibody anti-sera i.e.Anti-E, anti-Mia, anti-M etc. for blood group identification advance laboratory services including red cell serology and genotyping, HLA and plateletimmunology laboratories set up of the National Unrelated Stem Cell Registry Centre set up and updating of the National Blood Policy, National Guidelines/standards for bloodservices, Haemovigilance Guideline and Clinical Handbook for Appropriate Blood Use being a WHO collaborator on training programs in blood services for SERO and recognisingas training centre for blood collection technique, management system, HLA, stem celltransplantation process and immunohaematology for medical staff in Thailand and overseas223ASIA PACIFICASIA PACIFIC LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Oct27]. Available from:. https://www.cia.gov/library/publications/the-world-factbook/geos/th.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Oct 27]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2017 May 22].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Oct 27] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Oct 27] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Oct27]. Available from:. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Nuchprayoon C. Blood Transfusion Service in Thailand. Japanese Journal of Transfusion Medicine. [Internet] 1994[cited 2018 Feb 5]; 40(5). Available from: https://www.jstage.jst.go.jp/article/jjtc1958/40/5/40_5_772/_pdf8 The Thai Red Cross Society. National Blood Center [Internet] The Thai Red Cross Society Thailand, 2017 [cited 2017Oct 27] Available from: http://english.redcross.or.th/content/page/9499 The Thai Red Cross Society. At a Glance. Brief History of The Thai Red Cross Society [Internet] The Thai Red CrossSociety Thailand, 2017 [cited 2017 Oct 27]. Available from: http://english.redcross.or.th/node/4710 Making Plasma a Priority. Bangkok Post. [Internet] 2013 Jan 15 [cited 2018 Feb 5]. Available from:https://www.bangkokpost.com/print/330843/ASIA PACIFIC224EUROPE ANDASIA PACIFICLEVELCENTRALAASIAVIETNAMRed Cross of Vietnam:Level A (undertakes full blood service provision)20% of the national total blood collection1NATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking267thPopulation (world ranking)296.1 million (15th)Median age230.5Political system2Communist stateGDP per capita (worldranking)2$6,900 (159th)HDI Index (world ranking)30.683 - medium (115th)Health Expenditure27.1% of GDPPopulation prevalencehepatitis B4High: 8%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.47% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn the early 2000s, less than 15% of Vietnams blood requirements were met, with the majority ofthe supply coming from paid and family replacement donors.7 The blood supplies were also of poorquality6 with some of the blood not even being tested for disease markers before transfusion.8With an International Development Association (IDA) loan of US$38.2 million and World Bankexpertise, the government built the countrys first four blood centres and upgraded local knowledgeand skills for blood transfusion.7 By the end of the projects completion in 2009, Vietnam had:achieved 93% of donations from VNRBDcollected 250,000 units of blood and meet the need of 30 public hospitalsimproved blood transfusion safety7Total blood collections increased from approximately 776,000 in 2011 to almost 930,000 in 2013,and the number of paid donations in that time dropped by 30,000.9 The government has set a goalof 100% VNRBD by 20201. In 2015 VNRBD was at 97% for the nation.10The Central Institute of Blood Transfusion and Haematology is the biggest blood bank in northernVietnam, supplying blood to 120 hospitals in Hanoi and other provinces.11225ASIA PACIFICASIA PACIFIC LEVEL AIn January 2017, in an attempt to address blood supply shortages, the Ministry of Health introducedtwo options as draft law for approval by the National Assembly.12 Option one was compulsory blooddonation for all healthy Vietnamese at least once per year and option two was continue with voluntarydonations with those donating eligible for free blood transfusions if needed, along with two days offwork to give blood and recover.12 The mandatory draft law was withdrawn after debate regarding thesafety of compulsory blood donation.13NATIONAL SOCIETY (RED CROSS OF VIETNAM)Whilst the Vietnam Red Cross Society is generally involved in blood activities at Level B, the RedCross Branch in Ho Chi Minh City has been not only recruiting blood donors but also collecting bloodsince 1994. The blood is transferred to the health sector for screening and manufacture of bloodcomponents.Approximately 20% of the total blood supply is collected and provided by the Red Cross of Vietnam.1Community education activities are coordinated nationally by the National Society. They are fundedby the government or Ministry of Health. Both paid staff and volunteers are used for donorrecruitment programs, such as school/university programs and Club 25.The National Society does not receive technical assistance for VNRBD or blood service activitiesfrom an international partner. Financial support for VNRBD or blood service activities is only providedby the government.1MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.2 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Jan30]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/vm.html3 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 The World Bank. Vietnam: Regional Blood Transfusion Centers Project. [Internet] The World Bank Group 2013. [cited2017 May 29]. Available from: http://go.worldbank.org/C6CW58WK608 World Health Organization. 2013. Towards Self-Sufficiency in Safe Blood and Blood Products based on Voluntary NonRemunerated Donation. Global status 2013. Page 20.9 World Health Organization. Global Status Report on Blood Safety and Availability 2016 [Internet]. Geneva World HealthOrganization 2017 [cited 2018 Jan 29]. Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf10 Phuong, Ha. Vietnamese are not donating enough blood. VN Express International [Internet] 2016 June 13 [cited 2018Feb 26]. Available from: https://e.vnexpress.net/news/business/data-speaks/vietnamese-are-not-donating-enough-blood3419005.html11Vietnams major blood bank running dry. Thanhnien News [Internet]. 2015 June 23 [cited 2017 May 29]. Available from:http://www.thanhniennews.com/health/vietnams-major-blood-bank-running-dry-47010.html12 Surely not: Compulsory blood donations tabled in Vietnam. VN Express [Internet] 2017 Jan 12 [cited 2018 Feb 26].Available from: https://e.vnexpress.net/news/news/surely-not-compulsory-blood-donations-tabled-in-vietnam3526421.html13 Ministry of Health withdraws mandatory blood donation in draft law. Vietam.net [Internet] 2017 Jan 12 [cited 2018 Feb26]. Available from: http://english.vietnamnet.vn/fms/society/171082/ministry-of-health-withdraws-mandatory-blooddonation-in-draft-law.htmlASIA PACIFIC226EUROPE ANDASIA PACIFICLEVELCENTRALBASIACHINARed Cross Society of China (Excluding the Hong Kong branch which is Level A):Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationEastern AsiaGeographical size ranking15thPopulation (world ranking)11.38 billion (1st)Median age137.4Political system1Communist stateGDP per capita (worldranking)1$16,600 (106th)HDI Index (world ranking)20.738 - high (90th)Health Expenditure15.5% of GDPEfficiency of Healthcare325th of 51 countriesPopulation prevalencehepatitis B4High Intermediate: 5%-7%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.1% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Office of Medical and Blood Safety (under the Bureau of Medical Administration, NHFPC) is theonly state-level agency that administers blood-related affairs across the country (the armed force isindependent).7Chinas blood system is public and decentralized.8In 2013, there were a total of 452 blood banks in China7 9 (excluding Hong Kong, Macau or Taiwan):32 blood centres (at provincial capitals; municipalities)321 central blood stations (at prefecture-level cities)99 central blood banks (at county level cities or counties)7In addition, there were about 150 source plasma centres and seven cord blood banks.7An outbreak of HIV-1 infection triggered by commercial plasma donation in the 1980s led to theratification of the Law of the Peoples Republic of China on blood donation in 1998.10From this point, China transitioned from paid and involuntary unpaid blood donation to VNRBD7,though the law still allows for directed donations to friends and family. 11 To encourage voluntarydonation, the law provides volunteers with several days off work, a nutrition allowance, and priority227ASIA PACIFICASIA PACIFIC LEVEL Baccess to blood transfusion.11 Provisions such as priority access and directed donations have beenblamed for increasing the blood shortage in China and contributing to negative consequences suchas access for those most in need of blood who do not meet minimum donation requirements.11In 2011, a total of 20.82 million blood donations (each 200 mL) were collected in China, 8.53donations per 1000 population.7In 2012, 109,042 blood donations (less than 1%) were involuntary (mobilised), family donationsmade up 3.83% of the blood supply and the rest of the blood donations were VNRBD.7Excessive reliance on rural migrant workers and enrolled students is responsible for seasonalshortages of blood, leading to delays for scheduled surgeries and encouragement offamily/replacement donations.7 In addition, traditional Chinese beliefs may discourage voluntaryblood donation.12Blood collection and processing techniques range widely throughout the country as the blood centreshave traditionally been locally managed.7Plasma fractionation is generally commercial and operates separately to the blood system. Productcontamination in the 1990s led to the following rules8:Plasma from whole blood donations may not be used for fractionation.Source plasma obtained by apheresis cannot be used for transfusion8NATIONAL SOCIETY (RED CROSS OF CHINA)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by government of the Ministry of Health.The Red Cross of China:uses volunteers for donor recruitment. Routine publicity is used for thisreceives both technical assistance and financial support from IFRC. The VNRBD project wasimplemented in RCSC Qingdao branch from Oct 2014 to March 2015, aiming to promoteVNRBD among young people under 'Pledge 25' and increase the college RC volunteers'enthusiasm to participate in public welfare activities. Qingdao RC branch has designed andprinted 29,565 copies of IEC materials. 24 training workshops were held for a total of 4,530colleges and university studentswas previously been involved in blood at Level A, however in 1998 the Blood Donation Lawwas issued and accordingly the blood collecting work was transferred to Ministry of Healthhas no plan to expand or scale back its level of involvement in blood related activitiesASIA PACIFIC228EUROPE ANDASIA PACIFICLEVELCENTRALB1ASIACentral Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ch.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 September 18 [cited2017 May 22]. Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-theworld.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Yong-Hua Y, Chang-Qing L, Zhong L. Blood donation in China: sustaining efforts and challenges in achieving safetyand availability. Transfusion [Internet]. 2015 October [cited 2017 May 29];55(10):2523-2530. DOI: 10.1111/trf.131308 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.9 World Health Organization. Global Status Report on Blood Safety and Availability 2016 [Internet]. Geneva World HealthOrganization 2017 [cited 2018 Jan 29]. Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf10 Su Y. (Shenzhen Institute of Transfusion Medicine, Shenhen, China). Securing Stable Supply of Safe Blood (III).Paper presented at the Eighth Red Cross and Red Crescent Symposium of Blood Programs in the Asian Region; 2017Oct 18-20; Bangkok, Thailand.11 Xue R, Chen Y, Wen J. Correspondence. Blood donation shortages in China. The Lancet. [Internet] 2016 [cited 2017May 29]:387:1905. Available from: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30417-2.pdf12 Yu C, Holroyd E, Cheng Y, Tak Fai Lau, J. Institutional incentives for altruism: gifting blood in China. BMC PublicHealth [Internet] 2013 [cited 2017 May 29] 13:524. Available from:https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-524 DOI: 10.1186/1471-2458-13-524229ASIA PACIFICASIA PACIFIC LEVEL BCOOK ISLANDSCook Islands Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1215thPopulation (world ranking)110 thousand (225th)Median age135.9Political system1Self-governing parliamentarydemocracy in freeassociation with NewZealandGDP per capita (worldranking)1$12,300 (127th)HDI Index (world ranking)2n/aHealth Expenditure13.4% of GDPPopulation prevalencehepatitis Bn/aPopulation prevalencehepatitis C31.5% (2010)Population prevalence HIV40.03%NATIONAL BLOOD PROGRAMThe Cook Island Blood Service is overseen by the Cook Islands Ministry of Health (CIMoH) and theCook Islands Red Cross (CIRC) 5 . Until January 2015, the Cook Islands had been storing andtransfusing only whole blood, now the blood is separated into red cell concentrates and fresh frozenplasma.6In 2016, an MOU was signed between the MoH and the CIRC to improve health outcomes byproviding and maintaining safe blood supply through VNRBD.7 CIRC conduct and organise all blooddonor recruitment drives and the annual program of activities for blood donors 8 and providerefreshments for the blood donors while the MOH provides assistance to the CIRC to plan and deliverthe blood programs and provides technical assistance through collection, screening and processingactivities.7The Cook Islands use a bleed-on-demand process.6 The blood bank has a capacity of just 20 unitsand when blood stocks are low, donors from a panel are telephoned asking them to donate at theRed Cross hall within a few hours.6 On occasions, walk-in donors are also accepted at RarotongaHospital.6ASIA PACIFIC230EUROPE ANDASIA PACIFICLEVELCENTRALBASIAAccording to WHO, 2% of the population are voluntary donors.9The Cook Islands have a strong VNRBD culture, donating 100% of blood from VNRBD since 2009.10NATIONAL SOCIETY (COOK ISLANDS RED CROSS)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the Ministry of Health.The Cook Islands Red Cross:uses both paid staff and volunteers for donor recruitment programs, such as school/universityprograms, corporate programs and community / public events blood drivesdoes not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved in blood at Level Aplans to expand by working in collaboration with the laboratory staff within the Ministry ofHealth to promote its VNRBD program1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/cw.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. DOI: 10.1111/j.14690691.2010.03432.x4Global AIDS Progress Report. Cook Islands. 2014 [Internet] UNAIDS; 2015 [cited 2017 May 29] 24p. Available from:http://www.unaids.org/sites/default/files/country/documents/COK_narrative_report_2015.pdf5 Cook Islands Ministry of Health. Donate Blood [Internet] Cook Islands Ministry of Health 2018 [cited 2018 Jan 29].Available from: http://www.health.gov.ck/clientsconsumers/donate-blood/6 Tan S. Knowledge, attitudes and practice of blood donation in Rarotonga, Cook Islands. Paper presented at HAAConference; 2015 October 18-21; Adelaide.7 Cook Islands Red Cross Society. Facebook post [Internet] 2016 Sep 01 [cited 2018 Jan 30]. Available from:https://www.facebook.com/cookislandsredcross/posts/11451340055576848 UNAIDS. Global AIDS Progress Report Cook Islands 01 January - 31 December 2015 [Internet] UNAIDS 2016 [cited2018 Jan 30]. Available from:http://www.unaids.org/sites/default/files/country/documents/COK_narrative_report_2016.pdf9 World Health Organization. Blood donation success stories from countries, Cook islands, Changing the donor profile.[Internet] World Blood Donor Day 2012 Jun 14, updated 2018 [2018 Jan 30]. Available from:http://www.who.int/worldblooddonorday/media/success_story/en/10 Call for blood donations to help shortage in the Pacific. ABC News [Internet]. 2013 June 14 [cited 2017 May 29].Available from: http://www.abc.net.au/news/2013-06-14/an-pacific-blood-shortage/4755308231ASIA PACIFICASIA PACIFIC LEVEL BFIJIFiji Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1157thPopulation (world ranking)1920 thousand (161st)Median age128.6Political system1Parliamentary republicGDP per capita (worldranking)1$9,900 (139th)HDI Index (world ranking)20.736 - high (91st)Health Expenditure14.5% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2% - 4%Population prevalencehepatitis C4Very Low: 1.0% - <1.5%Population prevalence HIV50.10% among adults aged 15to 49NATIONAL BLOOD PROGRAMWHO reported in 2014 that the Ministry of Health has initiated large-scale reform of the Fiji NationalBlood Service (FNBS) to be more responsive to patients' needs and more convenient for blooddonors.6WHO has been supporting the FNBS by6:developing and reviewing national blood policies and strategic plansreviewing and advising on donor selection guidelinestraining local blood services staff through a one-year distance education program based onWHOs Blood Safety modules 6VNRBD donations have increased from 53% in 2011 to 75% in 2013 6 and 87% in 2014 with a targetof 100% VNRBD in 2018.7The FNBS collected 13,593 blood donations in 2013. By 2018, the blood service is aiming to collect17,500 blood donations annually.8A national blood and blood product transfusion policy was endorsed in 2010 with the aim of becomingstandard practice adopted in all health facilities in Fiji, where blood transfusion takes place.9In 2017, the Government of Japan donated funds to FNBS to purchase a new blood donor bus.10ASIA PACIFIC232EUROPE ANDASIA PACIFICLEVELCENTRALBASIANATIONAL SOCIETY (FIJI RED CROSS)Blood Donor Advocacy & Recruitment has been a core program & mandate of the Fiji Red CrossSociety since 2006 when the management of the Blood Service in Fiji was transferred to the Ministryof Health.The Fiji Red Cross are actively involved in promoting and advocating for the importance of voluntarynon remunerated blood donation.11 They also conduct educational sessions and distributeinformation, education and communication materials to the general public to recruit voluntary blooddonors, in particular young donors.11 These materials are also distributed through the Fiji NationalBlood Service Blood Banks around the country including other NGOs involved in communityservice.11Blood donor recruitment and retention activities are coordinated nationally and by the district/chapterof the National Society. Programs include school/university, club 25 and corporate programs. Donorrecruitment activities are funded by the National Society.Fiji Red Cross:uses paid staff and volunteers for donor recruitment activitiesdoes not receive technical assistance for VNRBD activities from outside the countryis planning to expand its current level of involvement in blood related activities by addingVNRBD services to additional branches (only 3 branches are currently active)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017October 02]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/fj.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 October 02]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 October 02] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectiousdiseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 October 02] Available from:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectiousdiseases-related-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017October 02]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 WHO. Western Pacific Region. WHO Fiji and friends give blood [Internet] 2014 June 13 WPRO 2017 [cited 2017October 02]. Available from:http://www.wpro.who.int/southpacific/mediacentre/releases/2014/wbdd-2014/en/7 Ravulo A. 87% Voluntary Non-remunerated Blood donation achieved. Fiji Village [Internet] 2015 November 23 [cited2017 October 02]. Available from: http://fijivillage.com/news/87-Voluntary-Non-remunerated-Blood-donation-achieveds925kr/8 Ministry of Health and Medical Services. Shaping Fijis Health. Blood donation [Internet] Ministry of Health and MedicalServices 2015 [cited 2017 October 02]. Available from: http://www.health.gov.fj/?page_id=11329 Ministry of Health and Medical Services. National Blood and Blood Product Transfusion Policy [Internet] Ministry ofHealth and Medical Services 2010 [cited 2017 October 02]. Available from:http://www.health.gov.fj/wp-content/uploads/2014/05/Blood-Transfusion-Guideline.pdf10 Hanatani T. Speech at the Grant Contract Signing Ceremony for Fiji National Blood and Ambulance Services, Habitatfor Humanity Fiji and Hilton Organization [Internet] Embassy of Japan 2017 Mar 03 [cited 2018 Jan 30]. Available from:http://www.fj.emb-japan.go.jp/files/000235437.pdf11 Argyle J. Fiji Red Cross Society. Review of the Fiji Red Cross HIV&AIDS and Blood IEC Materials [Internet] 2010August [cited 2017 October 02]. [22p] Available from: http://adore.ifrc.org/Download.aspx?FileId=83442&.pdf233ASIA PACIFICASIA PACIFIC LEVEL BKIRIBATIKiribati Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1187thPopulation (world ranking)1108,145 (191st)Median age124.6Political system1Presidential republicGDP per capita (worldranking)1$1,900 (210th)HDI Index (world ranking)20.588 - medium (137th)Health Expenditure110.2% of GDPPopulation prevalencehepatitis B38.00 - 14.99%Population prevalencehepatitis C42%Population prevalence HIV5Low (<100 people living withHIV)NATIONAL BLOOD PROGRAMThe National Blood Transfusion Service (NBTS) in Kiribati is run by the Ministry of Health andMedical Services and is overseen by the National Blood Transfusion Committee.6 The NBTS hasthree hospitals on the islands of South Tarawa, Christmas and Tabiteuea North.6 In 2015, 993donations were collected at the Tungaru Central Hospital (South Tarawa), which is inhabited by halfof the population of Kiribati.6 Defined donor selection algorithms and infectious disease testing arein place.6A national blood policy was developed6 following the signing of the Melbourne Declaration in 2009.7However, the national VNRBD rate in Kiribati is very low, approximately 13%. 6In 2014 the NBTS collected approximately 1,300 blood donations and tested them for HBsAg,syphilis, HIV and HCV. 8NATIONAL SOCIETY (KIRIBATI RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety, mainly on the capital island of Kiribati. They are funded by the National Society.ASIA PACIFIC234EUROPE ANDASIA PACIFICLEVELCENTRALBASIAThe donor recruitment program consists of volunteers going around the island looking for donors.No payments are made for volunteers involved apart from allowances and refreshment costs.The Kiribati Red Cross:does not receive technical assistance for VNRBD activities from outside the country - whilstthe Kiribati Red Cross received some funding as part of an HIV program in 2014, there wasno further funding from international partners in 2015is planning to expand its current level of involvement in blood related activities: To havevolunteers trained to do blood pull and to have our own blood bankhas not previously been involved in blood at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/kr.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Dec 12]. Available from: http://hdr.undp.org/en/countries/profiles/KIR3 WHO Western Pacific Region, Prevalence of chronic hepatitis B among adults in the Western Pacific Region [Internet]WHO 2016 [cited 2017 Dec 12]. Available from:http://www.wpro.who.int/hepatitis/data/chronic_hepatitis_b_prevalence2.jpg?ua=14 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. [Internet]. 2011 Feb [cited 2017 Dec12];17(2):107-115. Available from: https://www.ncbi.nlm.nih.gov/pubmed/210918315 UNAIDS. Country Factsheets Kiribati [Internet] UNAIDS 2017 [cited 2017 Dec 12]. Available from:http://www.unaids.org/en/regionscountries/countries/kiribati/6 Tauma, G. et al. Should Kiribati continue to aim for 100% voluntary non-remunerated blood donation as recommendedby the WHO? Public Health Action. [Internet] 2016 Dec 21 [cited 2017 Deb 12];6(4):261-266. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5176052/7 World Health Organisation. The Melbourne Declaration on 100% Voluntary Non-remunerated Donation of Blood andBlood Components [Internet] WHO 2009 [Cited on 2017 Dec 12]. Available from:http://www.who.int/worldblooddonorday/Melbourne_Declaration_VNRBD_2009.pdf?ua=18 UNAIDS. Global AIDS Response Progress. Kiribati Country Progress Report 2015. [Internet] 2015 [cited 2018 Feb 5].Available from: http://www.unaids.org/sites/default/files/country/documents/KIR_narrative_report_2015.pdf235ASIA PACIFICASIA PACIFIC LEVEL BMALAYSIAMalaysian Red Crescent Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking167thPopulation (world ranking)131 million (43rd)Median age128.2Political system1Federal constitutionalmonarchyGDP per capita (worldranking)1$28,900 (70th)HDI Index (world ranking)20.789 - high (59th)Health Expenditure14.2% of GDPEfficiency of Healthcare327th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low Moderate: 1.5 - <2.0%Population prevalence HIV60.45% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe National Blood Centre - NBC (Pusal Darah Negara) at Kuala Lumpur Hospital is responsiblefor the collection, screening, processing and supply of blood components in Malaysia. 7 Bloodservices started in 1955 in Malaysia and have always been based on voluntary donations. 8 TheMalaysian Ministry of Health sets National Standards by which the blood service abides.9In 2013, 636,481 whole blood donations were collected nationwide, all but 4 of these were fromvoluntary donors.10 Whole blood and apheresis collections are performed.10 11In 2013, there were 123 hospital based and 1 stand-alone blood centres in the country.10The blood centres in Malaysia are hospital based.12 Government hospital blood services collectblood from voluntary non-remunerated donors and provide it to government hospitals for free.12 Theprivate hospital BTS charge for collecting and processing the blood however the fee is heavilysubsidised by the government.12 Once recruited, donors are urged to donate regularly to helpdevelop a pool of safe donors.12ASIA PACIFIC236EUROPE ANDASIA PACIFICLEVELCENTRALBASIAThe blood transfusion services in Malaysia rely heavily on mobile blood units, which collectapproximately 70-80% of all blood donations.13 Mobile blood units actively recruit from universities,uniformed services, religious societies, non-government organisations and corporate bodies.13As it is comprised of many different cultures and ethnicities, Malaysia observes many national andstate holidays due to the regular celebration of significant religious and historic events. 14 Theresulting phenomenon is called balik kampung, which refers to the mass exodus of Malaysians totheir hometowns, and it has contributed to acute seasonal blood shortages around the country. 14 Inan effort to counteract this phenomenon, in 2011 the National Blood Centre set up a Blood ActionTeam (BAT) who was to be responsible for the following14:implementation of blood forecastingdiscussion of issues related to blood mobilesdevelopment of measures for recruitment and retention of blood donors and the generalpromotion of blood donationmonitoring of blood demand trends14Since the implementation of the BAT, the NBC has successfully overcome its annual seasonal bloodshortages.14NATIONAL SOCIETY (MALAYSIAN RED CRESCENT)The Malaysian Red Crescent Society began in 1948 as branches of the British Red Cross Societyin Sabah and Sarawak (then British North Borneo) and later in other parts of Malaysia. 15Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by private organisations.The Malaysia Red Crescent:uses both staff and volunteers for donor recruitment programs, such as school/universityprograms and corporate programsdoes not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved in blood at Level Ahas no plans to expand or scale back its level of involvement in blood related activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/my.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 September 18 [cited2017 May 22]. Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-theworld.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Pusat Darah Negara (PDN) National Blood Donor Centre [Internet] Pusat Darah Negara2017 April 06 [cited 2017 May30] Available from: www.pdn.gov.my/8 Pusat Darah Negara. Early history [Internet] National Blood Center (PDN) 2015 Oct 28 [cited 2018 Jan 30]. Availablefrom: http://pdn.gov.my/index.php?option=com_content&view=article&id=7&Itemid=128&lang=ms237ASIA PACIFICASIA PACIFIC LEVEL B9Ayob, Dr Yasmin (President, Malaysian Blood Transfusion Society). Comments on the Application for the Addition ofWhole Blood and Red Blood Cells to the WHO Model Essential Medicines List and the WHO Model Essential MedicinesList for Children. Letter to: Office of the EML Secretariat, WHO. 2013 Feb 25 [cited 2018 Jan 30]. Available from:http://www.who.int/selection_medicines/committees/expert/19/applications/MBTS_Blood_comments.pdf10 World Health Organization. Global Status Report on Blood Safety and Availability 2016 [Internet]. Geneva WorldHealth Organization 2017 [cited 2018 Jan 30]. Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf11 Lim C W. Top 10 things you didnt know about blood donation. The Star Online [Internet]. 2014 August 02. [cited 2017May 30] Available from: http://www.thestar.com.my/news/community/2014/08/02/things-you-didnt-know-about-blooddonation-only-25-malaysians-are-donors/12 Duraisamy Dr G. Blood Transfusion Service in Malaysia. Japanese Journal of Transfusion Medicine. [Internet] 1994[cited 2018 Feb 5]:40(5). Available from: https://www.jstage.jst.go.jp/article/jjtc1958/40/5/40_5_776/_pdf13 Wooi Seong K. Overcoming blood supply challenges in multi-ethnic donor and patient populations: the Malaysiaexperience. ISBT Science Series. [Internet] 2016 Dec 2 [cited 2018 Feb 5]. Available from:http://onlinelibrary.wiley.com/doi/10.1111/voxs.12329/full14 Wooi Seong K. Adopting a proactive approach to blood shortages: experience from the National Blood Centre,Malaysia. ISBT Science Series. [Internet] 2014 Jul 23 [cited 2018 Feb 5]. Available from:http://onlinelibrary.wiley.com/doi/10.1111/voxs.12104/full15 Malaysian Red Crescent. Our History [Internet]. Malaysian Red Crescent 2017 [cited 2017 May 30]. Available from:http://www.redcrescent.org.my/history/ASIA PACIFIC238EUROPE ANDASIA PACIFICLEVELCENTRALBASIAMICRONESIA, FEDERATEDSTATES OFMicronesia Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1191stPopulation (world ranking)1105 thousand ( 194th)Median age124.7Political system1Federal republic in freeassociation with the USGDP per capita (worldranking)1$3,400 (190th)HDI Index (world ranking)20.638 - medium (127th)Health Expenditure113.7% of GDPPopulation prevalencehepatitis B33.5%Population prevalencehepatitis C42%Population prevalence HIV5<0.01%NATIONAL BLOOD PROGRAMA total of 1,919 blood donations were collected in 2013, with 169 from voluntary donors. 6 TheMicronesia Red Cross (MRC) developed a blood donation registry for hospitals to use when locatingpotential blood donors.7 In addition to providing a useful service to the hospitals, the registry is alsovaluable during disaster situations when blood donation is required.7Since the success of the MRC blood-donation registry program depends on country-wideparticipation, the MRC aims to have the majority of its residents including foreign communitymembers on the register.7The U.S. Pacific Command and the Armed Services Blood Program supported a three day workshopon Blood Safety in Phonpei in July 2015, with the goal of developing infrastructure and knowledgefor the blood banking program.8239ASIA PACIFICASIA PACIFIC LEVEL BNATIONAL SOCIETY (MICRONESIA RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the National Society and the Global Fund to Fight Aids, Tuberculosisand Malaria (GFATM) through IFRC Suva Office.The Youth and Health Program Officer undertakes donor recruitment using the Blood Donor Registry.Micronesia Red Cross:does not receive technical assistance for VNRBD activities from outside the countryreceived funding from the Australian Red Cross for World Blood Donor Day previously, butthis funding is no longer availableis planning to expand its current level of involvement in blood related activities by trying to domore and reaching further, but with no fundinghas not previously been involved in blood at Level AThere were 30 people donating blood in 2013 with the assistance of the Micronesia Red Cross in2013.91Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/fm.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 WHO Western Pacific Region, Hepatitis data and Statistics [Internet] 2016 [cited 2017 May 23]. Available from:http://www.wpro.who.int/hepatitis/data/hepatitis_data_statistics/en/4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. doi: 10.1111/j.14690691.2010.03432.x5 Federated States of Micronesia. Global AIDS Response Progress Report 2015. Government of the Federated States ofMicronesia. 2016 [cited 2017 May 29] 22p. Available from:http://www.unaids.org/sites/default/files/country/documents/FSM_narrative_report_2016.pdf6 World Health Organization. Global Status Report on Blood Safety and Availability 2016 [Internet]. Geneva World HealthOrganization 2017 [cited 2018 Jan 30]. Available from:http://apps.who.int/iris/bitstream/10665/254987/1/9789241565431-eng.pdf7 Micronesia Red Cross. Partnerships in profile 2002-2003 [Internet] Micronesia Red Cross 2018 [cited 2018 Jan 30].Available from: https://www.preventionweb.net/files/27083_ifrcprofilefsmfmprofile.pdf8 Pellegrini J. Military Blood Program Supports Pacific Partnership 2015 [Internet] Armed Services Blood Program 2015July 21 (cited 2017 November 28]. Available from: http://www.militaryblood.dod.mil/viewcontent.aspx?con_id_pk=19269 The International Federation of Red Cross and Red Crescent Societies. Micronesia Red Cross Society [Internet] IFRC2016 [cited 2017 May 29]. Available from: http://data.ifrc.org/fdrs/societies/micronesia-red-crossASIA PACIFIC240EUROPE ANDASIA PACIFICLEVELCENTRALBASIAMONGOLIAMongolian Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationNorthern AsiaGeographical size ranking119thPopulation (world ranking)13 million (138th)Median age127.9Political system1Semi-presidential republicGDP per capita (worldranking)1$12,600 (122nd)HDI Index (world ranking)20.735 - high (92nd)Health Expenditure14.7% of GDPPopulation prevalencehepatitis B3High: >8%Population prevalencehepatitis C4High: >5%Population prevalence HIV50.04% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2008, the Government of Mongolia established a national blood program responsible for bloodand blood products and their safe and appropriate use. 6 The National Transfusiology Centre (NTC)manages the national blood program and is responsible for the nationwide planning, implementation,and monitoring of all blood activities.6The Branch Professional Council on Transfusion Medicine is part of the Ministry of Health (MOH)and is the advisory panel for development of policy, laws and regulations, and essential decisionmaking in relation to blood.6As of 2012, a National Blood Transfusion Authority (as recommended by WHO) has not yet beenestablished. 6The Mongolian blood transfusion services consists of the National Transfusiology Centre inUlaanbaatar and 26 branch blood banks located within hospitals.6The following challenges have been identified with Mongolias blood system6:241only about 80% of the demand for blood is meta shortage of human, technological and financial resourcesASIA PACIFICASIA PACIFIC LEVEL Black of space and privacy as all blood banks are located on hospital premises with an averagesize of three to five roomssome facilities transfuse blood without screening for TTIs due to erratic supply of reagentsthere are no systematic reports on adverse reactions, limiting the ability to developappropriate interventionslack of systematic screening of blood components for quality assurance6Blood wastage is significant, as a lot of prospective donors are carrying the hepatitis virus, whichaffects approximately half of Mongolias population.7It was announced in December 2015 that the NTC will complete several system and equipmentchanges throughout 2017 as part of the Fifth Health Sector Development Project (FifHSDP), anaffiliation between the Ministry of Health and Sports of Mongolia and the Asian Development Bankto improve health care services across Mongolia with the use of technology.8According to figures presented at the Eighth Red Cross and Red Crescent Symposium on Blood inthe Asian Region, Mongolia has reached 100% VNRBD with the exception of those patients whocannot afford the cost of blood, the family donates in lieu of payment.NATIONAL SOCIETY (MONGOLIAN RED CROSS)Under a law passed in 2000, Red Cross Mongolia has had sole responsibility for blood donorrecruitment in the country, although its limited resources make this difficult.7 The Red Cross Mongoliawebsite indicates that it recruits donors for approximately 60% of blood donations in Mongolia.9Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the blood service and by private organisations.The Mongolian Red Cross Society:uses volunteers for donor recruitment programs, such as school/university programs andClub 25does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved in blood at Level Ahas no plans to expand or scale back its level of involvement in blood related activitiesASIA PACIFIC242EUROPE ANDASIA PACIFICLEVELCENTRALB1ASIACentral Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/mg.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Fifth Health Sector Development Project. Subsector Analysis (Summary). Safe Blood Transfusion. Mongolia: FifthHealth Sector Development Project. 2012 November. [cited 2017 May 30]. 8p Report No.: RRP MON 45009. Availablefrom: http://www.adb.org/sites/default/files/linked-documents/45009-002-mon-oth-01.pdf7 International Federation of Red Cross and Red Crescent Societies. Mongolia blood donor recruitment faces seriousfunding shortage. IFRC News Stories [Internet] IFRC 2007 October 19 [cited 2017 May 30]. Available from:http://www.ifrc.org/en/news-and-media/news-stories/asia-pacific/mongolia/mongolia-blood-donor-recruitment-facesserious-funding-shortage/8 Cerus announces agreement with the National Transfusiology Center of Mongolia for the use of INTERCEPT plateletsand plasma [Internet]. Business Wire; 2015 December 10 [cited 2017 May 30]. Available from:http://www.businesswire.com/news/home/20151210005669/en/9 Red Cross Mongolia. Health Promotion Program [Internet]. Red Cross Mongolia. 2014 [cited 2015 March 15]. Availablefrom: http://www.redcross.mn/b/s/38-114243ASIA PACIFICASIA PACIFIC LEVEL BPALAUPalau Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1198thPopulation (world ranking)121 thousand (220th)Median age133.3Political system1Presidential republic in freeassociation with the USGDP per capita (worldranking)1$16,700 (105th)HDI Index (world ranking)20.788 - high (60th)Health Expenditure19% of GDPPopulation prevalencehepatitis B32.9%Population prevalencehepatitis C42%Population prevalence HIV50.02%NATIONAL BLOOD PROGRAMPalau operates a satellite health system, the Belau National Hospital is the main health facility in thecountry; four community health centres are strategically located and supported by four additionaldispensaries.6The Palau Ministry of Health helps screen, collect and store the blood for public use.The Palau blood bank has the capacity to store up to thirty units of blood at a time, however finds itdifficult to fulfil this quota from donors.7 There are a few residents who regularly donate blood, andon World Blood Donor Day the Palau Red Cross Society presents these people with Certificates ofAppreciation for being regular donors.8NATIONAL SOCIETY (PALAU RED CROSS)The Palau Red Cross Society has 928 registered blood donors on their database. They recruitvoluntary donors as and when blood is required by the Belau National Hospital.9Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the National Society. Both volunteers and paid staff are used for donorASIA PACIFIC244EUROPE ANDASIA PACIFICLEVELCENTRALBASIArecruitment. Whilst there do not seem to be specific programs such as school/university or corporateprograms, the National Society uses a Call on volunteers.The National Society also sponsors monthly blood drives, and plans on increasing this to bi-monthlyblood drives by the end of 2018.The Palau Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to expand by recruiting more donors from different nationalities and groups andto promote community education/ awareness programs1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ps.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 WHO Western Pacific Region, Hepatitis data and Statistics [Internet] WHO 2016 [cited 2017 May 23]. Available from:http://www.wpro.who.int/hepatitis/data/hepatitis_data_statistics/en/4Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. DOI: 10.1111/j.14690691.2010.03432.x5 2014 Global AIDS Progress Report. Republic of Palau. HIV/AIDS & STI Program, Ministry of Health, Palau. 2015March 31 [cited 2017 May 30]. 28p. Available from:http://www.unaids.org/sites/default/files/country/documents/PLW_narrative_report_2015.pdf6 Country Cooperation Strategy at a glance. Palau. World Health Organization; 2014 [cited 2017 May 30]. 2p. ReportNo.: WHO/CCU/14.03/Palau. Available from: http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_pak_en.pdf7 Poso M L. Palau needs more blood donors. Marinanas Variety. Regional News. [Internet] 2010 Jun 16 [cited 2018 Feb5]. Available from: http://www.mvariety.com/regional-news/27513-palau-needs-more-blood-donors8 Poso M L. PRR employees give 21 units of blood to the Hospital. Marinanas Variety. Regional News [Internet]. 2010September 20 [cited 2017 May 30]. Available from: http://www.mvariety.com/regional-news/30297-prr-employees-give21-units-of-blood-to-the-hospital9 Palau Red Cross Society. Blood Donor Recruitment [Internet] Palau Red Cross Society 2017 [cited 2018 Feb 19].Available from: http://palauredcross.org/blood-donor-recruitment.html245ASIA PACIFICASIA PACIFIC LEVEL BSAMOASamoa Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1178thPopulation (world ranking)1199 thousand (185th)Median age123.9Political system1Parliamentary republicGDP per capita (worldranking)1$5,700 (168th)HDI Index (world ranking)20.704 - high (104th)Health Expenditure17.2% of GDPPopulation prevalencehepatitis B35.5%Population prevalencehepatitis C40.75%Population prevalence HIV5<0.01%NATIONAL BLOOD PROGRAMThe Samoa health system consists of the:National Health Service (NHS), concentrating mainly on the provision of health services. Itmanages 12 health facilities6Ministry of Health, which is now focusing on its new role in overseeing the health sector aswhole7The Laboratory Service of the NHS provides a national pathology and laboratory service andincludes a blood bank.8 In 2013/14, there were 2,025 requests for blood for transfusion, less thanthe expected target of 2,400.8The majority of blood provided is from family replacement donors. 9 All blood donors are screenedfor HIV, syphilis, hepatitis B, and hepatitis C. 9NATIONAL SOCIETY (SAMOA RED CROSS)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the National Society, by the government or Ministry of Health and by the GlobalASIA PACIFIC246EUROPE ANDASIA PACIFICLEVELCENTRALBASIAFund. Both paid staff and volunteers are used for donor recruitment programs, such asschool/university programs, Club 25 and activities in community/church groups.The Samoa Red Cross Society:receives technical assistance for VNRBD activities from the Australian Red Cross, andreceives financial support which funds part of VNRBD recruitment activities, especially onWorld Blood Donor Day and World AIDS Dayhas not previously been involved at Level Ais planning to expand its level of involvement in blood related activities. Samoas NationalHealth Services is building a blood bank facility with space for donors to receive pre and postdonation counselling, lounges to donate and a refreshment area. There will also be area fortraining1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ws.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 WHO Western Pacific Region, Hepatitis data and Statistics [Internet] 2016 [cited 2017 May 23]. Available from:http://www.wpro.who.int/hepatitis/data/hepatitis_data_statistics/en/4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. DOI: 10.1111/j.14690691.2010.03432.x5 Government of Samoa. Global AIDS response progress report 2015. Samoa. UNAIDS, Ministry of Health Samoa 2015[cited 2017 May 30]. 40p. Available from:http://www.unaids.org/sites/default/files/country/documents/WSM_narrative_report_2015.pdf6 National Health Services. Hospitals and facilities [Internet]. National Health Services; 2017 [cited 2016 May 18].Available from: http://www.nhs.gov.ws/index.php/features.7 Country Cooperation Strategy for Samoa 2013-2017. Geneva; World Health Organization WPRO; 2012 [cited 2017May 30]. 46p. Available from: http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_wsm_en.pdf8 Government of Samoa. National Health Service Annual Report for the financial year July 2013 to June 2014. 2014[cited 2018 Jan 30] 47p. Report No.: NHS Annual Report 2013/14. Available from: http://nhs.gov.ws/wpcontent/uploads/2017/10/Annual-Report-FY-2013-2014.pdf9 Government of Samoa. Global AIDS response progress report 2015. Samoa. UNAIDS, Ministry of Health Samoa 2015[cited 2017 May 30]. 40p. Available from:http://www.unaids.org/sites/default/files/country/documents/WSM_narrative_report_2015.pdf247ASIA PACIFICASIA PACIFIC LEVEL BSINGAPORESingapore Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking1192ndPopulation (world ranking)15.8 million (114th)Median age134.3Political system1Parliamentary republicGDP per capita (worldranking)1$90,500 (7th)HDI Index (world ranking)20.925 - very high (5th)Health Expenditure14.9% of GDPEfficiency of Healthcare31st of 51 countriesPopulation prevalencehepatitis B44.1%Population prevalencehepatitis C51%Population prevalence HIV60.09%NATIONAL BLOOD PROGRAMThe Singapore Red Cross was chosen as the national blood donor recruiter in April 2001. 7 It workstogether with the Health Science Authority to collect blood from voluntary donors.7Singapore is one of the countries hat have reported having achieved 100% VNRBD in 2008.8There are four blood banks operating across Singapore.9 Donations can also be made via mobileblood collection sites, which are often set up for organisations hosting large groups (140+) ofdonors.10 In 2015, 29.3% of the donations were via mobiles blood collection sites.11The Health Sciences Authority Blood Services Group Laboratory provides12:blood processing and inventoryblood group serologyblood donor testingin-process control24-hour cross-match laboratorytissue typingcell processing laboratory and research12ASIA PACIFIC248EUROPE ANDASIA PACIFICLEVELCENTRALBASIAIn 201511:71,277 people (1.83% of Singapores population) donated bloodnearly two thirds (62%) of Singapores blood donors were malethere were 112,713 whole blood donations and 9,335 donations by apheresisover half the blood (54%) was used in general surgery, 31% in general medicine, 9% inhaematology and 6% in accident and emergency365,979 blood components were processed and over 1.2 million laboratory tests wereconducted on blood componentsNATIONAL SOCIETY (SINGAPORE RED CROSS)The Singapore Red Cross13 focuses on three main functions in the National Blood Program:recruitment, retention and recognition of blood donorspromotion and education on the importance of blood donationsorganisation of mobile blood donation drives in the community13Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the government or Ministry of Health. Paid staff are used for donor recruitmentprograms, such as school/university programs, corporate programs and the Youth DevelopmentProgram.The Singapore Red Cross:does not receive technical assistance for VNRBD activities from outside the countryreceives financial support through its partnership with the Blood Services Group of the HealthSciences Authorityhas not previously been involved at Level Ais not planning to expand or scale back its level of involvement in blood related activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/sn.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 September 18 [cited2017 May 22]. Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-theworld.html4 WHO Western Pacific Region, Hepatitis data and Statistics [Internet] 2016 [cited 2017 May 23]. Available from:http://www.wpro.who.int/hepatitis/data/hepatitis_data_statistics/en/5 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. DOI: 10.1111/j.14690691.2010.03432.x6 Update on the HIV/AIDS situation in Singapore 2014 [Internet]. Ministry of Health, Singapore; 2015 June 02 [updated2015 June 04; cited 2017 May 30]. Available fromhttps://www.moh.gov.sg/content/moh_web/home/statistics/infectiousDiseasesStatistics/HIV_Stats/update-on-the-hivaids-situation-in-singapore-2014.html7 Blood Services. About the National Blood Program [Internet]. Health Sciences Authority; 2014 [updated 2016 February25; cited 2016 March 18]. Available from:http://www.hsa.gov.sg/content/hsa/en/Blood_Services/Blood_Donation/Why_Should_I_Donate/About_the_National_Blood_Program.html.8 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] 2011 [cited 2018 Feb 14]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=1249ASIA PACIFICASIA PACIFIC LEVEL B9Singapore Red Cross. Where to donate blood? [Internet]. Singapore Red Cross Society 2017 [cited 2017 May 30].Available from: https://www.redcross.sg/give-blood/where-to-donate-today.html.10 Singapore Red Cross. How else can I help? [Internet]. Singapore Red Cross Society 2017 [cited 2017 May 30].Available from: https://www.redcross.sg/give-blood/how-else-can-i-help.html.11 Health Sciences Authority. The big blood picture 2015 [Internet]. Health Sciences Authority 2016 [cited 2017 May 30].Available from: http://www.hsa.gov.sg/content/dam/HSA/bloodservices/Big%20Blood%20Picture%202015.pdf12 Health Sciences Authority. Transfusion Medicine [Internet]. Health Sciences Authority 2014 [updated 2014 July 21;cited 2017 May 30]. Available from: http://www.hsa.gov.sg/content/hsa/en/Blood_Services/Transfusion_Medicine.html13 Singapore Red Cross. Blood Donor Recruitment Program. [Internet]. Singapore Red Cross Society 2017 [cited 2017May 30]. Available from: https://www.redcross.sg/our-services/blood-donor-recruitment-Program.html.ASIA PACIFIC250EUROPE ANDASIA PACIFICLEVELCENTRALBASIASOLOMON ISLANDSSolomon Islands Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1144thPopulation (world ranking)1635 thousand (169th)Median age122.2Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$2,100 (207th)HDI Index (world ranking)20.515 - low (156th)Health Expenditure15.1% of GDPPopulation prevalencehepatitis B318.8%Population prevalencehepatitis C42%Population prevalence HIV5<0.01%NATIONAL BLOOD PROGRAMThe Ministry of Health and Medical Services (MHMS) provides funding, regulation and healthservices, there are eight public hospitals and four private hospitals. 6The Solomon Islands Red Cross Society has included increasing VNRBD to 80% in its strategicframework for 2017-2020.7One obstacle to a VNRBD program in a Melanesian society is the culture of blood line, the majorityof people will only donate blood if the patient requiring blood is a family relative.8A temporary suspension of the blood program by the Solomon Islands Red Cross in January 2015exacerbated the blood shortage at the National Referral Hospital to a critical level. 9 10Solomon Islands National Referral Hospital requires 25-35 units of blood daily, however, collectionsduring blood drives are usually below 10 units.11In the Solomon Islands 45% of blood transfused is used for obstetric procedures, but there is onlyenough blood to meet 39% of requests.12251ASIA PACIFICASIA PACIFIC LEVEL BThe AUSAID annual report for 2012-13 indicates that the Solomon Islands government is working torecruit at least 2,000 new blood donors and is embarking on a three-year plan to build a new blooddonation facility that will improve services.13NATIONAL SOCIETY (SOLOMON ISLANDS RED CROSS)The main focus of blood donor recruitment and retention activities is in Honiara and the SIRC isbeginning activities in two provincial areas.Both paid staff and volunteers are used for donor recruitment programs, such as school/universityprograms, corporate programs, diplomatic missions and public events.The Solomon Islands Red Cross (SIRC):does not receive technical assistance for VNRBD activities from outside the countryreceives financial support from the Australian Government Department of Foreign Affairs andTrade through Australian Red Crosshas not previously been involved in blood related activities at Level Ais planning to expand its level of involvement in blood related activities and is awaitingSolomon Islands Government endorsement of National Blood Policy. SIRC is looking atcontinuing awareness programs in two other provincial centres of the countryThe SIRC program works closely with the Ministry of Health and Medical Services including theLaboratory and Clinical Services. Governance of the Program is provided by a Blood ProgramStakeholders Committee which includes representation from the Hospital, SIRCS, DFAT, UNICEF,WHO, HIV services, Medical Research Unit. The Committee is currently seeking membership froma blood donor representative and a corporate sector representative.ASIA PACIFIC252EUROPE ANDASIA PACIFICLEVELCENTRALB1ASIACentral Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bp.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 WHO Western Pacific Region, Hepatitis data and Statistics [Internet] 2016 [cited 2017 May 23]. Available from:http://www.wpro.who.int/hepatitis/data/hepatitis_data_statistics/en/4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. DOI: 10.1111/j.14690691.2010.03432.x5 Solomon Islands Global AIDS response progress report 2016. Ministry of Health and Medical Services STI/HIVDivision. 2016 April 08 [cited 2017 May 30]. 50p. Available from:http://www.unaids.org/sites/default/files/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/SLB_narrative_report_2014.pdf6 Hodge N. Slatyer B. Skiller L. Solomon Islands Health System Review. (Health Systems in Transition, Vol. 5 No. 12015) Manila; World Health Organization 2015. 146p. Report No.: NLM Classification: WA 540 LM5. Available from:http://apps.who.int/iris/bitstream/10665/208212/1/9789290616931_eng.pdf?ua=17 Solomon Islands Red Cross Society. Strategic Plan 2017-2020 [Internet] Solomon Islands Red Cross Society 2016[cited 2018 Jan 30]. Available from:https://reliefweb.int/sites/reliefweb.int/files/resources/RC%20Solomon%20Islands%20Strategic%20Plan.pdf8 Monitoring international trends [Internet]. National Blood Authority (Australia). 2015 June [cited 2017 May 30]. Availablefrom: https://www.blood.gov.au/system/files/documents/sector_monitoring_2015_june.pdf9 Hospital in critical situation as blood bank runs out. Solomon Islands Broadcasting Corporation [Internet]. 2015 January8 [cited 2017 May 30]. Available from: http://www.sibconline.com.sb/hospital-in-critical-situation-as-blood-bank-runs-out/10 Red Cross pulls out service, blood bank dries up. Solomon Star [Internet]. 2015 January 8 [cited 2017 May 30].Available from:http://www.solomonstarnews.com/news/national/5442-red-cross-pulls-out-service-blood-bank-dries-up11 Hospital blood bank runs out. Solomon Islands Broadcasting Corporation [Internet]. 2015 November 10 [cited 2017May 30]. Available from: http://www.sibconline.com.sb/hospital-blood-bank-runs-out/12 World Blood Donor Day. Voluntary blood donors helping to save lives across the Pacific. Australian Red Cross NewsArchive [Internet]. 2012 June 13 [cited 2016 March 18]. Available from: http://www.redcross.org.au/voluntary-blooddonors-helping-to-save-lives-across-the-pacific.aspx13 Australian Government. AusAID. AUSAID Annual Report 2012-13. Supporting blood supply in SolomonIslands.[Internet] 2013 [cited 2017 May 30]. Available from: https://dfat.gov.au/about-us/publications/corporate/annualreports/ausaid-annual-report-201213/chapter_2_report_on_performance/casestudy_supporting_blood_supply_in_solomon_islands.html253ASIA PACIFICASIA PACIFIC LEVEL BTIMOR-LESTETimor-Leste Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking1160thPopulation (world ranking)11.3 million (158th)Median age118.8Political system1Semi-presidential republicGDP per capita (worldranking)1$5,000 (172nd)HDI Index (world ranking)20.605 - medium (133rd)Health Expenditure11.5% of GDPPopulation prevalencehepatitis B3High Intermediate: 5-7%Population prevalencehepatitis C4Very Low: 0% - <1.0%Population prevalence HIV50.01%NATIONAL BLOOD PROGRAMAs of 2011, the national blood bank in the capital Dili collects around 1,500 units annually, withregional blood banks located in Baucau, Maliana and Oecusse where they collect and process asmall number of blood units.6 The national blood bank performs blood component separation andencourages clinicians to use blood responsibly.6In 2014, blood transfusions were only available at six referral hospitals (Dili, Baucau, Suai, Maliana,Oecusse and Maubisse), with seven districts lacking access to blood products, resulting in a highnumber of deaths each year.7In order to fast-track the development of blood transfusion services, the Ministry of Health hosted aconsultative workshop in the National Hospital in July 2014 to establish the countrys first everNational Blood Policy and National Blood Program Strategic Plan 2015-2019. 6Blood supply is well below the demand for blood. 8 In 2012 in Timor-Leste, 2,400 units of blood wererequired (mostly for the management of pregnancy related complications), but only 1,938 units werecollected.8In 2014, 63% of blood supplies were from VNRBD donors with the rest from patients relatives. 9Blood drives only take place in the Dili district and blood is only collected when needed.9 For electivesurgeries relatives are requested to bring donors. In emergencies defence and police personnel areasked to donate blood.9ASIA PACIFIC254EUROPE ANDASIA PACIFICLEVELCENTRALBASIANATIONAL SOCIETY (TIMOR-LESTE RED CROSS)Blood donor recruitment and retention activities are coordinated nationally and funded by theNational Society. Currently only staff costs are covered by the National Society.Both paid staff and volunteers are used for donor recruitment programs, such as school/universityprograms, corporate programs and promotion of blood donations in public places.Timor-Leste Red Cross Society (CVTL):commenced its blood program in 2016, engaging volunteer blood donorsreceives technical assistance through the participation of a VNRBD workshop in Seoul, Korea(April 2016) and the Australian Red Crossreceives financial support from the Australian Red Cross and IFRChas not previously been involved at Level Ais planning to expand its level of involvement in blood related activities: Timor-Leste RedCross Society is waiting for funding from Australia Red Cross and IFRC to expand with themain objectives of increasing mobilization and socializationCVTL has several MOUs in place with universities and organisations to donate blood regularly andwork with the Department of Health to support mobile blood collections in and around Dili.9834 donations were collected in 2016.91Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/tt.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Republica Democratica de Timor-Leste. UNGASS 2010 Country progress report. Ministry of Health, Timor-Leste. 2010[cited 2017 May 30]. Available from:http://data.unaids.org/pub/Report/2010/timorleste_2010_country_progress_report_en.pdf6 Choudhury N. Blood Transfusion in borderless South Asia. Asian Journal of Transfusion Science. [Internet]. 2011 [cited2018 Feb 6]: 5(2). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159238/7 WHO. Country Office for Timor-Leste. WHO bolster plans for blood transfusion service development in Timor-Leste.World Health Organization; 2014 June [cited 2017 May 30]. (WCO-TLS/PR036/06/14). Available from:http://www.searo.who.int/timorleste/pr_blood_transfusion_services_tl.pdf?ua=18 WHO. Country Office for Timor-Leste. Timor-Leste joins worldwide celebration of World Blood Donor Day. World HealthOrganization; 2014 June [cited 2017 May 30]. (WCO-TLS/PR032/06/14). Available from:http://www.searo.who.int/timorleste/mediacentre/pr_world_blood_donor_day2014.pdf9 Soares I. Country report, Timor-Leste. In: The Eighth Red Cross and Red Crescent Symposium on Blood Programs inAsian Region Securing Stable Supply of Safe Blood; 2017 Oct 18-20; Bangkok, Thailand.255ASIA PACIFICASIA PACIFIC LEVEL BTONGATonga Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1190thPopulation (world ranking)1106 thousand ( 193rd)Median age122.6Political system1Constitutional monarchyGDP per capita (worldranking)1$5,600 (169th)HDI Index (world ranking)20.721 - high (101st)Health Expenditure15.2% of GDPPopulation prevalencehepatitis B314.8%Population prevalencehepatitis C42%Population prevalence HIV5<0.01%NATIONAL BLOOD PROGRAMThe Health sector is managed by the Ministry of Health.6 Vaiola Hospital is the only hospital providingadvanced medical care.6 Vaiola Hospital has a blood bank and collects blood donations.7In conjunction with the Tonga Red Cross, the Blood Transfusion and Immuno-haematology Serviceat Vaiola Hospital is responsible for8:the collection of blood from low risk donorsscreening donated blood for transfusion transmissible infectionsblood groupingantibody testingcross matchingproduction blood products as requiredstorage and distribution of blood products8On average approximately 10 blood units are donated per week, however demand from the hospitalis 30 per week.9ASIA PACIFIC256EUROPE ANDASIA PACIFICLEVELCENTRALBASIANATIONAL SOCIETY (TONGA RED CROSS)Blood donors are recruited from workplaces, villages, churches youth, volunteer groups, tertiaryschools and sports clubs. Donor retention is maintained through follow up contact. When fundsbecome available the Tonga Red Cross Society (TRCS) plans to print out small blood donor cardsto encourage and motivate the donors to come in when they are due. Donor information is recordedin a blood donor database.The partnership with Ministry of Health is through a Memorandum of Understanding whereby thestakeholders from Ministry of Health alert TRCS with updates from the blood bank, and TRCS moveinto action and activate its blood donor stakeholders.Funding for blood donor recruitment is no longer available. Previously there were two paid staffperforming these duties. Currently a volunteer performs this task assisted by TRCS staff, maintainingvolunteer blood donor recruitment in Tonga.The Tonga Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to expand its level of involvement in blood related activities. The volunteer bloodrecruitment officer has incorporated community awareness into the recruitment process forplaces such as workplaces and villages, in addition to seeking funds from local business topurchase refreshments for the non-remunerated blood donors1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/tn.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 WHO Western Pacific Region, Hepatitis data and Statistics [Internet] 2016 [cited 2017 May 23]. Available from:http://www.wpro.who.int/hepatitis/data/hepatitis_data_statistics/en/4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. doi: 10.1111/j.14690691.2010.03432.x5 TONGA Global AIDS response progress report 2015. Kingdom of Tonga, Ministry of Health. 2015 April 15 [cited 2017May 30]. 35p. Available from:http://www.unaids.org/sites/default/files/country/documents/TON_narrative_report_2015.pdf6 Nishikawa K. Ex-Post Evaluation of Japanese ODA Grant Aid Project The Project for Upgrading and Refurbishment ofVaiola Hospital. Ernst & Young Advisory Co.Ltd. 2011 [cited 2017 May 30]. 20p. Available from:https://www2.jica.go.jp/en/evaluation/pdf/2010_0408700_4.pdf7 Tonga Red Cross Society. Staff of Tonga Red Cross Society met up at the Vaiola Hospital Laboratory donating blood toblood bank., 2014 December 15 [photograph on the Internet]. Nukualofa, Tonga Red Cross Society; 2014 [cited 2017May 30]. Available from: https://www.facebook.com/tongaredcross/posts/3112281790855898 Pacific Public Health Surveillance Network. Vaiola Hospital Laboratory Services 2002 Laboratory Handbook. [Internet]2002 [cited 2018 Feb 6]. Available from: https://www.pphsn.net/Services/LabNet/Laboratory-Handbook-Tonga.doc9 Tonga Marks World Blood Donor Day. Radio & TV Tonga. [Internet]. 2017 Jun 14 [cited 2018 Feb 6]. Available from:http://www.tonga-broadcasting.net/?p=7933257ASIA PACIFICASIA PACIFIC LEVEL BTUVALUTuvalu Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationOceaniaGeographical size ranking1238thPopulation (world ranking)111 thousand (223rd)Median age125.5Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$3,800 (182nd)HDI Index 20.58 (medium) in 1998Health Expenditure116.5% of GDPPopulation prevalencehepatitis B37.1%Population prevalencehepatitis C42%Population prevalence HIV50.1%NATIONAL BLOOD PROGRAMPrincess Margaret Hospital (PMH) located on the main island of Funafuti is the only hospital in Tuvaluand the primary provider of medical services for all of the islands of Tuvalu. 6 Blood is not stored atthe hospital, instead, the Tuvalu Red Cross (TRC) uses a Walking Blood Bank - a register ofpotential donors and blood types.7 Red Cross volunteers coordinate donations and contact suitabledonors in an emergency.7 Most donations are from the patients family with education campaignsencouraging VNRBD donations.7In 2009 the TRC and PMH coordinated a joint program for World Blood Donor Day in an attempt toraise awareness of the importance of donating blood while also increasing the number of voluntarydonors.8 The week long campaign included radio spots and a blood donor recruiting drive. 8 Bloodgroup testing was conducted on the drive for interested donors, with more further testing to beperformed later in the laboratory.8 The program was considered successful.8ASIA PACIFIC258EUROPE ANDASIA PACIFICLEVELCENTRALBASIANATIONAL SOCIETY (TUVALU RED CROSS)The Tuvalu Red Cross became the 190th member of IFRC on 4th December 2015.9Blood donor recruitment and retention activities are only run within the capital as most of thepopulation reside there, and it is the location of the national hospital. Activities are funded by theNational Society, by government or the Ministry of Health and by WHO.Both volunteers and paid staff handle donor recruitment. Recruitment of donors occurs duringcommunity awareness activities when celebrating World Blood Donor Day. The Tuvalu Red Crossrecruits blood donors and transports the donors to the laboratory. Donors are only called in asrequired when the laboratory asks for donors.The Tuvalu Red Cross:does not receive technical assistance for VNRBD from outside the countryhas successfully applied for successive AU$4,000 annual grants from the Australian RedCross for the implementation of activities around World Blood Donor Dayhas experimentally been involved at Level A and with additional training would like to becomeinvolved in blood at Level A. The Tuvalu Red Cross and PMH collaborated to train two PMHstaff members in blood collection and testing. Due to the training requirements, this task hasremained with PMH at the only laboratory able to perform testing for the countryis in the process of developing a Memorandum of Understanding with the Ministry of Healthfor interested Tuvalu Red Cross volunteers to be trained in phlebotomy work. The VNRBDprogram will benefit from the additional trained volunteers able to collect and test blooddonationsare hoping to expand services to the outer islands once all island health clinics have thefacilities and technical personnel in place1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/tv.html2 WHO. Western Pacific Region. Tuvalu. http://hiip.wpro.who.int/portal/countryprofiles/Tuvalu.aspx3 WHO Western Pacific Region, Hepatitis data and Statistics [Internet] 2016 [cited 2017 May 23]. Available from:http://www.wpro.who.int/hepatitis/data/hepatitis_data_statistics/en/4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. DOI: 10.1111/j.14690691.2010.03432.x5 Ministry of Health Tuvalu. 2015. Global AIDS Progress Report of Tuvalu. Tuvalu Department of Public Health; 2015March 31 [cited 2017 May 30]. 28p. Available from:http://www.unaids.org/sites/default/files/country/documents/TUV_narrative_report_2015.pdf6 Country Health Information Profiles Tuvalu. Geneva; World Health Organization 2011 [cited 2017 May 30]. 5p.Available from: http://www.wpro.who.int/countries/tuv/34TUVpro2011_finaldraft.pdf7 Unicef. Pacific Island Countries. Tuvalu [Internet]. Unicef [cited 2017 May 30]http://www.unicef.org/pacificislands/about_15924.html by selecting Part 2. Page 24.8 WHO. World Blood Donor Day. Events. Tuvalu Red Cross World Blood Donor Day 2009. [Internet] 2009 [cited 2018Feb 6]. Available from: http://www.who.int/worldblooddonorday/events/Tuvalu.pdf9 Kumar N. Tuvalu Red Cross Society becomes 190 th member of the IFRC. IFRC News Stories [Internet]. 2016 March 4[cited 2017 May 30]. Available from:http://www.ifrc.org/en/news-and-media/news-stories/asia-pacific/tuvalu/tuvalu-red-cross-society-becomes-190thmember-of-the-ifrc--71977/259ASIA PACIFICASIA PACIFIC LEVEL CAFGHANISTANAfghan Red Crescent:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern AsiaGeographical size ranking141stPopulation (world ranking)133 million (41st)Median age118.6Political system1Presidential IslamicrepublicGDP per capita (worldranking)1$1,900 (211th)HDI Index (world ranking)20.479 - low (169th)Health Expenditure18.2% of GDPPopulation prevalencehepatitis B3Low Intermediate: <2%Population prevalencehepatitis C4Low: 1.0 - <1.5%Population prevalence HIV50.04% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Afghanistan National Blood Safety and Transfusion Service (ANBSTS) is branch of the nationalhealth care system founded by the Ministry of Public Health (MoPH) to guarantee a safe andadequate national blood supply.6 The ANBSTS has five regional blood banks. 6 7 There are alsotransfusion services in many other public, private and NGO operated hospitals.7 In these transfusionservices the hospital determines the quality and safety requirements rather than the nationalregulations and guidelines.7Although operational progress has been made, blood transfusion services in Afghanistan requireimprovement to the quality of services: data information and quality assurance systems are not fullyestablished and there is no formal legislative instrument to guide, manage and supervise operationsof private blood banks.6Though blood donation in Afghanistan relies largely on replacement donors, the national VNRBDrate was reported as being 60% at the Eighth Red Cross and Red Crescent Symposium on Bloodprograms in the Asian Region, held in October 2017.8ASIA PACIFIC260EUROPE ANDASIA PACIFICLEVELCENTRALCASIAIn Kabul blood bank, the percentage of VNRBD is 45%, however the percentage in other centres islikely to be lower.7 Donor selection and donor interviews are inefficient.7 The majority of the blood isadministered as fresh whole blood.7ANBSTS provides all blood transfusion services free of charge to the public hospitals.7 Some fundingcomes from the MoPH, however international donors remain the source for operational costs andactivity expansion.7 Agence Francaise De Development (AFD) the French agency is a major providerfor the ANBSTS aiming to rebuild the Afghanistan blood transfusion service.7NATIONAL SOCIETY (AFGHAN RED CRESCENT)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the IFRC.The Afghan Red Crescent:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved in blood at Level A or Bis planning to expand its current level of involvement in blood-related activities by expandingPledge 25 in the existing targeted areas1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/af.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 WHO. Regional Office for the Eastern Mediterranean. Afghanistan, Programme Areas, Blood Safety and Transfusion,[Internet]. World Health Organization 2017 [cited 2017 May 30]. Available from:http://www.emro.who.int/afg/Programs/blood-safety-transfusion.html7 Cheraghali AM, Sanei Moghaddam E, Masoud A and Faisal H. Review. Current challenges and future achievements ofblood transfusion service in Afghanistan. Transfusion and Apheresis Science 2012 [cited 2017 May 30];47:127132.Available from: http://www.ecobsn.com/main/index.php?lang=en&mode=page&mcode=2&cat=&id=828 Sultani SM. Country report, Afghanistan. In: The Eighth Red Cross and Red Crescent Symposium on Blood Programsin Asian Region Securing Stable Supply of Safe Blood; 2017 Oct 18-20; Bangkok, Thailand.261ASIA PACIFICASIA PACIFIC LEVEL CBRUNEI DARUSSALAMBrunei Darussalam Red Crescent Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking1173rdPopulation (world ranking)1436 thousand (175th)Median age129.9Political system1Absolute monarchy orsultanateGDP per capita (worldranking)1$76,700 (10th)HDI Index (world ranking)20.865 - very high (30th)Health Expenditure12.6% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Very Low: 0% - <1.0%Population prevalence HIV50.015%NATIONAL BLOOD PROGRAMThe Blood Donation Centre at Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital is the governmentagency responsible for maintaining a safe and adequate inventory of blood. 6 It has been successfulin sustaining a sufficient blood supply for patients in need.63.3% of Bruneis population donated blood in 2011.6 Of the total of 12,427 blood donors whoregistered at the Blood Donation Centre in 2011, 2,958 were first time donors - an increase of 40%from the 2,119 new donors in 2010.6Brunei is one of the countries that have reported having achieved 100% VNRBD in 2008.7There was a decreasing trend for HBV over the five years between 2005 and 2009, whereas thetrend for syphilis and HIV was increasing.8NATIONAL SOCIETY (BRUNEI DARUSSALAM RED CRESCENT)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the National Society.ASIA PACIFIC262EUROPE ANDASIA PACIFICLEVELCENTRALCASIABrunei Darussalam Red Crescent Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level Bis planning to expand its current level of involvement in blood-related activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bx.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 UNAIDS. Global AIDS progress reporting 2014 in Brunei Darussalam, 2014 [Internet]. 2014 March 31 [cited 2017 May30]. Available from: http://www.unaids.org/sites/default/files/country/documents/BRN_narrative_report_2014.pdf6 Ibrahim D. 3.3% of Brunei population donated blood last year. Orlando Sentinel [Internet] 2012 June 25 [cited 2017May 30]. Available from: http://articles.orlandosentinel.com/2012-06-25/news/sns-mct-3.3-of-brunei-population-donatedblood-last-year-20120625_1_blood-donors-blood-last-year-blood-stocks7 World Health Organization. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. World Health Organization [updated 2011 June; cited 2017 May 30]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=18 Teo K, Saparudin M, Zaini Z, Morshidi M, Metassan N, Jaberudin R, Teo B, Yakup S, Abdullah Lim N. Transfusiontransmissible infections in Brunei Darussalam: A blood donor study. Brunei Int Med J. 2011[cited 2017 May 30];7(6):321-327. Available from: http://www.bimjonline.com/PDF/Bimj%202011%20Volume%207,%20Issue%206/321-7.pdf263ASIA PACIFICASIA PACIFIC LEVEL CCAMBODIACambodian Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking190thPopulation (world ranking)115.9 million (69th)Median age124.9Political system1Parliamentary constitutionalmonarchyGDP per capita (worldranking)1$4,000 (178th)HDI Index (world ranking)20.563 - medium (143rd)Health Expenditure15.7% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2-4%Population prevalencehepatitis C4High Moderate: 2.0-<5.0%Population prevalence HIV50.64% among adults aged15 to 49NATIONAL BLOOD PROGRAMCambodias National Blood Transfusion Centre (NBTC) is a department of the Ministry of Healthwithin the Blood Safety Program.6 The Ministry of Health formally gave NBTC the responsibility oforganising and supervising the collection and supply of blood throughout the country in 1991. 7 Thenational blood system consists of the NBTC in Phnom Penh and 21 Provincial Blood TransfusionCentres (PBTCs) located in 21 provinces.6 The majority of PBTCs are under the responsibility ofprovincial referral hospitals.8The National Blood Transfusion Centre is responsible for providing approximately 65% of thecountrys blood supply.9A policy for VNRBD donations was adopted in 1994.6The National Blood Policy and Priority Strategies for the Development of the National BloodTransfusion Services was developed in 20037, and revised in 2014.10 The Health Minister approveda new prakas (regulation) on blood policy in 2016.11National guidelines for transfusion practice were developed in 2013.12ASIA PACIFIC264EUROPE ANDASIA PACIFICLEVELCENTRALCASIAApproximately 60,000 blood donations are made annually in Cambodia with the NBTS workingtowards increasing the blood donation rate7. The national VNRBD rate, as reported at the EighthRed Cross and Red Crescent Symposium on Blood Programs in the Asian Region, is 30%. 6The NBTS is working closely with a range of partners to ensure sustainability and the developmentof the Blood Safety Program. 13These include:Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)World Health Organisation (WHO)United States Centre for Disease Control (US CDC)Nagasaki University of JapanUS Presidents Emergency Plan for AIDS Relief (PEPFAR)American International Health Alliance (AIHA)Australian Red Cross and Blood Service13Following extensive stakeholder engagement and a comprehensive assessment of the CambodianBlood System conducted as part of the Task Order in 2011/12 by Australian Red Cross and theAustralian Red Cross Blood Service, a five year strategic plan and work plan was developed to assistNBTC to deliver a safe and adequate supply of blood to meet Cambodias needs.14 The strategicplan involves funding and technical assistance partners such as WHO and Global Fund, in order toprovide an all-inclusive strategy for the blood service.14NATIONAL SOCIETY (CAMBODIAN RED CROSS)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the government or Ministry of Health.The Cambodian Red Cross Society:265promotes voluntary blood donors recruitment through youth club, volunteers, and motor taxidriversreceives technical assistance from the US CDCreceives financial support for VNRBD activities from the Ministry of Health and Global Fundwas previously involved in blood at Level B - during the civil war in Cambodia when theMinistry of Health had limited resources, the Red Cross needed to actively support theseactivities, however in 2006 the blood service and ambulance were handed over from theCambodian Red Cross to the Ministry of Health. The CRC Branch Phnom Penh Municipalitycontinues collaboration and support of blood donor recruitment with the Ministry of Healthis not planning to expand or scale back its level of activities, planning to continue its currentwork and strengthen current activitiesASIA PACIFICASIA PACIFIC LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/cb.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Kimcheng H. Country report, Cambodia. In: The Eighth Red Cross and Red Crescent Symposium on Blood Programsin Asian Region Securing Stable Supply of Safe Blood; 2017 Oct 18-20; Bangkok, Thailand.7 Kingdom of Cambodia. National Blood Policy and Priority Strategies for the Development of the National BloodTransfusion Services (2003-2007) [Internet] 2017 [cited 2017 November 28]. Available from:http://www.who.int/bloodsafety/transfusion_services/CambodiaNationalBloodPolicy2003_2007.pdf8 Pannasastra University of Cambodia. Blood Donation [Internet] 2013 August 14 [cited 2017 November 28]. Vailablefrom: http://www.puc.edu.kh/index.php/featured-article/103-announcements-events-activities/events-activities/265-blooddonation9 Business 2 business Cambodia. New Blood Banks Looks To Stock Up For National Needs [Internet] 2016 October 14[cited 2017 November 28] Available from: https://www.b2b-cambodia.com/articles/new-blood-bank-looks-to-stock-up-fornational-needs/10The American International Health Aliance. Cambodia. [Internet] 2016 [cited 2017 November 28]. Available from:http://www.aiha.com/our-projects/blood-safety/cambodia/11 PEPFAR Cambodia Blood Safety Program 2013-2018 Final Project Report. Australian Red Cross Blood Service. 2018February 19p.12 Kingdom of Cambodia. National guidelines for transfusion practice. Edition 2. July 2014. Ministry of Health, NationalBlood Transfusion Center, Cambodia. [cited 2017 May 30]. 84p. Available from:http://www.cambodiablood.com/media/1ecfa385/GuidelinesEdition2.pdf13 The American International Health Alliance. Cambodia Blood Safety Project [Internet] 2016 [cited 2017 Novemebr 28].Available from: http://www.aiha.com/2017/02/23/cambodia-blood-safety/14 Technical Assistance Support for the Strengthening of Blood Transfusion Services in Cambodia. Mid Term Review.Terms of Reference. Australian Red Cross. 2015 September 16p.ASIA PACIFIC266EUROPE ANDASIA PACIFICLEVELCENTRALCASIAMALDIVESMaldivian Red Crescent:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern AsiaGeographical size ranking1210thPopulation (world ranking)1393 thousand (177th)Median age127.8Political system1Presidential republicGDP per capita (worldranking)1$19,200 (93rd)HDI Index (world ranking)20.701 - high (105th)Health Expenditure113.7% of GDPPopulation prevalencehepatitis B3Intermediate: 5-7%Population prevalencehepatitis C41%Population prevalence HIV50.01% among adults aged15 to 49NATIONAL BLOOD PROGRAMMaldivian Blood Services (MBS) was formed on 1 November 2012 through a merger of the NationalThalassaemia Centre (NTC) and the National Blood Transfusion Services (NBTS).6 The aim of MBSis to provide services to patients with Thalassaemia and other haematological disorders, and toprovide safe blood to those who are in need.6MBS is comprised of two main divisions, Thalassaemia and other Haemoglobinopathies Centre(TOHC) and Central Blood Bank (CBB).6 Both voluntary and direct donors are received by CBB.6The CBB is responsible for blood collection, donor recruitment and retention, and processing of bloodproducts.6 MBS has a common laboratory which caters for the needs of TOHC and CBB.6 Thelaboratory has facility to screen blood for Transfusion Transmissible Infections, cross-match bloodfor transfusion and Thalassaemia Screening.6Prior to the formation of the MBS, the Indira Gandhi Memorial Hospital collected about 300 units permonth and the blood bank attached to National Thalassaemia Center collects about 500 units permonth. 7 At this time, about 80% of blood units are collected by from family replacement donors anddirected donors.7267ASIA PACIFICASIA PACIFIC LEVEL CNATIONAL SOCIETY (MALDIVIAN RED CRESCENT)The Maldivian Red Crescent became a member of IFRC in November 2011.8Community education activities are coordinated by both nationally and by district/chapter by theNational Society. They are funded by the National Society.The Maldivian Red Crescent:does not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countrywas not previously involved in blood at Level A or Bis not planning to expand or scale back its level of activitiestakes part in some of the large scale blood donation awareness community activities such asawareness walks on Word Blood Donor Day, organised by Ministry of Health. Staff andvolunteers take part in blood donation camps organised by NGOs these duties are supportiveonly and not coordinated by the Maldivian Red Crescent. Blood services are not listed as aservice area in the previous (2012 - 2015) or current (2016 - 2019) strategic plan for theorganisation1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/mv.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. doi: 10.1111/j.14690691.2010.03432.x5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Maldivian Blood Services. About us [Internet] Ministry of Health 2017 [cited 2017 May 29]. Available from:http://mbs.gov.mv/about-us/7 Choudhury, Nanajyoti. Blood Transfusion in borderless South Asia, Asian J Transfus Sci. 2011 Jul-Dec; 5(2):117-120.DOI: 10.4103/0973-6247.832348 Lowry J. Maldivian Red Crescent officially joins the IFRC at the 18th General Assembly. International Federation of RedCross and Red Crescent Societies [Internet]. 2011 November 23 [cited 2017 May 29]. Available from:http://www.ifrc.org/en/news-and-media/news-stories/asia-pacific/maldives/maldivian-red-crescent-formally-recognized-atifrcs-general-assembly/ASIA PACIFIC268EUROPE ANDASIA PACIFICLEVELCENTRALCASIAMYANMAR (FORMERLY BURMA)Myanmar Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouth-eastern AsiaGeographical size ranking140thPopulation (world ranking)157 million (25th)Median age128.6Political system1Parliamentary republicGDP per capita (worldranking)1$6,300 (163rd)HDI Index (world ranking)20.556 - medium (145th)Health Expenditure12.3% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2% - 4%Population prevalencehepatitis C4Low Moderate:1.5% - <2.0%Population prevalence HIV50.69% among adults aged 15 to49NATIONAL BLOOD PROGRAMIn 1945, a blood bank facility was established at Yangon General Hospital, now known as NationalBlood Centre (NBC). 6 In 1962, a national blood bank committee was created and the following yeara voluntary blood donation program was formalized.6 A national blood and blood product law wasenacted in January 2003 with an aim to save patients lives through blood transfusion of qualityassured blood and blood products and to prevent transfusion transmissible infections through thepromotion of VNRBD.6The Department of Health manages the NBC which has two national blood banks at Yangon Generalhospital and at Mandalay General Hospital, with an annual demand of 180,000 units of blood.6Nationally, there are 359 hospital-based blood banks with a demand of 200,000 units of blood.6There are many voluntary organizations that assist in donor recruitment and blood donation.6 Nearly100 hospitals of varying levels and more than 324 townships and station level hospitals performregular blood transfusions.6The NBC has earned the International Society of Blood Transfusion (ISBT) Developing CountryAward 2014 with one of the achievements being a reduction in HIV positive screening rates.7269ASIA PACIFICASIA PACIFIC LEVEL CMyanmars influential Buddhist monks play a key role in promoting VNRBD donation by discussingblood donation in sermons and acting as emergency blood donors.8 VNRBD increased from 25% in2004 to 73.6% in 2011.9NATIONAL SOCIETY (MYANMAR RED CROSS)The Myanmar Red Cross Society (MRCS) initiated blood donation activities in 19616 and currentlyworks in partnership with the National Blood Centre in Yangon.10 MRCS works closely with theMinistry of Health and Sports for all blood donation activities across Myanmar.Myanmar RCS originally responded as a Level B NS. However, since financial support from theCanadian Red Cross / IFRC has ceased, they are now operating at Level C.Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the National Society. Both paid staff and volunteers are used for donorrecruitment, such as school/university programs and corporate programs. Red Cross volunteersengaged in blood donor recruitment form an important part of the donor pool.The Myanmar Red Cross Society:does not receive technical assistance for VNRBD activities from outside the countryuntil recently received financial support for VNRBD activities from the Canadian RedCross/IFRCis planning to expand, but requires resources to do expand coverage. Branch Red Crossvolunteers are still running regular blood related activities using their own resources. Theyhave enough capacity to expand the community program.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bm.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Aung T. Status report of the blood transfusion services in Myanmar. Asian J of Transfus Sci [Internet]. 2009 Jan; 3(1):2225. Available from: http://www.ajts.org/text.asp?2009/3/1/22/45258 DOI: 10.4103/0973-6247.452587 Japan International Cooperation Agency. Myanmar National Blood Center: Receiving a Prestigious International Award[Internet]. 2014 June 1 [cited 2017 May 29]. Available from:http://www.jica.go.jp/myanmar/english/office/topics/140601.html8 Schatz, J. Need blood? In Myanmar, call the monastery. Aljazeera America [Internet]. 2014 November 10 [cited 2017May 29]. Available from: http://america.aljazeera.com/articles/2014/11/10/myanmar-monks-donatingblood.html9 Towards Self-Sufficiency in Safe Blood and Blood Products based on Voluntary Non-Remunerated Donation. Globalstatus. World Health Organisation. 2013. Page 20.10 Myanmar Red Cross Society. Give blood [Internet] Myanmar Red Cross Society; 2015 [cited 2016 March 29] Availablefrom: http://www.redcross.org.mm/en/support/givebloodASIA PACIFIC270EUROPE ANDASIA PACIFICLEVELCENTRALCASIANORTH KOREA (DEMOCRATICPEOPLES REPUBLIC OF KOREA)Red Cross Society of the Democratic People's Republic of Korea:Level C: National society is involved in occasional community education / awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern AsiaGeographical size ranking199thPopulation (world ranking)125 million (51st)Median age133.8Political system1Communist StateGDP per capita (worldranking)1$1,700 (215th)HDI Index (world ranking)2n/aHealth Expenditure1n/aPopulation prevalencehepatitis B3High Intermediate: 5% - 7%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV5<0.2% (est.)NATIONAL BLOOD PROGRAMThe Blood Service is nationally coordinated and centrally managed by the government under theministry of health. 6In 1999, WHO completed a study of the Blood Transfusion System in the Democratic PeoplesRepublic (DPR) of Korea.7 The study showed that approximately 25,000 volunteers donate bloodevery year without remuneration at the National Blood Centre in Pyongyang, out of a total pool of40,000 blood donors.7 Despite occasional shortages, the blood supply is reported to be adequatefor the countrys demand.7 Donors who visit the blood centre give a pre-donation sample, which istested for transfusion transmissible infections.7 They return later for their actual blood donation,which is not tested.7The Blood Transfusion System in DPR Korea faces several challenges, including 7:271use of glass bottles instead of disposable blood bags, which are required to be washed andsterilised before useuse of latex tubing sets at least 3 times before being discardedASIA PACIFICASIA PACIFIC LEVEL Clack of financial resourceslimited staff training and developmentinadequate physical infrastructureabsence of back-up generators for domestic refrigerators in regional blood banks andhospitals7The results of this study resulting in an appeal being launched for US$817,000 for 2002-2003 toimprove the Blood Transfusion System in DPR Korea.7NATIONAL SOCIETY (RED CROSS OF THE DEMOCRATIC PEOPLE'S REPUBLIC OFKOREA)The country was founded in 1946 and the Red Cross Society was involved in the blood servicesincluding donor recruitment.6 However, from mid 1950s, the Red Cross stopped donor recruitmentand Ministry of Public Health took over the responsibility.6The Red Cross are heavily involved in VNRBD promotion and awareness. They are not directlyinvolved in blood donor recruitment, however have provided assistance to the government by fundingblood donor facilities.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/kn.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 2006 Report on the global AIDS epidemic, A UNAIDS 10 th anniversary special edition. UNAIDS; 2006 [cited 2016 May26] 629p. Available from: http://data.unaids.org/pub/report/2006/2006_gr_en.pdf6 Choudhury, Nanajyoti. Blood Transfusion in borderless South Asia, Asian J Transfus Sci. 2011 Jul-Dec; 5(2):117-120.DOI: 10.4103/0973-6247.832347 WHO. News from DPR Korea. Safe Blood Transfusion. [Internet] 2002 Aug [cited 2018 Feb 6]. Available from:http://apps.who.int/disasters/repo/8071.pdfASIA PACIFIC272EUROPE ANDASIA PACIFICLEVELCENTRALCASIAPAPUA NEW GUINEAPapua New Guinea Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationOceaniaGeographical size ranking155thPopulation (world ranking)16.8 million (106th)Median age122.9Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$3,800 (183rd)HDI Index (world ranking)20.516 - low (154th)Health Expenditure14.3% of GDPPopulation prevalencehepatitis B3High: >8%Population prevalencehepatitis C4Very Low: 0% - <1.0%Population prevalence HIV50.72% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Blood Service was established in Port Moresby in 1961 by the Red Cross and AustralianAdministration, in the 1970s, blood banks were established in other towns. 6 The Blood Service wasmanaged by the Red Cross with funding from the government.6In 2009, the management was taken over by the Health Department, and in 2010 the National BloodTransfusion Service (NBTS) was established within the Health Department.6In 2014 the NBTS had one staff member, with no office set up and no national support staff. 6 Therewere 32 blood centres, with staff employed by the individual hospitals and health facilities.Collections are approximately 30,000, but this falls very short of the WHO minimum recommendationfor blood donation.6 The quality management system is poor, the VNRBD rate is 50% and the TTIrate is 25%.6The goal is to establish a national blood service as an integral part of the national health system thatwill ensure provision of safe blood with the implementation of a National Blood Policy. 6273ASIA PACIFICASIA PACIFIC LEVEL CTraining has been conducted with funding and technical support provided by WHO and includestraining for:donor managementVNRBD recruitmentquality management systems6NATIONAL SOCIETY (PAPUA NEW GUINEA RED CROSS)The Papua New Guinea Red Cross Society are currently involved in communityawareness/education of VNRBD (Level C), however information received from the IFRC Pacificoffice in 2016 indicates that they are developing a strategic plan which includes an intention toexpand activities to Level B.Red Cross volunteers have been provided training on VNRBD recruitment.6In 2012, 177 people donated blood with the assistance of the Papua New Guinea Red CrossSociety.71Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/pp.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Managing a Blood Service in Papua New Guinea Challenges, Paper presented at: APEC Regional Blood SafetyWorkshop Attaining a safe and Sustainable Blood Supply, 2014 Sep 30 Oct 1: Manila (PH). Powerpoint presentationavailable from: http://mddb.apec.org/Documents/2014/LSIF/PD/14_lsif_pd_011.pdf7 Papua New Guinea Red Cross Society. The International Federation of Red Cross and Red Crescent Societies. [cited2017 May 29]. Available from: http://data.ifrc.org/fdrs/societies/papua-new-guinea-red-cross-societyASIA PACIFIC274EUROPE ANDASIA PACIFICLEVELCENTRALCASIASRI LANKASri Lanka Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern AsiaGeographical size ranking1122ndPopulation (world ranking)122 million (57th)Median age132.5Political system1Presidential republicGDP per capita (worldranking)1$13,000 (121st)HDI Index (world ranking)20.766 - high (73rd)Health Expenditure13.5% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2% - 4%Population prevalencehepatitis C4Low: 1% - <1.5%Population prevalence HIV50.03% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe National Blood Transfusion Service (NBTS) is part of the Ministry of Health, and is the soleprovider of blood and blood products to all government hospitals and a large proportion of privatehospitals. 6 There are 90 hospital based blood banks and two standalone blood centres.6The International Society of Blood Transfusion acknowledged the achievements of the NBTS amongdeveloping countries, in providing safe and quality blood and blood products to completely meet therequirements of public and private hospitals.7NBTS has well-structured administrative and organizational systems in place, supported by nationalblood policies and regulations, including a national policy for VNRBD.7 Political commitment has alsoplayed a major role as the uninterrupted provision of quality health services, including safe bloodand blood products, is one of the mandates of the government.7 There are regulations on theimportation or exportation of blood and blood products as well as estimations of the demand andsupply of blood and blood products at national level.7Self-sufficiency in blood and blood products has progressively improved over the years, NBTS hasdoubled total blood collections from 190,000 in 20046 to more than 380,000 in 2014 with 100% beingcollected from VNRBD since 2013.6 A substantial increase in mobile blood collections (from 53% of275ASIA PACIFICASIA PACIFIC LEVEL Ctotal blood collected in 20056 to 92% in 20146) has contributed to this result. Sri Lanka has achievedan overall donation rate of 1.6 %.6In 2014, over 380,000 units of blood were collected, from 100% VNRBD (replacement collectionswere phased out in 2012).6The NBTS has a well-established haemovigilance system covering donor, process and recipientadverse events.6NATIONAL SOCIETY (SRI LANKA RED CROSS)Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the National Society.The Sri Lanka Red Cross Society:receives financial support for VNRBD activities from IFRChas not previously been involved at Level A or Bis not planning to expand or scale back its level of involvement in blood related activities.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ce.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Medical Statistics Unit. Annual Health Bulletin 2014. Colombo, Ministry of Health, Nutrition and Indigenous Medicine.2016 [cited 2017 May 29]. 221p Available from: http://www.health.gov.lk/enWeb/publication/AHB2014/AHB2014.pdf7 Towards Self-Sufficiency in Safe Blood and Blood Products based on Voluntary Non-Remunerated Donation. Globalstatus. World Health Organisation. 2013. Page 64-66.ASIA PACIFIC276EUROPE ANDASIA PACIFICLEVELCENTRALCASIAVANUATUVanuatu Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationOceaniaGeographical size ranking1164thPopulation (world ranking)1277 thousand (183rd)Median age121.7Political system1Parliamentary republicGDP per capita (worldranking)1$2,800 (195th)HDI Index (world ranking)20.597 - medium (134th)Health Expenditure15% of GDPPopulation prevalencehepatitis B317.5%Population prevalencehepatitis C42%Population prevalence HIV5<0.01%NATIONAL BLOOD PROGRAMManaged by the Ministry of Health, the central blood collection, blood bank and blood transfusioncentre within Vanuatu was established at Vila Central Hospital in the 1960s.6Programs to increase voluntary blood donation have been attempted to varying success, mainly dueto ongoing funding constraints.6NATIONAL SOCIETY (VANUATU RED CROSS)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the blood service, by the government or Ministry of Health and by private organisations.277ASIA PACIFICASIA PACIFIC LEVEL CThe Vanuatu Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level B, but ceased several years ago due to concernsaround the safety of the collection and lack of VRCS technical capacity at the timeis planning to expand its level of activities to Level B and is in the process of finalising amemorandum of understanding with the local MOH in order to support the Vanuatu RedCross Society with recruitment as well as technical and systems capacity1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/nh.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 WHO Western Pacific Region, Hepatitis data and Statistics [Internet] 2016 [cited 2017 May 23]. Available from:http://www.wpro.who.int/hepatitis/data/hepatitis_data_statistics/en/4 Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect. 2011:17(2):107-115. DOI: 10.1111/j.14690691.2010.03432.x5 Global AIDS Response Progress Report. Country: Vanuatu. 2014. Ministry of Health, UNAIDS, World HealthOrganization, UNICEF, European Centre for Disease Prevention and Control. 2015 [cited 2017 May 23]. 125p Availablefrom: http://www.unaids.org/sites/default/files/country/documents//file,94777,es..pdf6 Vila Central Hospital Blad Bank. Blad Bank VCH Vanuatu [Internet] [cited 2016 March 17] Available from:https://www.facebook.com/Bladbankvchvanuatu/info?tab=page_infoASIA PACIFIC278EUROPE ANDCENTRALASIAASIA PACIFICNIL (NOINVOLVEMENT)NEW ZEALANDNew Zealand Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationOceaniaGeographical size ranking176thPopulation (world ranking)14.5 million (126th)Median age137.8Political system1Parliamentary democracyunder a constitutionalmonarchyGDP per capita (worldranking)1$38,500 (47th)HDI Index (world ranking)20.915 - very high (13th)Health Expenditure111% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2 - 4%Population prevalencehepatitis C4Low Moderate: 1.5 - <2.0%Population prevalence HIV5<0.01%NATIONAL BLOOD PROGRAMThe Health Amendment Act 1998 appointed the New Zealand Blood Service (NZBS) as the soleprovider of blood services in New Zealand. 6 The NZBS is a statutory corporation with the Ministersof Health and Finance as shareholders.6 NZBS is based on VNRBD and is responsible for all blood,from collection to distribution to clinician.6NZBS operates under four strategic areas:Blood collection six main sites, three smaller donation centres and flexible mobile blooddrive teams exist to service local communitiesProcessing of blood donations - four sites collectively handling around 147,000 donations peryearAccreditation testing of blood donations - blood grouping and screening for infectious markersis performed in two sitesBlood banking - NZBS operates six blood banks in six cities, and another 28 District HealthBoard Blood Bank laboratories also perform pre-transfusion testing in line with defined qualitystandards6Medsafe, a division of the Ministry of Health, is the regulator for blood in New Zealand.7279ASIA PACIFICASIA PACIFIC NIL (NO INVOLVEMENT)In the 2015/16 year, NZBS:collected 119,967 units of whole bloodcollected 52,026 units of apheresis plasmahad 310 mobile blood drivesproduced 17,917 adult doses of plateletssupplied 67,152kg of source plasma to CSL Behring for fractionation manufacturing 8NATIONAL SOCIETY (NEW ZEALAND RED CROSS)In 1915, the New Zealand Branch of the British Red Cross was formed. 8 In 1932, a governmentproclamation officially recognised the New Zealand Red Cross National Society, which was soonfollowed by recognition from the International Committee of the Red Cross.8The New Zealand Red Cross is not involved in any blood related activities.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 May22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/nz.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 May 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 May 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 New Zealand AIDS Foundation. HIV in New Zealand [Internet]. New Zealand AIDS Foundation [cited 2016 March 14].Available from: https://www.nzaf.org.nz/hiv-aids-stis/hiv-aids/hiv-in-new-zealand/6 NZ Blood. Creation of NZBS [Internet]. New Zealand Blood Service. [updated 2014 February 27; cited 2017 May 29]Available from: https://www.nzblood.co.nz/about-nzbs/creation-of-nzbs/7 Medsafe. About Medsafe [Internet] 2012 June 25 [updated 2015 September 29; cited 2017 May 29]. Available from:http://www.medsafe.govt.nz8 New Zealand Red Cross. Our History [Internet]. New Zealand Red Cross 2016 [cited 2016 March 14]. Available from:https://www.redcross.org.nz/about-us/our-history/.ASIA PACIFIC280EUROPE AND CENTRAL ASIANATIONAL SOCIETY (NS) INVOLVEMENT IN BLOODPROGRAMS BY LEVELNil14 NS (26%)Level C10 NS (19%)281EUROPE AND CENTRAL ASIALevel A9 NS (17%)Level B20 NS (38%)TOTAL NUMBER NS = 53EUROPE AND CENTRAL ASIAFOCUS ON LEVEL A NATIONAL SOCIETY BLOOD SERVICESIN THE REGION9 out of 9 NSBS have achieved 100% VNRBD100%90%80%% VNRBD70%60%50%40%30%20%10%0%3 out of 9 NSBS provide 100% of the national blood supply100%90%% of national supply80%70%60%50%40%30%20%10%0%*Information unknownEUROPE AND CENTRAL ASIA282EUROPE AND CENTRAL ASIA LEVEL AAUSTRIAAustrian Red Cross:Level A (undertakes full blood service provision)95% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationCentral EuropeGeographical size ranking1115thPopulation (world ranking)18.7 million (95th)Median age144Political system1Federal parliamentary republicGDP per capita (worldranking)1$49,200 (33rd)HDI Index (world ranking)20.893- very high (24th)Health Expenditure111.2% of GDPEfficiency of Healthcare335th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very Low: 0 - <1.0%Population prevalence HIV6Low (approx. 0.1%)NATIONAL BLOOD PROGRAMThe Austrian Red Cross Blood Service collects approximately 95% of the nations whole blood (allof which is from voluntary blood donors), with the remainder being provided by three hospitals.7The seven Red Cross blood centres in Austria operate independently.7 Four of these (in Vienna,Lower Austria & Burgenland; Upper Austria; Carinthia; and Vorarlberg) undertake collection, testing,production and distribution activities.8 Three others (in Styria, Salzburg and Tyrol) are responsiblefor blood collection and distribution in conjunction with the Regional University Hospitals.8The coordination of the Austrian Red Cross Blood Services is undertaken by the blood centre inVienna8, where approximately 40% of all blood products are used.7283EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL ANATIONAL SOCIETY BLOOD PROGRAM (AUSTRIAN RED CROSS)The Austrian Red Cross:annually collects (2016):o 355,000 units of whole bloodo 15,000 units of platelet concentrates by apheresissupplies blood to approximately 200 hospitals/clinicsprocesses collected blood into componentsconducts screening testing of blood for infectious diseases and blood groupingconducts cross-matching for transfusion (this is also undertaken by hospitals)is accredited to ISO 9001:2008does not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis involved in the collection, processing or testing of cord blood stem cells, peripheral stemcells and bone marrow stem cellsis not involved in the collection, processing or testing of bone, solid organs or corneasBlood donor recruitment and retention activities are coordinated both nationally and bydistrict/chapter by the National Society. They are funded by the blood service. Paid staff are used toundertake school/university programs and corporate programs.The Austrian Red Cross Blood Service forwards plasma to a fractionation facility. Red Cross annuallysells approximately 65,000 litres of recovered plasma to various commercial fractionators.The Austrian Red Cross is not planning to expand or scale back its current level of involvement inblood-related activities.Austrian Red Cross Blood Services cooperate directly with the neighbouring Principality ofLiechtenstein to provide blood collection, processing and distribution support services for the country.(Refer also country report Liechtenstein).1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/au.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Dec 12]. Available from: http://hdr.undp.org/en/countries/profiles/AUT3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 September 18 [cited2017 Dec 12]. Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-theworld.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Network of low HIV prevalence countries in Central and South East Europe (NeLP). Testing country in profile in 2015 Austria. [Internet] NeLP 2016 [cited 2017 Dec 12]. Available from: http://www.nelp-hiv.org/countries/AT7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.8 European Blood Alliance. Austria [Internet] European Blood Alliance 2017 [cited 2017 Dec 12]. Available from:http://www.europeanbloodalliance.eu/membership/austria/EUROPE AND CENTRAL ASIA284EUROPE AND CENTRAL ASIA LEVEL ABELGIUMBelgian Red Cross:Level A (undertakes full blood service provision)97% of the national total blood collection (Flanders 100%; Wallonian 92%)100% VNRBDNATIONAL CONTEXTLocationWestern EuropeGeographical size ranking1141stPopulation (world ranking) 111.4 million (77th)Median age141.4Political system1Federal parliamentary democracyunder a constitutional monarchyGDP per capita (worldranking)1$46,300 (35th)HDI Index (world ranking)20.896 - very high (22nd)Health Expenditure110.6% of GDPEfficiency of Healthcare341st of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very Low: 0 - <1.0%Population prevalence HIV60.2% (2011 est.)NATIONAL BLOOD PROGRAMThe Belgian Red Cross (divided into the southern Wallonian section and the northern Flanderssection) undertakes 97% of the countrys blood collection (Flanders 100%; Wallonian 92%).Other providers are:ASBL La Transfusion Charleroi 6%CHU UCL Namur Site Godinne 2%The Federal Agency for Medicines and Health Products (FAMHP) under the Ministry of Health is theregulatory agency for blood activities.7Their responsibilities include:285marketing approvalapproval of new blood productsinspectionshaemovigilanceapproval of national drug pricing, which includes blood7EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL ANATIONAL SOCIETY (BELGIAN RED CROSS)FlandersWallonianAnnually collects (2015):o 250,000 units of whole bloodo 100,000 units by apheresisAnnually collects (2015):Processes collected blood into componentsProcesses collected blood into componentsConducts screening testing of blood for infectiousdiseases and blood groupingConducts screening testing of blood for infectiousdiseases and blood groupingConducts cross-matching for transfusion (this is alsoundertaken by hospitals)Does not conduct cross-matching for transfusionForwards plasma to a fractionation facilityForwards plasma to a fractionation facilityDoes not perform transfusionsDoes not perform transfusionsIs involved in the collection, processing or testing of cordblood stem cells, peripheral stem cells, bone marrowstem cells as well as bone, solid organs and corneas.Is involved in the collection, processing or testingof bone marrow stem cells. Is not involved in thecollection, processing or testing of peripheral stemcells, cord blood stem cells, bone, solid organs orcorneas.Supports a population of 6.5 millionSupports a population of 4.5 millionSupplies blood to 64 hospitals/clinicsSupplies blood to 43 hospitals/clinicsIs accredited to EUBIS, ISO 9001, ISO 15189Is accredited to ISO 9001 and ISO 15189Does not receive technical assistance or financialsupport for VNRBD or blood service activities fromoutside the countryDoes not receive technical assistance or financialsupport for VNRBD or blood service activities fromoutside the countryBlood donor recruitment and retention activities arecoordinated both nationally and by district/chapter by theNational Society. They are funded by the blood service.Both paid staff and volunteers are used to undertakeschool/university programs and corporate programs.Blood donor recruitment and retention activitiesare coordinated by district/chapter by the NationalSociety. They are funded by the blood service.Both paid staff and volunteers are used toundertake school/university programs, corporateprograms and mobile collections at villages blooddrives.oo156,000 units of whole blood26,000 units by apheresisThe Central Fractionation Unit, a not-for-profit corporation that is owned by LFB (France), receivesapproximately 85% of plasma from whole blood and nearly all plasma from plasmapheresis. 7 In2016, 190,000 litres of plasma was sent to the Central Fractionation Unit.7EUROPE AND CENTRAL ASIA286EUROPE AND CENTRAL ASIA LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Mar 13].Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/be.html2United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 15]. Available from: . http://hdr.undp.org/en3Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 September 18 [cited 2018Jan 15]. Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control and Prevention2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-totravel/hepatitis-b5Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control and Prevention2016 [cited 2018 Jan 15] Available from:. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-totravel/hepatitis-c6World Health Organization. Regional Office for Europe. Key facts on HIV epidemic in Belgium and progress in 2011. [Internet]World Health Organization 2013 [cited 2018 Jan 15]. Available from:http://www.euro.who.int/__data/assets/pdf_file/0006/191067/Belgium-HIVAIDS-Country-Profile-2011-revision-2012final.pdf?ua=17MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing Research Bureau Inc:2014. 203p.287EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL AFINLANDFinnish Red Cross:Level A (undertakes full blood service provision)100% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationNorthern EuropeGeographical size ranking166thPopulation (world ranking)15.5 million (117th)Median age142.5Political system1Parliamentary republicGDP per capita (worldranking)1$44,000 (37th)HDI Index (world ranking)20.895 - very high (23rd)Health Expenditure19.7% of GDPEfficiency of Healthcare319th of 51 countriesPopulation prevalencehepatitis B4Not availablePopulation prevalencehepatitis C5Very Low: 0 - <1.0%Population prevalence HIV60.1%NATIONAL BLOOD PROGRAMThe Finnish Red Cross Blood Service is the national blood service provider in Finland.The Finnish Red Cross Blood Service was founded in 1948 and has always been based on voluntary,unpaid blood donation. 7Blood Service operations are subject to the Finnish Blood Service Act (197/2005) and otherregulations, including the EU Blood Safety Directive, and are supervised by the National Agency forMedicines. 7The Blood Service is an independent, non-profit section of the Finnish Red Cross.8 Operational anddevelopment costs are covered by selling blood, products and services to the Finnish healthcaresystem 8. It costs on average approximately US$180 for one RBC unit. 9EUROPE AND CENTRAL ASIA288EUROPE AND CENTRAL ASIA LEVEL AMany functions of the Blood Service (including testing, quality control, administrative supportfunctions, research and development) are carried out at the Helsinki Blood Centre in Kivihaka.10 Inaddition, there are ten donor centres. 10NATIONAL SOCIETY (FINNISH RED CROSS)The Finnish Red Cross Blood Service is responsible for:annually collects (2014):o 216,485 units of whole bloodo 4,495 units by apheresis: plasmapheresis 3152, plateletpheresis 1343testing donated bloodmanufacturing blood productsblood cross-matchingtesting for coagulation factor and thrombocyte assays8blood group and blood group antibody tests for all pregnant women in Finland10testing required for organ, tissue and stem cell transplants8the Finnish Stem Cell Registry, which provides stem cell grafts for all stem celltransplantations performed in Finland8In addition, the Finnish Red Cross Blood Service:supplies blood products to 60 hospitals / clinics:o 194,320 red blood cell units were supplied to hospitals in 2016, a decrease of 1.5%over the previous year11o 34,850 units of platelet products were supplied to hospitals in 2016, a decrease of8.3% over the previous year. Despite platelet usage decreasing, Finland still usesmore that the European average11does not perform transfusionsis accredited to EN ISO 15189, EN ISO/IEC 17025, FACTdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryis not involved in cornea collection, processing or testingBlood donor recruitment and retention activities are coordinated nationally by the blood service.Activities include school/university programs as well as enterprises, communities and other interestgroups. Donor recruitment activities are funded by the blood service. Both volunteers and paid staffare utilised for donor recruitment.289EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan15]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/fi.html2 United Nations Development Programme. Human Development Report 2016 [Internet] 2016 [cited 2018 Jan 15].Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] United Nations DevelopmentProgramme 2014 [cited 2018 Jan 15]. Available from: https://www.bloomberg.com/graphics/infographics/most-efficienthealth-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 World Health Organization. World Health Statistics 2011 [Internet] World Health Organization 2011 [cited 2018 Jan 15].[171p]. Available from: http://www.who.int/gho/publications/world_health_statistics/EN_WHS2011_Full.pdf?ua=17 Finnish Red Cross Blood Service. About Us [Internet] Finnish Red Cross Blood Service 2016 November 17 [cited 2017October 02]. Available from: https://www.bloodservice.fi/about-us8 Finnish Red Cross Blood Service. The Blood Service in the Finnish Healthcare system [Internet] Finnish Red CrossBlood Service 2017 [cited 2017 October 02]. Available from: http://vuosikertomus.veripalvelu.fi/en9 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.10 European Blood Alliance. Finland [Internet] European Blood Alliance 2017 [cited 2017 August 21]. Available from:http://www.europeanbloodalliance.eu/membership/finland/11Finnish Red Cross Blood Service. Annual Report 2016 pdf [Internet] Finnish Red Cross Blood Service 2016 [cited2018 Jan 15]. Available from:http://vuosikertomus.veripalvelu.fi/media/vuosikertomukset/spr_veripalvelu_vsk_2016_en.pdfEUROPE AND CENTRAL ASIA290EUROPE AND CENTRAL ASIA LEVEL AGERMANYGerman Red Cross:Level A (undertakes full blood service provision)71% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationCentral EuropeGeographical size ranking164thPopulation (world ranking)181 million (19th)Median age147.1Political system1Federal parliamentary republicGDP per capita (worldranking)1$50,200 (27th)HDI Index (world ranking)20.926 - very high (4th)Health Expenditure111.3% of GDPEfficiency of Healthcare323rd of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very Low: 0 - <1.0%Population prevalence HIV60.2% among adults aged 15 to49NATIONAL BLOOD PROGRAMAccording to statistics by the Paul Ehrlich Institute (PEI), there were over 4 million allogeneic wholeblood donations and almost 3 million apheresis donations in 2016.7The proportions of whole blood donations provided were:72.7 % by the German Red Cross19.5% by state-run, non-profit limited liability donation services, services at municipal orprivate hospitals, German Army7.8% by private donation centres (this figure has risen from just 2.1%)7Below is a list of the number of manufacturers involved in collection, production, imports and exportsof blood and blood products in Germany in 2015 by type of organisation (as at 20 May 2016). 7291state-run, municipal or private hospitals, non-profit limited liability company 69Red Cross 12plasma processing industry 19EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL Aprivate donation centre 26Bundeswehr (German army) 1facilities collecting autologous blood, manufacturing blood components from directeddonations or hematopoietic stem cell preparations - 101There were 2,581 organisations using blood, including 1382 hospitals, the German Army, 974 paneldoctors / dialysis centres / surgeries and 224 other medical facilities.7In Germany, the PEI is the competent higher authority for blood products.8 Considered as medicinalproducts, both blood components for transfusion and plasma derivatives are regulated under theGerman Drug Law.8 The Transfusion Act of 1998 regulates a range of blood service technical andquality requirements. 9The PEI supervises approvals of new blood products, performs inspections and enforces EUrequirements.9 Blood component usage and guidelines on blood collection are managed by theGerman Medical Association (BK) in cooperation with the PEI.9Hospitals reimburse the German Red Cross for the blood products. 10Whilst the German Red Cross, government-run institutions and the military collect 100% of donationsfrom VNRBD, various combinations of whole blood, platelets and plasma are purchased bycommercial blood centres.9Nationally in 2010, 80% of whole blood and red blood cell donations were VNRBD.11NATIONAL SOCIETY (GERMAN RED CROSS)The German Red Cross has seven blood transfusion services including 28 donation centres andinstitutes. Some of these offer plasmapheresis.12The German Red Cross:annually collects (2014):o 3.15 million units of whole bloodo 2.5 million units by apheresissupplies blood to approximately 350 hospitals/clinicsprocesses collected blood into componentsconducts screening testing of blood for infectious diseases and blood groupingconducts cross-matching for transfusion (this is also undertaken by hospitals)performs transfusions - in some transfusion centres, outpatients receive transfusionsis accrediteddoes not receive technical assistance or financial support for VNRBD or blood service activitiesfrom outside the countryis involved in the collection, processing or testing of cord blood stem cells, peripheral stem cells,bone marrow stem cells, bone, solid organs and corneasBlood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the blood service. Both paid staff and volunteers are used to undertakeschool/university programs and corporate programs.The German Red Cross Blood Service forwards plasma to a fractionation facility. In 2008 the plasmafractionation operation in Springe was sold by the German red Cross to Octapharma.9The German Red Cross is not planning to expand or scale back its current level of involvement inblood-related activities.EUROPE AND CENTRAL ASIA292EUROPE AND CENTRAL ASIA LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan15]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/gm.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 15]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 15].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Trading Economics. Germany - Female adults with HIV (% of population ages 15+ with HIV) [Internet] TradingEconomics 2017 [cited 2018 Jan 15]. Available from:https://tradingeconomics.com/germany/female-adults-with-hiv-percent-of-population-ages-15-with-hiv-wb-data.html7 Henseler O. Report on notifications pursuant to Section 21 TFG (German Transfusion Act) for 2016. [Internet] PaulEhrlich Institute 2017 [cited 2017 October 02]. Available from: http://www.pei.de/EN/information/bloodsupply/reports/report-blood-supply-2012-2016-21tfg-content.html8 Seitz R. PEI Working for Blood Safety. [Internet] Paul-Ehrlich-Institut 2017 [cited 2017 October 03]. Available from:http://www.pei.de/SharedDocs/Downloads/EN/who/who-praesentation-seitz-en.pdf?__blob=publicationFile&v=29 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.10 Deutsches Rotes Kreuz. DRK-Blutspendedienste. Versorgung und Finanzierung. [Internet] Deutsches Rotes Kreuz2017 [cited 2017 October 03]. Available from: https://www.drk-blutspende.de/blutspendedienste/versorgung-undfinanzierung.php11 Council of Europe. Report of the survey on blood supply management organised by the TS003 Working Group inmember states and observer states of the Council of Europe. [Internet] Council of Europe 2014 [cited 2017 October 09].Available from: https://www.edqm.eu/medias/fichiers/report_survey_on_blood_supply_management_2012.pdf12 European Blood Alliance. Germany [Internet] European Blood Alliance 2017 [cited 2017 October 03]. Available from:http://www.europeanbloodalliance.eu/membership/germany293EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL AITALYItalian Red Cross:Level A (undertakes full blood service provision)100% VNRBDNATIONAL CONTEXTLocationSouthern EuropeGeographical size ranking173rdPopulation (world ranking)162 million (23rd)Median age145.5Political system1Parliamentary republicGDP per capita (worldranking)1$38,000 (49th)HDI Index (world ranking)20.887 - very high (26th)Health Expenditure19.2% of GDPEfficiency of Healthcare33rd of 51 countriesPopulation prevalencehepatitis B4Low intermediate: 2% - 4%Population prevalencehepatitis C5High moderate: 2.0% <5.0%Population prevalence HIV60.3% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe National Blood Centre in Italy was established by decree in April 2007.7 It is part of the NationalHealth Service with the Ministry of Health responsible for legislation, coordination and supervision.8,9Transfusion services are delocalised.9 Regional Health Services deliver blood and blood componentcollection, processing, testing, storage and distribution, and all transfusion medicine activities.8,9The National Blood Centre (Centro Nazionale Sangue CNS) is responsible for nationalcoordination as well as scientific and technical control of the national blood service.8,9 It alsomaintains a register of qualified blood inspectors, provides training and regularly assesses theirskills.8 With the support of the National Transplant Centre, CNS also coordinates the Italian CordBlood Network (ITCBN) and also collaborates with the National Medicines Agency in regards to theevaluation of plasma for fractionation and plasma-derived medicinal products.7Technical direction is provided to accredited donor associations for outsourced blood collectionensuring compliance with national regulation and self-sufficiency, quality and safety plans.9EUROPE AND CENTRAL ASIA294EUROPE AND CENTRAL ASIA LEVEL AWith explicit regional approval and accreditation these blood collection units are run by the followingfour main blood donor organisations: Association of Voluntary Italian Blood Donors (AVIS) Italian Federation of Blood Donors (FIDAS) FRATRES Italian Red Cross7100% of blood donation in Italy is VNRBD.10In 2017 almost 830,000 kilograms of plasma was collected for fractionation.11NATIONAL SOCIETY (ITALIAN RED CROSS)The Italian Red Cross is involved in blood activities at Level A:Blood is mentioned several times in the 2013 Annual report, including awareness-raisingactivities, organizing information days, and Club 25.12The website of the Italian Red Cross states that We promote and actively support thedonation of blood and blood products, and in addition, the Italian Red Cross promotes thedonation of bone marrow, organs, tissues and cells.131Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/it.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 19]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 19].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Centro Nazionale Sangue. CNS [Internet] Centro Nazionale Sangue 2018 [cited 2018 Feb 20]. Available from:http://www.centronazionalesangue.it/node/68 European Blood Alliance. Membership. Italy. [Internet] European Blood Alliance 2017 [cited 2018 Jan 19]. Availablefrom: http://www.europeanbloodalliance.eu/membership/italy/9 Centro Nazionale Sangue. The transfusions system in Italy [Internet] Centro Nazionale Sangue 2018 [cited 2018 Feb20]. Available from: http://www.centronazionalesangue.it/node/110 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organisation 2011 [cited 2018 Jan 19]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=111 Grazzini, G. Italian policies for blood and blood product self-sufficiency and safety. Paper presented at: TheInternational Federation of Blood Donor Organizations; 2012, June 23; San Marino. PowerPoint presentation availablefrom: http://www.avis.it/attachments/5773_documento.pdf Centro Nazionale Sangue. In 2017 collected almost 830thousand kilos of plasma [Internet] Centro Nazionale Sangue 2018 [cited 2018 Feb 20]. Available from:http://www.centronazionalesangue.it/node/65612 Croce Rossa Italiana. Annual Report 2013. [Internet] Croce Rossa Italiana 2014 [cited 2018 Jan 19]. Available at:http://data.ifrc.org/public/documents/IT/AR_Italy_2013_Italian.pdf13 Croce Rossa Italiana. Activity. Promotion of voluntary blood donation. [Internet] Croce Rossa Italiana 2017 [cited 2018Jan 19]. Available from: http://www.cri.it/flex/cm/pages/ServeBLOB.php/L/IT/IDPagina/21066.295EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL ALUXEMBOURGLuxembourg Red Cross:Level A (undertakes full blood service provision)100% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationWestern EuropeGeographical size ranking1179thPopulation (world ranking)1594 thousand (171st)Median age139.3Political system1Constitutional monarchyGDP per capita (worldranking)1$109,100 (5th)HDI Index (world ranking)20.898 - very high (20th)Health Expenditure16.6% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Very low: 0 - <1.0%Population prevalence HIV50.3% (in adults 15-49years)NATIONAL BLOOD PROGRAMThe Red Cross is involved in blood services at Level A and collects 100% of the national bloodsupply in Luxembourg.The Ministry of Health oversees blood activities in the country and performs annual inspections ofblood banks.6 All hospitals must have a transfusion committee which is responsible for blood safetyand haemovigilance.6The pricing for blood is also defined by the MoH; a red cell unit costs approximately US$309.6NATIONAL SOCIETY (LUXEMBOURG RED CROSS)The Luxembourg Red Cross:has ten fixed sites (approximately 70% of donations are collected at a central collectioncentre)6annually collects (2015):o 20,200 units of whole bloodo 3,550 units by apheresisEUROPE AND CENTRAL ASIA296EUROPE AND CENTRAL ASIA LEVEL Aprocesses collected blood into componentsconducts screening of blood for infectious diseases and blood grouping. National testing isalso conducted by the German Red Cross in Frankfurtconducts cross-matching for transfusion (as do hospitals)forwards plasma to a fractionation facility (Octapharma)6does not perform transfusionsis not involved in cord blood stem cells, peripheral stem cells, bone marrow stem cells,bone/solid organ transplants or corneassupplies blood to five hospitals/clinicsis accredited to ISO 9001 V2008 and ISO 15189 V2012is largely (95%) funded by the sale of blood products - the Ministry of Health provides theremaining 5% of the budget.does not receive technical assistance for VNRBD or blood service activities from outside thecountry, however some financial support is received from international partnersdonor recruitment and retention activities (mainly school/university programs) arecoordinated nationally, are undertaken by volunteers and are funded by the bloodestablishment in firms and donor associationsThere are nine Associations of Blood Donors in Luxembourg who are involved in blood donoreducation and recruitment activities and maintain a link between the public, the government and theLuxembourg Red Cross blood service.7 These groups recruit 300-400 new donors each year throughinformation stalls at public events.7The Luxembourg Red Cross does not have plans to either expand or scale back the current level ofinvolvement in blood related activities.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec11]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/lu.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Dec 11]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 11] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 11] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5World Health Organization: World Health Statistics 2011 [Internet] World Health Organization 2011 [cited 2017 Dec 11].Available from : http://www.who.int/gho/publications/world_health_statistics/EN_WHS2011_Full.pdf?ua=16 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p7 Croix-rouge luxemboureoise. Blood donor associations [Internet] Croix-rouge luxemboureoise 2017 [cited 2017 Dec 11]Available from : http://www.croix-rouge.lu/en/associations-de-donneurs-de-sang/297EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL ASPAINSpanish Red Cross:Level A (undertakes full blood service provision)5% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationSouth-western EuropeGeographical size ranking153rdPopulation (world ranking)148 million (28th)Median age142.7Political system1Parliamentary constitutionalmonarchyGDP per capita (worldranking)1$38,200 (48th)HDI Index (world ranking)20.884 - very high (27th)Health Expenditure19% of GDPEfficiency of Healthcare314th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low moderate: 1.5- <2.0%Population prevalence HIV60.4% among adults aged 15 to49NATIONAL BLOOD PROGRAMThe Red Cross blood centre operates in Madrid. Each of the 17 autonomous communities (AC orlocal government) in Spain has its own public blood program.7Despite their autonomous operations management, every Regional Blood Transfusion Service isfully incorporated into a unique and common Public National Health System, ensuring a blood supplybased on 100% VNRBD.8As of 2013, in addition to the 24 blood centres operating in the AC there were 341 transfusionservices in hospitals that used blood.7The Spanish Blood Transfusion Committee under the Public Health Directorate of the Ministry ofHealth ensures that there is a safe and adequate blood supply.8The Scientific Committee for Blood Safety makes proposals to the authorities about safety issuesand disseminate / publish their own studies, reports, recommendations etc. to the Spanish BloodTransfusion organisation.8EUROPE AND CENTRAL ASIA298EUROPE AND CENTRAL ASIA LEVEL AMajor providers of blood in Spain are:Andaluca Regional Blood Service (16%)Catalua Regional Blood Service (15%)Valencia Regional Blood Service (10%)Spanish Red Cross Blood Service (5%)Hospitals pay for the blood, with some price variation (approved by the AC Ministry) between ACs.In 2012:there were 1,769,471 blood donations in Spain from 2.17 million active donors376,000 litres of plasma was sent for fractionation to Grifols, a global plasma fractionationplan located near Barcelona7NATIONAL SOCIETY (SPANISH RED CROSS)The Spanish Red Cross:collected 88,522 whole blood donations in 2014, with 115,000 whole blood donations forecastfor 2015supports the community of Madrid (6.4 million people)does not process blood into components this is performed by the Ministry of Health /governmentdoes not conduct screening tests of blood for infectious diseases and blood grouping. thisis performed by the Ministry of Health / governmentdoes not conduct cross-matching for transfusion this is performed by hospitalsdoes not forward plasma to a fractionation facilitydoes not perform transfusionsis not involved in the collection, processing or testing in cord blood stem cells, peripheralstem cells, bone marrow stem cess, bone, cornea or solid organsis not accrediteddoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryThere are no plans to either expand or scale back the current level of involvement in blood relatedactivities.Donor recruitment and retention activities are coordinated by district/chapter by the National Society.Paid staff are used for donor recruitment programs, such as school/university programs andcorporate programs. The recruitment and retention activities are funded by the blood service.299EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan15]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/sp.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 15]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 15].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook [Internet] Central Intelligence Agency 2016 [cited 2018 Jan 15]Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p8 European Blood Alliance. Spain. [Internet] European Blood Alliance 2018 [cited 2018 Jan 15] Available from:http://www.europeanbloodalliance.eu/membership/spain/EUROPE AND CENTRAL ASIA300EUROPE AND CENTRAL ASIA LEVEL ASWITZERLANDSwiss Red Cross:Level A (undertakes full blood service provision)100% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationCentral EuropeGeographical size ranking1136thPopulation (world ranking)18.2 million (98th)Median age142.4Political system1Federal republicGDP per capita (worldranking)1$61,400 (17th)HDI Index (world ranking)20.939 - very high (2nd)Health Expenditure111.7% of GDPEfficiency of Healthcare316th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low moderate: 1.5% - <2.0%Population prevalence HIV60.35% among adults 15-49yearsNATIONAL BLOOD PROGRAMThe Swiss Confederation mandates that the Swiss Transfusion SRC along with the regional bloodtransfusion services safeguard the supply of blood products to hospitals and clinics across thecountry.7Swiss Transfusion SRC Inc. is an autonomous, non-for-profit public limited company within the SwissRed Cross (SRC).7 Most of its shares are held by the SRC; the remainder are owned by the 11regional blood transfusion services.7 Both the umbrella organisation, Swiss Transfusion SRC, andthe regional blood transfusion services are non-profit organisations.7Swiss Transfusion SRC works in close partnership with the competent agencies of the federaladministration, the Federal Office of Public Health (FOPH) and the Swiss Agency for TherapeuticProducts, Swissmedic.7Blood products are purchased by hospitals, the price for which is set by the national government.8In 2016, there were 295,015 blood donations.7301EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL ANATIONAL SOCIETY (SWISS RED CROSS)The Swiss Red Cross Blood Service:annually collects (2015):o 310,000 units of whole bloodo 20,000 donations by apheresisprocesses collected blood into componentsconducts screening of blood for infectious diseases and blood groupingconducts cross-matching for transfusion (cross-matching is also conducted by hospitals)forwards plasma to several fractionation facilitiesdoes not perform transfusionsis involved in cord blood stem cells, peripheral stem cells, bone marrow stem cellsis not involved in the collection, processing or testing bone/solid organ transplants or corneassupplies blood to 200 hospitals/clinicsis accredited to ISOdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryThere are no plans to either expand or scale back the current level of involvement in blood relatedactivities.Donor recruitment and retention activities are coordinated both nationally and by district/chapter bythe National Society. Paid staff as well as volunteers are used for donor recruitment programs, suchas school/university programs and corporate programs. The recruitment and retention activities arefunded by the blood service.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan15]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/sz.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 15]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 15].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook [Internet] Central Intelligence Agency 2016 [cited 2018 Jan 15]Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Transfusion CRS Suisse. Swiss transfusion SRC at a glance. [Internet] Transfusion CRS Suisse 2017 [cited 2018 Jan15] Available from: http://en.blutspende.ch/swisstransfusion.php8 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203pEUROPE AND CENTRAL ASIA302EUROPE AND CENTRAL ASIA LEVEL ATURKEYTurkish Red Crescent Society:Level A (undertakes full blood service provision)80% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationSouth-eastern Europe andSouth-western AsiaGeographical size ranking138thPopulation (world ranking)180 million (18th)Median age130.9Political system1Parliamentary republicGDP per capita (worldranking)1$26,500 (75th)HDI Index (world ranking)20.767 - high (71st)Health Expenditure15.4% of GDPEfficiency of Healthcare330th of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV6Low: <0.1%NATIONAL BLOOD PROGRAMThe Ministry of Health oversees blood banking and transfusion medicine services and is responsiblefor legislation, registration and monitoring of blood banks.7The first law regarding blood services was issued in 1983 and updated in 2007; the national bloodpolicy includes an aim for VNRBD and self-sufficiency in the national blood supply. 7 A nationalTransfusion Committee (MoH) develops specific requirements for blood safety including forcollection, processing and storage of blood. 8National laws require blood banks to follow quality control programs; accreditation is undertaken bythe Joint Commission International (JCI).7 As well as national recommendations, WHO and Councilof Europe guidelines are used nationally.7While there are references which state that the Turkish Red Crescent became the sole provider ofblood services in the country in 2007, when the law for a centralized national blood system waspassed8, their global mapping survey response indicates that they collect 80% of the national bloodsupply. The remaining 20% is collected by hospital blood banks.303EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL ABlood is provided for a fee to hospitals; the price per unit is set by the government and isapproximately US$65 per unit of RBC. 8In 2014, Turkey imported all its therapeutic plasma products as there was no plasma fractionationfacility in the country.8 In 2013 it was announced that the Red Crescent and the Ministry of Healthwere considering the construction of a plasma fractionation plant in Turkey.8NATIONAL SOCIETY (TURKISH RED CRESCENT)The Turkish Red Crescent has 17 Regional Blood Centres, 65 Blood Donation Centres and over 150mobile units.9 The majority of collections are from mobile drives and are from male donors.8The Turkish Red Crescent Society:annually collects (2016):o 1,904,609 whole blood donationso 33,367 blood donations collected by apheresisprocesses collected blood into componentsconducts screening tests of blood for infectious diseases and blood groupingdoes not cross-match for transfusion this is conducted by hospitals.does not forward plasma to a fractionation facilitydoes not perform transfusionsis accredited to Joint Commission International (JCI)supplies blood to 1,235 hospitals/clinicsis not involved in the collection, processing or testing of cord blood stem cells, peripheralstem cells and bone marrow stem cells, bone, solid organs or corneasdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countrysupports a population of 75 million peopleThere are no plans to either expand or scale back the current level of involvement in blood relatedactivities.Donor recruitment and retention activities are coordinated nationally by the National Society. Paidstaff, as well as volunteers, are used for donor recruitment programs, such as school/universityprograms, Club 25 and corporate programs. The recruitment and retention activities are funded bythe government or Ministry of Health.EUROPE AND CENTRAL ASIA304EUROPE AND CENTRAL ASIA LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec11]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/tu.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Dec 11]. Available from: http://hdr.undp.org/en/countries3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] 2 Bloomberg 014 [cited 2017 Dec 11].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 11] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 11] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Anadolu Agency. HIV/AIDS cases in Turkey reaches 1,734 in 2016 [Internet] Anadolu Agency 30 November 2016.[cited2017 Dec 11]. Available from: http://aa.com.tr/en/health/hiv-aids-cases-in-turkey-reaches-1-734-in-2016/6964197 World Health Organization. Regional Office for Europe. Country profile: Blood services in Turkey. [Internet] AnadoluAgency 2017 [Cited 2017 Dec 11]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/bloodsafety/archive/turkey/country-profile-blood-services-in-turkey8 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p9 Turkish Red Crescent. Blood Services [Internet] Turkish Red Crescent 2017 [cited 2017 Dec 11]. Available from:http://www.kizilay.org.tr/what-we-do/blood-services305EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BALBANIAAlbanian Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern EuropeGeographical size ranking1145thPopulation (world ranking)13 million (136th)Median age132.9Political system1Parliamentary republicGDP per capita (worldranking)1$12,500 (124th)HDI Index (world ranking)20.764 - high (75th)Health Expenditure15.9% of GDPPopulation prevalencehepatitis B3High Intermediate: 5 7%Population prevalencehepatitis C4Low: 1 - <1.5%Population prevalence HIV50.1% among adults aged 15to 49NATIONAL BLOOD PROGRAMAlbania has a national policy on blood with responsibility delegated to the Ministry of Health.6The National Blood Transfusion Service (NBTS) is funded by the government through the Ministryof Health. The NBTS includes:the National Blood Transfusion Centres (NBTC)32 hospital blood banks6Blood donors are recruited through the Red Cross and the Organisation of Voluntary Blood Donors.6In 2009, 29,232 blood donations were collected:64% were family replacement26% were VNRBD10% were paid6Albania has a history of paid blood donation with 80% of blood donations being paid for in 1994. 7Professional donors have been organised in a Paid Blood Donor National Organisation, which hasbecome a powerful lobby group standing in the way of VNRBD.7 VNRBD was first implemented in1994 with the support of the IFRC. The first law on blood came into effect in 1995, but did notemphasise the principle of voluntary donation.7EUROPE AND CENTRAL ASIA306EUROPE AND CENTRAL ASIA LEVEL BWhilst VNRBD donations are increasing through the efforts of the Red Cross, in 2015, 66% of blooddonated was from donors who donated blood only for a family member or friend.7 The rate of VNRBDis 10.5 per 1000 population.7Challenges to move towards 100% VNRBD include:lack of tradition/culture of VNRBD in rural areas70% of donors being malelack of budget to promote VNRBDexisting Paid Blood Donor National Organisation acting as a powerful lobby group againstVNRBD7NATIONAL SOCIETY (ALBANIAN RED CROSS)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the government or Ministry of Health. Paid staff are used for donor recruitment.Recruitment programs include school/university programs, Club 25 and corporate programs.Since 2007, Norway Red Cross has supported the Albanian Red Cross Society providing bothtechnical assistance (Club 25) and financial support.Albania Red Cross has not previously been involved at Level A.In 2015, a proposal was sent to the Health and Care Coordinator in Budapest for the furtherdevelopment of the National Blood Program in Albania.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan15]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/al.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 15]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook [Internet] Central Intelligence Agency 2016 [cited 2018 Jan 15]Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6Durro V. Increasing blood availability and providing the highest donor and patient safety in transfusion therapy inemergency special circumstances. Situation in Albania. 2014 Jul 7-9; Bucharest. Presentation available from:http://www.azus.gov.rs/wp-content/uploads/2014/07/Country-Presentation_Albania_Vjollca-Durro.pdf7 Deliana, A. Report of Albanian Red Cross Blood Program for Global Advisory Panel. Albanian Red Cross; 2015.307EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BAZERBAIJANRed Crescent Society of Azerbaijan:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-western AsiaGeographical size ranking1114thPopulation (world ranking)19.9 million (90th)Median age131.3Political system1Presidential republicGDP per capita (worldranking)1$17,400 (99th)HDI Index (world ranking)20.759 - high (78th)Health Expenditure16% of GDPEfficiency of Healthcare349th of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5High moderate: 2.0 - <5.0%Population prevalence HIV60.1% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Blood Transfusion Service of Azerbaijan was created by the former Soviet Union and was madeup of a central institute for blood transfusion in Baku and four regional blood transfusion stationslocated in Sheki, Gandja, Kuba, and Nakhichevan.7Blood services in Azerbaijan are overseen by the Research Institute on Haematology andTransfusiology, which contains the central blood bank, and there are interregional blood banks inthe cities of Gyandzhe, Sheki and Gube, and in the independent republic of Nakhchivan.7In 2008, a VNRBD law was passed allowing only non-paid blood donors, and there is noremuneration for donors other than travel expenses in special cases.7In 2010, 45,149 blood donations were collected in Azerbaijan.8EUROPE AND CENTRAL ASIA308EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (RED CRESCENT OF AZERBAIJAN)In 2004, the Azerbaijan Red Crescent Society, supported by the Norwegian Red Cross Society,initiated "Development of Blood donation in Azerbaijan" program, whose aim is to recruit VNRBDdonors.7Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the National Society and small scale events are funded by the AzRC,while expanded via AzRC plus partners.Volunteers are used for donor recruitment. Recruitment programs include school/universityprograms and Club 25.The Red Crescent Society of Azerbaijan:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywould like to strengthen non-remunerated blood donor recruitment and attract more volunteerblood donors by organizing public/promotion activities, creating Pledges-25, and plan toestablish close contacts with blood banks in the country and with other partners within andoutside the countryhas not previously been involved at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan15]. Available from https://www.cia.gov/library/publications/the-world-factbook/geos/aj.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 15]. Available from: . http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 15].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook [Internet] Central Intelligence Agency 2016 [cited 2018 Jan 15]Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Economic Cooperation Organisation. Blood Safety Network. Republic of Azerbaijan [Internet] Economic CooperationOrganisation 2012 [cited 2018 Jan 15] Available from:http://www.ecobsn.com/main/index.php?lang=en&mode=page&mcode=1&cat=&id=48 Economic Cooperation Organisation. Blood Safety Network. Azerbaijan Country Report [Internet] EconomicCooperation Organisation 2015 [cited 2018 Jan 15] Available from:http://www.ecobsn.com/main/index.php?lang=en&mode=page&mcode=7&cat=&id=166309EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BBOSNIA AND HERZEGOVINARed Cross Society of Bosnia and Herzegovina:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern EuropeGeographical size ranking1129thPopulation (world ranking)13.9 million (128th)Median age142.1Political system1Parliamentary republicGDP per capita (worldranking)1$11,400 (135th)HDI Index (world ranking)20.750 - high (81st)Health Expenditure19.6% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0 - <1.5%Population prevalence HIV5<0.1%NATIONAL BLOOD PROGRAMThe blood transfusion service in Bosnia and Herzegovina is decentralized and divided into threeparts: Federation of Bosnia and Herzegovina, the Republic of Srpska and Brcko District.6The Institute of Transfusion Medicine FBiH is the largest and best equipped transfusion institution. 6Four transfusion centres operate in Tuzla, Mostar-East, Mostar West and Zenica. In addition, thereare eight hospital departments for transfusion.6A Law on Blood and Blood Components was implemented in 2010, which regulates the organisationof transfusion services, conditions and quality standards, security and surveillance in the collection,testing, processing, storage, distribution, issuance and use of human blood and blood componentsin Bosnia and Herzegovina. 6Collection, testing, processing, storage, distribution and use of blood and blood components in theFederation, shall be in accordance with EU directives, the WHO recommendations, therecommendations of the CoE, good laboratory, manufacturing and clinical practice, as well as otherregulations in this field. 6Each year, 70,000 to 80,000 units of blood are collected, with 1.8% of the population donating. 6EUROPE AND CENTRAL ASIA310EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (RED CROSS OF BOSNIA AND HERZEGOVINA)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the blood service, the National Society and by private organisations.Volunteers are used for donor recruitment. Recruitment programs include school/universityprograms and corporate programs.The Red Cross Society of Bosnia and Herzegovina:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis planning to expand (no details provided)has not previously been involved in blood at Level ARed Cross Society of Bosnia and Herzegovina 2012 annual report describes the printing anddistribution of booklets for blood donors, thank you letters and posters, as well as awards andcelebrations for world blood donor day. 7The number of people donating blood at or with the help of the Red Cross Society of Bosnia andHerzegovina was 5000 in both 2012 and 2013. 81Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan15]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bk.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 15]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 World Health Organization: HIV/AIDS country profile 2011: Bosnia and Herzegovina [Internet] World HealthOrganization 2013 [cited 2018 Jan 15] Available from: http://www.euro.who.int/en/countries/bosnia-andherzegovina/publications2/hivaids-country-profile-2011-bosnia-and-herzegovina6 Djozo A, Ljuca A. Blood transfusion service in Bosnia & Herzegovina; 2014 Jul; Bucharest. Presentation available from:http://www.azus.gov.rs/en/wp-content/uploads/2012/10/Country-Presentation_BiH_Aida-Djozo.pdf7 The Red Cross Society of Bosnia and Herzegovina. 2012 Annual Report [Internet] The Red Cross Society of Bosniaand Herzegovina 2016 [cited 2018 Jan 15] Available from: http://adore.ifrc.org/Download.aspx?FileId=419378 The Red Cross Society of Bosnia and Herzegovina. [Internet] The Red Cross Society of Bosnia and Herzegovina 2016[cited 2018 Jan 15] Available from: http://data.ifrc.org/fdrs/societies/the-red-cross-society-of-bosnia-and-herzegovina311EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BCROATIACroatian Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern EuropeGeographical size ranking1128thPopulation (world ranking)14.2 million (127th)Median age143Political system1Parliamentary republicGDP per capita (worldranking)1$24,100 (82nd)HDI Index (world ranking)20.827 - very high (45th)Health Expenditure17.8% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2-4%Population prevalencehepatitis C4Low: 1.0-<1.5%Population prevalence HIV5<0.1%NATIONAL BLOOD PROGRAMThe Croatian Institute of Transfusion Medicine (CITM) is responsible for approximately 55% of thenational blood supply, with the remaining collections undertaken by eight hospital based bloodbanks.6The CITM provides a reference center service to the Croatian Ministry of Health.7There are a number of laws which regulate the functioning of blood services in the country and theMinistry of Health (with a transfusion member board of experts) provides oversight. 8 There are alsonational standards for blood bank procedures.8A national blood policy was drafted in 2007.8 Approximately 180,000 blood units are collected in thecountry each year, all from voluntary donors. 8 9The Agency for Medicinal Products and Medical Devices is responsible for blood service licensingand the Agency of Accreditation performs laboratory accreditation.8Croatia has a pharmaceutical plant which performs plasma fractionation for the preparation ofalbumin and immunoglobulins.8EUROPE AND CENTRAL ASIA312EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (CROATIAN RED CROSS)The Croatian Red Cross provides education on voluntary blood donation, recruits blood donors andundertakes blood drives, and provides recognition to donors (such as awards).Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the government or Ministry of Health.Paid staff are used for donor recruitment programs, such as corporate programs.The Croatian Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Athe Croatian Red Cross has indicated that they would like to expand their services to Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/hr.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Dec 12]. Available from: http://hdr.undp.org/en/countries/profiles/HRV3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 UNAIDS. Country Factsheets Croatia [Internet] UNAIDS 2017 [cited 2017 Dec 12]. Available from:http://www.unaids.org/en/regionscountries/countries/croatia/6 Council of Europe, European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM).Report of the survey on blood supply management organised by the TS003 Working Group in member states andobserver states of the Council of Europe [Internet] Council of Europe 2012 [cited 2017 Dec 12] Available from:https://www.edqm.eu/medias/fichiers/report_survey_on_blood_supply_management_2012.pdf7 European Blood Alliance. Membership Croatia [Internet] European Blood Alliance 2017[cited 2017 Dec 12] Availablefrom: http://www.europeanbloodalliance.eu/membership/croatia/8 World Health Organisation Europe. Blood Services in South-Eastern Europe Current Status and Challenges. [Internet]World Health Organisation Europe 2007 [cited 2017 Dec 12]. Available from:http://www.euro.who.int/__data/assets/pdf_file/0014/90401/E90300.pdf9 Croatian Red Cross. Voluntary blood donation [Internet] Croatian Red Cross 2017 [cited 2017 Dec 12] Available from:http://www2.hck.hr/en/category/-voluntary-blood-donation-61313EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BCYPRUSCyprus Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationMediterranean IslandGeographical size ranking1170thPopulation (world ranking)11.2 million (159th)Median age136.8Political system1Presidential democracyGDP per capita (worldranking)1$36,600 (52nd)HDI Index (world ranking)20.856 - very high (33rd)Health Expenditure17.4% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2-4%Population prevalencehepatitis C4Very low: 0 - <1.0%Population prevalence HIV50.06% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn Cyprus, 7-8% of the population are active blood donors, which is almost double the proportion ofactive blood donors in other European countries.6In Cyprus, 60,000 units of blood are donated and 120,000 blood products are transfused every year.7Cyprus has created a good VNRBD tradition and is able to cover all its blood related needs throughVNRBD.8NATIONAL SOCIETY (CYPRUS RED CROSS)There are six branches in the Cyprus Red Cross Society: Nicosia, Limassol, Famagusta, Larnaca,Paphos and Kyrenia. The Limassol Branch is the most active one in terms of Blood Donation andhas a great cooperation with schools/universities. The other Branches have very limited or noinvolvement at all in Blood donation.Initiated in 1969, the blood donation scheme of the Limassol Branch continues with great success.The blood is collected in Limassol and Limassol District Schools, and is offered to the Blood Bank ofEUROPE AND CENTRAL ASIA314EUROPE AND CENTRAL ASIA LEVEL Bthe General Limassol Hospital. Members and volunteers of the Branch offer to all blood donors asandwich with a bottle of water after their donation.Also, certificates and ID card are issued to each donor. Once a year, a prize is given to the schoolwhich offered the most blood units. Approximately 4000 units are collected every year for the BloodBank.Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. They are funded by the National Society (Limassol Branch).Volunteers are used for donor recruitment programs, such as school/university programs.The Cyprus Red Cross (Limassol Branch):receives technical assistance from the Limassol General Hospitaldoes not receive financial support for VNRBD activities from outside the countryis not planning to expand or scale back its current level of involvement in blood-relatedactivitieshas not previously been involved at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan15]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/cy.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 15]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 15] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook [Internet] Central Intelligence Agency 2016 [cited 2018 Jan 15]Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Evripidiou, S. A leading light in blood donation. Cyprus Mail [Internet] 2014 Jun 13 [cited 2018 Jan 15] Available from:http://cyprus-mail.com/2014/06/13/a-leading-light-in-blood-donation/7 Cyprus tops European blood donor table. Cyprus Mail [Internet] 2016 Jun 14 [cited 2018 Jan 15] Available from:http://cyprus-mail.com/2016/06/14/cyprus-tops-european-blood-donor-table/8 Cyprus Red Cross Society. What We Do. Blood donation. [Internet] Cyprus Red Cross Society 2018 [cited 2018 Jan15] Available from : http://www.redcross.org.cy/en/what-we-do/blood-donation315EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BCZECHIA (CZECH REPUBLIC)Czech Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral EuropeGeographical size ranking1117thPopulation (world ranking)110.6 million (87th)Median age142.1Political system1Parliamentary republicGDP per capita (worldranking)1$35,200 (55th)HDI Index (world ranking)20.878 - very high (28th)Health Expenditure17.4% of GDPEfficiency of Healthcare318th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV60.02% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Czech Blood Transfusion Service is comprised of 53 blood transfusion centres which collectand process blood into components, the overwhelming majority of these (50) are hospital based withthe remaining three being independent centres.7 The independent centres support regional hospitalsand there are an additional 29 collection and autologous centres located in smaller hospitals.7 Bloodcomponents may be utilised in the given hospital or distributed to blood banks of other hospitals.7127 blood banks perform cross-matching and issue blood components to clinical wards as eitherpart of a hospital blood establishment, through the blood collection centre of a hospital or as anindependent department of the hospital.7 Only the smallest hospitals do not have their blood bank.7National coordination is indirect but there are common rules and principals observed and a commonsystem of financing.7 The cost of blood components is compensated by a Health Insurance Companyto the hospital and the blood establishment charges the hospital by blood components delivered anddistributed.7EUROPE AND CENTRAL ASIA316EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (CZECH RED CROSS)Czech Red Cross closely cooperates with blood transfusion centres and participates in recruitingand appreciation of blood donors.The 2014 annual report describes the following projects:non-renumerated blood donation recruit donors, promote and publicise the projectStudent Blood Harvest aimed at high school and university studentsdonate blood only as if familiarise secondary school students with blood donationaward ceremonies, concerts and balls 8In 2014, 29,291 blood donors received a range of awards for donating blood at least ten times.In 2013, 270,800 people were donating blood with the help of the Czech Red Cross. 91Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16] Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ez.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 16]. Available from http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 16].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Country Progress Report. The Czech Republic. Global AIDS Response Progress Report 2015 [Internet] 2016 [cited2018 Jan 16] Available from: http://www.unaids.org/en/regionscountries/countries/czechrepublic7 Council of Europe. European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM).Report of the survey on blood supply management organised by the TS003 Working Group in member states andobserver states of the Council of Europe [Internet] Council of Europe 2012 [cited 2018 Jan 25] Available from:https://www.edqm.eu/medias/fichiers/report_survey_on_blood_supply_management_2012.pdf8 Czech Red Cross. 2014 Annual report; [Internet] Czech Red Cross 2016 [cited 2018 Jan 16]. 40 p. Available at:http://data-api.ifrc.org/documents/CZ/AR_Czech%20Republic_2014_English.pdf9 International Federation of Red Cross and Red Crescent Societies. Federation-wide databank and reporting system.Czech Red Cross [Internet] International Federation of Red Cross and Red Crescent Societies 2016 [cited 2018 Jan 16]Available from: http://data.ifrc.org/fdrs/societies/czech-red-cross317EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BGEORGIARed Cross Society of Georgia:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-western AsiaGeographical size ranking1122ndPopulation (world ranking)14.9 million (124th)Median age137.9Political system1Semi-presidential republicGDP per capita (worldranking)1$10,600 (137th)HDI Index (world ranking)20.769 - high (70th)Health Expenditure17.4% of GDPPopulation prevalencehepatitis B3Low intermediate: 2-4%Population prevalencehepatitis C4High: 5%Population prevalence HIV50.5% among adults aged 15to 49NATIONAL BLOOD PROGRAMPrior to the early 90s when Georgia was part of the Soviet system, voluntary blood donations werecollected by regional blood centres and some hospital-based centres led by the National BloodTransfusion Centre in Georgias capital Tbilisi. 6 As part of the governments privatization plan,between 2007 and 2010 the standalone blood centres of Georgia (including the National Centre,which is now the Georgian Central Blood Bank) were purchased by private firms, these private firmsmostly paid donors for blood donations.6 By 2012, just 10% of blood was collected from VNRBDdonors with the remainder from paid donors, and most of the collected blood was from six facilitiesin Tbilisi.6The private centres collect blood based on hospital orders and both the centres and hospitals onlyhave small reserves, RBCs and platelets are often not available in emergencies. 6 Red Crossvolunteers are called on to donate during blood shortages.7Blood policy and regulations are managed by the National Centre for Disease Control and PublicHealth under Georgias Ministry of Labour, Health and Social Affairs, however, there is a lack ofcompliance inspections, formal regulations or approval of blood products. 6The main products issued are whole blood and red cells, although implementation of apheresiscollections in two blood centres in Georgia was planning to start in 2014.6EUROPE AND CENTRAL ASIA318EUROPE AND CENTRAL ASIA LEVEL BFour cases of transfusion-associated HIV transmission were discovered in 2012, but the date of thetransfusions is uncertain. 6NATIONAL SOCIETY (RED CROSS OF GEORGIA)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the IFRC and participating National Societies bilaterally by the Norwegian RedCross blood program.Since 2009, a VNRBD project has been running in Georgia with the support of the Norwegian RedCross with the aim of increasing VNRBD donations amongst youth aged 18-30.8 In 2015, workshopsreached 594 volunteers and 3022 young people.8 571 young people, ready to donate blood, weremobilized, of those, 321 people (including 35 Red Cross Society of Georgia volunteers) donatedblood in 2015.8Both paid staff and volunteers are used for donor recruitment programs, such as school/universityprograms and corporate programs.The Red Cross Society of Georgia:has not previously been involved in blood activities at Level Ais planning to expand its current level of involvement in blood-related activities:o blood donor recruitment activities being implemented in six of the 33 local brancheso additional financial support - it plans to widen the coverage and involve as manybranches as possible to raise the proportion of VNRBD1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/gg.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 16]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-totravel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-totravel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.7Anca A. Georgia: Red Cross volunteers donate blood to save mothers. International Federation of Red Cross and RedCrescent Societies [Internet] 2014 Sept 3 [cited 2018 Jan 16]. Available from: http://www.ifrc.org/en/news-andmedia/news-stories/europe-central-asia/georgia/world-blood-donation-day-66970/8 Georgia Red Cross Society. Annual Report 2015. [Internet] Georgia Red Cross Society 2015 [cited 2018 Jan 16].Available from: http://www.redcross.ge/ge/component/k2/item/336319EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BHUNGARYHungarian Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral EuropeGeographical size ranking1111thPopulation (world ranking)19.9 million (92nd)Median age142.3Political system1Parliamentary republicGDP per capita (worldranking)1$28,900 (69th)HDI Index (world ranking)20.769 - high (70th)Health Expenditure17.4% of GDPEfficiency of Healthcare338th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV60.1%NATIONAL BLOOD PROGRAMAll of Hungarys blood and stem cell services are provided by the Hungarian National BloodTransfusion Service (OVSZ), founded in 2000.7,8 Since 2007 the OVSZ has also provided all organprocurement processes, in accordance with Government Decree.7,8 The OVSZ operates under thedirection of the Hungarian Ministry of Healths National Haematology and Blood Transfusion Institute,which was established in 2000.9All regional activity is coordinated by the national centre in Budapest8, which along with five regionalblood centres with 20 linked local centres comprises the blood operations of the OVSZ.9The OVSZ and the Hungarian Red Cross work very closely, with the Red Cross having recruitedvoluntary donors since 19598. Around 400,000 blood donations take place annually an average of1.6 blood donations for each active donor.10 All blood donors are unpaid.9In 2012, approximately 71,500 litres of plasma was sent for fractionation by Human Bioplazma.9EUROPE AND CENTRAL ASIA320EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (HUNGARIAN RED CROSS)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the blood service.Both paid staff and volunteers are used for donor recruitment programs, such as school/universityprograms.The Hungarian Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis not planning to expand or scale back its current level of involvement in blood-relatedactivitieshas not previously been involved at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/hu.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 16]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 16].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16]. Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16]. Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 World Health Organization: World Health Statistics 2010 [Internet] World Health Organization 2010 [cited 2018 Jan 16].Available from: http://www.who.int/gho/publications/world_health_statistics/EN_WHS10_Full.pdf7 Hungarian National Blood Transfusion Service. Hungarian National Blood Transfusion Service [Internet] 2012 Jun 13[cited 2018 Feb 19]. Available from: http://www.hnbts.hu/8 Hungarian National Blood Transfusion Service. Blood Donation Giving is Good [Internet] Hungarian National BloodTransfusion Service 2012 [cited 2018 Feb 19]. Available from:http://www.ovsz.hu/sites/ovsz.hu/files/ovsz_dokumentum/csatolmanyok/the_hnbts_has_three_main_missions/hnbts_introduction.pdf9 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.10 European Blood Alliance. Membership. Hungary. [Internet] European Blood Alliance 2018 [cited 2018 Jan 16].Available from: http://www.europeanbloodalliance.eu/membership/hungary/321EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BKAZAKHSTANKazakh Red Crescent:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AsiaGeographical size ranking110thPopulation (world ranking)118.5 million (62nd)Median age130.6Political system1Presidential republicGDP per capita (worldranking)1$26,100 (77th)HDI Index (world ranking)20.794 - high (56th)Health Expenditure14.4% of GDPPopulation prevalencehepatitis B3High Intermediate: 5-7%Population prevalencehepatitis C4High moderate: 2.0% <5.0%Population prevalence HIV50.20% among adults aged15 to 49NATIONAL BLOOD PROGRAMBlood services in Kazakhstan are very fragmented and mostly hospital based with no nationalcoordination. 6 There are 23 blood centres: Scientific Production Centre of Blood Transfusion inAstana, Republican Blood Centre in Almaty, 14 regional and 7 city centres, as well as 21 bloodtransfusion units, each working within a defined geographical area.7Ministries of Health regulate all blood service activities, but there is a lack of adequate laws,regulations, policies, and strategies on blood services.6 Blood centres provide medical facilities withblood and blood products.6Blood safety is a concern in Kazakhstan, in a region in Southern Kazakhstan, 143 children aged onemonth to three years were diagnosed with HIV and the transfusion of blood was identified as asignificant risk factor for HIV transmission.6In 2009, a total of 280,861 units of blood were collected in Kazakhstan, of which 79% were wholeblood donations and 21% plasmapheresis donations.6EUROPE AND CENTRAL ASIA322EUROPE AND CENTRAL ASIA LEVEL BDuring 2000-2011, the proportion of VNRBD donations decreased from 97.6% in 2000 to 77.9% in2011.7 In the same period, the proportion of VNRBD plasma donations decreased from 60.1% to29.8%.7Whilst the average number of blood donations per 1,000 population reduced from 19.8 (2000) to16.8 (2011), plasma donations increased from 1.4 to 3.1 in the same period.7NATIONAL SOCIETY (KAZAKH RED CRESCENT)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the National Society and participating National Societies.Volunteers are used for donor recruitment programs, such as school/university programs, Club 25and corporate programs.The Kazakh Red Crescent Society:receives technical assistance from CDCdoes not receive financial support for VNRBD activities from outside the countryis planning to expand its current level of involvement in blood-related activities by expandingpromotion of VNRBD into all brancheshas not previously been involved at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/kz.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 16]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Economic Cooperation Organization. Blood Safety Network. Kazakhstan. [Internet] Economic Cooperation Organization2015 [cited 2018 Jan 16]. Available from: http://www.ecobsn.com/Library/kazakh.pdf7 Igissinov N, Kulmirzayeva D, Magzumova R, Sibinga D, Alpeissova S. Trends in blood and plasma donations inKazakhstan: 12-years retrospective analysis. Iran Journal of Public Health. 2014 May; 43(5): 601-609. Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449408/323EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BLATVIALatvian Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationEastern EuropeGeographical size ranking1125thPopulation (world ranking)11.9 million (149th)Median age143.6Political system1Parliamentary republicGDP per capita (worldranking)1$27,300 (73th)HDI Index (world ranking)20.830 - very high (44th)Health Expenditure15.9% of GDPPopulation prevalencehepatitis B3No current data availablePopulation prevalencehepatitis C4High moderate: 2.0 - <5.0%Population prevalence HIV50.8% among adults aged 15to 49.NATIONAL BLOOD PROGRAMAdministration and coordination of the Latvian Blood Donor Service is from the State Blood Centrein Riga.6 There are eight blood establishments and 52 hospital blood banks which must comply withlegislation and mutual agreements, and are certified by the State Agency of Medicine.6All Latvian patients receive blood components and plasma free of charge.6The functions of the State Blood Centre are to:promote human blood and blood components for Latvian self-sufficiencyensure that blood and blood components are free donationprotect public health and prevent the transmission of infectious diseases7In 2014, the blood centre produced:33,346 units of packed red cells33,346 units of fresh frozen plasma4,465 platelets6631 cryoprecipitate7EUROPE AND CENTRAL ASIA324EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (LATVIAN RED CROSS)The purpose of the Latvian Red Cross is to promote voluntary non-remunerated blood donation inLatvia, as well as recruiting donors to provide blood for those who need it.8 In 2013, 11,653 peoplewere donating blood at or with the help of the Latvian Red Cross. 9Blood donor recruitment and retention activities are coordinated both nationally and bydistrict/chapter by the National Society. They are funded by the blood service, the National Societyand by government / Ministry of Health.Both paid staff and volunteers are used for donor recruitment programs, such as school/universityprograms and corporate programs.The Latvian Red Cross:does not receive technical assistance for VNRBD activities from outside the countryreceives financial support for VNRBD activitiesis not planning to expand or scale back its current level of involvement in blood-related activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/lg.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 16]. Available from:. http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16]. Available from http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16]. Available from http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 World Health Organization: World Health Statistics 2010 [Internet] World Health Organization 2010 [cited 2018 Jan 16].Available from: http://www.who.int/gho/publications/world_health_statistics/EN_WHS10_Full.pdf6 European Blood Alliance. Membership. Latvia [Internet] European Blood Alliance 2018 [cited 2018 Jan 16]. Availablefrom: http://www.europeanbloodalliance.eu/membership/latvia/7 Valsts asinsdonoru centra. 2014 Gada Publiskais Prskats [2014 annual report of the Latvian National Blood Service in Latvian] [cited 2018 Jan 16]. Available from:https://www.vadc.lv/data/gada_parskati/vadc-publiskais-parskats-2014.pdf8 Latvijas Sarkanais Krusts [Latvian Red Cross]. Blood donors movement. [Internet] Latvijas Sarkanais Krusts 2018 [cited2018 Jan 16]. Available from: http://www.redcross.lv/en/what-we-do-2/health-promotion/blood-donors-movement/9 International Federation of Red Cross and Red Crescent Societies. Federation-wide databank and reporting system.Latvian Red Cross [Internet] International Federation of Red Cross and Red Crescent Societies 2016 [cited 2018 Jan 16]Available from: http://data.ifrc.org/fdrs/societies/latvian-red-cross325EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BLIECHTENSTEINLiechtenstein Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral EuropeGeographical size ranking1219thPopulation (world ranking)138,244 (213th)Median age143.2Political system1Constitutional monarchyGDP per capita (worldranking)1$139,100 (1st)HDI Index (world ranking)20.912 - very high (15th)Health Expenditure1n/aPopulation prevalencehepatitis B3Low: <2.0%Population prevalencehepatitis C4Very low: <1.0%Population prevalence HIVN/ANATIONAL BLOOD PROGRAMIn a report on trends and observations on the collection, testing and use of blood and bloodcomponents in Europe, it states that no data could be obtained for Liechtenstein as blood transfusionactivities are run by operators acting under the responsibility of control authorities from neighbouringcountries. 5Currently there are about seven blood drives per year. Production, testing and distribution are theresponsibility of the Austrian Red Cross. There are only about 2000 donations a year andLiechtenstein Red Cross is involved in 50% of them. The other 50% are made in a local hospital withno Red Cross involvement.NATIONAL SOCIETY (LIECHTENSTEIN RED CROSS)The Liechtenstein Red Cross works in cooperation with the Blood Transfusion Service of the AustrianRed Cross. 6 The Liechtenstein Red Cross is involved in motivation and recruitment. Additionally theyhelp at the mobile drives but they are not responsible for the collection, production and distribution.EUROPE AND CENTRAL ASIA326EUROPE AND CENTRAL ASIA LEVEL BCurrently there are seven annual blood donation drives annually in Liechtenstein collecting around500 litres of blood. These are organised by the local Samaritan clubs in cooperation with the AustrianRed Cross.7In 2013, 974 people were donating blood at or with the help of the Liechtenstein Red Cross. 81Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ls.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 16]. Available from:. http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Janssen M.P, Behr-Gross M.-E. Trends and observations on the collection, testing and use of blood and bloodcomponents in Europe. 2001-2008 report. Council of Europe. [cited 2018 Jan 16]. 92 p. Available from:https://www.edqm.eu/medias/fichiers/trends_and_observations_on_the_collection_testing_and_use_of_blood_and_blood_components_in_europe.pdf6 Liechtensteinisches Rotes Kreuz. Jahresbericht ber das Geschftsjahr 2014 des Liechtensteinischen Roten Kreuzes[2014 Annual report in German] [cited 2018 Jan 16]. Available from: http://dataapi.ifrc.org/documents/LI/AR_Liechstenstein_2014_German.pdf or http://www.roteskreuz.li/.7 Liechtensteinisches Rotes Kreuz. Blutspenden.[Liechtenstein Red Cross. Blood Donations] [Internet]Liechtensteinisches Rotes Kreuz [cited 2018 Jan 16]. Available from: https://www.roteskreuz.li/blutspenden/8 International Federation of Red Cross and Red Crescent Societies. Federation-wide databank and reporting system.Liechtenstein Red Cross [Internet] International Federation of Red Cross and Red Crescent Societies 2016 [cited 2018Jan 16]. Available from: http://data.ifrc.org/fdrs/societies/liechtenstein-red-cross327EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BMACEDONIARed Cross of the Former Yugoslav Republic of Macedonia:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern EuropeGeographical size ranking1150thPopulation (world ranking)12.1 million (145th)Median age137.9Political system1Parliamentary republicGDP per capita (worldranking)1$15,200 (109th)HDI Index (world ranking)20.748 - high (82nd)Health Expenditure16.5% of GDPPopulation prevalencehepatitis B3No dataPopulation prevalencehepatitis C4Low: 1.0%-<1.5%%Population prevalence HIV5<0.1%NATIONAL BLOOD PROGRAMThe National Institute for Transfusion Medicine (NITM) is the major organisation in Macedoniaresponsible for transfusion service.6 The NITM comprises three regional centres (in Stip, Tetovo andBitola) and services in 18 hospitals.7 NITM services have been nationally coordinated since 2011,prior to this they were state based.7The NITM is the responsibility of the Macedonian Ministry of Health and is financed by a HealthInsurance Fund, state budget and a fee for service to hospitals.8A number of laws regulate blood service activities, the National Blood Policy was developed by theNational Commission for blood transfusion.8In 2013/2014 the European Union IPA project Strengthening the blood safety system supportedthe implementation of a quality system for the NITM and national guidelines for blood safety as wellas strengthening the capacity of health professionals.6In 2004, 54,758 units of whole blood and 170 apheresis platelets were collected.8EUROPE AND CENTRAL ASIA328EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (MACEDONIAN RED CROSS)The Macedonian Red Cross are the main partner of the NITM for blood donor recruitment.8Blood donation in Macedonia is based on the principles of VNRBD. 9Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the National Society and the government or Ministry of Health.Volunteers are used for donor recruitment programs, such as school/university programs, Club 25,corporate programs and other.The Macedonian Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis not planning to expand or scale back its current level of involvement in blood-relatedactivitieshas not previously been involved at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/mk.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Dec 12]. Available from: http://hdr.undp.org/en/countries3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 UNAIDS. Country Factsheets Macedonia [Internet] UNAIDS 2017 [cited 2017 Dec 12]. Available from:http://www.unaids.org/en/regionscountries/countries/theformeryugoslavrepublicofmacedonia6 Grubovic RM. Et al. Strengthening of the Blood Safety System in the National Blood Transfusion Service Implementation of the European Union IPA Project at the Institute for Transfusion Medicine of the Republic ofMacedonia. Macedonian Journal of Medical Sciences. 2014 Sep 15; 7(3):506-509. http://dx.doi.org/10.3889/MJMS.18575773.2014.04237 National Institute of Transfusion Medicine, History Blood donations in Macedonia through times [Internet] NationalInstitute of Transfusion Medicine 2016 [cited 2017 December 14] Available from:http://itm.org.mk/en/%D0%B8%D1%81%D1%82%D0%BE%D1%80%D0%B8%D1%98%D0%B0%D1%82/8 World Health Organisation Europe. Blood Services in South-Eastern Europe Current Status and Challenges. [Internet]World Health Organisation 2007 [cited 2017 Dec 14]. Available from:http://www.euro.who.int/__data/assets/pdf_file/0014/90401/E90300.pdf9 Macedonian Red Cross. Blood donation [Internet] Macedonian Red Cross 2016 [cited 2017 Dec 12] Available from:http://ckrm.org.mk/en/d0-ba-d1-80-d0-b2-d0-be-d0-b4-d0-b0-d1-80-d0-b8-d1-82-d0-b5-d0-bb-d1-81-d1-82-d0-b2-d0-be/329EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BMONTENEGRORed Cross of Montenegro:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern EuropeGeographical size ranking1162ndPopulation (world ranking)1642,550 (168th)Median age140.7Political system1Parliamentary republicGDP per capita (worldranking)1$17,400 (100th)HDI Index (world ranking)20.807 - very high (48th)Health Expenditure16.4% of GDPPopulation prevalencehepatitis B3Not readily availablePopulation prevalencehepatitis C42.4% in Central Europe(including Montenegro)Population prevalence HIV50.02%NATIONAL BLOOD PROGRAMMontenegro has recently received support from the European Union (EU) and the World HealthOrganisation (WHO) to introduce and apply European blood transfusion standards in Montenegro. 6The new Law on Blood supply was adopted by Parliament on 9 January 2014, and entered into forceon 17 January 2014. 7WHO has also provided support to develop:a communication strategy for donor promotiona plan for human resources in transfusion medicine for the period 2013-2022occupational standards for staffa quality model and manual for the blood service7The EU provided funds to provide laboratory equipment (including consumables), furniture, ITequipment and technical support for the new Blood Transfusion Institute in Montenegro which wasofficially opened in September 2015. 8In Montenegro, blood donors make about 2.7% of the total population which is only two thirds ofthe required level of 4%. 9In 2014 the proportion of VNRBD donors in Montenegro was just 32%. 10EUROPE AND CENTRAL ASIA330EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (RED CROSS OF MONTENEGRO)Red Cross of Montenegro is the organization who is responsible for motivation, promotion andraising awareness activities in the area of Voluntary Blood Donation.Blood donor recruitment and retention activities are coordinated nationally and by district/chapter bythe National Society. They are funded by the National Society and the government or Ministry ofHealth.Both volunteers and paid staff are used for donor recruitment programs, such as school/universityprograms, Club 25 and VBD clubs which are under the Red Cross Branches.The Red Cross of Montenegro:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis planning to expand its current level of involvement in blood-related activities by raisingawareness activities and promotion of VBDhas not previously been involved at Level A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/mj.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 16]. Available from: http://hdr.undp.org/en3 Schweitzer A, Horn J, Mikolajczyk R, Krause G, Ott J. Estimations of worldwide prevalence of chronic hepatitis B virusinfection: a systematic review of data published between 1965 and 2013. The Lancet. 2015; 386(10003): 1546-1555.Available from: http://www.sciencedirect.com/science/article/pii/S014067361561412X?via%3Dihub4 Hanafiah K, Groeger J, Flaxman A and Wiersma S. Global epidemiology of hepatitis C virus infection. New estimates ofage-specific antibody to HCV seroprevalance. Hepatology. 2013; 57(4): 1333-1342. Available from:http://onlinelibrary.wiley.com/doi/10.1002/hep.26141/full5 UNAIDS. Country progress report. Montenegro [Internet] UNAIDS 2014 [cited 2018 Jan 16]. Available from:http://www.unaids.org/sites/default/files/country/documents//file,94668,es..pdf6 World Health Organization Europe. Promotion of voluntary blood donation in Montenegro. [Internet] World HealthOrganization 2014 [cited 2018 Jan 16]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/bloodsafety/news/news/2014/12/promotion-of-voluntary-blood-donation-in-montenegro7 World Health Organization. Regional Office for Europe. Country work. [Internet] World Health Organization 2018 [cited2018 Jan 16]. Available from:http://www.euro.who.int/en/health-topics/Health-systems/blood-safety/country-work8 EU Director Paquet and PM Djukanovic open the Blood Transfusion Institute of Montenegro. European Union.Delegation of the European Union to Montenegro. [Internet]. 2015 Sept 14 [cited 2018 Jan 16]. Available from:http://www.delmne.ec.europa.eu/code/navigate.php?Id=31799 Societe Generale Montenegro. Blood donor activity. Humanitarian action of employees of Societe Generale BankaMontenegro. [Internet] Societe Generale Montenegro 2015 [cited 2018 Jan 16]. Available from:http://www.societegenerale.me/en/novosti/davanjekrvi10 World Health Organization Europe. Progress towards improved blood transfusion system in Montenegro [Internet]World Health Organization 2014 [cited 2018 Jan 16]. Available from: http://www.euro.who.int/en/health-topics/Healthsystems/blood-safety/news/news/2014/08/progress-towards-improved-blood-transfusion-system-in-montenegro331EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BNORWAYNorwegian Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationNorthern EuropeGeographical size ranking169thPopulation (world ranking)15.3 million (120th)Median age139.2Political system1Parliamentaryconstitutional monarchyGDP per capita (worldranking)1$70,600 (12th)HDI Index (world ranking)20.949 - very high (1st)Health Expenditure19.7% of GDPEfficiency of Healthcare311th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: <1.0%Population prevalence HIV60.15% among adults aged15 to 49NATIONAL BLOOD PROGRAMAll blood banks in Norway are owned by regional health trusts and incorporated with the hospitals. 7Three quarters of blood is collected by 14 blood banks, despite the fact that there are approximately50 blood centres and the 14 larger blood banks provide plasma to a commercial company forfractionation.7Blood donors are defined under national legislation as patients, and blood and blood products aredefined as drugs.8 The competent authority for blood, tissue, organs, cells and medical devices isthe Norwegian Directorate of Health (under the Ministry of Health), however they are not the authorityfor drugs.8In 2012, just over 100,000 donors contributed to 213,031 blood donations (all leukoreduced), 14,447by apheresis, in addition, a small amount of blood was collected at private hospitals. 8Donors are tested pre-donation for disease markers which reduces the rate of donations testingpositive.8EUROPE AND CENTRAL ASIA332EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (NORWEGIAN RED CROSS)The majority (80%) of blood donors are recruited by the Norwegian Red Cross.8Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by an earlier provision or fund.Volunteers and one manager (paid by the National Society via the provision or fund mentionedabove) are used for donor recruitment programs. Recruitment programs include stands arranged bylocal Red Cross branches. The National Society operates social media (Facebook) and internet.The Norway Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe country. On two occasions, support has been received from national governments toacquire more blood donorshas previously been involved at Level A blood activities - the Red Cross provided Norway'slargest blood bank until 1996 when it was transferred to Oslo University Hospital, and theearmarked funds are now being used for activities currently provided1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/no.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 16]. Available from http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 16].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Index Mundi. Norway HIV/AIDS adult prevalence rate.[Internet] Index Mundi 2014 [cited 2018 Jan 16]. Available from:https://www.indexmundi.com/norway/hiv_aids_adult_prevalence_rate.html7 European Blood Alliance. Norway [Internet] European Blood Alliance 2018 [cited 2018 Jan 16]. Available from:http://www.europeanbloodalliance.eu/membership/norway/8 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.333EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BPOLANDPolish Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral EuropeGeographical size ranking171stPopulation (world ranking)138.5 million (36th)Median age140.7Political system1Parliamentary republicGDP per capita (worldranking)1$29,300 (66th)HDI Index (world ranking)20.855 - very high (36th)Health Expenditure16.4% of GDPEfficiency of Healthcare321st of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV60.07% among adults aged15 to 49NATIONAL BLOOD SYSTEMIn Poland, the National Blood Centre in Warsaw helps coordinate activities among the 21 regionalblood centres which manage over 150 collection sites.7 Blood centres are also operated by theMinistry of Interior and the military, however these represent less than 5% of total blood collected inPoland. 7Whilst all blood donations are VNRBD, incentives are provided via income tax deductions for eachlitre of whole blood and plasma donated.7In 2012, the regional centres issued 1,089,418 RBCs to hospitals, produced over 300,000 units ofplatelets and more than 200,000 litres of FFP.7EUROPE AND CENTRAL ASIA334EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (POLISH RED CROSS)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the National Society and private organisations.Both paid staff and volunteers are used for donor recruitment programs corporate programs.The Polish Red Cross:does not receive technical assistance from outside the countryreceives financial support for VNRBD activitiesis not planning to expand or scale back its current level of involvement in blood relatedactivitieswas previously involved at Level A, however stopped collecting blood in 19581Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan17]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/pl.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 17]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 17].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 17] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 17] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Index Mundi. Poland HIV/AIDS adult prevalence rate.[Internet] Index Mundi 2014 [cited 2018 Jan 17]. Available from:https://www.indexmundi.com/poland/hiv_aids_adult_prevalence_rate.html7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p335EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BRUSSIARussian Red Cross Society:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationNorth AsiaGeographical size ranking11stPopulation (world ranking)1142 million (9th)Median age139.6Political system1Semi-presidentialfederationGDP per capita (worldranking)1$27,900 (71st)HDI Index (world ranking)20.804 - high (49th)Health Expenditure17.1% of GDPEfficiency of Healthcare351st of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5High moderate: 2.0 <5.0%Population prevalence HIV61%NATIONAL BLOOD PROGRAMIn 2007 there were 181 publically-funded blood centres in Russia, however this number decreasedto 130 in 2012.7 Hospital-based transfusion departments (blood banks) also decreased in this timeand numbered 386 in 2012.7 Hospitals receive blood free of charge.7In 2012, approximately 4.15 million whole blood donations were made with roughly 82% of wholeblood donors unpaid.7 The ratio of donors in Russia is only 14-17 per 100,000.8In 2013, the law on donation of blood and blood components came into force, which prohibiteddonating large amounts of blood.9 The law also limited payment for donations to rare bloodcomponents and blood groups, and specified the exclusive function of the Russian Red Cross in thepromotion of voluntary blood donation.8 The new law led to fears of a shortage of blood. 9Despite the law outlining that donor benefits be restricted to intangible benefits 9, there are severalincentives still offered to donors in Russia:they may be offered two days off work for donating7receive an award and 9,959 roubles (approximately 142 EUR) once they reach 40 wholeblood or 60 plasma donations9many plasma donors receive payment of approximately 1,128 roubles per donation 7EUROPE AND CENTRAL ASIA336EUROPE AND CENTRAL ASIA LEVEL BIn 2008 Russia lifted the deferral of men having sex with men, however with a rise in the HIVepidemic in Russia the rate of HIV positive donors increased by over 50% which brought questionsover whether the ban should be reinstated.7NATIONAL SOCIETY (RUSSIAN RED CROSS)The Global Mapping survey was completed for both Levels B and C. It appears that some branchesact at Level B and others at Level C.Only 24 of the Russian Red Cross regional branches are working in the field of non-remuneratedblood donation. These branches provide an information campaign on blood donation and some ofthem are involved in the recruitment of donors.Blood donor recruitment and retention activities are coordinated by district/chapter by the NationalSociety. Some branches are funded by the blood service.Volunteers are used for donor recruitment programs, such as Club 25.Financial support was provided by the Federation for the implementation of the club 25 project at theSt Petersburg branch. All other branches of the RRC are working without financial support.The Russian Red Cross Society has not previously been involved in blood at Level A and is notplanning to expand or scale back its current level of involvement in blood related activities.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan17]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/rs.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 17]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 17].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 17] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 17] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Russian HIV-AIDS epidemic worsening under Kremlin policies, says expert. The Guardian [Internet] 2015 May 15 [cited2018 Jan 17]. Available from: http://www.theguardian.com/world/2015/may/15/russian-hiv-aids-epidemic-worseningunder-kremlin-policies-says-expert7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.8 Russia: New law puts Red Cross centre stage in blood provision. International Federation of Red Cross and RedCrescent Societies [Internet] 2013 Jun 13 [cited 2018 Jan 17]. Available from: http://www.ifrc.org/en/what-wedo/health/blood-services/world-blood-donor-day/russia-new-law-puts-red-cross-centre-stage-in-blood-provision-62505/9 Ponomareva Y. Russia caps payments for blood donations. Russia beyond the headlines [Internet] 2013 Jan 26 [cited2018 Jan 17]. Available from:https://rbth.com/society/2013/01/26/russia_caps_payments_for_blood_donations_22239.html337EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BSERBIARed Cross of Serbia:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth-eastern EuropeGeographical size ranking1118thPopulation (world ranking)17.1 million (102nd)Median age142.6Political system1Parliamentary republicGDP per capita (worldranking)1$15,200 (108th)HDI Index (world ranking)20.776 - high (66th)Health Expenditure110.4% of GDPEfficiency of Healthcare337th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low: 1.0 - <1.5%Population prevalence HIV60.05% among adults aged15 to 49NATIONAL BLOOD PROGRAMIn 2003, the European Agency for Reconstruction financed a project for the reorganisation of theSerbian blood service.7Serbia adopted a national strategy for providing adequate quantities of safe blood and bloodproducts in 2005, which was seen as a significant step forward in achieving compliance with EUdedicated directives.8In 2012, Serbia had 44 hospital based blood establishments (processing blood from donors todelivering to patients).9 In addition, there are three Institutes of Blood Transfusion:Institute of Blood transfusion of Serbia (based in Belgrade)Institute of Blood Transfusion of VojvodinaInstitute of Blood Transfusion of Nis9Just over half (51%) of the blood is provided by the three Institutes of Blood Transfusion, with theremainder being provided by the hospitals.9National coordination of all blood systems is provided by the Direction of Biomedicine Ministry ofHealth of Serbia, however, coordination was not yet well established in 2012.9EUROPE AND CENTRAL ASIA338EUROPE AND CENTRAL ASIA LEVEL BNATIONAL SOCIETY (RED CROSS OF SERBIA)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the government or Ministry of Health. In addition, the National Society and localRed Cross branches apply for small grants in order to provide additional funds for promotion,recruitment and retention of VNRBD.Both paid staff and volunteers are used for donor recruitment. Programs include school/universityprograms, Club 25. The promotion and recruitment of VNRBD takes place as part of daily operations,as well as part of other programs implemented by the Red Cross of Serbia. Each blood drive is(annually there are more than 3,000) is also used as a promotional activity. Promotional activitiesare led by the volunteers of the Red Cross.The Red Cross of Serbia:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais not planning to expand or scale back its current level of involvement in blood relatedactivities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan18]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ri.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 18]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 18].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 18]. Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 16]. Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Index Mundi. Serbia HIV/AIDS adult prevalence rate.[Internet] Index Mundi.2013 [cited 2018 Jan 18]. Available from:https://www.indexmundi.com/serbia/hiv_aids_adult_prevalence_rate.html7 World Health Organisation. Regional Office for Europe. Blood services in south-eastern Europe. Current status andchallenges. [Internet] World Health Organisation 2007 [cited 2018 Jan 18]. Available from:http://www.euro.who.int/__data/assets/pdf_file/0014/90401/E90300.pdf8 Hafner V, Dobrota A, Sarlija D, Rasovic G. Quality and Safety of the National Blood Supply: A Priority for Action Subregional Overview Bulgaria, Croatia, Romania, Serbia and Montenegro. Transfusion Medicine and Hemotherapy[Internet]. 2006 Sep 18 [cited 2018 Jan 18] 2006:33:427-431. Available from: https://www.karger.com/Article/Pdf/949929 Council of Europe. European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM).Report of the survey on blood supply management organised by the TS003 Working Group in member states andobserver states of the Council of Europe [Internet] Council of Europe 2012 [cited 2018 Jan 18] Available from:https://www.edqm.eu/medias/fichiers/report_survey_on_blood_supply_management_2012.pdf339EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BSLOVAKIASlovak Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral EuropeGeographical size ranking1131stPopulation (world ranking)15.4 million (118th)Median age140.5Political system1Parliamentary republicGDP per capita (worldranking)1$32,900 (59th)HDI Index (world ranking)20.845 - very high (40th)Health Expenditure18.1% of GDPEfficiency of Healthcare333rd of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5High moderate: 2.0% <5.0%Population prevalence HIV60.02% among adults aged15 to 49NATIONAL BLOOD PROGRAMSlovakias Ministry of Health coordinates the national blood system and the cost of bloodcomponents is funded by the government.7 Slovakia has 11 regional blood establishments makingup the National Transfusion Service, which is responsible for 70% of the countrys blood supply. 7The remainder of the blood is collected by 31 hospital based blood establishments which deliverblood components to their own hospitals.7Slovakia reported having achieved 100% VNRBD in 2008.8NATIONAL SOCIETY (SLOVAK RED CROSS)188,141 people were donating blood with the assistance of the Slovak Red Cross in 2013.9Blood donor recruitment and retention activities are coordinated both nationally and bydistrict/chapter by the National Society. They are funded by the National Society, by government orMinistry of Health and by private organisations.EUROPE AND CENTRAL ASIA340EUROPE AND CENTRAL ASIA LEVEL BBoth paid staff and volunteers are used for donor recruitment. Programs include school/universityprograms and corporate programs.The Slovak Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais planning to expand its current level of involvement in blood related activities by involvingthe corporate sector more1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/lo.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 19]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 19].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Index Mundi. Slovakia HIV/AIDS adult prevalence rate.[Internet] Index Mundi 2014 [cited 2018 Jan 19]. Availablefrom: https://www.indexmundi.com/slovakia/hiv_aids_adult_prevalence_rate.html7 Council of Europe. European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM).Report of the survey on blood supply management organised by the TS003 Working Group in member states andobserver states of the Council of Europe [Internet] Council of Europe 2012 [cited 2018 Jan 19] Available from:https://www.edqm.eu/medias/fichiers/report_survey_on_blood_supply_management_2012.pdf8 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organisation 2011 [cited 2018 Jan 19]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=19 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Slovak Red Cross. [Internet] International Federation of Red Cross and Red CrescentSocieties2016 [cited 2018 Jan 19]. Available from: http://data.ifrc.org/fdrs/societies/slovak-red-cross341EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BSLOVENIASlovenian Red Cross:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationSouth Central EuropeGeographical size ranking1155thPopulation (world ranking)12 million (147th)Median age144.5Political system1Parliamentary republicGDP per capita (worldranking)1$34,100 (58th)HDI Index (world ranking)20.890 - very high (25th)Health Expenditure19.2% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV1< 0.1% among adults aged15 to 49NATIONAL BLOOD PROGRAMSince 1953 the Slovenian Red Cross has been the only organisation in the country recruiting andretaining blood donors. 5The transfusion service in Slovenia is currently made up of:the Blood Transfusion Centre of Slovenia (BTCS) together with units of transfusion medicinelocated in Novo Mesto, Trbovlje, Slovenj Gradec, Izola and Jesenicethe Centre of Transfusion Medicine Maribor (CTM) together with units located in Ptuj andMurska Sobotathe Centre of Transfusion Medicine Celje (CTM)the Department of Transfusion Medicine at the Dr. Franc Derganc Nova Gorica GeneralHospital 6The processing of blood into components is performed at:the Blood Transfusion Centre of Slovenia in Ljubljanathe Centre of Transfusion Medicine Mariborthe Centre of Transfusion Medicine Celje6The processed blood is returned to the units according to their needs and the plan.6EUROPE AND CENTRAL ASIA342EUROPE AND CENTRAL ASIA LEVEL BBlood is tested at the Blood Transfusion Centre of Slovenia in Ljubljana and the Centre ofTransfusion Medicine Maribor.6In 2011, there were:101,380 blood collections - 98,307 for whole blood62,872 blood donors14,359 registered bone marrow donors730 stored units of umbilical cord blood in the public bank6In Slovenia 100% of blood is collected from VNRBD. 7NATIONAL SOCIETY (SLOVENIAN RED CROSS)The Slovenian Red Cross is made up of 56 local branches, each covering one to three localmunicipalities. Each year, it conducts 380 field drives and motivates more than 62,000 regularindividual blood donors, thus ensuring a sufficient blood supply. The Slovenian Red Cross closelycooperates with the Ministry of Health, Blood Transfusion Centre of Slovenia and various otherinstitutions and companies.5Blood donor recruitment and retention activities are coordinated both nationally and bydistrict/chapter by the National Society. They are funded by the National Society and by thegovernment or Ministry of Health.Both paid staff and volunteers are used for donor recruitment programs, such as school/universityprograms and Club 25.The Slovenian Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais not planning to expand or scale back its current level of involvement in blood relatedactivities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/si.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 19]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Slovenian Red Cross. Brief overview of the Slovenian Red Cross. [Internet] Slovenian Red Cross 2015 [cited 2018 Jan19]. Available from: http://www.rks.si/sl/About_Slovenian_Red_Cross/6 The Slovenian Blood Transfusion Service. Full of Life. Life flows 2011. Annual Report of the Slovenian BloodTransfusion Service. [Internet] The Slovenian Blood Transfusion Service 2011 [cited 2018 Jan 19] Available from:http://www.ztm.si/uploads/publication/LP2011_ENG.pdf7 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organisation 2011 [cited 2018 Jan 19]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=1343EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL BUZBEKISTANRed Crescent Society of Uzbekistan:Level B - involved in the systematic/regular recruitment of voluntary non-remunerated blooddonors but with no involvement in blood collectionNATIONAL CONTEXTLocationCentral AsiaGeographical size ranking158thPopulation (world ranking)129.7 million (44th)Median age128.6Political system1Presidential republicGDP per capita (worldranking)1$7,000 (158th)HDI Index (world ranking)20.701 - medium (105th)Health Expenditure15.8% of GDPPopulation prevalencehepatitis B3High Intermediate: 5-7%Population prevalencehepatitis C4High: 5%Population prevalence HIV50.15% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe government of the Republic of Uzbekistan approved a law on donations of blood and itscomponents in 2002.6 In 2004, a loan agreement was made between the government and the AsianDevelopment Bank, committing US$7.2 million to upgrade blood services in Uzbekistan. 6 In 2006and 2007, comprehensive recommendations were developed to improve regional blood centresaccording to international standards, including upgrading medical and laboratory equipment, and in2008, a program for actions on non-remunerated blood donations was signed. 6The blood service in Uzbekistan is quite fragmented with 27 blood transfusion stations and 187 bloodtransfusion departments in 20107. Five regional blood centres and one national blood centrecomprise the national structure under the Ministry of Health.7 A program to promote voluntary nonremunerated blood donation was developed which included educational products about donation,and involved:state institutionsmass mediaNGOsvarious other funds 7EUROPE AND CENTRAL ASIA344EUROPE AND CENTRAL ASIA LEVEL BIn the early 2000s, the number of VNRBD donors decreased considerably to just 0.4-0.5% of thepopulation after the Uzbek authorities were unable to order a host of public sector employees tovolunteer to donate blood, despite the Soviet government doing this in the past.8 There are reportsof students being made to give blood and receiving bags of sugar as payment for their donation. 8NATIONAL SOCIETY (RED CRESCENT OF UZBEKISTAN)Blood donor recruitment and retention activities are coordinated nationally by the National Society.They are funded by the government or Ministry of Health.Both paid staff and volunteers are used for donor recruitment, such as school/university programs.The Red Crescent Society of Uzbekistan:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryhas not previously been involved at Level Ais not planning to expand or scale back its current level of involvement in blood relatedactivities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/uz.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 19]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Index Mundi. Uzbekistan HIV/AIDS adult prevalence rate.[Internet] Index Mundi 2015 [cited 2018 Jan 19]. Availablefrom: https://www.indexmundi.com/uzbekistan/hiv_aids_adult_prevalence_rate.html6 Economic Cooperation Organization. Blood Safety Network. Uzbekistan. [Internet] Economic Cooperation Organization2015 [cited 2018 Jan 19] Available from: http://www.ecobsn.com/Library/uzbak.pdf7 Training Workshop on achieving 100% Voluntary Non-Remunerated Blood Donation for priority countries in Europe andCentral Asia. World Health Organisation Europe Training Workshop. [Internet] 2010 Jun 16-18. Barcelona, Spain. [cited2018 Jan 19] Available from:http://www.euro.who.int/__data/assets/pdf_file/0010/128692/non_remunerated_blood_CEE_wkshp.pdf8 Sergeeva Y. Uzbekistan: Blood Shortages Cause Concern. Institute for War and Peace Reporting [Internet] 2009 Aug27 [cited 2018 Jan 19]. Available from: https://iwpr.net/global-voices/uzbekistan-blood-shortages-cause-concern345EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CANDORRAAndorran Red Cross:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouth-western EuropeGeographical size ranking1196thPopulation (world ranking)177 thousand (200th)Median age144.3Political system1Parliamentary democracy,co-principalityGDP per capita (worldranking)1$49,900 (29th)HDI Index (world ranking)20.858 - very high (32nd)Health Expenditure18.1% of GDPPopulation prevalencehepatitis BNot availablePopulation prevalencehepatitis CNot availablePopulation prevalence HIV30.07%NATIONAL BLOOD PROGRAMAs a very small country, Andorra does not have its own blood program. Instead it has agreementswith its neighbouring countries France and Spain.NATIONAL SOCIETY (ANDORRAN RED CROSS)Community education activities are coordinated nationally by the National Society. They are fundedby the government or Ministry of Health.The National Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas not previously involved in blood at Level A or Bis not planning to expand or scale back its level of activitiesEUROPE AND CENTRAL ASIA346EUROPE AND CENTRAL ASIA LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/an.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 19]. Available from:. http://hdr.undp.org/en3 World Health Organisation. Regional Office for Europe. Key facts on HIV epidemic in Andorra and progress in 2011.[Internet] World Health Organisation 2011 [cited 2018 Jan 19] Available from:http://www.euro.who.int/en/countries/andorra/publications/hivaids-country-profile-2011-andorra347EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CBELARUSBelarus Red Cross:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern EuropeGeographical size ranking187thPopulation (world ranking)19.5 million (93rd)Median age140Political system1Presidential republic,dictatorshipGDP per capita (worldranking)1$18,600 (95th)HDI Index (world ranking)20.796 - high (52nd)Health Expenditure15.7% of GDPEfficiency of Healthcare342nd of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.4% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe first blood transfusion unit in Belarus was an extension of the Central Institute of BloodTransfusion centre in Moscow and was responsible for blood collection and preparation as well asclinical testing and transfusion.7 In 1967, the manufacture of blood products was undertaken by theBelarussian Republican Station of Blood Transfusion (BRSBT), however they reformed in 2004 toform one unit under the Ministry of Health.7 The department was renamed in 2011 to become theRepublican Scientific and Practical Centre of Transfusiology and Medical Biotechnologies, andmodern testing and processing technologies were introduced to bring the centre in line with worldstandards.7Belarus experienced a very significant increase in VNRBD blood donations from 56% VNRBD in2004 to 99.9% in 2008. 8EUROPE AND CENTRAL ASIA348EUROPE AND CENTRAL ASIA LEVEL CNATIONAL SOCIETY (BELARUS RED CROSS)Community education activities are coordinated nationally and by district/chapter by the NationalSociety. In 2015 a funded project to promote blood donation was implemented, and these activitiescontinue occasionally without funding.The Belarus Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas not previously involved in blood at Level A or Bis planning to expand its level of activities and is looking for financial opportunities andsupport1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bo.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 19]. Available from:. http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 19].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Republican Scientific and Practical Center of Transfusiology and Medical Biotechnologies. History [Internet] RSPC2014 [cited 2018 Feb 20]. Available from: http://eng.blood.by/o-centre/istoriya8 World Health Organisation. Blood safety. Key global facts and figures 2011. [Internet] World Health Organisation 2011[cited 2018 Jan 19]. Available from:http://www.who.int/worldblooddonorday/media/who_blood_safety_factsheet_2011.pdf349EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CBULGARIABulgarian Red Cross:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouth-eastern EuropeGeographical size ranking1106thPopulation (world ranking)17.1 million (103rd)Median age142.7Political system1Parliamentary republicGDP per capita (worldranking)1$21,600 (85th)HDI Index (world ranking)20.794 - high (56th)Health Expenditure18.4% of GDPEfficiency of Healthcare345th of 51 countriesPopulation prevalencehepatitis B4Low Intermediate: 2-4%Population prevalencehepatitis C5Low: 1.0 - < 1.5%Population prevalence HIV6< 0.1% of adults aged 15to 49NATIONAL BLOOD PROGRAMThe Bulgarian government is responsible for the national blood service.7 A legislative framework forthe blood service was created in 2003 in line with EU requirements and WHO recommendations.7 Anational accreditation scheme for blood institutions is being introduced with the new legalframework.7 The Blood Safety Strategy 2005-2010 states blood safety as a strategic priority fornational health care policy.7Regulatory bodies include:the Ministry of Health, functioning through authorised officials and the Bulgarian Drug Agencythe National Drug Agency and the Expert accreditation committee of the Ministry of Healthhave regulatory functionsa National consultative committee for the stimulation of VNRBD was planned in the nationalProgram7EUROPE AND CENTRAL ASIA350EUROPE AND CENTRAL ASIA LEVEL CThe Blood Service consists of a National Centre of Haematology and Transfusiology (NCHT), fiveRegional Centres of Haematology and Transfusiology, and 23 Departments of TransfusionHaematology in hospitals. 8In 2015, there were less than 170,000 blood donors in Bulgaria or 24 per 1,000 population. 9NATIONAL SOCIETY (BULGARIAN RED CROSS)Community education activities are coordinated nationally and by district/chapter by the NationalSociety. They are funded by the National Society and by the government or Ministry of Health.The Bulgarian Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level B - due to legislative amendments in 1996 carriedout by the Ministry of Health, the Bulgarian Red Cross was excluded from the blood donorrecruitment system and was limited to the role of carrying out public promotion of VNRBD.With the amendments, the state-owned blood centres were tasked to engage in promotionaland recruitment activities, with respective new structures and job positions created within theblood centresis planning to expand its level of activities - it cooperates closely with the national and regionalblood centres, and will intensify efforts to ensure funding and state support for long-termVNRBD promotion in the society1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/bu.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 19]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 19].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 UNAIDS. Country Factsheets. Bulgaria 2016. [Internet] UNAIDS 2016 [cited 2018 Jan 19]. Available from:http://www.unaids.org/en/regionscountries/countries/bulgaria7 World Health Organisation. Regional Office for Europe. Blood services in south-eastern Europe. Current status andchallenges. [Internet] World Health Organisation 2007 [cited 2018 Jan 19]. Available from:http://www.euro.who.int/__data/assets/pdf_file/0014/90401/E90300.pdf8 Bulgaria with electronic blood donation registry by mid-2014. Novinite.com Sofia News Agency [Internet] 2013 Jun 13[cited 2018 Jan 19]. Available from:http://www.novinite.com/articles/151211/Bulgaria+with+Electronic+Blood+Donation+Registry+Mid-20149 Number of blood donors in Bulgaria ranks country among last in Europe Expert. Bulgarian News Agency [Internet]2016 Jan 19 [cited 2018 Jan 19] Available from: http://www.bta.bg/en/c/NW/id/1254561351EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CESTONIAEstonia Red Cross:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern EuropeGeographical size ranking1133rdPopulation (world ranking)11.3 million (158th)Median age142.7Political system1Parliamentary republicGDP per capita (worldranking)1$31,500 (61st)HDI Index (world ranking)20.865 - very high (30th)Health Expenditure16.4% of GDPPopulation prevalencehepatitis B3Low Intermediate: 2.4%Population prevalencehepatitis C4High moderate: 2.0% <5.0%Population prevalence HIV51.3% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Estonian Blood Transfusion Service consists of four separated blood centres attached to largehospitals:North Estonia Blood Centre located in capital city TallinnTartu University Clinics Blood CentrePrnu Hospital Blood CentreEast-Viru Hospital Blood Centre6The four blood centres work independently, but are covered by a common legislation whichregulations the collection, testing, processing and quality issues.7In 2017, there were 55,057 blood donations (from 17,558 donors), of which over half (54%) occurredin Tallinn.7All blood in Estonia is collected from unpaid donors, with slightly more donating at static sites (55%)than at mobile sites (45%). Hospitals purchase the blood products at fixed prices. 8EUROPE AND CENTRAL ASIA352EUROPE AND CENTRAL ASIA LEVEL CA 2012 University study of the blood system in Estonia found that the system supply chain workedwell and was relatively efficient, however the report recommended the establishment of centralcoordination, management and planning for Estonias blood system. 9Since 2004, around ten HIV cases annually have been identified amongst blood donors 0.02% ofall donors.10NATIONAL SOCIETY (ESTONIAN RED CROSS)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the National Society.The Estonia Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas not previously involved in blood at Level A or Bis not planning to expand or scale back its level of activities1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/en.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 19]. Available from: http://hdr.undp.org/en3 European Centre for Disease Prevention and Control. Annual Epidemiological Report for 2015 Hepatitis B. [Internet]ECDC Stockholm 2017 [cited 2018 January 25]. Available from:https://ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-hepatitis-B.pdf4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Index Mundi. Estonia HIV/AIDS adult prevalence rate.[Internet] Index Mundi 2014 [cited 2018 Jan 19]. Available from:https://www.indexmundi.com/estonia/hiv_aids_adult_prevalence_rate.html6 European Blood Alliance. Estonia [Internet] European Blood Alliance 2018 [cited 2018 Jan 19]. Available from:http://www.europeanbloodalliance.eu/membership/estonia/7 North Estonia Medical Centre Blood Centre. About us. Blood transfusion service in Estonia. [Internet] North EstoniaMedical Centre Blood Centre 2016 [cited 2018 Jan 19]. Available from: http://www.verekeskus.ee/en/about-us/bloodtransfusion-service-in-estonia/8 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.9 Alloja J, Espenberg K, Kiivet R. The analysis of cost-effectiveness of the optimal system of the blood service. Universityof Tartu. [Internet] 2012 [cited 2018 Jan 19]. Available from: https://www.sm.ee/sites/default/files/contenteditors/eesmargid_ja_tegevused/Tervis/Muud_infot/raportvereteenistus_ingk.pdf10UNAIDS. HIV in Estonia. Situation, prevention, treatment and care. Narrative report for GARPR 2014 [Internet]UNAIDS 2014 [cited 2018 Jan 19] Available from:http://www.unaids.org/sites/default/files/country/documents//file,94496,es..pdf353EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CKYRGYZSTANRed Crescent Society of Kyrgyzstan:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationCentral AsiaGeographical size ranking188thPopulation (world ranking)15.8 million (114th)Median age126.5Political system1Parliamentary republicGDP per capita (worldranking)1$3,700 (185th)HDI Index (world ranking)20.664 - medium (120th)Health Expenditure16.5% of GDPPopulation prevalencehepatitis B3High: 8%Population prevalencehepatitis C4High moderate: 2.0% <5.0%Population prevalence HIV50.2% among adults aged15 to 49NATIONAL BLOOD PROGRAMKyrgyzstans Ministry of Health operates the countrys Blood Transfusion Service, which includesthe Republican Blood Centre, five regional blood centres, 39 local clinical transfusion departmentsand a bus for mobile blood drive. 6Blood transfusion services in the Kyrgyz Republic lack of a systematic approach for the provision ofsafe blood transfusions.7 Blood is often donated by family members or paid donors and as a resultof this a number of programs were implemented to address these issues.7The Government of the Kyrgyz Republic established a State Program for the Development of theBlood (Transfusion) Service for 2007 - 2011 to:review the policy in the field of blood transfusion servicesincrease the number of voluntary blood donorsimprove the infrastructure and technical know-how in blood transfusion servicesassure blood and blood product quality and safety and a rational use of blood, bloodcomponents and related medicationsincrease the efficiency of the blood transfusion systems organisation 7EUROPE AND CENTRAL ASIA354EUROPE AND CENTRAL ASIA LEVEL CThe state program was followed by the HIV/AIDS Prevention Program II - Safe Blood Transfusion"from 2011 to 2015 to improve the quality and safety of blood transfusion and to increase theefficiency of the blood transfusion system in the Kyrgyz Republic. 7In 2011, the German Government provided 4 million Euros for a safe blood transfusion project toimprove the quality and safety of blood transfusions and to increase the efficiency of the blooddonation and transfusion system in Kyrgyzstan.8 Deliverables of this 30 month project included:rehabilitate selected blood banksmodernise blood bank equipmentestablish a Quality Assurance systemthe development and achievement of rationalisation measures 8In 2011, 34771 units of blood were collected at a rate of 6.6 per 1000 population.6NATIONAL SOCIETY (RED CRESCENT OF KYRGYZSTAN)Community education activities are coordinated by district/chapter by the National Society. They arefunded by the blood service, the National Society and Club 25 is supported by and under thesupervision of Republic Blood Centre of Kyrgyz Republic.The Red Crescent Society of Kyrgyzstan:receives both technical assistance and financial support for VNRBD activities from outsidethe country:o technical assistance was provided by US CDC to the National Society by provision ofa small grant, as well as assistance by WHO to the blood serviceo financial support to the National Society was provided by US CDC and Turkish RedCrescent by small grantswas not previously involved in blood at Level A or Bis planning to expand its blood related services nationally by mobilising the resources, andnoted in the survey that it would be good to have technical and financial support from IFRCfor VNRBD projects1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/kg.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 19]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan19]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Economic Cooperation Organisation. Blood Safety Network. Kyrgyzstan [Internet] Economic Cooperation Organisation2015 [cited 2018 Jan 19] Available from: www.ecobsn.com/Library/kyrkiz.pdf7 EPOS Health Management. HIV/AIDS Prevention Program II - Safe Blood Transfusion [Internet] EPOS HealthManagement 2017 [cited 2018 Jan 19]. Available from: http://www.epos.de/projects/hivaids-prevention-Program-ii-safeblood-transfusion8 EPOS Health Management. Safe blood transfusion project launched in Kyrgyzstan [Internet] EPOS HealthManagement 2015 [cited 2018 Jan 19]. Available from: http://epos30.de/content/safe-blood-transfusion-project-launchedkyrgyzstan355EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CMALTAMalta Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouthern EuropeGeographical size ranking1208thPopulation (world ranking)1416 thousand (175th)Median age141.8Political system1Parliamentary republicGDP per capita (worldranking)1$42,500 (42nd)HDI Index (world ranking)20.856 - very high (33rd)Health Expenditure19.7% of GDPPopulation prevalencehepatitis B34.2%Population prevalencehepatitis CNot availablePopulation prevalence HIV4<0.1%NATIONAL BLOOD PROGRAMMalta has always been self-sufficient with regards to labile blood products.5There is one government funded blood establishment, with two fixed donation sites and one mobileunit, which collects processes, screens and distributes blood and there are four hospital bloodbanks which are mainly involved with patient care.6About 16,000 units of whole blood and 400 apheresis platelets are collected annually from donorshaving a Maltese ID card (confirms residence in Malta).6 All donations are VNRBD.6A national haemovigilance system lead by the Public Health Regulation Division captures theadverse events and reactions reported by all hospitals. 6NATIONAL SOCIETY (MALTA RED CROSS)Malta Red Cross, on an ad hoc basis, aids with the marketing by sharing or posting requests forblood on its Facebook page, and also through a banner on the Malta Red Cross Lifeguard Toweron the beach.EUROPE AND CENTRAL ASIA356EUROPE AND CENTRAL ASIA LEVEL CIn addition, Malta Red Cross occassionally brings together volunteers and their respective familiesto donate blood.Five people in 2012 and six people in 2013 are recorded as having given blood at or with the helpof the Malta Red Cross Society.7The Malta Red Cross plans to implement a website with a link to the National Blood Transfusionsite and vice versa.1Central Intelligence Agency. The World Factbook. Malta. Washington, DC. https://www.cia.gov/library/publications/theworld-factbook/geos/mt.html2 United Nations Development Program. Human Development Report 2015. http://hdr.undp.org/en3 European Centre for Disease Prevention and Control. Annual Epidemiological Report for 2015 Hepatitis B. [Internet]ECDC Stockholm 2017 [cited 2018 January 25]. Available from:https://ecdc.europa.eu/sites/portal/files/documents/AER_for_2015-hepatitis-B.pdf4 UNAIDS. Global AIDS Response Reporting Narrative Report- Malta (January to December 2013) [Internet] UNAIDS2013 [cited 2018 Jan 19] Available from:http://files.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2014countries/MLT_narrative_report_2014.pdf5 European Blood Alliance. Malta [Internet] European Blood Alliance 2017 [cited 201 Jan 19]. Available from:http://www.europeanbloodalliance.eu/membership/malta/6World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organisation 2011 [cited 2018 Jan 19]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=17 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Malta Red Cross. [Internet] International Federation of Red Cross and Red Crescent Societies2016 [cited 2018 Jan 19]. Available from: http://data.ifrc.org/fdrs/societies/malta-red-cross-society357EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CMOLDOVA, REPUBLIC OFRed Cross Society of the Republic of Moldova:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern EuropeGeographical size ranking1140thPopulation (world ranking)13.4 million (131st)Median age136.7Political system1Parliamentary republicGDP per capita (worldranking)1$5,700 (167th)HDI Index (world ranking)20.699 - medium (107th)Health Expenditure110.3% of GDPPopulation prevalencehepatitis B3High Intermediate: 5-7%Population prevalencehepatitis C4High Moderate: 2-5%Population prevalence HIV50.60% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Blood Transfusion Service in the Republic of Moldova consists of:The National Blood Transfusion Centre3 regional blood transfusion centres17 blood departments67 blood banks 6A law on blood donation and blood transfusions was enacted in 2008.6The Ministry of Health is responsible for the development and review of the Policy for NationalTransfusion Safety as well as approving documents which enable the policy to be implemented. 6The National Blood Transfusion Centre coordinates the implementation of the blood policy at anational and regional level.6National regulations are in place as well as quality standards and guidelines which are in accordancewith the European Directives and WHO recommendations.6EUROPE AND CENTRAL ASIA358EUROPE AND CENTRAL ASIA LEVEL CIn 2013, Moldova recorded 78,598 blood donations (48% voluntary, 52% replacement donors).6However, by 2017 of the more than 79,000 blood donors, approximately 80% of these werevoluntary.7The Republic of Moldova undertakes fractionation activities, after receiving funding support from theCouncil of Europe Development Bank for the purchase of fractionation equipment in 2012.8In April 2017, the Ministry of Health and National Blood Transfusion Centre, with the support of theSwiss Red Cross, announced plans to develop a new laboratory within the National BloodTransfusion Centre (to test blood products collected in the districts) and to modernise regionalcentres. 9 The projected is called Consolidation of blood transfusion security in the Republic ofMoldova 2017-2021.9In July 2017, the Government of Moldova also approved a National Transfusional Security and SelfGuarantee Program of Moldova for blood for 2017-2021 to ensure safety and security of the bloodprogram.7 The program objectives include continuing quality assurance, supply and demand,development of the voluntary donor base and increasing the number of donors each year.7NATIONAL SOCIETY (RED CROSS OF THE REPUBLIC OF MOLDOVA)Community education activities are coordinated both nationally and by district/chapter by theNational Society and are funded by the National Society.The Red Cross Society of the Republic of Moldovadoes not receive technical assistance or financial support for VNRBD activities from outsidethe countrywas previously involved in blood at Level Bis not planning to expand or scale back its blood related servicesAccording to the IFRC Federation-wide Databank and Reporting System, there were 1,800 peopledonating blood in conjunction with the Red Cross Society of the Republic of Moldova in 2014 and2,000 in 2015. 10359EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL C1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/md.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Dec 19]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 19] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec19]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Svetlana Cebotari. Republic of Moldova. Applied quality and safety requirements for blood donor and patientmanagement in emergency special circumstances in the Republic of Moldova [Internet] July 2014 [cited 2017 Dec 19]Available from: http://www.azus.gov.rs/wp-content/uploads/2014/07/Country-Presentationa_Moldova_SvetlanaCebotari.pdf7 Government of republic of Moldova. Government approved national blood transfusion and self-insurance program forblood products. [Internet] Guvernul Republicii Moldova 2014 [cited 2017 Dec 19] Available from:http://www.gov.md/en/content/government-approved-national-blood-transfusion-and-self-insurance-program-bloodproducts8 Council of Europe Development Bank. Moldova CEB donation to blood transfusion infrastructure[ Internet] CEB, 20June 2012 [cited 2017 Dec 19] Available from: http://www.coebank.org/en/news-and-publications/news/moldovadonation-blood-transfusion-infrastructure/9Publika.MD Aproape De Oameni. Patients Will Be Safer. Countrys blood transfusion centers will be endowed withmodern medical appliances. [Internet] General Media Group, 2016 [cited 2017 Dec 19] Available from:http://en.publika.md/patients-will-be-safer-country-s-blood-transfusion-centers-will-be-endowed-with-modern-medicalappliances_2636360.html10 International Federation of Red Cross and Red Crescent Societies. Federation-wide databank and reporting system.Red Cross Society of the Republic of Moldova [Internet] International Federation of Red Cross and Red CrescentSocieties 2017 [cited 2017 Dec 19] Available from: http://data.ifrc.org/fdrs/societies/red-cross-society-of-the-republic-ofmoldovaEUROPE AND CENTRAL ASIA360EUROPE AND CENTRAL ASIA LEVEL CROMANIARomanian Red Cross:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationSouth-eastern EuropeGeographical size ranking184thPopulation (world ranking)121.5 million (58th)Median age141.1Political system1Semi-presidential republicGDP per capita (worldranking)1$24,000 (83rd)HDI Index (world ranking)20.802 - high (50th)Health Expenditure15.6% of GDPEfficiency of Healthcare331st of 51 countriesPopulation prevalencehepatitis B4High intermediate: 5%-7%Population prevalencehepatitis C5High moderate: 2.0% <5.0%Population prevalence HIV60.1% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe Ministry of Health is responsible for the National Institute of Blood Transfusion. 7 Romania isorganized into 41 counties/districts, as well as the municipality of Bucharest having its ownadministrative unit.7 Each county has a blood transfusion centre, eight of which are Regional BloodTransfusion Centres, which collect, test, prepare, store, and distribute blood / blood components toauthorized hospitals. 7Romania has transposed many EU legislative and regulatory documents on Blood Safety and hasincluded WHO Recommendations. 7Nearly all blood donations in Romania are VNRBD, with just a small percentage (3-4% in 2013) fromreplacement donors, particularly when there is a shortage of a particular blood type. 7428,140 units of blood were collected in 2013 (a 7% increase over 2012) and 424,010 units weredelivered, meeting about 73% of demand. 7 Blood is provided free of charge to hospitals. 8In 2012, about 6% of the blood was collected via mobile collections. 8361EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CThe proportion of blood that is being separated has increased steadily from 66% in 2008 to 85% in2012. 8A West Nile Virus (WNV) epidemic in August 2010 impacted the blood supply in Romania. 7 Donordeferrals and quarantined donated blood (for 15 days) led to difficulties in maintaining an appropriateblood supply elective surgeries were cancelled.7 This situation also led to the establishment of anaction plan for the provision for special situations in the national transfusion legislation.7NATIONAL SOCIETY (ROMANIAN RED CROSS)Community education activities are coordinated by district/chapter by the National Society. They arefunded by local Romanian Red Cross (RRC) branches. The RRC conducts campaigns to supportVNRBD and help recruit donors, especially among young people, and to encourage donors to adopta healthy lifestyle.9 There were 48 blood donation campaigns in 2012/13.10The Romanian Red Cross:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryindicated that it was not previously involved in blood at Level A or B, however in a previousglobal mapping survey in 2008, indicated that it was involved in blood activities at Level Bis planning to expand its blood related services to community education coordinated at anational level4,979 people donated blood at or with the assistance of the Romanian Red Cross in 2013. Thisnumber was zero in 2012. 111Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ro.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme2016 [cited 2018 Jan 22]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 22].Available from: http://www.bloomberg.com/graphics/best-and-worst/#most-efficient-health-care-2014-countries4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Burta OL, Rosin A, Parvu S, Posea C, Pacurariu L. EU requirements for donor and patient safety in emergency specialcircumstances: case studies from Romania. Presented at: The workshop increasing blood availability and providing thehighest donor and patient safety in transfusion therapy in emergency special circumstances; 2014 Jul;. Bucharest (EU).Presentation available from: http://www.azus.gov.rs/wp-content/uploads/2014/07/Country-Presentation_Romania_OliviaLigia-Burta.pdf8 Burta OL, Rosin A, Parvu S. Blood collection management in Romanian transfusion network; current and perspectivefeatures. ISBT Science Series [Internet] 2013 May 31 [cited 2018 Jan 22];8(1):242249. Available from :http://onlinelibrary.wiley.com/doi/10.1111/voxs.12046/full9 Crucea Rosie Romana. Promovarea donarii de sange voluntare si neremunerate (Promoting voluntary and unpaidblood donation) [Internet] Crucea Rosie Romana 2016 [cited 2018 Jan 22]. Available from: https://crucearosie.ro/cefacem/educatie-pentru-sanatate/campanii-de-donare-de-sange/10 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.Crucea Rosie Romana. Raport de activitate 2012-13. (Romanian Red Cross. Annual report 2012-13) [Internet]International Federation of Red Cross and Red Crescent Societies 2016 [cited 2018 Jan 22]. Available from: http://dataapi.ifrc.org/documents/RO/AR_Romania_2013_romanian.pdf11 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Romanian Red Cross. [Internet] International Federation of Red Cross and Red CrescentSocieties 2016 [cited 2018 Jan 22]. Available from: http://data.ifrc.org/fdrs/societies/romanian-red-crossEUROPE AND CENTRAL ASIA362EUROPE AND CENTRAL ASIA LEVEL CTAJIKISTANRed Crescent Society of Tajikistan:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationCentral AsiaGeographical size ranking197thPopulation (world ranking)18.5 million (96th)Median age124.5Political system1Presidential republicGDP per capita (worldranking)1$3,100 (193rd)HDI Index (world ranking)20.627 - medium (129th)Health Expenditure16.9% of GDPPopulation prevalencehepatitis B3High intermediate: 5-7%Population prevalencehepatitis C4High moderate: 2.0% <5.0%Population prevalence HIV50.3% among adults aged 15to 49NATIONAL BLOOD PROGRAMAs at 2010, the Blood Service of Tajikistan was composed of one Republican Research Blood Centre,three regional centres, 44 departments of blood transfusion in medical establishments and 29cabinets of transfusion therapy.6 In 2009, the government adopted the law on donating blood and itscomponents, and approved a program to develop blood donation and improve the blood services forthe period 20102014.6 It also adopted a program for blood safety control and a program for therational use of blood.6The aims for the national blood program were to:363complete the process of centralization, re-structuring and refurbishment of the serviceensure sustainable financingimplement quality assurance mechanisms for the testing laboratories, including externalquality assessment schemespromote voluntary unpaid donationtrain medical staff in the clinical use of bloodincrease donation rates to 1012/1000 population by 2014 so that there are sufficient blooddonations to meet the clinical request for blood and blood products6EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL CIn 2006 there were 14,000 blood donors.7 By 2013 it was reported that 20,000 unpaid donors giveblood each year in Tajikistan.8NATIONAL SOCIETY (RED CRESCENT OF TAJIKISTAN)The Red Crescent Society of Tajikistan is currently involved in blood activities at Level C, howeverthey were previously involved in blood at Level B. This program was completed in 2005 whenfunding finished.Blood donor recruitment and retention activities are coordinated nationally by the National Society,and are funded by private organisations.The Red Crescent Society of Tajikistan:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryis planning to expand its current level of involvement in blood related activities - the NationalSociety of Tajikistan in collaboration with the Ministry of Health is planning to conducteducational activities in the field of blood donation among university students1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ti.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Training Workshop on achieving 100% Voluntary Non-Remunerated Blood Donation for priority countries in Europe andCentral Asia. World Health Organisation Europe Training Workshop. [Internet] 2010 Jun 16-18. Barcelona, Spain. [cited2018 Jan 22] Available from:http://www.euro.who.int/__data/assets/pdf_file/0010/128692/non_remunerated_blood_CEE_wkshp.pdf7 Kondrashova V. Tajikistan marks World Blood Donor Day today. Asia-Plus [Internet] 2006 Jun 14 [cited 2018 Jan 22].Available from: http://www.news.tj/en/news/tajikistan-marks-world-blood-donor-day-today8 World Health Organisation. Regional Office for Europe. Tajikistan celebrates World Blood Donor Day 2013 [Internet]World Health Organisation 2013 Jun 27 [cited 2018 Jan 22]. Available from:http://www.euro.who.int/en/countries/tajikistan/news/news/2013/06/tajikistan-celebrates-world-blood-donor-day-2013EUROPE AND CENTRAL ASIA364EUROPE AND CENTRAL ASIA LEVEL CUKRAINEUkrainian Red Cross Society:Level C: National society is involved in occasional community education/awarenessprograms that help promote voluntary non-remunerated blood donation (e.g. World BloodDonor Day), but no involvement in the systematic recruitment of donors or blood collection.NATIONAL CONTEXTLocationEastern EuropeGeographical size ranking147thPopulation (world ranking)144 million (32nd)Median age140.6Political system1Semi-presidential republicGDP per capita (worldranking)1$8,700 (146th)HDI Index (world ranking)20.743 - high (84th)Health Expenditure17.1% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4High moderate: 2.0% - <5.0%Population prevalence HIV50.9% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn 2010, significant deficiencies in the Ukrainian blood system were identified. 6 Despite the Ministryof Health's commitment to blood safety, no single individual or agency has full-time responsibility forthe regulation and administration of the blood transfusion system.6 Most blood donors are paid andthe level of HIV prevalence among blood donors in Ukraine is the highest in Europe.6The laboratory system for blood donation screening in Ukraine is developed and is located atregional blood transfusion centres.6 However, this screening does not have quality assurance/qualitycontrol (QA/QC) systems in place, nor is there an active blood transfusion monitoring system(haemovigilance system) to accurately determine the rates of transfusion-transmitted infections.6 In2008, a total of 21 cases of HIV infection were reported related to contamination of blood and/orblood products. 6The US Presidents Emergency Plan for AIDS Relief (PEPFAR) 2010 strategies for the Ukrainianblood system were:365development of policies to allow creation of a nationally coordinated blood transfusion servicedevelopment of a low-risk volunteer donor-oriented programdevelopment of QA/QC systems in laboratories to cover 100% of transfusionsEUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA LEVEL Cadequate training of blood system technical staff at all levels by 2013review of clinical blood utilizationdevelopment of a monitoring and evaluation system 6PEPFAR continued to fund blood safety in Ukraine, with US$517,790 allocated in 2015.6 $300,000of this was allocated to the American International Health Alliance (AIHA). 7 AIHAs Blood SafetyProject in Ukraine worked closely with the Ministry of Health and National Blood TransfusionServices. 8Several recent news stories describe blood donor campaigns and volunteer blood donors.9,10, 11NATIONAL SOCIETY (UKRAINIAN RED CROSS)Community education activities are coordinated nationally by the National Society. They are fundedby the National Society.The Ukrainian Red Cross Society:does not receive technical assistance or financial support for VNRBD activities from outsidethe countryindicated that it was not previously involved in blood at Level A or B, however in a previousglobal mapping survey in 2013/14, indicated that it was involved in blood activities at Level Bis not planning to expand or scale back its level of blood related servicesThe Ukrainian Red Cross Society webpage reports that in 2011 there was continued advocacy forfree donation, with the distribution of 38,000 flyers, 9,000 booklets and 500 publications in regionaland district press.12 3200 gifts, 225 diplomas and 552 thanksgiving were awarded. 121Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/up.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 22]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 US Presidents Emergency Plan for AIDS Relief (PEPFAR). Ukraine Operational Plan Report FY 2010 [Internet]PEPFAR 2012 [cited 2018 Jan 22]. Available from: http://www.pepfar.gov/documents/organization/145739.pdf7 amfAR (The Foundation for AIDS Research). Making AIDS History. PEPFAR Country/Regional Operational Plans(COPs/ROPs) Database. [Internet] amfAR 2015 [cited 2018 Jan 22]. Available from:http://copsdata.amfar.org/s/Ukraine/HMBL/20158 The American International Health Alliance. Ukraine. [Internet] The American International Health Alliance 2016 [cited2018 Jan 22]. Available from : http://www.aiha.com/ukraine/9 Ukrainian Independent Information Agency. UN family members donate blood in Ukraine. [Internet] UkrainianIndependent Information Agency 2008 Jun 12 [cited 2018 Jan 22]. Available from:https://www.unian.info/society/122838-un-family-members-donate-blood-in-ukraine.html10 Krasnikov D. Ukrainian tech startup aims to encourage blood donation. KyivPost. [Internet] 2016 Apr 15 [cited 2018Jan 22]. Available from: https://www.kyivpost.com/article/content/ukraines-it-edge/ukrainian-tech-startup-aims-toencourage-blood-donation-412073.html11 Censor.net. Kyiv residents in large numbers donate blood for Ukrainian soldiers wounded in ATO. [Internet] 2017 Feb03 [cited 2018 Jan 22]. Available from:https://en.censor.net.ua/video_news/426333/kyiv_residents_in_large_numbers_donate_blood_for_ukrainian_soldiers_wounded_in_ato_its_my_civic_stance12 Red Cross Society of Ukraine. Donor. [Internet] Red Cross Society of Ukraine 2016 [cited 2018 Jan 22]. Availablefrom: http://redcross.org.ua/index.php?pageid=20EUROPE AND CENTRAL ASIA366EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)ARMENIAArmenian Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationSouth-western AsiaGeographical size ranking1143rdPopulation (world ranking)13 million (137th)Median age135.1Political system1Parliamentary democracyGDP per capita (worldranking)1$9,100 (144th)HDI Index (world ranking)20.743 - high (84th)Health Expenditure14.5% of GDPPopulation prevalencehepatitis B3Not availablePopulation prevalencehepatitis C4High: 5%Population prevalence HIV50.2% among adults aged 15to 49NATIONAL BLOOD PROGRAMIn Armenia, there are 22 blood banks 11 in Yerevan and 11 the regions. 6In 2011, the Republic of Armenia Human blood and its components donation and transfusionservice law was adopted. 6In 2012, around 13,000 blood donations were conducted in Armenia significantly below the 60,000required. 6 With just 3.1 units of WB/RBC used per 1,000 population in 2009, Armenia had the lowestblood use reported amongst the countries examined in the Council of Europe report. 7Armenia pays for donations, and just 5% of Armenias donations were VNRBD in 2010. 7NATIONAL SOCIETY (ARMENIAN RED CROSS)The Armenian Red Cross is not involved in any blood related activities and, according to their globalmapping survey response, never has been.367EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/am.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 22]. Available from:. http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency2013 [cited 2018 Jan22]. Available from:https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Sahakyan A. Social Good Summit Yerevan. YouTube. [Online video] 2013 Sept 24 [cited 2018 Jan 22]. Available from:https://www.youtube.com/watch?v=efwbHn1PRlE7 Council of Europe. European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM).Report of the survey on blood supply management organised by the TS003 Working Group in member states andobserver states of the Council of Europe [Internet] Council of Europe 2012 [cited 2018 Jan 22] Available from:https://www.edqm.eu/medias/fichiers/report_survey_on_blood_supply_management_2012.pdfEUROPE AND CENTRAL ASIA368EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)DENMARKDanish Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationNorthern EuropeGeographical size ranking1134thPopulation (world ranking)15.6 million (116th)Median age141.8Political system1Parliamentary constitutionalmonarchyGDP per capita (worldranking)1$49,600 (31st)HDI Index (world ranking)20.925 - very high (5th)Health Expenditure110.8% of GDPEfficiency of Healthcare334th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV60.2% among adults aged 15to 49NATIONAL BLOOD PROGRAMBy law, only public hospitals in Denmark are permitted to collect blood.7In the 1990s, many hospital-based centres were amalgamated by the blood sector into five bloodcentres each supporting a region covering 0.6 to 1.7 million people.8 Each blood centre is locatedin a major public hospital however they remain reasonably autonomous, assisting with resourcesharing and collaborating on national blood issues.8In 2001 the Organisation of Transfusion Centres in Denmark (OTCD) was established to coordinatenational responsibility for the blood transfusion services in addition to representing the interests ofDenmarks blood program.7The Danish Health and Medicines Authority (DHMA) regulates medicines including blood productsand is responsible for licensing the blood centres in line with EU Directives, as well as gathering dataon serious adverse events including incidents related to the use of blood products.8It is mandated by law that blood donors do not receive payment for giving blood.8 Some 66 localdonor associations comprise the Blood Donors in Denmark federation, representing approximately369EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)224,000 voluntary blood donors and are responsible for recruiting the majority of donors in Demark,receiving a fee from the regional authorities for each donation recruited.8Clinical guidelines changed to encourage more conservative use when it was recognized thatDenmark transfused more blood per capita than any other country which led to a drop from 66RBCs/1,000 population in 2003 to just below 50 RBCs/1,000 population in 2012.8Denmark sells recovered plasma to CSL for fractionation, and the resulting plasma derivatives aredistributed through hospital pharmacies.8 In 2012, Denmark sent approximately 61,000 litres ofplasma to CSL.8NATIONAL SOCIETY (DANISH RED CROSS)The Danish Red Cross is not involved in any blood related activities. It was previously involved inblood at Level B, but this function has now been taken over by the government.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/da.html2 United Nations Development Programme. Human Development Report 2016 [Internet] Central Intelligence Agency2016 [cited 2018 Jan 22]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 22].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Trading Economics. Denmark Prevalence of HIV, total (% of population ages 15 49) [Internet] Trading Economics2013 [cited 2018 Jan 22]. Available from: https://tradingeconomics.com/denmark/prevalence-of-hiv-total-percent-ofpopulation-ages-15-49-wb-data.html7 European Blood Alliance. Denmark.[Internet] European Blood Alliance 2018 [cited 2018 Jan 22]. Available from:http://www.europeanbloodalliance.eu/membership/denmark8 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.EUROPE AND CENTRAL ASIA370EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)FRANCEFrench Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationWestern EuropeGeographical size ranking144thPopulation (world ranking)167 million (21st)Median age141.4Political system1Semi-presidential republicGDP per capita (worldranking)1$43,600 (39th)HDI Index (world ranking)20.897 - very high (21st)Health Expenditure111.5% of GDPEfficiency of Healthcare38th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV60.4% (2016 est.)NATIONAL BLOOD PROGRAMThe French National Blood Service (EFS) was established in January 2000 as the only civilian bloodtransfusion organisation in France.7 Blood, plasma and platelets are collected.7 The safety of thetransfusion chain from the donor to the receiver is guaranteed by EFS.7In 2014 there were:17 blood establishments, including 3 overseas2 cord blood banks91 health centres9810 employees147 blood collection sites40,000 mobile donor sites1 million patients treated2,845,622 blood donations (whole blood, platelets, plasma)1,602,203 blood donors1500 hospitals and clinics supplied with labile blood products. 8France created its first law on blood transfusion in 1952 which prohibited the sale of blood for profit.9371EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)Blood donors in France also do not receive payment for their donation.10 Large donor associationsexist to recruit donors as well as promoting:blood donationsafety in blood collectionsafe transfusion practices. 10Minimising wastage and optimising blood use are part of the role that the EFS plays by managingthe transfusion services of 80% of hospitals that they supply.10 Hospitals purchase the bloodproducts for a fee which is set by the Ministry of Health.10Frances biovigilance program is conducted by the Agence Franaise de Scurit du Mdicament etdes Produits de Sant (ANSM), which in 2012 replaced the Agence Franaise de Scurit Sanitaireet des Produits de Sanguins (AFSSAPS).10 The ANSM also regulates the blood centre licensing andinspections.10In an effort to be self-sufficient for all blood and plasma products, EFS plasma is sent to privatecompany Laboratoire Franais du Fractionnement et des Biotechnologies (LFB) for fractionation intoplasma-protein products. 10NATIONAL SOCIETY (FRENCH RED CROSS)The French Red Cross is not involved in any blood related activities and, according to their globalmapping survey response, never has been..1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/fr.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 22]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 22].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention2016 [cited 2018 Jan 22] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2018 [cited 2018 Jan22]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Ministry of Solidarity and Health. EFS (French Blood Establishment) [Internet] Ministry of Solidarity and Health 2015Nov 13 [cited 2018 Jan 22]. Available from: http://solidarites-sante.gouv.fr/ministere/acteurs/agences-etoperateurs/article/efs-etablissement-francais-du-sang8 French Blood Establishment. The link between the generosity of blood donors and the needs of the sick. Activity report2014. [Internet] French Blood Establishment 2015 [cited 2018 Jan 22]. Available from:https://www.efs.sante.fr/sites/instit/files/2016-08/RA2014-PDLO.pdf9 NATA. Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis. Evolving Laws andRegulations on Transfusion. [Internet] NATA 2018 [cited 2018 Jan 22]. Available from:http://nataonline.com/np/406/evolving-laws-and-regulations-transfusion10 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.EUROPE AND CENTRAL ASIA372EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)GREECEHellenic Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationSouthern EuropeGeographical size ranking198thPopulation (world ranking)110.8 million (85th)Median age144.5Political system1Parliamentary republicGDP per capita (worldranking)1$27,800 (72nd)HDI Index (world ranking)20.866 - very high (29th)Health Expenditure18.1% of GDPEfficiency of Healthcare324th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low moderate: 1.5% <2.0%Population prevalence HIV60.1% (2014 est.)NATIONAL BLOOD PROGRAMGreeces Blood Transfusion Services are made up of nine blood centres and 101 hospital transfusionservices.7 By the end of 2012, Greece aimed to commence new reform, moving to an even morecentralised framework with regulations consistent with the European legislation and the Council ofEurope and WHO recommendations. 7Greece needs 600,000 700,000 units of blood each year with 30 - 40% of this amount currentlyprovided by volunteers and an additional 30,000 units are imported from Switzerland annually. 8,9Two individuals frustrated with this situation and the blood systems lack of a blood donor informationsystem have set up Blood-e in 2012.9 Blood-e is a digital community of volunteer blood donors wherethose in need of blood can publish their requests. 9NATIONAL SOCIETY (HELLENIC RED CROSS)The Hellenic Red Cross (HRC) is not involved in any blood related activities, however in a previousglobal mapping survey in 2008, indicated that it was involved in blood activities at Level C.373EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/gr.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 23]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 23].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Hellenic Centre for Disease Control & Prevention (HCDCP) E-bulletin. Recent data on HIV infection in Greece, October2014. [Internet] Hellenic Centre for Disease Control & Prevention 2015 [cited 2018 Jan 23]. Available from:http://www2.keelpno.gr/blog/?p=6240&lang=en7 Hellenic Republic Ministry of Health. Laboratory Sector. Blood Donation Center. [Internet] Ministry of Health 2018[cited 2018 Jan 23]. Available from: http://www.ahepahosp.gr/en_med3_aimod.asp8 Matsaidoni T. November 7 dedicated to blood donation.Greek Reporter. [Internet] 2014 May 23 [cited 2018 Jan 23].Available from: http://greece.greekreporter.com/2014/05/23/november-7-dedicated-to-blood-donation/9 Nanopoulou K. This Startup Aims To Solve Greece's Blood Donor Problem. Huffington Post. [Internet] 2015 Jun 26[cited 2018 Jan 23]. Available from: http://www.huffingtonpost.com.au/entry/greece-volunteer-blooddonors_n_7666358.htmlEUROPE AND CENTRAL ASIA374EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)ICELANDIcelandic Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationNorthern EuropeGeographical size ranking1109thPopulation (world ranking)1340 thousand (178th)Median age136.5Political system1Parliamentary republicGDP per capita (worldranking)1$52,100 (24th)HDI Index (world ranking)20.921 - very high (9th)Health Expenditure18.9% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.3% (2011 est.)NATIONAL BLOOD PROGRAMThe Icelandic Blood Bank is the sole supplier of blood products in Iceland, approximately 7,000 to8,000 people donating blood regularly (at least once a year).6 Registered donors comprise almost2.5 percent of the total population in Iceland.6The Blood Bank has two main collection sites located in the National University Hospital of Icelandand at Akureyri Hospital, as well as a mobile blood collection unit that operates in Rejkjavik and visitstowns in the North and West of the country.6NATIONAL SOCIETY (ICELANDIC RED CROSS)The Icelandic Red Cross is not involved in any blood related activities. It was previously involved inblood at Level A, but the Red Cross withdrew from blood drive activities in 1995 and the governmenttook on this responsibility.375EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ic.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 23]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 World Health Organization. Regional Office for Europe. Key Facts on HIV Epidemic in Iceland and Progress in 2011[Internet] World Health Organization 2013 [cited 2018 Jan 23]. Available from:http://www.euro.who.int/__data/assets/pdf_file/0007/191077/Iceland-HIVAIDS-Country-Profile-2011-revision-2012final.pdf6 National University Hospital. Blood Bank. Blood Donation in Iceland. [Internet] National University Hospital [cited 2018Jan 23] Available from: http://blodbankinn.is/blodgjafar/english/EUROPE AND CENTRAL ASIA376EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)IRELANDIrish Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationWestern EuropeGeographical size ranking1121stPopulation (world ranking)15 million (121st)Median age136.8Political system1Parliamentary republicGDP per capita (worldranking)1$72,600 (11th)HDI Index (world ranking)20.923 - very high (8th)Health Expenditure17.8% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4Low: 1.0% - <1.5%Population prevalence HIV50.2% among adults aged 15to 49NATIONAL BLOOD PROGRAMThe Irish Blood Transfusion Service (IBTS) is a not-for-profit organisation under the Ministry ofHealth that was established in 19656 when the National Blood Transfusion Service in Dublin mergedwith two former services located in Cork and Limerick.7 The IBTS is the countrys only provider ofblood for transfusion and consists of the National Blood Centre which operates in Dublin and aregional centre located in Cork.7The regulatory authority for blood products and establishments is the Irish Medicines Board (IMB),responsible for collecting data on serious adverse reactions from blood and passing it onto theNational Haemovigilance Office for review.7Federal law governs that blood donors should not receive payment for giving blood, therefore alldonors are voluntary, non-remunerated.7Hospitals purchase blood for a fee which is set by the IBST and approved by the government.7IBTS also manages the Irish Unrelated Bone Marrow Registry and the IBTS tissue bank comprisedof the National Eye Bank, the Heart Valve Bank and the Directed/sibling umbilical cord bloodbank.7,8,9377EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)NATIONAL SOCIETY (IRISH RED CROSS)The Irish Red Cross is not involved in any blood related activities.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ei.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 23]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 23] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan23]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Irish Blood Transfusion Service. About Us [Internet] Irish Blood Transfusion Service 2018 [cited 2018 Feb 26]. Availablefrom: https://www.giveblood.ie/About-Us/7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.8 Irish Blood Transfusion Service. Clinical Services [Internet] Irish Blood Transfusion Service 2018 [cited 2018 Feb 26].Available from: https://www.giveblood.ie/Clinical-Services/9 European Blood Alliance. Ireland [Internet] European Blood Alliance 2017 [cited 2018 Feb 26]. Available from:http://www.europeanbloodalliance.eu/membership/ireland/EUROPE AND CENTRAL ASIA378EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)LITHUANIALithuanian Red Cross Society:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donation.NATIONAL CONTEXTLocationEastern EuropeGeographical size ranking1124thPopulation (world ranking)12.8 million (140th)Median age143.7Political system1Semi presidential republicGDP per capita (worldranking)1$31,900 (60th)HDI Index (world ranking)20.848 - very high (37th)Health Expenditure16.6% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4High moderate: 2.0% - <5.0%Population prevalence HIV50.2% (2016 est.)NATIONAL BLOOD PROGRAMThere are three blood centres in Lithuania:the National Blood Centre founded by the Ministry of Health which collects 70% of all bloodand component donations.two hospital based blood banks which produce blood components only for their own hospital.6In 2015 there were 70,774 donations, 74.5% of these were VNRBD.6 Paid donations are classed asthe donor being compensated for donation time and travel expenses (12 Euro per donation), whichis covered by the Government of Lithuania. 6The National Blood Centre:is licenced for blood establishment activityis licenced for manufacturing plasma derivativesis GMP certifiedwas certified with ISO 9001:2008 in 20097The Ministry of Health is responsible for the coordination of blood establishments activities.7379EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)NATIONAL SOCIETY (LITHUANIAN RED CROSS)The Lithuanian Red Cross Society is not involved in blood activities, but was previously involved atLevel C. The survey response indicates that all activities related to blood donation and blood donorsare now carried out by National Blood Centre.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan24]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/lh.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 24]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 24] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 24] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan24]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 European Blood Alliance. Lithuania [Internet] European Blood Alliance 2017 [cited 2018 Jan 24]. Available from:.http://www.europeanbloodalliance.eu/membership/lithuania/7 Council of Europe. European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM).Report of the survey on blood supply management organised by the TS003 Working Group in member states andobserver states of the Council of Europe [Internet] Council of Europe 2012 [cited 2018 Jan 24] Available from:https://www.edqm.eu/medias/fichiers/report_survey_on_blood_supply_management_2012.pdfEUROPE AND CENTRAL ASIA380EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)MONACORed Cross of Monaco:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donation.NATIONAL CONTEXTLocationWestern EuropeGeographical size ranking1253rdPopulation (world ranking)131 thousand (217th)Median age153.1Political system1Constitutional monarchyGDP per capita (worldranking)1$115,700 (3rd)HDI Index (world ranking)2n/aHealth Expenditure14.3% of GDPPopulation prevalencehepatitis B3Low: <2% (Western Europe)Population prevalencehepatitis C4Moderate: 1.5-3.5%(Western Europe)Population prevalence HIVn/aNATIONAL BLOOD PROGRAMMonacos Blood Transfusion Centre is located at the Princess Grace Hospital. 5 The BloodTransfusion Centre organises blood donations on-site and in mobile blood donation units in thePrincipality.6 Blood donations in Monaco are 100% VNRBD.7NATIONAL SOCIETY (RED CROSS OF MONACO)The Red Cross of Monaco is not directly involved in blood activities; however they do have a separateorganisation, linked to the Red Cross which deals with donor motivation. The Blood Donors FriendlySociety, an association of the Monaco Red Cross with 1600 members:promotes anonymous, volunteer and non-renumerated blood donationmaintains donor relationshipsrepresents donors before authorities and administration8IFRC data shows that in 2013, 2,390 people donated blood at or with the assistance of the RedCross of Monaco.9381EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan24]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/mn.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 24]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention Centres for Disease Control and Prevention 2016 [cited 2018 Jan 24] Available from:http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] 2016 [cited 2018 Jan 24] Availablefrom: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-c5 Centre Hospitalier Princesse Grace. Blood Donation. [Internet] Centre Hospitalier Princesse Grace 2016 [cited 2018Jan 24]. Available from : https://www.chpg.mc/don-du-sang/6 Public Services of the Princely Government of Monaco. Blood donations. [Internet] Public Services of the PrincelyGovernment of Monaco 2017 [cited 2018 Jan 24]. Available from: http://en.service-public-particuliers.gouv.mc/Socialhealth-and-families/Public-health/Useful-information/Blood-donations7 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organisation 2011 [cited 2018 Jan 24]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=18 Monaco Red Cross. Blood Donors Friendly Society. [Internet] Monaco Red Cross 2017 [cited 2018 Jan 24]. Availablefrom: http://www.croix-rouge.mc/en/what-we-do/associations/blood-donors-friendly-society/9 International Federation of Red Cross and Red Crescent Societies. Federation-Wide Databank and Reporting System.National Society Profiles Monaco Red Cross. [Internet] International Federation of Red Cross and Red CrescentSocieties 2016 [cited 2018 Jan 24]. Available from: http://data.ifrc.org/fdrs/societies/red-cross-of-monacoEUROPE AND CENTRAL ASIA382EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)NETHERLANDS, THEThe Netherlands Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donation.NATIONAL CONTEXTLocationWestern EuropeGeographical size ranking1135thPopulation (world ranking)117.1 million (66th)Median age142.6Political system1Parliamentary constitutionalmonarchyGDP per capita (worldranking)1$53,600 (22nd)HDI Index (world ranking)20.924 - very high (7th)Health Expenditure110.9% of GDPEfficiency of Healthcare340th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV60.2% (2014)NATIONAL BLOOD PROGRAMIn 1998 the Dutch blood banks and the Central Laboratory of the Netherlands Red Cross BloodTransfusion Service (CLB) merged to form Sanquin. 7,8 The not-for-profit Sanquin Blood SupplyFoundation is the sole organisation in the Netherlands permitted to manage blood and bloodproducts.7,8Blood is purchased by the hospitals for a fee which the Dutch Ministry of Health must approve everyyear.9Regional blood donor organisations help Sanquin with blood donor recruitment and creatingawareness of the need for blood.9 A National Donor Council run by donors assists Sanquin with thefollowing:383coordination of blood donor organisation activitiesproviding advice on donor policy and recognitionhandling feedback from donors and donor organizations.9EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)In 2016, there were a total of 726,565 blood donations made and 343,112 registered donors.10 2016also saw Sanquin finalise a draft for the expansion of their plasma production plant, Sanquin PlasmaProducts aimed to improve their good manufacturing practices.10NATIONAL SOCIETY (THE NETHERLANDS RED CROSS)The Netherlands Red Cross is not involved in blood activities, but was previously involved at LevelA.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan24]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/nl.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 24]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 24].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 24] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 24] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 UNGASS Country Progress Report. The Netherlands and Parts of the Dutch Kingdom in the Caribbean. [Internet]UNGASS 2014 Mar 31 [cited 2018 Jan 24]. Available from:http://www.unaids.org/sites/default/files/country/documents//NLD_narrative_report_2014.pdf7 Sanquin. About Sanquin [Internet] Sanquin 2016 May 19 [cited 2018 Feb 26]. Available from:https://www.sanquin.nl/en/about/about-sanquin/8 European Blood Alliance. The Netherlands. [Internet] European Blood Alliance 2017 [cited 2018 Jan 24]. Availablefrom: http://www.europeanbloodalliance.eu/membership/the-netherlands/9 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p10 Sanquin. Annual Report 2016 [Internet]. Sanquin 2017 [cited 2018 Feb 26]. Available from:https://www.sanquin.nl/repository/documenten/nl/over-sanquin/over-sanquin/37356/Sanquin_Annual_report_2016.pdfEUROPE AND CENTRAL ASIA384EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)PORTUGALPortuguese Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donation.NATIONAL CONTEXTLocationSouth-western EuropeGeographical size ranking1112thPopulation (world ranking)110.8 million (84th)Median age142.2Political system1Semi-presidential republicGDP per capita (worldranking)1$ 30,300 (65th)HDI Index (world ranking)20.843 - very high (41st)Health Expenditure19.5% of GDPEfficiency of Healthcare328th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low Moderate: 1.5-<2.05%Population prevalence HIV6<0.5% (approx. 44,000people living with HIV)NATIONAL BLOOD PROGRAMThe Portuguese Institute of Blood and Transplantation (IPST, IP) was established in 2012 and isresponsible for 60% of blood transfusion services in the country. 7,8 The remaining 40% is collectedby hospitals.7 The IPST, IP have three blood centres in Lisbon, Coimbra and Porto who collect,process and distribute blood and provide oversight of blood services in their region. 8 80% of bloodcollections by the IPST, IP are from mobile sites.7Portugal has a national VNRBD rate of 100%.7The IPST, IP is responsible for ensuring availability of safe blood products for the country, thedevelopment and monitoring of quality standards (including international standards), administrativeand financial management rules for blood centres and promotion of research on blood relateddevelopments and technologies.8The IPST, IP are also responsible for haemovigilance as well as a Bone Marrow Donor Registry,Public Cord Blood Bank, Multiorganic Tissue Bank and they provide national coordination of OrganTransplantation.7Blood is sold to hospitals for a fee; in 2012 a unit of red blood cells cost approx. US$260. 9In 2010, pathogen reduction was introduced for platelets and in 2014 this was extended to plasma.7385EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)NATIONAL SOCIETY (PORTUGUESE RED CROSS)The Portuguese Red Cross is not currently involved in blood activities, but previously assisted thegovernment with mobilisation of blood donors (Level B).1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Dec12]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/po.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Dec 12]. Available from: http://hdr.undp.org/en/countries/profiles/PRT3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2017 Dec 12].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Dec 12] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 UNAIDS. Country Factsheets Portugal [Internet] UNAIDS 2017 [cited 2017 Dec 12]. Available from:http://www.unaids.org/en/regionscountries/countries/portugal/7 European Blood Alliance. Membership Portugal [Internet] European Blood Alliance 2017[cited 2017 Dec 12] Availablefrom: http://www.europeanbloodalliance.eu/membership/portugal/8Portugese Ministry of Health. Portugese Institute of Blood and Transplant [Internet] Portugese Ministry of Health 2015[cited 2017 Dec 12] Available from: https://www.portaldocidadao.pt/en/web/instituto-portugues-do-sangue-e-datransplantacao/instituto-portugues-do-sangue-e-da-transplantacao9 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203pEUROPE AND CENTRAL ASIA386EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)SAN MARINORed Cross of the Republic of San Marino:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donation.NATIONAL CONTEXTLocationSouthern EuropeGeographical size ranking1229thPopulation (world ranking)134 thousand (215th)Median age144.4Political system1Parliamentary republicGDP per capita (worldranking)1$59,500 (19th)HDI Index (world ranking)2n/aHealth Expenditure16.1% of GDPPopulation prevalencehepatitis B3Not availablePopulation prevalencehepatitis C4Not availablePopulation prevalence HIV50.24% (2011 est.)NATIONAL BLOOD PROGRAMThe Hospital of San Marino has a Department of Transfusion Medicine and Clinical Pathology.6Through the support of the Association of Volunteers in San Marino of Blood and Organs(Associazione Volontari Sammarinesi del Sangue e degli Organi), the Department of TransfusionMedicine and Clinical Pathology procures, stores and distributes blood components and bloodproducts necessary to the activities of hospital departments.6In 2012, San Marino implemented European Standards setting out the rules, quality and safety forthe collection, control, the production, storage and distribution of blood human and its componentsand blood products. 7San Marino achieved 100% VNRBD in 2008. 8NATIONAL SOCIETY (RED CROSS OF THE REPUBLIC OF SAN MARINO)The Red Cross of the Republic of San Marino is not involved in any blood activities. They previouslyresponded as Level C to the 2008 GAP Global Mapping survey.387EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan25]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/sm.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 25]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 25] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 25] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 World Health Organisation. Regional Office for Europe. Key facts on HIV epidemic in San Marino and progress in 2011.[Internet] World Health Organisation 2013 [cited 2018 Jan 25]. Available from:http://www.euro.who.int/__data/assets/pdf_file/0010/191089/San-Marino-HIVAIDS-Country-Profile-2011-revision-2012final.pdf?ua=16 Republic of San Marino. Institute for Social Security. Transfusion Medicine and Clinical Pathology. [Internet] Republic ofSan Marino [cited 2018 Jan 25] Available from: http://www.iss.sm/on-line/home/dipartimento-ospedaliero/medicinatrasfusionale-e-patologia-clinica-laboratorio-analisi.html7 Repubblica Di San Marino. Consiglio Grande e Generale. DD 93/2012 Implementation of European directives thatestablish quality and safety standards for the collection, control, processing, storage and distribution of human blood, itscomponents and blood derivatives. [Internet] Repubblica Di San Marino 2012 [cited 2018 Jan 25]. Available from:http://www.consigliograndeegenerale.sm/on-line/home/in-evidenza-in-home-page/scheda17127871.html8 World Health Organisation. Countries that reported having achieved 100% voluntary non-remunerated blood donationin 2008. [Internet] World Health Organisation 2011 [cited 2018 Jan 25]. Available from:http://www.who.int/bloodsafety/voluntary_donation/countries_100pct_vnrbd_2011.pdf?ua=1EUROPE AND CENTRAL ASIA388EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)SWEDENSwedish Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donation.NATIONAL CONTEXTLocationNorthern EuropeGeographical size ranking157thPopulation (world ranking)110 million (91st)Median age141.2Political system1Parliamentary constitutionalmonarchyGDP per capita (worldranking)1$51,300 (26th)HDI Index (world ranking)20.913 - very high (14th)Health Expenditure111.9% of GDPEfficiency of Healthcare320th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV60.2% among adults aged 15to 49NATIONAL BLOOD PROGRAMResponsibility for the blood system in Sweden is delegated to the six Swedish health serviceregions.7 Approximately 30 regional universities principally coordinate the blood supply and, alongwith county hospital blood centres, undertake the collection and processing of blood.8 The regionscooperate with regard to national blood promotion, resource sharing and other joint tasks.8The Swedish Medical Products Agency under the Ministry of Health is responsible for the bloodcentres and performs centre inspections every two years.8The Swedish Society for Transfusion Medicine performs the following functions:389oversight of the entire blood collection, testing, production, storage and distributionprocessesproduction of manuals, guidelines and annual reportsoperating the national haemovigilance programmonitoring blood production and use9EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)In 2004, the Swedish Blood Alliance (SweBA) was formed as a not-for-profit organisation to formallycoordinate activities between the regions.7 It is a member of the European Blood Alliance and otherinternational organisations.7,9In Sweden in 2012:approximately 229,000 people donated460,779 blood donations were collected132,000 litres of plasma were sold to Octapharma for fractionation8There are no paid donations - 100% of donations are VNRBD.10Despite the fact that blood collection and processing is performed by the hospital blood centres, thehospitals still have to purchase their blood from the blood banks and prices vary by region.8NATIONAL SOCIETY (SWEDISH RED CROSS)The Swedish Red Cross is not involved in any blood related activities and, according to their globalmapping survey response, never has been.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan24]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/sw.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 24]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] v2014 [cited 2018 Jan 24]. Availablefrom: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 24] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 24] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan24]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html7 Swedish Blood Alliance. About Us, Regions [Internet] 2011 Jul 27 [cited 2018 Feb 26]. Available from:http://www.sweba.se/regionerna8 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.9 European Blood Alliance. Sweden. [Internet] European Blood Alliance 2017 [cited 2018 Jan 24]. Available from:http://www.europeanbloodalliance.eu/membership/sweden/10 Council of Europe. European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM).Report of the survey on blood supply management organised by the TS003 Working Group in member states andobserver states of the Council of Europe [Internet] Council of Europe 2012 [cited 2018 Jan 24] Available from:https://www.edqm.eu/medias/fichiers/report_survey_on_blood_supply_management_2012.pdfEUROPE AND CENTRAL ASIA390EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)TURKMENISTANRed Crescent Society of Turkmenistan:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donationNATIONAL CONTEXTLocationCentral AsiaGeographical size ranking154thPopulation (world ranking)15.4 million (119th)Median age127.9Political system1Presidential republicGDP per capita (worldranking)1$18,700 (94th)HDI Index (world ranking)20.691 - medium (111th)Health Expenditure12.1% of GDPPopulation prevalencehepatitis B3Not availablePopulation prevalencehepatitis C4High: 5%Population prevalence HIV5<0.1%NATIONAL BLOOD PROGRAMThe Turkmenistan Blood Service is organized nationally, supported by dedicated legislation andregulations approved by the Ministry of Health and Medical Industry, and fully financed from the statebudget. 6The national blood service is comprised of 4 regional blood banks, 38 offices and 18 ambulatoryblood transfusion departments, with additional blood transfusion service units in many large medicalinstitutions.6The national health authority commenced rebuilding health facilities and selected blood banks anda new blood centre is being built in Ashgabat.6Turkmenistans program to ensure a safe and uninterrupted blood supply to its population is incontrast to that of the World Health Organisation recommendations with paid donors used to createa reliable blood supply, in line with the Resolution of the President of Turkmenistan.7 From 1st April2013, the rates of monetary payments to blood donors as well as the cost of their meals on the dayof blood donation are fixed in Turkmenistan.7391EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)NATIONAL SOCIETY (RED CRESCENT OF TURKMENISTAN)The Red Crescent Society of Turkmenistan is not involved in blood activities. It was involved in blooddonation activities until 1989 at Level B, but these activities are now performed by the Ministry ofHealth as the Red Crescent Society of Turkmenistan had insufficient funds to maintain involvement.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan25]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/tx.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 25]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 25] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 25] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 World Health Organization. Global Health Observatory (GHO) Data. World Health Statistics 2010 [Internet] WorldHealth Organization 2010 [cited 2018 Jan 25]. Available from:http://www.who.int/gho/publications/world_health_statistics/en/6 World Health Organisation. Regional Office for Europe. Blood safety. Turkmenistan. [Internet] World HealthOrganization 2018 [cited 2018 Jan 25]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/bloodsafety/archive/turkmenistan7 The rates of monetary payments to blood donors are fixed. Turkmenistan Golden Age. [Internet] 2013 Mar 19 [cited2018 Feb 26]. Available from: http://www.turkmenistan.gov.tm/_eng/?id=2029EUROPE AND CENTRAL ASIA392EUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)UNITED KINGDOMBritish Red Cross:National society has no involvement at all, not even advocacy for voluntary non-remuneratedblood donation.NATIONAL CONTEXTLocationWestern EuropeGeographical size ranking181stPopulation (world ranking)165 million (22nd)Median age140.5Political system1Parliamentary constitutionalmonarchyGDP per capita (worldranking)1$43,600 (40th)HDI Index (world ranking)20.909 - very high (16th)Health Expenditure19.1% of GDPEfficiency of Healthcare310th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Very low: 0 - <1.0%Population prevalence HIV60.16%NATIONAL BLOOD PROGRAMThe United Kingdom has four Blood Transfusion Services:National Health Service Blood and Transplant (NHSBT) for England and North WalesScottish National Blood Transfusion Service (SNBTS)Welsh Blood Service (WBS)Northern Ireland Blood Transfusion Service (NIBTS)7Each is coordinated in their respective country and therefore reports to the relevant national healthminister.7 Cooperation between the services is coordinated by the UK Blood Services Forum whichhas a Joint Professional Advisory Committee (JPAC) involved with advice and standards, andpublishes the transfusion guidelines, termed the Red Book.7 UK ministers and health departmentsrely on the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) for advice onthe best ways to safeguard the safety of blood, cells, tissues and organs fortransfusion/transplantation.7393EUROPE AND CENTRAL ASIAEUROPE AND CENTRAL ASIA NIL (NO INVOLVEMENT)NATIONAL SOCIETY (BRITISH RED CROSS)The British Red Cross is not involved in any blood related activities. It was previously involved inblood at Level C. The establishment of the National Health Service in 1948 meant a supporting roleonly for the British Red Cross and this ceased entirely in 1987.1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2018 Jan25]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/uk.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2018 Jan 25]. Available from: http://hdr.undp.org/en3 Bloomberg. Where Do You Get the Most for Your Health Care Dollar? [Internet] Bloomberg 2014 [cited 2018 Jan 25].Available from: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 25] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b5 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2018 Jan 25] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c6 Public Health England. HIV in the UK 2016 Report. [Internet] Public Health England 2016 [cited 2018 Jan 25]. Availablefrom: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/602942/HIV_in_the_UK_report.pdf7 European Blood Alliance. United Kingdom. [Internet] European Blood Alliance 2018 [cited 2018 Jan 25]. Available from:http://www.europeanbloodalliance.eu/membership/united-kingdom/EUROPE AND CENTRAL ASIA394MENAMIDDLE EAST AND NORTHERN AFRICANATIONAL SOCIETY (NS) INVOLVEMENT IN BLOODPROGRAMS BY LEVELNo response2 NS (11%)Level A4 NS (22%)Nil3 NS (17%)Level C4 NS (22%)395Level B5 NS (28%)MIDDLE EAST AND NORTHERN AFRICA (MENA)TOTAL NUMBER NS = 18MENAFOCUS ON LEVEL A NATIONAL SOCIETY BLOOD SERVICESIN THE REGION1 out of 4 NSBS have achieved 100% VNRBD100%90%80%% VNRBD70%60%50%40%30%20%10%0%EgyptIsraelJordan*Lebanon* Information unknown0 out of 4 NSBS provide 100% of the national blood supply100%90%% of national supply80%70%60%50%40%30%20%10%0%EgyptIsraelJordan*Lebanon* Information unknownMIDDLE EAST AND NORTHERN AFRICA (MENA)396MENA LEVEL AEGYPTEgyptian Red Crescent Society:Level A (undertakes full blood service provision)10% of the national total blood collection95% VNRBDNATIONAL CONTEXTLocationNorthern AfricaGeographical size ranking131stPopulation (world ranking)197 million (14th)Median age123.8Political system1Presidential republicGDP per capita (worldranking)1$13,000 (119th)HDI Index (world ranking)20.690 - medium (108th)Health Expenditure15.6% of GDPPopulation prevalencehepatitis B3Low: <2%Population prevalencehepatitis C4High: >5%Population prevalence HIV50.02% among adults aged15 to 49NATIONAL BLOOD PROGRAMThe providers of blood in Egypt are: National Blood Transfusion Services (22) 60% Ministry of Health 25% Egyptian Red Crescent Blood Banks 10% Universities / private 5%In 1996, with the Swiss government, Egypts Blood Transfusion Services commenced a project formajor restructure.6 The project comprised of three phases, with the first to establish the NationalBlood Transfusion Centre (NBTC) and eight Regional Blood Transfusion Centres (RBTCs) toguarantee quality collecting, testing and processing of blood.6 The National Blood TransfusionCentre (NBTC) is located in Giza and opened in 2000.6 In 2004, the network of RBTCs extended to17 regional and six district centres, all under the supervision of the NBTC.6 And in 2007, all hospitalblood banks started being converted to storage blood banks only.6The National Blood Policy was implemented in 2007, following ministerial decree, and iscomplemented by the following protocols National Blood Standards, National Guidelines for the397MIDDLE EAST AND NORTHERN AFRICA (MENA)MENA LEVEL AAppropriate Use of Blood, National Lab Strategy, Blood Safety Manual, Blood Technical Manual,and National Guidelines for Donor Counselling.6Standardised procedures for blood collection, processing and testing were developed by the NBTCas part of an overall quality infrastructure which, along with the licensure and inspection, has beentransferred to a National Blood Regulatory Authority (under the MoH) which now oversees theNBTS.7Whilst considerable improvements have been made by the NBTC, it is unable to meet the nationsdemand for blood, collecting only 30% of the nations blood supply.8 Two issues have been cited asthe major challenges for the blood situation in Egypt - recurring insufficient blood supplies and thepresence of unsafe blood.8In addition to the NBTC blood centres, the Red Crescent operates five blood transfusion centres. 9Paid blood donations were outlawed in 1999.6The MoH funds the NBTS and blood is provided free to public hospitals, with private hospital beingcharged a fee.7NATIONAL SOCIETY (EGYPTIAN RED CRESCENT)The Egyptian Red Crescent:annually collects (2016):o 75000 units of whole bloodo 100 plasma donorsprocesses collected blood into componentsconducts screening of blood for infectious diseases and blood groupingconducts cross-matching for transfusiondoes not forward plasma to a fractionation facilityperforms transfusions for thalassemic, haemophilic and haemodialysis patientsis not involved in cord blood stem cells, peripheral stem cells, bone marrow stem cells,bone/solid organ transplants or corneassupports a Regional population of 35,000,000supplies blood to 30 hospitals/clinicsis working towards accreditation to National / AABB standardsdoes not receive technical assistance or financial support for VNRBD or blood serviceactivities from outside the countryoperates a haemophilia treatment centre in CairoBlood donor recruitment and retention activities are coordinated by sharing the experience ofrecruitment programs with other Blood Services, as they are following the same procedures. Theyare funded by the blood service and the National Society. Volunteers are used to undertakerecruitment programs arranged by the facility.The Egyptian Red Crescent Blood Banks are planning to expand the following activities:the number of daily mobile donationsplatelet and plasma apheresis donationsantibody screening servicedonor recruitment programsMIDDLE EAST AND NORTHERN AFRICA (MENA)398MENA LEVEL A1Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Sept11]. Available from: https://www.cia.gov/library/bpulications/the-world-factbook/geos/eg.html2 United Nations Development Programme. Human Development Report 2016 [Internet] United Nations DevelopmentProgramme 2016 [cited 2017 Sep 11]. Available from: http://hdr.undp.org/en3 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Sep 11] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-b4 Centres for Disease Control and Prevention. CDC Yellow Book 2016. [Internet] Centres for Disease Control andPrevention 2016 [cited 2017 Sep 11] Available from: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseasesrelated-to-travel/hepatitis-c5 Central Intelligence Agency. The World Factbook 2013-14 [Internet] Central Intelligence Agency 2013 [cited 2017 Oct31]. Available from: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html6 Moftah F.M. Integration of blood transfusion services into National Health System, Egypt, experience. ISBT ScienceSeries [Internet]. 2009 Feb 13 [cited 2017 Nov 29];4:124-128. Available from:http://onlinelibrary.wiley.com/doi/10.1111/j.1751-2824.2009.01220.x/pdf7 MacPherson J. Blood Collections & Transfusion A Global Perspective 2014. Connecticut: The Marketing ResearchBureau Inc: 2014. 203p.8 The Triple Effect. Blood in Egypt [Internet] Triple Effect 2013 [cited 2017 Nov 29] Available from:http://tripleffect.com/all-about-blood/blood-in-egypt/9 Egyptian Red Crescent. Blood Banks [Internet] Egyptian Red Crescent 2017 [cited 2017 Nov 29]. Available from:http://www.egyptianrc.org/ERC-Activities/Activities/ActivityDetails/11.399MIDDLE EAST AND NORTHERN AFRICA (MENA)MENA LEVEL AISRAELMagen David Adom in Israel:Level A (undertakes full blood service provision)94% of the national total blood collection100% VNRBDNATIONAL CONTEXTLocationMiddle EastGeographical size ranking1154thPopulation (world ranking)18.3 million (97th)Median age129.9Political system1Parliamentary democracyGDP per capita (worldranking)1$36,200 (53rd)HDI Index (world ranking)20.899 - very high (19th)Health Expenditure17.8% of GDPEfficiency of Healthcare37th of 51 countriesPopulation prevalencehepatitis B4Low: <2%Population prevalencehepatitis C5Low: 1.0% - <1.5%Population prevalence HIV60.2%NATIONAL BLOOD PROGRAMThe Israeli National Blood Services is a division of the not-for-profit organisation Magen David Adom(MDA) 7 which is a member of the International Red Cross / Red Crescent. MDA manages all aspectsof the blood donations from collection through to nationwide distribution.7 The facility, located inRamat Gan, includes the central Blood Bank laboratories, which were established in 1987, and theFractionatio