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
Español - GAP VNRBD Newsletter - June 2018
IFRC Blood Policy
GB/11.1/1Original: EnglishINTERNATIONAL FEDERATION OF RED CROSS ANDRED CRESCENT SOCIETIES24th Session of the Governing Board,Geneva, Switzerland, 28-30 September 2011Item 11.1 of the agendaPolicy on Promoting Safe and Sustainable National Blood SystemsIt is recommended that:The Governing Board,approves the draft policy on Promoting Safe and Sustainable National BloodSystems and refers it to the upcoming General Assembly for final decisionExecutive summary.The attached version of the revised policy includes modifications to the text submitted to theGoverning Board in December 2010. More specifically there are some substance additions tothe version proposed by the Advisory Body on Health And Sustainable Development - especiallyin the list of points describing an integrated approach to blood safety (just below thedescription of Level B programmes) - and there is clarification of roles and responsibilitiesrelated to risk management at global and other levels. The key modifcations related to riskmanagement are to be found in the section on Specific Responsibilities arising out of thispolicy. In summary, it is underlined that the primary responsibility for managing safety andrisks of blood programmes lies with national governments. The remainder of the text remainslargely largely unchanged in substance over the version presented to the Governing Board inDecember last year.What is the issueThe need for a new blood policy was in part triggered by a comprehensive report submitted bythe Global Advisory Panel on Blood (GAP) on the Review of risks associated with bloodservice delivery for National Societies engaged in blood programmes to the Governing Board inSeptember 2009. While there was subsequently relatively quickly agreement on the maintechnical substance, it took a while longer to find consensus around the definition of roles andresponisbilities related to the management of the various risks associated with different forms ofengagement of the membership in blood related activities.The relation to previous governance decision(s)Following the December 2010 Governing Board decision asking the Secretariat to conductfurther consultations with National Societies on the draft blood policy as well as the April 2011decision supporting the proposal of the Secretary General to continue consultations on the bloodpolicy specifically in the area of risk management, a final draft is now presented to theGoverning Board for endorsement and for transmission to the General Assembly for finaldecision.The relation to existing policiesThis policy replaces the 1999 policy on Quality Provision of Blood ServicesThe relation to strategic objectivesRed Cross Red Crescent work on blood issues is in particular covered by strategic aim 2 ofStrategy 2020.How does this decision solve the issueThe new policy provides clarity on the scope of Red Cross Red Crescent blood related activitiesas well as roles and responsibilities related to management of associated risksResearch, analysis and consultations carried outVarious key stakeholders have been consulted, including the Advisory Body for Health and SustainableDevelopment, GAP (Global Advisory Panel on Blood), the Risk and Audit Comittee and senior managersand leaders of Natioanl Societies. In addition the Secretariat took into consideration pro bono workof a British law firm.Any other relevant information: to be refered in annexesNot applicableResource implicationsThere are at this stage no specific resource implications for the Secretariat. The membership atalrge is being constinously asked to support theRecommended optionsThe Secretariat orally updated the Governing Board at its April 2011 session on its perspectiveon possible legal liabilities and the various options of managing risk at the global level as wellas options for the future legal structure of GAP. There are separate terms of reference for GAP,and discussions and work are being carried out towards establishing GAP as a separate legalentity.Any potential risks to the FederationRed Cross and Red Crescent engagement in blood activities will always come with reputationaland other risks. Adherence to the policy will signifcantly contibute to effective management ofrisks.Implementation and Monitoring and how implementation will be monitored and reportedto the Governing BoardThe Secretariat is a member of the GAP Board, and will update the Governing Board through theSecretary General on material issues and risks that are brought to its attention in relation toimplementation of the blood policy.POLICYPromoting 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 theirhealth systems.The International Federation recognises that health security is a fundamental and indispensableprerequisite to global, national and individual development1 and it supports the advancement ofglobal health security by promoting voluntary non-remunerated blood donation (VNRBD), andadvocating for the safe provision of blood and products2.While the World Health Organisation (WHO) recognises that it is the responsibility of governments toensure a safe and adequate supply of blood3, Red Cross/Red Crescent Societies in many countries,as auxiliaries 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.Scope of policyThis policy sets out the International Federation and member National Societies position onadvancing health 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 ofblood could be a major concern in the event of a disaster, the safety is also always of paramountconcern to any emergency/disaster response. Blood is used for a multitude of life saving purposesincluding: assisting patients undergoing surgery; treating diseases including anaemia and malaria;caring for patients on chemotherapy; supporting women with complications during childbirth(postpartum haemorrhage) and patients on Antiretroviral (ARV) treatments. The unavailability of safeblood can lead to serious health consequences such as death from haemorrhage or thetransmission of life threatening infections HIV/AIDS, hepatitis B and C, syphilis and other infections.There should be preparedness plans to provide rapid response to emergency situations and forpost-disaster 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; and1Health Policy adopted at the 15 session of the General Assembly of the IFRC, Seoul, November 2005.Strategy 2020, p 15, IFRC3Blood Safety, Aide-Memoire for National Blood programme, WHO, 200226. combating HIV/AIDS, malaria and other diseases.It is recognised that a sufficient supply of safe blood and blood components based on voluntary nonremunerated blood donation (VNRBD), and the security of that supply, are important national goalsto prevent blood shortages and meet the transfusion needs of the patient population4.VNRBD is a critical component in ensuring a safe and sustainable blood supply that meets theneeds of all recipients. VNRBD was enshrined as a fundamental principle of blood service when the1975 World Health Assembly (WHA) resolution called for member states to promote thedevelopment of national blood services based upon voluntary non-remunerated donation of blood5.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 bloodcomponents so 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 inherentin the blood transfusion process, including accidental exposure to transfusion transmitted infectionssuch as HIV. To secure the safety of the blood supply, blood services must ensure that appropriatedonor screening and quality management processes are in place, and that they remain vigilantagainst new threats to the blood supply.Characteristics 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 thatobjective. 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 activitiesblood service delivery,donor re-motivation viaexcellent donor serviceFULL BLOOD SERVICE (INCLUDING BLOOD COLLECTION)Level AStrategic campaigns,accessibility of blood centresRECRUITMENTLevel Bimpact of broad based communityeducation/awareness programmesMOTIVATION AND ADVOCACYLevel C45WHA resolution 63.12.WHA resolution 28.72 This principle was reasserted again by the WHA in 2005 (WHA58.13) and 2010 (WHA28.72)Each level of National Society involvement in blood services is characterised by differentrequirements regarding capacity and risk management. While Level A requires the most resourcesand has the highest level of risk, a well run National Society blood service can contribute enormouslyto the health and well-being of the community in which it is based. However, all National Societiescan contribute towards the development of a safe and sustainable blood system through theadvocacy and promotion of VNRBD.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. Asummary of the main characteristics of a well-functioning level A or B blood programme is providedbelow.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, includingVNRBD, and it 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 the National Society reflect the overall responsibility of the Government to ensure anadequate and safe blood 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,equipment and trained staff and volunteers; ando implement appropriate donor care and risk management systems leading to high quality,safe and effective blood products. The blood programme is nationally coordinated to ensure uniformity of standards and costefficiency Donor selection criteria are in place to identify low risk donors and counselling is provided incases of deferral 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 forits blood service activities, including clinical advice. The National Society should assure that adequate external assessments are conductedregularly to ensure that the Blood services operate under the necessary quality assuranceprogramme and adheres to a national regulatory framework based upon internationallyrecognised standards. The blood service is involved in collaborations and partnerships to ensure a safe and adequateblood supply and appropriate product use.At Level B: The blood service to which the National Society recruits donors operates under a qualityassurance programme and adheres to a national regulatory framework based uponinternationally recognised standards.There are agreements in place whereby the roles and responsibilities of the National Societiesand the Blood Service are clearly defined.It is therefore important that National Societies consider carefully the level of blood activity which ismost appropriate for their engagement. The global burden of disease due to unsafe blood can beeliminated or substantially reduced through an integrated approach to blood safety, requiring,The establishment of a nationally coordinated blood serviceFormalization 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 operatingprocedures, accurate records, monitoring and evaluation aligning to Government policy.Collection of blood only from vnrbd from low risk populationsHaemovigilance system for monitoring, reporting and investigating adverse events.Trained staff and continuing professional development and upgrading for latest technologyas a prerequisite.Ensure efficient and good laboratory practices in screening for transfusion transmissibleinfections, blood grouping, compatibility testing, blood component production, storage andtransportationReduction 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.Meanwhile, 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 evidencebased considerations and the precautionary principlepromote and uphold high ethical standards, integrity and accountability consistent with theCode of Ethics for Blood Donation and Transfusion of the International Society of BloodTransfusion, as adopted by the International Conference of Red Cross and Red CrescentSocieties, 1981, and supported 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 accordancewith their capacity, technical know-how, available resources, local priorities and in liaison withgovernmentpromote safe, sustainable and equitable practices in the development and administration ofblood programmesensure their blood programme has an adequate governance structure with a well-definedsystem for delegation 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 inblood services 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 SustainableNational Blood Programmes Manual, which may necessitate a more detailed analysis,assessment and development of an exit strategyrespect the confidentiality and privacy of all information relating to blood donors and blooddonationadminister any blood programmes in compliance with this position; inform all staff, volunteersand blood sector partners participating in blood programmes of this positionwhere practical, provide support to other National Societies and blood services in achieving asafe and sustainable blood system in ways that enable self-empowerment and long-termsustainabilitytake steps in consultation with GAP and other partners to ensure that appropriate riskmanagement measures are implemented; this includes ensuring that its senior managementand governing leaders are alerted to any material risks and that appropriate action issubsequently 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 GlobalFramework for action-towards 100 per cent voluntary blood donationshare knowledge and exchange information with GAP at a strategic, regional and countrylevel.ensure this policy is reviewed after five yearswork with the GAP membership to help ensure necessary GAP resourcingkeep through the International Federation Secretary General International FederationGovernance appropriately informed of major material risks for the International Federation itbecomes aware ofThe GAP has a responsibility to:share knowledge and provide advice to National Societies on governance and management ofrisk associated with blood programmes, as resources allowensure any lessons learned from the implementation of the GAP manual Development of Safeand Sustainable National Blood Programmes are incorporated into an update of the manual atsame time as 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 nonremunerated blood 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)
GAP Structure
GAP Association 2018Executive BoardDr Philippe VandekerckhoveDr Wolfgang MayrDr Rudolf SchwabeMs Shelly Park(President)(Vice President)(Permanent Board Member)(Board Member)Dr Emanuele Capobianco(Permanent Observer)Financial AuditorGAP SecretariatDr Wolfgang MayrAustralian Red Cross Blood ServiceGAP Members and Regional Coordinators (RC)AMERICASASIA & PACIFICEUROPE & CENTRAL ASIAMENA / AFRICAHondurasDr Elizabeth Vinelli (RC)JapanDr Masahiro SatakeAustriaDr Wolfgang Mayr (RC)IsraelProf. Eilat Shinar (RC)USAMr Chris HroudaAustraliaMs Shelly ParkFinlandDr Satu PastilaThailandDr Ubonwon CharoonruangritBelgiumDr Philippe VandekerckhoveChina (Hong Kong)Dr Cheuk Kwong Lee (RC)GermanyDr Erhard SeifriedIndiaDr Vanshree SinghSwitzerlandDr Rudolf SchwabeIFRCDr Emanuele Capobianco(Head of Health )(Permanent Observer)
Self-assessment - English
GAP Self-AssessmentDesigned for National Societies active in blood services(Level A)2017Please refer to the GAP Self-Assessment guidelines for background and instructionsCountry:Name of Blood Service:Name of person completingthe survey:Position:Date completed:Once completed,please email to GAPSelfassessment@redcrossblood.org.au (preferred)or fax to +61 8 6213 5949Contents PagePart A - Blood service activities overviewPart B - Key issuesKey Issue 1: Minimum conditionsKey Issue 2: Essential organisational requirementsKey Issue 3: Protection against claims for damagesKey Issue 4: Support for recipients of infected bloodKey Issue 5: Safety versus costKey Issue 6: FundingKey Issue 7: Education on blood risks and consequencesKey Issue 8: Management skillsKey Issue 9: FractionationKey Issue 10: Administration of blood and blood productsKey Issue 11: Other ActivitiesRecommended next stepsFinal commentsList of AcronymsAABBCoEGAPIFRCMMRMoUNPNSNSBSSAVNRBDWHOAmerican Association of Blood BanksCouncil of Europe (European Committee (Partial Agreement) on Blood Transfusion (CDP-TS))Global Advisory Panel on Corporate Governance and Risk Management ofBlood Services in Red Cross and Red Crescent SocietiesInternational Federation of Red Cross and Red Crescent SocietiesMajor Material RiskMemorandum of UnderstandingNot ProvidedNational SocietyNational Society Blood ServiceGAP Self-assessmentVoluntary non-remunerated blood donationWorld Health OrganisationPart A - Blood Service Activities OverviewPlease provide a brief overview of your blood service, with the most recent data available to you. This sectionwill help set an overall picture of the blood activities in your National Society, and assist in evaluating progressover time.What percentage (%) of the total national blood supply does your National Society BloodService provide?If your National Society Blood Service provides less than 100% of the national blood supply, please list the topfive providers of blood in your country with the approximate % share of overall supply.Name% Share1.2.3.4.5.Is your National Society Blood Service centrally co-ordinated at anational level?YesNoYesNoPlease provide comments below:Are there any National Society Blood Service operations that arecontrolled at a state or provincial level?Please provide comments below:Please provide the number of fixed collection sites operated by your National SocietyBlood Service:Please provide the percentage (%) of total blood collections by your National SocietyBlood Service that are undertaken at mobile venues/camps?Please provide the total number of collections by your National SocietyBlood Service annually of:whole bloodNumber ofunitsVolume per unit (mls)apheresis plasmaapheresis plateletsother (please specify)Is the amount of plasma collected for fractionation in your countryenough to meet the requirements?Please provide comments below:YesNoDoes the National Society or Blood Service receive:YesNoa) Technical assistance for VNRBD or blood service activities from an internationalpartner (e.g. US CDC or AABB)?b) Financial support for VNRBD or blood service activities (e.g. The Global Fund to FightHIV/AIDS, Tuberculosis and Malaria)?If YES, please give details:Are you aware of any other organisations in your country that use theRed Cross/Red Crescent emblem, that carry out blood services?YesNoYesNoIf YES, please give details:Would you be willing to share some of your local success stories withother Red Cross/Red Crescent Blood Services?When returning your completed questionnaire to the GAP Secretariat, could you please provide a copy ofyour:- governance structure- organisation chartThis will assist GAP with the evaluation of the survey results and will help us to understand the local operatingcontext.Part B - Key IssuesKey Issue 1 - Minimum ConditionsExplanatory Note:When undertaking a blood programme, GAP recommends that a NSBS should meet a number of minimum conditions to ensure the delivery of a safe andadequate blood supply. These include the clarification of the roles and responsibilities of all key stakeholders in the blood program (including government),implementation of a national policy of 100% VNRBD and ensuring sufficient funding and supplies to meet regulatory requirements and operational needs.Are the roles and responsibilities clearly defined and described between theblood service and:1.1YesPartially(Please givedetails)NoUnknownNotApplicablethe national governmentthe local governments (if applicable)the National SocietyHospitals/clinicsPlease give details:If the roles and responsibilities are clearly defined and described, pleaseindicate how they are defined:1.1.1MemorandumofUnderstandingContract orother writtenagreementOther (pleaseNot Applicablespecify below)the national governmentthe local governments (if applicable)the National SocietyHospitals/clinicsOther (please specify):If the roles and responsibilities are clearly defined and described, are theseactively adhered to by:1.1.2YesPartially(Please givedetails)NoUnknownNotApplicableNoUnknownNotApplicablethe national governmentthe local governments (if applicable)the National SocietyHospitals/clinicsPlease give details:Does your countrys government have a national policy of securing supply ofsafe blood through voluntary and non-remunerated blood donation(VNRBD)?1.21.3YesPartially or InProgress(please givedetails)Please give details:Approximately what percentage (%) of the blood supply from your NationalSociety Blood Service is collected from VNRBD donors?(Please note: VNRBD does not include replacement donations from familyor friends)%Is your blood service a separate legal entity from the National Society? (i.e.do the National Society and Blood Service have legal protections in place tolimit the transfer of liability between both parties)1.41.4.1Partially(Please givedetails)If you answered NO to Q1.4, please describe what protections are in placeto prevent shared liability?1.5YesNoPlease give details:If you answered NO to Q1.5, please provide details of the consequences ofthis to the Blood Service's ability to meet minimum technical standards andguidelines.(e.g. is it impairing the Blood Service's ability to ensure appropriate supply oftesting reagents?)Does the Blood Service have sufficient of the following resources to meetregulatory requirements/minimum standards?1.6No, slightNo, significantshortageshortageYes, sufficient(*Please(*Pleaseprovide further provide furtherinformation)information)FacilitiesSuppliesEquipment1.6.1Trained staff/volunteersIf you answered "No, slight shortage" or "No, significant shortage" toany of the resources in Q1.6, this could indicate a potential Major MaterialRisk (MMR), so please provide further detailed information regarding theshortage and whether plans are in place to improve this.Are you able to assure privacy and confidentiality of donor information?1.7NoPlease give details:Does your National Society Blood Service have a long-term, sufficient andsustainable source of revenue/funding?1.5.1YesYesNoPlease give details:Please feel free to provide other comments or further information to clarify your responses to this section:UnknownNotApplicableKey Issue 2: Essential Organisational RequirementsExplanatory Note:The implementation of blood programmes is a complex undertaking with inherent risks which requires specialist technical and financialknowledge and expertise. To ensure the appropriate level of guidance is received and the significant risks that face all blood programmes canbe reduced, GAP recommends that all NS blood services are governed separately by a professional, specialist blood service Board withdelegated responsibility for strategic direction and having the specific skills required to manage the blood programme and oversee operationalperformance. It is particularly useful for board members to have bio- technical, medical/scientific management, economic/financial, politicaland legal skills and knowledge. Any governance structure should be guided by systems of delegation that clearly describe the role of theBoard, and the authority and accountability between the NS Council and the blood service Board.2.1Does the National Society have a separate organisational managementPartiallystructure to manage the blood service including a separate board of governance(PleaseYeswith delegated responsibility for the blood programmegive- strategic planning;details)- operational management; and- delegated financial authority.Please give details:If you answered YES to Q 2.1, does the National Society have a well-definedsystem for delegation, providing clarity on authority and accountability betweenthe:2.1.1YesPartially(Pleasegivedetails)NoUnknownNotApplicableNoUnknownNotApplicableNoUnknownNotApplicableNoUnknownNoUnknownNational Society and blood service boardsThe blood service board and blood service managementPlease give details:If you answered YES to Q 2.1, does your National Society Blood Service havethe skills and knowledge to implement and manage change, maintain strict rolesand responsibilities and otherwise perform its responsibilities as per Q2.1?2.1.2Is your National Society Blood Service based on a nationwide organisationalmodel?2.2Partially(PleaseYesgivedetails)Please give details:YesPartially(Pleasegivedetails)Please give details:Does the blood service have contingency plans or systems in place to maintainblood service delivery in the event of disaster? (e.g. a business continuity planor disaster preparedness procedures in place for the blood program)YesPartially(Pleasegivedetails)2.3Please give details:Please feel free to provide other comments or further information to clarify your responses to this section:Key Issue 3: Protection against claims for damagesExplanatory Note:A National Society Blood Service should have a clear definition of their relationship with the government and the governments role in protecting theNational Society against claims and damages. No matter how good a blood services quality management and safety procedures, there is always thepossibility of an incident of no fault transfusion transmitted infection. It is important, therefore, that the Blood Service has in place insurance orindemnity to protect it from potential liabilities should this occur, particularly in countries where litigation is a possible consequence. Blood Servicesshould also ensure to keep secure and accurate records.Does the government provide legal and/or financial protection to the blood service forundertaking its activities?3.1YesPartially(Please givedetails)NoUnknownNotApplicableNoUnknownNotApplicableNoUnknownNotApplicableNoUnknownNotApplicableNoUnknownNotApplicableNoUnknownNotApplicablePlease give details:Has a separate corporate structure been established between the National Societyand the blood service to enable protection of National Society funds from damagesrelating to blood service activities?Yes (PleasePartially(Please givegivedetails)details)3.2Please give details:Does the blood service operate according to international standards in bloodprogrammes (e.g. WHO, AABB, CoE)?(If YES or PARTIALLY, please indicate which standards)3.3PartiallyPlease give details:Does the blood service operate according to national or country specific minimumstandards?(If YES or PARTIALLY, please indicate which standards)3.4YesPartiallyPlease give details:Where the blood service does NOT operate according to international or nationalstandards in blood programme delivery, is the reason documented and accepted bygovernment?3.5YesPartially(Please givedetails)Please give details:Is your blood service accredited to a relevant blood standard? (e.g. AABB, cGMP, EUdirectives, GMP, WHO, AfSBT or AABB stepwise accreditation).If YES, please indicate certification, level and date of last inspection/audit.3.6Yes*When returning your completed Self-assessment questionnaire, please alsoprovide a copy of the blood standard being used.YesPartially/InProgressPlease give details:Does the blood service retain donor and donation records according to a definedpolicy?3.7Partially(Please givedetails)NoUnknownNotApplicableNoUnknownNotApplicableNoUnknownNoUnknownPlease give details:Does the blood service maintain insurance cover against the following potentialliabilities?3.8YesYesPartially(Please givedetails)property losspublic liabilityblood and blood products liabilitydirectors' and officers' liabilityprofessional indemnityinternal frauddonor injurymalicious product tamperPlease give details:3.9Does the blood service obtain regular professional advice on the levels and type ofinsurance cover?Does the blood service enjoy either commercial or government indemnity protectionfrom blood-borne disease liabilities?3.10Yes, at leastannuallyYesYes,periodicallyPartially(Please givedetails)Please give details:Please feel free to provide other comments or further information to clarify your responses to this section:NotApplicableKey Issue 4: Support for Recipients of Infected BloodExplanatory Note:While the blood service cannot be held responsible for the risk of infection which is inherent in blood products, it is appropriate forNational Society blood services to provide support and compassion to affected transfusion recipients. This is currently an area of riskfor almost all NS blood services as the provision of this type of support is an important aspect in sustaining the reputation of the RedCross/Crescent as a humanitarian organisation.Does the blood service or the health department provide support torecipients of infected blood?(Please select all mechanisms of support that are provided)YesPartially(Pleasegivedetails)- financial compensation- professional psychological support4.1- medical support- social support (e.g. in discussions with health insurance providers)- other (please specify):Please give details:If the blood service or the health department do not provide support torecipients of infected blood, which agency provides this support (if any)?4.2Please feel free to provide other comments or further information to clarify your responses to this section:NoUnknownNotApplicableKey Issue 5: Safety Versus CostExplanatory Note:A significant role of a National Society blood service is to balance safety, cost and availability of blood products. Although there is acontinued move towards improving the safety of blood, it is also important to ensure that a known small risk is not being replaced by anunknown and potentially greater risk. Efforts to increase safety can have an impact on the availability of blood products overall.Ensuring a continued awareness of emerging threats and the education of government agencies about new safety measures areimportant functions of the blood service.Does the blood service conduct a cost/benefit analysis of new safetyenhancement proposals? (e.g. Nucleic Acid Testing)YesPartially(Pleasegivedetails)NoUnknownNoUnknownNoUnknownNoUnknown5.1Please give details:Does the blood service actively advise government agencies on theimportance of adequate funding for new blood safety initiatives and theconsequences of not funding them?YesPartially(Pleasegivedetails)5.2Please give details:Does the blood service have systems in place to monitor emerging threatsto the safety of the blood supply (e.g. regional disease surveillance)?YesPartially(Pleasegivedetails)5.3Please give details:Does the blood service have systems in place to ensure the followingaspects of blood transfusion safety are being met (to ensure optimalpatient outcome):5.4YesPartially(Pleasegivedetails)The correct blood is being provided.The right built-in mechanism for lookback.Please give details:Does the blood service aim to influence hospitals/clinics in the appropriateuse of blood components including storage, handling and minimisingwaste?YesPartially(Pleasegivedetails)NoUnknownNoUnknownNoUnknown5.5Please give details:5.5.1If you answered YES or PARTIALLY to Q5.5, please indicate how youinfluence hospitals/clinics.If you answered YES or PARTIALLY to Q5.5, what percentage (%) of5.5.2 major hospitals that use blood components from your blood service do youhave a written agreement in place with?5.65.6.15.7%What percentage (%) of major hospitals that use blood components fromyour blood service have active multi-disciplinary transfusion committees?Does the blood service participate in multi-disciplinary transfusioncommittees?Please indicate the national proportion (%) of hospitals/clinics:Public hospitalsPrivate hospitalsNot-for-profit hospitalsClinicsArmed forcesOther (please specify):Does the blood service participate with relevant health authorities in thedevelopment of national standards?%Yes (all)YesYes(some)%%%%%%Partially(Pleasegivedetails)5.8Please give details:Please feel free to provide other comments or further information to clarify your responses to this section:Key Issue 6: FundingExplanatory Note:GAP advocates that NS should ensure, as a priority, that their blood service activities have sustainable and transparent financialarrangements. Sufficient and long-term funding should be in place and reviewed by the National Society before commencing orremaining in a blood programme. This is best secured through either cost recovery or government funding, although in some areasuse of public donations is supported. Transfer of funds between the National Society and blood service should be in the context of anappropriate service level agreement.6.16.2What percentage (%) of your total blood service budget comes from:Please give % for each:government%hospitals%cost recovery charge to hospitals/clinics%internal funding activities%your National Society%other National Societies%NGOs (non-governmental organisations) & international funds%public/private health insurance system%Other (please specify):%Does the blood service ensure that 'for profit' organisations or suppliersPartiallyhave no equity share or management control in the blood programme?(PleaseYesNogive(For example: Ensuring that suppliers of equipment/reagents do notdetails)influence blood service decision making)UnknownPlease give details:Does the blood service manage potential conflict of interest for:Yes6.3Partially(Pleasegivedetails)NoUnknownboard memberssenior staffvolunteersmajor suppliersPlease give details:A potential conflict of interest is a situation in which a person is in a position topersonally benefit from decisions made in their official capacity. Some examplesof mechanisms to manage conflict of interest are:a) board members with a conflict of interest are required to abstain from decisionmaking where a conflict exists; orb) policies are implemented that ensure suppliers are not influencing bloodservice independence on decision making.Is a formal agreement in place to manage National Society access toblood service funds?6.4Yes - NS cannot access fundsYes - formal agreement allows NS toaccess funds where appropriateNoUnknownOther : (please give details below)Not ApplicablePlease give details:Are blood service funds quarantined for use by the blood service only?Yes6.5Partially(Pleasegivedetails)Please give details:NoUnknownNotApplicableDoes the National Society provide funding to the blood service?6.6Yes(Pleasegivedetails)Partially(Pleasegivedetails)NoUnknownNotApplicableNoUnknownNotApplicablePlease give details:Do the National Society and blood service have separate accountingsystems?YesPartially(Pleasegivedetails)6.7Please give details:Please feel free to provide other comments or further information to clarify your responses to this section:Key Issue 7: Education on Blood Risks and ConsequencesExplanatory Note:While NS blood services may not be directly responsible for transfusing blood products to patients, GAP recommends that theyprovide a duty of care to patients by ensuring that they are made aware of the inherent risks of blood transfusion and that hospitalsand clinicians using the blood services products practice appropriate use of blood and effective patient consent protocols. Theprovision of appropriate education on the risks of blood transfusion should extend to the general public, NS, government, clinicalcolleges and blood service staff.Do patients have to provide written informed consent prior totransfusion?YesPartially(Pleasegivedetails)NoUnknownNoUnknownNoUnknownNoUnknown7.1Please give details:Has the blood service developed and implemented strategies aimed atimproving public education in relation to the safety of the blood supplyand risks of blood transfusion?7.2Examples may include:- school programmes- media (including social media)- information on a website- brochures/leaflets- informal networks- donor education- placing representatives on appropriate decision making bodies- other (please specify):Does the blood service provide education on the risks of bloodtransfusion to clinicians and other stakeholders, including:7.3YesPartially(Pleasegivedetails)Please give details:YesPartially(Pleasegivedetails)National SocietyGovernmentHospitals & clinical collegesBlood service staffParticipation on hospital transfusion committeesOther (please specify):Please give details:Does the blood service conduct regular campaigns to educate the publicon the need for regular blood donations?Yes(Pleasegivedetails)Partially(Pleasegivedetails)7.4Please give details:Please feel free to provide other comments or further information to clarify your responses to this section:NotApplicableKey Issue 8: Management SkillsExplanatory Note:In order to achieve and maintain a good standard of management skills, GAP recommends that a NS blood service is coordinated andguided by a national strategic plan, with a clear vision, mission and objectives. The strategic plan should be supported by tools suchas performance goals and key performance indicators which allow the blood service to measure progress towards an achievement ofthese goals.Does the blood service have the following in place?Yes8.1Partially(Pleasegivedetails)NoUnknownNoUnknownNoUnknowna clear visiona clear missiona strategic planstrategic objectivesPlease give details:Does the blood service have key performance goals and indicators?(e.g. % decrease in staff injury time, % decrease in product wastage)YesPartially(Pleasegivedetails)8.2Please give details:Does the blood service have training programmes in place to maintainand develop management and leadership skills?8.3YesPartially(Pleasegivedetails)Please give details:Please feel free to provide other comments or further information to clarify your responses to this section:Key Issue 9: FractionationExplanatory Note:It is not desirable for Red Cross/Red Crescent to commence fractionating activities unless the size of the operations in that country makes itviable and the blood service can meet international standards of GMP and quality assurance. GAP recognises that in some developingcountries, involvement in fractionation may be the only way that plasma derived products can be sourced, and the NS may considerfractionation, provided that appropriate government authority and support is secured. If plasma is to be discarded, donors should beadvised.If NS do want to fractionate or outsource to other fractionators, it is recommended that prior approval from appropriate governmentauthorities is obtained on both the product manufacturing and marketing processes. GAP also recommends the blood service reviews itsindemnity and insurance provisions to ensure that it is adequately covered for involvement in this additional activity and to minimise theimpact of the associated potential risk exposure. The NSs position is that a policy of national self-sufficiency is a matter for that countrysgovernment.Does the blood service collect plasma for fractionation into plasma derived medicininal products and send it toa plasma fractionator?9.1YesNoYesNoYesNoYesNoYesNoPlease give details:If NO, does the blood service plan to be involved in this activity in the future?9.1.1 Please give details:Does the blood service operate a plasma fractionation facility or directly perform fractionation (proteinpurification)?9.2Please give details:If YES, is the blood service insured/indemnified for these activities?9.2.1 Please give details:If NO, does the blood service plan to be involved in this activity in the future?9.2.2 Please give details:Does the blood service sell plasma derived medicinal products (derived from plasma fractionation)?9.3YesNoYesNoYesNoYesNoYesNoPlease give details:If NO, does the blood service plan to be involved in this activity in the future?9.3.1 Please give details:Does the blood service distribute plasma derived medicinal products to hospitals/clinics/patients?Please give details:9.4If NO, does the blood service plan to be involved in this activity in the future?Please give details:9.4.1If the blood service is involved in plasma fractionation activities, are donors informed of this?Please give details:9.5Please feel free to provide other comments or further information to clarify your responses to this section:Key Issue 10: Administration of Blood and Blood ProductsExplanatory Note:The involvement of a National Society blood service in any activities relating to the administration or therapeutic collection of bloodproducts, including compatibility testing and clinical advice, carries with it an increased exposure to potential risk for the blood service andNational Society.Does the blood service transfuse or administer blood products (e.g. blood, blood components, plasma derivedproducts, or cell therapies)?10.1YesNoYesNoYesNoYesNoYesNoPlease give details:If YES,- Is there official approval from government for these activities?- is the blood service/National Society insured/indemnified for these activities?10.1.1 Please give details:If YES, are there systems in place to ensure:- The right product is being transfused or administered to the correct patient?- Traceability (for patient lookback)10.1.2Please give details:If NO, does the blood service plan to be involved in these activities in the near future?10.1.3 Please give details:Does the blood service undertake therapeutic collection of whole blood or plasma?10.2Please give details:Does the blood service provide compatibility testing services / cross matching services for hospitals?10.3NoYesNoPlease give details:Does the blood service provide clinical advice or approval for blood and blood product transfusion oradministration (e.g. does the blood service review and approve requests for patient access to plasma derivedproducts such as IVIg or FVIII)?10.4YesPlease give details:Please feel free to provide other comments or further information to clarify your responses to this section:Key Issue 11: Other ActivitiesExplanatory Note:The extent and level of activities that the blood service is involved in will directly affect their potential risk exposure, as well as the risk for theNational Society. With the development of therapies and technologies, new areas of interest are emerging for some NSBS; howeverinvolvement these activities may also carry with them an inherent increase in associated risk which should be considered.Does the blood service undertake activities involving cells and tissues? (cells and tissue involvement includesthe collection, storage, testing, distribution and/or administration of cells and tissues)11.1YesNoYesNoYesNoYesNoYesNoPlease give details:If YES,- Is there official approval from government for these activities?- is the blood service/National Society insured/indemnified for these activities?11.1.1 Please give details:If NO, does the blood service plan to be involved in activities involving cells and tissues in the future?11.1.2Please give details:Does the blood service/National Society undertake consumables manufacture (e.g. blood bags/test kits)?Please give details:11.2If YES,- Is there official approval from government for these activities?- Is the blood service/National Society insured/indemnified for these activities?11.2.1 Please give details:If NO, does the blood service plan to be involved in activities consumables manufacture in the future?11.2.2 Please give details:Please feel free to provide other comments or further information to clarify your responses to this section:YesNoRecommended Next StepsRecommended Next StepsThe Self-assessment is intended to enable National Societies and their blood services to identify issuesthat require further attention. Each question in the SA describes a condition which, if not met, canrepresent a risk to the blood service and its National Society. A plan to address each of the unmetconditions - beginning with those under key issue one - should significantly reduce the level of risk to theblood service and its National Society.To assist the blood service in addressing its identified risks, GAP will provide it with an individualSelf-assessment feedback report with risk management recommendations.In the interim, GAP has suggested various possible 'next steps' for the blood service's considerationbelow:Governance and Management Establish a working group within the National Society and/or blood service to review the servicescurrent governance and management structure, and to prepare a strategic plan. Consider obtaining specialist assistance or advice on governance and management issues fromother National Societies/blood services, or by engaging a specialist external advisor. The working group or advisor could consider whether: the current structure provides sufficient oversight, and clarity of responsibility the management of the blood service and that of the National Society should be separated the blood service should be established as a separate legal entity from the National Society a structure involving a supervisory board of directors (with strategic oversight functions), a chiefexecutive (responsible for day-to-day management, reporting to the board), and a seniormanagement team (reporting to the chief executive) would be workableLegal Issues and Risk Management Identify the legislative and regulatory basis for the blood services operations. Assess whethercurrent government laws and regulations: accurately state the relationship between the blood service and government authorities adequately regulate the services activities provide the blood service with any protection or indemnification from legal claims Consider whether legislative changes are necessary, and how best such changes can beachieved. Consider advocacy with the government, and appropriate public health authorities, to gain theirsupport for such proposals. Establish a risk management team within the blood service, to conduct an assessment of theservices activities and to prepare policies for identifying, minimizing and eliminating risks.Funding and Insurance Review sources of funding and potential revenue streams. Assess whether current serviceagreements (if any) with the National Society and public bodies are sufficient, or require changes. Seek advice about the availability and cost of comprehensive insurance for the service and itsstaff.Policies and Standards Conduct an operational audit to assess the extent of compliance with international bloodprogramme delivery standards. Identify steps for improving compliance. Review operational policies (for example, policies for the recruitment and training of staff,document preservation, patient informed consent, public education, media relations, and so on). Systematically review and prioritize the key issues and key points from the Self-assessment, andincorporate them into policy and planning materials. Repeat the Self-assessment periodically in order to review progress.Final Comments and FeedbackPlease feel free to provide GAP with any further comments or information, for example:- Further clarification on any answers provided in the questionnaire;- Is there anything that your blood service is concerned about or you need further information on?- Feedback on the process of completing the Self-assessment (suggestions for changes or other comments)THANK YOUMany thanks for your participation in the Self-assessment. If you have any other information or feedback that you would like to provide, pleaseaddress it by email to:GAPSelfAssessment@redcrossblood.org.auPlease expect to receive your individual feedback report upon completion of the Self-assessment process within your region.
GAP Annual Report 2016
GAPANNUAL REPORT2016Good Governance, safe bloodThe Global Advisory Panel onCorporateGovernance and Risk Management of BloodServices in Red Cross and Red CrescentSocieties (GAP) is a global network of Red Crossand Red Crescent Blood Services with specificexpertise inrisk management and corporategovernance of blood programmes.ContentsMessage from the President22016 Highlights 3GAP is an independent Association accordingtoSwiss Law and is affiliated with theRed Cross/Red Crescent Movement.Governance4Global Mapping8The organisations purpose is to:Self-assessment14 Coordinate assistance to NationalSociety blood services inpost-emergency situationsincluding blood program recovery;Country Support Programmes17 Influence global blood policyinconjunction with partners;Global Networks 26 Provide advocacy and support to theRed Cross/Red Crescent Movement andNational Society blood services onissuesaffecting blood programmes.Financial Report29History33 Provide corporate governance and riskmanagement advice to National Societyblood services; Promote knowledge sharing, networkingand partnership among and betweenNational Society blood services andexternal partners; Develop and provide tools, guidelines andpriority country assistance to NationalSociety blood services most in need;Our VisionAll Red Cross/Red Crescent blood programmes will be safe, well governedandself-sustainable, based on the principle of voluntary non remuneratedblooddonation for the benefit of patients and to safeguard blood donors.Our MissionGAP will support Red Cross/Red Crescent blood services in risk management andcorporate governance of blood programmes and promote goodpractices andknowledge exchange.OVERVIEW | 1Message fromthe President2016 HighlightsProfessor Philippe Vandekerckhove, MD, PhDGAP PresidentThe last year, again, saw a lot of media attention for artificial blood.Onemaywonder why, in light of this news, Red Cross/Red Crescentnationalsocieties worldwide are still involved in promoting blood donationand/or blood banking activities?Indeed, whereas medicine and the press pay a lot of attentionto new medical and scientific breakthroughs, not muchattention is given to the fact that millions of lives are savedbythe daily act of blood transfusion.Besides the fact that the concept of artificial blood in itsdifferent forms has been around the corner for the past40years or so, it is unlikely that this technology will becomemature and safe in the very near future, and even should it beso, it will probably remain very expensive. The reasons for this,as is the case with certain plasma derived bulk componentssuch as albumin, is that it is just cheaper to obtain it fromhuman donors than to make it artificially in the laboratory.At a time when all health care systems are struggling tokeep up with finding funding for new technologies and drugsthat become available, this is an increasingly importantfactor. Maximizing cost effectiveness has now supersededmaximizing effectiveness in most health care systems. Manyof us, working in the health care systems, have becomefamiliar with the term cost per qaly (quality adjusted life year).For reasons of both effectiveness and cost-effectiveness,human donors will continue to remain an indispensable assetto satisfy the needs of health care systems worldwide foradequate supplies of safe blood and blood derived products.It is precisely for this reason that Red Cross/Red Crescentnational societies worldwide are involved in this activity.Since voluntary non-remunerated blood donation forms anessential part of the safety of the donated blood supply, andsince working with volunteers and organizing their efforts isthe core business of any Red Cross/Red Crescent nationalsociety, it is all but evident that the Red Cross is, and remainsinvolved.Global Mapping increased visibilityof National Societyinvolvement in bloodprogrammesExpanded Self-assessment programmeconducted in IndiaEnabled andsuccessfully facilitatedthe first meeting ofrepresentatives fromRed Cross blood banksthroughout IndiaReview of Self-assessment questionnairetoaddress new andemerging risksMaximised the potentialfunding support for theNepal Red Cross bloodservice recovery andfurther developmentprogram by PartnerNational SocietiesContinued prioritycountry support to theBangladesh Red Crescentand Honduran Red CrossBlood ServicesIn-country visit toIndonesia to discussprogress of the PalangMerah Indonesian BloodServiceIncreased GAP supportto National Societies involuntary blood donationWelcomed new GAPmember representativefor the Australian RedCross Blood ServiceFacilitation of theIFRC/Korean RedCross voluntarynon-remunerated blooddonation (VNRBD)workshop in Seoul byGAP member Prof EilatShinar (MDA Israel)Participation in the IFRCHealth & WASH meetingfor the Asia Pacific regionin Kuala LumpurGAP plays a role in supporting this collective effort throughdifferent means;By providing a global network with specialized expertisein blood program management to advise and supportNational Society Blood Services and IFRC on issuesaffecting blood programmes;By developing the tools, guidelines and examplematerials for blood services to ensure effectivecorporate governance and risk management of theirblood programBy providing targeted support and technical assistanceprogrammes to those blood services most in need;By facilitating blood programme knowledge transfer,networking and partnership on a global, regional orcountry based level;By coordinating assistance, in post-emergencysituations for blood programme recovery.As part of the Red Cross / Red Crescent Movement, GAPsthirteen member blood services collectively supply blood andblood products made from over 20.8 million donations ofwhole blood and apheresis products a year. Additionally, manymore National Societies motivate and recruit voluntary blooddonors and supply blood to support those in need.We at GAP strive to provide a strong network of supportfor National Society Blood Services to enable the ongoingprovision of safe blood and good governance.I hope you enjoy reading this annual report.The GAP global mapping book that will be published in thefollowing year, will document the huge commitment of RedCross/Red Crescent national societies worldwide. It is aneffort that has been going on for decades, and is likely tolastfor many decades more.Professor Philippe Vandekerckhove, MD, PhDGAP President2| GAP Annual Report 20162016 Highlights|3GovernanceThe GAP Association structure consists of GAP member National Societiesand their representatives, Regional Coordinators, theGAP Executive Board,a Secretariat and a permanent observer who representsthe InternationalFederation of Red Cross/Red Crescent(IFRC).New GAP Member Representativein 2016GAP member representative for Australia,Ms Jennifer Williams, resigned from theAustralian Red Cross Blood Service inMarch 2016, and consequently vacatedher position as a GAP Executive Boardmember. GAP would like to thank MsWilliams for her valuable contributiontoGAP activities over the last 7 years.Members pay an annual membership fee and arerepresented by the head of their National Societybloodservice or a nominated representative.GAP MembershipGAP Membership is open to National Society bloodservices which meet the criteria for membership,includingthe effective operation of a full Level A bloodservice (a blood service which collects blood from donorsand mayalso test, process and distribute blood collected).To be a GAP member, a National Society blood servicemusthave achieved, or be aspiring to achieve 100% voluntarynon-remunerated blood donation (VNRBD) andagree toregularly complete the GAP Self-assessment questionnaire.Collectively, GAP members provide advice on corporategovernance and risk management of blood services and,at an individual level, contribute their expertise andknowledge to support a range of GAP programsdesignedtoassist National Society blood services.GAP was pleased to welcome MsShellyPark, new Chief Executive Officer of theAustralian Red Cross Blood Service, asthe new GAP member representativeforAustralia in 2016.GAP is supported by a small secretariat which is basedinPerth, Australia and provided by the Australian RedCrossBlood Service.GAPs current membership is 13 National Society bloodservices from around the globe.GERMANYProf Erhard SeifriedGerman Red CrossBlood Transfusion CentreFINLANDDr Satu PastilaFinnish Red CrossBlood ServiceJAPANBELGIUMProf PhilippeVandekerckhoveBelgian Red CrossBlood ServiceDr Kenji TadokoroJapanese Red CrossBlood ServiceHONG KONGAUSTRIAAMERICADr Cheuk Kwong LeeHong Kong Red CrossBlood Transfusion ServiceProf Wolfgang MayrAustrian Red CrossBlood ServiceMr Chris HroudaAmerican Red CrossBiomedical ServicesINDIADr Veer BhushanIndian RedCross SocietyHONDURASDr Elizabeth VinelliHonduran Red CrossNational Blood Centre4| GAP Annual Report 2016THAILANDDr Ubonwon CharoonruangritThai Red Cross NationalBlood CentreSWITZERLANDDr Rudolf SchwabeTransfusion SwissRed CrossISRAELProf Eilat ShinarMagen DavidAdom - IsraelAUSTRALIAMs Shelly ParkAustralian RedCross Blood ServiceGovernance|5GAP Executive BoardGAP Regional CoordinatorsIn 2016, the GAP Regional Coordinators were:GAP is led by an Executive Board, the members of whichplay a vital role in governance and decision makingfor theorganisations activities and strategic direction.Boardmembers are generally appointed for a three-year term,butmay be eligible for reappointment if required.In addition to the generic skills that are required for mostboards, our Boards skills include knowledge and expertisein transfusion medicine, specifically in relation to NationalSociety blood programmes.Prof Philippe VandekerckhovePresidentChief Executive OfficerBelgian Red CrossBlood ServiceThe GAP Executive Board convenes regularly to review,approve and action GAP-related activities and objectives.In August 2016, Ms Shelly Park was elected as a newGAP Executive Board member following the resignationofMsJennifer Williams from this position.In addition to the GAP Executive Board, the organisation isalso represented by Regional Coordinators from the 5 IFRCregions (Americas,Asia & Pacific, Europe & Central Asia,Middle East &NorthernAfrica andAfrica).The role of the these coordinators is to liaise closely withtheir local IFRC regional office and look for opportunitiesto collaborateon activities in the critical area of corporategovernance and risk management for National Societiesinvolved in blood programmes.AmericaDr Elizabeth Vinelli (Honduras)Asia & PacificDr Kenji Tadokoro (Japan)Europe & Central AsiaDr Rudolf SchwabePermanent Board memberDr Wolfgang Mayr (Austria)Chief Executive OfficerTransfusion SwissRed CrossMENAProf Eilat Shinar (Israel)AFRICAPosition vacantProf Wolfgang MayrVice PresidentMs Shelly ParkBoard memberMedical CouncillorAustrian Red CrossBlood ServiceChief Executive OfficerAustralian Red CrossBlood Service2016 GAP Annual General MeetingLeft: GAP members atthe 2016 AGM in Dubai.The GAP Annual General Meeting is the primary decisionmaking forum of the organiation and consists of all memberrepresentatives and IFRC observers.In 2016, the GAP AGM was held in Dubai, United Arab Emirates.6| GAP Annual Report 2016One of the key outcomes of the 2016 GAPAGMwas the decision to increase GAP support toNational Societies in Voluntary Non-RemuneratedBlood Donation (VNRBD).Governance|7Global MappingWhat is global mapping?To fulfil its governance and risk management mandate, itis critical for GAP to have accurate and current information on theblood activities of National Societies. GAP conducts a regular global survey (global mapping) of all Red Cross/Red CrescentNational Societies to determine their level ofinvolvement in their countrys national blood program. The most recent surveywas conducted in 2015/16, withdata requested from all 190 National Societies.National Societies may be involved in a national blood programme at 3 levels or they may have noinvolvement at all (Nil).Level of involvement in Blood Program ActivityThe 2015/2016 Global Mapping has achieved an 88% response rate (168 responses from 190 National Societies). Thisresult demonstrates the high success of the program this year, as compared to previous analysis and reporting periods. In2013/2014, the response rate was just 38%.100How will the Global Mapping data be reported?A report on all 190 National Societies has been preparedby GAP which includes the data collected from the globalmapping survey, as well as additional information obtainedby GAP from public sources.For each Red Cross/Red Crescent National Society,the report provides:A. Full Blood Service ProvisionGovernance Advocacy for appropriate use Product distribution Laboratory testing Component preparation Collection services/donor care Donor recruitment Promotional campaigns Education and awareness Involvement in WBDD Donor recruitment Promotional campaigns Education and awareness Involvement in WBDDLevel of engagement of the National Society in the bloodprogramme (A, B, C or Nil)National context (including size of country, population,economy, health system)National blood programme (providers, regulation,trends, VNRBD rate)Red Cross/Red Crescent blood programme (history,funding, statistics, accreditation, partnerships)Any current changes in a National Society level of activityin a blood programme or intentions to expand/decreasethe level of activityB. Systematic Blood Donor RecruitmentDonor recruitment Promotional campaigns Education and awareness Involvement in WBDDC. Advocacy for VNRBDPromotional campaigns Education and awareness Involvement in WBDDIn addition to determining the level of involvement in bloodservices, the global mapping data is also used to inform theGAP Self-assessment and disaster response managementprotocols.Self-assessmentThe information obtained from the GAPglobal mappingprocess is primarily used as a precursor to the GAP Selfassessment programme (for Level A blood services) whichassists National Societies to identify and manage theirparticular corporate governance and risk managementissues; thereby helping to ensure the long term sustainabilityof their blood service.The highest level of risk resides with those National Societiesoperating full blood services (Level A), therefore GAPsprimary focus is on providing support to Level A NationalSocieties and their associated blood services.Disaster responseThe global mapping data is also a valuable referencetool for GAP and the IFRC in disaster response, to enablerapid assessment of the potential impact of a disaster ona National Society blood program, and to determine theextent of support that may be required if the blood service isaffected.8| GAP Annual Report 2016How was the data collected?The survey was distributed to National Societies in all 5 IFRCregions - Africa, America, Asia & Pacific, Europe & CentralAsia and Middle East & Northern Africa.806040200Number of blood collectionsInvolvement in any fractionation, transfusion or cell/tissue therapiesBlood Service accreditationCertain National Societies in the Africa region were askedsupplementary questions relating to the Ebola recoveryeffort, following the outbreak in West Africa in 2014-2016.AfricaAmericaAsia PacificEurope &Central AsiaMENALegendNo. receivedNational Societies in regionThe GAP Global Mapping Report will be publishedin 2017 and will be available on the GAP website:www.globaladvisorypanel.orgUnknown22 (12%)All National Societies were asked to provide information onthe mode of coordination of their blood program activities,funding mechanisms, donor recruitment programs (if inplace) and any potential plans to expand ordecrease theiractivities.For those National Societies operating a Level A bloodservice (collecting blood from donors and also possiblyprocessing, testing and distributing blood collected),questions were included for GAP to gain a comprehensiveunderstanding of the scope of activity including:Global Mapping Survey Response Rate(2015/2016)Level A36 (19%)Nil 25 (13%)Global mapping results from all regionsin 2015/2016 (total 190 National Societies)Level C39 (20%)Level B68 (36%)Of the 168 respondents, 143 (85%) are involved in theirnational blood programme.There are currently 36 known Level A National Societies(those involved in providing a full blood service).More National Societies are involved in the systematicrecruitment of blood donors (Level B 68) than at anyotherlevel.Global Mapping|9Global Mapping Results Per Region in 2015/201610| GAP Annual Report 2016Global Mapping| 11Level of Involvement of National SocietiesbyRegionAFRICAAMERICASFocus on Level A National SocietiesASIA PACIFICMENA511251311129181Number of National Societieswho have achieved 100% VNRBD0No. of National Societies thatcollect 100% countrys supplyAMERICA5IsraelNicaragua, Suriname,America, El Salvador,Guatamala14103EUROPE & CENTRAL ASIAEUROPE & CENTRAL ASIA14108MENA9The greatest number ofLevel A National Societyblood programmescontinues to be in theAsia Pacific region with12 National Societies,accounting for 33% of allLevel A National Societiesidentified.332206No. of National Societies thatcollect 100% countrys supplyNicaragua, Suriname, HaitiNumber of National Societieswho have achieved 100% VNRBDAustria, Belgium, Finland,Germany, Luxembourg, Spain,Switzerland, Turkey3Number of National Societieswho have achieved 100% VNRBDEurope &Central Asia= 9 (25%)AFRICAAmericas= 11 (31%)No. of National Societies thatcollect 100% countrys supplyFinland, Luxembourg, SwitzerlandMENA=3(8%)Asia Pacific= 12 (33%)0Number of National Societieswho have achieved 100% VNRBD0No. of National Societies thatcollect 100% countrys supplyAfrica = 1 (3%)ASIA PACIFICLegendLevel A12Level B| GAP Annual Report 2016Level CNil Involvement4Number of National Societieswho have achieved 100% VNRBDAustralia, Japan,Republic of Korea, Thailand3No. of National Societies thatcollect 100% countrys supplyAustralia, Japan, LaosGlobal Mapping| 13Self-assessmentGAPs primary tool for Level ANational Society Blood Services isthe distribution and evaluation of theSelf-assessment survey. The GAPSelf-assessment tool was developedin 2003 to assist National Societiesin assessing whether they haveappropriate measures in place tomanage the risks associated withprovision oftheir blood service, and isrun every two to three years.The Self-assessment assists National Societies to ensurethat appropriate steps are being taken to support thelong term stability and sustainability of their blood servicewithoutexposure to unnecessary risk. National Society bloodservices can measure their progress against selected criteriaidentified by National Society blood experts as fundamentalaspects for appropriate corporate governance and riskmanagement of a blood programme.It is a National Societys responsibility to manage the risksassociated with its blood service activities. GAPs role isto provide advice to assist the National Society and theirblood service in their efforts to improve their own corporategovernance and risk management. The Self-assessmentprocess provides individual feedback to the blood serviceon risk and governance issues including recommendedstrategies and suggested next steps for reducing exposure toany current risks.GAP also provides de-identified regional reports to enablecomparison of performance and identification of commonthemes or challenges within a region which are furtherdiscussed with National Society blood services at GAPregional meetings following the Self-assessment process.Above: Attendees at the GAP Self-assessment meeting, Delhi November 2016Indian Red Cross SocietyQuestionnaire ReviewThe GAP Self-assessment questionnaire is regularlyreviewed by members to ensure it remains relevantwith the rapidly changing global environment and itincludesemerging infectious diseases and continualadvancements in medical expertise and technology.In 2016, additional questions were added to the GAPSelf-assessment to evaluate a National Society bloodservices risk profile with regard to:1. Disaster preparedness The ability for a NationalSociety blood service to have systems in place tomaintain service delivery in the event of a disaster(e.g. business continuity plan or disaster preparednessprocedures) is an important risk mitigation measure.2. Global stepwise accreditation standards In somecountries, national technical standards may notexist and achievement of international best practicetechnical standards may not be feasible, particularlyfordeveloping countries. Stepwise accreditationstandards provide minimum standards and a systematicprogression toward higher levels of accreditation. Theinclusion of a reference to global stepwise standards14| GAP Annual Report 2016in the Self-assessment enables the blood service toindicate that they are working towards accreditation.3. Use of the Red Cross/Red Crescent log by non RC/RCentities The use of the name or logo by non RC/RCorganisations may have an impact onthe reputationalrisk for the IFRC.The national blood system in India is decentralised, with 2767blood banks in operation across the country run by either theMinistry of Health, NGO/not-for-profit organisations or theprivate/commercial sector.TheIndian Red Cross Society is responsible forapproximately 5-10% ofthe national total bloodcollection and has 166 independent blood banksacross the 36 states and Union Territories.With the assistance of Dr Vanshree Singh (Blood BankDirector - Indian Red Cross New Delhi HQ), GAP has beenundertaking an expanded Self-assessment process withinIndia, with 17 of the largest blood banks having completedthe GAP questionnaire since 2015. This process is aimingtoprovide increased visibility for the Indian Red Crossnational headquarters and GAP on the risks which existineach centre and for the Indian Red Cross blood networkasa whole.The meeting was also attended by representatives of theIndian government Ministry of Health (MoH) who provided anupdate on the MoH training programmes available and recentchanges to national regulations. The MoH are very supportiveof the Red Cross national blood program in India includingany future opportunities to strengthen this network.There were a number of positive outcomes of the GAPmeeting in Delhi, including:A commitment by the Indian Red Cross to improvestandardisation and integration of the Red Crossbloodbank networkPlans to improve visibility for the Indian Red Crossthrough data collection and reporting to the Red Crossnational HQ in DelhiFuture strengthening of individual blood banks andthe Red Cross network by increasing available trainingopportunitiesAn agreement for the Indian Red Cross to collectivelyapproach the Ministry of Health to discuss the nationalblood cost recovery model and the impact on this tostable funding arrangements for the blood banksSelf-assessment MeetingIn November 2016 a GAP delegation visited India to meetwith representatives of the Indian Red Cross blood bankswho had completed the GAP Self-assessment.Participants at the GAP meeting were provided with anopportunity to present an overview of their blood bank. Anumber of common strengths and challenges were identified.Positively, many centres noted adequate funding, equipment/infrastructure, high levels of VNRBD and achievement ofnational accreditation.GAP will continue to assist the Indian Red Cross in 2017withthe distribution of the Self-assessment to a furthersubset of blood banks across the country.Self-assessment| 15Country Support ProgrammesGAP provides targeted assistance to a small numberof identified priority country National Society bloodservices. These countries have been assessed by GAPasrequiring specific support in corporate governanceand risk management of blood programmes followingthecompletionof the GAP Self-assessment questionnaire.Above: Dr Veer Bhushan (Indian Red Cross Joint Secretary) and Dr Vanshree Singh (Indian Red Cross Blood Bank Director) withGAP delegatesSupport provided to GAP priority countries may include:In-country support visitsProvision of GAP tools, resources and GAP expertiseIdentification of partnering opportunitieswith other National Society Blood ServicesCo-ordination of technical assistance from GAPmembers or partnersAdvocacy support with key stakeholdersIn 2016, GAPs priority countries were Nepal,Bangladesh, Honduras and Indonesia.Indian Red Cross blood banks who have completed the GAP Self-assessment questionnaireNew DelhiPatnaAhmedabadAnand & GodhraRajkotNavsariDadra & Nagar Haveli UTBombay CityLaturSolapurVisakhaptanamKurnoolNelloreBangaloreThanjavurTamil Nadu16 | GAP Annual Report 2016Dr Veer Bhushan (Acting Secretary General,Indian Red Cross), Dr Vanshree Singh andthe meeting attendees noted that the GAPmeeting in India was the first opportunityfor representatives of the Indian Red Crossblood banks to come together to discusstheir activities, and they were very pleased tohave been provided with this opportunity. Themeeting showcased individual blood bankachievements that could be realised nationallyby the Indian Red Cross by leveraging thestrengths and expertise that already existswithin this network.Country Support Programmes| 17Nepal Post Earthquake Recovery ProgrammeIn 2010, the Nepal Red Cross Society (NRCS) NationalBlood Transfusion Service was selected as a GAP prioritycountry blood service and GAP has maintained a close andcollaborative relationship with the Blood Service ever since,through the provision of specific risk management servicesand technical assistance.Following the devastating 7.9 magnitude earthquake inNepal in April 2015, which caused extensive destructionto infrastructure and livelihoods, GAP has been providingassistance to the Nepal Red Cross in the reconstruction ofthe national blood service. GAP has a specialist role in postemergency situations, including short-term relief as well aslong term rebuilding, in accordance with GAPs Terms ofReference.The earthquake in Nepal resulted in significant damagetoblood service buildings and facilities, both in Kathmanduand regional areas. The Central Blood Transfusion Service(CBTS) centre in Kathmandu, which serves as the primarycoordination hub for the national blood service, was severelydamaged and was demolished during 2016. The blood centrewill be rebuilt with financial support from theThai Red Cross.An extensive scoping assessment of the earthquake impacton blood service facilities was undertaken by GAP in 2015,and recommendations and proposed activities to rebuild theblood program were developed and discussed with PartnerNational Societies interested in providing financial and/ortechnical support.The development and distribution of GAPsrecovery proposal for the Nepal Red Cross Societyblood program, combined with the series ofmeetings held with prospective stakeholders, hasenabled GAP to maximise potential partner fundingand support for this project and has providedtransparency of multiple partner programs tominimise the risks of duplication of activities andinvestmentsFollowing an adjustment of the project coordination modalityby GAP to align with the local Nepal Red Cross EmergencyResponse Operations Unit (ERO), contracting for blood centrefacility construction is being managed by the dedicatedNRCS ERO Unit, with GAP providing increased technical inputand expertise to NRCS and partners for the project, includingtechnical input on facility design.With the support of Partner National Societies, the projectis providing assistance to the Nepal Red Cross SocietyBlood Service with:Blood centre facility rebuild/repairCapacity buildingTechnical trainingStrategic supportCritical blood service equipmentLocal coordination support and Technical assistanceDuring 2016, a GAP delegation visited Nepal in May andNovember to meet with the NRCS Blood Service DirectorDrManita Rajkarnikar, key stakeholders and Partner NationalSocieties to confirm the agreed support activities. Furtherassessments were conducted of blood service infrastructureand facilities including temporary facilities and arrangementsfor the NRCS blood program. The November visit included aGAP facilitated joint meeting for all blood program supportpartners to provide an update on GAP activities and programstatus.Left: Nepal Red Cross Blood Service staffAbove: Nepal Red Cross Blood Service staff and voluntary blood donor18| GAP Annual Report 2016Above: GAP Member Dr Ubonwon Charoonruangrit (Thailand National Blood Centre) in NepalCountry Support Programmes| 19GAP coordination support to the programmehasbeen effective in:Developing a single national plan for facility,equipment and capability improvementactivities which is matched to assessedandagreed local requirements andminimumstandards within Nepal;Providing a baseline assessment for thetechnical training program developmentbytraining partnersProvision of different models for themanagement of donated funds and servicesto accommodate the preferred supportarrangements for each of thePartner National Societies.Above: Meeting with Partner National Societies in NepalGAPs technical input and support for the NRCS blood program recovery includes:Facility designs/layouts and workflow advice for blood centres (new facility buildsand for retrofits/modifications)Critical blood service equipment specification development and installation/validation protocolsBase line assessment to stepwise accreditation standards as basis for thedevelopment of tailored capacity building and training programs by partnersTechnical advice on blood service processes,interim arrangements and transition plans20| GAP Annual Report 2016Above: Earthquake damage at the Nepal Red Cross Bhaktapur Blood Bankand Chapter buildingCountry Support Programmes| 21HondurasGAP has been providing assistance to the Honduran RedCross Blood Service as a GAP priority country since 2012,in conjunction with a bilateral programme of support fromthe Swiss Red Cross. GAP member and Chief ExecutiveOfficer of Transfusion Swiss Red Cross, Dr RudolfSchwabe, provides expertise to this project.Following assessment visits and recommendations fromthe Swiss Red Cross in 2013, the project - Strengtheningof the Honduran Red Cross National Blood Programwas developed. The overall objective of this project is toensure the availability and security of blood and bloodproducts for all patients in Honduras, by strengthening thetechnical, administrative and governance capacity of thenational blood programme of the Honduran Red Cross.The beneficiaries of this project are the vulnerablerecipients of blood products in Honduras includingchildren, the elderly, pregnant women and trauma victims.The project will also directly benefit the Honduran RedCross blood programme and staff.GovernanceVoluntary Blood DonationIn 2016 the Swiss Red Cross project supported the HonduranRed Cross in strengthening their governance structureincluding the appointment of the new General Managerforthe Blood Service, Dr Glenda Arriaga, who has beenwiththe organisation for over 19 years. Dr Juan Pablo Bulneswas also appointed as the new Deputy General Manager.DrBulnes began working with the Honduran Red Cross BloodService in May 2016 and also took over the general projectlead.To assist in strengthening voluntary blood donation inHonduras, GAP is supporting the development of an onlinedonor recruitment training module for the Honduran RedCross Blood Service. This is being facilitated through theSwiss Red Cross bilateral partnership as an adjunct activityto the existing program.Dr Elizabeth Vinelli (GAP member representative forHonduras) resigned from the position of Medical Directorof the Honduran Red Cross Blood Service in early 2016 butcontinues to provide support and expertise to the project,andto GAP, through her position on the Blood Service board.WorkshopsAbove: Honduran Red Cross Blood Service staffThe Honduran Red Cross Blood Service is the mainprovider of blood in the country, collecting 50% of thenational supply.Project outcomes for the Honduran Red Cross Blood Service:As part of the bilateral project with the Swiss Red Cross, twoworkshops on risk management were held in Honduras (Mayand October 2016) for the staff of the Honduran Red Cross.The first workshop identified, analysed and prioritised therisks for the National Society. During the second Workshopan action plan was developed to address these risks. Theparticipants were very engaged in the discussions andappreciated this opportunity.During 2016, the Honduran Red Cross began the adaptationof the VNRBD training materials of the European BloodAlliance/Domaine Project for the Honduran context. Thee-learning component experienced delays in implementationdue to the changes in management of the Blood Service andthe required familiarisation with the Blood Service and theproject.The storyboard for the online tool will be ready for specialisedprofessional programming and format translation for theIFRC learning platform in late 2017, atwhich time the pilotproject will be implemented.It is anticipated that, once complete, the online tool will alsobe made available to other National Societies worldwide, witha view to assisting with the achievement of 100% VNRBD.This is acknowledged as a major challenge for developingcountries.The Swiss Red Cross delegates also participated in anotherin-country workshop, facilitated by the Honduran Ministry ofHealth and the Pan-American Health Organisation, to discussthe outline of a new national blood policy for Honduras.Defined constitutedgovernance structureImprovingVNRBD ratesProject outcomesfor the HonduranRed CrossBlood ServiceTechnical capacitybuilding22| GAP Annual Report 2016Improved coordinationof the NationalBlood SystemAbove: GAP member Dr Rudolf Schwabe (rear right) with staff of the Honduran Red Cross Blood ServiceCountry Support Programmes| 23BangladeshIndonesiaIn 2016, GAP continued to support the Bangladesh Red CrescentBlood Service who have been a GAP priority country since 2014.Key activities for the year included:Above: Above: GAP visit to Indonesia September 2016The Indonesian Red Cross (PalangMerah Indonesia PMI) has beena GAP priority country since 2005;however this status was placed onhold in 2013 while PMI were involvedin a bilateral support partnership withthe Australian Red Cross. PMI provide90% of the national blood supply inIndonesia and 92% of these collectionsare from VNRBD donors.In September 2016, GAP visitedIndonesia to assess the risk statusofthe PMI Blood Service followingthecompletion of their bilateral projectwith the Australian Red Cross.Thevisit provided an opportunity forGAP to review the progress of the PMIBlood Service since the completion ofthe Self-assessment questionnaire in2013 and to discuss risk managementadvice for any new areas of activity forthe Blood Service.Since 2012, the bilateral program withthe Australian Red Cross focussedon implementing a national qualitymanagement system and progressingtowards a centralised national bloodservice.24| GAP Annual Report 2016The PMI Central Blood Transfusion Service managementteam arehighly engaged and demonstrated a commitmenttoproviding a quality blood service for Indonesia, includingthe implementation of improvements to achieve nationalGood Manufacturing Practice (GMP) accreditation andan appreciation of the necessary requirements for riskmanagement.The PMI Blood Service has benefittedfrom the expertise and trainingprovided during the program anda number of achievements andimprovements were evident duringthe GAP visit in September, includingthe implementation of new qualitydocumentation and processes.Sponsorship and funding toenable the Bangladesh RedCrescent Blood Service Director,Dr Tarique Mehedi and a seniorrepresentative from the BloodService to attend the joint IFRC/Korean Red Cross VNRBDworkshop in Seoul, Korea.Establishment of Partner NationalSociety support for the provisionof a specific technical assistanceprogram for the Blood Service,to be provided byAustralian RedCross through the Australian RedCross Blood Service.Provision of advice and support toDr Mehedi to:GAP provided specific advice to PMIregarding the risks of fractionationandappropriate safeguards requiredfor involvement in this activity.PMI CBTS have also recentlyundertaken their own internalcapacitymapping for all 212PMI bloodtransfusion centresto determinethe requirementsnecessaryto achieve GMPaccreditation.Significantly, the visit enabled GAPto discuss with the blood service thefuture plans of PMI to provide plasmafor fractionation to a governmentrun fractionation plant in 2020.Currently a large proportion of theplasma produced in Indonesia isdiscarded (approximately 80%) andthis will provide an opportunity for thedomestic manufacture and supply ofplasma derived products (includingFactor VIII, Factor IX, Albumin andImmunoglobulins).Progress the implementation ofthe strategic plan for the BloodService.Hold seminars for the staff of theBangladesh Red Crescent andstakeholders on VNRBD, safetransfusion and rational use ofblood. The plans for the seminarswere subsequently placed on holdin 2016 due to the current securityissues in Bangladesh; howeverGAP is providing remote supportwhere possible.Above: Representatives of the Bangladesh Red Crescent Blood Service attendedthe IFRC/Korean Red Cross VNRBD workshop in Seoul (Korea) in April 2016.Country Support Programmes| 25Global NetworksIFRC Asia Pacific MeetingOur links with IFRCGAP cooperates with the International Federation of Red Cross/Red CrescentSocieties (IFRC) at a global, regional and secretariat level on strategicand operational matters relating to the corporate governance and riskmanagementaspects of National Society blood programmes.GAPs role and purpose is described in the IFRCs blood policy PromotingSafeand Sustainable Blood Systems which outlinesthe specificresponsibilities of the IFRC, GAP, National Societies and blood services inmanaging blood programme risk. TheIFRC has a permanent observer status onGAP and an IFRC representative attends meetings of the GAP Executive Boardto ensure theflow of information and coordination with the IFRC.IFRC Reference CentreGAP is recognised as an IFRC Reference Centre forthespecialist support function that GAP provides toRedCross/Red Crescent National Societies with regardtotheirinvolvement in the provision of a blood programme.Theare hosted by Red Cross/Red Crescent NationalSocieties around the world.Each centre has a specific focus and supports knowledgeexchange essential for National Society operations includingtraining, technical assistance, advocacy, knowledgemanagement and research. The primary function ofeachreference centre is to develop strategically significantknowledge and best practice to inform the future operationsof the IFRC and National Societies in their key areas ofinterest and influence.Above: Dr Julie Hall (Director Health& Care) was the IFRC observer on GAPin 2016.In July 2016, GAP was highlighted in thefortnightly publication of the IFRC Health & CareBulletin. This newsletter is distributed to over 500subscribers globally from a variety of networksincluding health and WASH staff and advisors,FirstAid Coordinators, Disaster Managementcolleagues and the IFRC secretariat managementin Geneva. Thearticle on GAP provided anoverview of the role of GAP and our activities, witha special focus on the global mapping project as ameans to encourage those National Societies whohad not yet responded to complete the survey.Michelle Wsolak from the GAP Secretariat represented GAPat the IFRC Asia Pacific Regional Health & WASH meeting inKuala Lumpur (Malaysia) in June 2016. The purpose of thismeeting was to share knowledge and provide updates onregional health and WASH (water, sanitation and hygiene)issues and activities across a range of health-related areasin the Asia Pacific. The event was attended by 59 delegatesfrom National Societies globally.GAP presented on safe blood systems, voluntary blooddonation and, in recognition of World Blood Donor Dayon June 14th, spoke of the importance of recognising theincredibly valuable contribution of blood donors globally tosupport sustainable blood programs. A case study was alsopresented on the effects of migration on availabilityof rare blood types in patients and donors in Australia.The meeting also provided an opportunity for GAP toholddirect discussions with the new IFRC Head of Health, DrJulieHall and IFRC Asia Pacific Health Coordinator, OyungerelAmgaa on emerging Asia Pacific regional healthissues.Above: Michelle Wsolak presenting at the Asia PacificRegional Health and WASH meeting in Kuala Lumpur.Transfusion TodayGAP was featured in the June 2016 issue of TransfusionToday, in a focus on Alliances and networks in bloodtransfusion. The article provided an overview of thestructure and role of GAP as well as the Self-assessmentandpriority country activities. Inclusion of GAP in thispublication provided an excellent promotional opportunityforthe organisation.26| GAP Annual Report 2016Global Networks| 27Financial ReportAsia Pacific VNRBD WorkshopActual I&E 2016(Includes Aust & SwissAccounts)Approved 2016 BudgetSwiss AccountAustralian AccountsNotesOpening balanceGAP accountsAustralian Account417,860Swiss Account417,86096,95996,959IFRC Funding accountAustralian AccountAbove : GAP member Prof Eilat Shinar (Magen David Adom Israel) presenting at the VNRBD workshop in Seoul.Above: Attendess at the VNRBD workshop in Seoul.(444)Combined opening balance at 1 January417,416(444)96,959514,374IncomeAn Asia Pacific workshop on voluntaryblood donor recruitment was heldin Seoul (South Korea) in April 2016and was co-hosted by the IFRC andthe Republic of Korea National RedCross. GAP participated in both theplanning of the event and facilitationof the workshops and panel/groupdiscussions during the meeting.GAPrepresentation was provided byour member representative for Israel,Professor Eilat Shinar.The purpose of the workshop wasto increase the capacity of NationalSocieties in the Asia Pacific regiontoimplement quality voluntary nonremunerated blood donation (VNRBD)recruitment programmes and tostrengthen regional cooperation andnetworking among National Societies.The event was attended by 89participants from 23 countries.GAP also provided financial supportfor two delegates from the BangladeshRed Crescent Society to attend theworkshop as part of GAPs prioritycountry assistance program, to helptoimprove the national VNRBD ratesinBangladesh.One of the key points highlighted inthe final workshop report was theimportance of the cooperation betweenGAP, IFRC, Korean Red Cross and otherdeveloped blood services in improvingVNRBD rates in the Asia Pacific region.Prof Shinar presented GAPsPerspective on VNRBD, as well asthedevelopment and maintenance ofa young VNRBD program using Israelasa model.2016 Member ContributionsAmerica21,00021,00021,000Australia21,00021,00021,000Finland21,00021,00021,000Israel21,00021,00021,000Japan21,00021,00021,000Switzerland21,00021,00021,000Germany21,00021,00021,000Austria21,00021,00021,00021,00021,00021,000BelgiumIndia01Thailand21,00021,00021,000210,000210,000065,000016,5035,00016,50300000500016,503070,50016,503Hong Kong - special statusHonduras - exemptsubtotal210,00002016 IFRC MOU funding IncomeIncome22016 Interest IncomeInterest GAP AustralianaccountOur sincere thanks to Prof Eilat Shinar for attendingandrepresenting GAP at the workshop and forproviding valuablefeedback to members on theworkshops keytopics.28| GAP Annual Report 2016Interest GAP Swiss accountInterest IFRC fundingaccountsubtotalFinance| 29Actual I&E 2016(Includes Aust & SwissAccounts)Approved 2016 BudgetSwiss AccountAustralian AccountsNotesActual I&E 2016(Includes Aust & SwissAccounts)Approved 2016 BudgetSwiss AccountAustralian AccountsNotesSupport for Nepal Recovery ProgramPriority country supportBelgium contribution preserved for Gorkha blood centre3VNRBD Consultancy(Belgian Red Cross)4113,574113,574NepalOther IncomeTotal Income37,537377,61437,5370280,500Post disaster support see separate line itemNRCS CBTS director trainingwith Australian Red CrossBlood Service(Approved GAP EB April 2015)(5,652)Support program, travel andaccomodation(4,374)(51,000)(4,374)(12,177)(39,242)(12,177)(4,258)(10,000)(4,258)0(1,000)0(1,177)(6,000)(1,177)(1,807)(130,000)(1,807)(24,770)(33,800)(24,770)(23,776)(43,391)(23,776)(12,177)(54,400)(12,177)(391)(2,500)(391)377,614BangladeshExpenditureSecretariat coordination,logistics and supportSecretariatSelf Assessment costs:Salary and oncosts(35,434)(35,979)(35,434)Secretariatcosts:Secretariat salary, oncosts andoffice expenses(80,430)(81,666)(80,430)(115,864)(117,645)(115,864)subtotal(5,652)HondurasTravel & accommodationOther expensesIndonesiaTravel and accomodationPost disaster response NepalSpecialist AdviceGAP SupportTranslation - Self assessmentreports, GAP manual, questionnaire, publications/standards(1,422)(5,000)(1,422)MMR followup (salary and travel)Professional expertise eg legal0(1,000)0Stakeholder meetings(e.g. VNRBD W/S, IFRC,Reference Centres,WHO, ISBT)Travel & accommodation5Global mapping (salary and travel)6Stepwise accreditationWebsite hosting and technical maintenance(3,068)(5,000)(3,068)Insurance0(1,000)0Bank fees(1143)(1,143)Meeting costs(4,404)(10,000)(4,404)Project cost recovery19,03219,032Participant costs(8,350)(5,000)(8,350)(2,390)(9,000)(2,390)Meeting venue/catering(623)(2,000)(623)GAP networking events(dinner)(297)(2,000)(297)GAP Annual Report(308)Other meeting expenses(900)(1,000)(900)Regional meetingsContingency funds0(20,000)0(555,678)(210,297)Annual General MeetingTravel & accommodationOther expenses00Teleconferencing Calls costs0(1,000)0(2,000)0Teleconferences30| GAP Annual Report 2016(205,139)(5,158)Closing balance589,89091,801681,692(308)Executive Board Meeting(s)Meeting venue/catering andtravel accommodationTotal Expenditure(2,700)0NotesExchange rates:1.Membership fees for 2016 & 2017 (42,000 CHF) received Dec 2015.Opening Balance Exchange rate as per XE Currency converter Oanda website31 December 2015: 1 AUD = 0.7243 CHF 2.Funding from IFRC not received in 2016.3.Belgium contribution preserved for Gorkha blood centre(Nepal) Euro 101,045.4.Belgium contribution for VNRBD consultancy (50,000 Euro) invoicedinDec 2016 but not received until Jan 2017.5.2016 budget (130,000 CHF) approved to cover GAP coordinationof post disaster support in the event that no external funding sourced.Expenditure Exchange rate as per weighted average 1 AUD = 0.6910 CHF6.Global mapping budget of 43,391 CHF is for 2015 & 2016.Closing Balance Exchange rate as per XE Currency converter Oanda website asat 31 Dec 2016 = 1AUD = 0.734642 CHFInterest Exchange Rate as per average exchange rate for the year 0.7328Belgium contribution for Gorkha Exchange rate as per average exchange ratefor the year 0.7328VNRBD Consultancy Fees received in January used average exchange rateinJan17 - 0.750735Finance| 31HistoryGAP was formed in May 2001 by a group ofexperts from National Society blood services inorder to share knowledge on risk managementand to provide advice to Red Cross/Red CrescentNational Societies on the proper managementofrisks associated with blood programmes.Thiswas a result of the IFRC governing boarddeciding to distance itself from blood bankingdue to concerns regarding the legal liabilitiesassociated with this activity.The initial members of GAP were the American,Finnish, Japanese, Swiss, Thai and AustralianRedCross. Since that time, GAPs membership hasgrown and GAP has continued to provide technicalsupport and assistance to National Societyblood services. In June 2012, GAP was officiallyestablished as an independent Associationregistered under Swiss law, and governed by anExecutive Board.Currently GAPs membership standards at thirteenNational Society blood services, all of whomconduct Level A blood programmes.32| GAP Annual Report 2016History| 33Contact GAPGAP SECRETARIATA Level 1, 69 Walters Drive, Osborne Park WA 6017, AustraliaP +61 8 6213 5909F +61 8 6213 5949E gapsecretariat@redcrossblood.org.auW globaladvisorypanel.orgGood Governance, safe blood
GAP Annual Report 2015
GAP ANNUALREPORT 2015Good Governance, safe bloodCONTENTSOVERVIEWOverview1GAPs purposeVision and missionMessage from the President2015 Performance HighlightsGovernance4MembershipExecutive BoardZonal CoordinatorsGAP ElectionsIFRCThe Global Advisory Panel onCorporate Governanceand Risk Management of Blood Services in Red Crossand Red Crescent Societies (GAP) is a global networkof Red Cross and Red Crescent Blood Services withspecific expertise in risk management and corporategovernance of blood programmes.8Memorandum of UnderstandingWorld Blood Donor DayEveryone Counts ReportIFRC Reference CentreGAP is an independent Association, registered underSwiss Law and affiliated with the International Federationof Red Cross and Red Crescent Societies (IFRC).The networks purpose is to:Activities10Global MappingSelf-assessmentPriority Country SupportDisaster Response Nepal EarthquakeFinanceIncome & Expenditure Report 2015Audit Report25 Provide technical advice in termsof corporate governance and riskmanagement to National Society BloodServices; Coordinated assistance to NationalSociety Blood Services in post-emergency situations including blood programrecovery; Promote knowledge sharing, networkingand partnership among andbetween National Society BloodServices and external partners; Influence global blood policyin conjunction with its partners; Develop and provide tools, guidelinesand priority country assistance toNational Society Blood Servicesmost in need; Provide advocacy and support to theIFRC and National Society Blood Serviceson issues affecting blood programmes.OUR VISIONOUR MISSIONAll Red Cross/Red Crescent blood programmes will be safe, well governed andself-sustainable, based on the principleof voluntary non remunerated blooddonation for the benefit of patients andto safeguard blood donors.GAP will support Red Cross/Red Crescent blood services in risk managementand corporate governance of blood programmes and promote good practicesand knowledge exchange.OVERVIEW| 1MESSAGE FROMTHE PRESIDENTProfessor Philippe Vandekerckhove, MD, PhDGAP President2015 has seen GAP continue to deliver itscore programme of work, which centres uponproviding assistance to Red Cross and RedCrescent National Societies to identify anypotential risks associated with their involvementin a blood programme and providing specialistsupport to help address any risk areas.Since GAPs early beginnings back in 2000,the risk identification programme has beenbased on the use of a self-assessment toolspecifically designed to highlight key areas ofrisk. The analysis by GAP of the informationprovided through the assessment, the development of advice and strategies to addressthese risks and challenges, and the provisionof advocacy for voluntary non remuneratedblood donation, remains the fundamental basis of GAPs support for National Societies.In recent years however, GAPs role hasfurther evolved and adapted to the changing needs of National Society blood programmes and their areas of activity, as wellas adapting to the needs of IFRC to supportthe implementation of the blood policy. GAPhas increased the visibility of its support service capability and expertise among NationalSocieties, through its recognised role as anIFRC reference centre. Simultaneously, GAPhas had an increased level of involvementin the field, directly supporting a numberof priority country Blood Services throughdedicated assistance programs and particularly, in the last 12 months, in the provisionof post-disaster recovery assistance andcoordination.In terms of disaster response, the existenceof a quality blood service is critical to meetthe high healthcare demand for blood duringthe initial emergency phase. While the availability of blood may be a concern in the event2| GAP ANNUAL REPORT 2015of a disaster, ensuring the safety of the bloodsupply is also of paramount concern. Therecent experience of the devastating earthquake in Nepal demonstrated the active rolethat GAP has in this arena, assisting the National Society to restore a functional and safeblood supply as soon as possible followingthe disaster and importantly in coordinatingthe long-term rebuilding and recovery of theblood programme once the initial urgencyhad passed, in conjunction with the supportof Partner National Societies.Healthcare systems world-wide require reliable access to a safe and sustainable bloodsupply, which is based on the principle of voluntary non-remunerated blood donation. Weat GAP hope to continue our path of workingtogether with Red Cross and Red CrescentNational Societies to assist them in ensuringthe availability of a safe supply of blood andblood products, and in doing so, to maximally assist those most vulnerable populationsaround the globe.OUR 2015PERFORMANCEHIGHLIGHTSGLOBAL NETWORKSCOMPLIANCESAFETY & GOVERNANCE33 Completionof GAP website33 Self-assessmentdistributed to 10 IndianRed Cross Society bloodcentres33 Priority country support to the BangladeshRed Crescent Blood Service, expertise providedby Dr Wolfgang Mayr.33 GAP recognised as anIFRC reference centre33 Participation in 2015World Blood Donor Day(Shanghai, China)33 Revision of Self-assessment questionnaire toaddress new and emerging risks33 Priority country support to the Honduran Red CrossBlood Service, expertise provided by Dr Rudolf Schwabe.33 Training programme for the Director of the Nepal RedCross Blood Service provided by GAP member, AustralianRed Cross Blood Service33 Library of resources available on the GAP websiteRELATIONSHIPSMEMBERSHIPSIFRC33 Coordination of theNepal post-earthquakerecovery for the bloodprogramme, with NRCS,IFRC and PartnerNational Societies33 New member in 2015 Indian Red Cross33 Participation of GAP in 2015 World Blood Donor Day33 Promotion of VNRBD through priority countryactivities in Bangladesh and Nepal.33 Funding of VNRBD online recruitment trainingmodule for the Honduran Red Cross Blood Service.Professor Philippe Vandekerckhove,MD, PhDGAP PresidentOVERVIEW|3GAP ASSOCIATIONGOVERNANCEMEMBERSHIPCHANGES IN 2015The Global Advisory Panel structure consists of GAP Membersand their representatives, Zonal Coordinators, GAP Executive Board,the Secretariat and IFRC representatives (permanent observeron the GAP Executive Board and Senior VNRBD Officer).GAP member representativeswho retired during the year:GAP MEMBERSHIPCollectively, GAP members provide advice on corporategovernance and risk management of blood servicesand at an individual level, GAP members contribute theirexpertise and knowledge to support a range of GAP programs designed to assist priority country blood services.A General Meeting of all GAP members is held annually.GAP Membership is open to National Society Blood Services which meet the criteria for membership,including theeffective operation of a full Level A blood service. Memberspay an annual membership fee and are represented byeither their Chief Executive, head of their National SocietyBlood Service or a nominated representative.American Red CrossBiomedical ServicesThailand NationalBlood CentreHong Kong Red CrossBlood Transfusion ServiceRichard BenjaminDr Soisaang PhikulsodDr Che Kit LinAmericas Zone CoordinatorWelcome to new memberrepresentatives in 2015:GERMANYDr Erhard SeifriedGerman Red CrossBlood Transfusion CentreFINLANDDr Martti SyrjlDr Satu PastilaFinnish Red CrossBlood ServiceDr Wolfgang MayrAustrian Red CrossBlood ServiceDr Satu PastilaTHAILANDINDIADr Ubonwon CharoonruangritDr Soisaang PhikulsodThai Red Cross NationalBlood CentreDr Veer BhushanIndian RedCross SocietyNew GAP member in 2015SWITZERLANDDr Rudolf SchwabeTransfusion SwissRed CrossDr Gabriel PictetDr Julie HallIFRC PermanentObserver on GAP| GAP ANNUAL REPORT 2015Dr Cheuk Kwong LeeHONG KONGGENEVA4Dr UbonwonCharoonruangritDr Cheuk Kwong LeeDr Che Kit LinHong Kong Red CrossBlood Transfusion ServiceMr Chris HroudaDr Richard BenjaminAmerican Red CrossBiomedical ServicesDr Elizabeth VinelliHonduran Red CrossNational Blood CentreFinnish Red CrossBlood ServiceDr Kenji TadokoroJapanese Red CrossBlood ServiceAUSTRIAHONDURASHong Kong Red CrossBlood Transfusion ServiceJAPANBELGIUMProf PhilippeVandekerckhoveBelgian Red CrossBlood ServiceAMERICAThailand NationalBlood CentreISRAELProf Eilat ShinarMagen DavidAdom - IsraelPERTHGAP SecretariatAustralian RedCross Blood ServiceAUSTRALIAMs Jennifer WilliamsAustralian RedCross Blood ServiceIndian Red Cross Society is GAPsnewest member country. India joinedGAP in December and member representation is being provided by Dr VeerBhushan, Joint Secretary of the IndianRed Cross Society.GOVERNANCE|5GAP ZONALCOORDINATORS IN 2015GAP EXECUTIVEBOARDThe GAP Executive Board members play avital role in governance and decision makingfor the organisations activities. Board members are generally appointed for a three-yearterm, but may be eligible for reappointment.In addition to the generic skills that arerequired formost boards, our Boards skillsinclude knowledge and expertise in transfu-sion medicine and National Societyblood programmes. An IFRC permanentobserver holds a position on the GAP Executive Board to ensure the flow of informationand coordination with the IFRC. The Executive Board convenes regularly to review,approve and action GAP-related activitiesand objectives.The role of the GAP Zonal Coordinatorsis to liaise closely with their local IFRCzone office and look for opportunitiesto collaborate on activities in the criticalarea of corporate governance and riskmanagement for National Societiesinvolved in blood programmes.AMERICASDr Richard Benjamin (USA)and Dr Elizabeth Vinelli (Honduras)ASIA & PACIFICProf Philippe VandekerckhovePresidentChief Executive OfficerBelgian Red CrossBlood Service FlandersDr Wolfgang MayrVice PresidentMedical CouncillorAustrian Red CrossBlood ServiceMs Jennifer WilliamsBoard memberChief Executive OfficerAustralian Red CrossBlood ServiceDr Che Kit Lin (Hong Kong)and Dr Kenji Tadokoro (Japan)EUROPE & CENTRAL ASIADr Wolfgang Mayr (Austria)MENAVacant in 2015AFRICAVacant in 2015GAP ELECTIONSDr Rudolf SchwabePermanent Board memberChief Executive OfficerTransfusion SwissRed Cross6| GAP ANNUAL REPORT 2015Dr Julie HallIFRC Permanent ObserverIn 2015, GAP held an election for all Executive Board and Zonal Coordinator positionswhich came to the end of their 3 year termsin December 2015. The result of this wasthat all members were re-elected to thesame positions commencing from1st January 2016.Prof Eilat Shinar (MDA Israel) was newlyelected to the previously vacant positionof Zone Coordinator for the Middle Eastand Northern Africa region.GOVERNANCE|739GAPs role and purpose is described in theIFRCs blood policy Promoting Safe andSustainable Blood Systems which outlinesthe specific responsibilities of the IFRC,GAP, National Societies and blood servicesin managing blood programme risk.The IFRC was instrumental in the creationof GAP and participates as a permanentobserver to ensure the flow of informationand coordination with the IFRC. Regularcommunication and constructive ties between GAP and the IFRC Secretariat ensurethe coordination of work programs andsupport links, particularly with respect toVNRBD. The IFRC has a permanent standinginvitation to attend the GAP Annual GeneralMeetings and the Executive Board meetings.Dr Gabriel Pictet (Acting Head of Health,IFRC) was the IFRC observer on GAPuntil September 2015, at which timeDr Julie Hall was appointed to thisposition (IFRC Head of Health)Memorandum of UnderstandingIFRC provided GAP with a grant in 2015to strengthen GAPs ability to act accordingto the IFRC Blood Policy Promoting Safeand Sustainable National Blood Systems.This grant was supported by a Memorandumof Understanding, agreed to by both parties.The funding was provided to supportthe following GAP activities:1. Extension of the GAP Self-assessmentprocess into an additional region in 2015The Self-assessment process wascompleted in the Middle East &Northern Africa (MENA) region andcommenced as an expanded activityin India in 2015.2. Conduct Major Material Risk(MMR) follow-up and investigation:In 2015, GAP conducted a visitto India as a follow up to theSelf-assessment process.3. Support for GAP priority countries:GAP provided support, includingin-country visits, to priority countriesBangladesh and Nepal.This was a joint initiative by the World HealthOrganisation (WHO), the International Societyof Blood Transfusion (ISBT), the InternationalFederation of Blood Donor Organisations(FIODS) and the Shanghai Blood Bank.8| GAP ANNUAL REPORT 2015Societies over the year which is measuredAlongsidetheproxyWorld HealthOrganisation, we stronglythrough the sevenkeyindicatorsbelieve in a policy of 100 per cent voluntary non-remufrom the IFRCneratedStrategicPlan.becauseOne ofblood donation,thattheseis safest.At present,only number60 countries havefully achievedthis norm. Givenindicators is theof peopledonatingworldwide shortages of blood and its components, there isblood. Each NationalSocietyprovidesthea long way to go to achieve global blood security. Culturalattitudesan undoubtedin some places.IFRC with theirown aredatafor thisconstraintindicatorand GAP providedadditionalinformationOf the 108 million blood donations collected globally,from its own globalmappingactivities.about 21 millionor a fifthare associated with Red Crossand Red Crescentblood services.GAP also contributeda narrativetoMalesthe tend to dominateas donors, and the Asia Pacific and Europe regions makepublication whichhighlightedtrendsthe most donations (Figure 5.11).of National Society involvement in blood,Operating a full-scale blood programme is a complex andas well as a humaninterest case study fromhighly technical affair, with managing risk and mainandBloodquality beingthe core concerns. Morethe AustraliantainingRedsafetyCrossService.than 80 per cent of National Societies are involved inblood-related activities. A partial survey indicates thatthis is at three levels, ranging from promotion and advocacy for voluntary unremunerated blood donation, tothe systematic recruitment of blood donors, and finally,the provision of full blood services including collecting,testing, processing, and distribution (Figure 5.12).IFRC ReferenceCentreGAP is recognised as an InternationalFederation of Red Cross and Red CrescentSocieties (IFRC) Reference Centre due to thespecialist support function that GAP providesto Red Cross and Red Crescent NationalSocieties with regard to their involvementin the provision of a blood programme. TheReference Centres are delegated functionsof the IFRC and are hosted by Red Cross/RedCrescent National Societies around the world.Each centre has a specific focus and supports knowledge exchange essential for National Society operations including training,technical assistance, advocacy, knowledgemanagement and research. Their primaryfunction as centres of excellence are to develop strategically important knowledge andbest practice that will inform the future operations of the IFRC and National Societies intheir key areas of interest and influence .2015 World Blood Donor DayIn June 2015, a GAP representative attendedthe World Blood Donor Day celebration whichalso included a round-table discussion onthe promotion of voluntary non-remuneratedblood donation (VNRBD) in Shanghai, China.To serve others by donating your spare money, time, orskills is commendable. To give of your own self is trulynoble. It is, therefore, unsurprising that the Red Crossand Red Crescent has been associated with blood servicesIn 2015, GAP evercontributedto the IFRCsince the technology became available. Safe andaccessibleblood suppliesare crucialto save or preservepublication, theEveryoneCountsreport.life in medical care and in the aftermath of accidents,This report highlightstheworkofNationalviolence, and disasters.The objective of the round table discussionwas to address the challenges of promotingVNRBD, ways to overcome barriers and toshare new initiatives for VNRBD promotion.GAP provided a presentation which includedinformation on the history and role of GAPand current activities, including the promotion of VNRBD and global mapping.In 2015, GAP was included in the IFRCReference Centres brochures publication,which provides information on the individualreference centres and the support that theyprovide. The article on GAP highlighted thepurpose and key services of the organisationas well as contact information. The IFRCReference Centres brochure was distributeddirectly to all 190 National Societies globallyand is available on both the IFRCand GAPwebsites.Figure 5.11Figure 5.12Number of blood donors(2013 data from 178 National Societies22)JPAsia PacificEuropeAmericasMiddle East andNorth AfricaAfricaDE10,036,243KR6,343,594TRTypes of National Society involvement in blood services(20132014 data from 74 National Societies)7454+ 40+ 36+OUR LINKS WITH IFRC5.5 Promoting safeEveryoneblood systemsCounts Report37%US3,753,442Full blood serviceincluding collection477,38027%139,490Recruitment ofblood donorsTop five National Societies:1. Japanese Red Cross Society2. American Red Cross3. The Republic of Korea National Red Cross4. German Red Cross5. Turkish Red Crescent Society20%Global gender breakdown of the number of blood donors65.8%658+342=MaleFemale34.2%16%Promotion andadvocacy for voluntarynon-remuneratedblood donorsNo involvementSource: FDRS22 Number of National Societies reporting on blood donors in Asia Pacific:32, Europe:51,Americas:35, Middle East and North Africa:16, Africa:44.Number of National Societies reporting on gender breakdown of blood donors:121.18Source: Global Advisory Panel on Corporate Governance and Risk Management of BloodServices in Red Cross and Red Crescent SocietiesReD CRoss ReD CResCent RefeRenCe CentResGlobAl AdVisorypAnel (GAp)on CorporAteGoVernAnCe AndrisK MAnAGeMentoF blood serViCesin red Cross Andred CresCentsoCietiesInternational Federation of Red Cross and Red Crescent SocietiesKey services (e.g. Knowledgemanagement,Everyone Counts| Progress 2015research, technical assistance, advocacy, networking)1 Provide technical advice in terms ofcorporate governance and risk managementto National Society blood programmes2 Promote knowledge sharing, networking,and partnership among and betweenRed Cross and Red Crescent blood servicesand external partners3 Develop tools and guidelines as appropriatewithin the area of National Society bloodprogramme delivery4 Coordination of Red Cross/Red Crescentassistance to National Society blood servicesin post-emergency situationsHigHligHtsPurpose of CentreThe purpose of GAP is to provide advice to NationalSocieties and their affiliated blood services, IFRCand other related bodies in matters related to bloodservice corporate governance and risk management.GAP has developed a Self-assessment tool toassist National Society blood services to ensurethe long term stability and sustainability of theirblood service without exposure to any unnecessary risk. The Self-assessment is located at:www.globaladvisorypanel.org. On completion ofthe Self-assessment, GAP provides each bloodservice with a detailed feedback report, includinganalysis of the results, identification of areas ofconcern, and providing recommendations on riskmanagement strategies to address the identifiedrisks. GAP holds regional meetings for participantblood services to compare their performanceagainst regional benchmarks and best practices.The results of the Self-assessment are outlined,regional issues are highlighted, and specific toolsand information are provided to assist bloodservices to manage their key risks. Partneringopportunities for blood services with strongerregional counterparts are also identified.Contact information: gapsecretariat@redcrossblood.org.au: www.globaladvisorypanel.org: https://fednet.ifrc.org/en/resources/health-and-care/blood/materials-and-tools/IFRC| 9GLOBAL MAPPINGIn 2015, GAP commenced a global mapping exercise to determine the level of involvement of Red Cross and Red Crescent National Societies in the provision of their national bloodprogramme. National Societies may be involved in a bloodprogramme at 3 levels - Level A (full blood service provision),B (blood donor recruitment), C (advocacy for VNRBD) or theymay have no involvement.Understanding the scale of National Society involvementin a blood programme at the global level is important asa potential risk indicator and may impact on the likelihoodof the existence of a Major Material Risk.Accurate information on all National Society Blood Services is criticalfor GAP and the IFRC to plan for future support activities and to conductSelf-assessment processes at a regional or global level.Level of involvement in Blood Program ActivityA. Full Blood Service ProvisionGovernance Advocacy for appropriate use Product distribution Component preparation Collection services/donor careDonor recruitment Promotional campaigns Education and awareness Involvement in WBDD2015 RESULTSOf the 190 surveys distributed, 57 (30%) of the190 National Societies submitted acompletedquestionnaire in the latter half of 2015.Number of responses received per zone in 2015NO.RECEIVEDNATIONALSOCIETIESIN REGIONRESPONSERATE IN 2015Africa3486%Americas143540%REGIONAsia Pacific73619%Europe & Central Asia265349%MENA71839%TOTAL5719030%Nil11B. Systematic Blood Donor RecruitmentDonor recruitment Promotional campaigns Education and awareness Involvement in WBDDC. Advocacy for VNRBDPromotional campaigns Education and awareness Involvement in WBDDThe questionnaire was developed in conjunction withthe IFRC and contained questions specifically tailoredfor particular National Societies depending on their regionand level of involvement. All National Societies were asked to provide informationon the mode of coordination of activities, funding mechanisms, donor recruitment programs (if in place) andany potential plans to expand or scale back activities. For those National Societies operating a Level Ablood service, questions were included for GAPto gain a comprehensive understanding of thescope of activity including:Number of blood collectionsInvolvement in any fractionation,transfusion or cell/tissue therapiesAccreditation The National Societies in Sierra Leone, Guineaand Liberia were asked supplementary questionsrelating to the Ebola recovery effort The survey was availablein English, French and Arabic10| GAP ANNUAL REPORT 2015The GAP global mapping questionnaire was distributedto National Societies in all IFRC regions (Africa, the Americas, Latin America & the Caribbean, Asia Pacific, Europe& Central Asia and Middle East & Northern Africa) in thesecond half of 2015.Global mapping results from all regionsin 2015 (total 57 National Societies)833 National context (size, population, economy,health system etc.)12213563125533 National Society Blood Programme (history, funding,statistics, accreditation, partnerships etc.)33 Regional and global summaries and visual mapping21Europe& Central Asia233 Any current changes in a National Society levelof activity in a blood programme or intentionsto expand/scale back the level of activityLevel BMiddle East& Northern AfricaThis report will include information on:33 National blood programme (providers, regulation,trends, VNRBD rate etc.)17Level CGlobal mapping results per region in 2015Once data collection is complete in late 2016, GAP willprepare a comprehensive report on all 190 NationalSocieties which will include the results of the global mappingquestionnaire, analysis and country narratives for each(obtained from both primary and secondary data sources).Level AAmericas21124Asia PacificAfricaACTIVITIES| 11SELF-ASSESSMENTOne of GAPs major ongoing projects isthe distribution and evaluation of theSelf-assessment survey for each NationalSociety Blood Service. The Self-assessmentquestionnaire assists National Societiesto ensure that appropriate steps are beingtaken to support the long term stability andsustainability of their blood service withoutexposure to unnecessary risk. NationalSociety Blood Services can measure theirprogress against a number of selectedcriteria identified as fundamental aspects ofcorporate governance and risk management.The Self-Assessment process providesindividual feedback to the blood service onrisk and governance issues including recommended strategies and suggested next stepsfor reducing exposure to current risks.GAP also provides de-identified regional reports to enable comparison of performanceand identification of common themes orchallenges within the region which are further discussed with National Society BloodServices at GAP regional meetings.SELF-ASSESSMENT FOCUSINDIAQUESTIONNAIRE REVIEWDuring 2015, the Self-assessment questionnaire was reviewed by GAP members at theAnnual General Meeting. A number of modifications were made including the additionof supplemental questions, refinements towording to improve clarity and improvementto the method of scoring the questionswhich are used to derive the overallpercentage score of the blood service.These opportunities for the improvementof the Self-assessment questionnaire wereidentified through: Feedback from GAP members andNational Society Blood Services undertaking the process in 2014/2015 GAP/IFRC discussions on Major MaterialRisk in developing countries due to lackof financial resources GAP priority country visits and third partyinformation which has identified newNational Society Blood Service risks.Above: Ms Tonks visitingthe Indian Red Cross SocietyNew Delhi National HQblood bank with DirectorDr Vanshree SinghBelow: GAP delegateswith Dr Agarwal (ICRSSecretary General)In 2013, GAP received a completed Self-assessment survey from the Indian RedCross Society (IRCS) New Delhi NationalHQ Blood Centre as part of the distributionof the Self-assessment (SA) to all Level ANational Society Blood Services in the AsiaPacific region. Following the return of the SAIndividual Feedback Report to the IRCS NewDelhi Blood Centre and during the follow-upby GAP to the responses provided in the survey, GAP became aware that there are 166independently operating IRCS blood banks inIndia across the 36 states and Union Territories. It was acknowledged therefore that theSelf-assessment responses provided by theIRCS New Delhi National HQ in 2013 represented the situation for one centre only andwas not indicative of the activities in otherRed Cross blood centres in India.As it was not feasible for GAP to distributethe SA to all 166 centres, an expanded GAPSelf-assessment process was undertakenin 2015 with the assistance of Dr VanshreeSingh (Blood Bank Director, India Red CrossSociety, New Delhi National HQ). GAP distributed the SA questionnaire to a subset of thelargest Red Cross blood centres in India.9 responses were received from:Ahmedabad (Gujarat);Voluntary Blood Bank and Blood Component Centre, Dist Panchmahal (Gujarat);Karnataka Red Cross Blood Bank;Tamil Nadu Branch;Blood Bank & Component SeparationUnit (Dadra & Nagar Haveli UT);Bombay City Branch Blood Centre(Maharashtra);Dr. Balchandra Blood Bank,Latur (Maharashtra);Blood Bank Service CentreThanjavur State Branch;Patna (Bihar).The updated version of the Self-assessmentquestionnaire will be distributed in 2016.ACTIVITIES| 13SELF-ASSESSMENT FOCUSINDIA cont.PRIORITYCOUNTRY SUPPORTAs resources permit, GAP provides targetedassistance to a small number of identifiedpriority country National Society Blood Services (NSBS). These NSBS are assessed byGAP as requiring specific support in corporate governance and risk management ofblood programmes following the completionof the Self-assessment questionnaireThis assistance may include:in-country support visitsprovision of GAP tools,resources and GAP expertiseidentifying partnering opportunities withother Blood Servicesco-ordination of technical assistancefrom GAP members or partnersIn 2015, GAPs priority countrieswere Nepal, Bangladesh, Honduras,Indonesia and Haiti.Above: Ms House discussingthe Self-assessmentresults with DirectorDrVanshreeSinghThe completed SA questionnaires werereceived from these IRCS blood centresbetween January and March 2015. The responses were analysed and individual bloodcentre Self-assessment feedback reportswere distributed to each centre with the assistance of Dr Vanshree Singh in May 2015.The reports provided a detailed analysisof the responses for each question anda summary of strengths and challengesfor the blood centre.In-country visitA GAP delegation (Ms Emily Tonks and MsOlivia House) visited India from 10th17thSeptember to validate the data provided inthe survey results from these IRCS centres.During the visit, the delegation met with keyrepresentatives of major stakeholders in thenational blood program. These included theIndian Red Cross Society (IRCS) at national,state and district level, the IRCS Blood BankNational Headquarters in New Delhi andtwo state IRCS blood centres, IFRC SouthAsia Regional Delegation office and NACO(National AIDS Control Organisation, IndianMinistry of Family Health & Welfare).Through these meetings, and together withinformation provided by the Indian Red Crosscentres in the GAP Self-assessment, GAPwas able to assess the blood service, itsoperational context, and identify a numberof areas of success and also some areasof remaining challenge.14| GAP ANNUAL REPORT 2015The GAP delegation visited 3 IRCS bloodcentres who had completed the SA questionnaire New Delhi National HQ, Ahmedabadand Godhra (Gujarat). The Self-assessmentresults were discussed with the blood centredirectors and representatives of the NationalSociety and a summary of the strengths andchallenges were highlighted. The delegationalso reviewed the blood centre facilities andoperations. The management and staffof the IRCS blood centres visited were highlyengaged and eager to identify any areasin which they could improve their servicesand standards.A Self-assessment sub-regional meetingwill be held in India in 2016 following thedistribution of the questionnaire to a secondsubset of IRCS blood centres. The meetingwill enable a representative of each centre tocome together to discuss the results, including country specific strengths and challenges. The meeting will also aim to enableincreased knowledge sharing and networkingon regional issues.PRIORITY COUNTRYSUPPORTNEPALGAP has a well-established association with Nepal RedCross Blood Transfusion Service through its prioritycountry support program. Since 2010 GAP has beenworking with the Nepal Red Cross Society to providespecific risk management and technical assistanceto the blood service.In December 2015, Dr Manita Rajkarnikar(Director, Nepal Red Cross Society NationalBlood Transfusion Service) commenceda 3 month training programme with theAustralian Red Cross Blood Service, providedby GAP through the 2015 GAP-IFRC Memorandum of Understanding funding for prioritycountry assistance.Dr Rajkarnikar commenced the training program in Perth, Western Australia, includingan initial introduction and orientation sessionwith the GAP secretariat. Key learningobjectives were developed by GAP for eachtraining element, to assist the delivery ofthe technical training program. The trainingschedule also included visits to AustralianRed Cross Blood Services sites in Brisbaneand Melbourne.The programme included trainingin the following key areas:Donor eligibility/selection and collection(including fixed site and mobile bloodcollection)Quality Systems (GMP requirements,external quality assurance programs,change control, corrective andpreventative measures)Donor notification andcounselling servicesTesting and processingOrder fulfilment & customer serviceVisit to a major hospital to observepre-transfusion laboratory processesand clinical use of bloodClinical transfusion practice (componentuse, transfusion guidelines, patient bloodmanagement, managing adverse events,hospital transfusion committees)Corporate and strategic planning,supply chain management andmonitoring inventoryDisaster management and contingencyMarketing and donorrecruitment strategiesFinance (cost model development)GAP received very positive feedbackfrom Dr Rajkarnikar on the training.Above: Dr Manita Rajkarnikarat the Melbourne ProcessingCentre (Australian Red CrossBlood Service)As NRCS is planning to construct new Central BloodService building and other district buildings as damagedby earth quake, this training is very fruitful to learn aboutthe system; database, new technology organizationalstructure, management and coordination with thestakeholders. Along with the training we had the chanceto work on the post EQ recovery project. I convey mysincere thanks to GAP for all support to make thistraining possible and look forward to continuedsupport and collaboration in future. I look forward toimplementing in our field whatever I have learned andgained once I return back to the home country.DR MANITA RAJKARNIKA, DIRECTORNepal Red Cross SocietyNational Blood Transfusion Service16| GAP ANNUAL REPORT 2015ACTIVITIES| 17PRIORITY COUNTRYSUPPORTHONDURASThe Honduran Red Cross Blood Service hasbeen a GAP priority country since 2012.The Swiss Red Cross (SRC) provides directsupport to the Honduran Red Cross bloodprogram as a dedicated bilateral project,including support for corporate governanceand risk management issues. GAP memberand Chief Executive Officer of TransfusionSwiss Red Cross provides expertise to theproject alongside the Medical Director of theHonduran Red Cross Blood Service (and GAPmember) Dr Elizabeth Vinelli.The bilateral project Strengthening of theHonduran Red Cross National Blood Program is scheduled to be completed by endof 2016. The overall objective of this projectis to assure the availability and security ofblood and blood products for all patients, bystrengthening the technical, administrativeand governance capacity of the HonduranRed Crosss National Blood Program.The expected outcomes are:1. Establishment of the National BloodPrograms own, duly constituted governance structure, with the delegation ofresponsibilities necessary to conducteffective technical and administrativemanagement.2. Creation of a unified coordinated National Blood System based on voluntary,non-remunerated blood donation.3. Strengthening the National Blood Programs technical and administrative, governance and risk management capacity.4. Strengthening voluntary blood donation.HAITI & INDONESIAIn April 2015, the General Assembly of theHonduran Red Cross approved the revisedstatutes and the new governance structuresof the organisation. In the revised statutes,the activities of the Blood Transfusion Service were included, and the mission to provide safe and sufficient blood products fromvoluntary non-remunerated blood donors isexplicitly mentioned.Further central activitiesof the project were: Capacity building for collaborators andexecutives of the Honduran Red CrossHaitiIndonesiaThe Haitian Red Cross was selected as aGAP priority country in 2010, following theHaiti earthquake. As GAP was not involved inany active support or engagement withthe National Society Blood Service since2012, the priority status of Haiti was closedin 2015. GAP will encourage the NationalSociety Blood Service to continue to complete the GAP Level A Self-assessmentquestionnaire when the questionnaire isnext distributed to the Americas, LatinAmerica & The Caribbean.The priority country status of PalangMerah Indonesia (PMI) was on hold in 2015pending completion of their bilateral supportprogramme with the Australian Red CrossBlood Service. Promotion of VNRBD in collaborationwith the local chapters of the HonduranRed Cross.In 2015 the Honduran Red Cross BloodService was accredited by the AABBAccreditation Standards for the 6th time.In 2015, GAP provided additional financialsupport to Outcome 4 of the project withthe approval of funding for an online donorrecruitment training module. This will also beadministered through the Swiss Red Crossas an adjunct activity to the existing bilateralsupport program. It is anticipated that thisonline tool will also be made available toother National Societies, with a view toassisting with the achievement of 100%VNRBD which is acknowledged as a majorchallenge in developing countries.Left: Workshop with theSupport commission ofthe National Blood Programof the Honduran Red Cross.ACTIVITIES| 19PRIORITY COUNTRYSUPPORTBANGLADESHThe Bangladesh Red Crescent Blood Service (BRCBS) wasselected for GAP priority country support in July 2014 following the completion of the GAP Self-assessment questionnaire, which identified that some corporate governance andrisk management challenges existed for the blood service.In consultation with Mr Afsar Uddin and Dr Tarique Mehedi,and taking into consideration the discussions held with various key stakeholders, recommendations for a plan for GAPand bilateral partner support for the BDRCBS, against thefollowing six areas of identified need were developed.In November 2014, a preliminary scoping visit was undertaken by GAP to assess the Blood Service, its operationalcontext and to identify areas of success and areas that wouldbenefit from support. Dr Wolfgang Mayr (GAP member andMedical Councillor for the Australian Red Cross Blood Service) provides ongoing advice and expertise to this project.1. Assistance in advocacy with governmentDuring 2015, two visits to Bangladesh were undertakenby GAP (in May and November) to meet with the BangladeshRed Crescent Society (BDRCS) Blood Service Director andother key stakeholders in order to:4. Training for technical staff, includingthe GAP Regional Training Programin Australia further understand BRCSs requirementsfor the specific areas of support requestedby the BRCS Blood Service; and progress the options for GAP or bilateral partner support.During each visit, the GAP delegation met with key staff ofboth the Bangladesh Red Crescent Society and Blood Service,including the BDRCS Director of Health and Blood, Mr AfsarUddin and the Deputy Director and In-Charge Dhaka BloodCentre, Dr Tarique Mehedi. The delegation reviewed of thestatus of the blood service and any progress since the lastvisit, reviewed current and emerging challenges, and plans forfuture development of the BDRCS blood program.Meetings were also held with representatives from theMinistry of Health and Family Welfare (Line Director ProfMd Shamiul Islam) and with the Bangladesh Red CrescentSociety Secretary General, BMM Mozharul Huq and Treasurer,Advocate Tauhidur Rahman.2. Support for an operationalisedstrategic plan3. Assistance to design and implementa quality system5. Assistance in business case developmentfor Dhaka facility improvement/rebuild6. Promotion to IFRC of the needfor VNRBD supportDuring the May visit, the GAP delegation attended a mobilevoluntary blood donor collection session held at StandardChartered Bank facilities in Dhaka and also observed theoperational processes for collection, testing, processing andtransfusion of blood at the Dhaka Blood Centre.As well as visiting two district blood centres (Chittagong andJessore), the focus of the November visit was on assistingthe BDRCS to commence development of a National Strategic Plan for the Bangladesh Red Crescent Blood Service asa key corporate governance and risk reduction strategy, andculminated in a strategic planning workshop. The workshopincluded blood service participants from Dhaka and 5 of the7 regional blood centres (Chittagong, Jessore, Sylhet, Natoreand Rajshani).The GAP delegation and BDRCSBlood Service Director: Discussed the workshop purposeas well as the roles and responsibilitiesof each centre and GAP Developed a shared understandingof the strategic planning processand a typical strategic plan format Commenced the strategic planningprocess for BDRCS, including:Scanning the current internal andexternal operating environmentWorkshopping of strengthsand challenges of each centreGoal setting for each centre Discussed the next part of the strategicplanning process Discussed and agreed on the next stepsfor development of the national strategicplan, including confirmation of strategicpriorities and development of activitiesunder each strategic priorityAbove: Ms Tonks observing operational processes at the Dhaka Blood CentreFollowing the advice provided by GAP toBDRCS during the November visit, the BloodService Director, Dr Mehedi progressed thestrategic planning activity by leading a localworkshop in December 2015 with representatives from all 8 BDRCS blood centresacross Bangladesh. The workshop wasalso attended by: the Chairman of BDRCS the Head of Delegation of IFRC, and the Line Director from the Ministryof Health and Family WelfareOne of the outcomes of the planningworkshop was a comparison of performanceand practice of each blood centre againstselected key parameters (such as %VNRBD,testing technologies used, percent components issued), with a view to identifying areasof focus for future strategy.Right: Dr Mayr reviewinglaboratory processeswith BDRCS Directorand laboratory manager,Dhaka blood centre.20| GAP ANNUAL REPORT 2015BDRCS continues to progress and implementtheir strategic planning at a local level.Above: Dr Mehedi (BDRCS Blood Service Director) running local workshopACTIVITIES| 21DISASTER RESPONSENEPAL EARTHQUAKEOn 25th April 2015 a devastating earthquakeof magnitude 7.9 occurred in Nepal.Inaddition to loss of lives, the earthquakecaused extensive destruction and damageto infrastructure, housing and livelihoods.Immediately following the earthquake,GAP liaised with the Director of the NepalBlood Service, Dr Manita Rajkarnikar, to provide support. The impact had resulted in significant and extensive damage to the NepalRed Cross Blood Service, both in Kathmanduand in regional and district areas. Severalblood centres were extensively damaged.The earthquake and aftershocks had intensified pre-existing vulnerabilities resulting inserious concerns that the impending monsoon season would increase both the leveland urgency of needs and the challenges forrelief and recovery.Below: Temporary bloodbank facilities in Kathmandu.The Central Blood Transfusion Service(CBTS) facility in Kathmandu, which servesas the primary coordination hub for thenational blood service, was severely damaged and was structurally unsound for use.This resulted in the CBTS being transferredto temporary and unsustainable facility arrangements in tents. Emergency blood bankinfrastructure, constructed by the British RedCross in 2014/15, helped provide mediumterm facilities support to the CBTS, whilstthey moved toward a longer term solution.GAP has a specialist role in the provisionand coordination of assistance to NationalRed Cross or Red Crescent blood servicesin post emergency situations in accordancewith GAPs Terms of Reference. This includesimmediate, short-term assistance as wellas long term support to rebuild the blood service once the initial urgency of the disasterresponse has passed. In this capacity, theNepal Red Cross Society (NRCS) SecretaryGeneral requested that GAP coordinate theNepal Blood Service reconstruction andrecovery effort following the earthquake.GAP attended the Nepal post-earthquakeplanning meeting in Kathmandu in June2015 involving senior management fromNRCS, IFRC, the International Committeeof the Red Cross (ICRC), Governmentand the United Nations. The purposeof the meeting was to: Endorse the strategic prioritiesin relation to relief, recovery andcapacity building of the NRCS; Endorse the framework forpartner support for Nepalincluding an initial mappingof needs to be addressed,objectives and targets to be met; Understand movement partnerscapacities, resources andpractical arrangementsfor working in Nepal.In August and September 2015, an expertassessment team was sent by GAP to Nepalto conduct a detailed scoping assessmentof the affected NRCS Blood Service facilities throughout the country and to developrecommendations and proposed activitiesfor the immediate and longer term supportrequirements necessary to rebuild the bloodprogram following the disaster.The team visited the CBTS in Kathmandu(as well as the Lalitpur Emergency BloodBank) and regional centres in Bhaktapur,Pokhara, Kavre, Dhading, Gorkha andNuwakot. Meetings were also held withthe Nepal Red Cross Society to reviewthe recovery proposal, which focusseson four key areas of support:22| GAP ANNUAL REPORT 2015NEPAL RECOVERY PROGRAMFour Key Areas of Support1234INFRASTRUCTURERebuild or repair damaged NRCS blood service facilities and infrastructure, including the establishmentof adequate temporary facilities for the CBTS. This includes the provision of building experts to assist withtechnical advice for the design of new buildings at CBTS and Kavre since these were extensively damagedin the earthquake and required replacement.EQUIPMENTProvision of critical blood service equipment to support blood service operations immediately andinto the future for eight NRCS blood service sites. The equipment includes transport vehicles, collections,processing and testing equipment as well as testing reagents and refrigerators.CAPABILITYDelivery of comprehensive technical training and support for central, regional and district staff to assistthe NRCS Blood Service to improve national capability. This includes training in collections, laboratorymethods, quality management, clinical practice, policy management/organisation and facilities technicalsupport (layout and GMP requirements).PROJECT MANAGEMENT AND LOCAL SUPPORTA dedicated GAP project manager will coordinate all aspects of the NRCS Blood Service recoveryprogram with support from local teams in Nepal. This includes the coordination of funding assistanceby Partner National Societies to ensure no duplication of activities or investment.DISASTER RESPONSENEPAL EARTHQUAKE cont.2016 Approved Budget(CHF)Actual I&E (CHF)1 Jan-31 Dec 2015(Includes Aust&SwissAccounts)Approved 2015 Budget(CHF)CHF account(CHF)AUD Converted to CHF(CHF)GAP will continue to maintain its close relationship with the NRCS, the NRCS NationalBlood Transfusion Service and the Blood Service Director, Dr Manita Rajkarnikar, to deliverthe post-earthquake recovery program andto enable the NRCS Blood Service to improveits own capacity to manage its challengesboth in the short term and to ensure its longterm sustainability.Total AUD Account(AUD)The GAP team also included a buildingexpert to assist with the design of the newbuildings including the Central Blood Transfusion Service and Kavre facilities as thesewere extensively damaged in the earthquakeand require replacement.The GAP delegates met with potentialpartner National Societies to discuss theNRCS blood program recovery requirementsand the proposed support plan. Thesediscussions subsequently resulted in severalpartner National Societies confirming theirsupport commitment to assist the bloodprogram recovery with GAPs coordination.NotesFollowing the assessment visits, and development of the recovery proposal a GAP delegation visited Kathmandu in November 2015to meet with potential partners, understandthe post-earthquake recovery environmentand seek funding commitments for the bloodprogram recovery. Meetings were held withthe Nepal Red Cross Society, IFRC, ICRC andpotential Partner National SocietiesFINANCIAL REPORTOpening balanceGAP accountsAustralian Account402,578326,987Swiss Account326,98797,97597,975IFRC Funding accountAustralian Account*94,52676,777497,104403,764America28,38021,000Australia28,502Finland27,113IsraelCombined opening balance at 1 January76,77797,975501,738514,37421,00021,00021,00021,00021,00021,00021,00021,00021,00021,00021,00027,60921,00021,00021,00021,000Japan27,16721,00021,00021,00021,000Switzerland26,50221,00021,00021,00021,000Germany26,52321,00021,00021,00021,000Austria26,16521,00021,00021,00021,000Belgium26,74221,00021,00021,00021,000Thailand27,25021,00021,00021,00021,00042,00042,000042,0000Income2015 Member ContributionsIndiaHong Kong - special status00Honduras - exempt00subtotal313,952252,000210,000252,000210,00087,86265,00065,00065,00065,00016,75215,7528,00015,7525,0001,3021,22518,05416,9768419,868333,97682015 IFRC MOU funding IncomeIncome2015 Interest IncomeInterest- GAP AustralianaccountInterest - GAP Swiss account8Interest - IFRC funding accountsubtotalAbove: Dr Manita Rajkarnikaat the temporary blood bankfacilities in Kathmandu.Right: GAP delegationin Nepal with Dr ManitaRajkarnikar.24| GAP ANNUAL REPORT 2015Payment from HKRC for NepalJoint Project ContributionTotal Income801,2255006,66016,9845,500281,660333,984280,500FINANCE| 252016 Approved Budget(CHF)Actual I&E (CHF)1 Jan-31 Dec 2015(Includes Aust&SwissAccounts)Approved 2015 Budget(CHF)CHF account(CHF)AUD Converted to CHF(CHF)Total AUD Account(AUD)Notes2016 Approved Budget(CHF)Actual I&E (CHF)1 Jan-31 Dec 2015(Includes Aust&SwissAccounts)Approved 2015 Budget(CHF)CHF account(CHF)AUD Converted to CHF(CHF)Total AUD Account(AUD)NotesExpenditurePriority country supportSecretariatNepalSelf Assessment costs:Salaryand oncosts@(34,595)(35,979)(458)0subtotal(35,052)(35,979)@(78,525)(81,666)Phone,rent, officesupplies,postage,stationery(2,947)0Office equipment, software, training,sundry(3,497)Online surveylicense feesSecretariat costsSecretariatsalary andoncostsSpecialist AdviceTranslation - Self assessmentreports, GAP manual, questionnairepublications/standardsProfessional expertise eg legalStakeholder meetings(e.g. IFRC, Reference Centres,WHO, ISBT)(84,968)(143,772)(135,186)(196)(184)(184)000(1,246)(1,172)(40)(37)000(120,021)(81,666)(10,000)(135,186)(1,172)(117,645)(5,000)(2,000)00(1,000)Secretariat coordination, logistics and support0Travel & accommodation(5,000)Other meeting expenses00(2,000)0(1,000)000(373)(351)(18,000)(351)(10,000)(1,953)(1,837)(10,000)(1,837)(5,000)000(30,000)(33,245)000(3,000)00(18,988)(17,854)(22,000)(17,854)(51,000)(9,107)(8,563)(37,733)(8,563)(39,242)0(10,000)(1,000)(17,637)(1,000)Travel & accommodation00(20,000)00Other expenses00(2,000)0000000000(6,000)Post disaster response Nepal(78,835)(74,127)(113,000)(74,127)(130,000)MMR followup(20,207)(19,001)(32,500)(19,001)(33,800)(4,113)(3,867)(3,867)(43,391)000(54,400)(9,461)(8,896)(8,896)(2,500)00(1,000)(1,000)(1,000)(95)(89)(24)(113)0Contingency funds000(20,000)Journal adjustment000HaitiIndonesiaTravel and accomodationGlobal mapping(new approved activity 2015-16)Website hosting and technical maintenance(7,000)(20,000)2014 IFRC Funded Activities journalled in Jan2015 (website, project support, Nepal joint GAPproject with HKRC)^0002014 HRKC Expenditure already adjusted in theopening income balance*14,22013,37013,370(340,671)(320,325)(7,186)(15,000)(7,186)(1,620)(3,800)(1,620)(2,000)Total ExpenditureGAP networking events(dinner)(1,005)(945)(2,000)(945)(2,000)Closing balanceOther expenses (annualreports)(423)(397)(1,000)(397)(1,000)Notes(9,000)00(1,200)0(2,000)Executive Board Meeting(s)Exchange rates:Opening Balance Exchange rate as per XE Currency converter website 31 Dec2014: 1 AUD = 0.8122324904 CHFWeighted average rate for report 1AUD=0.9403CHFTeleconferences(1,503)(33,245)(10,000)(7,642)(3,800)(35,357)0(1,723)(1,503)0(17,637)Travel & accommodation(1,598)00Meeting venue/cateringTeleconferencing Calls costs0(18,757)Other Expenses (online VNRBDmodule)Bank fees0Meeting venue/catering andtravel accommodation@Insurance(10,000)Annual General MeetingSupport program, travel andaccomodationStepwise accreditation (new activity for 2016)(37)0Participant costsBangladeshVietnam0Meeting costsOther expenses0Travel & accommodationRegional meetingsSupport program,travel & accommodationHondurassubtotalPostage, stationeryPost disaster support- see separate line item(2,700)Calculation of Weighted Average Rate303,349322,616 0.940300.9403CHF - OB+IncomeReceived-CBAUD - OB+Income Received-CBWeighted AvgCheck(1,024)(497,054)(321,349)(591,657)286,345514,374203,217Closing Balance Exchange rate as per Oanda websiteconversion rate - 1 AUD = 0.7243 CHF*Opening Balance in Q621 includes the adjustment of $14kHRKRC expenditure that was only reallocated to Q621 in Jan-15India membership fees for 2016 and 2017(42,000CHF) invoiced in Dec 2015, but not yet received^2014 IFRC Funded Activities relate to activities carriedout in 2014. Due to timing of costs incurred, the projectswere only finalised in early 2015.** 2016 Budget Secretariat costs converted to CHF usingthe exchange rate:AUD/CHF 0.73815 Reference: Oanda 26 May 2015@ Budget allocation for salary provided in AUD may needto be revisited if significant movement in exchange rate26| GAP ANNUAL REPORT 2015FINANCE| 27AUDIT REPORTHISTORYGAP was formed in 2000 by a group of expertsfrom National Society Blood Services in orderto share knowledge on risk management and toprovide advice to Red Cross/Red Crescent Societieson the proper management of risks associatedwith blood programmes.Since that time, GAPs membership has grownand GAP has continued to provide technical supportand assistance to National Society Blood Services.In June 2012, GAP was officially established as anindependent association registered under Swiss law,and governed by an Executive Board.Currently GAPs membership stands at thirteenNational Society Blood Services, all of whomconduct Level A blood programmes.28| GAP ANNUAL REPORT 2015CONTACT GAPGAP SECRETARIATA Level 1, 69 Walters Drive, Osborne Park WA 6017, AustraliaP +61 8 6213 5909F +61 8 6213 5949Egapsecretariat@redcrossblood.org.auWglobaladvisorypanel.orgGood Governance, safe blood
Transfusion Today - June 2016
Transfusion Today | Number 107, June 2016Alliances and networksin blood transfusionDubai CongressElections Board of Directors 2016Membership renewalCME on Blood Transfusion Services Expanding HorizonsContents16Judith ChapmanEditorialThe focus section features five organisations that some18 4of us are familiar with but many of us are not. We hope23that you will have a better understanding of each ofthe organisations after reading about them. PleaseIn Focusemail the ISBT Central Office if you have a question Regional and International Alliances and Networks in Blood Transfusion;Asia Pacific Blood Network; Asia Pacific Economic Cooperation; Allianceof Blood Operators; Global Advisory Panel; European Blood Alliance; 60years of official relationsRoche Blood Safety SolutionsCount on us, because patients are counting on you.13For more information, contact your local Roche Diagnosticsrepresentative.you will find a page dedicated to education. We haveintroduced the page to promote some of the educationalFrom ISBT Central OfficeLook out for the case studies that are being prepared byElections for vacant positions on the Board of Directors 2016;Membership renewal; Welcome to our new members; 34th InternationalCongress of the ISBT, September 3 - 8, 2016 Dubaithe Immunohaematology Working Party and which willfeature on the website in the coming months.We are looking forward to the 34th International17Technology uniquely designed to deliver a safe and efficientblood supply.Comprehensivesolutions for bloodbanks and plasmafractionatorscontact with them. In this issue and future issuesmaterial and resources that are available from ISBT.ISBT Academycongress of ISBT in Dubai. Over 800 abstracts Case studies in Immunohematology; ISBT at the 16 InternationalAs a world leader in blood screening, Roche has been committed tohelping improve safety while enhancing efficiency. And now, weretaking it to the next level. With Roche Blood Safety Solutions weprovide an expansive portfolio of pre-analytics, serology* and NATtechnologies that deliver real-time virus discrimination along withexcellent seroconversion sensitivity for early detection and safetyassurance. Because doctors and patients are counting on you,Roches advanced systems and extensive resources are there for youwhen it counts most.or comment about their work and we will put you in20thYoung Investigators (YI) indicated they wished to beRegional Newsis still time to sign up for the YI breakfast which will 1995-2015: Twenty years of haemovigilance in Greece; New TransfusionNational Guidelines; Blood transfusion in the Russian Far East region;CME on Blood Transfusion Services; External quality assessment schemefor hospital blood banks in Malawi27were received and many were high scoring. 148Haemovigilance Seminar; ISBT Academy Begins a Fourth Year FundingImmunohematology Workshops in India;Upcoming Eventsconsidered for the YI session; unfortunately we only hada few slots available in the session. If you are a YI theretake place on Monday September 5. There are manydifferent activities within the scientific programmeincluding Transfusion Practitioner sessions and a varietyof workshops. More information can be found on theDubai page of this issue of TT and on the website.We hope you will come to Dubai and delve into thescience at the congress and use your free time to takeadvantage of being in a modern vibrant city. You will bepleasantly surprised.President Celso Bianco Secretary General Roger Dodd Executive Director Judith ChapmanDesign drukkerij Teewes Photography Transfusion Today Advertising Monique van Dorp,communication@isbtweb.orgCOBAS and LIFE NEEDS ANSWERS are trademarks of Roche.2015 Roche Molecular Systems, Inc. All rights reserved.www.roche.com*The serology product range is not available for blood screening settings in Canada,Philippines, and the United States. For all other countries, please contact your localRoche representative to check availability.Statements and opinions expressed in Transfusion Today are those of the individual contributors andnot that of ISBT. Reproduction in whole or part requires permission by the publisher. ISBT membersneed not obtain permission if proper credit is given.Send all correspondence to ISBT - Marnixstraat 317, 1016 TB, Amsterdam, the Netherlands.T + 31 20 7601 760, F + 31 20 7601 761, communication@isbtweb.org.Gold membersTransfusion Today | Number 107, June 20163In Focus Alliances within the Field of Transfusion MedicineIn Focus Alliances within the Field of Transfusion MedicineRegional and InternationalAlliances and Networks inBlood TransfusionFive of the most common acronyms within the field of bloodtransfusion are ABO, APBN, APEC, EBA and GAP. They easilyroll off the tongue but more often than not people hearing orreading them do not know what is behind them. Is it a newblood group, method, machine, organisation or what?They are the acryonyms of five organisations committed topromoting safety, security and cost effectiveness within thefield of Transfusion Medicine. Each of the organisations is aregional or global alliance or network. The five articles in thefocus section of this issue of Transfusion Today will give youan insight into the membership of these organisations andtheir vision, mission and objectives. They are all working forthe benefit of transfusion services, donors and ultimately thepatient.Asia-Pacific BloodNetwork (APBN)The Asia Pacific Blood Network (APBN) is a network of notfor profit blood operators in the Asia Pacific region who arecommitted to voluntary non-remunerated blood donation.The current Members of APBN are: Australian Red Cross Blood Service Hong Kong Red Cross Blood Transfusion Service Japanese Red Cross Society Blood Service Republic of Korea National Red Cross Blood Service Macao Blood Transfusion Service New Zealand Blood Service Blood Services Group, Health Sciences Authority, Singapore Taiwan Blood Services Foundation National Blood Centre - Thai Red Cross SocietyAPBN was established in 2006 to promote blood safety andefficiency of blood service operations among members. In2014 we revised the APBN Strategic Plan which sets out thefollowing vision, mission and strategic aspirations for five yearsthrough to 2019.Vision: Our patients have access to safe, secure and effectiveblood and blood products appropriate to their needs.Mission: APBNs mission is to contribute to the safety, sufficiencyand cost effectiveness of blood and blood product supply in theregion, based on scientific and ethical principles. Our committedblood donors are key partners in achieving our mission.Objectives: Promote APBN members organisational efficiency andcost effectiveness through benchmarking, performanceimprovement, best practice achievement and knowledgeexchange Provide member value through the development of tools toensure safe, secure and effective blood and blood productsfor patients Strengthen members ability to secure a sufficient andsustainable donor panel to meet patient needs for blood andblood products Raise awareness of, and influence blood sector issues in theregion including promoting scientific and ethical principles indonor care in APBN members Provide an opportunity for a common regional voice tobetter influence and engage stakeholders at both countryand regional levels in relevant blood sector issues throughdevelopment of recommendations on key shared issues Inspire other countries in our region, and internationally, toimprove their standards by providing examples of good practice4Transfusion Today | Number 107, June 2016Transfusion Today | Number 107, June 2016Kenji TadokoroChair, Asia Pacific Blood Networkand Chief Executive Officer, BloodService Headquarters, Japanese RedCross Society Maximise value of APBN Network for membersThe APBN holds face-to-face meetings usually twice a yearas well as regular teleconferences. In these forums membersexchange ideas and insights and compare operational practices(CoP).CoP items include: blood components issued per population blood donations by types of donation donors per population new donors ratio efficiency of collection testing and processing per full time employees collection of source/recovered plasma for fractionationEvery 6 months, members also discuss updated activities ofeach blood service in areas such as management, finances,collection, testing, processing, research and development,haemovigilance, customer services, and patient bloodmanagement. These issues are discussed openly andfrankly based on the confidentiality agreement and on anappreciation that members operate in different domesticcontexts. Furthermore, Members share recent trends andideas of operation and learn from best practices to improverespective operations. We discuss in depth selected issues ofmembers interest in the general meetings. Ssubcommitteesare established on emerging infections which are or mightaffectblood safety and collection efficiency in the region. Awhite paper on Dengue virus describing the scientific data andmembers experiences is published on the website.Moreover, APBN exchanges information and shares selectedCoP data on supply/donation trends and operational efficiencieswith the Alliance of Blood Operators (ABO) under the umbrellaof a Memorandum of Understanding. We have held open forumon trends of red cell demand and patient blood managementconcurrently with the ISBT annual meeting inviting other bloodservices.APBN also seeks to provide strategic leadership in the AsiaPacific region and to support policy development. The Networkprovides a regional voice and perspective on blood-relatedthemes.Part of our activities are seen on the website,http://www.apbnonline.com/.Address of APBN secretariat is as follows;Level 1, 69 Walters Drive Osborne Park, WA 6017,Email: apbn@redcrossblood.org.au5In Focus Alliances within the Field of Transfusion MedicineIn Focus Alliances within the Field of Transfusion MedicineAsia-Pacific EconomicCooperation (APEC)Maureen M. Goodenow, Ph.D.Chair, APEC Life SciencesInnovation Forum Planning GroupSenior Science Advisor andFounded in 1989, the Asia-Pacific Economic Cooperation(APEC) forum is an intergovernmental organization of 21Member Economies that operates on the basis of non-bindingcommitments and open dialogue to strengthen intra-regionaleconomic growth. APECs Member Economies are Australia,Brunei Darussalam, Canada, Chile, China, Hong Kong-China,Indonesia, Japan, Republic of Korea, Malaysia, Mexico, NewZealand, Papua New Guinea, Peru, Philippines, Russia,Singapore, Chinese Taipei, Thailand, United States, andVietnam. APEC maintains nearly 40 permanent sub-fora withresponsibilities that span most economic sectors, includinghealth and medical life sciences. These groups manage shortand long-term initiatives that facilitate policy alignment as wellas economic and technical cooperation. Activities undertakenand recommendations made each year at the working leveladvance to policy level bodies for review and consideration.APECs working level activities and projects are guided byAPEC Senior Officials. APEC Senior Officials report to APECMinisters at the policy level. APEC Leaders (heads of state),who convene each year and set the policy agenda, consider theannual recommendations of APEC Ministers. APEC encouragesparticipation by the business community, academia and civilsociety and is chaired by a different economy each year. Peru isserving as host in 2016 and Vietnam will host in 2017.Established by APEC Leaders in 2002, the Life SciencesInnovation Forum (LSIF) is APECs leading initiative on healthand health sciences innovation. The LSIF brings togetherrepresentatives of government, the private sector and academiato advance policies that foster the growth of life sciencesinnovation and the improvement in public health in the AsiaPacific region.In October 2014, the APEC LSIF convened senior leadersfrom government, academia, the private sector, civil society,and other international and regional organizations in Manila,Philippines to discuss the regional blood safety landscapeand determine whether APEC had a role in advancing bloodsafety in the region. Delegates welcomed APECs initiativewith great enthusiasm and identified several areas whereAPEC could support the translation of global blood safetypolicy recommendations and local economy blood safetyplans into concrete, measurable results. APEC representativessubsequently developed and endorsed the APEC Blood SupplyChain 2020 Roadmap, launching a long-term multi-sectoraleffort to address blood safety policy issues and to supportcapacity development of blood services, infrastructure,governance, as well as the achievement of international safetyand quality standards for the blood supply chain.In early 2015, the APEC Blood Supply Chain PartnershipTraining Network (PTN) was established by the LSIF tosupport implementation of the APEC Blood Supply Chain2020 Roadmap. The PTN serves as an evolving network of6Jefferson Science Fellow,Department of State, United StatesProfessor andAlliance ofBlood OperatorsChris HroudaChair, Alliance of Blood OperatorsStephanyW.Holloway EndowedChair for HIV/AIDS Research,College of Medicine, University ofFloridainstitutional expertise on blood safety across government,academia, and industry in the APEC region. The networksupports and assists APEC Member Economies in designing,implementing, and promoting projects and priorities consistentwith the Roadmap. Activities are currently focused on twopriority areas: policy and quality systems capacity building.Training modules will be developed that are scalable andreproducible, and will be available for all economies to use tostrengthen their blood safety systems. The PTNs work willbe consistent and will complement and not duplicate existingactivities carried out by other international and regionalorganizations.The PTN has an Advisory Board which provides strategicdirection and oversight of the PTNs activities. It is cochaired by the U.S. Department of State and AABB and hasrepresentatives of nearly a dozen global blood safety bodiesincluding the ISBT, APBN, WHO, and the leaders of nationalblood services of 10 APEC Member Economies. There arealso two seats for representatives of the APEC Blood SafetyIndustry Coalition. The Coalition is comprised of businesseswith expertise in blood safety and is currently co-chaired byGrifols and Baxalta. The Coalition enables the private sector toprovide input into the PTNs activities in a transparent mannerand without the perception of a conflict of interest.On June 23-24, 2016, Peru will host the PTNs 1st PilotTraining program on Embracing Quality Systems at theColegio Mdico del Per in Lima, Peru. The pilot programwill convene approximately 50 blood bank managers andlaboratory leaders from the APEC sub-region (Chile, Mexico,Peru, and the United States) to learn about the principles ofQuality Management Systems in blood banks. In late 2016,Vietnam will host the 3rd APEC Blood Supply Chain PolicyForum convening approximately 150 blood safety leadersfrom throughout the Asia-Pacific region to discuss and identifyinnovative solutions to the regions priority blood safety policyissues. A 2nd PTN Pilot Program on Quality ManagementSystems will be held immediately after the policy forum andwill convene 50 blood bank managers and laboratory leadersfrom Vietnam and other Southeast Asian economies. The PTNWebsite, co-hosted by APEC and AABB, (http://blood.apec.org)will be launched in May 2016 and will serve as a library for allPTN trainings (webinars) and APEC blood safety documents.Transfusion Today | Number 107, June 2016The Alliance of Blood Operators (ABO) is a network of not forprofit blood service providers with voluntary non-remuneratedblood donor bases.ABO was established in 2002 by a small group of bloodoperator leaders who sought to improve their local bloodestablishments through the exchange of strategically usefulinformation. Since that time, ABO has grown to represent over90 blood operator members, collecting 35.5 million units ofblood for a total population of 815 million people across threecontinents: North America, Europe, and Australia.ABO membership includes: Americas Blood Centers, consisting of more than 60independent blood operators American Red Cross Australian Red Cross Blood Service Blood Systems Inc. Canadian Blood Services European Blood Alliance, comprising blood operators from25 European countries National Health Service Blood and Transplant whichprovides blood services for England and Northern WalesABOs purpose is to be a high performing internationalcollaboration of blood operators who drive memberperformance improvement, knowledge exchange and resolutionof strategic issues for the benefit of patients and the healthsystems. A number of working groups within ABO support theprogramme and currently include: Donor Engagement and Relationship: sharing strategies torecruit and retain blood donors and developing opportunitiesto access and inform donors globally Benchmarking: facilitating the identification anddevelopment of best practice, encouraging organisationallearning and performance improvement. The group collectsperformance data from participating members on an annualbasis to produce the ABO benchmarking report Medical Directors: Chief Medical Officers ensure toolsand materials to enable sustainable and effective clinicalleadership and management across the blood sector inmember organisations Cost Model: comparing the financial considerations of bloodat an operational level to understand variations in cost Risk Based Decision-Making: bringing into operationTransfusion Today | Number 107, June 2016an integrated risk-based decision-making framework,encompassing donor safety and patient outcomes which hasthe potential to guide major policy and operational change Research and Development: exchanging strategies onimproving the impact and effectiveness of ABO memberresearch and development (R&D) programs by examining themanagerial, administrative and leadership issues affectingR&DABO is further supported by a small secretariat and Point ofContact from each member organisation.Confidentiality of data is closely maintained and the groups arevery sensitive to issues of competition that may affect specificmembers and limit participation.ABO has long recognised the value of the global networkand has strived to deliver benefit to its members throughglobal sharing, horizontal learning and by providing a unitedblood operator voice on policy issues that cross internationalboundaries. Globalisation across all industries has made theworld a little smaller since 2002, but the principles establishedby the ABO Chief Executives more than a decade ago still formthe solid foundations for the 2014-2019 strategic plan.The current ABO objectives are: Objective 1: improve organisational performance Objective 2: identify, analyse, and monitor emerging trendsand strategic shifts Objective 3: transform the decision-making paradigm Objective 4: provide high value to membersABO has also recently formed a collaborative relationship withthe Asia Pacific Blood Network (APBN) which further enhancesour understanding of issues at a global level.ABO will continue to focus on performance improvement formembers as well as target complex issues where our combinedvoice, expertise and resources can achieve what is difficult toachieve individually. Through shared experience and problemsolving, we will improve our organisations and our service tocustomers.ABO is about Global sharing. Local results.For more information about ABO, please visit our websiteat:https://www.allianceofbloodoperators.org7In Focus Alliances within the Field of Transfusion MedicineIn Focus Alliances within the Field of Transfusion MedicineGlobal Advisory Panel onCorporate Governance andRisk Management of BloodServices in Red Cross andRed Crescent Societies (GAP)GAP is a global network of Red Cross and Red CrescentBlood Services with specific expertise in risk management andcorporate governance of blood programmes.The networks purpose is to: Provide technical advice in terms of corporate governanceand risk management to National Society Blood Services(NSBS); Promote knowledge sharing, networking and partnershipamong and between NSBS and external partners; Develop and provide tools, guidelines and priority countryassistance to NSBS most in need; Coordinate assistance, to NSBS in post-emergencysituations including blood program recovery; Influence global blood policy in conjunction with itspartners; Provide advocacy and support to the IFRC and NSBS onissues affecting blood programmes.Under the leadership of its dedicated Executive Board andsupported by its membership of Blood Service Chief ExecutiveOfficers, GAP pursues the vision that all Red Cross/RedCrescent blood programmes will be safe, well governed andself-sustainable, and are based on the principle of voluntarynon-remunerated blood donation for the benefit of patients andto safeguard blood donors.Dr Philippe VandekerckhoveCurrently GAPs membership is thirteen National Society BloodServices:NSBSMember representativeAustraliaShelly ParkAustriaWolfgang MayrBelgium - FlandersPhilippe VandekerckhoveHong Kong (China)Cheuk Kwong LeeFinlandSatu PastilaGermanyErhard SeifriedHondurasElizabeth VinelliIndiaVeer BhushanIsraelEilat ShinarJapanKenji TadokoroSwitzerlandRudolf SchwabeThailandUbonwon CharoonruangritAmericaChris HroudaGAP delivers its work program in close cooperation with IFRCHealth and has an IFRC observer on its Board. In addition,some of these members also act as GAP Zonal Coordinators toassist and coordinate GAP activities at a regional level, and toidentify opportunities for regional assistance and collaboration.GAPs principal tool is the Self-assessment questionnaire,which assists National Societies to ensure that appropriatesteps are being taken to support the long term stability andsustainability of their blood service without exposure tounnecessary risk. NSBS can measure their progress against anumber of selected criteria identified as fundamental aspectsof corporate governance and risk management for NSBS.The results of the self-assessment are analysed by GAP andan individual feedback report is provided outlining specificgovernance and risk management recommendations forconsideration. GAP also provides de-identified regional reportsto enable comparison of performance within the regional andidentifying common themes or challenges within the regionwhich are further discussed with NSBS at GAP regionalmeetings.As resources permit, GAP provides targeted assistance to asmall number of identified priority country blood services.Thismay include: in-country support visits, provision of GAP tools, resources and GAP expertise, identifying partnering opportunities with other BloodServices, coordination of technical assistance from GAP members orpartners.In coordination with IFRC and partners, GAP provides supportto National Society Blood Services at a global, regional andcountry level.For more information about GAP, please visit our website at:www.globaladvisorypanel.orgGAP was initially formed in May 2001 by the Finnish RedCross Blood Service, at the request of the InternationalFederation of Red Cross and Red Crescent (IFRC) to set up anexperts group from a range of countries to share knowledgeand to provide advice on the proper management of bloodprogramme risk.In 2012, GAPs role and purpose to provide expertise andadvice to blood services was cemented with the release ofthe IFRCs blood policy Promoting Safe and SustainableBlood Systems which outlined the specific responsibilities ofIFRC, GAP, National Societies and blood services in managingblood programme risk. GAP was established as a Swissbased independent association, and is governed by its electedExecutive Board.8Transfusion Today | Number 107, June 2016Transfusion Today | Number 107, June 20169In Focus Alliances within the Field of Transfusion MedicineEBAKari ArankoWillemijn KramerExecutive DirectorRCommunications andAdministrations OfficerEuropean Blood AllianceEuropean Blood Alliance is representing non-profit bloodestablishments throughout EuropeIn 1998, nine directors of Blood Establishments decidedto come together to discuss the plans of the EuropeanCommission to establish a Directive on blood safety and donorselection. According to a news item in Vox SanguinisI, the goalof their meeting was to see if they could speak with one voiceto Brussels. Besides discussing the EU Directives, the groupfound that networking and liaising on operational items wasvery helpful in their daily managerial lives. Over the years,the group grew and now comprises 25 members and twoobservers. European Blood Alliance (EBA) members are locatedthroughout the European Union and European Free TradeArea States. The observers are located in Europe and in theUnites States. Members are either the national blood service oralliances representing more than a half of the blood supply inthe country. EBAs members annually collect 16 million blooddonations, they are responsible for collecting, testing, preparingand distributing blood components from those blood donationsand serving a population of 450 million.The mission of EBA is to contribute to the safety, securityand cost effectiveness of the blood and tissue and cell supplyfor the citizens of Europe by developing and maintaining anefficient and strong collaboration amongst European blood andtissue and cell services. It does so through four key objectives: To increase public and professional awareness of voluntaryand non-remunerated donation (VNRD) of blood and bloodcomponents, and of preparation of blood components as anindispensable therapeutic means to help patients. Provide technical and professional support to nationaland European authorities, particularly those involvedin preparation / revision of regulations, standards,recommendations, guidelines, to promote best practice. To assist European blood establishments to continuouslyimprove their performance, based on scientific and ethicalprinciples for the benefit of patients To facilitate information collection and knowledge exchange.Each of the 25 member countries have a voting representativein the Board Meeting whom elect 6 Executives, including aPresident, Vice-President and Treasurer. The working structureof EBA is based on activities carried out by expert memberson a voluntary basis, which are coordinated by the EBA Office:EBA has over 150 experts working in 9 working groups andprojects. The EBA Office is in Amsterdam, in the SanquinBlood Supply head office, with 3 persons and, based in Paris,the collaborative procurement manager.To support members to improve their productivity, EBA hasa Working Group on Benchmarking, aimed at identifying bestpractices. Also, EBA invested in collaborative procurement10to address the other half of the costs base of bloodestablishments. The first joint procurement project, calledEurobloodpack, found its roots in a willingness by EBA Memberorganisations to harmonize and standardize the technicalspecifications of blood packs used for the collection andprocessing of whole blood donations throughout EuropeII.Thisproject was successfully completed securing multi-millioneuro savings and is now followed by several other projects.Another successful working group is the EBA EmergingInfectious Disease (EID) Monitor, which has established itselfas an important forum to share information on new emerginginfections and interpretation of available data.The speaking with one voice for which EBA was actuallyestablished, is still very important. EBA has collaborated withthe European Centre for Disease Control (ECDC) to furtherdevelop the European Up-Front Risk Assessment Tool calledEuFRAT: an online tool with manuals and examples supportingrisk assessment of EIDs, which can be reached at ECDCwebsiteIII. Also, EBA works together with CoE and EC withadvice, and EBA is a happy partner of ISBT in funding anddeveloping training leading to transfusion medicine certificate.EBA has a long legacy in initiating and promoting EU fundedprojects to enforce quality standardsIV V, patient bloodmanagementVI VII and currently ongoing donor healthcareVIII IX. More information of EBAs members and activities canbe found at www.europeanbloodalliance.eu. The key positionsand recommendations of EBA have been summarised in thebook Blood, tissues and cells from human origin: the EuropeanBlood Alliance PerspectiveX, which can be downloaded fromthe EBA website .We thank ISBT for a longstanding friendship and hope to beable to introduce ourselves personally to you at some event! European Blood Alliance founded, Vox Sanguinis, 1998, 75: 25.http://dx.doi.org/10.1046/j.1423-0410.1998.7530259.xII Nightingale, et al. Vox Sanguinis, 2011, 101(3):250-4.doi: 10.1111/j.1423-0410.2011.01480.xIII European UpFront Risk Assessment Tool: EUFRAT at ECDC websiteIV European standard operating procedure (SOP) methodology reflectingEuropean best practice within the area addressing the quality and safetyof blood: EU-Q-Blood-SOP projectV EU Blood Inspection: EuBISV Optimal Blood Use. Promoting and sharing best practice across the EU:Optimal Blood UseVII Van Kraaij et al., Vox Sanguinis, 2015, 109 (Suppl. 1), 14;http://onlinelibrary.wiley.com/doi/10.1111/vox.12304/epdfVIIIDonor management in Europe: DOMAINEIX The Donor Health Care programme: DoHeCaXwww.europeanbloodalliance.eu/eba-bookITransfusion Today | Number 107, June 2016CMYCMMYCYCMYKIn Focus Alliances within the Field of Transfusion MedicineFrom ISBT Central OfficePaul StrengersSecretary General of ISBT 2000 - 201060 years of official relationsbetween ISBT and WHO.IN 1956, Dr. Colonel Jean Julliard, Secretary-General ofISBT, described in his report on the The Activities of theInternational Society of Blood Transfusion that at the 15thSession of the World Health Organization in February 1955,ISBT was recognized as a scientific society and was admittedto official relations with WHO. This important event gaverecognition and international scientific credit to transfusionmedicine and to ISBT. Every following two years the ExecutiveBoard of WHO reaffirmed the official relation between WHOand ISBT as a Non-Governmental Organization (NGO) andthe Board of the WHO expressed its appreciation for ISBTscontinuing support for WHO objectives and contribution toworld health. At the beginning it was agreed that ISBT andWHO should work together on recommendations regardingpractical and psychological problems with transfusion inparticular on biological standardization, on blood donors whoshould be unconditional, voluntary and altruistic, and - it wasthe time of the Cold War - on the personnel in case of disastersand conflicts. The WHO Expert Committee of BiologicalStandardization (ECBS) still addresses each year major topicson blood and plasma and has published a great number ofrecommendations on improvements to transfusion medicineworldwide. ISBT was invited to be present at World HealthAssemblies and at sessions of the WHO Executive Council andWHO Regional Committees. In return WHO representativeswere invited to attend meetings of the ISBT Council andBoard as an observer and to give presentations at (opening)sessions of ISBT Congresses. Many common initiatives weredeveloped such as in 1976 the World Blood ResourcesCommittee to monitor the manner in which blood programsin various countries develop and for which ISBT offered theexpertise of some selected members to training courses whichwere the responsibility of the WHO and the League of the RedCross Societies. In 1980 the ISBT Code of Ethics for BloodDonation and Transfusion was adopted by the ISBT GeneralAssembly and two years later submitted for adoption to theWHO General Assembly because the consideration of thehealth of the donor and the safety of the recipient should beaccepted by every health authority as a primary responsibility.Unfortunately, WHO encountered difficulties because according12to the minutes the commercial industry was not ready toespouse these fine ethical principles. For ISBT this was adisappointing outcome and a reason for reviewing the futureof the collaboration between ISBT and WHO. Six years laterhowever, the ISBT Council strongly supported the objectives ofthe Global Blood Safety Initiative (GBSI) launched by the WHOin May 1988 in consortium with the League of Red Cross,ISBT and the United Nations Development Programme. Someyears later GBSI became integrated in the Global Program onAIDS focusing on developing countries. As in any relation ISBTand WHO had its ups and downs. The minutes of the Councilmeeting in 1992 where the WHO representative requestedISBT for funding noted politely, referring to heavy discussionsthat there was much overlap in the goals of ISBT and WHObut ISBT does not have the finances to help support the WHOprograms as requested. Luckily, problems were solved andtwo years later Dr. Antezana, Assistant-Director of the WHO,opened the International ISBT Congress with the lecture onThe role of the WHO in blood transfusion and handed over theDistant Learning Material on Safe Blood and Blood Productsto ISBT. ISBT continued its support to WHO programs suchas the Global Collaboration on Blood Safety (GCBS), the manyinformal consultation meetings on different blood transfusionaspects varying from anemia and selection of donors to qualitymanagement training courses, on putting plasma derivedmedicinal products on the WHO Essential Medicines List, onvoluntary non-remunerated blood donors, on guidelines for theproduction, control and regulation of plasma for fractionation,on collaborative studies in biological standardization, on theWHO Achilles project, etcetera. The renewed Code of Ethicswas officially adopted by WHO in 2000 and in 2004 WorldBlood Donor Day was established by ISBT, WHO, FIODSand IRCRCS in order to create awareness on the voluntary,non-remunerated blood donor. Sixty years of internationalcollaboration for improving blood transfusion medicine haveshown that the official relation between ISBT and WHOis a great asset and it is paramount for the many patientsworldwide who rely on transfusion therapy with blood andplasma products.Transfusion Today | Number 107, June 2016Elections for vacantpositions on theBoard of Directors 2016Voting commences June 14, 2016 and closesAugust 6, 2016ISBT, our society, is guided by a Board of Directors which isresponsible for development and oversight of the strategy of theorganization. The Board is comprised of, and elected by, themembership of the Society. Board members have fixed termsof service and elections are held every two years. The termsfor newly-elected Board members begin at the InternationalCongress and will be announced at the General Assembly to beheld in Dubai September 6, 2016.Nominations closed on May 17, 2016. One nomination wasreceived for the positions of Vice President, Treasurer andRegional Director for Africa and Western Pacific and thereforethese candidates are elected unopposed. Elections will takeplace for President Elect and the Regional Directors for Europeand South East Asia.Transfusion Today | Number 107, June 2016According to Article 16 of the ISBT Statutes all members of theSociety who were a member on March 1, 2016, the date of thecall for nominations, will receive an email notice on June 14,2016 inviting them to take part in the election which will beheld online. The elections will close at 23.59 CET on August 6,2016.ISBT exists for, and is guided by its members. The Board playsa vital role in this process and all of you who are eligible to voteare encouraged to exercise your right to vote for the candidateof your choice for these three positions. For your guidance eachcandidate has provided a brief biography, statement of theirinvolvement in ISBT and a statement of motivation on why theyare a suitable candidate for the position and what they intend tocontribute to the Board and the Society if elected. These will beavailable on the online voting pages.13From ISBT Central OfficeFrom ISBT Central OfficeMembership RenewalWelcome to our new members(April 2016 May 2016)It is time to renew your membershipThank you for your membership of ISBT during the membershipyear 2015/16. Your membership helps us to achieve ourmission of sharing knowledge to enhance transfusion practicethrough providing opportunities for advancing knowledgeand education. Your membership renewal means that youwill continue to receive the benefits of membership of ISBTincluding:Access to the ISBT Academy ePortal (including congresswebcasts and presentation Subscription for Vox Sanguinis (paper + online)* Receipt of Transfusion Today (paper + online)* Receipt of the monthly E-news Registration discount at ISBT congresses Online access to Working Party material* Online access only for 35 years and under feeWe kindly remind you to renew your ISBT membership for thenew membership year 2016-2017 (April 1, 2016 to March31, 2017). Continuing your ISBT membership will give youthe opportunity to connect and participate in our growingtransfusion medicine community.Please settle your membership fee before June 30th 2016.Scroll down or click on the hyperlinks for detailed informationon: How to renew | Payment methods | Invoice | Membershipcard | Fees | Discounted fee 35 years and under | Addressup-to-date? | Questions?We are looking forward to welcoming you again in the newmembership year!Best wishes,Team ISBTHow to renewLogin with your current email address and password.Click on My Membership & Payments to pay your membershipfee for 2016/2017.Payment methodsOnline payments can be made using the following methods: Recurring direct debit* Credit card (no 3D-secure) PayPal IDEAL (Netherlands only)14* Recurring direct debit is available to members resident inmost European countries. By using direct debit you authorizeISBT to collect the payment of your annual ISBT membershipfee at the start of every new membership year. This saves yourenewing your membership every year so we highly recommendit!Africa JAPAN: Hiroyuki Oguro, Yoshiyuki Akashi, NIGERIA: Garba Umar Kangiwa, Awwal Borodo, Uchenna Please make sure when paying by credit card you haveauthorization from your bank to make payments abroad andthat you have sufficient funds, otherwise the payment will becanceled. MALAYSIA: Hemalatha ShanmugamIf you do not have a credit card or PayPal account you canemail membership@isbtweb.org to arrange for a bank transferAmericas UNITED STATES OF AMERICA: Kerri Weinert, Jennifer InvoiceAn invoice is available after logging in on the Payments page.Membership cardAfter payment, your membership card will be available fordownload (in PDF-format) at your personal profile on ourwebsite from April onwards.FeesISBT Membership fees are based on your age and your country.Read more about our fees.Discounted fee for those who are 35 years and underIf you are 35 years and under, you pay a discounted fee of 55 per year. You can find more information on our discountedmembership here.Address up-to-date?To ensure that you continue to receive Vox Sanguinis andTransfusion Today and the monthly E-news, please check thatyour membership details e.g. postal and email addresses areup-to-date and complete. You can edit your details by loggingin and by going to Edit Profile. Make sure you click on Updateprofile on the bottom of the page to safe your changes.Questions?Most of the answers you can find at our Frequently AskedQuestions. If you have any other questions, please let us know.Our mailing address is:International Society of Blood TransfusionMarnixstraat 3171 st floorAmsterdam, Noord-Holland 1016 TBNetherlandsShinya Matsumoto SOUTH AFRICA: Fred Kloren, Carl Fourie TAIWAN: Yang Bing-Heng ZIMBABWE: Judith Juliet ParirewaSato, Zachary Antovich, Marsha Senter, Ashok Tholpady,Ann SmithEastern MediterraneanPAKISTAN: Saman Ansari,Maqbool Alam SAUDI ARABIA: Daryll Sulleza,Maha Eid Al-Johani UNITED ARAB EMIRATES: Hiba AlhumaidanEurope BOSNIA AND HERZEGOVINA: Jasminka Kurilic CROATIA: Nina Ipavec GREECE: Magdalini Pape, Efthymia Serafi HUNGARY: Human BioPlazma LLC IRELAND: Sanjay Shahi NETHERLANDS: Peter Ligthart, Jan-Willem Andriessen,Judith Lie, Anja Mkelburg, Lenneke Prinzen NORWAY: Janne Pedersen RUSSIA: Dmitriy Likhonin, Ivan Krivov UNITED KINGDOM: Ali Shokoohi, Stephen Smedley TURKEY: Gonca GokyarSouth East AsiaINDIA: Devi Prasad Acharya, Ganesh Mohan, Jitin Narula, Asbhisekh Gowda, Ruchi Jaipuria, Sachin GargWestern Pacific AUSTRALIA: Bronwyn Pearse, Shelly Park, Leah Kivivali,Simon Benson CHINA: Zhoulin Zhong, Yan Zhou, Mei Yu, Zhaohui Liao, Transfusion Today | Number 107, June 2016Ejikeme, Isaac OlajideWenbiao Liang, Ningyu HeTransfusion Today | Number 107, June 201615From ISBT Central OfficeISBT Academy34th International Congress of theISBT, September 3 - 8, 2016 Dubai34th International Congress of the ISBT, September 3 8,2016 DubaiScientific programmeEllen van der Schoot, our Scientific Secretary has puttogether a superb scientific programme with new speakersand new topics as well as more familiar themes. Theprogramme includes almost 90 invited speakers and 118 oralpresentations chosen from high scoring submitted abstracts.The programme has three parts; the local/regional day onSaturday September 3 this is specifically designed for peoplefrom the region, the Academy or education day on SundaySeptember 4 designed for those who want to update theirknowledge and the main scientific programme taking placefrom Monday September 5 Thursday September 8.Transfusion PractitionersNew this year are special sessions for TransfusionPractitioners. These sessions are organised by the TransfusionPractitioner sub group of the Clinical Working Party and willinclude; how the transfusion practitioner role can involvepatients in the transfusion process, single unit transfusions(how to measure practice what has worked), the use oftechnology in patient safety and a workshop on making datafun and work for you. Please spread the word in the TPcommunity about these sessions.WorkshopsA number of workshops are taking place. On September2, 2016 the Immunohaematology Working Party will behosting a day long workshop on the clinical significance ofred cell alloantibodies, on Sunday September 4 the QualityManagement Working Party will host a half day afternoon16workshop on Quality Management and the inspection ofBlood Establishments and the Clinical Working Party willhost a workshop on the most important aspects of designing,performing, analyzing, reporting and reading clinicaltransfusion research. On September 5 at 08.30 there is aworkshop on peer review which will give you an insight intothe requirements of peer reviewing and how to do it well.Visit www.isbtweb.org/Dubai to find out more about theseworkshops and to sign upExhibitionThere will be a large exhibition running alongside the scientificprogramme. You are invited to visit the exhibition and discusscurrent and upcoming technologies with the exhibitors. Weare anticipating that around 80 companies will be exhibiting.All coffee and tea breaks take place in the exhibition halls soyou also have the opportunity to meet up with colleagues andfriends from around the world.Social programmeJoin us for the opening ceremony and welcome reception. Youwill be welcomed to the opening ceremony by an Arabic danceperformance. As well as the usual speeches and award givingthe ceremony will feature a sand or collage artist and a band.Following the opening ceremony traditional food will be servedthroughout the exhibition hall.The congress party will take place in the iconic Asateer tentwhere glittering lights, oriental entertainment and a wide arrayof buffet dishes and traditional delicacies awaits you! You willexperience spectacular and dazzling views of the Dubai skylinefrom Atlantis private beach.Transfusion Today | Number 107, June 2016Case studies inImmunohematologyDr. Thierry PeyrardPharmD, PhD, EuropeanOne of the focal points of the Working Party onImmunohematology is to provide information andeducational opportunities through the ISBT WorkingParty Website. One of the most popular formats forsmall and large group meetings is ImmunohematologyCase Studies. One of the reasons these are so popularis that the participant can learn from cases thatthey may not see often but should be able to detectand handle or learn new practical approaches toantibodies that are seen in their institution.tekstThe members of the Working Party onImmunohematology are planning by the end of 2016to bring 12 case studies to the members of ISBT whoare interested in viewing them. The members who aresharing these case studies are: Sofia Lejon Crottet,Nicole Thornton, Cinzia Paccapelo, Ankit Mathur,Franz Wagner, Eduardo Muiz-Diaz, Erwin Scharberg,Susan Johnson, Anu Korhonen, Fang-Yeh Chu,Christof Weinstock and Abdullah Meshi.Specialis in ClinicalChemistry and LaboratoryMedicineDirector, NationalImmunohematology ReferenceLaboratoryNational Institute of BloodTransfusion Paris, FranceSandra J Nance, MS,MT(ASCP)SBBSenior Director, IRLsAmerican Red Cross Philadelphia, USAThese members are representative of the newWorking Party, with wide global reach (see map). TheWorking Party is excited that these case studies couldbe valuable as learning tools for all levels of thoseinterested in immunohematology. The path to find theCase Studies once signed into the ISBT Webpage isISBT Webpage>Working Parties> Working Party onImmunohematology> Education> Case Studies.We hope these cases will be of interest for all ofyou and would be happy to get your feedback andcomments.Transfusion Today | Number 107, June 201617ISBT AcademyISBT AcademyISBT at the 16th InternationalHaemovigilance SeminarThe International Haemovigilance Network (IHN)thanks the ISBT Academy for its support of the 17thInternational Haemovigilance Seminar, held in Parisfrom 7-9 March, 2016.ISBT joined French governmental, transfusionprofessional, blood establishment and industrypartners in supporting the event, which welcomed270 people from over 50 countries, includingrepresentatives from a number of countries attendingfor the very first time.Photo 1: Travel award recipients, supported by the ISBTAcademyThe program covered donor, product and transfusionrecipient vigilance, with a plenary session onhaemovigilance in African countries, and aneducation morning in French. Other sessions exploredinflammation and its consequences and the potentialof new technologies to understand it, sickle celldisease and hyperhaemolysis, and iron status (toolittle, too much) for donors and patients. Therewas a session on microbiological haemovigilanceincluding hepatitis E, and a range of presentations ondifference tools for practice improvement, includingthe use of simulation for educating and traininghealthcare professionals and patients. High qualityoral presentations and posters were presented from alarge number of submitted abstracts.Dr Luc Noel was honoured for his contributions tohaemovigilance and a coordination of vigilance effortsacross a wide range of medical products of humanorigin internationally. Dr Noel delivered the IHN Awardlecture, which can be found along with other seminarpresentations at http://ihs-seminar.org.Dr Peter Tomasulo was awarded the IHN Medal,in recognition of his contributions to IHN andto haemovigilance in the United States andinternationally, with a particular focus on donor healthissues.Erica Wood on behalf of the IHN Board,JoWiersum on behalf of the ISBT Working Partyon Haemovigilance, and Pierre Tiberghien andPhilippe Renaudier on behalf of the Local OrganisingCommitteeIHN thanks all participants and speakers andsupporting organizations who made the Seminarsuch a success. ISBT Academy funding enabled fourtravel grants, awarded to Dr Michael Acquah fromGhana, Dr Salam Sawadogo from Burkina Faso, MrAbiy Belay Ambaye from Ethiopia, and Dr Hilda MariaSilva Ballaster from Cuba. ISBTs support was greatlyappreciated.ISBT Academy Beginsa Fourth Year FundingImmunohematologyWorkshops in IndiaThe ISBT Academy entered its fourth year offunding immunohematology training in India at theend of March with the first of two annual IndianImmunohematology Initiative (III) wet workshops. Thisworkshop hosted by the Lions Blood Bank in New Delhifrom 28 March to 1 April included 14 participants inphysician and technical roles. This event came closeon the heels of a six-day workshop at Rotary ttk BloodBank in Bangalore in January, the second in the 2015Academy funding cycle. The timing of the March eventallowed III faculty members, Susan Johnson and JimPerkins, to participate in a joint congress of the BloodBanking and Transfusion society of Turkey (BBTST) andthe Asian Association of Transfusion Medicine (AATM)with two presentations each.The III is a non-profit, USA-based group of 4transfusion medicine professionals, Martha Rae CombsMT(ASCP)SBB, Janis Hamilton MS, MT(ASCP)SBB,Susan Johnson MS, MT(ASCP)SBB, and the author,who have been teaching Immunohematology in SouthAsia for over 10 years. The workshop model hasevolved over time from one of presenting antibodydetection and identification workshops at various sites,often in association with a National meeting, to thefixed-location classroom concept embodied by theabove.But after four years at these two sites, III faculty arehoping to change the model again! The local hosts inNew Delhi and Bangalore are confident that they cantake over teaching their annual, week-long workshops.The III does not expect to send two faculty membersto New Delhi again, and the Autumn workshop inBangalore is slated to be the last with two III membersat that site as well. Local faculty at these sites intendto expand their schedule to multiple events of varyinglength and with varying objectives during the year. TheIII will continue to support teaching at the two sites, butinstead of staffing the workshops personally, III facultyhope to go back on the road.As immunohematology develops in India officialsof AATM, have been encouraging the III to conductworkshops in other member countries. To do so moreNaamJimPerkins, M.D.,FunctieIIIDirectorrobust equipment, particularly a new set of serologiccentrifuges, is required to replace the current, aging setwhich will stay in the Delhi and Bangalore classrooms.The III has been working with a Mumbai equipmentmanufacturer, Remi, to develop a new, purpose-builtserologic centrifuge, the Quikfuge. The plan is fortwelve of the latter to form the nucleus of a workshopin a box. The Quikfuge has performed well, and four ofthe five machines provided for the January Bangaloreworkshop were snapped up by participants! Discussionshave begun with two other AATM member countries tohost 2017 workshops in each.Although individual workshop evaluations are stronglypositive, in 2015 the III attempted to evaluate the longterm impact of its activities in India using an onlinesurvey method. One hundred eighty five (185) pastworkshop participants with known email addresseswere sent a 15 question survey to which 66 responded.Two thirds of respondents were physicians reflectingthe bias introduced by the requirement for a currentemail contact. Although half of respondents indicatedthat they had 5 years or more experience at the timethey took the workshop, only a third of physicians and20% of technical workers reported having had previousformal training in blood group antibody detection andidentification. About 95% of participants stronglyagreed that the workshops were well organized andtaught. More to the point two thirds gave the samerating to a statement that the workshop had helpedtheir professional career, the remainder giving thestatement an agree rating. All of the physiciansand 95% of the technical workers strongly agreedor agreed that their personal ability to providecompatible RBC transfusion was improved, and95% gave the same ratings to the statement that theworkshop had improved the ability of their laboratoryas a whole. Of note however, the latter rating was evenhigher for the question whether the laboratorys abilitywould improve in the future, reflecting current resourcelimitations. Finally, about 30% of respondents reportedtraining at least 10 other individuals.ISBT members interested in observing an III workshopare invited to observe the next workshop in Bangalorein September.Photo 2: Members of the IHN Board and Local Organising Committee, with Dr Luc NoelAcademy18Transfusion Today | Number 107, June 2016Transfusion Today | Number 107, June 201619Regional EuropeRegional Europe1995-2015:Twenty years ofhaemovigilancein GreeceProf. Constantina PolitisHead of Hellenic CoordinatingHaemovigilance CenterC. Politis1, E. Zervou2, L. Kavallierou,1C.Richardson,3 G. Martinis,4 M. Hatzitaki,5P.Damaskos,1 M Parara,1 E Grouzi,6 K. Fountouli,7PHalkia,8 M. Asariotou1, E.Aliverti1,1Coordinating Haemovigilance Centre (SKAE), Hellenic Centrefor Disease Control and Prevention, Athens2University Hospital Blood Centre, Ioannina3Panteion University of Social and Political Sciences, Athens4University Hospital Blood Centre, Alexandroupolis5Koutlibaneio Hospital Blood Centre, Larisa6Agios Savas Hospital Blood Bank Athens7University Hospital Blood Bank, Heraklion, Crete8ACHEPA University Hospital Thalassaemia Unit, ThessalonikiBackgroundThe Coordinating Haemovigilance Centre (abbreviatedas SKAE in Greek) was founded by the HellenicCentre for Disease Control and Prevention (KEELPNO)in November 1995 on a voluntary basis. It wasestablished in line with European National legislation(Min.Res. 261/2011) defines SKAE competencepursuant to European Directives for the developmentand implementation of the haemovigilance systemunder the aegis of KEELPNO of the Ministry of Health.MethodsSKAE collects, monitors, and analyses all adversereactions (ARs) and adverse events (AEs) related totransfusion and donation including epidemiologicalsurveillance of transfusion transmissible infections(TTIs). EU and ISBT/IHN standard definitions maintainhomogeneity in reporting and allow benchmarking.Other activities include traceability, look-back, qualitymanagement indices, crisis management, costeffectiveness and training (Figure 1).The haemovigilance system includes networksbetween hospital clinical departments and hospitalblood banks, blood establishments, and the NationalBlood Centre (Figure 2).15% and TAD 7%). Trends over the surveillance periodshow significantly increased incidence of febrile ARsand TAD, and decrease of IBCT. Nine fatalities werereported: three ABO incompatibility, two TRALI, twobacterial, one TACO, one GvHD.Conclusions/RecommendationsTwenty years of haemovigilance in Greecedemonstrate coordinated progress towardsbetter quality and safety in blood donation andtransfusion.Two transmissions of HIV from one donor owing todonation during the window period and 54 cases ofbacterial infection were recorded. The distribution ofARs by imputability in 2014 was 18% definite, 47%probable, 29% possible and 6% impossible.However, the prevalence of TTIs remainsrelatively high especially regarding HIV andoccult HBV. At the same time notable progressin the implementation of NAT screening forHCV-RNA, HIV-RNA and HBV-DNA as well asfor WNV-RNA seasonal screening has led tosignificant advances in assuring blood safety.- Incidence of serious AEs in 2006-2014 was 1:13,368processed units of BCs. Near misses were 1:3,059units .60% of all AEs are attributed to human error.- Blood donation: the incidence of any AR in 2014 was1:86 donors (78% vasovagal). SARs were 0.3%.- Seroprevalence of infectious markers (HBsAg,anti-HIV, anti-HCV, Syphilis and anti-HTLV) in donorblood in 1996-2014 totalled 0.32 % (Figure 4). Ratesstabilized in 2008-2014 NAT yields for HIV-RNA,HCV-RNA, HBV-DNA in 2007-2014 were 1:391,255,1:195,628 and 1:8,325, respectively. WNV-RNA in2010 2014 was 1:11,289.SKAEs action plan has developed towards newactivities including haemovigilance for specificpatients groups e.g. thalassaemia, root causeanalysis (RCA) and contribution to the development ofbiovigilance (Figure 3).Continuous nursing and medical supervisionduring donation and management ofcomplications especially vagovasal reactionsand injury by the needle will contribute greatlyto safeguarding the well-being of our donors andensure their willingness to be retained as regulardonors.ResultsCoverage is 93% of total blood units issued fortransfusion. In 2014 the incidence of all ARs was1:460 units of blood components (BCs). Febrile nonhaemolytic (45%) and allergic reactions (37%) werecommonest. Serious ARs were 1:6,863 units. 34%were attributed to IBCT and 39% were associatedwith the respiratory track system (TACO 17%, TRALI20Transfusion Today | Number 107, June 2016The frequency of transfusion of wrong blood tothe wrong patient due to pre-marked samplingtubes and failure to verify identity of the patientin the clinical environment has been decliningover the second decade of the surveillanceperiod, however IBCT remains one of the mostimportant adverse events attributed mainly tohuman error.Implementation of patient identification systemand full computerized record keeping inblood services and clinical departments aswell as universal application of pre-storageleukodepletion and use of pathogen reductiontechnologies are recommended for theavoidance of adverse reactions in transfusion.Transfusion Today | Number 107, June 201621Regional Eastern EuropeRegional EuropeNew TransfusionNational GuidelinesDeveloped bythe Ministry ofHealth in UkraineUkraine is an Eastern European country and thelargest country within Europe with a populationof ~43 million of which 27.5 million are potentialdonors. The human development index of the countryin 2014 was 0.747 (high), positioned 81st accordingto the United Nations Development Programme. In2015, ~500,000 whole blood donations and over3,000 apheresis donations of plasma and plateletwere collected. The donation index is ~13 donationsper 1,000 inhabitants.In April 2016, Ukraine began developing new nationalguidelines on the clinical use of blood. The developmentof the new guidelines is a collaborative effort by theCoordination Working Group of Experts (WG) on bloodservice development of the Ministry of Health (MoH)of Ukraine and domestic and international clinicians.The project is supported under the US PresidentsEmergency Plan for AIDS Relief (PEPFAR), funded bythe U.S. Centers for Disease Control and Prevention(CDC), and implemented by American InternationalHealth Alliance (AIHA).The current official document that regulates the clinicaluse of blood and blood components is an instructionapproved by a Decree of the MoH in 1999. Followingthe active approach of the MoH to harmonize theregulatory framework on blood with EU requirementsand Directives, and based on recommendations bythe European Commission and the Council of Europe,the WG was created in September 2015. This groupdefines the priorities of blood system reform, includingthe development of evidence-based national guidelineson the clinical use of blood components.The basis for developing the new guidelines is basedon best practices developed within the PEPFARblood safety project implemented in Kyrgyzstan,where new national clinical guidelines were adoptedas federal regulations by the MoH of Kyrgyzstan inFebruary 2015. Those guidelines were the result ofa joint effort by international consultants and Kyrgyzclinicians providing expertise in different areas ofclinical practice. The Kyrgyz guidelines were suggestedto the MoH of Ukraine for review and adaptation to alocal format. Local specialists evaluated the documentagainst Ukrainian national regulatory requirements,made comments and edits which were shared withinternational consultant, Dr. Miguel Lozano.22Oleksandr SergiienkoAlexandru VolocHead of Blood Safety Sector,AIHA, Blood Safety ProjectPublic Health Department,Country DirectorMinistry of Health of UkraineMiguel LozanoISBT, European DirectorDr. Lozano met with the clinicians and MoH WG todiscuss the suggested draft guidelines, and emphasizedthe need to base them strictly on modern evidencebased medicine principles, and in parallel to follow theprovisions of the EU Directives and Commission onblood safety and quality. The guidelines will includepractical instructions to clinicians about indications,contraindications, dosage and administration, andside effects associated with each type of bloodcomponent and plasma derivative. Sections include pretransfusion testing, blood administration and criteria ofeffectiveness of a given blood product.Further steps in adopting the document includesubmission for review by Ukrainian leading specialistsand public comment over the MoH website, withsubsequent approval of the new national clinicalguidelines by a MoH decree as national regulations.Theadoption of the new clinical guidelines as aregulatory document is crucial in order to ensure astandardized approach to be followed by all clinicians inUkraine. It will also require medical schools in Ukraineto revise their curricula in accordance with the newguidelines.With approval by CDC, AIHA will continue supportingfinalization of the guidelines and promote local capacitydevelopment in training and use of blood componentsaccording to the new requirements. Dr. Lozano willcontinue participating in the process and will mentorthe new trainers.The collaboration between the international consultants,local clinical experts and the MoH in the developmentand adoption of the new national regulatory guidelineson the clinical use of blood is a significant achievementas Ukraine approaches modern evidence-basedTransfusion Medicine.Blood transfusionin the RussianFar East regionThe annual regional blood service conference took placein Khabarovsk February 10-11, 2016. 159 delegateswere present, including directors of the Blood Servicesfrom the Far Eastern regions, blood bank staff, medicaldoctors and transfusion practitioners from Baikal toPacific Ocean. Important questions for blood servicespecialists, clinical doctors with different specialties andhealth officials and medical scientists were discussed.Professor Eugene Zhiburt talked about the changes intransfusion medicine, about ensuring safety of bloodproducts, platelets pooling, pathogen inactivation andimmune hemolytic reactions. The head physician of themain Far Eastern Blood Center Oksana Kozhemyakoreported about achievements of Far Eastern BloodService in 2015. She appreciated the results ofThis article was supported by the CooperativeAgreement Number 1U2GGH000861 from the Centersfor Disease Control and Prevention. Its contents aresolely the responsibility of the authors and do notnecessarily represent the official views of the Centersfor Disease Control and Prevention.Transfusion Today | Number 107, June 2016Takhir ShikhmirzaevKhabarovsk Regional BloodTransfusion Stationcentralization of Blood Service in the Far East, wherethe process of donor blood components preparationwas concentrated mainly in 10 large institutions, for thehighest effectiveness and safety.In 2015 blood components from more than 87000donors were prepared in the Far Eastern region ofRussian Federation. Quality and safety of bloodproducts are increasing. E.g. in Yakutia all plateletconcentrates are pathogen reduced. Current FFPquarantine storage is available and good for two yeartransfusion if needed.During the master class Universal protocol for thecollection of platelets, blood processing technologyin automatic separator were demonstrated. Apheresisand pooling of platelets technologies have beenbroadly discussed. Kirill Slovesnov calculated thatpooled platelets are at two times cheaper and have thesame quality compared with apheresis platelets. Thegreat interest has been attracted with the informationprovided by Sergey Madzaev that pathogen inactivationcould replace irradiation for TA-GVHD prevention.These conferences have become a yearly event. Theygive information platform for constructive interaction ofRussian specialists from different regions of the countryand define priorities for Blood Service of the RussianFar East development. All colleagues are kindly invitedto attend the next meeting on Sakhalin Island in 2017.Transfusion Today | Number 107, June 201623Regional Southeast AsiaI M M U N O H E M AT O L O GY // I H - 5 0 0 SYST E MCME on BloodTransfusion Services-Expanding HorizonsProf Neelam MarwahaProfessor, Dept. of Transfusion Medicine, Postgraduate Institute of MedicalEducation and Research, Chandigarh,IndiaISBT Regional Director, South-EastAsiaThe Departments of Transfusion Medicine at thePostgraduate Institute of Medical Education andResearch and the Government Medical College andHospital, Chandigarh, jointly organized a CME onBlood Transfusion Services -Expanding Horizonson April 29, 2016. Prof. Atul Sachdev, DirectorPrincipal, Government Medical College and Hospital,Chandigarh inaugurated the CME and Dr. VanitaGupta, Director Health Services, UT, Chandigarhalso graced the occasion as guest of honour. Prof.Neelam Marwaha, organizing chairperson of the CMEhighlighted newer techniques in improving bloodsafety and the role of this speciality in therapeutics.Transfusion Medicine is a rapidly evolving andexpanding field. Traditionally the scope of the servicewas limited to the process of blood collection,storage and issue. But today it has emerged asa multi-faceted and multi-dimensional medicaldiscipline. It now includes innovative procedures forblood and component collection, complex laboratorytechnologies for red cell and platelet serology andtesting for transfusion transmissible infections,direct involvement in patient care through apheresistechnology and stem cell therapies, haemovigilanceand donor vigilance, platelet and plasma derivedmedicinal products. All this has to be balanced withina highly regulatory environment.The scientific programme was divided into foursessions; two sessions were lecture based,there was one panel discussion and one sessionon learning transfusion medicine through casediscussions.The first session was on Challenges of blood safetyfrom transfusion transmissible infections and waschaired by Prof Neelam Marwaha and Prof KulbirKaur. Dr. Kabita Chatterjee presented a talk on TheRole of Nucleic Acid Testing in blood safety. Shehighlighted window period reduction through NATand its feasibility in our country. Quality assurance inTTI testing was discussed by Dr Naveen Agnihotri.Prof Ravneet Kaur drew attention to the emergingand re-emerging infectious diseases which couldimpact blood safety Dengue, Chikungunya, potentialthreat of Zika virus and reported chronicity ofHepatitis E virus infection. The second session was24IH-500Innovation Driven by Experienceon Therapeutic Apheresis and included three talksby eminent speakers. Dr Rajesh Deshpande spokeabout the Principle and Technologies for therapeuticplasma exchange (TPE). Dr Rekha Hans talked aboutthe role of TPE in thrombotic microangiopathieswhere its a first-line therapy. Dr Aseem Tiwari sharedhis experience with the role of TPE in neurologicaldisorders and support in ABO incompatible kidneytransplants.Our country has always faced shortages ofplasma derived medicinal products like albumin,immunoglobulins and FVIII and FIX concentrates.Recently, Government of India has taken positivesteps to achieve self-sufficiency for plasma derivedmedicinal products and the role of TransfusionServices has further expanded to support theplasma product industry. There was a paneldiscussion moderated by Dr Gagandeep Kaur onthe Governments recent initiatives for achievingself sufficiency in blood and plasma products. Theimplementation of these guidelines was deliberatedupon intensely between the transfusion medicineexperts and the regulators. Finally, in addition to theinvited talks and panel discussions we had a highlyinteractive session on Learning Transfusion Medicinethrough case presentations. There was a postersession too for the young specialists and postgraduatestudents and awards were presented to the three bestposters. The CME was attended by 150 delegatesfrom the region. The delegates expressed immensesatisfaction and hoped for participation in more suchCMEs in the future.Transfusion Today | Number 107, June 2016Discover our Innovative Universe.Bio-Rad is one of the worlds most respected suppliersof blood screening systems.We have been serving blood banks and transfusion centersacross the world for more than 30 years, consistentlydeveloping and delivering cost-effective, high-performanceand reliable systems designed to meet your changingrequirements.We know that our future and yours depends on our abilityto search beyond todays solutions.These are the reasons behind the development of ournew fully-automated immunohematology platform,the IH-500 system.The Complete Solution for Safe TransfusionWE ARELISTENINGTO YOUIt will only take2 minutes of your time.survey2016biorad.comIH-500 is not available in the U.S.For more information: www.bio-rad.com/IH-500Follow us on Twitter: @Biorad_DiagSoluTransfusion Today | Number 107, June 20162016_03_IH 500_INNOVATION_EN ENQUETE 20 x 28 V1.indd 12506/04/2016 10:17Regional AfricaUpcoming EventsExternal qualityassessment scheme forhospital blood banks inMalawiIntroductionExternal Quality Assessment (EQA) is an importantpart of the overall quality system that should be inplace in any blood bank. There are many benefitsfor participating laboratories and for patients. EQAschemes can drive forward quality where qualitysystems are not in place and help awareness ofquality issues and need for quality systems. A goodEQA scheme will include a training element aimed ataddressing weakness identified by the Scheme.BackgroundThe Malawi Blood Transfusion Service (MBTS)collects and processes blood for all hospitals inMalawi. Hospital blood banks (HBBs) transport,store, crossmatch and issue blood from MBTS topatients. In 2007, MBTS initiated a national externalquality assessment scheme (NQAS) for grouping andcrossmatching as part of a wide strategy to improvetransfusion practice in Malawi. The scheme wasestablished with the help of a Technical Consultantfrom UK. The scheme is supported by the Ministryof Health and has designated the MBTS as referenceLaboratory in Immunoheamatology. Training for hospitalblood bank staff is a key activity in the strategy.ActivitiesA HBB is enrolled in the NQAS after one of its staffmembers has attended a training course organized byMBTS. By the end of 2015, 18 exercises had beendistributed and the number of HBBs enrolled had risenfrom 14 to 83. Each exercise consisted of 3 wholeblood samples and one serum sample/plasma, preparedat MBTS Laboratories in Blantyre and distributedto HBBs by local courier service to arrive within 72hours. At the initial stage of the program, one set ofthe samples was sent to MBTS Centre in Lilongwe andreturned to Blantyre for testing on the closing date asone way of checking the quality of sample. The programdistributes samples twice a year. HBBs that performpoorly are visited to offer technical support. Certificatesof participation are issued to HBBs that participatefully each year. The MBTS keeps a small stock of bloodgrouping and crossmatch reagents which it sells tohospitals at a small fee in case they have run out ofthese reagents.26Daniel NdhlovuQuality ManagerMalawi Blood Transfusion ServiceResultsWith one exception the samples distributed were ofgood quality and survived the rigors of transportation.On average 100% of hospitals got the ABO andRhD typing correct while 78% of the hospitals gotthe correct crossmatch results in the last exercisedistributed in 2015. The number of hospitals thatperform the Indirect Antiglobulin Test (IAT) crossmatchhas increased by 75%. All Public, Private and ChristianHospital Association of Malawi (CHAM) Hospitals areenrolled in the program. 56% of the HBBs were issuedwith certificate of participation in 2015.DiscussionThe overall performance of ABO & RhD typing wasgood. The ABO incompatibility was recognized bymost participants. Other incompatibilities were missedas 25% of HBBs do not use IAT or have no reagentsor suitable centrifuges. The program realized thatimprovements in practice could not occur if HBBstaff are equipped with knowledge only, without theappropriate infrastructure and equipment. As suchbetween 2007 and 2012 MBTS sourced and suppliedparticipating hospitals with basic equipment andrehabilitated 18 HBBs.July 13 - 15, 20162nd European Conference on DonorHealth and Management 2016Cambridge, UKwww.ecdhm.org03 - 08 September, 201621 - 24 September, 201615th International Congress onAntiphospholipid AntibodiesIstanbul, Turkeywww.apsistanbul2016.orgOctober 20 22, 201634th International Congress of the ISBTDubai, United Arab Emirateswww.isbtweb.org/dubai3rd Congress on Controversies inThrombosis and Hemostasis (CiTH)Moscow, Russiahttp://congressmed.com/cith17 - 21 June, 201725 - 28 November, 2017October 22 25, 2016AABB Annual MeetingOrlando, USAwww.aabb.orgOctober 28 30, 201621st Annual Congress of Asia PacificBlood and Marrow TransplantationGroup 2016 (APBMT 2016)Singapore, Singaporewww.apbmt2016.orgConclusionThe scheme can be considered a success. Although theresults to date might, to some in countries with moredeveloped services, seem poor; the aim of the nationalstrategy of which the scheme is a part, is to improvetransfusion practice. WHO Guidelines state that EQAschemes are essential for driving forward improvementsand this relatively simple and inexpensive scheme ishelping to do just that.RecommendationFor BTSs with low incomes to establish this type of aprogram with support from their Ministries of Health asa tool to monitor transfusion practices.Transfusion Today | Number 107, June 201627th Regional Congress of the ISBTCopenhagen, DenmarkTransfusion Today | Number 107, June 201628th Regional Congress of the ISBTGuangzhou, Peoples Republic of China27When emerging pathogenspose a risk to the blood supply,The INTERCEPT Blood System is ready.INTERCEPT is the only US FDA approved pathogen reductionsystem for platelets and plasma.Pathogen reduction has been called upon to help maintain a safe and adequateblood supply as part of epidemic preparedness planning. Examples include:2005 chikungunya (CHIKV) epidemic on Ile de La Runion, France12014 CHIKV and dengue (DENV) outbreaks in the Caribbean region22016 Zika (ZIKV) outbreak in Puerto Rico32016 WHO4 and US FDA guidances5 offer pathogen reduction as oneoption to mitigate risks related to ZIKV outbreaksBe ready.For more information on availability in your country,please visit www.interceptbloodsystem.com.1Rasongles P, et al. Transfusion 2009;49:1083-91. 2 Rico, S et al. Treatment Use Study of INTERCEPT Platelet Components in Response to the Chikungunya and Dengue Epidemic in Puerto Rico:TRUE Study. Poster presented at BMT Tandem Meeting; February 2016. 3 Cerus Corporation Press Release (March 3, 2016 ) 4 WHO Interim guidance WHO/ZIKV/HS/16.1 February 2016. 5 FDAGuidance for Industry February 2016. No pathogen inactivation system has been shown to inactivate all pathogens. The INTERCEPT Blood System is not available for sale in certain countries.2016 Cerus Corporation. Cerus, INTERCEPT and INTERCEPT Blood System are trademarks of Cerus Corporation. MKT-EN 00215-01
GAP Annual Report 2014
GAPANNUALREPORT2014Global Advisory Panel onCorporate Governance andRisk Management of BloodServices in Red Cross andRed Crescent SocietiesGood Governance, safe blood.aGAPANNUAL REPORT 2014CONTENTS1. GAPs Role12. GAP Association Governance23. Strategic Plan54. Global Mapping65. Self-assessment96. Management of Risk107. Projects118. Priority Countries169. Finance19GAPANNUAL REPORT 20141.GAPS ROLEWe advocate and support the establishment of safe and sustainable bloodsystems, promote the adoption of best practice, and facilitate resourcemobilization and knowledge transfer between blood services.The purpose of GAP is to provide advice to National Red Cross and Red Crescent Societies, and their affiliatedblood services, in matters concerning corporate governance and risk management in the field of National Societyblood programmes, as well as the International Federation of Red Cross and Red Crescent Societies (IFRC)Secretariat and other relevant IFRC bodies.Aims: To provide technical advice in terms of corporate governance and risk management to National Societyblood programmes; To promote knowledge sharing, networking and partnership among and between Red Cross and Red Crescentblood services and external partners; To develop tools and guidelines as appropriate within the area of National Society blood programme delivery; To coordinate Red Cross/Red Crescent assistance to National Red Cross and Red Crescent blood servicesin post-emergency situations.1GAPANNUAL REPORT 20142.GAP ASSOCIATION GOVERNANCEIn 2014, Prof Philippe Vandekerckhove, Chief Executive Officer of the BelgianRed Cross Blood Service (Flanders) held the position of GAP President.GAP is comprised of an Executive Board, the members of which play a vital role in governance and decision makingfor the organisations activities. An IFRC permanent observer holds a position on the GAP Executive Board to ensurethe flow of information and coordination with the IFRC. Regular communication and constructive ties between GAPand the IFRC Secretariat ensures the coordination of work programs and supports links particularly with respectto voluntary non-remunerated blood donation (VNRBD).The GAP Zonal Coordinators liaise closely with their IFRC zone office(s) and look for opportunities to collaborateon activities in the critical area of corporate governance and risk management for National Societies involvedwith blood programmes.GAP Executive Board1.2.1. Prof Philippe VandekerckhovePresident2. Dr Wolfgang MayrVice President3. Dr Rudolf SchwabePermanent Board member4. Ms Jennifer WilliamsBoard member3.4.5. Dr Stefan Seebacher/ Dr Gabriel PictetIFRC Permanent Observer (Absent)2GAPANNUAL REPORT 2014GAP Association StructureGAP Executive BoardGAP SecretariatFinancial Auditor Dr Elizabeth VinelliAustralian Red Cross Blood ServiceGAP Members, Zonal Coordinators and Permanent ObserversAfrica[ZC Position Vacant]AmericasLatin America& the CaribbeanUSADr Richard Benjamin(ZC)HondurasDr Elizabeth Vinelli (ZC)Asia & PacificChina (Hong Kong)Dr Che Kit Lin (ZC)JapanDr Kenji Tadokoro (ZC)AustraliaMs Jennifer WilliamsThailandDr Soisaang PhikulsodEurope &Central AsiaMiddle East &Northern AfricaFinlandDr Tom Krusius (ZC)Dr Martti SyrjlIsraelProf Eilat ShinarAustriaDr Wolfgang Mayr (ZC)Belgium (Flanders)Prof PhilippeVandekerckhoveGermanyDr Erhard SeifriedSwitzerlandDr Rudolf Schwabe3[ZC Position Vacant]IFRCDr Stefan SeebacherDr Gabriel Pictet(Permanent Observer)Dr Guenther Wittauer(Senior VNRBD Officer)GAPANNUAL REPORT 2014GAP Finland representativeOne of GAPs founding members; Dr Tom Krusius from the Finnish Blood Service retired from the Blood Servicein 2014 and consequently vacated his position as GAP Zonal Coordinator for Europe and Central Asia. Dr Krusiushas been a very active GAP member, with particular contribution at the time of the 2004 Boxing Day tsunami,where he led the coordination of responses in affected countries.Dr Martti Syrjl, Chief Executive Officer, Finnish Red Cross Blood Service, is now providing Finlandsmember representation on GAP.Appointment of Europe & Central Asia Zonal CoordinatorDr Wolfgang Mayr from the Austrian Red Cross Blood Service was nominated unchallenged to the positionof GAP Zonal Coordinator for the Europe and Central Asia region in November 2014. The position wasconfirmed and Dr Mayr commenced the role in January 2015.International Federation of Red Crossand Red Crescent SocietiesPermanent Observer and VNRBD OfficerIn October 2014 Dr Stefan Seebacher retired fromhis position as Head of Health Department, IFRC.Dr Gabriel Pictet is currently acting in this positionand is representing the IFRC as a PermanentObserver on the GAP Executive Board.Guenther Wittauer retired from his position as SeniorVoluntary Non-Remunerated Blood Donation Officer(Health Department, IFRC) in June 2014. The positionremained vacant for the remainder of 2014.Blood Policy ReviewA review of the IFRC Blood Policy commenced in late 2014. A number of suggested changes were proposedand reviewed by the Secretariat and members. The final version of the Blood Policy will be approved by GAPand the IFRC in 2015.Memorandum of UnderstandingThe Memorandum of Understanding (MOU) between the IFRC and GAP was accepted signed by both partiesat the GAP Executive Board meeting in Madrid, April 2014. This MOU sets out the modalities of the partnershipbetween the two organisations including, but not limited to:The IFRC role in GAP;The reporting obligations including Major Material Risk;The engagement with the National Society through a Self-assessment process;Funding;Priority country support andThe coordination of blood programmes in disaster situations.4GAPANNUAL REPORT 20143.STRATEGIC PLANGAPs initial strategic plan was developed in 2007 for the period 2009-2012. The plan includeda vision and mission statement, primary objectives and key outputs. During 2014, these werereviewed with feedback from members on GAPs strengths, weaknesses and opportunities.The new GAP Strategic Plan for 2014-2019 was finalised at the 2014 AGM with updatedvision and mission, key objectives and performance indicators.VISION:All Red Cross/Red Crescent blood programmes will be safe, well governed and self-sustainable, based on theprinciple of voluntary non-remunerated blood donation for the benefit of patients and to safeguard blood donors.MISSION:GAP will support Red Cross/Red Crescent blood services in risk management and corporate governanceof blood programmes and promote good practices and knowledge exchange.OBJECTIVES:1.GAP to be recognized as a global network of experts in risk management and corporate governanceof blood programmes.2.Enable all Red Cross/Red Crescent blood services to undertake the GAP Self-assessment and demonstrateprogress towards achieving compliance with minimum standards and fundamental GAP requirements.3.Relationships, networks and collaborations will be developed which improve GAPs reach and effectivenessand to help execute GAPs programme of work.4.Service delivery will be enhanced through the provision of practical help to Red Cross/Red Crescent BloodServices to improve safety, sufficiency and good governance.5.Extend involvement of GAP membership to improve the reach of expertise available.6.IFRC will be supported by GAP activities in the goal of achieving 100% voluntary non-remunerated blooddonation and implementation of the IFRC Blood Policy.5GAPANNUAL REPORT 20144.GLOBAL MAPPINGIn 2013 and 2014, GAP conducted global mapping to determine the level of involvement thatRed Cross and Red Crescent National Societies have in the provision of their nations bloodprogramme. A survey was created by GAP and distributed to National Societies in the regionsof Africa, the Americas, Latin America & the Caribbean, Asia Pacific, Europe & Central Asia andMiddle East & Northern Africa. The survey requested the National Society to indicate whetherthey were involved in a blood programme at Level A, B or C or had no involvement.A. 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 WBDDOf the 186 surveys distributed in the 2 year period, only 71 (38%)National Societies responded to the global mapping exercise, a notablylow response rate. A summary of the results is displayed on thefollowing pages, these also include information gathered throughthe Self-assessment process and through GAPs member network.GAP plans to perform an extended global mapping exercise in 2015-2016 to obtain accurate information on all National Society Blood Services.This is critical for GAP and the IFRC to plan for future support activities andto conduct Self-assessment processes at regional and global levels.6GAPANNUAL REPORT 20142013-2014 Global Mapping ResultsNo.National SocietyLevel of InvolvementAmericas, Latin America & the Caribbean1American Red CrossA2Colombian Red Cross SocietyA3Ecuadorian Red CrossA4Honduran Red CrossA5Suriname Red CrossA6Dominica Red Cross SocietyB7Saint Lucia Red CrossB8Bolivian Red CrossC9The Canadian Red Cross SocietyNil10Costa Rican Red CrossNilMiddle East & Northern Africa (MENA)11Egyptian Red Crescent SocietyA12Magen David Adom in IsraelA13Lebanese Red CrossA14Red Crescent Society of the Islamic Republic of IranA15Iraqi Red Crescent SocietyB16Algerian Red CrescentC17The Palestine Red Crescent SocietyC18Moroccan Red CrescentNil19Qatar Red Crescent SocietyNil20Red Cross of BeninB21Togolese Red CrossB22Uganda Red Cross SocietyB23Central African Red Cross SocietyB24Red Cross Society of EritreaC25Ethiopian Red Cross SocietyC26Liberian Red Cross SocietyC27Malagasy Red Cross SocietyC28The Sudanese Red CrescentC29Australian Red CrossA30Bangladesh Red Crescent SocietA31Indian Red Cross SocietyA32Indonesian Red Cross SocietyA33Japanese Red Cross SocietyA34The Republic of Korea National Red CrossA35Laos Red CrossA36Nepal Red Cross SocietyAAfricaAsia & Pacific7GAPANNUAL REPORT 2014No.National SocietyLevel of InvolvementAsia & Pacific37Pakistan Red Cross SocietyA38Philippine Red CrossA39The Thai Red Cross SocietyA40Vietnam Red Cross SocietyB41Micronesia Red CrossB42The Sri Lanka Red Cross SocietyB43Afghan Red Crescent SocietyC44New Zealand Red CrossNil45Austrian Red Cross SocietyA46Spanish Red Cross SocietyA47Belgian Red CrossA48Finnish Red CrossA49German Red CrossA50Luxembourg Red CrossA51Swiss Red CrossA52Andorran Red CrossB53Bulgarian Red CrossB54Croatian Red CrossB55Cyprus Red Cross SocietyB56Hungarian Red CrossB57Red Cross of MontenegroB58Norwegian Red CrossB59The Red Cross of SerbiaB60Slovenian Red CrossB61Ukrainian Red Cross SocietyB62Albanian Red CrossC63Estonia Red CrossC64Malta Red Cross SocietyC65Red Cross Society of the Republic of MoldovaC66Romanian Red CrossC67Red Crescent Society of TajikistanC68Armenian Red Cross SocietyNil69Belarus Red CrossNil70British Red CrossNil71Danish Red CrossNil72Icelandic Red CrossNil73Irish Red Cross SocietyNil74Lithuanian Red Cross SocietyNilEurope & Central Asia8GAPANNUAL REPORT 20145.SELF-ASSESSMENTGAPs principal tool when working with National Society Blood Services is the Self-assessmentquestionnaire. The Self-assessment assists National Societies to ensure that appropriate stepsare taken to support the long term stability and sustainability of their blood service withoutexposing the Society to any unnecessary risks. It enables National Society blood programmesto measure their progress against key issues which have been identified as fundamental aspectsof corporate governance and risk management for Red Cross/Red Crescent blood programmes.Asia-PacificThe Self-assessment process was conducted throughout theAsia Pacific region in late 2013, with participation from 13 LevelA National Society Blood Services. Following the analysis anddistribution of the individual and regional feedback reports,a regional meeting was held on 20th September, 2014 inKathmandu, Nepal. Participants from the Blood Servicesof The Philippines, Nepal, Indonesia, Thailand, Hong Kong,Japan, Australia and the GAP Secretariat attended. Participantsprovided country updates and reviewed and discussed the regionalSelf-assessment results including potential strategies to addresscommon regional risk management challenges.Self-assessment TranslationsThe revised Self-assessmentquestionnaire has been fully translatedinto Spanish and Arabic languages.Both translations are available on theGAP and IFRC Fednet websites.Middle East and Northern Africa (MENA)In September 2014 the Self-assessment questionnaire was distributed to the National Society Blood Servicesin the MENA zone who had confirmed in the 2014 global mapping survey that they are involved in a Level A bloodprogram. Individual country feedback reports were issued to the respondents, identifying key areas of potential riskfor the blood service together with suggested strategies to address these. As there were insufficient respondentsto retain the anonymity of the supplied information, a de-identified regional report was not issued and a regionalmeeting was not held.IndiaFollow-up activity with regards to Indias 2013 Self-assessment response (Asia Pacific region) identified that thereare 166 independently operating Red Cross Blood Service centres in the country, and that the Self-assessmentdata reviewed by GAP in 2013 is not indicative of all centres. As it is not feasible for GAP to distribute the surveyto all 166 centres with its current resources, GAP will initially distribute the Self-assessment to a sub-set of thelargest Red Cross Blood Services centres. The Self-assessment questionnaire was sent out in November 2014with the assistance of the Indian Red Cross Society.An Indian sub-regional meeting will be held in 2015 to discuss the results. The GAP Executive Board willdetermine an appropriate strategy for further action, if required, once further clarity on the scale and scopeof the Red Cross Blood Service in India is known. This may include the further distribution of theSelf-assessment to additional centres.9GAPANNUAL REPORT 20146.MANAGEMENT OF RISKGAP has a responsibility under the IFRC Blood Policy to inform both the IFRC Secretariat andconcerned National Societies of Major Material Risks (MMR) for the IFRC discovered throughthe GAP Self-assessment programme and any other GAP work.Major Material Risk, is defined by GAP as being: A circumstance in which an individual National Society or BloodService knowingly endangers a high number of donors and/or recipients or acts in contravention to the principlesof the Federation, thereby exposing the IFRC or sister National Society to potential reputational damage. An MMRbehaviour is defined by GAP as being any conduct by a National Society or Blood Service which has the potentialto cause an MMR.Major Material Risk FrameworkThe IFRC Secretariat and GAP members developed a comprehensive set of operating rules and a frameworkfor risk reporting to guide GAP in its activities. The Major Material Risk Advisory Framework was finalised in late2013 by GAP and the IFRC as the agreed methodology to identify, report and manage MMR in National SocietyBlood Services.The Self-assessment process conducted in the Asia Pacific and Middle East & Northern Africa regions in2013-2014 provided the first opportunity for use of the new MMR framework. In accordance with the framework,GAP was required to follow-up with a number of National Society Blood Services in response to the answers providedto particular questions in the Self-assessment which may indicate a potential MMR situation exists. Individual countryfollow-up was progressed by the GAP Secretariat in conjunction with the Asia Pacific Zone Coordinators, and inaccordance with the agreed MMR framework.Following the first in-practice use of the framework for the follow-up of Self-assessment results in the AsiaPacific region in 2013/2014, the framework was reviewed by the GAP Executive Board. The review highlightedthat application of the agreed MMR framework to the Self-assessment responses received from the region wouldrequire GAP to follow up with many National Society Blood Services that may not have a true MMR. It was agreedthat the MMR process flowchart contained within the IFRC Major Material Risk Advisory Framework would berevised to further clarify the process.Self-assessment QuestionnaireThe Self-assessment questionnaire was also reviewed in 2014 to include additional questions (see table below)to ensure that it does not trigger an unspecified MMR, but will trigger a demonstrable and specific incident whichrequires the attention of the IFRC. By specifically requesting further information from the National Society BloodService within the questionnaire, the need for unnecessary follow-up will be circumvented wherea true MMR does not exist. A summary of these questions is provided below.Additional Self-assessment questionsExplanation1.2.1If YES or Partially:Have these policies been implemented?What is the level of VNRBD in your country?Are there steps in place to increase VNRBD?1.2.2If NO:What is the level of VNRBD in your country?Are there steps in place to increase VNRBD?1.4.1If not, Why?Are plans in place to change this?These questions request additional information if the blood service indicates that they do not havea long-term sufficient and sustainable source of revenue.1.5Does the Blood Service have sufficient of the following resources to meet regulatory requirements(facilities, supplies, equipment, trained staff/volunteers)?If the blood service selects No, slight shortage or No, significant shortage a prompt for furtherinformation has been added and a caution that a negative response may indicate a potential MMR.4.1If NO, which agency provides support for these recipientsThis question asks for further information if the blood service states that they (or the health department)do not have a mechanism for providing support to recipients of infected blood.Are you participating in any bilateral support programmes for your blood service?Part BAre you receiving any funds from other sources to support bilateral arrangements?These questions prompt the blood service to provide additional information in regards to a national policyof securing supply of safe blood through voluntary non-remunerated blood donation (VNRBD).These questions request further information from the blood service regarding any existingsupport arrangements.10GAPANNUAL REPORT 20147.PROJECTSAfrica Zone (IFRC Funding 2013 2014)GAP sought to increase its level of support in the Africa and MENA (Middle East & Northern Africa) Zonethrough the completion of the Self-assessment process and efforts to attract and train a Zone Coordinator(ZC) for the region.The responses from the Africa Zone to the GAP global mapping survey in 2014 did not identify a NationalSociety with current involvement in blood activity at Level A or B. Two level C National Societies were identified Madagascar and Sudan. This indicated that a request for a representative to consider the role of GAP ZoneCoordinator (ZC) in the Africa region was not warranted at this time given the absence of Level A and B activity.GAP Priority Country (Nepal) Joint IFRC and Hong Kong Red Cross Funding (2013-2014)A collaborative initiative between the Hong Kong Red Cross Blood Transfusion Service (HKRC BTS), Nepal RedCross Society National Blood Transfusion Service (NRCS NBTS) and GAP, this project aimed to build capacityin the Nepal BTS through provision of support in three key areas:1.Procurement and installation of critical equipment;2.Providing technical support by developing a risk management frameworkand providing training on donor care and counselling;3.Improving national coordination of the blood program by holding a developmentforum with key stakeholders.Following an extensive procurement process by the project steering committee, the equipment was purchasedin July 2014 from Insignia International (New Delhi) and was delivered to the Nepal Red Cross Society CentralBlood Transfusion Service on 25th August 2014. This supplier was chosen due to their proximity to Nepal(reduced transport costs), competitive pricing and excellent service and communication. Plaques were placedon the equipment acknowledging the funding from the Hong Kong Red Cross.The equipment was funded by the Hong Kong Red Cross and was comprised of: Vertical Autoclave 100L (1) Manual Plasma Extractors (5) Stainless Steel sample racks, 48 tube capacity (25) Centrifuge Balance (1) Blood Refrigerator, 150 bag capacity (3)11GAPANNUAL REPORT 2014The in country support component of the project was undertaken from August 25th 29th 2014. The teamincluded GAP Asia Pacific Zone Coordinator and HKRC BTS technical expert Dr Che Kit Lin, Ms Michelle Wsolakand Ms Emily Tonks from the GAP Secretariat and Australian Red Cross Blood Service risk management expertsMr Christopher Wheatley and Mr Mathew Manning.The week long programme included training workshops, a high level development forum and a number of meetingswith key stakeholders in Nepal including Dr Manita Rajkarnikar (Director of the NRCS NBTS), the Secretary Generalof the Nepal Red Cross Society, representatives of the governments National Public Health Laboratories, WHO andthe US Embassy. The meetings included discussions on the progress, challenges and future plans of the NRCSNBTS including the strategic plan developed with GAP.A review of the progress of the Blood Service to key challenges was undertaken and significant policy changesand issues were discussed, primarily including the revised national blood policy which permits new entrants toprovide blood in Nepal a significant shift in national direction. The role of the Ministry of Health in blood centreregulation and oversight, and the role of the Nepal Red Cross Society, in ensuring appropriate funding and selfsufficiency were discussed together with the recent WHO Essential medicines listing of blood and blood products.The team visited: Nepal Red Cross Society Central Blood Transfusion Service A district blood centre operated by the NRCS NBTS Tribhuvan University Teaching Hospital Blood Bank Centre Grande Private Hospital Blood BankDr Che Kit Lin (HKRC BTS) andDr Manita Rajkarnikar (Director,NRCS NBTS) showing the plaquesacknowledging equipment fundingfrom the Hong Kong Red Cross12GAPANNUAL REPORT 2014Training WorkshopsTwo training workshops were held for Nepal Red Cross Society Blood Service staff. The training participantsincluded technical representatives from the central, district and remote regional blood centres, and also includedparticipants from the Nepal Red Cross Society executive and management teams.Workshop 1: Blood donor care and counselling.The GAP delegation provided presentations to 28 participants on the donation process and targeted donor careand counselling recommendations, led by Dr Che Kit Lin. Participants performed donor counselling role playexercises, practising the techniques highlighted in the theory sessions. Each participant was provided with ahandbook outlining the material covered during the theory session together with additional reference information.It is intended that the handbooks may be circulated widely or used to base future internal training sessions withinthe NRCS NBTS and throughout the district and regional centres.Participants at the training workshops in Nepal13GAPANNUAL REPORT 2014Dr Che Kit Lin presenting at the training workshops in NepalWorkshop 2: The Risk Management Planning WorkshopThe workshop, which was attended by 47 participants, assisted the NRCS NBTS with the developmentof an appropriate risk management system by identifying key organisational risks which were capturedinto a risk register. A theoretical session on risk management was provided, followed by worked examplesand practical application of the risk management system to identify, prioritise and prepare treatment plansfor NRCS NBTS risks. Practical sessions were conducted in groups to assist in working through theprocess for risk management based on each particular area of technical expertise. A handbook outliningthe risk management system for further development and tailoring by the NRCS NBTS was providedto all participants, together with relevant reference material. The outcomes of the practical sessionsand group work were captured into a risk register, which was provided to the blood service Director.Development ForumA development forum was held where the 42 attendees (from NRCS NBTS executive/management,Nepals national Public Health Laboratories, IFRC, Nepal Red Cross Society, World Health Organisation,various embassies and UNICEF) were provided with presentations on National Blood System requirements,emerging policy issues, the progress of the national strategic plan, additional elements required for bestpractice and any current barriers to implementation. Group sessions and discussions were facilitated toengage the participants in the sessions, and to seek opportunities to leverage support and assistancefor the NRCS NBTS in achieving their strategic plan, and enabling delivery of an effective national bloodprogram for the people of Nepal.FeedbackDr Rajkarnikar reported at the GAP AsiaPacific regional meeting in September2014 that the training provided was highlyvalued and thanked GAP and the HongKong Red Cross for providing the bloodservice with this support. It was suggestedthat the materials provided during thetraining were so well regarded that theyshould be placed on the GAP websiteas a resource for other countries toaccess. As a result, the presentationshave been added to the GAP websiteand are available on the public pages.GAP team in Nepal with Dr ManitaRajkarnikar (Director, NRCS NBTS)ai14GAPANNUAL REPORT 2014The GAP website homepageGAP Website (IFRC Funding 2013-2014)The GAP website was developed to support GAP member, blood service and public access to materials,resources and tools and to provide users with direct links to GAP contacts and information.The development of the website was guided by member input from a user requirements survey which providedvaluable information on the content of the website that would be most useful to members. A detailed comparisonof potential website developers was undertaken, including consideration of critical factors such as security, cost,provision of ongoing maintenance, support and hosting arrangements, developer responsiveness, reputationand reliability.The Secretariat worked closely with the website developer during 2014 to finalise the design, features, content,security and access requirements.The GAP website was launched on 17th February 2015. Members were notified of the GAP website location,www.globaladvisorypanel.org and given their unique login to access the restricted member only pages on thesite. A link to the GAP website has been created on the IFRC Fednet website on the Blood Donation page.The website has: Public pages (open access) information about GAP and public events/tools GAP member pages (login required) restricted access documents, events and tools. Discussion forum - for members.15GAPANNUAL REPORT 20148.PRIORITY COUNTRIESNepalThe collaborative project between the Hong Kong Red Cross, Nepal Red Cross Society National Blood TransfusionService and GAP, completed during 2014, aimed to improve blood service capability through the provision of criticalequipment and staff training as well as guidance in the development of a risk management framework andimprovements to national policy and planning.In conjunction with the World Health Organisation (WHO) and Dr Che Kit Lin (GAP Asia Pacific Zonal Coordinator)and building on the outcomes of the 2014 Nepal training workshops, the Secretariat is coordinating a potential visitfor the Nepal Minister of Health and Nepal Red Cross Society Secretary General to visit Hong Kong and Australia.The purpose of the visit is to review well-functioning models within the region where National Society Blood Servicesoperate a single national blood program with government funding support*. The visit will enable the Nepal Ministryof Health and Secretary General to gain a detailed understanding of the governance, structural and operationalarrangements which support such models and which ensure effective and close cooperation with government.Nepals status as a GAP priority country will continue to be reviewed by the GAP Executive Board.* The Nepal Government recently revised its blood policy to now permit agencies other than the Nepal Red Cross Society to provide blood.A number of national changes to the organisation, regulation and oversight of blood centres will be implemented in the near future and theaim of the visit is to show the Minister examples of effective models whereby the national blood program is delivered by RC/RC but fundedby government.BangladeshBangladesh was selected as a GAP priority country in May 2014, on the basis of their GAPSelf-assessment results in 2013, which identified a number of areas of potential significant risk.GAP delegates Dr Wolfgang Mayr and Ms Michelle Wsolak conducted an initial scoping visitof the Bangladesh Red Crescent Blood Service (BRCBS) from 24th 27th November, 2014.The purpose of the visit was to increase GAPs understanding of the Blood Service situationin Bangladesh, including the operational context of the Blood Service within the broader healthsector and coordination with other agencies, to assess and prioritise the key risk management and corporategovernance needs of the BRCBS in the provision of its blood program and to develop recommendations anda proposal for a future programme of GAP support to Bangladesh Red Crescent Blood Service for consideration.During the visit, the GAP delegates met key stakeholders in Bangladesh including: Dr Tarique Mehedi - Deputy Director and In-Charge BRCBS; Representatives from the Safe Blood Transfusion Expert Committee; WHO consultant - Dr Murad Sultan; Secretary General Bangladesh Red Crescent Society - BMM Mozharul Huq; IFRC country delegation Programme Coordinator Mr David Easson and Manager Health - Dr Abu Faruq.16GAPANNUAL REPORT 2014GAP delegates in Bangladeshwith Bangladesh Red Crescent BloodService Deputy Director & In-ChargeDr Mehedi and WHO representative.The delegates also toured the BRCBS Dhaka Blood Centre Facility, a major maternity hospital blood bank(Mohammadbpur Fertility Services and Training Centre Dhaka) and attended a Voluntary Blood DonorCamp at Karwan Bazar sponsored by Bank Asia.A full report of the visit was provided to the BRCBS, including a number of prioritised recommendationsfor action, and proposed options for GAP support to BRCBS to assist in managing these key risk areas.The recommendations for the future of GAP support to Bangladesh are currently being finalised by GAPand the BRCBS Director.HondurasIn October 2013, a second workshop was held with Honduran Red Cross (HRC), Swiss Red Cross (SRC),and GAP to clarify the roles and responsibilities of HRC and prepare an action plan. Workshop outcomesincluded the development of a proposed new governing and organisational structure for the HonduranRed Cross National Society. In January 2014, GAP received advice from the Honduran Red Cross that theyhave adapted their governing structure according to GAPs recommendations, signalling significant progressin addressing this area of key risk. GAP has written to the HRC to formally endorse the proposed structure.GAP member Dr Rudolf Schwabe continues to support the bilateral project with Honduras, through the SwissRed Cross, to assist in strengthening the technical, administrative and governance capacity of the HonduranRed Crosss National Blood Program.17GAPANNUAL REPORT 2014HaitiThe priority country status of Haiti is currently on hold pending completion of their bilateral support programmes.IndonesiaThe priority country status of Indonesia is currently on hold pending completion of their bilateral support programmes.VietnamThe priority country status of Vietnam has been closed on the basis of information provided by the VietnamRed Cross that they are not involved in a Level A blood programme.Laboratory in Honduras18GAPANNUAL REPORT 20149. FINANCIAL REPORTGAP Income and Expenditure for period 1 January 2014 to 31 December 2014Opening balance at 1 January 2014NotesAUD accountCHF accountTotal CHFGAP accountsAustralian Account291,411Swiss Account236,693107,922107,922369,868107,922408,340AUD accountCHF accountTotal CHFIFRC Funding accountAustralian AccountCombined opening balance at 1 January 201478,457*Income63,7252014 Member ContributionsAmerica26,27721,343Australia26,34621,399Finland23,80919,339Israel24,96620,278Japan24,65420,025Switzerland25,29220,543Germany24,01019,502Austria24,81420,155Belgium25,34620,587Thailand24,99420,301250,508203,47177,58463,016Hong Kong - special statusHonduras - exemptsubtotal2014 IFRC funding IncomeIncome2014 Interest IncomeInterest- GAP Australian account11,555Interest - GAP Swiss account9,38544Interest - IFRC funding account2,805subtotal14,36023,831442,2784411,707Other IncomePayment from HKRC for Nepal Joint Project ContributionTotal IncomeExpenditure19,356366,28344297,550AUD AccountCHF AccountTotal CHFSecretariatSelf Assessment costsSecretariat costs#(40,354)(32,777)(89,906)(73,024)(125)(101)Specialist AdviceTranslation- Self assessment reports, GAP manual, questionnaireProfessional expertise eg legalStakeholder meetings (e.g. IFRC, WHO, ISBT)Travel & accommodationOther meeting expensesRegional meetingsMeeting costs269219(10,815)(8,785)Travel & accommodation(2,275)(1,848)Meeting venue/catering(3,457)(2,808)(907)(737)(3,324)(2,700)(16,637)(13,513)(21,413)(17,393)Participant costsAnnual General MeetingGAP networking events (dinner)Other expensesExecutive Board Meeting(s)Meeting venue/catering and travel accommodationTeleconferencesNepal (priority NS)GAP-HKRC Joint Project for Nepal - IFRC Funded ExpenditureGAP-HKRC Joint Project for Nepal - HKRC Funded ExpenditureHonduras (priority NS)Travel & accommodation(8,919)(8,919)Insurance(1,000)(1,000)Bank fees(72)(72)Other ExpensesContingency fundsIFRC funding expenditurePriority Country Support - Bangladesh(9,969)(8,097)(29,228)(23,740)Translation Costs(1,352)(1,098)Website Development(9,553)(7,759)Project SupportPriority Country Support - Nepal (Joint GAP Project with HKRC) refer aboveTotal Expenditure**(239,047)(9,991)Surplus/(Deficit)127,236(9,947)93,398Closing balance at 31 December 2014497,10497,975501,73819(204,152)Notes* Exchange rate as per XE Currency converter website 31 Dec 2014: 1 AUD = 0.8122324904 CHF** Cost Accrual not yet shown but fully expended. A further 6,476 CHF for Project Support will be incurred in January 2015.# Secretariat costs include salary and oncosts, phone, training, office supplies, postage, rent, other secretariat sundry expenses Cost incurred were for AUD 21,413 and invoice raised in Nov 2014 was for USD 20,132.47. Amount received in Dec 2014 wasfor AUD 23,831 as a result of exchange rate fluctuation as at date of payment.GAPANNUAL REPORT 201420
IFRC Reference Centres Brochure
Mark Munkel/Danish Red CrossRed Cross Red CrescentReference Centres2015Contributing to the impact of the global Red Cross Red Crescent Movementwww.ifrc.orgSaving lives, changing minds.Red Cross Red Crescent Reference CentresForewordIt is my pleasure to offer you an overview of the many Red Cross Red Crescent Reference Centresworking to support and build the capacity of the International Red Cross and Red Crescent Movement.Since the early 1990s, the International Federation of Red Cross and Red Crescent Societies (IFRC)has supported the development of 12 specialized Reference Centres hosted in National Societiesacross the globe. Working in close coordination with the IFRC secretariat, the Reference Centres arepart of an inclusive and collaborative network designed to provide technical assistance, informationsharing, research and advocacy to the Movement. Each of these centres integrates the experience ofthe worlds largest humanitarian network with the latest research, innovations and developmentsin various fields, developing strategically important knowledge and best practices to inform RedCross and Red Crescent operations in key areas of interest and influence.The collective contribution of the centres has been beneficial to the Movement on many levels. Byaggregating research, innovation and best practices, the centres have elevated the quality of the toolsand guidance we employ to save lives and build stronger communities. They have also connectedNational Societies with common interests and facilitated knowledge sharing, building a stronger,more robust Movement. In addition, the centres serve as spaces for creative thinking that help theMovement to continue to grow and innovate, improving existing services and helping solve newproblems in a rapidly changing world.This brochure offers a brief snapshot of the range of services each centre provides. I encourage eachNational Society to avail themselves of these resources and reach out to whichever centres cansupport their work. I hope you are able to use the expertise and experience of these centres to helpus build a stronger, smarter and more effective Movement that is better prepared for the future.Elhadj As SySecretary General34Red Cross Red Crescent Reference CentresAbout the Red Cross Red CrescentReference CentresRed Cross Red Crescent Reference Centres (Centres)resources they provide are of the highest quality,are delegated functions of the Internationalreadily accessible and adapted to local needs. TheyFederation of Red Cross and Red Crescent Societiesrespect the IFRCs founding principles as well as(IFRC). They are hosted by Red Cross Red Crescentthe practices and policies of the International RedNational Societies around the world. Each CentreCross Red Crescent Movement and the Nationalfocuses on a specific subject or thematic area andSocieties that host them.supports the strategic exchange of knowledgeessential for future Red Cross Red Crescentoperations. The Centres offer National Societiestraining, technical assistance, advocacy, knowledgemanagement, and research, and make sure that theRed Cross Red Crescent Reference CentresCentres of Expertise around the World1. Caribbean Disaster Risk Management Reference Centre2. Centre for Evidence-Based Practice3. Climate Centre4. Global Disaster Preparedness Centre5. Global First Aid Reference Centre6.Livelihoods Resource Centre7.Reference Centre for Community Resilience8.Reference Centre for Institutional Disaster Preparedness9.Reference Centre for Psychosocial Support10.Shelter Research Unit11.Reference Centre on Volunteering12.Regional Reference Centre for Medical Emergenciesand Pre-hospital Care13. Global Advisory PanelBarbadosBelgiumThe NetherlandsUnited States of AmericaFranceSpainCosta RicaEl SalvadorDenmarkBelgium, Netherlands, LuxembourgGreat Britain - SpainEcuadorAustralia - Switzerland56Red Cross Red Crescent Reference CentresRED CROSSCARIBBEAN DISASTERRISK MANAGEMENTREFERENCE CENTRECADRIMHosted by the BarbadosRed Cross SocietyPurpose of CentreThe Red Cross Caribbean Disaster Risk ManagementReference Centre (CADRIM) is a regional platformthat assists Caribbean Red Cross Societies andpartner organizations to investigate, analyse andKey Services1 Manages knowledge and shares information.2 Develops and adapts toolsand methodologies3 Offers internships and technical exchanges4 Hosts and maintains a regionaldatabase of trainersHighlightsTo date, CADRIM has developed and updatedsix different methodologies for creating saferand more resilient communities and strongerRed Cross National Societies in the Caribbean.They build on the participation, innovation andexpertise of Red Cross national societies, tertiarylevel institutions and partners. Since 2011, theCentre has hosted 22 internships, as well astwo staff secondments, from the Caribbean,Europe, Central America and the United States,and facilitated three technical exchanges inthe Caribbean.develop knowledge on how to strengthen community resilience through sustainable preparednessand risk reduction activities , particularly in SmallIsland Developing States (SIDS).Contact information: www.cadrim.org: www.facebook.com/CADRIM.IFRC: cadrim.americas@ifrc.org: https://twitter.com/CADRIM1VCA in Carenage, Trinidad and Tobago. CADRIMRed Cross Red Crescent Reference CentresCentre forEvidence-BasedPracticeCEBaPHosted by BelgianRed CrossPurpose of CentreThe Centre for Evidence-Based Practice (CEBaP)of the Belgian Red Cross provides scientificallysubstantiated information, advice and support toKey Services1 Knowledge development aroundevidence-based practice guidelinesand systematic reviews2 Knowledge management anddissemination of knowledgeHighlightsCEBaP seeks to assist and inspire organizationsto use evidence-based methods in their work.It published a methodological charter in a peerbased review on how humanitarian organizations can apply an evidence-based approach(De Buck et al. 2014. International Journal ofEvidence-Based Healthcare. 12(1):39-49). Ithas developed an evidence-based approachto teaching first aid in primary and secondaryschools, which includes a curriculum and targetsfor knowledge, skills and attitudes.Red Cross and Red Crescent partners in order todetermine which activities are most effective andContact informationto create uniformity among the various activities: www.info.redcross.be and clickof National Societies. CEBaP aims to create a bridgeCentre for Evidence-Based Practicebetween science and practice and offers support to(a publication list of peer-reviewed publicationsthe Belgian Red Cross for policy implementation.can be found on our webpages): cebap@redcross.beNigerian Red Cross volunteers conduct an interview as part of the on-goingmonitoring survey in Cross River State. Benoit Matsha-Carpentier/IFRC78Red Cross Red Crescent Reference CentresClimate Centre Hosted by theNetherlandsRed CrossKey Services1 Assists National Societies toaccess climate information2 Conducts research into climatescience and humanitarian action3 Provides technical assistance and developsparticipatory methods to link climateinformation and humanitarian operations4 Advocates in climate policy forumson behalf of the most vulnerablePurpose of CentreThe Climate Centre supports the Red Cross and RedCrescent Movement and its partners in reducing theimpacts of climate change and extreme weatherevents on vulnerable people.HighlightsThe Climate Centre works on applying scientificforecasts of weather and climate to help predictpotential disaster and long-term change. Thisenables humanitarian organizations and vulnerable people to respond sooner, and to preparefor changing risk patterns to reduce lossesof lives and livelihoods. Standard operatingprocedures support the stepwise actions thatcan be taken when early warnings reach certainagreed thresholds. Scientists are constantlyimproving forecasts, and the reduction in lossesand suffering produced by early action morethan justifies the original investment.Contact information: www.climatecentre.org: climatecentre@climatecentre.org: @RCClimateVietnam Red Cross staff and volunteers support communitieson the coast to bring in their rice harvests ahead of atyphoon. Tran Quang Tuan/Vietnam Red CrossRed Cross Red Crescent Reference CentresGlobal DisasterPreparednessCentreGDPCHosted by AmericanRed CrossPurpose of CentreThe Global Disaster Preparedness Centre (GDPC)helps to enhance the disaster preparednesscapacities of Red Cross and Red Crescent nationalsocieties and the wider humanitarian community. ItKey Services1 Knowledge management2 Research3 Technical assistance4 Networking and coordinationHighlightsGDPC initiatives such as the Universal AppProgram (UAP) create scalable approaches todisaster preparedness and resilience. The UAPis a web-based platform that enables NationalSocieties to adapt first aid and multi-hazard appsto their needs. Each Red Cross or Red CrescentSociety will be able to customize apps via aneasy-to-use interface that is efficient and costeffective. The GDPC website, PrepareCenter.org, hosts a virtual network of disaster preparedness practitioners and offers peer-to-peerlearning opportunities.provides specific network-wide services in responseto national and community demands for tools andlearning on disaster preparedness and resilience.Contact information: www.preparecenter.org: gdpc@redcross.org: www.facebook.com/disaster.preparedness.center: @PrepareCenterResidents practice using a participatory tool that allows communitiesto improve their living environment, build safer shelters anddesign better settlements. Agostino Pacciani/IFRC910Red Cross Red Crescent Reference CentresGlobal First AidReference CentreKey ServicesGFARCHosted by FrenchRed Cross3 Building capacities1 Harmonizing first aid2 Sharing competences4 Promoting evidence basedapproach and research5 Advocating for first aid6 Supporting risk reductionand resilience strategyHighlightsPurpose of CentreThe Global First Aid Reference Centre (GFARC) is theIFRCs technical expertise hub, providing first aidinformation and related support to Red Cross andRed Crescent National Societies around the world.The main goal of the GFARC is to ensure agrowing number of people and communities,anywhere (at home, at work, at school), areprepared and equipped to save lives whena disaster or an emergency during daily lifeoccurs. To achieve this goal the GFARC strives toprovide National Societies with tools and trainingmethods tailored to meet the needs of localcommunities. Improving the quality of first aideducation will help make people confident to acteverywhere anytime. By giving ordinary peoplelife-saving skills, first aid is also a cost-effectivetool that empowers individuals by giving thema chance to help themselves and others, andcontributes to building resilient communities.Contact information: first.aid@ifrc.orgArgentinian Red Cross volunteers provide first aid tocommunity members. Daniel Cima/IFRCRed Cross Red Crescent Reference CentresLivelihoodsResource CentreKey ServicesLRCHosted by SpanishRed Cross3 Promotes and disseminates policiesPurpose of CentreThe Livelihoods Resource Centre (LRC) spreadsawareness of effective livelihoods programmingstrategies, and helps IFRC members to enhancecommunity capacity and individual skills, restoreand sustain sustainable livelihoods, and therebyestablish more secure living conditions. The LRCis also a network of community-based livelihood1 Creates and shares knowledge2 Builds capacity, mainly through trainingand strategic approaches4 Offers technical assistanceHighlightsThe LRC is developing innovative solutionsto some of the most demanding policychallenges in livelihood programming: generating livelihoods in chronic disaster situations;increasing resilience; establishing an integratedprogramming approach; applying urban cashtransfer programmes. As National Societieswork more and more with marginalized groupsin urban areas, the LRC plans to become areference for humanitarian organizations in thisarea, facilitating cooperation and disseminatinggood practices and lessons learned.experts, who can pass on knowledge, developmethodologies and policies, build capacity, andContact informationprovide technical assistance.: www.livelihoodscentre.org: Livelihoods@cruzroja.es: www.facebook.com/livelihoods.centreA resident prepares his boat before sailing to fish with thehelp of the Philippine Red Cross livelihood assistance projectafter Typhoon Bopha. Cheryl Gagalac/IFRC1112Red Cross Red Crescent Reference CentresReference Centrefor CommunityResilienceCentro deReferencia parala ResilienciaComunitariaCRRECHosted by the CostaRica Red CrossKey Services1 Researches and develops new technologies2 Offers technical assistance in support ofefforts to strengthen community resilience3 Develops methodologies,materials and learning tools4 Provides international training toNational Societies, non-governmentalorganizations and other partnersHighlightsIn Latin America CRREC gives advice andguidance on Red Cross Red Crescent vulnerability and capacity assessments; risk in urbancontexts: livelihoods; early warning systems; andcommunity resilience. It builds capacity throughinternships, trainings, and a series of disasterpreparedness modules titled Prevention is Better.Contact informationPurpose of CentreThe Reference Centre for Community Resilience(CRREC) specializes in methodologies for investigating, systematizing, validating and analysingcommunity education with respect to disasterpreparedness, prevention, mitigation, and earlywarning. By developing innovative and complementary tools and methodologies, it aims to reduce thevulnerability of communities across Latin America.Red Cross volunteers in Guatemala show a new water treatment systemwith enough water for 85 households and a school. Marko Kokic/IFRC: www.crrec.cruzroja.org: crrec.americas@ifrc.org: https://www.facebook.com/pages/Centro-de-Referencia-para-la-ResilienciaComunitaria-C-R-R-E-C/386953838001802Red Cross Red Crescent Reference CentresReference Centrefor InstitutionalDisasterPreparednessKey ServicesCentro deReferencia enPreparacinInstitucionalpara Desastres3 Standard operating proceduresCREPDHosted by the ElSalvador Red Cross1 National intervention teams, such as: water,sanitation and hygiene promotion; health inemergencies; disease control; psychosocialsupport; and humanitarian logistics2 Response and contingency plans4 Operation of emergency operation centres5 Disaster assessments6 Simulations and drills7 IFRC online learning platformHighlightsCREPD and the Learning Unit of the IFRCAmericas Zone Office provide technical anddevelopment support to online learning courses.CREPD has supported courses on coordinationand management of temporary housing, andassisted National Societies to explore othervirtual learning opportunities.Contact information: www.crepd.cruzroja.org: https://www.facebook.com/pages/Centro-de-Referencia-en-Preparaci%C3%B3nInstitucional-para-Desastres/483503008335725Purpose of CentreThe Reference Centre for Institutional DisasterPreparedness (CREPD) works closely with the IFRCAmericas Zone Office to strengthen the preparedness and response capacity of National Societies,and their expertise in vulnerability reduction. Itdevelops methodologies, tools and harmonizationprocesses that draw on the technical expertiseand good practices of Red Cross societies inLatin America.Participants at regional Water and Sanitation training. IFRC1314Red Cross Red Crescent Reference CentresReference Centrefor PsychosocialSupportKey ServicesPS CentreHosted by DanishRed Cross4 Advocacy and communicationsPsychosocial CentrePurpose of CentreThe Reference Centre for Psychosocial Support(PS Centre) assists National Societies to providepsychological and psychosocial assistance, raisesawareness of psychological reactions to disasterand social disruption, promotes restoration ofcommunity networks and coping mechanisms,and improves the provision of emotional supportto staff and volunteers.Volunteers play with a group of children at the psychosocialcentre in Dweila, Syria. Ibrahim Malla/IFRC1 Provides technical and operational support2 Builds the capacity of National Societies andthe competence of staff and volunteers3 Creates and shares knowledgeHighlightsThe primary task of the PS Centre is to supportNational Societies and enable them to providepsychosocial support. It responds to requests byNational Societies for technical and operationalguidance, and facilitates capacity building.National Societies have become increasinglyable to provide broad and more specific trainingto their staff and volunteers, who use theseskills and knowledge to help individuals whoare affected by crisis situations.Contact information: www.pscentre.org: psychosocial.centre@ifrc.org: https://www.facebook.com/Psychosocial.CenterRed Cross Red Crescent Reference CentresShelterResearch UnitKey ServicesSRUHosted by BeneluxRed Cross Societies2 Analyses techniques and practices(Belgium, Netherlands, Luxembourg)1 Maps shelter solutions and strengthensand disseminates shelter knowledgeto identify and address technicalgaps by research and innovation3 Improves products by linking humanitarianpractitioners, academic institutionsand private enterprises in research4 Tests materials and items to ensure theyare appropriate for humanitarian shelterinterventions and develops specificationsHighlightsPurpose of CentreThe IFRC-SRU focuses on protecting people fromshelter-related vulnerabilities and risks afterdisasters. It was established by Benelux Red CrossSocieties and the IFRC Shelter and SettlementsDepartment in Geneva to improve humanitarianshelter interventions by strengthening the technical capacity and resources of the Red Cross RedCrescent Movement.The IFRC-SRU holds an annual conference on atechnical topic relevant to humanitarian shelter(use of steel, anchoring and fixing, cladding andfixing). Based on this and other learning, it hasdeveloped a virtual Shelter Solutions Databasethat documents and analyses shelter solutionsand practices, and materials, building techniquesand designs.Contact information: www.ifrc-sru.org: ifrc-sru@croix-rouge.luAs part of its disaster preparedness programme, the Pakistan Red CrescentSociety is constructing homes on higher ground to ward off flooding shouldriver waters rise again in the upcoming monsoon season. IFRC1516Red Cross Red Crescent Reference CentresReference Centreon VolunteeringKey ServicesHosted by BritishRed Cross andSpanish Red Cross2 Produces newsletters on volunteering1 Runs training courses, including Volunteermanagement in the Red Cross/Red Crescent3 Runs a news service on volunteering4 Maintains the Reference Centreon Volunteering website5 Researches good practice involunteer managementPurpose of CentreThe Reference Centre on Volunteering develops,promotes, facilitates and manages knowledgeon volunteer management and volunteeringdevelopment in Europe.HighlightsThe Reference Centre on Volunteering wasfounded in 2005 by the former Western EuropeanNetwork for the Development of Volunteering(WENDOV), now known as the European Networkfor Development of Volunteering. It is supportedby the Spanish and British Red Cross, andfacilitates knowledge sharing on volunteeringin Europe. Having broadened its scope, theCentre now promotes online training courseson volunteer management and the mapping ofvolunteering practices across Europe.Contact information: www.rcvolunteering.orgSouth Sudan Red Cross volunteers take part in a training in preparationfor the independence celebrations. Conor Ashleigh/IFRCRed Cross Red Crescent Reference CentresRegionalReference Centrefor MedicalEmergencies andPre-hospital CareCREMYAPHosted by theEcuadorian Red CrossPurpose of CentreThe Regional Reference Centre for MedicalEmergencies and Pre-hospital Care (CREMYAP)aims to assist members of the InternationalFederation of Red Cross and Red Crescent Societiesin the Americas in strengthening National RedCross and Red Crescent Societies capacity in providing pre-hospital care through the developmentof methodologies, tools, learning techniques, andharmonized processes, taking into account theexisting knowledge and best practice of the globalnetwork of National Societies.Key Services1 Technical assistance to National Red Cross andRed Crescent Societies, non-governmental,public and private organizations2 Develops, systematizes and harmonizes trainingprocesses in the area of of pre-hospital care3 Promotes best practices andstandards of adequate qualityHighlightsCREMYAP seeks to strengthen the capacity ofNational Red Cross and Red Crescent Societiesin the Americas through research, systematizationand analysis of techniques, equipment and regulations in the area of pre-hospital care, to ensure theprovision of quality services to the most vulnerable,as well as to improve or establish a sustainablesource of revenue for National Societies. CREMYAPrelies on the support of experts from National RedCross and Red Crescent Societies with in-depthexperience in pre-hospital care, as well thesupport of Ecuadorian Red Cross TechnologicalInstitute, which has skilled personnel certified bythe Ecuadorian Higher Education Council.Contact information: presidencia@cruzroja.org.ec,cremyap@cruzrojainstituto.edu.ec#: (593) 603 6096, (593) 228 48125: (593) 998 242 761, (593) 983 519 178: https://www.facebook.com/cremyapcreStudents attending CPR session at the Ecuadorian RedCross Technological Institute facility. CREMYAP1718Red Cross Red Crescent Reference CentresGlobal AdvisoryPanel (GAP)on CorporateGovernance andRisk Managementof Blood Servicesin Red Cross andRed CrescentSocietiesKey Services (e.g. Knowledge management,research, technical assistance, advocacy, networking)1 Provide technical advice in terms ofcorporate governance and risk managementto National Society blood programmes2 Promote knowledge sharing, networking,and partnership among and betweenRed Cross and Red Crescent blood servicesand external partners3 Develop tools and guidelines as appropriatewithin the area of National Society bloodprogramme delivery4 Coordination of Red Cross/Red Crescentassistance to National Society blood servicesin post-emergency situationsHighlightsPurpose of CentreThe purpose of GAP is to provide advice to NationalSocieties and their affiliated blood services, IFRCand other related bodies in matters related to bloodservice corporate governance and risk management.GAP has developed a Self-assessment tool toassist National Society blood services to ensurethe long term stability and sustainability of theirblood service without exposure to any unnecessary risk. The Self-assessment is located at:www.globaladvisorypanel.org. On completion ofthe Self-assessment, GAP provides each bloodservice with a detailed feedback report, includinganalysis of the results, identification of areas ofconcern, and providing recommendations on riskmanagement strategies to address the identifiedrisks. GAP holds regional meetings for participantblood services to compare their performanceagainst regional benchmarks and best practices.The results of the Self-assessment are outlined,regional issues are highlighted, and specific toolsand information are provided to assist bloodservices to manage their key risks. Partneringopportunities for blood services with strongerregional counterparts are also identified.Contact information: gapsecretariat@redcrossblood.org.au: www.globaladvisorypanel.org: https://fednet.ifrc.org/en/resources/health-and-care/blood/materials-and-tools/Red Cross Red Crescent Reference CentresThe Fundamental Principles of the InternationalRed Cross and Red Crescent MovementHumanity The International Red Cross and Red Crescent Movement, born of a desire to bring assistancewithout discrimination to the wounded on the battlefield, endeavours, in its international and nationalcapacity, to prevent and alleviate human sufferingwherever it may be found. Its purpose is to protect lifeand health and to ensure respect for the human being.It promotes mutual understanding, friendship, cooperation and lasting peace amongst all peoples.Independence The Movement is independent. TheNational Societies, while auxiliaries in the humanitarian services of their governments and subject tothe laws of their respective countries, must alwaysmaintain their autonomy so that they may be able atall times to act in accordance with the principles ofthe Movement.Voluntary service It is a voluntary relief movementnot prompted in any manner by desire for gain.Impartiality It makes no discrimination as to nationality, race, religious beliefs, class or political opinions.It endeavours to relieve the suffering of individuals,being guided solely by their needs, and to give priorityto the most urgent cases of distress.Unity There can be only one Red Cross or Red Crescent Society in any one country. It must be open to all.It must carry on its humanitarian work throughoutits territory.Neutrality In order to enjoy the confidence of all, theMovement may not take sides in hostilities or engageat any time in controversies of a political, racial, religious or ideological nature.Universality The International Red Cross and RedCrescent Movement, in which all societies have equalstatus and share equal responsibilities and duties inhelping each other, is worldwide.19Red Cross Red Crescent Reference Centreswww.ifrc.orgSaving lives, changing minds.20

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