Consultations

IQM consulting involvement in international consultations since 2001

WHO EMRO TECHNICAL ASSISTANCE

FOLLOW UP TECHNICAL WORK GROUP TO COMPLETE THE IBTO 15 YEARS TREND ANALYSIS, THE REGIONAL STATUS REPORT AND THE PLANNED MANUSCRIPTS, CAIRO 10-15 NOVEMBER 2019

WHO has been collecting information on blood safety and availability from Member States regularly since 1998, through a survey linked to the Global Database on Blood Safety (GDBS). In order to have a better understanding of the situation in the Region, WHO EMRO, analysed the latest information (2013 and 2014-2015) and is preparing a regional status report, and a 15-year trend analysis of the blood supply in the Region. This is done in collaboration with the Iranian Blood Transfusion organization (IBTO), a WHO Collaborating Center, and with technical assistance of Prof. Cees Smit Sibinga (expert consultant). As part of this collaboration, a first draft Regional Status Report 2017 is underway, and documentation has been provided to start the analysis of the information collected since 2001.

The work group meeting will cover completion of the planned document ready for publication.

FOLLOW UP TECHNICAL SUPPORT MISSION TO AFGHANISTAN NATIONAL BLOOD TRANSFUSION SERVICE,  7 – 13 APRIL 2019

Many countries in the Eastern Mediterranean Region, including Afghanistan, are facing major challenges in ensuring the safety and availability of blood transfusion during humanitarian emergencies and armed conflicts to meet the increased demand for blood transfusion. WHO through WCO and EMRO have been providing assistance to the National Blood Transfusion Service to address some of the challenges. WHO EMRO focal person had face-to-face meetings with the director of NBTS during the regional consultations and training held in Tunis, Amman and Tehran in 2016 and 2017. These were followed by a WHO EMRO mission in January 2018 to assess the status of blood safety and availability in the country. The mission identified gaps in the leadership and governance of the national blood system, in coordination and collaboration among relevant stakeholders, in the provision of safe and adequate supply of blood products at all times, in the rational use of blood and in quality system management. In addition, actions to address the identified challenges were discussed and agreed with the management of the national blood transfusion service.

WHO CO provided technical support to and close follow up of the implementation of the plan of action. Development of policy documents. SOPs and governance structures is one of the key recommendations of the mission, for which additional technical assistance is required.

 Objectives of the mission

  1. To follow up on the progress of the implementation of the action plan agreed during the previous mission.
  2. To advocate for better governance of the blood system and update relevant documents of the vein-to-vein transfusion

 

FOLLOW UP TECHNICAL SUPPORT TO NATIONAL BLOOD TRANSFUSION SERVICE OF IRAQ,  18 – 24 FEBRUARY 2019 

In order to support ongoing efforts by the Ministry of Health and WHO Iraq, a WHO technical support mission was conducted in 2016 (Kurdistan Region). The mission was a follow up to earlier WHO mission conducted in 2011 to (a) assess the situation of the blood supply and clinical use; (b) conduct a consensus workshop to create awareness and ownership of the key issues (pillars) of the reform of the national blood transfusion program; and (c) assist in the technical revision of the blood transfusion SOPs and technical guidelines produced by MOH.

In addition to the 2016 mission, WHO Iraqi Country Office has also regularly conducted monitoring visits to the NBTC to discuss challenges encountered in the implementation of the 2016 mission report recommendations. The most recent monitoring visit was conducted in January 2019.

The reports of both expert missions and a summary of the outcome of the January 2019 monitoring visits have been shared with NBTS Iraq and WHO Iraq. These reports identified weaknesses that need to be addressed and outlined a list of recommendations to improve blood transfusion services in Iraq. WHO Iraq provided technical support to and follow up of the implementation of the recommendations of both missions. The proposed mission aims to provide additional technical assistance.

Objectives of technical assistance

  1. To review the current situation of blood transfusion services in Iraq (based on the reports prepared in 2011 and 2016, and outcomes of the January 2019 monitoring visit) and follow up on the recommendations of previous missions.
  2. To develop an action plan to address the identified gaps including:
    a. Immediate actions – in view of meeting the increased demand for blood during the on-going humanitarian emergencies and during the ongoing recovery phase;
    b. Long term actions – to develop the blood transfusion services in Iraq.

Activities 

  1. Discussions with NBTS and NBTC colleagues and other relevant Iraqi blood safety professionals working in major blood safety facilities in Baghdad and in other governorates, including representations from Kurdistan governorates as the MOH deems necessary;
  2. Field visits to at least two hospitals/facilities involved in providing blood transfusion/safety related services to beneficiaries;
  3. Debriefing meeting with the MOH Senior management/leadership, including HE the Health Minister, in case his schedule would allow.

An assessment mission report highlighting the progress made by Iraq since the 2016 mission; gaps/challenges that are still hampering the efficiency of the blood transfusion services in Iraq and recommendations on how to address these gaps with a time lined action plan, will be produced and shared with MOH for action.

WHO EMRO TECHNICAL ASSISTANCE

01 December 2018 – 28 February 2019

Technical support to prepare guidance on blood transfusion during humanitarian emergencies, regional status report on blood safety and availability 2017 and report on 15-year analysis of trends on blood safety and availability in the EMR.

Terms of Reference

Technical support to prepare –

  1. Guidance on blood transfusion during humanitarian emergencies
  2. Regional status report on blood safety and availability 2017 and report on 15-year analysis of trends on blood safety and availability in the EMR

 Dates:  1 December 2018 to 28 February 2019

 Background:  This terms of reference has two components:

  1. Guidance on blood transfusion during humanitarian emergencies

The safety and availability of blood and blood products is a great concern for populations in humanitarian emergencies and armed conflicts, which increase the demand for blood and blood products and make delivery of these lifesaving products challenging, complex, and requiring coordination, collaboration and cooperation among all stakeholders.

Based on the recommendations of the regional consultation on the availability and safety of blood transfusion during humanitarian emergencies from 15 to 16 May 2016 in Tunis, Tunisia, WHO EMRO will develop a short guidance document on blood transfusion during humanitarian emergencies. The guidance will take in to account existing guidelines and tools to see what information may be leveraged.

Considering the technical expertise needed to lead the development of the guidance document, there is a need for a senior international consultant to support the process (Annex: process of the development of the guidance).

  1. Regional status report on blood safety and availability 2017 and report on 15-year analysis of trends on blood safety and availability in the EMR

Based on information collected annually through the survey lined to the Global Database on Blood Safety, WHO EMRO published the first regional status report on blood safety and availability 2016. This report was based on 2013 data. The report was produced in collaboration with Iranian Blood Transfusion Organization (IBTO), which is a WHO Collaborating Center for Research and Training on Blood Safety, and a senior international consultant in the field. Member States have already submitted 2014 and 2015 data and IBTO has started preparing the report for 2017. In addition, IBTO will also prepare a report on 15-year analysis of trends on blood safety and availability in the EMR, also with the help of a senior international consultant.

This document outlines the Terms of Reference for consultant contract for the above mentioned tasks, starting on 1 December 2018 to 28 February 2019.

Terms of reference

  1. Development of guidance on blood transfusion during humanitarian emergencies
    • Lead the technical working group established for the development of the guidance document.
    • Develop outline and contents that will be presented to the technical working group for discussion and comments.
    • Facilitate virtual consultations (e-mail, teleconferences, WebEx etc.).
    • Finalize the guidance document for endorsement.
  1. Preparation of the regional status report on blood safety and availability 2017 and report on 15-year analysis of trends on blood safety and availability in the EMR.
    • Provide guidance to IBTO and WHO EMRO in data entry, analysis and report writing.
    • Prepare manuscripts of the regional status report 2017 and 15-year analysis of trends on blood safety and availability in the EMR.
    • Review comments and recommendations from reviewers to finalize the manuscripts.

 

WHO TECHNICAL ASSISTANCE MISSION TO AFGHANISTAN
27 January – 3 February 2018

Many countries in the WHO Eastern Mediterranean Region, including Afghanistan, are facing major challenges in ensuring the safety and availability of blood transfusion during humanitarian emergencies and armed conflicts. During humanitarian emergencies, the number of people requiring blood transfusion will increased due to injuries. WHO through WCO and EMRO (to a limited extent) have been providing assistance to the Afghanistan National Blood Safety and Transfusion Service (ANSBTS) to address the challenges in ensuring safety and availability of blood transfusion for the patients in need.

WHO EMRO focal person had face-to-face meetings with the director of NBTS during the regional consultations and training held in Tunis, Amman and Tehran in 2016 and 2017. It was agreed during these meetings that a country mission should be organized to identify technical assistance needs of the national programme and provide support to the programme through the WCO.

Objectives of the mission

  1. To review the current situation of blood transfusion services of Afghanistan in view of the regional strategic framework for blood safety and availability (2016-2025)
    • Document review
    • Meetings with relevant bodies
    • Visits to blood banks in Kabul and Kandahar.
  2. To develop a technical assistance plan to strengthen blood transfusion services to meet demand for blood especially during emergencies.
  3. To support training of blood bank staff organized at Kandahar.

WHO EMRO, Cairo, Egypt

WHO EMRO is supporting blood transfusion services of several countries in humanitarian emergencies and armed conflicts. These emergencies increase the demand for blood and blood products and make delivery of these lifesaving products challenging.

Review of existing legislation in EMR and design of a new model blood legislation for the Region

One of the recommendations of the preliminary assessments conducted in two countries is to conduct a systematic review of existing blood legislations from nine countries that have legislation in place (Egypt, Iran, Jordan, Lebanon, Morocco, Pakistan, Saudi Arabia, Tunisia and UAE), with the objective of providing feedback to these EMR countries and create a model (template) blood legislation that will be adopted by all EMR countries. The model (template) blood legislation will lead to harmonization, integration and convergence of the regulatory systems across the Region.

Considering the technical expertise required for the task, WHO EMRO  requires additional technical guidance by a senior expert in the field of blood regulatory systems, which is not currently available within the EMRO Department/Unit.

Planned timelines: 01/08 till 31/10/2017

Work to be performed: 

Output 1 – Conclusion report of the systematic desk review of existing blood legislations from the nine countries in the Region.

Output 2 – Model (template) blood legislation with a plan for advocacy and implementation in the countries in the Region that will lead to harmonization, integration and convergence of the regulatory systems across the region

Yemen –

Yemen was invited to participate in the 2016 survey (availability and safety of blood transfusion in humanitarian emergencies) as well as the regional consultation, May 2016 Tunis, Tunisia . Unfortunately, the assessment questionnaire was not completed by Yemen, and the country was not represented during the regional consultation.

The objectives of a proposed mission to Yemen 2017 are:

  1. Visit the blood transfusion service in Yemen (e.g. Sana’a or Aden) to have a better understanding of the situation on the ground and complete the questionnaire;
  2. Develop an action plan for the integration of blood transfusion services in the overall humanitarian response plan, and for further development of blood transfusion services (recovery).

For security reasons the mission was put on hold.

Pakistan –

The mission in 18-28 April 2017 did have two components:

  1. The WHO assessment criteria for national blood regulatory systems will be sent to the blood regulators in Pakistan four weeks before the mission, to be completed by responsible bodies in selected Provinces.
  2. Technical support mission by WHO EMRO to discuss the findings of the review, initiate the process of updating the blood regulatory system and participate in a WHO workshop on blood regulation (planned in the last week of April).

A second mission will take place 21-22 December in Karachi:

Facilitate a national consultation on blood regulation in Pakistan (21 – 22 December 2017) –

  1. Review the status of provincial regulatory systems and evaluate the progress made;
  2. Idenify lessons learned in regulating blood transfusion services;
  3. Develop an action plan for strengthening blood regulatory systems in the country.

    GIZ Project Social Protection-Social Health Protection (SP-SHP)

Assignment: Technical supervision of deliverables under SBT result area ‘Safe Blood Transfusion’ for strengthening Regulatory Bodies, Regional Blood Centres (RBCs) and attached Hospital Blood Banks (HBBs) as newly reformed units in Pakistan.

The assignment fits into the WHO EMRO Strategic Framework 2016-2015b priority areas.

Purpose: To contribute to strengthen the newly reformed blood supply/transfusion system in Pakistan with special focus on new blood safety laws, regulatory bodies, prescribers and operators of centralized model of blood centres and hospital blood banks.

Specific objectives: To enhance knowledge, skills and competencies of the provincial/regional programme managers, regulatory inspectors, prescribers and staff of regional blood centres in their specific domain of work. In order to achieve this objective, the consultant will be required to give supervisory inputs to ongoing/planned activities under SBT result area ‘Safe Blood Transfusion’ and will follow decentralized approach for conduction training and advisory session wherever needed under ToRs.

Specific tasks: 

4.1. Review of the outputs/deliverables by consultants under the following interventions;

  • Review of Training Needs Assessment (TNA) methodology and tools for RBCs and HBBs both at staff and organization level;
  • Comment on results/recommendations of management training course;
  • Comment and provide recommendations on ToRs for quality management technical training consultancy and provides supervision in initial training sessions.

4.2. Act as training resource person for;

  • onsite technical training/visits at selected blood centres in coordination with consultant for quality management technical trainings;
  • training of hospital transfusion committees on rational use of blood and components in coordination with the provincial counterparts Prof. Dr. Muhammad Tahir (SBT programme manager KP) and Dr. Shahtaj (associate professor haematology and HBB incharge HMC) in Peshawar and with Prof. Nadeem Samad (SBT programme manager Balochistan) in Quetta, (if required review/use of modules already developed by Alina Dobrota, Jean-Claude Faber, Jean-Jacques Fournel (Int’l short term experts);
  • training of blood transfusion inspectors (BTA KP expected to be established in later half of the year, BTA Balochistan (recently established and started inspection), or AJK (to re-strengthen existing capacity)

The training sessions/workshops will take place in Peshawar, Quetta, Lahore and Muzaffarabad.

  • reviewing and advising to programme managers/secretary BTAs on laws, rules and regulations;
  • participate in the quarterly SBT progress & review meeting expected in November, 2017 in coordination with national coordinator SBTP.

Expected outputs/deliverables:

  • Reviewed documents with comments and recommendations
  • Reports on training sessions for technical staff of selected blood centres (QM technical trainings), hospital transfusion committees (on rational use of blood) and blood transfusion inspectors.

 Anticipated timeline: 01 September till 30 November 2017 (28 consulting days).

 Field mission – 12 November – 1 December 2017

  •  Education and training site-visits to Peshawar, Quetta, Lahore and Muzaffarabad focused on rational   use of blood, and regulations and inspections;
  • Joint SBT Quarterly workshop, Islamabad.

 


3M Deutschland GmbH, Wuppertal, D

Scientific review and literature search of the Clinical Evaluation of the 3M Blood Separation System, in particular the effect of filtration on Factor V decrease in the fresh plasma.

Scientific guidance for the 3M Blood Separation System and future developments for the blood transfusion market.

Speaker at 3M symposium and 3M events.

WHO EMRO, Cairo, Egypt

Review of the draft Eastern Mediterranean Regional Strategy for Blood Safety (2016-2025).

Advice and guidance on the implementation of the 2016-2025 Strategy.

Technical advice and support to prepare the Regional Report on Blood Safety; assisting WHO EMRO and IBTO.

Technical Advisor and Facilitator

15-16 May 2016, Tunis, Tunesia: Regional Consultation on the Availabiity and Safety of Blood Transfusion during Humanitarian Emergencies.

17-19 May 2016, Tunis, Tunesia: Regional Meeting of Directors of National Blood Transfusion Services.

EMRO, Field Mission Erbil, KR, Iraq – July 2016

Terms of Reference

As a first implementation step of the WHO EMRO Action Plan to strengthen blood safety and availability in a protracted humanitarian emergency situation, a mission to Erbil, Iraq – 22 to 31 July 2016, was assigned to IQM Consulting (Prof. Dr. Cees Th. Smit Sibinga).

Background

Many countries in the Eastern Mediterranean Region, including Iraq, still face major challenges in making sufficient supplies of safe blood and blood products available, accessible, affordable and sustainable, while also ensuring the quality and safety of these products in the face of known and emerging threats to public health including humanitarian emergencies and armed conflicts.

Iraq has taken the initiative to develop a nationally supported safe and sustainable blood supply system through the establishment of a National Blood Transfusion Service (NBTS) and Center (NBTC), based in Baghdad. There have been efforts by NBTC to reform the fragmented hospital based blood supply, and created seven Regional Blood Banks that are to be developed to accommodate sufficient economy of scale to supply the hospitals in their respective regions. These efforts also include conversion from family/replacement and hidden paid blood donations to an all voluntary non-remunerated and regular blood donor system mobilized from identified low risk groups in the community.

In order to provide technical support to the NBTS, Prof Smit Sibinga (IQM consultant) was in Erbil in June 2011 to:

  • Assess the situation of the blood supply and clinical use in Iraq
  • Conduct a consensus workshop to create awareness and ownership of the key issues (pillars) of the reform of the national blood transfusion program
  • Conduct technical revision of the blood transfusion SOPs and technical guidelines produced by MOH.

The report of the mission was shared with NBTS Iraq and WHO Iraq. The report identified weaknesses that need to be addressed and outlined a list of recommendations to improve blood transfusion services in Iraq. However, the implementation of the recommendations was not followed up by the Iraqi authorities..

In 2016, a brief situation analysis was conducted by Dr Alaa Makki (Supervisor at Erbil Blood Transfusion Center). The findings of this assessment were similar to the findings in 2011.

Objectives of the mission

  1. To review the current situation of blood transfusion services in Iraq (based on the reports prepared in 2011 and 2016) and follow up on the recommendations of previous missions.
  2. To develop an action plan to address the identified gaps including:
    1. Immediate actions – in view of meeting the increased demand for blood during the on-going humanitarian emergencies and armed conflict.
    2. Long term actions – to develop the blood transfusion services in Iraq.

Deliverables

  1. Action plan to address identified gaps
  2. Identify focal persons for each governorate to establish working relationships for the implementation of the Action Plan.

EMRO, Field Mission Damascus, Syria – December 2016

Background

Since the beginning of the Syrian conflict, the number of people requiring blood transfusion has increased due to injuries. Seven of the 25 blood centres are out of control and the infrastructure of some of these centres has been damaged. The Syrian national Establishment for Blood Transfusion and Medical Industries has taken the initiative to address the challenges in ensuring availability and safety of blood transfusion for the patients in need. WHO has been providing technical and financial assistance to the Ministry of Health of Syria to ensure availability and safety of blood transfusion in health facilities both in government and opposition held areas.

Objectives of the mission

  1. To review the current situation of blood transfusion services in Syria.
  2. To support WHO’s ongoing initiative to support the blood transfusion services and to evaluate progress made to date.
  3. To develop an action plan to address the identified gaps including:
    1. Immediate actions – in view of meeting the increased demand for blood during the on-going humanitarian emergencies and armed conflict.
    2. Long term actions – to develop the blood transfusion services in Syria.

Deliverables

Report of the observations and discussions including conclusions and recommendations.


KWIK-TS, Groningen, NL 

Advice on validation and implementation of the chiplabel on red cell products; continuation of the support.

Due to problems in the financing of the project, KWIK-TS decided during 2016 to put the developments on hold.


3M Deutschland GmbH, Wuppertal, D

Scientific review of the clinical evaluation of the 3M Blood Separation System.

Scientific guidance for the 3M Blood Separation System and future developments for the blood transfusion market.

Speaker at 3M symposium and 3M events.

WHO EMRO, Cairo, Egypt

Review of the draft Eastern Mediterranean Regional Strategy for Blood Safety (2016-2025)


KWIK-TS, Groningen, NL

Advice on validation and implementation of the chiplabel on red cell products, continuation of the support.


Membrana GmbH, Wuppertal, D
CE registration has been achieved and marketing has been initiated.

KWIK-TS, Groningen, NL
advice on the preprarations for a clinical trial in one or more Dutch hospitals.


Membrana GmbH, Wuppertal, D
advice on and contribution to the CE registration procedure within the EU.

GIZ Pakistan

To support the GIZ HSS team, National coordinator of SBT, provincial blood transfusion program managers and authorities in review / assessment of the outputs of Phase I of SBTP, conduct the gap analysis and facilitate the development of the road map for SBT HSS II (2014 – 2015). The consultant shall work closely with the GIZ team in the country and Provincial and regional partners during the entire process and will report to the Principal Advisor (AV) of GIZ Health Sector Support Programme Pakistan.

Based on the development of / achievements of SBTP phase I, following activities have been outlined for HSS II (Output B):

  • Development of policy and legal advisory framework
  • Establishment of quality standards in blood transfusion
  • Establishment of management information systems
  • Establishment of a “Blood Donor Organization” (BDO) Network
  • Provide technical advice for accreditation processes (via Pakistan National Accreditation Council) for secondary facilities i.e. blood banks and professional associations of haematologists
  • Support harmonization of provincial blood safety policies and laws

Specific Objectives:

  1. To conduct assessment / review of the outputs / gap analysis of SBTP phase 1 implementation in Pakistan.
  2. To facilitate a two days’ workshop to share review findings and the gaps identified,
  3. To facilitate the continuation/revision of the “National Strategic Framework” for the next five years (2014-2020)
  4. Advocacy / sensitization of policy makers for reformed safe blood transfusion system in Pakistan.
  5. To support the design of the future roadmap for the national and the provincial SBTPs.
  6. To support the design of a Plan of Operation for the HSSP (Output B, SBT)

Deliverables/Reports:

  1. Review/gap assessment report
  2. Future road map for the national SBT Programme Pakistan
  3. Draft Plan of Operation (2014 – 2015) for the Health Sector Support Programme (HSSP, Output B, SBT)

KWIC bv, Groningen, NL
continued advise and presentation of important background information to a political party delegation, interested in the cost-effectiveness and blood saving aspects of the design.


Membrana GmbH, Wuppertal, D
Exchange of information on a composite blood bag system for processing of collected blood, which includes a gravity principle to avoid the need for centrifugation. This might be of particular importance in those areas where power supply is not guaranteed, while developments continue and justify a processing of collected blood into clinically useable components.

GIZ Pakistan
there has been a regular electronic exchange of information, guidance and advices. Most of the consulting contact were through the Project Director Dr. Hasan Zaheer (Safe Blood Transfusion Programme) In the Spring of 2012 the progress of the GFA team was evaluated along with other GiZ health projects. GFA received a favourable report which recommended their contract extension beyond September 2012. Unfortunately a period of uncertainty followed which continues to persist. GFA was informed to continue working beyond their contract period (September 2012). In December 2012 there was another high level 3rd party evaluation of GiZ health projects including GFA. Recommendations were favourable but it is still not clear if GiZ health component will continue beyond June 2013. This uncertainty is obviously not good. The GiZ Country Director in Pakistan was requested to continue with the TC component beyond June 2013 so that the gains achieved so far are not wasted and lost.
At the beneficiary side there is a transition phase which is likely to be over soon as the present Federal Government is completing its tenure within a couple of months. The Health Ministry is then likely to be revived in some form and shape.


KWIC, Groningen, NL
technical and strategic consultation on the value and application of a blood cold chain temperature monitoring and evaluation device, that might be of importance in reducing unnecessary loss of blood components due to inadequate monitoring of the cold chain conditions in hospitals, but also during transportation from blood collection and distribution centres to intermediate (processing laboratories and storage locations) and final destinations (hospitals, wards and surgical theatres). An emphasis was given to the conditions in various developing situations and prerequisites identified and discussed that may be of value for the marketing at a global level.

GIZ Pakistan
The Spring mission was a continuation of the lead expert supervisory consultation for GIZ. Meetings were conducted with the GFA team, the EPOS team and the NBTP in Islamabad to analyse the progress and related gaps and problems.

The following recommendations were formulated – Next steps for the GFA team

  • Complete the Plan of Action for the March – July 2011 period with measurable indicators per time set.
  • Implement the Plan of Action for the March – July 2011 period
  • Improve on the communication, team building and leadership capacities of the in-country team and start involving the capacities of the international team members.
  • Replace the positions that have been vacated to strengthen the team and spread the work load of TA provision.
  • Continue to strengthen a harmonized working relation with KfW and their project team to coordinate, synergize and synchronise the implementation of both projects and their phases.
  • For a successful implementation, the first emphasis has to be on organization and structure with related infrastructure. This includes the development of a broad senior management cadre to lead the Provincial/Territorial development and implementation. This cadre should then manage the organization of the procurement centres/Regional Blood Banks and have the concept translated into appropriate and step wise operational actions – organograms with clear lines of command, QMS with uniform documentation (M&E), donor management strategies, training programs for operational staff competencies and creation of public (VNRBD) and clinical awareness (in-hospital QS/QM and development of rational use of blood).Note of caution – stay within the cadres of the project terms of reference.

Croatia
Framework Contract Commission 2007 EuropeAid/123314/ C/SER/multi: Blood establishments – assessment of laboratory equipment & assistance in supply tendering procedure (TAIB 2009 project ‘Strengthening the Institutional Capacity for Blood, Tissues and Cells’ HR2009-03-28-11). The tender was awarded to the EPRD consortium (EPRD, Bolt and IDTM Consulting). The consultation started January 2011 for a period of 10 months and is based on the following – Global objective

  1. The global objective is to support the Delegation of the European Union to the Republic of Croatia (EUD) in its verification of whether the proposed investments in the field of Blood under an IPA 2009 project (HR2009-03-28-11) are relevant to the needs of the Blood establishments – assessment of laboratory equipment & assistance in supply tendering procedure (TAIB 2009 project “Strengthening the Institutional Capacity for Blood, Tissues and Cells” HR2009-03-28-11)) – version of 02/12/2010 Page 4 of 8 beneficiaries and the population in Croatia;
  2. improve compliance of the sectors with relevant EU directives.he EUD was supported in its assessment and analysis of existing equipment at the main beneficiaries, and of their capacity to deal with present and future work load, in the light of European requirements.The relevance of requests for new equipment was evaluated in the light of sector needs, existing national strategies and other ongoing reform in the sectors,
    European requirements, good value for money principle.The draft Tender Dossier was evaluated and advice for a revision was provided.Additionally, advice and support was provided during a special evaluation session in Brussels.EU decided to hold the project because of insufficient efforts from the beneficiary to fully comply with the relevant EU directives.

WHO EURO Montenegro
consultation in Montenegro December 2011.EU IPA – Implementation of the European Blood Transfusion System in Montenegro.
Mission assignment:

  1. attend as an observed the inaugural meeting of the Steering Committee
  2. conduct an introductory 3 day workshop on Principles of Quality Management in Blood Transfusion

Specific objective of the project – To secure sufficient quantities of safe blood and blood products to meet the needs of all patients, in regular and emergency situations, provided as a part of a sustainable and modern blood transfusion programme within the existing health care system in accordance with the EU standards for blood transfusion. Actions planned –
Component 1 – legal and organizational framework

  1. Legal and regulatory framework harmonized with EU requirements and WHO recommendations
  2. System of VNR blood donation extended
  3. Quality management established and initiated

Component 2 – Capacity building

  1. Staff involved in the blood transfusion service and the clinical site adequately trained according to assessed needs.

Component 3 – Physical infrastructure

  1. Construction/renovation of appropriate facilities
  2. Needs assessment and specifications for equipment
  3. Procurement of equipment and training of staff

GTZ Pakistan
The missions were a continuation of the previous years albeit as lead expert consultant for GTZ. The winning TA providing consortium consisting of GFA, Germany and Sanquin Consulting Services, Netherlands started implementation following the Operational Planning workshop January 2010. Two consulting missions were completed in June and October.


Iraq
Al-Shita co (Mr. Al-Jabori) has approached IQM Consulting to seek support for the development of the blood supply and clinical use of blood in Iraq. The project is a joint WHO-EMRO/EU initiative, conducted from the WHO EMRO Iraq office in Amman, Jordan. A first meeting with Iraqi transfusion specialists was organized in Amman. The present Project for Upgrading and Strengthening Blood Services in Iraq has been developed to focus on the following components:

  • support to the policy/strategy development and quality assurance system
  • support to the existing NBTC in the areas of human resources development (training, and capacity building), training of staff on the use and in the maintenance of the newly received equipment, provision of reagents
  • Establishing three to four regional blood services centers (depending on funds available). The priority is as follow (1) Basra, (2) Al Najaf and (3) Ninewah (4) Erbil.
  • Capacity building aimed at strengthening the managerial and operational (functional) capacity of the new centers as well as to increase the ownership of the MOH and the community in close collaboration with the Ministry of Higher Education.

The consultation will result in a 6 – 8 months project for the year 2011 The WHO EMRO/EU project started June 2011 with a first mission to Kurdistan with the following objectives – In collaboration with NBTS Iraq and WHO-Iraq the consultant will promote the key elements of a national blood program in Iraq, including the development of a national blood policy and strategic plan consistent with the five year health strategy and plan for Iraq as well as structured blood transfusion service in Iraq in accordance with the current international recommendations and principles of blood transfusion, both for the procurement and for the clinical use (supportive hemotherapy).
To achieve the objective the following activities were planned – The following activities are needed to achieve the above objective:

  1. Assessment of the current situation blood supply and clinical use in Iraq
  2. Conduct a consensus workshop to create awareness and ownership of the key issues (pillars) of the reform of the national blood transfusion program – policy, strategies, legal and regulatory framework, managerial and operational structure and related infrastructure (e.g. finances, human capacity, Quality Management, logistics and communication/ICT, education.
  3. Technical Revision of the Blood Transfusion SOPs and Technical Guidelines produced by MOH.

Croatia
Framework Contract Commission 2007 EuropeAid/123314/C/SER/multi: Blood establishments – assessment of laboratory equipment & assistance in supply tendering procedure (TAIB 2009 project ”Strengthening the Institutional Capacity for Blood, Tissues and Cells” HR2009-03-28-11). The tender was awarded to the EPRD consortium (EPRD, Bolt and IDTM Consulting). The consultation will start January 2011 for a period of 10 months and is based on the following – Global objective The global objective is to support the Delegation of the European Union to the Republic of Croatia (EUD) in its verification of whether the proposed investments in the field of Blood under an IPA 2009 project (HR2009-03-28-11) are
(1) relevant to the needs of the Blood establishments – assessment of laboratory equipment & assistance in supply tendering procedure (TAIB 2009 project “Strengthening the Institutional Capacity for Blood, Tissues and Cells” HR2009-03-28-11)) – version of 02/12/2010 Page 4 of 8 beneficiaries and the population in Croatia;
(2) improve compliance of the sectors with relevant EU directives. Specific objective(s)

  • To support the EUD in its assessment and analysis of existing equipment at themain beneficiaries, and of their capacity to deal with present and future workload,in the light of European requirements.
  • To support the EUD in its evaluation on the relevance of requests for new equipment, in the light of sector needs, existing national strategies or otherongoing reform in the sectors, European requirements, good value for moneyprinciple.
  • To assist the EUD in the assessment/revision of the draft Tender Dossier and during the tender evaluation.

GTZ Pakistan
The missions were a continuation of the previous years and focused on consensus on the desired structure and organization, the legal framework and the needed leadership development. The four priorities for the immediate and medium-term future were the basis for a three years GTZ financed project proposal

  1. Change of the public mind set/culture – creation of voluntary non-remunerated blood donation;
  2. Human capacity building – managerial and operational;
  3. Development of a national quality and quality management system;
  4. Clinical interface and hospital transfusion chain – appropriate use of blood and alternatives;

Assistance was given to the composition of the Terms of Reference for the project. As off the start of the project implementation early 2010 a position as lead expert consultant for GTZ was offered in order to allow proper supervision of the implementation of the project by the winning TA providing consortium.

GFATM Cambodia
visits January/February and April/May The main objective was to help Cambodia develop implementable clinical transfusion guidelines. During the first visit the base line situation with respect to the blood supply and the clinical use was mapped and a plan for improvement and implementation was designed in close cooperation with the Cambodian National Blood Swervice in Phnom Penh and representatives of blood prescribing clinicians from all over the country – consensus development of clinical guidelines. The second visit focused on the consensus acceptance of the designed clinical guidelines, and a road map for implementation – training and acceptance.


GTZ Pakistan – Cambodia & Pakistan
The missions were a continuation of the previous year and focused on consensus on the desired structure and organization, the legal framework and the needed leadership development. During the consensus meeting four priorities for the immediate and medium-term future were developed

  1. Change of the public mind set/culture – creation of voluntary non-remunerated blood donation;
  2. Human capacity building – managerial and operational;
  3. Development of a national quality and quality management system;
  4. Clinical interface and hospital transfusion chain – appropriate use of blood and alternatives;

To develop priority one a nation wide KAP-study will be undertaken. The outcome would serve as a base for the design of as long term and sustainable public awareness campaign focused on a sustained change of the mind set/culture and the development of an all voluntary and non-remunerated regular blood donor system. For priority two an inventory of existing educational (teaching and training) progammes and related institutes is planned. The concept of the inventory is focused on a harmonization of existing education programmes for human capacity building. The priority three will be met with a first Nation wide Quality Management training course to be conducted beginning of 2009 focused on training potential Pakistani trainers from all parts of the country. For the last priority focused clinical use seminars will be organized to generate clinical awareness and consensus on the principles of rational clinical use of blood.The consultation resulted in an assessment report and plan for the set up of a national blood supply system and quality management system in Pakistan.

GCBS
Eighth General Meeting, Geneva, Switzerland.


Turkish Red Crescent, TK
further discussions on the project proposal for improvement of the blood supply chain in Turkey by means of education and training programmes for donors, quality managers and doctors. Mr. Hans Molijn together with Mr. Leo Hertogs and Mr. Hans Duffels visited the Ankara Red Crescent Blood Center to assess compliance of the organization with the EU guidelines and GMP.


Pakistan
The planned project is jointly supported by GTZ and KfW, Germany under the overall title Pre-Feasibility Study on Safe Blood Transfusions in Pakistan. There was a small team of two consultants from KfW and one from GTZ. The overall objective of the consultancy is to support the Government of Pakistan to reduce blood borne transmission by ensuring safe blood transfusion services. The mission was followed by a second GTZ supported mission in August focused on the revision of the 2003-2007 Policy and Strategic Framework document and advice on the design of the new framework legislation.

GCBS
Seventh General Meeting, Cairo, Egypt.


MoH Cyprus
Objective – advice on how to implement the EU Directive 2002/98/EC and completion of the EU Twinning Light project


Bangladesh
Ministry of Health and Family Welfare (MoHFW), and World Bank (WB) consultation with the following objectives and terms of reference – Global objective: to propose a technical assistance plan for the national safe blood transfusion program (NSBTP). Specific objectives:

  • Assess the institutional arrangements and capacity of the SBTP, including council, committee and reference laboratory, and make recommendations regarding needed staffing/ qualifications and programmatic linkages with other health programs (including its location within the overall MoHFW’s structure). Staffing recommendations should take into account MoHFW’s overall budget envelope.
  • Review the content and status of blood safety related policies, including the 1992 Law, 1997 AIDS Policy, 2002 Law, to determine if any adjustments would be required to improve the functioning of the blood safety initiatives.
  • Assess the implementation of existing policies, identify bottlenecks and make recommendations for the improvement of the blood safety program to establish a functional referral network that will cover the entire country.
  • On the basis of the above recommendations, identify priority technical assistance needs, indicating what could be reasonably carried out within the next 18 months.

Requested services:

  • Review background materials to be provided upon signing of the contract.
  • Interview programme managers in the SBTP, MoHFW and reference laboratory; current and past TA providers in WHO and UNDP; stakeholders including National AIDS/STD Programme, DFID, World Bank, UNAIDS, WHO etc.; and other relevant people related to the project.
  • Visit a sample of public sector blood banks to assess blood collection and blood banking procedures as well as a sample of hospitals and health centres to assess hemotherapy and blood transfusion practices. For comparison, 2 or 3 non-governmental sites should also be visited.
  • Debrief with Bank and DFID with preliminary recommendations in preparation for a final debriefing with the Government.
  • Debrief with Director General Health Services of the MoHFW, SBTP and development partners, in a final wrap up meeting to present findings and recommendations. The consultation resulted in an assessment report and plan for the set up of a national blood supply system and quality management system in Bangladesh.

MoH Greece
Objective – advice on how to implement the EU Directive 2002/98/EC


MoH Cyprus
Objective – advice on how to implement the EU Directive 2002/98/EC and preparation of a EU Twinning Light project


WHO-EURO meeting, Ljubljana, Slovenia
Objective – define priorities to assist Member States in strengthening the safety of the blood supply, promote the use of operational tools for baseline assessment including training needs evaluation, and contribute to the South East European Health Network development within the Stability Pact Initiative for Social Cohesion.


Romania
EU PHARE consultation ‘Strengthening the capacity of the Romanian Ministry of Health in order to comply with the EC Standards regarding the transfusion safety’ in Romania, contract nr. Buzduga 121 – PHARE – RO-PAO/CFCU. This fact finding and preparative consultation took 3 months (January till March 2005) with the objective:To assist the Romanian authorities in drafting :

  1. the ToR corresponding to the project fiche ‘Strengthening the Romanian blood transfusion system to comply with EC requirements for quality and safety of human blood and blood components’;
  2. the technical specifications for the necessary equipment.

The requested services were in particular: Technical assistance will provide support to the National Institute of Transfusion Haematology and Romanian blood transfusion centres in order to ensure compliance with article 11 of EU Directive 2002/98/EC by establishing a quality system based on the principles of good practice, to ensure quality control and traceability of each single blood donation and each single blood unit and components thereof in accordance with the provisions of articles 11 & 14 of EU Directive 2002/98/EC, to comply with the requirements for storage, transport and distribution of article 22 of EU Directive 2002/98/EC, to comply with the provisions of article 20 of EU Directive 2002/98/EC in relation to measures to encourage voluntary and unpaid donations.
The consultation was done jointly with Dr. Casper Jersild from Denmark and Dr. Dimitris Kalogeropoulos from Greece and resulted in an assessment report and draft ToR for an EU PHARE implementation project.


Pakistan
Ministry of Health/NACP and FHI consultation ‘Development of quality assurance system for the operations of blood transfusion services in Pakistan.’ The objective of the consultation:

  • to ensure the ‘operationalization’ and appropriate implementation of a Quality Assurance Programme that ensures the availability of high quality blood and blood components for transfusion with maximum efficacy and cost-effectiveness and minimum risk to both the donors and recipients. The desired quality management system should aim at:
  • implementation of standardized methods for identification, preparation, storage, handling and testing of blood and blood components;
  • ensuring maximum detection of significant in-vitro donor-recipient incompatibility;
  • ensuring minimum donor variability;
  • maximum effectiveness of the Blood Transfusion Systems.

GCB
Fifth General Meeting, Geneva, Switzerland.


Euromediterranean Health meeting
Algiers, Algeria


CoE Committee of Experts on Blood Transfusion and Immunohaematology (SP-HM)
Strasbourg, France – informative presentation.


Uzbekistan
ADB mission to Uzbekistan.

  1. to review the national plan to improve the blood transfusion services and the related blood donor program, and the specific needs of PHC and WCH services;
  2. make a rapid assessment of the needs and opportunities for improving of the blood transfusion services and donorship program in the Project oblasts;
  3. assess the blood background strategy report to be produced by MOH;
  4. make recommendations on the rational use of blood, blood products, and intravenous replacement fluids in primary and secondary health care services in the context of health sector reform and in relation to WCH, and for collecting, testing, storing and managing the blood; make recommendations for the project, including procurement, training, logistics, storage, and costs.
  5. some studies of current practices of blood use, storage, testing methods, and inventory will also be required;
  6. estimations on the need for blood or blood products in the country.

What is the current status in the country on the national blood safety program, what institutions are involved in blood safety, what policies are currently in place, what policies are needed, and what institutes need to be strengthened for such a program.


Yemen
WHO EMRO assignment to Yemen.

  1. Develop a plan of action for Quality Assurance1 and total Quality Management in the Blood Transfusion Services.
  2. Develop biological standards for Blood Transfusion Services.
  3. Conduct workshop and training activities for National staff running the Blood Transfusion Services.
  4. Evaluate the Blood Transfusion Services in the 5 Governorates of Yemen.

Tunis, Tunesia
WHO EMRO teaching assignment to Tunis, Tunisia. Lectures (French language) to a class of transfusionists from Tunisia, followed by written examination.


Geneva, Switzerland
WHO HQ Informal Consultation on the Development of a Global Strategy on Education and Training in Transfusion Medicine (chair).


Dubai, UAE
WHO EMRO training mission.

  1. To train local staff in the United Arab Emirates on optimal use of blood and its components.
  2. Submit a typed assignment report in English, including an Executive Action Document (Executive Summary, Recommendations, and Plan of Action) together with an electronic copy.

Bosnia and Herzegovina
The consultation was arranged on special request of Prof. Dr. Midhat HARAČIĆ, Director of the Federation Blood Transfusion Institute and Vice Dean for Postgraduate Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina. Objectives:

  1. to explore the state of the art in blood transfusion in Federation of Bosnia and Herzegovina and Republika Srpska
  2. to explore the potential capacity for developing a safe and sustainable blood supply and transfusion system in Federation of Bosnia and Herzegovina and Republika Srpska;
  3. to advice on a project proposal for development.
  4. A follow up was given through a special workshop in Sarajevo on Essentials and Minimum Requirements for a Nationally Supported Blood Supply and Transfusion System, and Transfusion Medicine as an Integral Part of the Health Care System – the Slovenian Experience (presented by Dr. Bozidar Voljc, Ljubljana, Slovenia), with interactive discussion leading to consensus in the group and outline of a Plan of Action – strategy.

Lithuania
Ministry of Health consultation on ‘Optimization of Blood Service Activities’, Vilnius University Santariskes Hospital. Participants: specialists from all five Lithuania Blood Banks, State Patient Fund of Lithuania and Ministry of Health of Lithuania.

  1. Reorganization of National Blood Transfusion Service enhancing safety and cost effectiveness of blood supply: Needs and essentials for Nationally supported structure and organisation of the Blood Supply
  2. Organization of plasma collection and quality control for processing out-side of the country.
  3. Quality Systems and Quality Management of the Blood Supply in the EU blood components, plasma and the Directive EU2002/98.

GCBS
Fourth General Meeting, Tunis, Tunesia

Libya
WHO EMRO assignment to Libya. Terms of Reference were:

  1. to conduct a situation analysis of Laboratory and blood safety.
  2. to put a plan of action for the development of blood transfusion services.
  3. to conduct a workshop on quality management in blood transfusion services for blood bank officials, physicians and technicians.
  4. to submit a typed assignment report including an Executive Action Document (EAD: Executive Summary, Recommendations and Plan of Action).
  5. Tunesia – WHO EMRO teaching assignment to Tunis, Tunesia.
    Lectures (French language) to a class of transfusionists from Tunesia, followed by written examination.

Portugal
AABB Consulting Services Division consultation of the Portuguese Blood Institute including Lisbon, Oporto and Coimbra. Terms of Reference:

  1. to explore the progress made as a result of the pilot assessment and report of September 2002;
  2. to advice that all necessary processes and procedures in place are in compliance with AABB Standards for Blood Banks and Transfusion Services and requirements in preparation for a formal AABB audit;
  3. to train appropriate staff for
    – Good Manufacturing Practices (specific to blood banking)
    – AABB Standards
    – Self Assessment Process
  4. to assist PBI in identifying documentation to be developed, and assist in identifying a suitable format, milestones and timelines. An integral aspect of the consulting service will be the on-going guidance and assistance through-out the period of preparation for Audit

Singapore
AABB Consulting Services Division consultation and pilot assessment of the Centre for Transfusion Medicine of the Health Sciences Authority. Terms of Reference:

  1. to study the range of services, processes and procedures of CTM with the purpose of establishing the level of compliance with respect to the AABB Blood Bank and Transfusion Service standards and requirements;
  2. to identify gaps and set work plans and measures to bridge the gaps from existing level of compliance to that which would comply with AABB Standards for Blood Banks and Transfusion Services;
  3. to provide advice on all necessary processes and procedures which need to be in place for compliance with AABB Standards for Blood Banks and Transfusion Services and related requirements;
  4. to advise CTM in preparations for a formal AABB audit and accreditation.

A second consultation was done in October 2003 with the following Terms of Reference:

  1. to review the observations made on the 10 Quality System Essentials and the progress made on the recommendations to allow establishing the current level of compliance with respect to the AABB Blood Bank and Transfusion Service standards and requirements;
  2. to identify remaining gaps and set work plans and measures to bridge the gaps from existing level of compliance to that which would comply with AABB Standards for Blood Bank and Transfusion Service;
  3. to provide advice on the following processes and procedures:
    a) Training and competence assessment of staff;
    b) Mechanisms for document control;
    c) Details on software, hardware and database requirements;
    d) Non-compliance policy as a process of improvement which need to be in place for compliance
    with AABB Standards for Blood Bank and Transfusion Services and related requirements;
  4. to advise CTM in further preparations for self-assessment and a formal AABB audit and accreditation.

Singapore – AABB Consulting Services Division consultation of CordLife. Terms of Reference:

  1. to explore the progress made as a result of the pilot audit and report of May
    2002;
  2. to advice that all necessary processes and procedures in place are in compliance with AABB Cord Blood Services standards and requirements in preparation for a formal AABB;
  3. to train appropriate staff for
    – details of Quality System Essentials and Management
    – Good Manufacturing Practices (specific to cord blood Banking)
    – AABB Standards
    – Self Assessment Process
  4. to assist CordLife in identifying documentation to be developed, and
    assist in identifying a suitable format, milestones and timelines. An integral aspect of the consulting service IS the on-going guidance and assistance through-out the period of preparation for Audit

WHO/BCT, Geneva, CH
Re-organize the available text elements for the recommended blood safety legislation and regulations; draft and shape the basic text for the recommended legislation and regulations into a version ready for penultimate discussion by working group on national policies and plans; review and reconsider the necessary appendices and annexes. (World Health Organization)


Kuwait – WHO-EMRO
Advice on training of Human Lymphocyte Antigen (HLA) typing by Polymerase Chain Reaction (PCR); advice on production of reference sera through (National) External Quality Assurance Schemes (EQAS); training of trainers (National Training Activity) for Total Quality Management in Blood Transfusion Services (World Health Organization)


Armenia
To explore the state of the art in blood transfusion in Armenia, to explore the potential capacity for developing a safe and sustainable blood supply and transfusion system in Armenia; to advice SDOK on the support to develop the Blood Bank in Hrazdan. The consultation was done on request of Stichting De Ondergrondse Kerk (SDOK), Dordrecht.


Georgia
Pilot assessment to explore the state of the art in blood transfusion in Georgia, to explore the potential capacity for developing a safe and sustainable blood; supply and transfusion system in Georgia and to advice on the selection of potential participants in the WHO Europe Region QMT course.


Croatia
First analysis of the current blood supply and related quality management system in Croatia


Croatia
Joint Programme Council of Europe/Council of Europe Development Bank Strasbourg, France: Seminar on the Management of the Quality and Safety of Blood and Blood Products. Objective: to prepare a report on the problems of access, needs, and infrastructure of the blood transfusion services in Croatia and recommendations for actions, including infra-structural needs.


GCBS
Third General Meeting, Geneva, CH

WHO/BCT
Core Facilitators Meeting for Quality Management Training (QMT) in Blood Transfusion Services, Groningen, NL (World Health Organization)


WHO-EMRO
Regional Meeting for Directors of Blood Transfusion Services, Cairo, Egypt (World Health Organization)


WHO/HQ Geneva, CH
Meeting of Interested Parties – Blood Safety, Essential Drugs, Vaccines (World Health Organization)


WHO-EURO
Quality Management Training (QMT) Course for Blood transfusion Services, European Region. Groningen, NL (World Health Organization)


WHO-WPRO
Meeting on Quality Management Project (QMP) for Blood Transfusion Services in the Western Pacific Region. Singapore (World Health Organization)


WHO-EURO
Regional Workshop – Development of Quality Systems to Improve the Clinical Use of Blood. Groningen, NL (World Health Organization)


GCBS
Second General Meeting, Geneva, CH (World Health Organization)


Ministry of Health, P.R. of China
Seminar on Quality Management Project for Blood Transfusion Services. Beijing, P.R. of China (World Health Organization)