CDC-CMAI Quality Management Systems Project (2013 – 2019)

Quality Management Systems (QMS) for Government supported Blood Banks (BB) is a top priority under
the National AIDS Control Program (NACP Phase IV) of India’s Ministry of Health and Family Welfare.
U.S. PEPFAR joins hands with the UN Targets of 90-90-90 and QMS-BB Project is a major detection and
prevention strategy. Blood Transfusion Services play an integral role in the provision of safe, quality
blood and blood products.

The Christian Medical Association of India (CMAI) under a collaborative agreement (Co-Ag) signed in
October 2013, with the U.S. Centers for Disease Control and Prevention (CDC)/India in strengthening
QMS in NACO certified blood banks and blood transfusion services in India. During the first year this
project has conducted rapid situational analysis, standardization of training, national consultation
meeting (and launch of e-Voluntary Blood Donation registry.

The project aims at providing technical assistance (TA) to the National Blood safety program to
strengthen the quality of blood banks across the country and to reduce Transfusion Transmitted
Infection(TTIs), including HIV.

Our Partners and their contributions:

CMAI is working closely with the National AIDS Control Organization (NACO) in partnership with
Christian Medical College, Vellore and Catholic Health Association of India (CHAI), under the guidance of
CDC, India, to provide technical, training and monitoring support.

CMAI plays a major role in the following activities.

• Capacity Building of different tiers of staff working in the Government supported blood banks
• Quality Management Systems
• Strategic Information Management Systems
• Continuous advocacy with state and national stakeholders

Capacity Building:

The project provides Technical Assistance (TA) to the National Blood Transfusion program to improve
the quality of services at blood banks across India, build the capacity of blood bank staff on the key
blood bank functions, and strengthen the quality of testing with an objective to reduce the Transfusion
Transmitted Infections (TTIs) including HIV. In order to facilitate nationwide capacity building and EQAS
implementation, a network of xxxx blood banks was created under NACP. A competency-based
assessment was undertaken in 40 regional blood banks using standard tools, of which, 20 training
centers were selected under the National AIDS control program during FY-14.
Progress so far:

Training Curriculum Development:

During the FY 15, the project focused on strengthening the capacity of 20 regional training centers,
developed and reviewed training materials, national guidelines on blood transfusion to standardize and
ensure quality in-service training across the blood bank network. A pool of 140 master trainers was
created. Regular training of blood bank staff commenced during FY-15. Blood Bank staff from 147
blood banks have been trained so far. (46 Medical Officers, 15 lab technicians & 86 nurses).

• During the last quarter, 52 batches and 1054 BB staff had been trained across 17 regional
training centers. Overall trained since Sept 2015: 90 batches & 1862 trained (Total: 142 batches
and 2916)
• Counselors’ modules have been finalized and printed. Previously the project had prepared
modules for Medical Officers, Lab Technicians and Nurses.
• Six additional training centers identified for Uttarakhand, West Bengal, Assam, Chhattisgarh,
Himachal Pradesh & Bihar. Currently there are 23 training centers.
• Master trainers orientation completed for 12 trainers from the newly selected six Regional
Training Center

Strengthen Strategic Information Management System

The BTS division heavily relies on the National Strategic Information System (SIMS) to measure the
progress and plan future activities. However, there are several gaps and issues in reporting, quality,
accuracy, completeness, timeliness, analysis and use of data for programme planning, To address the
gaps, the project organized a National consultation on “Review and strategize the Monitoring and
Evaluation System related to Blood Transfusion Services in India. Following this, the project is providing
technical support to NACO and SACS to improve the SIMS by creating an accurate list of Blood banks in
the country, improving the reporting status and quality of reporting by providing TA.

Progress so far:

Baseline assessment of NACO BB

The project created a SIMS data collection protocol and currently it is in the process of analysis. The
report has to be prepared and disseminated. During the last quarter, concept, methods and tools have
been developed

Online format has been finalized and orientation program has been given to joint directors of State
AIDS Control Societies.

Estimation of Blood requirement

The project in collaboration with NACO, and National Institute of Medical Statistics developed the
protocol including study methodology and obtained approval from all the technical bodies of NACO that
are, Technical Resource Group-Blood Safety, Technical resource Group (Research and Development) and
Ethics Committee, NACO. The protocol was approved by Institution Review Board of Christian Medical
College as well. Secondary data collection and a comprehensive literature review have been conducted.

During the last quarter, CDC approval has been obtained, primary data collection is in progress, pilot
study has been completed and the Delphi technique of data collection has been completed among
surgeons.

Shortly, primary data collection will be completed and three rounds of Delphi will be carried out
(Physicians, OBGYN & Pediatricians). The next steps will be data collection from health care facilities;
data Analysis and report writing.

Quality Management System and EQAS

The project in collaboration with NACO, created a network of Blood Banks that will be enrolled in the
EQA Programme for TTIs and Immunohematology parameters in the first year. Three Proficiency testing
providers were assessed and two of them have been selected to provide EQA Programme to the
selected Blood Banks. The EQA roll out plan is in progress.

During the last quarter, QMS orientation training has been completed in four zones for Non NACO
supported Blood bank Lab technicians (5 batches & 152 participants), two batches in Maharashtra (62
participants) and one batch in Andhra Pradesh (22 participants).

In the next year, the project plans to review and finalization of QMS modules; QMS orientation training
for Non NACO supported Blood bank Lab technicians ( 30 batches & 750 participants)

External Quality Assurance Scheme

The project has established an External Quality Assurance System and harmonization of EQAS among
the three EQAS providers.

E-Blood Banking and Technology based solutions

The project has finalization of Database of licensed Blood Banks in India to be displayed as a Directory
for Public, State and National blood transfusion bodies. Populated Geo-coordinates of approximately
2400 licensed Blood Banks in public and private sectors. It also developed Blood Bank locator App and
NBTC webpage with Directory of Blood Banks on the National Health Portal (NHP). A Piloting of Blood
stock availability database with all licensed Blood Banks in Delhi & Mizoram (78 Blood Banks) was
carried out. A total of 127 Blood Banks have started reporting in the Blood stock availability database.
We are in the process of enrolling all the 2460 licensed Blood Banks in NHP web portal.

During the last quarter, national e-registry of Voluntary Blood Donors was initiated through SMS based
campaign in Delhi & Tamilnadu as a pilot initiative over two weeks. 1400 citizens registered themselves
as voluntary blood donors from these two states.

Innovation and Technology:

In order to plot all the blood banks across the country, mapping exercise has been initiated which will
help the country to plan and design programs. Geo coordinates for 2400 Blood banks were obtained
through this exercise.
Among other achievements in strategic information system for NACO are:

• Strengthening the Monitoring and Evaluation System; Updated the list of NACO supported BBs,
Typology in SIMS; and ensured more than 90% reporting.
• Towards achieving easy access to the availability of blood for the consumers the project updated
85 percent of all blood banks across the country the National Health Portal’s Blood Bank
window.
• NBTC website development in progress

Advocacy to SACS and NACO

The project has been continuously providing technical support to the State AIDS Control Societies
through the Zonal Managers and Central Project Team. In specific the project team was actively involved
in the development of state annual action plan for BTS Division of the respective states.

The project has provided continuous technical support to review the National policies and Drugs and
Cosmetic-1940 periodically, through Technical Resource Group (Blood Safety) and, National Blood
Transfusion Council (NBTC) which is the policy formulating apex body related to blood transfusion
services in the country. In response to the request by Ministry of Health and Family Welfare and Central
Drugs Standard Control Organization, the project provided TA to constitute a technical working group to
review the Drug and Cosmetics (Amendment) Bill, 2015 which is governing the Blood Transfusion
Services in the Country. The technical working group conducted a comprehensive review of the bill and
made comments and suggestions on each component in the bill. Similarly, in response to the Ministry of
Health and Family Welfare’s (MoHFW) request for comments on the Draft National Health Policy-2015,
CDC in collaboration with the Blood Transfusion Division of NACO, constituted a technical working group
to review the Blood Transfusion Services component and submitted a technical advisory note to the
MoHFW to be considered in the final National health policy. The has also provided technical and legal
support to the BTS division of NACO to deal with the legal and policy related queries from the
Parliament and the court law.

The project has been providing technical support and technical support to the State AIDS Control
Societies through its Zonal Managers and Central Project Team. The project team was actively involved
in the development of state annual action plan for BTS Division of the respective states.

• Organized SBTC review meeting for all states – Jan 2016

• Organized National consultation on Voluntary Blood Donation (VBD) – Jan 2016

Facilitated national Events

The project has supported the National AIDS Control Organization to conduct National Level events
such, Voluntary Blood Donors Day, World Blood Donor Day

Blood Bank – ICTC Linkages

Linkage between Blood Banks & Integrated Counseling and Testing Centres (ICTCs) on referral &
registration of HIV+ donors In line with the current plan for synergizing with implementation partners in
the cluster areas, the project proposes to develop a referral mechanism for HIV cases identified in blood
banks to be registered in ICTCs which are considered to be gateway for HIV services. The project
proposes to develop a mobile based system to ensure referral & registration of HIV cases in ICTCs, the
process is illustrated below.

Tracking tool – The project will develop a mobile application that will capture the Name of HIV+ donor,
age, gender, registration # & referral #. This information will be uploaded by the blood bank counselor
after providing appropriate counseling to the HIV+ donor. This information will be relayed to only the
appropriate ICTC as chosen by the Blood bank counselor. The counselor from the blood bank will call the
donor for follow-up session and registration in ICTC. The counselor upon completion of registration of
the individual will update this information in the database. The advantages of this method are,

• Ensures confidentiality of the individual

• Centralized database of identified HIV cases in blood banks, # referred, # registered with ICTC.
This will aid in tracking Lost to Follow-ups (LFUs) and target reducing the same through regular
and repeated follow-up calls
• This database can plug in to the existing review mechanism by the DAPCUs & SACS and thereby
strengthening the initiatives to reduce LFUs