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ContentsPage

Contents ……………………………………………………………………………………. i

Vision and Mission Statement ................................................................................... ii

Quality Policy ............................................................................................................. ii

Committees of National Blood Service Zimbabwe .................................................... iii

Chairman’s Report .................................................................................................... 1

Medical Director’s Report .......................................................................................... 6

Chief Executive Officer’s Review of Operations ........................................................ 10

Appendix I: Audited Financial Statements ............................................................. 21

Appendix II: Range of Products and Services ....................................................... 42

Appendix III: Branch Network ................................................................................. 43

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BWE Vision Statement

To be recognised internationally as the institution of excellence in the procurement,processing, storage and distribution of blood and blood products through innovativeand contemporary technology in compliance with international standards.

Mission Statement

To serve the nation by the provision of a cost effective service that ensures adequate,low risk blood and blood products to all those in need, through commitment, dedicationand care.

Quality Policy

The goal of NBSZ is to be the leader in provision of high-quality safe blood and bloodproducts and related services that provide the best clinical value for our customersand patients. We will accomplish this by providing products and services that meetor exceed the expectations of our customers today and tomorrow through totalcommitment to continual improvement in everything we do. ISO 9001: 2000 shallform the foundation of the Quality Management System encompassing Health, Safetyand Environmental concerns. We are committed to compliance with legislationapplicable to our products and services. Our operational values are based on thequality and strategic objectives, which are integrated in the quality policy.

NBSZ Management and staff shall continually align our Mission and Goals to ensureadequate quality safe blood and related services “from vein to vein”.

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BWECOMMITTEES OF NATIONAL BLOOD SERVICE ZIMBABWE

COMMITTEE MEMBERSHIP

A. National Committee 1. The Chairman – Justice L G Smith (Retd.);2. Vice Chairman – Dr B Nyathi;3. Harare Elected Members – Mr A Mandisodza; Mr P M Ndoro;

Mrs C Shaamano; Mr BC Brown; Mr M Southall4. Bulawayo Elected Members – Dr P Moyo; Mr M Esat5. Co-opted members – Mrs S Sanyanga; Dr T Magure;

Mrs E. Kundishora6. Government Co-opted members – Mr T A Zigora;

Mr L Mabandi7. Ex-officio Members – Mr D A Mvere; Dr M E Chitiyo;

Mr N M Muchineuta8. Pledge 25 Club, National Chairperson – Mr N Salowa

B. Executive Committee 1. Chief Executive Officer – Mr D. A. Mvere2. Medical Director – Dr M. E. Chitiyo3. Bulawayo Branch/Laboratory Services Manager – Mr. N.

M Muchineuta4. Finance and Administration Manager – Mr Z. Musekiwa5. Laboratory, Quality and Safety Manager – Ms L. Marowa6. Blood Procurement and Public Relations Manager –

Mr E. Masvikeni7. Assistant Blood Procurement and Public Relations

Manager – Sr J. J. Parirewa8. Executive Officer – Research, Development and Data

Management – Mr T. Mapako

C. Workers’ Committee 1. Harare: Mr J. Kefasi, Mr A. Wafawarova, Mr A. Makunuraand Mrs B Dzikiti

2. Bulawayo: Ms Sitho Ndlovu, Ms T. Nyambanje and Mr. M.Mafu, Mr N Msimanga

3. Gweru: Mr B. Chingoto4. Mutare: Mr. J. Masamba5. Masvingo: Mr N. Kanougwere

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BWEChairman’s Report

IntroductionDuring the first four months of 2009, theoperating environment in Zimbabwewas uncertain due to the socio-politicaland economic changes the country wasgoing through. Activities in the HealthSector remained depressed and donorrecruitment and the demand for bloodand blood products remained low.However, thanks to the dollarization ofthe economy, there was overallimprovement in the national economythough it was slower than expected dueto the slow implementation of thepolitical agreements. However, theoperating environment did continue toimprove and with it, there was improvedperception of life in Zimbabwe. Althoughthe national economy continued tostruggle to return to normal, theavailability of products in the marketespecially fuel, water and electricitysignificantly improved. As a result, theService was able to manage theoperations better than the previous yearwhich had been characterized by ahyper-inflationary environment andshortages of consumables such asfood, medicines and medicalequipment, vehicles, spare parts andfuel.

Blood Donations and SuppliesIn the last 15 years, youth donors havecontributed on average 70% of all bloodcollected. The depressed schoolpopulation in 2009 due to various factorssuch as closures of many schools,shortage of teachers, and failure ofparents to pay fees, significantly

affected access to the potential blooddonors by NBSZ staff. This was furthercompounded by the lack of transport anddonor incentives to give the students,particularly in the first half of the year. Inthe general population, access to blooddonors in commerce and industry, andthe general, community remained low.Things improved in the last half of 2009,but still did not reach previous levels.The Service managed to collect a totalof 42,074 units of blood, signifying a 14%decline from the previous year. A totalof 5 054 units, constituting 12% of totalblood collections, were realised throughthe Pledge 25 Club blood drives, namelythe Men’s Splash, Ladies Gala andYouth Donor Month. The adult blooddonors contributed about 24% of thetotal collections. Donor screening alsosuffered in that collections from schoolsdropped in favour of the adult population,with a resultant increase from 0,58 to0.77% in HIV seropositivity in donatedblood. However, the requests for bloodand blood products were equallydepressed throughout the year fromboth private and government institutions,due to affordability, the shortage ofspecialists in the hospitals and also thelow capacity of the general public toaccess medical services in the privateor public sector.

Finances of the NBSZCost recovery has been severelystrained in the last 3 years due to lowbudget allocations by Government to thepublic hospitals for the procurement ofblood and blood products, coupled with

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the hyperinflation. The capacity ofhospitals to pay for blood products wasseverely affected in 2009 and so hasthe cash flow situation of the NBSZ. TheService did receive some grants fromthe MOHCW and assistance from itsresource partners for the procurementof critical items: blood bags and test kits.However, the donations were notadequate. For example, in 2009, againsta pledge of $900,000, only $200,220was actually received from MoHCW.This affected the cash flow immenselyand contributed in no small measure,to the overall loss of $500,000 reportedin the 2009 accounts. The capacity ofGovernment to subsidise the cost ofblood and blood products and servicesremains low. The assistance from theresource partners also remained verylimited. The Service worked out that itcosts $105 to produce a safe unit ofblood. Thanks to the support fromresource partners it was possible toreduce the fees payable at publicinstitutions and rural mission hospitalsto $78 and $50 a unit respectively. TheService continued to lobby Governmentand resource partners for a better grantin order for a realistic subsidy to berealised so that the fees chargeablewould be significantly reduced.

In 2000, the Service, working with NetOne, initiated a project to introduce acompetitive element into blooddonations from the schools throughoutthe country. In each Province, theschool whose pupils donate the mostblood receives a shield and a certificate,and other prizes such as net balls, volleyballs, footballs, T-shirts, whistles and asmall medicine chest. The World Blood

Donors’ Day (WBDD) was held on the13th of June 2009 at Mpopoma HighSchool, Bulawayo. A donor awards/stakeholder meeting was held atRainbow Hotel in Bulawayo on the eveof the WBDD celebrations. The meetingwas well attended and it assisted to bringthe organisation in contact with variousstakeholders. WHO provided financialassistance to the tune of over USD10,000. A report of the proceedings waspublished and, circulated and isavailable on the NBSZ website. TheService received basic commoditiesfrom Macro Wholesalers of South Africafor staff support in 2009, funded by theSwiss Red Cross (SRC) under the BloodSafety Humanitarian supportprogramme (2008-2009). The Servicealso received 2 Nissan Double cabs aspart of the financial support from SRC.The Service received further donationsof vehicles; 12 Nissan Double Cabs and4 Nissan Single cabs from the ExpandedSupport Programme (ESP) for use bymobile clinics. However, UNICEF retainsthe ownership of these 16 vehicles. ESPalso provided the bulk of laboratoryreagents, test kits and blood bags, worthUSD669, 488.00, in 2009. WHOweighed in with US$38,590.41 for theprocurement of computers andlaboratory equipment, and therefurbishment of the Harare cold chain.Delta Beverages provided soft drinks fordonor comforts and Lobels providedbiscuits to our Bulawayo Branch.

Human ResourcesDue to the constrained cash flows duringthe year, the Service was limited to therecruitment for critical positions only.Even though the Service faced problems

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to raise staff salaries, we managed toachieve a 97.01% staff retention ascompared to 87.64% during theprevious year. The employees weresupplied with food stuffs as incentiveswith the assistance of Swiss Red Cross.With the implementation of theseincentives and the recommendations ofthe staff satisfaction survey, our staffretention percentage improvedmarkedly. It is very fortunate that wehave a very dedicated staff complementand it is hoped that they will alwayscontinue to give their support to theService.

Quality Management SystemThe NBSZ attained ISO 9001:2000certification in 2007 and hassuccessfully maintained it throughout2009. This was possible due to thecommitment of top management to thequality management system.Continuous staff training, review of thedocumentation processes and qualitycontrol of blood products and servicesand internal and external audits allcontinued to play a role in themaintenance of the quality managementsystem. The ISO certification applied tothe Head Office in Harare and theBulawayo Branch. We had planned toextend the certification to the Mutare,Gweru and Masvingo Branches in 2009but that was not possible, due tofinancial constraints. It is hoped toextend the ISO Certification to the threeBranches in 2010. The Service hasendorsed the world-wide concept that“quality costs but failure of the qualitysystem costs much more”. Twoexternal audits were carried out by SAZin March and November 2009. The

Service is presently upgrading to therevised edition of the Standard (ISO9001:2008).

Trust FundThere has been little activity on the partof the Trustees this year. In 2008 therewere a number of fund-raising functionsthat were held, in conjunction with theRed Cross Society and Island Hospice.Unfortunately, the monies that wereraised had disappeared by the beginningof 2009, after numerous zeros wereremoved from the Zimbabwe currency.2009 was not a good year to start tryingto raise money from the commercialworld. Every single company wasstruggling to get back to life after theterrible hyper-inflation in 2008, and toadapt to the dollarization of theeconomy. It is hoped, however, that2010 will be better. It was with muchregret that we lost Mr. Alastair Black whoresigned from the Trust when heemigrated to the UK. He was a real livewire and go-getter in getting fund-raisingventures off the ground. We wish himand his wife well in their new life inEngland. Thank you, Alastair, for all youdid for the Trust. If any donor would beprepared to accept appointment as aTrustee, or knows anyone who would bean effective fund raiser and is preparedto accept appointment please contactme or our Chief Executive Office, Mr.David Mvere.

National CommitteeThe National Committee met three timesduring the year to review theperformance of the Service. Six of themembers are elected donors in Harareand three are elected donors in

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Bulawayo. There are a number of othermembers who represent ourstakeholders, namely the MoHCW,NAC, the Zimbabwe Red Cross Society,and AHFOZ. The National Committeehas established a Finance Committee.I wish to acknowledge the dedicationand commitment of the members, bothelected and co-opted. Their servicesare very much appreciated.

Collaborative activitiesDuring the period 31 August to 4September, NBSZ received a numberof medical directors from Kenya BloodTransfusion Service. We had fruitfuldiscussions with them. The NBSZparticipated at the AfSBT 5th

International Congress that was held inJune in Nairobi, Kenya. This was aremarkable achievement and thescientific quest for the organisationshould be maintained. Congratulationsto our CEO, Mr Mvere, who was re-elected for the third term running to thepost of Secretary-General of the AfSBTfor a further two year term, and to theEO-RDDM, Mr Mapako, for beingappointed as the Webmaster andResearch Coordinator of the AfSBT.This representation at such high levelposts, help to get the name of theorganisation recognized internationally.The Service signed an MoU withBiomedical Research and TrainingInstitute to collaborate in research anddevelopment activities on bloodtransfusion research work. In pursuit ofthe 2007 Memorandum ofUnderstanding (MoU) with SANBS invarious collaborative activities, whichinclude research and development,three members of the Management

visited SANBS in August.

Future OutlookIt is our intention to improve blood safetyand we will move in the direction ofNucleic Acid Testing (NAT). This willfurther improve the safety of the bloodsupply. The Service has activelyengaged the Centre for Disease Control(CDC) to assist us in setting up a NATlaboratory, and we hope this will cometo pass in 2011. In the quest for newknowledge and in anticipation of futuredemands on the Service, the BulawayoBranch Manager attended a cord bloodbanking workshop in Italy in November.Cord blood represents a new source ofstem and haemopoietic progenitor cellswhich are capable of repopulating amyeloblasted patient. Diseases such asleukaemia, lymphoma and haemo-globinopathies can be greatly alleviatedby cord blood.

DonorsI have already mentioned the supportwe received from the Swiss Red Crosswhich provided basic necessities for ourstaff, and donations of test kits and bloodbags from the ESP. There are a numberof other donors whose assistance hasbeen very welcome and is very muchappreciated. Without them, we wouldreally have suffered. Net One assistsby providing prizes for the schools whichprovide the most blood in the variousProvinces. This introduces a competitivespirit amongst the schools to see howmany of their scholars they canpersuade to donate blood. Our otherregular donors are Mutare BottlingCompany and Delta Corporation thatdonated drinks worth $19 000 in 2009.

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If any of our members know of anybusinesses which might be prepared tohelp the Service by donating muchneeded supplies, please let us know.

Pledge 25 ClubThe efforts of the members of thePledge 25 Club are very muchappreciated. The Mens Splash, LadiesGala and Youth Donor Month which theyorganized were very successful. Ourthanks go to the Pledge 25 Club.

ConclusionI would like to conclude my report byexpressing my deepest appreciation tothe Management and other members ofstaff. No organization can succeedunless it has well trained and motivatedstaff and a Management team that issuitably qualified, experienced and

efficient. The NBSZ has come throughthe difficult years of 2008 and 2009 andmanaged to survive, thanks to the ChiefExecutive Officer, Mr. David Mvere, theMedical Director, Dr. Mac Chitiyo, othermembers of the ManagementCommittee and the staff generally. Weare going into 2010 with a strongfoundation and we hope that the Servicewill soon return to its position before2008, when it was able to satisfy all theneeds for safe blood at affordable prices.

JUSTICE L.G. SMITH (Rtd)CHAIRMAN

JUNE 2010

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BWE Medical Director’s Report

1. Blood SupplyThe mission statement of the Service is, among other provisions, to collectadequate and safe blood for the needs of the country. Throughout the world,Zimbabwe included, the demand for blood has increased faster than the supplyand in this context we record our failure to meet demand.

The challenges faced by the procurement department include:

i. Constant breakdown of mobile team vehicles for the greater part of 2009.The new vehicles recently received will, no doubt, put this challenge torest for some time to come.

ii. Unavailability of funds made it difficult for the mobile teams to stick to theadvertised time tables for bleeds. Funding will remain a challenge in 2010as the budget for the Service has been further trimmed down.

iii. The school pupils (16-20 years of age) who usually donate up to 70% or alittle more of the total only managed to give 64% of that total. Collectionwas affected by closure of schools for part of the year because the teacherswere on industrial action. However, the impact of lowered collections onmajor referral hospitals was off-set by reduced demand by these hospitals.It became apparent that patients were moving away from city hospitals toout-lying mission hospitals which are not only cheaper but also use lessblood. These hospitals complain about the high cost of blood. The popularmission hospitals in Mashonaland include those at Howard, Mutoko andKaranda.

2. Blood SafetyThe transfusion-transmissible infection statistics shown along with bloodcollections indicate that HIV, Hepatitis B and C and Syphilis remained undergood control as a result of strict donor selection criteria. We are aware thatthere remains a residual risk of the window period with regard to viral infections.It is for this reason that our efforts to improve blood safety are moving in thedirection of Nucleic acid testing (NAT). The Service has actively engaged theCentres for Disease Control to assist us in setting up a NAT laboratory, and wehope this will come to fruition in 2010.

3. Failed copper sulphateA total of 1,117 donors failed the haemoglobin estimation test using the coppersulphate method in 2009 compared to 809 in 2008. This could be attributed to

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poor diet because of the attendant economic hardships. Ferrous sulphate tabletscould not be issued to these donors as they were not available on the market.

4. Autologous and Directed DonationsOver the years, the number of autologous donors has continued to decrease.For the second consecutive year no patients were referred for autologous blooddonation. No directed donations were conducted during the period under review,compared to 1 donation in 2008. This is the desired situation as such a donationsystem compromises the safety of the blood programme.

5. Therapeutic BleedsThere were 183 bleeds carried out in 2009: 173 in Harare, 8 in Mutare and 2 inBulawayo. These were largely for secondary polycythaemia a few forhaemochromatosis. The total number of procedures, was less than the 247carried out in 2009. There has been a considerable debate on the use of bloodcollected from haemochromatosis patients for allogeneic donation. The USAhas used such blood for transfusion since 1999. Switzerland, Canada andAustralia also use this blood. The Service has accepted as allogeneic donorshaemachromatosis patients who qualify.

6. The Apheresis UnitOnly one apheresis machine based at Headquarters in Harare was operating in2009. 134 units of single donor platelets were produced with no adverse events.No therapeutic procedures, either for – red cells or plasma exchange werecarried out.

7. Donor adverse eventsIn past years, fainting was not uncommon in school children, who form themajority of our blood donors. These reactions have reduced tremendously andonly one such case was reported in 2009. Usually these reactions, occurring ingroups of children are the result of a psychosomatic chain reaction through avisual and thought process. If one faints a number in the group will also faint. Itis possible that the decline in these attacks is the result of bonding andcamaradery brought about by the Pledge 25 Club.

8. Post-donation CounsellingDuring 2009, a reduced number of donors came for post-donation counselingwhen their test results were unsatisfactory. Our voluntary non-remunerateddonors are covered by the United Nations Universal Declaration on HumanRights and this Service respects the basic rights of the donor to health and toinformation and we have adequate procedures for proper post-donationcounseling. We can therefore safely say that these donors reneged on their

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right to information but the cause is not clear. Financial problems may be involved.Implementation of the donor rights and our obligation to them can only enhancethe confidence in blood supply for all involved – donors, patients and staff at theBlood Service.

On the contrary, paid donors (who we thankfully do not use) are covered by theright to property, rules for free trade, rights to equal market access and WorldTrade Organisation rules. A right to sell blood implies that any reason for donordeferral has to be interpreted narrowly in order to assure the right of access tothe blood market to anyone. Little or no attention is paid to the health of donorswilling to sell their blood to a consumer willing to pay the most. As a Service, weshould strive to show a donor the care enshrined on our mission statement.There were no family replacement or directed donations at the five centres ofthe Service in 2009. We are, however, aware that some mission hospitals areusing replacement donors, a practice that we discouraging through activeengagement. We are encouraging them to use alternatives to blood transfusionwhenever this is possible.

9. Transfusion reactions2009 had a total of 35 transfusion reactions which represented a decreasefrom 37 in 2008. Most of the cases reported minor symptoms which includedPyrexia (47%), Urticaria and rash (21%) and rigor (12%). The componentsinvolved in these cases whole blood 29 (82.9 %) and packed cells 6 (17.1%).

10. Visits/Conferences

i. Medical Director’s from Kenya Blood transfusion Service visited our Serviceduring the period 31 August – 4 September 2009. We had fruitfuldiscussions with them, covering topic such as:

v The role of the physician in a blood transfusion service

v History of blood transfusion

v The usefulness of blood or otherwise in blood transfusion.

ii. In the quest for new knowledge and in anticipation of future demands onthe Service the Bulawayo Branch Manager attended a cord blood bankingworkshop in Italy in November 2009. Cord blood represents a new sourceof stem and haemopoietic progenitor cells which are capable ofrepopulating a myeloblasted patient. Diseases such as leukaemia,lymphoma and haemoglobinopathies can be greatly alleviated by cordblood.

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iii. The Africa Society for Blood Transfusion 5th International Congress washeld in Nairobi from 24-27 June 2009. Senior members of the Service,including the Medical Director attended and presented papers which werewell received.

DR. M.E. CHITIYO

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1. IntroductionThe NBSZ maintained the ISO 9001: 2000 certification it earned in 2007. Thequality management system in place institutionalised the management of alldocumentation including Standard Operating Procedures (SOPS), standardisedtraining of staff using the SOPs and the auditing of all processes at every branchin a systematic way. This enabled NBSZ to continuously improve the quality ofproducts and services to the satisfaction of the customers.

The operating environment has continued to improve with most critical itemsreadily available only subject to resource constraints. Donor access has alsomarkedly improved and blood donors are more readily using the donation sites.However, demand for blood continued to drop because of the shortage ofspecialists in the hospitals and also the low capacity of the general public toaccess medical services in the private or public sector. The cost of blood hasalso been identified as a constraint as it is deemed still too high by hospitalsand patients and this may be a factor contributing to morbidity and mortalityespecially among obstetric cases. However, the stakeholders aware of thesechallenges have together with management worked alternate ways to addressthis for example by reducing the fees for mission hospitals in rural areas andalso special funding support for obstetric cases in the major referral and provincialhospitals.

Funding of the NBSZ remains a challenge. The current cost of producing a safeunit of blood remains high and unless government subsidises this cost throughgrants and other donations it is not possible for NBSZ to reduce these costs.The national economy is still struggling to return to normality and thereforegovernment income remains low and resource partner support is limited.Therefore, the capacity of government to subsidise the cost of blood productsand services remains low. NBSZ cannot afford to reduce operational costsanymore than current without risking the safety of the blood supply. The cashflow challenges persist together with low capacity to replace equipment orrefurbish existing premise. The NBSZ ended with an overall loss in its financialaccounts amounting to $574,961.

Overall the blood collections have declined by 14% to their lowest (42,074)ever due to slow recovery in the capacity of NBSZ to mobilise the donor public.Shortage of vehicles, staff, fuel and donor incentives all affected blood collectionsfrom a donor public that was equally compromised by the harsh socio-economicenvironment in which priorities were on food survival. Fortunately, the demandfor blood was also low because access to hospitals, lack of specialists andpharmaceuticals was a major contributory factor to the decline in admissions.

Chief Executive Officer’s Review of Operations

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The provision of blood products remained a challenge. The preparation of wetcomponents was affected by the continued lack of technical staff and equipmentespecially in Masvingo and Gweru branches. Unlike previous years where 98%of whole blood collections were processed into components the year saw almost20 % of all collections released as whole blood for transfusion. Approximately,64% of the FFP made was used for blood transfusion. Imported blood productssuch as Albumin and Rhesus Anti D Immunoglobulin were not readily availableand some mothers entitled to the prophylactic treatment did not receive theimmunoglobulin. The availability of Factor VIII & Factor IX was equally erraticwith supplies being sourced directly by the Zimbabwe Haemophilia Associ-ationfrom sister organization in Canada and the USA.

The WP risk climbed significantly from 11 per 100,000 donations to 14 per100,000 donations notwithstanding other factors such as data loss or shortageof reagents to confirm initially reactive samples in the current and previous yearwhich are difficult to reconcile. However, based on the overall increase in HIVseropositivity, the figures appear realistic. Supporting this view is the fact thatover 35 % of all donations were bled in dry bags, instead of the usual 20%. Thisreflected the relatively high risk population NBSZ staff screening donorsencountered. Discussions have started with CDC regarding funding NAT testingof blood donations. NAT testing will reduce the WP risk most markedly as theWP will be reduced from 14-21 days to 1-6 days.

2. Operational Performance Highlights

2.1 Blood Collection and SafetyDonations by the youth (16-19 years) accounted for 64% of total collections.The HIV sero-prevalence amongst the blood donor population increased to0.77% compared to 0.50% in 2008. The sero-prevalence of Hepatitis B andSyphilis also increased to 1.03% and 0.58% respectively in comparison toprevalence of 0.92% and 0.24% in 2008. Table 2.1 shows the blood collectionand testing results data. Figure 2.1 shows the trends in blood collections andHIV sero-prevalence and Figure 2.2 shows monthly blood collections trends.

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Table 2.1: Blood collections and TTI’s statistics

Collections HIV % HBV % Syphilis %

OVERALL 42074 326 0.77 432 1.03 242 0.58

Branch

Harare 17339 127 0.73 180 1.04 93 0.54

Bulawayo 6941 39 0.56 30 0.43 38 0.55

Gweru 5244 40 0.76 30 0.57 28 0.53

Mutare 6735 73 1.08 83 1.23 51 0.76

Masvingo 5815 47 0.81 109 1.87 32 0.55

Venue

Fixed Clinics 9387 45 0.48 41 0.44 44 0.47

Factories/Community 7777 121 1.56 90 1.16 93 1.20

Schools/colleges 24910 160 0.64 301 1.21 105 0.42

Sex

Females 18399 175 0.95 147 0.80 92 0.50

Males 23675 151 0.64 285 1.20 150 0.63

Age Group

16-20 27083 158 0.58 307 1.13 95 0.35

21-29 8260 91 1.10 78 0.94 36 0.44

30-39 3323 52 1.56 22 0.66 37 1.11

40-44 1007 13 1.29 13 1.29 22 2.18

45+ 2394 12 0.50 11 0.46 52 2.17

Risk Category

I (low) 14254 50 0.35 72 0.51 52 0.36

II 16367 128 0.78 224 1.37 88 0.54

III 3151 30 0.95 21 0.67 26 0.83

IV (High) 8253 118 1.43 114 1.38 76 0.92

Pack Type

Triple 16180 93 0.57 138 0.85 60 0.37

Single 11006 53 0.48 125 1.14 43 0.39

Dry 14675 179 1.22 169 1.15 138 0.94

Apheresis 127 0 0.00 0 0.00 0 0.00

Donor Type

Regular 17512 68 0.16 99 0.24 70 0.17

Lapsed 5225 39 0.75 59 1.13 34 0.65

New 19294 219 1.14 274 1.42 138 0.72

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Figure 2.1: Trends in Blood Collections and HIV Seroprevalence (1998-2009)

Figure 2.2: Trends in monthly blood collections (2005-2009)

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Table 2.2. Blood Donor Profiles

Characteristic Description Number %

Total Donors 31366 100

Branch Harare 12575 40Bulawayo 5252 17Gweru 4055 13Mutare 5161 16Masvingo 4323 14

Gender Females 14472 46Males 16894 54

Donation Site Fixed site 5736 18Mobile site 25626 82

Age Group 16-20 21841 7021-29 5657 1830-39 2022 640-44 614 245 + 1226 4

Donor Types Regular 7387 24Lapsed 5081 16New 18857 60

Blood Groups O 16171 52A 7842 25B 5858 19AB 1217 4

2.2 Blood Donor ProfilesA total of 31 366 donors donated in 2008 compared to 36 163 in 2008. Table2.2 shows the profile of donors in 2009.

2.3 Donor RetentionOf the 36 163 donors who donated in 2008, 9350 (26%) came back to donatein 2009. This is a further decline from the 2007/8 donor retention rate of 34%.

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2.4 Donor CounsellingPre-donation counselling was effectively carried out on all donors who donatedblood. Although there was a slight increase in donors who presented themselvesfor post donation counselling, the low turnout remains worrisome to NBSZ. TheService’s donor care role extends to the provision of post donation counsellingand in some instances referral to counselling organisations for supportcounselling. This has the effect of mitigating against the wanton spread of HIVand other transfusion transmissible-infections. The long awaited review of thedonor notification and counselling finally commenced in December 2009 and isset to be completed by June 2010. It is our conviction that through this reviewpolicy changes in the donor notification and referral system will indeed assist toimprove access to donor counselling by all donors in need.

2.5 Youth Programmes

2.5.1 Peer Promoters ProgrammeA total of 264 peer promoters from 130 schools received induction training.The schools targeted were those earmarked for Pledge 25 Club recruitment.Peer promoters are a strategic component of the donor recruitment programmeand are invaluable to the NBSZ in their work.

2.5.2 Pledge 25 ClubA total of 5054 units, constituting 12% of total blood collections were collectedfrom the Pledge 25 Club blood drives namely the Men’s Splash, Ladies Galaand Youth Donor Month (YDM). These blood drives are organised during schoolholidays in order to meet the potential shortfall of blood supplies during schoolholidays. A total of 1 476 units were collected during the YDM compared to1 522 units in 2008. The Club was invited to, and participated in activitiesorganised by the Zimbabwe Red Cross in Nyanga, Rotaract Club in Harare,Junior Chamber International Kwekwe, Volunteers Services International inHarare and Zimbabwe Aids Network. The Club’s Annual General Meeting washeld in Nyanga where new office bearers were elected. This was followed upby a Strategic Plan Workshop that was held in Masvingo where a three yearstrategic plan was crafted.

2.6 Public Relations and Special eventsThe Harare, Bulawayo and Mutare Annual General Meeting and Blood DonorAward Ceremonies were held. A number of blood donors were awardedcertificates and shields for achieving the 25, 50, 75, 100, 150, and 175 donationmilestones. Similar award ceremonies are planned for Gweru and Masvingobranches in the ensuing year. Net-One through its Easy Call brand sponsoredthe purchase of another caravan for use during blood collection drives. Theyalso supported the Provincial Schools Blood Donor Competion. The winning

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school for 2009 were Dewure High School in Masvingo Province, Regina MundiHigh School in Midlands Province, Waddilove High School in MashonalandEast Province Mabelreign Girls High in Harare Metropolitan Province, NgeziHigh School in Mashonaland West Province, Visitation High School inMashonaland Central Province, Mpopoma High School in Bulawayo MetropolitanProvince, John Tallach High School in Matabeleland North Province, MindaGirls High in Matabeleland South Province, and Anderson Adventist High Schoolin Manicaland Province.

3. Laboratory ServicesOverall there was a decline in the number of blood products received andprocessed by the laboratory. Component produc-tion continued. Disruptions inthe supply of test kits and reagents and equipment breakdown impacted on thenational blood supplies because of the centralised testing in place in Harare.

3.2 Blood Supplies

3.1 Blood products stocked

56%

33%

8%3%

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3.3 Testing equipment performanceConstant breakdowns of the analysers for transfusion transmissible infectionswas a major challenge during the year. The poor maintenance by the localservice engineers and poor support from their principals were responsible.However, new agreements were put in place with the service engineers to ensurethat the equipment was well maintained for the rest of the year.

3.4 Blood Cold ChainThe performance of cold rooms and freezers remains a challenge as most ofthese are very old now and requires refurbishment. No new equipment wasbought or refurbished.

4. Human Resources

4.1 StaffingThe average monthly staff establishment of 167 was recorded in 2009 comparedto 171 in 2008. Appointment of staff was limited to critical positions only asmost posts were postponed to 2010 due to budgetary constraints. The employeeturnover rate of 5.3% was recorded and this reflects how much the organizationretains its staff with a staff retention rate of 97%. The recommendations of thestaff satisfaction survey done in 2008 were implemented and together with thehumanitarian assistance from Swiss Red Cross also provided further relief andincentives to staff.

4.2 Staff training and developmentTable 4.2 shows external staff training and development programme for 2009.Some training activities were deferred to 2010 due to financial constraints.

Table 4.2 Staff Trainings

Activities Trainees

1. Managing and implanting windows 2003 Server 1

2. Certified Network Associate (CISCO) 1

3. Defensive Driving Course 3

4. QMS Internal Auditing 5

5. Systemic Counselling 6

6. ISO 9001: 2008 Transition 167

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5. Quality Management SystemTwo external audits were carried out by Standards Association of Zimbabwe(SAZ) in March and November 2009. There were no internal audits due toshortage of internal auditors. The Service did not receive Proficiency Testing(PT) samples from SANBS due to reported challenges at SANBS. The Servicereceived four PT shipments from ZINQAP and all the participants passed. TheUK NEQAS and the Australian NRL schemes were not subscribed to due tobudgetary constraints.

6. Purchasing, Infrastructure and Maintenance

6.1 Purchasing and SupplyThe procurement process did well in 2009 as compared to 2008, mainly becauseof the adoption of a multicurrency in 2009. The Service managed to source criticalproducts in 2009 for its core operations. The Service received two Nissan Doublecabs as part of the financial support from SRC. The service further receiveddonation of 16 vehicles from the Expanded Support Programme (ESP) of theMinistry of Health and Child Welfare for use by mobile clinics. ESP also providedthe bulk of laboratory reagents, test kits and blood bags worth USD669,488.00 in2009. WHO provided US$38,590.41 for the procurement of computers, laboratoryequipment. Delta beverages provided soft drinks for donor comforts for 10 months.The Service managed to retain all outsourcing contracts, which include IT, Laundry,Equipment maintenance, Cold chain maintenance, plumbing and transport. Theoutsourcing or subcontracting provide NBSZ with the most economic way oflowering costs. High costs of utilities such as telephone, electricity and watercontinue to affect the payment pattern of other critical suppliers.

6.2 InfrastructureRefurbishment of all branches was not achieved due to financial constraints.

6.3 Stand-by GeneratorsThe standby generators at all branches continue to perform well despite theexcessive power outages. ZESA has been approached to spare NBSZ facilitiesfrom load shedding, but no progress has been reported to date. These powersupplies interruptions continue to threaten blood supplies.

6.4 Information Communication TechnologyAlthough the state of computers for the year was satisfactory, most of thecomputers now need to be replaced. Bar-code scanners are also needed TheService upgraded the speed of the internet connection from 128 kb to 512 kb,and together with the change from the leased line to the Powertel fibre linkimproved the speed of the Wide Area Network and internet. The Local AreaNetwork (LAN) and Wide Area Network (WAN) have not been stable for most ofthe year due to power cuts and disconnection on the fibre link by Powertel.Bulawayo which is connected through fibre was greatly affected during the first

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quarter of the year. The network uptime for the year averaged 92.1%. Newlaptops and desktops were procured. The Safenet re-design project is stillongoing, but there isn’t any significant progress from the consultants responsiblefor the project. Three members of staff went for content management trainingat Cyberplexafrica to update and improve the website and changes are beingmade on the website.

7. Research, Development and Data Management7.1 Research Activities

A protocol to evaluate the over 10 year old donor notification and counselling modelwas developed and approved. It is designed in three phases: (i) Phase I involvesreviewing the NBSZ counselling programme/data and started in December 2009for all branches; (ii) Phase II targets counselling partner organisations; and(iii) Phase III is a survey soliciting views from public, donors and stakeholders onhow to improve on the donor notification and counselling system. Several studentresearches were supported by the Service in 2009.

7.2 Data ManagementThe Donor Records was ear-marked for transformation into a data managementunit and a concept paper to that effect was developed. A national re-orientationworkshop for the seven staff was held in July 2009. This will strengthen datamanagement for both routine operations and in research work.

7.3 Strategic PlanningThe Service developed a strategic recovery plan May - December 2009 to helpthe Service recover from the socio-economic situation that had be-delved thecountry. This was done after the formation of the Inclusive Government whichrevived the country’s hope. The implementation of the Service 5-year strategicplan (2006-2011) will only be realistic if the Service first fully recover henceneed for the recovery plan to mimic the Government Short Term EconomicRecovery Plan (STERP) initiative. A review of the implementation of the recoveryplan was conducted in October/November 2009 and it shows that the Servicehad not fully recovered though some progress were noted.

7.4 Collaborative ActivitiesThe Service signed an MoU with Biomedical Research and Training Institute(BRTI) to collaborate in research and development activities on blood transfusion.In pursuit of the 2007 Memorandum of Understanding (MoU) with SANBS tocollaborate in various activities, including research and development threemembers of the management visited SANBS on a three day business trip inAugust 2009. The main objective of the visit was to familiarise with SANBSoperations and identify areas of immediate collaboration. A joint action planwas developed and approved for implementation in 2010.

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7.5 International/National Congresses, Conferences and TrainingsThe NBSZ participated at the 2009 AfSBT 5th International Congress that washeld in June in Nairobi, Kenya. The Service contributed 11 presentations to theCongress Scientific programme. The CEO was re-elected for the third termrunning to the post of Secretary General of the AfSBT for further two years. TheGeneral Assebly of Delegates approved the restructuring of AfSBT into fourregions of SADC, ECA, ECOWAS and RAFT. It also established an ExecutiveArm of the AfSBT. Three staff members participated at the SANBS conferencethat was held in Johannesburg in October 2009. One member participated atthe Reviewers Forum that was held by MRCZ at Crown Plaza in November2009. One member attended a Transfusion Medicine Research Course (Trainingin Clinical Research – International Transfusion Safety) at the Western ProvinceBlood Transfusion Service in Cape Town, South Africa from 28 September to7 October 2009.

8. Financial PerformanceThe Service’s functional and presentation currency changed from Zimbabwe Dollarsto United States Dollars effective 1 February 2009. The turnover for the yearamounted to $3.6 million. The Association realized a loss of $574,961. The property,plant and equipment amounted to $961,449. Current Assets amounted to$949,076 and included trade receivables of $487,989 mainly attributable to NBSZ’smajor customer the Ministry of Health and Child Welfare. The current liabilities of$1.6 million comprised of trade creditors, salary arrears and statutory paymentsarrears. Though the country’s economy is projected to growth, the health sectorenvironment still remains uncertain due to liquidity problems of the Government ofZimbabwe; which is a major player in the health sector.

The full audited financial statements are shown in Appendix I.

D. A. MVERE

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Appendix I

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Appendix II

Range of products and services

1. Whole Blood

2. Autologous donations

3. Red cell concentrates• Red cell concentrates in additive solution, buffy coat removed• Leucocytes poor red cell concentrates• Red cell concentrates, washed• Red cell concentrates, paediatric

4. Frozen blood products• Fresh frozen plasma• Cryoprecipitate

5. Platelets• Platelets concentrates – single random donor• Platelets concentrates – aphaeresis

6. Viral inactivated plasma derivatives• Immunoglobulins• Albumin• Factor VIII• Factor IX

7. Donor sample testing• Blood Group serology• Compatibility testing• Transfusion transmissible infections testing

8. Therapeutic Services• Therapeutic venesection• Therapeutic aphaeresis

9. Paternity Studies

10. HLA / Tissue Typing

11. Any other related services as deemed appropriate by the Service or Ministry ofHealth & Child Welfare

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