UNITED NATIONS DEVELOPMENT

PROGRAMME

AZERBAIJAN

REHABILITATION OF BLOOD TRANSFUSION

SERVICES IN AZERBAIJAN

00034950

Final Project Evaluation Report

Prepared by Casper Jersild December 2006

 Table of Contents

1 Executive Summary....................................................................................................3
2 Project and Concept Design........................................................................................1
2.1 Context of the Project...........................................................................................1
2.2 Project Document ................................................................................................1
3 Project Implementation...............................................................................................2
3.1 Activities..............................................................................................................2
3.2 Quality of Monitoring and Backstopping.............................................................2
1.1.1Monitoring and Evaluation of Individual Project Activities..........................2
4 Project Results.............................................................................................................5
4.1 Relevance.............................................................................................................5
4.2 Efficiency.............................................................................................................6
4.3 Outputs.................................................................................................................6
4.4 Immediate Objectives...........................................................................................7
4.5 Development Objective........................................................................................8
4.6 Effectiveness........................................................................................................8
4.7 Capacity Building.................................................................................................8
4.8 Impact...................................................................................................................9
4.9 Sustainability........................................................................................................9
4.10 Follow-up...........................................................................................................9
5 Conclusions...............................................................................................................10
5.1 Relevance...........................................................................................................10
5.2 Performance........................................................................................................10
5.3 Success...............................................................................................................10
6 Recommendations.....................................................................................................11
6.1 To UNDP and other UN partners.......................................................................12
6.2 To the Host Government....................................................................................12
7 Lessons Learned........................................................................................................12
8 Annexes.....................................................................................................................14
8.1 Persons met.........................................................................................................14
8.2 Documents reviewed..........................................................................................15
 List of Abbreviation

BB Blood Bank
BTS Blood Transfusion Service
FFP Fresh Frozen Plasma
HIV/AIDS Human Immunodeficiency Virus/Acquired
Immunodeficiency Syndrome
IDU Injecting Drug Users
IEC Information, Education and Communication
ILO International Labour Organisation
M&E Monitoring and Evaluation
MoE Ministry of Education
MoF Ministry of Finance
MoH Ministry of Health
NGO Non-Governmental Organization
NPD National Project Director
NSF National Strategic Framework
PEPFAR U.S. President’s Emergency Program for
AIDS Relief
PIU Project Implementation Unit
PLWHA People living with HIV/AIDS
PMTCT Prevention of Mother to Child Transmission
RBC Red Blood Cells
SIDA Swedish International Development Agency
STI Sexual Transmitted Infection
ToR Terms of Reference
UNAIDS United Nations Joint Program on HIV/AIDS
UNDP United Nation Development Program
UNODC UN Office on Drugs and Crime
USAID US Agency for International Development
VCT Voluntary Counseling and Testing
WHO World Health Organization
Introduction and Acknowledgements

The Project Rehabilitation of Blood Transfusion Services in Azerbaijan was

initiated based on the identified needs described during 2001 in a report from
UNOPS. The tender process began by May 2002, and Pricewaterhousecoopers
Advisory in Norway was contracted by UNOPS in October 2002 for the whole project
period in 2003 and 2004. Beginning 2004, following application from UNDP, the
Ministry of Foreign Affairs in Norway provided additional financial support, and the
project was extended to the beginning of 2005. In order to finalise remaining project
activities and give higher priority to a sustainable development, the project was
extended once more in 2005, again funded by the Norwegian Ministry of Foreign
Affairs and also co-funded by UNDP, who took over responsibility for the execution
of the project from 2004 and onwards.

The main components of this project were:

• Assist in formulation of a Legal Framework for the BTS
• Improve Clinical use of Blood
• Donor recruitment and retention
• Safe blood, including testing of blood, production of blood components and
establishing a Quality System.
• Research and education
• Blood Bank management training
• IT development

This evaluation covers the project throughout its duration from October 2002
to the end of 2006 and was conducted from December 6 – 15, 2006, thus approx. 10
months after the completion of the project.

I would like to acknowledge the invaluable assistance provided to me by the

UNDP office in Baku, my translator and my driver for the duration of this evaluation.

Casper Jersild
December 2006
1 Executive Summary
Overall the project 00034950 was well designed and addressed a grave
situation within the Blood Transfusion Service of not being able to deliver safe blood
in sufficient quantities to the health care system. In fact, blood supply has been so low
that patients have died due to lack of blood transfusion. At the same time the majority
of donors were paid, which carried a higher risk for their blood being infected with
types of viral infections, which can be transmitted to the recipient patient. In particular
the rising frequency of HIV/AIDS in the population has been of concern, and was the
driving force for this project to be implemented.
Changing the blood donor population from paid donors to un-paid is a major
undertaking, and the Red Crescent Society of Azerbaijan has been willing to
undertake the task of recruiting new donors. This was done under a service contract
with the Blood Services and a letter of understanding. Substantial improvement in
number of non paid donors attending blood donation sessions has been seen, the
increase from 2002 to 2005 being over 60%.
The project focused on the legal frame for a blood transfusion service, and the
passing of a new Law for this area was an important contribution. It has been drafted
by the Contractors of the project but also broadly discussed by blood bank directors in
the country as well as Members of the Parliament and Ministry of Health. It is now
ready for implementation. A significant sign of commitment to implement the Law on
the part of the Government is manifested in the adoption of a National Strategy on
Blood Safety and Donations.
Introduction of a computer system for the blood bank in Baku has been a
major step forward for modernising the blood service. It is expected to be
implemented also in the 4 other regional blood banks in the country. In modern blood
banking, the large number of information collected in connection to blood donation
and testing has to be correctly recorded, and the computer system does provide an
excellent mean of securing accurate documentation.
Finally the project provided technical support and training to blood bank staff,
including study tours to some blood banks in Oslo. This was highly motivating for the
staff, which also was able to better accept changes in workflow in the Baku blood
bank following a renovation.
In order to sustain project achievements, the following issues will need to be
addressed:
• Implementation of the new Law on Blood Transfusion and new
National Strategy on Blood Safety and Donations on Blood
Transfusion
• Continuation of training and capability strengthening
• Recruitment of blood donors needs to be strengthened further.
• Continuation of the project should be explored and funds applied for.
• For the UN system, it is recommended that Project Management for an
extended project remains with UNDP. It is also recommended that
UNDP explore the possibility of a shared project responsibility with
WHO Euro, who will be able to provide technical advise and training
opportunities.
2 Project and Concept Design
2.1 Context of the Project
Given the present epidemiological situation in Azerbaijan with high
prevalence rates of HIV and Hepatitis types B and C, which all can be transmitted by
blood transfusion, it can be concluded that the UNDP project concept, design and
institutional arrangements were highly appropriate at the time of approval.
The project documents specifically addresses the opportunity of collaboration
and cost sharing from several organisations, including UNDP, UNOPS, WHO Euro,
National Red Crescent, International Federation of Red Cross and Council of Europe
as well as WHO Azerbaijan, and MOH. The established Coordination Committee of
the project took advantage of the UNDP Azerbaijan Office’s administrative
capabilities as the main multilateral partner in terms of project execution. The
Committee acted as a forum for coordinating the various activities in the area of blood
safety with the stakeholders such as bringing the various organisations together for
dialog and practical collaboration.

2.2 Project Document

The project document is well designed and gives a clear outline of the project
approach to be used in addressing the different components of the project.

The Technical Approach

The project focused on developing the capacities of the existing staff and
systems of the selected blood banks. Due to the limited funds available, Norwegian
Consultants were only present in the country during several shorter visits. The blood
bank staffs were assigned specific activities contributing to the overall goals of the
project, and these activities were then followed up by the consultants on each visit. A
national project manager working full-time in the blood bank was assisting the UNDP
project manager in planning, preparing, announcing, evaluating and finalising
procurement of blood bank equipment, consumables and IT-equipment. In addition
selected BB staffs were trained at the BB’s in Oslo, Norway during several short term
visits.

Objectives, Indicators and Major Assumptions

Immediate objectives are realistic, clearly stated, and highly relevant.
Indicators relating to capacity building and transfer of knowledge are lacking, but
activities to be implemented are listed. This makes it difficult to systematically and
objectively determine the effectiveness and efficiency of these actions or their impact.
The Inception Report by the Contractors specifically lists several presumptions
or risks, which all seem very realistic.

Project Evaluation Report December 2006 Page 1 of 18 pages

 Modalities of Execution
The first phase of the project was implemented through UNOPS using funds
for Norwegian Consultancy Services and Programme Activities. The second phase of
the project was implemented according to the direct execution modality. UNDP as
executing agency held overall management responsibilities of the project.
A detailed evaluation and monitoring mechanism is outlined in the project
plan, which did provide an excellent overview of impact, fulfilment of objectives and
achievement of outputs. A total of four bi-annual project reports have been published
of which the latest dated 15 March 2006 is the final report. In addition, a sustainability
analysis has been reported in November 2003.
It should however be noted that activities related to capacity building, training
sessions held in Oslo and courses in Blood Bank Management were not assessed by
pre- and post-training assessment of participants or impact documented in other ways.

3 Project Implementation
3.1 Activities
Those involved in the project reported that the quality of backstopping from
UNDP and the UNDP Programme Officer in particular was highly satisfactory, and
that the Programme Officer ensured maximum success of the project under the given
circumstances. No major delays or barriers were noted as a result of UNDP
backstopping.
The major parts of the activities planned in the project documents were
undertaken. Lack of appropriate funding from the MOH for daily consumables, i.e.
blood bags, made it impossible to implement the production of blood components.
Participants and blood bank staff generally noted a large degree of satisfaction
with international experts and consultants involved in the project. The aim of creating
a long-term relation between involved parties both within Azerbaijan and with
Norwegian sister organisation were fully accomplished.

3.2 Quality of Monitoring and Backstopping

1.1.1 Monitoring and Evaluation of Individual Project Activities
A. With National Focus.
1. Sustainability analysis for Blood Transfusion Services.
A comprehensive Sustainability Analysis was delivered by the Consultants in
November 2003. It discusses in great detail the following issues: (1) The present
transfusion service in Azerbaijan, (2) Quality issues related to blood and blood
components, (3) An estimate of future need for blood in Azerbaijan and its clinical
use, (4) Analysis of costs connected to production of blood, (5) Models for cost
recovery and financing of the national blood transfusion service, (6) A Future

Project Evaluation Report December 2006 Page 2 of 18 pages

structure and organisation of the national blood bank and transfusion service, and (7)
A detailed discussion and recommendations.
The Sustainability analysis does provide a balanced and useful discussion of
the many and various aspects of a blood transfusion service which needs to be taken
into consideration by the Government if the further development shall be successful.
The project delivered in full the planned activity.

2. Legal framework.
A Draft Law regulating the Blood Transfusion Service in Azerbaijan was
developed and presented to the Parliament, who held several hearings on this topic. In
addition a visit to Norway for some members of Parliament to meet with counterparts
in Norway was arranged. Following initial hearings, the draft law passed the third and
final hearing on 3rd May 2005.
National Strategy on Blood Safety and Donations regulating the Blood
Transfusion Service in Azerbaijan was developed by the MOH and the Blood Banks
as an implementing mechanism for the Law, without support of the project.
At present, the national regulatory framework for blood safety and donations
consists of four separate papers: (1) The Law of the Republic of Azerbaijan: On
donation of blood and blood components and blood transfusion services; (2) Directive
No. 4082 of 29. July 2005; and (3) Decree of the President of the Republic of
Azerbaijan: On implementation of the Law of the Republic of Azerbaijan on “Blood
and Blood components donation and blood transfusion service”; 4) National Strategy
on Blood Safety and Donations.
It should be noted that:
1. The Law does have regulations regarding remunerated blood donations
(Chapter 1, article 4.3, and Chapter 2, articles 7 and 10), which are not in
line with WHO guidelines, Council of Europe Guidelines, and EU
Directives. A safe blood donor is always non-remunerated, and does not
receive whole days off work.
2. The State is responsible for providing a licensing mechanism for all blood
banks however the detail of how this is done and who is responsible is not
mentioned in the Law (Chapter 1, article 3).
3. The organizational structure of the BTS is not described in any details, and
especially is management responsibilities, including financial management
not outlined.
The project delivered the planned activity, although the present law should be
adjusted in order to fully rely on safe blood donors. Also implementation of the new
National Strategy on Blood Safety and Donations and especially establishment of
regular GMP inspections by a national authority has however not yet materialised.

3. Clinical use of Blood

Printing of guidelines for clinicians on clinical use of blood was one of the
main activities. The Council of Europe “Guide on the preparation, use and quality
assurance of blood components” 10th Edition was translated into Azeri language by

Project Evaluation Report December 2006 Page 3 of 18 pages

the project. In addition WHO Azerbaijan arranged for the translation of its handbook:
“Clinical use of Blood”. And finally, a major conference for approx. 250 clinicians
was held in Baku 27 October 2005.
The project thus delivered in full the planned activity.

4. Donor Recruitment and Retention

The most important activity of this project was to increase the number of non-
paid, voluntary blood donors and to create a panel of repeat donors with low risk for
TTI’s. In order to monitor this activity the project developed a comprehensive data
collection sheet to cover the main blood bank activities. This ensured a uniform
reporting of data related to blood donation and their use and this also ensured a
reliable set of detailed data for evaluation of progress. The data sheets were developed
by the consultants in close collaboration with senior blood bank staff.
Recruitment of blood donors was carried out by the Red Crescent Society of
Azerbaijan, based on a memorandum of understanding between the Institute and the
RC. Reporting of the RC activities is not detailed as to number of recruitment sessions
held and outcome in terms of persons willing to become a blood donor. In the future
however, they will report outcome of activities, which may facilitate a more focused
approach to upcoming recruitment efforts.
As a result of the project, a close collaboration between the RC of Azerbaijan,
IFCR in Azerbaijan, the Norwegian RC and the Institute has been created and will
contribute to the sustainability of this activity.
In terms of actual blood donations the collected data shows that donations rose
from 14.057 (2002) to 22.862 (2005). Data for 2006 are not yet available. During the
same period the percentage of unpaid voluntary donors rose from 48% (2003) to 76%
(2005) for the Baku Blood Bank, and a similar increase was recorded for the Ganja
Blood Bank.
The project has thus performed well according to projected activity.

B. Local Activities
1. Safe Blood (Test Line, Product Line, Quality Systems)
Appropriate testing of all collected blood was ensured by provision of test kits
(initially procured by the project) and new ELISA equipment delivered during April
2003. The staffs were very knowledgeable and performed these tests well. Test
routines were changed by the consultants in order to assure a smoother and more
reliable testing process than what had existed before.
Production of blood components, Red Cells in Additive Solution, FFP and
Platelets, has been planned for but yet implemented despite the fact that necessary
equipment and and limited number of triple blood bags has been procured.
Development of a quality management system has been initiated through
lectures given, development of a standardised frame for Standard Operation
Procedures, and creation of a supporting project group to assist Blood Banks in Baku
and Ganja. Visit to the Baku Blood Bank with interview with its director did not bring
any evidence that a more comprehensive quality management system was in place.

Project Evaluation Report December 2006 Page 4 of 18 pages

There were no organogram of the institute, job descriptions or records of training of
staff. Also from visit to the different laboratories, there were no recording of
maintenance of equipment. Production of SOP’s were initiated, and in use.
2. Research and Education
Training and education has been an integral part of all visits of consultants to
Azerbaijan. In addition a total of 16 people from Azerbaijan with relation to the
project have been visiting Norway in smaller groups and on several occasions during
the project. The aims of educational activities are well documented however there is
no evaluation of training outcome documented. From interviewing some of the
participating staff members it is clear, that the overall objectives of this activity were
reached. In addition these visits contributed to motivate staff and give them an in
depth understanding of modern blood banking in Europe.
Input from WHO Euro in training sessions on Clinical use of Blood is seen as
a result of the collaborative efforts of the Project Coordination Group.
The project has thus performed well according to planned project activities.

3. Blood Bank and Project Management

Consultants have met on several occasions with senior blood bank staff in both
Baku and Ganja providing guide on Quality Management requirements. Discussions
and meeting on work flow in the blood banks, organisation of regular training
activities for staff members, and computerisation of the blood bank in Baku has been
the main activities.
Measurable indicators for these activities are lacking, but verification of
outcome for the Baku blood bank has been done through visit and interview with
various staff members.
In conclusion there are no firm indicators attached to these activities, but it is
obvious that the workflow in the blood bank has been revised and allows a smoother
workflow. Also the handlings of blood donors seems now to be more in line with the
new requirements, and are user friendly to the donors.

4. IT Development
A blood bank computer system was installed and in use in the Baku Blood
Bank by the end of 2005. The system is of major importance for accurate recording of
all data produced in the blood bank and minimises the risk for introduction of errors.
The project delivered more than expected in this activity.

4 Project Results
4.1 Relevance

All aspects of the project were and remain highly relevant, particularly given
(a) indicators for HIV/AIDS, Hepatitis B and Hepatitis C in the general population
and particular among paid donors, (b) the continued efforts to shift blood supply from

Project Evaluation Report December 2006 Page 5 of 18 pages

paid blood donors to safe recurrent, non-paid blood donors, (c) implementation of
quality management standards for blood banks, (d) increased the availability of blood
for health care.

4.2 Efficiency

Project resources were efficiently used also given the low level of previous
activity and funding from Government. No major delays in project implementation
have been noted.
Efficiency issues in regard to specific components include:
At National level there was a high degree of efficiency in formulating,
presenting and having the legal framework for blood transfusion services produced
and approved. Implementation of the National Strategy on Blood Safety and
Donations is to a high degree the responsibility of Government, but the project have
been promoting this case effectively.
The clinical use of blood provided relevant literature translated into Azeri in
an efficient way and for donor recruitment and retention the operation carried out
by Red Cross in Azerbaijan has been implemented in an efficient way. Since this is a
nation wide approach it should be noted, that verification of implementation outside
Baku has not been established during this assessment.
At he Local Blood Bank Level safe blood, research and education, blood bank
and project management as well as IT development, have all been efficiently
implemented taking into account the shortfalls listed above.

4.3 Outputs

Outputs were all achieved, albeit to varying degrees. The lack of verifiable
means to measure the precise degree to which some of the outputs were met
forecloses a definitive judgement on the extent of their success.
The following outputs deserve to be commented:
1. Blood Bank related product and service are further developed and/or
improved. The target output states that at least two product or service lines
are developed or substantially improved. As mentioned earlier lack of
supply of useful blood bags for production of blood components have
delayed this activity, which is not completed. It is mainly the responsibility
of the MOH to procure consumables for the daily running of the blood
banks, and the project as such is not to blame. Equipment, training and other
necessary items are in place and provided by the project.
2. Framework for blood donor recruitment developed. This output has been
met in full, however the workload and the necessary coordination with the
individual blood bank does make it more appropriate that the blood bank
appoint a blood donor manager.
3. Institutional, policy and legal framework related to blood transfusion are
revised and improved. The Contractor has provided invaluable assistance in
formulating and presenting the new Law of the Republic of Azerbaijan: On

Project Evaluation Report December 2006 Page 6 of 18 pages

 donation of blood and blood components and blood transfusion services.
The output was met in full.

4.4 Immediate Objectives

The immediate objectives of the project included:

• Education and transfer of knowledge in blood bank management.
• Development of new product and service lines in the blood bank.
• Provision of equipment and supplies to blood banks in Baku and Ganja.
• Development of a new legal framework and sustainability analysis for blood
transfusion service.
• Promotion of modern approaches to clinical use of blood.
• Building a panel of voluntary, non-remunerated blood donors.
• Promotion of quality assurance schemes.
• Computerization of blood bank procedures.

Education and transfer of knowledge: This immediate objective can be said

to have been achieved. Although there are only scheduled visits and training sessions
to verify the associated activities and not firm indicators such as level of knowledge
before and after training, it is the general impression, that the objective has been
accomplished. This view is supported by interview with the Contractor as well as
selected staff at the Baku Blood Bank.

Development of new product and service lines in the blood bank The
technical conditions for implementation of a new product line with respect to training,
provision of equipment and renovation of premises have all been fulfilled. However a
new product line for blood components is at present not functioning due to lack of
suitable blood bags to be procured by the MOH.
Provision of equipment and supplies: This objective has been accomplished,
equipment received and installed.
Development of a new legal framework and sustainability analysis: The Law
of the Republic of Azerbaijan: On donation of blood and blood components and blood
transfusion services was drafted and passed the Parliament on the 3rd of May 2005.
New National Strategy on Blood Safety and Donations was developed and approved
by the Government. The objective has been achieved in full.
Promotion of modern approaches to clinical use of blood: WHO guidelines
on clinical use of blood has been translated into Azeri language, and a seminar held
for clinicians. The objective has been accomplished.
Building a panel of voluntary, non-remunerated blood donors. Collaboration
with Red Cross, who recruit new blood donors, have been partly successful in Baku
and Ganja. However more efforts need to be put into this activity, which can be
verified to have been only partly accomplished.
Promotion of quality assurance schemes. The only verifiable component of
this objective has been the production of SOP’s related to individual work areas of

Project Evaluation Report December 2006 Page 7 of 18 pages

importance. Training in how to develop these guidelines has been provided and a
general training in GMP has also been provided. This objective has only been partly
accomplished.
Computerization of blood bank procedures: A computer system was installed
in the blood bank in Baku, staff trained in use, and the system is actually working.
This objective has been fully accomplished.

4.5 Development Objective

The overall objective of this project is to improve the capacities of the Blood
Banks in Azerbaijan in order to increase their production of a sufficient quantity of
safe blood units of high quality to cover the needs of the health cares system of
Azerbaijan. The two blood banks, one in Baku and one in Ganja, can in the future act
as examples and eventually become centers for further training. This will assist in
dissemination and transfer of knowledge to other blood banks in Azerbaijan. It is
firmly advised that technical support and expert assistance will continue in the
country during this new phase.

4.6 Effectiveness

The overall effectiveness of the project has been very satisfactory. The few
components which were less effective were influenced by outside factors, such as low
government funding. This is especially true for the establishment of the blood
component production.

4.7 Capacity Building

Objective means for verifying increases in capacity amongst the staff of the
National Blood Transfusion Service, in particular in Baku and Ganja, are not
available. However, visits and interviewing the various participants in formal training
sessions and visits to Oslo, the overwhelming expression by the participants is that
they have benefited quite substantially. It also adds to the difficulty of verification,
that the International Consultants from Norway conducted more on the spot and
informal training, discussions and instructions, which undoubtedly have been useful
for the staff. This can be indirectly verified by observing the work in the laboratories
and donor reception as well as the changed workflow.
Executing Agency: The UNDP has no previous experience in implementing
safe blood projects. It is however evident that the UNDP Project Manager in
Azerbaijan has gone through a learning process and now is very knowledgeable in
many aspects of blood banking. The project execution has been very effectively
handled by the local UNDP Office.
Governmental Counterparts: Through the project special care was taken to
inform members of Parliament about the requirements for modern blood banking.
Selected members of the Health Committee of the Parliament were brought to
Norway to discuss and create a network with their counterparts. This was of
significant importance for the successful approbation of the new Law of the Republic
of Azerbaijan: On donation of blood and blood components and blood transfusion
services and its subsequent implementation through a new National Strategy on Blood
Safety and Donations on Blood Transfusion Services in Azerbaijan.
Project Evaluation Report December 2006 Page 8 of 18 pages
 NGO’s: Azerbaijan Red Crescent Society has played a significant role in
mobilising new donors. The output has been verifiable and has been documented in
several reports by the Contractor. It should be noted that the UNDP programme on
HIV/AIDS have provided training for the Red Crescent staff.

4.8 Impact

Even the fact that the project closed some 10 months ago, it is still difficult to
assess the overall impact. The following can however be stated:
It is possible to recruit non-paid, voluntary blood donors in Azerbaijan.
However in order to meet the needs for safe blood in the health care, there should be
devoted more resources into this field both from the Blood Banks, MOH and the Red
Crescent Society. Also the activities should be expanded more effectively in other
regions of the country especially where regional blood banks are located.
The impact on HIV-transmission by blood transfusion can not be verified due
to very low numbers and lack of reliable statistics.
The amount of blood unit made available to the health care has increased but it
has still not reached an acceptable level. Patients are still dying because they have no
access to blood transfusion.

4.9 Sustainability

Some positive factors, which will ensure the sustainability of the project,
include:
• Increase in budgets for the National Blood Transfusion Service from
year 2007, as indicated by the MOH.
• Existence of a network to transfusion specialists in Norway, who will
be willing to assist further development.
• Implementation of the new National Strategy on Blood Safety and
Donations on Blood Services will improve operation of blood banks.
Risks that may hinder sustainability of project achievements include:
• Lack of capability to organise a true nationwide Service.
• Lack of a clear plan for implementing a National Blood Transfusion
Service with its allocated budget, especially serving the rural areas of
the country.

4.10 Follow-up

In terms of planning for follow-up, the following observations can be made:

Implementation of the new National Strategy on Blood Safety and
Donations on Blood Transfusion needs to be implemented. This task will require the
Project Evaluation Report December 2006 Page 9 of 18 pages
full attention of the Medical Directors at the National Institute as well as the Regional
Centres. It is therefore strongly advised that the international consultants continue
their work and that a stronger collaboration and participation with WHO Regional
Office will be established.
Continuation of training and capability strengthening is a very important next
step. It is advised that training will cover basic blood bank technology, and in order to
cover the large number of staff, it will be an advantage to use the Distance Learning
Materials developed by WHO. This learning material cover all essential parts of
running a blood transfusion service.
Continuation of the project should be explored and funds applied for. It is
envisaged that the Ministry of Health should cover the actual running cost of their
blood bank service, and fund should therefore be devoted primarily to technical
assistance and training.
Recruitment of blood donors needs to be strengthened further. It is advised
that special staff be recruited at the regional blood banks in order to work with the
Red Crescent Society in promotion and recruitment efforts. It is essential that this
work can be scaled up, and that the Red Crescent Society receives the necessary
funding through the Ministry of Health.

5 Conclusions
5.1 Relevance

All aspects of the project has been, and are still highly relevant, in particularly
given (a) a fundamental lack of safe blood available for the health care system in
Azerbaijan, (b) the high prevalence rate of HIV and Hepatitis B and C in the general
population and especially among the paid donors, and (c) protection of the consumer
(patient) against attracting fatal infections due to blood transfusion.

5.2 Performance
The execution and overall performance of the Executing Agency was rated
excellent. UNDP has played a major role in establishing a network between the
International Consultants and key persons within the Ministry of Health and
Parliament. The strategic approach to formulation of a draft Law of the Republic of
Azerbaijan: On donation of blood and blood components and blood transfusion
services was to a great extent helped by efforts within UNDP. Also the process of
procurement of equipment to the project was handled with great expertise.
The International Consultants performed well, and did a very good job in
creating good relations with their colleagues in Azerbaijan. This has led to a
friendship of lasting importance for future exchange of technical capabilities between
these two countries.

5.3 Success
Given the status of the blood transfusion service in year 2000, where services
to the health care system were not met at a relevant level, the project has been able to
reverse this situation to some extend for Baku and Ganja. What has hampered the

Project Evaluation Report December 2006 Page 10 of 18 pages

project to some extend has been the lack of appropriate funding from the Ministry of
Health leading to insufficient supplies of consumables and test kits.
At the time of project closure there is still left important steps in implementing
the new National Strategy on Blood Safety and Donations on Blood Transfusion,
including proper licensing and inspection mechanisms for GMP. In order to be of
value for the whole country, development of the other regional blood transfusion
centres should be initiated within the next years to come.

6 Recommendations
It is recommended that:
1. Implementation of the new National Strategy on Blood Safety and
Donations on Blood Transfusion is pursued at the Blood Bank level, and the
possibility of establishing a more formal management structure, which will include a
Board of Directors, a Financial Director, and Quality Managers, to be included in the
management structure. In addition, representatives of user’s of blood and blood bank
related services should be included in an Advisory Group to the Board of Directors.
It seems important that Azerbaijan’s legislation within the area of blood
transfusion is close to international standards and best practice. Payment of blood
donors and excessive compensations such as several days off work, should be further
regulated and conform to international standards for voluntary blood donors.
2. Continuation of technical assistance, including training and capability
strengthening through a continuation of the project and in collaboration with the
Norwegian experts. It is recommended that training will cover basic blood bank
technology. In order to cover the large number of staff and blood banks, it is
recommended that the Distance Learning Materials developed by WHO be used and
that a stronger collaboration and participation with WHO Regional Office will be
established.
3. Continuation of the project is recommended and appropriate funds applied
for. It is envisaged that the Ministry of Health should cover the actual running cost of
their blood bank service, such as test kits, blood bags and other consumables. Project
funds should be devoted primarily to specific technical assistance and staff training.
4. Recruitment of non-paid, voluntary blood donors should be strengthened
further. It is therefore recommended that special staff be recruited at each of the
regional blood banks in order to work with the Red Crescent Society in promotion and
recruitment efforts. It is essential that this work can be scaled up, and it is therefore
also recommended that the Red Crescent Society receives additional funding through
the Ministry of Health in order for this task to be effectively carried out.
5. IT Support Staff has been provided to the Baku Blood Bank by the present
project. It is of extreme importance that there is IT support staffs available in order to
solve eventual problems in the daily use of the IT system. It is therefore highly
recommended that the IT support staff is employed by the Blood Bank and/or MOH
in order to be able to continue their work.

Project Evaluation Report December 2006 Page 11 of 18 pages

6.1 To UNDP and other UN partners

1. It is recommended that Project Management for an extended project

remains with UNDP. It is also recommended that UNDP explore the possibility of a
shared project responsibility with WHO Euro, who will be able to provide technical
advice and training opportunities.

6.2 To the Host Government

1. Implementation of National Strategy on Blood Safety and Donations on

Blood Services should be implemented, at it is necessary that the MOH plays a more
active role in facilitating this process. It is recommended that the MOH in addition to
already existing advisors also establish a focal office within the MOH for
implementing the National Strategy on Blood Safety and Donations and establishing
licensing and inspection of blood banks. It is also strongly recommended that the
Medicinal Agency will be the executing authority for GMP Inspections and Licensing
of the Blood Transfusion Service.

7 Lessons Learned
The project design was highly relevant in the given situation with poor
delivery of safe blood from existing blood banks, use of mainly paid donors with high
risk of infections, and poor management of the blood banks.
The impact of this project on the overall HIV prevention is difficult to asses,
but it should be noted, that sensitisation and education of potential blood donors
during recruitment efforts does provide the general public with increased knowledge
on HIV/AIDS and how to stay healthy. This aspect supports the UNDP Country
Programme outcome: Strengthened policies, institutional capacity, and awareness
regarding HIV/AIDS and STI prevention.
Networking and raising awareness about the project has been a key element
for success. The Contractor and UNDP could never have succeeded in this project
without the help and assistance from all organisations and persons especially:
International Federation of Red Cross and Red Crescent
WHO Azerbaijan
Ministry of Health
Parliament members
Statoil Azerbaijan
The Norwegian Embassy in Baku
Norwegian Ministry of Foreign Affairs
The Blood Banks in Oslo and Bærum
The Norwegian Board of Health
WHO Copenhagen
UNOPS Copenhagen

Project Evaluation Report December 2006 Page 12 of 18 pages

 In creating this network, the Norwegian Embassy has been very important and
have showed a continued interest and engagement in this project, which without any
doubt have been instrumental.
Project scope. It has been noted by the Contractor that handling both local
activities (Baku and Ganja) as well as overall national planning can create challenges,
since there may be a conflict of interest. It would have been an advantage to have a
formal scientific board with important national stakeholders in order to carry out
national activities. Also handling the local parts of this project, it would have created
more transparency if an agreement with mutual responsibilities between the Ministry
of Health and the Contractor would have existed. This would have added clarity on
the local performance and improvement of work.
Technology. The Blood Bank organisations were quite weak in using
technology and implement new technical complex systems. Training was provided,
but it is the view of the Contractor that more training could have benefited the project.
Immediate needs versus long term capacity building. The key activity was
to increase the number of blood donations. However when the project was initiated it
was stipulated that a larger increase than what has actually happened. As stated by the
Contractor: “one of the main reasons for this is the project did not procure more
consumables (blood bags and reagents). This decision has been thoroughly discussed
within the project group, and is still considered as the right one. In the end of the day
Azerbaijan has to be able to finance their healthcare services themselves, and foreign
project resources cannot be expected to contribute to increased corruption. The key
learning point is that some decisions, which contradict with the developing country’s
short term needs, sometimes have to be made to ensure long term sustainability.”

Project Evaluation Report December 2006 Page 13 of 18 pages

8 Annexes
8.1 Persons met
1. Harald Noddeland, MD, Medical Director, Project Consultant, PWC, Norway
2. Bjarte Solheim, MD, Blood Transfusion Specialist, Consultant Oslo, Norway
3. Elkhan Rahimov, Executive Secretary, Azerbaijan Red Crescent Society
4. Dilbar Iskandarova, Deputy Executive Secretary, Azerbaijan Red Crescent
Society
5. Mustafayeva Aynur, Health Assistant, Azerbaijan Red Crescent Society
6. Elkhan Gasimov, MD, Liason Officer, WHO Office, Azerbaijan
7. Gøril Johansen, First Secretary, Royal Norwegian Embassy, Baku
8. Gajiev Azad, MD, PhD, Director, Scientific Research Institute of
Haematology and Transfusiology, Baku
9. Asadov Chinqiz, MD, Head Haematologist, Scientific Research Institute of
Haematology and Transfusiology, Baku
10. Tahire Mammadova, MD, Chief Doctor, Regional Blood Transfusion Service,
Ganja
11. M. Fatih Yegul, Director, International Center, Qafqaz University
12. Adila Z. Abasova, Professor, Dr., Chief, Social Legislation Department of the
National Assembly of the Azerbaijan Republic
13. Jamila Ibrahimova, Senior Programme Adviser, UNDP Azerbaijan
14. Ashraf Kuliyev, Project Manager, UNDP Azerbaijan
15. David Eizenberg, Deputy Resident Representative, UNDP Azerbaijan

Project Evaluation Report December 2006 Page 14 of 18 pages

8.2 Documents reviewed

1. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.

Sustainability Analysis, Novermber 2003. Pricewaterhouse Coopers.
2. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Final Report, 15.03.2006. Pricewaterhouse Coopers.
3. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Bi-annual Project Report No. 1, January – June 2003, 30.06.2003.
Pricewaterhouse Coopers.
4. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Bi-annual Project Report No. 2, July – December 2003, 20.02.2003.
Pricewaterhouse Coopers.
5. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Bi-annual Project Report No. 3, January – June 2004, 09.07.2004.
Pricewaterhouse Coopers
6. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Bi-annual Project Report No. 4, July – December 2004. 22.02.2005
Pricewaterhouse Coopers.
7. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Final Report, 15.03.2006. Pricewaterhouse Coopers.
8. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Annex 2: Budget for Purchase Order with Pricewaterhouse Coopers,
Oslo.04.07 and 25.09.2002.
9. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Annex 2: Budget for Purchase Order with Pricewaterhouse Coopers,
Oslo.09.03.2004.
10. “Rehabilitation of the Blood Bank and Transfusion Services in Azerbaijan”.
Technical Component of Proposal for Consultancy Services for
UNDP/UNOPS. Project Plan 2003 – 2004 (Report from Inception Mission.
Pricewaterhouse Coopers, Oslo.25.11.2002.
11. UNOPS: INT/97/R12 Fund for Norwegian Consultancy Services and
Programme Activities 00 AZE 2130 – Rehabilitation of Blood Transfusion
System, 27.12.2002.
12. Project Document: Government of the Republic of Azerbaijan, UNDP,
Ministry of Health, WHO, and IFRC: Rehabilitation of the Blood Transfusion
Services in Azerbaijan. Project period 2004 - 2005.
13. UNDP Project Fact Sheet (from web-site)
14. Statistics on AIDS in Azerbaijan (updated). Press release of the National
Center on Struggle with AIDS, 1.12.2006.
15. Ibrahimova, J. & Mamedova, L.: HIV/AIDS in Azerbaijan. In press.
16. UNDP Country Programme 2005 – 2009.
17. UNDP Annual Report, Health section. 2002.
18. The Law of the Republic of Azerbaijan: On donation of blood and blood
components and blood transfusion service. 3 May 2005.
19. Decree of the President of the Republic of Azerbaijan: On implementation of
the Law of the Republic of Azerbaijan on “Blood and blood components
donation and blood transfusion service”.

Project Evaluation Report December 2006 Page 15 of 18 pages

 20. Directive No. 4082: The Republic of Azerbaijan Cabinet of Ministers, with
regard ot the Implementation of the Law of the Republic of Azerbaijan on
“Donation of blood and blood components and blood transfusion services.”

Project Evaluation Report December 2006 Page 16 of 18 pages