Restructuring of Blood Transfusion Services in Khyber Pakhtunkhwa

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Restructuring of Blood Transfusion Services in Khyber Pakhtunkhwa

Dr. Noor-e-Saba, Manager, Regional Blood Centre, Peshawar

Blood transfusion services are an integral part of the health-care system. Millions of lives are saved each year through blood transfusions. Provision of safe blood and blood components is the responsibility of the national health care system. Safety of blood has assumed greater importance and relevance in developing countries where HIV, hepatitis B and hepatitis C are becoming diseases of greater public health importance.

According to the WHO, safe blood transfusion is a universal human right. Safe blood means blood that will not cause harm to the recipient and that has been fully screened and is not contaminated by any blood-borne disease such as HIV/AIDS, hepatitis, malaria, or syphilis; is free of infections or contamination due to drugs or other chemical substances; is used within the specified time period and stored in the right conditions, correctly labelled, and properly sealed.

The blood transfusion service in Pakistan is compromised, largely due to fragmentation and lack of a coordinated blood transfusion system. The result is the emergence of large number of private and NGO sector blood banks operating without any regulatory oversight.  The situation in the province of Khyber Pakhtunkhwa (KP) is not different and until recently the system was not organized according to the internationally accepted centralized model of blood transfusion services. All the stakeholders worked in isolation in the fragmented system. The system lack a reliable healthy donor base and a registry of voluntary non-remunerated regular donors, therefore most of the blood donors are replacement based family donors.

In 2010, the Government of Pakistan, supported by a grant-in-aid from the Government of Germany, initiated the Safe Blood Transfusion Project. The overall objective of this project was to reform the blood transfusion system towards a “nationally coordinated system” based on a centralized model with regional blood centres collecting, testing, processing and distributing blood to hospital blood banks which will store and select blood and blood components and issue them to clinical wards.The detailed operational planning and implementation lies in the responsibility of federal, state, and provincial health departments through the PC-1s.The KP province PC-1 budgeting 190.17 million in Phase 1 (2010-16) has been successfully completed. A regional blood centre (RBC) has been established and made operational in Peshawar under the project in 2016.

Essentially the role of the Regional Blood Centre (RBC) in Peshawar is mobilization of voluntary non-remunerated blood donors, collection of blood donations, its processing, screening, component preparation and storage. Development of a system of traceability through proper identification and record maintenance as well as surveillance of adverse reactions, reagents standardization and evaluation also falls in the domain of the Centre. All these activities are being carried out in line with the principles of Good Manufacturing and Laboratory Practices (GMP & GLP).

As envisaged in the project PC-1, the RBC is supplying blood and blood components to its linked Hospital Blood Banks (HBBs) according to their needs and requirements and includes blood banks of Lady Reading Hospital, Khyber Teaching Hospital, Institute of Kidney Diseases, and Hayatabad Medical Complex.

The role of these HBBs will now be primarily focusing on patient oriented transfusion medicine functions, namely; storage, distribution, compatibility testing and haemovigilance. For the rational use of blood, the hospitals need to activate and functionalize their hospital transfusion committees, who should carry regular meetings, create awareness among clinicians, nursing staff and any other staff associated and improve the status of transfusions taking place in the hospitals.

In Phase II (2016-19), three more Regional Blood Centres will be established at Swat, Abbottabad, and DI Khan and 10 Hospital based blood banks will be upgraded at a budget of 676.856 million PKR. All the Centres will receive equipment and Blood Bank Management Information System (BBMIS). Attached hospitals will also be refurbished. These Centres will serve as blood procurement and distribution centres ensuring quality system to regulate all the activities which involve mobilization and retention of voluntary and regular blood donors, maintenance of donor database, collection of blood donations as well as processing, screening testing, component preparation and storage of the prepared components.

Transfusion services starts from a donor’s vein to the patient’s vein, therefore in order to ensure safe blood we need to achieve 100% voluntary blood donations. The awareness and support from the community plays a key role in the process. The community should have a good knowledge of the benefits of donations and more importantly about the support a donor can give to a patient in need of safe blood. The community should be aware of the life styles of the patients who are chronic recipients of blood, e.g. thalassaemics, haemophilics, etc.  The media both print and electronic should support this noble cause and join hands to initiate a provincial campaign on voluntary blood donations. At the same time, advocacy and sensitization is needed for the clinicians to focus on rational use of blood and blood components. Hepatitis B and C are among the most serious health problems burdening the health care system in Pakistan (7.4% prevalence: National PMRC survey 2008). A safe blood transfusion service can make a significant contribution to reducing the occurrence of hepatitis B and C and thus contributes directly to MDG 6. The risk of poverty resulting from ruinous health expenditure is reduced. The blood transfusion services, therefore, also makes an indirect contribution to MDG 1.