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Safe Blood Transfusion

1                    Situation analysis: To promote blood safety Government has established 98 Safe Blood Transfusion Centers throughout the country for screening blood for HIV, Syphilis, Malaria, Hepatitis B and Hepatitis C. Legislation for safe blood transfusion is in place but its implementation countrywide is a challenge, as most of the blood screening centers and private health institutions need to be fully equipped with modem facilities to screen blood. Therefore strengthening and expansion of blood safety to 100% coverage and coordination between NASP and SBTP must be given priority;

2                    Standard precautions for infection control need to be promoted at all healthcare facilities. Hospital hazardous wastes, including used syringes and bloodstained materials are routinely dumped in open public containers, and not incinerated. Therefore, an appropriate mechanism and institution are required to promote to deal with these problems in a systematic and comprehensive manner;

3                    The 5th General meeting of Global Collaboration (GCBS) held on 10-12 November 2004, WHO, Geneva advised that Blood transfusion service should be based on national blood policy that would lead the formation for National blood program for achieving the centrally coordinated sustainable service with implementation of all quality standards;

4                    The blood transfusion service was very rudimentary and neglected in the total health care service before 1999.  According to WHO published Data in 2001 which showed that paid blood donors shared the major portion (70%) of collected blood in the country .The prevalence Hepatitis-B (29%), Hepatitis-C (6%), and Syphilis (22%) were significantly high risking the population. Before the implementation of Safe Blood Transfusion program in December 1999 no where in the hospitals in Bangladesh mandatory blood screening facilities were available (Proposed Activities for Safe Blood Transfusion Program:  July, 2011- June, 2016, Safe Blood Transfusion Program (SBTP);

5                    To prevent the spread of Transfusion Transmissible Infections (TTIs) Safe Blood Transfusion Program was launched in 1999 with the assistance of UNDP under HPSP. The program implementation was started by Director Hospital, DGHS. Through this programme blood screening facilities were developed in 99 Blood Transfusion Centres in 2001. All public medical colleges, district hospitals, combined military hospitals, medical institutes, Red Crescent blood center, two non-government medical college hospitals were provided with equipment, laboratory furniture and regular supply of blood screening kits and other consumables. Hands on training and other motivational training for voluntary blood donor recruitment were provided to of medical technologists and medical officers;

6                    Under an agreement with WHO in September 2004 a new strategy was adopted for establishment of fractionation of blood componens in 6 centers (Dhaka Medical College, AFIP, BSMMU, Rajshahi Medical College, MAG Osmani Medical College and Chittagong Medical college ) . National Blood center of Thai Red Cross imparted training to manpower of the center. These 6 blood centers have also been equipped with modern mobile blood collection van for outdoor blood collection;

7                    A report of the screenings done in these centers is given below for a glimpse of the infections that were screened in these centers’;

8                    Under HNPSP a total of 100 new centers were developed at the upazila health complexes in addition to previously established 99 centres. After capacity building till date blood screening has started in 146 centres for HIV, hepatitis B and C, Syphilis and Malaria. The rest out of new 100 the centers would be made functional by the end of this year;

9                    A Safe Blood Transfusion Law was enacted in 2004, which paved for formation of National Safe Blood Council for policy development. It also gives emphasis to the implementation of regulatory system for unauthorized blood transfusion centres, application of good manufacturing practice, application of appropriate and rational use of blood. Pertinent rules and regulations in connection to implementation of the objectives of the law have been published as S.R.O in 2008. The honorable Health Minster by position is the president and Director General of Health Service is the member secretary of the Council and Directors of Institutes, heads of the department of blood transfusion are the members;

10                A National Safe Blood Transfusion Expert Committee was formed subsequently. It consists of transfusion specialists as members and member secretary and Director General is the chairman of the forum. Its main ToR is to implement the decisions  of National Safe Blood Transfusion Council;

11                Since the beginning the requisite numbers of manpower for the blood transfusion centres were not fulfilled, which compromise the standard operating procedure, coupled with weakness in the maintenance system. Presence of unauthorized blood bank posed challenges for maintaining the quality of blood collection system. Inadequate manpower and resources in the licensing unit (Director Hospital and his/her team) have been unable to execute regular monitoring and inspection of authorized and unauthorized blood transfusion centres. Uncoordinated activities of voluntary blood donor organizations for collection of blood leads to inequitable and improper utilization of valuable resources and the government blood centres suffer from shortage of blood. Power interruptions hinder cold chain management. Interest to use blood component is inadequate among the clinicians. Absence of physical structure and manpower for blood collection is critical for government blood transfusion centres, this also hampers building up of an adequate stock of blood.  Frequent changes of key implementers of SBTP at short intervals slows down the spirit of the program;

12                There has been great need for development of confirmatory HIV testing and facilities for counseling for the donor as well not only for HIV but also for hepatitis B and C. The National Safe Blood Transfusion Council decided that 10 centres will be equipped with all facilities for VCT service .A separate unit will be set in these 10 centres and blood transfusion will support laboratory testing for the clients. It was also decided that any client other than blood donors also get the VCT services from these centres;

13                The decision for establishment of National Blood Transfusion Centre was taken in the meeting of National Safe Blood Transfusion Council. held in 2007. Following the decision a site selection committee visited the proposed site and reported to MOHFW. The MOHFW finally approved the site which is situated in the Medical Village of Mohakhali west of the Infectious Disease Hospital (IDH) in between Institute of Health Technology on its east side and Institute of Public Health School on its west. The total area allocated is 41,800 square feet, which is equal to .96 acres. The proposed NBTC will be implemented by mobilizing resources from HNPSP for procurements. The construction work will be done by PWD and the fund will be reflected under operational plan of construction of MOHFW. The proposed manpower for the center is 185;

14                Bangladesh achieved commendable reduction of paid donation from 70% to 9%. The directed donors have been increased from 20% to 60% and voluntary blood donation has increased from 10% to 31%. Till today 146 centers attained the capacity to provide screened blood. Six centers attained the capacity and producing blood components. More data is given below:

15                Indicators

Input indicators

(i)              Number of hospitals run autonomously with an independent board;

(ii)            Percentage of facilities with assured logistics, medicines and training;

(iii)         Percentage of hospitals with all staff in place;

(iv)         Percentage of hospitals providing effective referral services;

(v)          Regulatory functions of BMDC carried out effectively on both the public as well as private sector health facilities;

(vi)       Licensing functions of LD, Hospital and Clinical Services carried out effectively on both the public as well as private sector health facilities;

Output indicators

i.       Percentage increase of patients than previous years, increase in the utilization rate of the poor, women and children;

ii.      Percentage of hospitals certified as women, adolescent, child, elderly and disable friendly by physical design and service motto;

iii.      Average days of hospitalization;

iv.      Hospitals, clinics and diagnostic centers fulfill all the required licensing and regulatory criteria;

v.      Quality of hospital services improved to the satisfaction of the patients and attendants;

vi.      Standard of AMC established;

vii.      Efficacy and safety of the most commonly used alternate medicines established;

viii.      Patients seeking alternate medical care are satisfied with the outcome of the services provided;

ix.      Provision of financial assistance to the poor patients.