Message

Until recently Pakistan had a completely fragmented blood transfusion system where large, medium and small size blood banks in the public, private and NGO sector operated with varying standards and insufficient regulatory oversight. To reform this unsafe blood transfusion system, the government of Pakistan initiated blood safety systems reforms in the country in 2010 with the support of the German government. The reforms are based on the internationally recommended model of a nationally coordinated blood transfusion system, in which the newly established Safe Blood Transfusion Programmes of seven federating units harmonize their approaches gradually to introduce functional separation between production of blood in the new Regional Blood Centers and utilization of blood in the restructured and refurbished existing Hospital Blood Banks.

Since the establishment of the Safe Blood Transfusion Programme in 2010, the Programme in coordination with the German and other partners has been able to deliver a series of outputs which were important inputs into the ongoing safe blood transfusion system reform process. Key target audiences for these outputs include (1) blood bank technicians (operational guidelines, tools and instructions), (2) hospital administrations (hospital transfusion committees), (3) clinicians in the field of haemotherapy (clinical use of blood), (4) academia (institutes of education and training and their regulatory bodies), (5) blood transfusion sector governance bodies (laws, policies), and (6) the general public (awareness on voluntary and replacement donation).

The Programme has been able to establish strong working relations with all stakeholders from the entire country. These include the technical level of blood bank laboratory staff, the public health administrations of provinces, representatives of the regulatory bodies for medical sciences and blood transfusion, the broad spectrum of private organizations, many of which are dealing with the biggest burden for the blood transfusion system in the country, the thalassaemia patients. The Programme has been able to bring the stakeholders on a joint platform (e.g. concerning VNRBD, MIS, the basic design of Regional Blood Centers and Hospital Blood Banks, law and regulatory authorities, etc.). The interaction with the different stakeholders has deepened the SBT Programmes understanding of the existing diversity in terms of structures, technology, human resource capacity and overall organization.

The Programme has successfully progressed despite constitutional and administrative challenges and the new infrastructure development work involving construction and equipment procurements of the Phase I was completed in 2016 in which 10 modern RBCs were developed and 60 existing HBBs were upgraded. On completion of the new infrastructure, the same were handed over to the provinces for operationalization. Punjab and Sindh chose to manage their new RBCs and the linked HBBs through Public-Private Partnerships. This model functions with complete administrative and financial autonomy and has demonstrated excellent results within a very short period of time. In other provinces and regions, the system is being managed by the health departments and providing direct benefit to the public in the shape of easy access to safe and efficacious blood for transfusion.     

Based on the impressive project implementation the German government committed to finance the SBTP Phase II also with an additional grant from the KfW. In Phase II the size and scope of the project is being further expanded in the ight of the lessons learnt and consolidation of the gains and achievements of the Phase I. The German Ambassador classified the project as ‘a success story’, ‘an experience to emulate’ and overall termed the project as a “matchless experience”.  

The RBC-HBB model of blood transfusion service is gaining popularity and acceptability by the provincial health departments as well as the private stakeholders. The provinces are planning to develop RBCs through their own resources and existing larger reputable blood establishments in the public and private sector are now following the SBTP footsteps and adopting a new role to function as modern RBCs supporting a limited number of HBBs in their vicinity. The new infrastructure and the model system is thus gradually consolidating itself and replacing the unsafe fragmented system. As a result many medium to small blood banks which were not providing good quality service have ceased to exist.

In addition to the infrastructure development a lot of technical work has also been carried out simultaneously to ensure quality standards in the new system particularly through creation of a trained workforce. These efforts include development of national blood policy, donor policy, strategic framework, national standards, curriculum development, trainings, regulation strengthening, revision of legislation, rationale use of blood, voluntary donations promotion, development of operational manuals, guidelines etc. The Programme, since its inception in 2010, is regularly publishing a monthly e-newsletter which records activities and updates on transfusion medicine from across the country to keep all informed of the progress. Contact is also maintained with the national and international partners through the social media.

In addition to the strengthening of the service delivery system the blood transfusion regulation system is also being reformed. This effort is led from the platform of the Islamabad Blood Transfusion Authority (IBTA) which has developed a practical model of regulation for the federal capital which is well suited for the provinces also. Accordingly, IBTA is coordinating with its provincial counterparts and strengthening the blood transfusion regulation system in the provinces also.     

As a result of these ground breaking developments, awareness and the trend of voluntary blood donations is increasing, the concept of RBC supporting HBBs is gaining widespread acceptance, processing of blood components from whole blood collections is on the rise, quality of serological screening is transforming, automation in blood banking becoming common, standard of data management improving, HR standards improving, equipment and facilities increasing, component therapy becoming popular, rationale use of blood increasing and whole blood transfusions reducing. However, the most significant aspect of all these exciting developments is that the ‘Safe Blood Transfusion Programme’ has emerged as the ‘national platform and voice of blood safety’ in the country. It is thus justified to conclude that the foundation has now been firmly laid in Pakistan for a system which will ensure adequate and nationwide access to safe, efficacious and affordable blood supply.

Prof. Hasan Abbas Zaheer 
National Coordinator 
Safe Blood Transfusion Programme 
M/o National Health Services, Regulation & Coordination Government of Pakistan