The Government
of Pakistan with support from the Government of Germany initiated the
restructuring of the blood transfusion system in the country. The strategy
involved gradually replacing the existing unsafe fragmented system with the
internationally recommended centralized model.
The Safe Blood
Transfusion Programme was established by the Ministry of Health in 2010 which created
a high visibility environment to promote a modern national blood transfusion
system as part of its health services. Required resources for national and
provincial safe blood transfusion programmes were defined and approved in the
respective PC-1s (project documents). The national and provincial commitment
was enhanced by the German support through technical advisory services (GIZ)
and the establishment of a network of fully equipped regional blood centres in
strategic areas throughout the country (through KfW).
The project
design conceived in 2008, anticipated the forthcoming 18th
constitutional amendment and the devolution of the subject of health to the
provinces. It was, therefore, the policy decision of the Health Ministry to
develop separate PC-1s for the federal, regional and provincial programmes. The
devolution process initiated in 2011 resulted in a shift from national to
provincial level, however, the National Coordination role was maintained at the
federal level through the Safe Blood Transfusion Programme. The SBT Programme
has continued to scale up visibility through a series of strategy and training
workshops on all aspects of blood safety.
In
Phase I, 10 modern Regional Blood Centers (RBCs) were constructed and equipped
and 60 existing Hospital Blood Banks (HBBs) renovated through the KfW (German
Development Bank) funding. In addition, technical work, funded by GIZ, was also
carried out including 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. On completion of the new infrastructure, the same was 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.
Based
on the impressive project implementation, despite constitutional and
administrative challenges, the German government committed to finance the SBTP
Phase II, with an additional grant of € 10M through the KfW. The German
Ambassador classified the project as ‘a success story’, ‘an experience to
emulate’ and overall termed the project as a “matchless experience”. In the
current Phase II, the scope and scale of the Project is being further expanded
(construction of 5 new RBCs and up-gradation of 23 hospital based blood banks)
and the gains of the Phase I are being consolidated. The current Phase II of
the national project will end in December 2020 after which German support to
the project will cease. Currently the project has gained remarkable momentum as
a result of the tireless efforts of the Programme and the stakeholders as well
as through the service delivery of the Phase I infrastructure which is making a
tremendous impact on blood safety in the country.
Since its
establishment in 2010, the SBTP has been able to deliver a series of outputs
which have significantly contributed to improvement in blood safety standards
and establish strong bonds among the national stakeholders. The close
collaboration with the assorted stakeholders has deepened the Programme’s
understanding of the existing ´diversity´ in terms of structures, technology,
human resource capacity and overall organization. Working groups and task
forces, comprising of eminent local experts, have been formed to develop key
policy and operational documents including Model SOPs, National Standards and
Guidelines, National CUB Guidelines, Business Plan, Functional Briefs for
MIS, BTA, RBC and HBB, Inventory of BDO
and BT Laws, etc. The inclusive approach has enhanced local ownership and
integration of experience and evidence, thus increasing local users’ expertise
and capacity. The SBTP is also implementing a capacity building plan aimed at
creating a suitably qualified workforce, well equipped to adequately operate
both in the new system and in the current reality.
The SBTP remains
in close contact with the partners through its regular annual reports, monthly
e-newsletters, electronic, print and social media, frequent capacity building,
promotional and technical activities and regular participation in national and
international meetings, etc. The monthly e-newsletter are regularly published
in which all the programme and related activities are documented. The
newsletter is shared with an ever increasing number of stakeholders in the
country and abroad. The feedback received from the partners especially the
international partners is very encouraging and supportive. The global blood
transfusion fraternity takes a very keen interest in the development and
progress of the national blood transfusion service in Pakistan.
The Programme has
continued to strengthen and scale up the implementation process by engagement
of committed resources and the conduction of strategic system and regulatory
reform efforts under the National Blood Policy and Strategic Framework. Apart
from creating a conducive environment for sustainable blood programmes within
their health systems, efforts are made to strengthen the capacity of system
governance and safe blood transfusion practices through institutional and
regulatory reforms.
The Safe Blood
Transfusion Programme remains high on the priority of the present Government.
The National Health Task Force frequently deliberates on the progress of the
blood safety systems reforms. The Task Force has also established a
Sub-Committee on blood safety which has proposed establishment of more large
modern RBCs and conversion of existing large blood centres to RBCs to be
managed through Public Private Partnerships. The Sub-Committee has also
presented its recommendations for strengthening the regulation of the blood
transfusion sector to be managed by the government itself.
The new
government is earnestly finalizing interventions to prevent and control endemic
communicable diseases in the country through the creation of the National
Hepatitis C Programme, revamping of the HIV/AIDS control programme and scaling
of the Safe Blood Transfusion Programme with continued support from the German
government. To chart out the future course of direction and reforms, the Health
Ministry through the Programme and the technical assistance of WHO, is organizing an international meeting of blood
transfusion experts. The meeting aims to take stock of the achievements of the
Programme thus far and on the basis of the lessons learnt and regional
experiences agree on a way forward to achieve the target of universal access to
safe and efficacious blood for all in the country.