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.