Voluntary Non-Remunerated Blood
The collection of blood from voluntary, non-remunerated blood donors
(VNRBDs) is an important measure for ensuring the safety, quality, availability
and accessibility of blood transfusions. The WHO recommends that all countries
should be self-sufficient in all blood products and that every blood donation
should be voluntary, anonymous and non-remunerated. World Health Assembly
resolutions WHA 28.72 and WHA 58.13 urged Member States to develop national
blood transfusion services based on voluntary non-remunerated blood donation.
Most developed countries have well-functioning systems of non-remunerated blood
donations. However, the developing countries including Pakistan have a very low
VNRBD base with an estimated 10% voluntary donations. Within the system reform
of the blood transfusion sector in Pakistan, it is foreseen as an essential
component. In order to increase blood safety and to create a donor base for the
future Regional Blood Centres, SBTP team is promoting the concept of VNRBD to
gradually replace the traditional concept of ‘family replacement’ donors. Since
its inception in 2010, the SBTP took concrete steps to improve the VNRBD
scenario as enumerated below;
National Blood Policy and Strategic
The SBTP formulated the National Blood Policy and Strategic Framework
2014-20, which provides fundamental principles and identifies clear priority
areas to be pursued for attaining self-sufficiency in blood products in the
country. The National Policy states ‘Development,
implementation, organisation and management of National Blood Transfusion
Services able to meet blood demand of the country from voluntary
non-remunerated blood donors in a manner that is safe, effective, equitable,
non-profitable, sustainable, rational, without wastage and ensures the
protection of donor and healthcare workers’ rights and safety’. In
addition, in the Strategic Framework, the Cluster 3: Core Business identifies donor management including community interface
as a key priority area. The development of a consensus document endorsed by all the provinces,
regions and the federal government augurs well for the SBTP and provides a
model for policy making in the post devolution era that can be emulated by the
other devolved subjects also.
National Blood Donor Policy
With the objective of harmonization in donor management
and ensuring blood safety, a national Donor Policy was developed for adoption
by all institutions involved in blood collection. This policy document is based
on national (to incorporate local requirements), regional (ECO countries) and
international expertise (to provide expertise from international models) and
was drafted by a working group of the First National VNRBD Workshop and later
approved by the National Blood Transfusion Programme and endorsed by the
National Steering Committee. The dissemination of the document covered the key
governing institutions like National and Provincial Blood Transfusion
Programmes and Blood Transfusion Authorities as well as Blood Donor Organizations
(BDOs), most of which are working autonomously and without much regulation,
some of them with a less than optimal registration.
The national strategy to promote VNRBD as outlined in the
Policy aims to encourage the conversion of the vast population of ‘Family Replacement
Donors’ into regular blood donors as many of these regular donors are suitable
to become voluntary donors. But in the absence of a properly coordinated blood
transfusion system, these donors are not sensitized to donate regularly on a
voluntary basis and are thus lost. The national strategy proposes availing the
opportunity of the onetime visit by the replacement donor to the blood centre
for donating blood for his/her relative by providing them counseling and
convincing them to return again as a voluntary blood donor. The second strategy
to increase reliance on VNRBDs is to strengthen the capacity of the blood
centres and engage with voluntary Blood Donor Organizations (BDOs) operating in
colleges and universities to yield their true potential. With proper
coordination and capacity building, the true potential of these committed BDOs
can be multifold increased. In addition to these two specific strategies, the
national policy also proposes promoting general awareness about blood safety
among the public.
Local KAP Survey (Qualitative)
In 2009, the SBTP through technical assistance of
GIZ (German International Cooperation) conducted a small baseline survey in a
small district of Rawalpindi which highlighted the local beliefs in Pakistan on
voluntary blood donation. The research, conducted by Prof. Zubia Mumtaz from
Alberta, explored the various and complex meanings embedded in blood using
empirical ethnographic data from Pakistan, with the intent of informing
development of a national blood policy. Using a focused ethnographic approach,
data were collected in 26 in-depth interviews, 6 focus group discussions,
12 key informant interviews and 25 hours of observations in blood banks and
maternity and surgical wards.
The key finding was that notions of caste-based
purity of blood, together with the belief that donors and recipients are
symbolically knitted in a kin relationship, place a preference on kin-blood.
The anonymity inherent in current systems of blood extraction, storage and use
as embedded in contemporary policy discourse and practice was problematic as it
blurred distinctions that were important within this society. It was
recommended that in order to ensure a safe blood supply, it is important to
base blood procurement policies on local, context-specific belief systems
rather than relying on uniform, one-size-fits-all global policies.
National KAP Survey (Quantitative)
One of the key strategies towards achieving the 100%
VNRBD, in parallel with introducing governance through a well-implemented donor
policy, was increasing awareness through a well-designed Public Awareness
Campaign (PAC). In order to design an appropriate PAC, a nationwide KAP survey,
assessing the knowledge, attitudes and practices of a multilayer, randomized
sample of 3,000 respondents, was conducted in 2011, with support from and
within the ‘circumscription’ of BDOs. The selection of BDOs, rather than the
‘general public’ for the KAP survey was in accordance with the planned
selection of BDOs (potential donor communities) for the pretesting of PACs
(especially in areas of low response).
In Pakistan, the transfusion services are being provided
by the public, private and NGO/BDO sector blood banks, mostly hospital based.
BDOs are mostly university based voluntary organizations managed by students.
On the one hand, these organizations form the backbone of (voluntary) donor
mobilization and blood collection in Pakistan.
On the other hand, they are working independently, without an agreed
governance or communication framework. The potential importance of BDOs in the
BT system reform process, however, lies in the fact that they are collecting
enormous quantities of (voluntary) blood donations through their donor
motivation and mobilization programmes.
Though the existence of this kind of support
organizations was already known yet nobody had gained an overview of the
dimensions of their contributions, and since they functioned in isolation
within their university environments, even they themselves were mostly unaware
of their potential and importance at a national scale. BDOs from all parts of
the country were contacted and the relevant data were collected in order to
learn more about their existing strategies and potentials. The information
gathered was used for the elaboration of a ‘First National Inventory of Blood
Donor Organizations’ published under the National Blood Transfusion Programme’.
About 80 BDOs were identified in this inventory working independently and with
The SBTP established a network of BDOs in 2015 with the
aim of interchanging experience and best practices, while on the other hand
being open to policy advice from the national programme and joint strategies
and actions for the promotion of blood donation and the advancement of blood
safety. The partnership with the BDOs enables the public sector to benefit from
quality, innovation and efficiencies. There are many modalities for cooperation
such as the private sector BBs could act as “regional blood centers‟ both for
public and private HBBs. The BDOs could be linked to RBCs and deliver blood
directly to these centres rather than to individual hospitals/patients.
The BDO Association intends to develop close liaison with
the IFBDO (International Federation of Blood Donor Organizations) which is the
leading association constituting more than 70 countries. It is an international
organization whose main stated aim is self-sufficiency of the member states in
blood proceeding from voluntary non-remunerated blood donors, as well as
harmonization of the security standards for blood donation and inspection
processes. To develop the capacity and future strategy of PakBDO, the SBTP
organized a series of three workshops for all the provinces in 2016. The
workshops were supported by the WHO/OFID Joint Project (OPEC Fund for
International Development). The activities were actively participated by the
representatives of BDOs, large blood banks and provincial leadership of the
Heimer, Consultant, German Red Cross, Germany: Mr. Heimer conducted two short
term assignments in Pakistan in October and December 2010, and assessed the challenges and barriers regarding VNRBD. He developed communication strategies for
donor recruitment/retention from low risk populations, donor information and
education campaigns and materials for the target groups. He facilitated the
first national VNRBD workshop (Dec 2010) and also supported SBTP in the
formulation of national blood donor policy and creating a platform of blood
donor organizations to share experiences and develop evidence based strategies
to strengthen their programmes.
Ton (A) PM Los, Medical
Sociologist, Sanquin Consulting Services, Amsterdam, Netherlands: Mr. Ton Los conducted two assignments in Pakistan
with the objective to support the development of institutional capacity to
design a needs based approach to VNRBD under the new blood donor policy. In his
first mission, in coordination with SBTP, the expert visited various blood
donor organizations and social science faculties to assess the existing
potential as well as capacity development requirements. He conducted a nationwide KAP survey wth a sample size of 22 BDOs. In
his second mission, the expert supported SBTP in the analysis of the results of
the KAP survey. Main output was the
profiling of donors and non-donors. The results of the survey were presented in
the second national VNRND workshop held in Dec 2011 in Islamabad.
Wim de Kort, Professor of Donor Healthcare, University of Groningen, Netherlands:
Prof. Wim facilitated the conduction of a first national workshop on blood
donor management through the support from WHO EMR office in December 2017.
Lars, Head of Donor Management, Austrian Red Cross/Blood Center for Vienna, Austria: Mr. Lars facilitated the conduction
of a first national workshop on blood donor management through the support from
WHO EMR office in December 2017.
The recruitment of safe donors is a challenging task and
the first step is to have a comprehensive voluntary blood donation programme
with special emphasis on campaigns targeting young people. Building a
sustainable base of safe blood donors needs a long-term approach that requires
not only the establishment of an effective voluntary blood donor programme but
also improved public awareness and acceptance of the importance of blood donation
as a social norm. It is emphasized in the PACs that blood and blood products
are a unique and precious national resource as they are obtainable only from
individuals who donate blood or its components.
To promote the concept of VNRBD
in the country, the SBTP through the FC component (KfW funded), hired two firms
to develop video
documentaries and design material for promotion and motivation of voluntary
non-remunerated blood donors. The
documentaries and videos highlight the significance of VNRBDs for the benefit
of the policy makers, potential partners, international and national donors,
public/private organizations leadership, NGOs/BDOs, philanthropist, general
public and also act as a tool for disseminating information regarding the need
and importance of safe blood transfusion in Pakistan. The material is telecasted
on websites, TV channels, local cable networks, projectors, RBCs waiting area,
mobile blood camps in university/offices /factories etc.
The various Documentaries and Video spots developed cover
the key components of the Programme. They include clips highlighting the status
of blood transfusion services in Pakistan; areas where the mortality is very
high due to disease burden and requiring frequent blood transfusions, the
benefits of the replacement verses voluntary blood donors, demonstrations of
blood drives and campaigns, safety in using blood components against the
present practice of transfusing whole blood, and children in particular with
regard to thalassaemia, blood cancers and the current challenges. The Phase I regional
blood centres in all provinces and the modern equipment installed therein is
visibly filmed. Interviews of professionals, community members and safe blood
transfusion manager and technical staff are incorporated as an important means
to communicate the key messages.
World Blood Donor Day Celebrations
Thanks to the sustained efforts of the SBTP, the World
Blood Donor Day (WBDD) is now extensively celebrated all over the country in
the month of June since
2009. The impact of these celebrations has resulted in increasing awareness
about voluntary blood donations. The WBDD activities are receiving more and
more coverage in the electronic and print media which is a reflection of the
sustained and committed efforts of the Safe Blood Transfusion Programme. The
key feature of WBDD celebrations has been the organization of various
competitions to mark the Day, including speech, assay and poster competitions.
These competitions are participated by a very large number of spirited youth
who get an opportunity to express their talent and gain recognition and at the
same time creates awareness about the noble cause. The Programme also organizes
a Cricket Match and Hiking Tour (Hike for Life) every year to commemorate the
WBDD. The media coverage of the WBDD celebrations is increasing every year and the
Programme issues a special edition of its E-newsletter and also a full
pictorial Report to cover the WBDD activities. Many of these activities are
graced by important policy makers and social personalities.
In February 2016, Ms. Sharmeen Obaid-Chinoy was appointed
as the ‘Honorary Ambassador for Blood Safety’ by the Government of Pakistan.
Sharmeen Obaid-Chinoy is a double Oscar Award winning film maker from Pakistan.
She is an internationally acclaimed filmmaker known for highlighting women
right issues and has also produced documentaries on various health issues
including blood transfusion and blood safety. As ‘Honorary Ambassador,’ Ms.
Chinoy promotes the culture of voluntary blood donation especially among the
youth besides advocating safe blood transfusions in Pakistan.
In August 2017, the Programme signed an agreement,
through ABBOTT Diagnostics, with the renowned international football star,
Cristiano Ronaldo, to promote the culture of voluntary blood donations in
Pakistan. The Ronaldo national campaign is planned to be launched in early 2019.
Donor Haemovigilance Guidelines
Through the technical assistance of International Hemovigilance
Network and WHO, the SBTP revised the national guidelines on quality control in
transfusion medicine. The revised document ‘National Guidelines for Quality
Control in Transfusion Medicine 2017’ includes a special chapter on donor
haemovigilance, e.g. definitions of the adverse events, data collection forms,
etc. Through the Islamabad Blood Transfusion Authority, the donor
haemovigilance has been made a pre-requisite for licensing of blood banks. The
same strategy has now been adopted by the other provincial and regional Blood
USAID funded Jphiego project, an affiliate of the Johns Hopkins
University, is implementing a Mother and Child Health project in Pakistan with
a particular focus in the interior of Sindh. The SBTP experts in collaboration
with Jphiego organized VNRBD and blood safety seminars in 15 districts of
interior Sindh through three visits. Extensive interaction with the local
political and society leadership as well as the general public was done during
these activities for the promotion of VNRBD in the region.
National Blood Donor
The World Health Organization
in collaboration with the Safe Blood Transfusion Programme convened a national
consultative workshop on Blood Donor Management in 2017. The workshop was
organized to strengthen blood donor management which is identified as a
critical need in the country. The training was facilitated by internationally
renowned experts in the field of blood donor management; Prof. Wim de Kort,
Professor of Donor Healthcare, University of Groningen, Netherlands, Dr.
Eberhart Lars, Head of Donor Department, Austria, Dr. Yetmgeta E. Abdella, Head
of Blood Safety Unit, WHO-EMRO, Cairo, Egypt and national experts, Prof. Hasan
Abbas Zaheer and Dr. Noaman Siddiqui. The meeting participants included
stakeholders working as blood donor managers, programme managers, senior
haematologists and transfusion specialists. The training provided current
information on the essential components of blood donor management including
infrastructure requirement for blood donor management, establishing and
maintaining blood donor base, donor recruitment and retention strategies, safe
blood collection techniques, blood donor counseling, referral and care, human
resources management, information technology, and ethical considerations in
blood donor management. The Donor Management training has special relevance at
this stage as the RBCs developed in the Phase I are operational and providing
direct benefit to the people by providing safer blood. It is thus important
that improved Donor Management services are in place in the new infrastructure
as well as in the existing system.
The global social media giant “Facebook”
launched a blood donation Feature for Pakistan in early 2018 in collaboration
with the SBTP. The Feature makes it possible for people to easily sign up to be
blood donors and to help connect donors with people in need and blood centers.
This is the first time that Facebook has launched any Feature specifically for
Pakistan, a country with 35 million Facebook users. The Pakistan specific blood
donation feature on the Facebook allows potential donors and the blood centers
to become connected in a coordinated manner. Success of this FB Feature will
redefine the voluntary blood donation scenario in Pakistan in a most
cost-effective manner. It will also compliment the national efforts to promote
blood safety being implemented through the German government funded Safe Blood
Transfusion Project which is developing a nationwide network of modern RBCs.
Joint workshops have also been organized with the representatives of the blood
banks and BDOs to familiarize them with the Feature to help promote its use. A
pilot study conducted with five selected blood centres was presented at the
annual congress of the International Society of Blood Transfusion in Basel,
Switzerland, June 22-26, 2019. Facebook Vice-President visited Pilot Site of FB
Voluntary Donation Feature and also met the Prime Minister of Pakistan and
discussed the progress of the various Facebook projects in Pakistan.
The SBTP team regularly
interacts with the print and electronic media for awareness and sensitization
of the general public on blood safety, VNRBD and rational use of blood. In
addition, media personnel are invited to cover the SBTP seminars/workshop
coverage. Supportive coverage of the blood safety campaign and its messages in
the press, on radio and TV, and by web-based news providers is enhancing SBTP
visibility, broadening its audience and lending added credibility to the
The Programme has been promoting the culture of research
and development in the transfusion sector in Pakistan. Following is a list of
published research articles in international journals and conferences with
reference to VNRBD;
- Ahmad M, Saeed M, Waheed U, Khalid A, Rasheed N, Ghaznavi
S, Arif M. Blood
donation: General perception of University students in Lahore, Pakistan. Vox
Sanguinis 2017; 112 (Suppl. 1): p 111.
- Noor ul Amin M, Ramzan M, Waheed U, Arshad M. A nexus
between volunteerism and blood donation: A case study of PMAS-Arid Agriculture
University Rawalpindi and Quaid-i-Azam University Islamabad, Pakistan. Vox
Sanguinis 2018; 113 (Suppl. 1): p 123
- Ansari A, Waheed U, Zaheer HA. Establishment of Donor
Haemovigilance System in Blood Banks of Islamabad, Pakistan. Vox Sanguinis
2015; 109 (Suppl. 1): p 148-9.
- Inventory of Blood Donor Organizations,
SBTP 2011 (available at www.sbtp.gov.pk)
- Kayani IS, Ishtiaq M, Waheed U, Zaheer HA. Adverse
Reactions in Blood Donors in a Tertiary Care Teaching Hospital Blood Bank of
Islamabad. JIMDC. 2016; 5(2):81-83.
- Kayani IS, Waheed U, Hafeez R, Maqbool A, Zaheer HA.
Implementation of Donor Haemovigilance System in Islamabad, Pakistan. Vox
Sanguinis 2016; 111 (Suppl. 1): p 142.
- Los APM, Waheed U, Kohorst P, Smid WM.
Creation of an enabling environment for Voluntary Blood Donation in Pakistan.
Vox Sanguinis 2012; 103 (Suppl. 1): p 100.
- Waheed U, Zaheer HA. Blood donor deferral pattern in
Islamabad, Pakistan. Vox Sanguinis 2017; 112 (Suppl. 2), p 68
- National Blood Donor Policy, SBTP 2011 (available
- Mumtaz Z, Bowen S, Mumtaz R. Meanings of
blood, bleeding and blood donations in Pakistan: implications for national vs
global safe blood supply policies, Health Policy and Planning, 2012; 27:
(2) 1, 147–155.
- National Blood Policy and Strategic Framework
2014-20, SBTP 2014 (available at
- Ullah I, Shahzad A, Waheed U, Zaheer HA. Knowledge, Attitude and Practices regarding Blood Donation in
Islamabad Capital Territory: A Sociological Study in Public and Private
Hospitals. XI Annual Conference of Asian Association of Transfusion Medicine,
Oct 9-11, 2015, p128.
- Waheed U, Arshad M, Sultan S, Saeed M, Arshad A,
Irfan SM, Zaheer HA. Iron deficiency and iron deficiency anemia in blood donors
at a tertiary care hospital in Islamabad, Pakistan. Glob J Transfus Med
- Waheed U, Azmat M, Zaheer HA. Knowledge, Attitude and
Practices towards Blood Donation: A Nationwide Survey. Hematol Transfus Int J.
2015; 1(4):00018. DOI: 10.15406/htij.2015.01.00018.
- Waheed U, Zaheer HA. Donor Vigilance in Blood Transfusion
Services, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Blood
Transfus 2014; 12(Suppl. 2): s457.
- Waheed U, Zaheer HA. Evaluation of Deferral Pattern among
the Blood Donors in Islamabad, Pakistan. Glob J Transfus Med
- Workshop Report: The Role of BDOs in
Promoting VNRBD, SBTP 2015 (available at www.sbtp.gov.pk)
- Workshops Report: National Consultation
of PakBDO Association, SBTP 2016 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U. Blood Safety System Reforms in Pakistan.
Blood Transfus 2014; 12(4): 452-457.
- Zaheer HA, Waheed U. Blood Transfusion Service in
Disasters. Transfus Apher Sci. 2016; 55(2). http://dx.doi.org/10.1016/j.transci.2016.09.007
- Zaheer HA, Waheed U. World Blood Donor
Day Report, SBTP 2010 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U. World
Blood Donor Day Report, SBTP 2011 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U. World
Blood Donor Day Report, SBTP 2012 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U. World
Blood Donor Day Report, SBTP 2013 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U. World
Blood Donor Day Report, SBTP 2014 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U. World
Blood Donor Day Report, SBTP 2015 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U. World
Blood Donor Day Report, SBTP 2016 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U, Wazeer
A. World Blood Donor Day Report, SBTP 2017 (available at www.sbtp.gov.pk)
- Zaheer HA, Waheed U, Kaenat
N, Tahir S. World Blood Donor Day Report, SBTP 2018 (available at