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
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.
Dr. Ahmareen Khalid Sheikh
Safe Blood Transfusion Programme
M/o National Health Services, Regulation & Coordination Government of Pakistan