KARACHI, Oct 30 Under a nationwide safe blood transfusion programme being launched with German government funding, 13 regional blood transfusion centres (RBTC) will be established to provide safe blood to 78 public and private hospitals across the country. These hospitals to be linked with the centres will become operational after three years.

In the first phase of the programme, which envisages a nationwide access to safe blood transfusion, six big and seven small RBTCs will be established to cater to the needs of their respective areas in a coordinated manner. Serving as the blood procurement and distribution centres, they will cover all provinces and federally-administered areas and territories.

Talking to Dawn after attending a seminar on “Blood transfusion services in Pakistan” at the Ojha Campus of the Dow University of Health Sciences on Saturday, Paul Lutz, the country representative of GTZ (a German agency for technical cooperation), said that after working on the programme since 2004, when the German government offered funding for a safe blood transfusion project in Pakistan, many of the core elements of an independent rational composition were in place now. He hoped that the infrastructure for a consolidated national transfusion system was set to be laid and the system could start functioning after three years.

More funds from the German government would start coming in as soon as the technical designs of the blood transfusions centres planned for the first phase of the programme were prepared and approved by the relevant forum, he said, adding that the German government would be providing an amount of about 15 million euros for the project.

He, however, made it clear that promulgation of legislation on safe blood transfusion at the national and provincial level was also awaited to put the national blood transfusion programme into operation. The legislation would provide a cover to the entire safe blood transfusion scheme, replacing the existing fragmented blood transfusion system in the country, he said.

Draft law already okayed

Dr Zainab Mukhtar Sangi, a GTZ technical expert, said that the draft federal law on blood transfusion had been approved by the health ministry for presentation to the relevant forum and finally in the National Assembly. The draft of the legislation at provincial level as well as other relevant legislations had also been examined by the respective provincial governments, she said, adding that as soon as the new laws were implemented, the existing set-up of the blood transfusion system would be reviewed.

She said that for the purpose of licensing blood banks, the working of all existing blood banks enjoying recognition in some of the provinces would also be reviewed. “There is a likelihood of some blood banks losing their recognition and stop functioning anymore,” she said.

Dr Sangi said Sindh was likely to get four blood transfusion centres — two in Karachi and one each in Hyderabad and Sukkur.

Earlier, speaking at the seminar, which was organised by the DHUS and the National Blood Transfusion Programme (NBTP), Dr Sangi said stressed the need for upgrading the regulatory framework of blood transfusion services in Pakistan. The entire process should be in line with the international agencies' aspiration that governments should be responsible for the protection of national resources in the shape of human blood through legislation and regulations. It was supposed that blood donation should be voluntary and non-remunerated; it must be duly tested and processed while its clinical demand should be reduced, she added.

The expert said that the draft of the national blood transfusion laws was based on the European Union's directives on safe blood transfusion issued in 1998. “The laws will help regulate the whole spectrum of a donor's vein to an acceptor's vein blood transfusion process, thus ensuring uniformity in the quality of blood products across the country,” she said.

Universal right

NBTP national manager Dr Hassan Abbas Zaheer told the seminar participants that WHO was of the view that safe blood transfusion was a universal human right and provision of safe blood and blood components was the responsibility of the national health care system.

According to the WHO fact sheet of 2008, about 150,000 pregnancy related deaths in the developing countries can be avoided through safe blood transfusion. Dr Zaheer said that unsafe blood transfusion remained a major but frequently neglected contributor to the global spread of HIV and Hepatitis B and C.

Discussing the scenario in Pakistan, he also subscribed to some earlier findings in the researches undertaken by WHO and some Pakistani and international researchers that Pakistan had a fragmented blood transfusion system under which around 1.5 million units of blood were transfused annually. “Only 50 per cent of the collected blood bags are screened; 80-85 per cent of the blood is transfused as 'whole blood', while predominant reliance is on 'replacement donors' rather than 'voluntary donors',” he observed, and said that paid blood donations were also common in the country.

Dr Zaheer said that the need for the establishment of a consolidated national blood transfusion service in Pakistan in line with the WHO recommendations and guidelines was identified in August 2007 when stakeholders had reached the consensus that the existing fragmented blood transfusion system, which was not geared to meet the demands of the nation, could not be reformed or strengthened as it promoted unsafe blood transfusion.

He said that the goal of NBTP was to establish the core elements of an independent rational structure of a national blood transfusion system that could ensure adequate, safe and efficient blood supply in a cost-effective manner.

NBPT objectives include ensuring 100 per cent quality in the testing of all donated blood for transfusion against transmitted infections and promoting rational clinical use of blood and principles of 'haemovigilance' as well as developing human resources, according to him.

He said that the federal government would provide national-level monitoring, supporting a province-oriented structure of the blood transfusion services. Each province would have a provincial blood transfusion programme that would manage its regional blood transfusion centres and hospital-based blood banks, he said, adding that RBTCs would serve as the public and private service providers.

According to him, RBTCs will also mobilise voluntary blood donors, collect blood donations and conduct processing, screening, testing, component preparation and storage. Each of the RBTCs will also feed six respective hospital-based banks linked to it. These centres will have complete financial and administrative autonomy.

Dr Zaheer said that the existing hospital-based blood banks would be refurbished, remodeled and converted into patient-oriented hospital transfusion services performing the functions of storage, distribution and compatibility testing, haemovigilance, etc.

He stated that while the German government would provide funding for the development of the relevant structures, the federal and provincial governments would bear the expenses under the heads of salaries, consumables and other recurrent costs of the blood transfusion centres and hospital-based banks.

In his keynote address DUHS Vice-Chancellor Prof Masood Hameed Khan said that realising the need of trained manpower for the new blood transfusion system in the country, his university had already moved in the direction and started taking up various educational and training programmes for doctors, technical professionals and medical students.

He also proposed the establishment of 'Dow Institute of Haematology and Transfusion Medicine', and said that the university wanted to establish the facility under one roof to provide diagnostics and blood transfusion services and offer postgraduate training programme in blood transfusion medicine.