Scarcity of safe, inexpensive blood fast-tracking deaths
• 1.8m Units Needed Yearly • Only 51, 433 Collected From NBTS Centres • NBTS functioning poorly
• No Full Implementation of Blood Policy • Budget for NBTS Insufficient • Patients Pay High Prices For Blood
As the world marks this year’s World Blood Donor Day on Wednesday June 14, the country would do so with the grim realisation that millions of patients in emergency care, particularly mothers and children, are ending their lives midstream due to delay in blood supply.
Despite the establishment of the National Blood Transfusion Service (NBTS) – a national blood system designed to make blood affordable and adequately available at all times, millions across the country still toil very hard to procure the increasingly expensive precious liquid needed to save the lives of their loved ones.
According to the World Health Organisation (WHO), which maintains that without a system based on voluntary blood donation, no country can provide sufficient safe blood for all patients requiring transfusion, Nigeria needs about 1.8 million units of blood yearly to save people from dying during emergency medical care.
This is a far cry from the 51, 433 units provided by NBTS in 2016, according to its national coordinator, NBTS, Federal Ministry of Health, Dr. Toyin Smith, in an exclusive interview with The Guardian.Blood obtained from other medical facilities, mainly through commercial blood donors and family replacement methods, were about 1.4 million units. This takes the total figure obtained from NBTS and other facilities to 1.5m units and therefore a deficit of over 300, 000 units.
The Federal Government in 2005, set up the NBTS to provide quality, cost effective and adequate safe blood to citizens through a voluntary blood donation system. But 12 years after its establishment, the NBTS has still not been able to effectively discharge its mandate to citizens, through a 100 per cent voluntary blood donation system, as stated in the National Blood Policy.
A national baseline data survey on blood transfusion, conducted by the NBTS indicates that blood donors in public hospitals comprise of 25 per cent commercial donors and 75 per cent of replacement donors, while voluntary unpaid donors constituted a very negligible number.
At private hospitals, commercial donors constituted 75 per cent; replacement donors 25 per cent, while voluntary unpaid donors is also very negligible here.Away from the foregoing scenario, the high cost of procuring blood even from the NBTS, which is supposed to be subsidised is very worrisome.
Investigations by The Guardian reveal that a unit of blood from NBTS now sales for N10, 000 at designated hospitals, and goes for much more for rare blood groups, and access fee for each blood in March this year moved up from N2, 000 to N5, 000.
In confirming this, the NBTS national coordinator said: “Yes, N2, 000 was agreed upon in 2005. But a unit of blood now costs about N20, 000 to produce. In the face of lack of funds for NBTS operations, rising cost of blood screening reagents, escalating foreign exchange, and in order to institute a partial cost recovery scheme, we sought approval to increase the blood access fees in March this year and it was granted.”
The Guardian discovered that obtaining blood transfusion at government and private hospitals in the country is not only costly for an average Nigerian, but even the blood is usually not available.
That explains why Mr. Abel Paul, father of a sickle cell anaemic boy had to pay N30, 000 at the Lagos State University Teaching Hospital, Ikeja, for the screening of six pints of blood given to his ailing son.
“When he is in crisis, we have to transfuse at least four pints of blood. Since the hospital does not have blood for sale, I also had to pay people to donate blood. I pay N8, 000 to the donors for each pint, and this takes everything to a total of N78, 000.”In some general hospitals visited in Lagos State, including General Hospital, Ikorodu, General Hospital, Gbagada, and General Hospital, Randle, it was discovered that for a patient to get blood transfusion, he has to get a family member to donate blood compulsorily. After this, the patient still pays between N4, 500 to N5, 000 for the blood to be screened. This fee, patients and their families lament is prohibitive and they want it slashed.
“I have been donating blood to NBTS for four years now, but when my father fell ill and needed four pints of blood at LUTH, I had to pay for the blood and for it to be screened. This is unfair, what then is the use of voluntary blood donation?” Israel Udoka, a blood donor questioned bitterly.
In private hospitals patronised by a large population of Nigerians, it was discovered that the cost of blood is higher.For instance, a pint of blood now goes for between N15, 000 and N 25, 000, depending on the blood group, that is AB, O- and O+. However, O-, which is the scarce blood group, sometimes attracts as much as N30, 000.
Explaining why blood donated freely at NBTS ends up being sold, Smith said: “People have to pay because of the cost of screening the blood. We use very expensive equipment- 4th generation ELISA technology to screen the blood. Even the consumables used to work on one consignment of blood can’t be used on another. We also have to buy reagents. In foreign countries, those that need blood still have to pay through their health insurance. In Nigeria, there is nothing like that.”
On the high fees charged by private facilities and commercial donors, Smith said: “We are against what they are doing, but unfortunately, blood banks are not regulated. So, we can’t tell them the cost per pint for now. We told them initially to bring the blood so we can screen for them. If they do that, it will be cheaper for them. But they don’t have large quantity of blood and we screen large quantity.”
No Funding To Sustain NBTS
THE American government, through the United States President’s Emergency Plan for AIDS Relief (PEPFAR), funded the service from 2005 to 2015, when it withdrew its funding.
According to the NBTS boss, before the funding ceased: “These funds were deployed to set up six zonal blood centres in Kaduna (North-West), Owerri (South-East), Ibadan (South-West), Jos (North-Central), Maiduguri (North-East) and Benin (South-South). Subsequently, the Federal Government established the Abuja operational center and 10 additional centres in the states (Lokoja, Nangere-Potiskum, Abeokuta, Katsina, Enugu, Ado-Ekiti, Calabar, Jalingo, Sokoto and Port-Harcourt), through the Debt Relief Grant for Millennium Development Goals (DRG– MDGs) and budgetary capital allocations, bringing the total number of NBTS Centres to 17, by the end of November, 2015.”
Since the funding from PEPFAR ended in September 2016, she continued, “sources of funding to the NBTS include annual capital budgetary appropriation from the Federal Government, and funds generated from handling charges (blood access fees) at N5, 000 per unit of blood, which is highly subsidised and serves as the only source of funds for operational costs to the NBTS,” she said.
According to her, what is actually needed to run all 17 centres is about N1.2bn -1.6bn annually.“The amount appropriated for capital expenditure is not adequate. In 2016 about N30m was appropriated. This year, N84m has been allocated, which is yet to be released as the annual budget has not been assented to by the president, but no one knows whether the actual appropriation will be more or less. For us to sustain the blood service, we are now looking for partnership through PPP,” she added.
The National Blood Policy:
IN 2006, the NBTS produced the National Blood Policy, a guideline for blood transfusion activities. According to the policy, blood donation shall be based on the principle of regular, voluntary and non-remunerative.
The policy also explained that the family replacement donation system shall gradually be phased out as voluntary donation programmes become established. It states that states and local councils shall establish their blood service centes.
From the WHO’s point of view, the National Blood Policy must ensure the safety and availability of blood and blood products as they play a major role in preventing the transmission of HIV, hepatitis, virus and other blood borne pathogens in health care settings.The Guardian discovered that this policy is not being implemented fully and some states and local councils do not have blood centres as stipulated.
Throwing more light on this, The NBTS Boss said, “Yes, full implementation is yet to be achieved. In order to be fully implemented, the policy needs to be backed by appropriate legislation and regulation. Hence the need for the NBTS Draft Bill, which has been developed and is currently being considered by the Minister of Health for submission to the Federal Executive Council.”Continuing, she said there is the compelling need to fast-track the legislative processing of the NBTS Draft Bill.
“If enacted, it will guarantee dedicated funding from the Federal Government, and open doors to other sources of funding to ensure sustainability. It will greatly reduce/eliminate unwholesome practices in the field and enable the NBTS regulate blood transfusion practice, ensure compliance with the National Blood Policy and Operational Guidelines for Blood Transfusion Practice. It will also ensure sufficient supply of safe blood nationwide,” Smith said.
In order for NBTS to function optimally, she said there is need to obtain a self accounting status for overhead and recurrent appropriation for all NBTS centres in order to institute mechanisms for adequate and regular funding to run the blood safety programme post PEPFAR.
“All states and local governments to take ownership of blood safety activities in their respective domain as recommended in the National Blood Policy. There is need to fast track the absorption of former project staff (core technical staff), into the ministry’s 2017 manpower budget, and to obtain the necessary waiver from the Office of the Head of Service of the Federation for their regularisation/absorption into the Federal Civil Service,” she said.
She listed some of the barriers to blood donation to include low public awareness on voluntary non-remunerated blood donation arising from deep cultural myths and misconceptions, and Inadequate designated blood donation centres/facilities.
Meanwhile, the Country Director of Evidence For Action (E4A) Mamaye, a maternal health programme, Dr. Tunde Segun, says compulsory blood donation is not ideal in saving life.
He is therefore, encouraging Nigerians to become voluntary donors in order to save women from dying during childbirth due to blood related reasons. According to him: “Reports show that 34 per cent of pregnant women die in labour as a result of complications of bleeding and lack of blood for transfusion in the country.This year’s world donor day, focuses on blood donation in emergencies with slogan: “What can you do?, with the secondary message: Give blood. Give now. Give often.”