Overview and Background:
Blood is an intrinsic requirement for health care and proper functioning of the health system. NACO has been primarily responsible for ensuring provision of safe blood for the country since 1992. NACO supports a network of blood banks across the country in over 600 districts.
Government of India adopted the National Blood Policy in April 2002 which aims to develop a nationwide system to ensure easy access to adequate and safe blood supply. Supreme Court judgment of 1996 mandated creating of National Blood Transfusion Council and removal of professional blood donation. National Blood Transfusion Council (NBTC), the apex policy making body for issues pertaining to blood and plasma is a part of National AIDS Control Organization.
Government has adopted a comprehensive, efficient and total quality management approach. Government has taken number of steps towards the modernization of blood banks in the country by providing the critical inputs under the blood safety programme through all phases of the National AIDS Control Programme and has been primarily responsible for ensuring provision of safe blood for the country throughout the first three phases of National AIDS Control Programme. During this time HIV sero-reactivity also declined from 1.2% to 0.2% in NACO supported Blood Banks. The availability of safe blood increased from 44 lakhs units in 2007 to 98 lakhs units by 2013.
The annual requirement of blood for the country is estimated at 12 million units of blood, of which NACO supported blood banks have collected 57 Lakh units in 2013-14. 84 % of this was through voluntary non remunerated blood donation.
NACP IV strategy and targets:
The NACP IV Working Group on Blood Safety suggested that the nomenclature should be changed from Blood Safety to Blood Transfusion Service. In fact during the fourth phase, Blood programme has been accorded due priority by expanding the scope of the Blood Safety programme to a full fledged programme for Blood Transfusion Services. National Blood Transfusion Council (NBTC), the apex policy making body for issues pertaining to blood and plasma is a part of NACO.
End of Project targets for Blood Transfusion Services (under NACO support):
Cumulative Number of Blood Banks
Total number of Blood units Collected
90 Lakh Units
Percentage of Voluntary Blood Donation
Number of Blood units converted to Blood Components
- Assessing blood needs and requirements of the country.
- Increasing regular voluntary non-remunerated blood donation to meet the safe blood requirements of the country.
- Promoting component preparation and availability along with rational use of blood in healthcare facilities.
- Capacity building of health care providers.
- Enhancing blood access through a well networked centrally coordinated, efficient and self sufficient blood transfusion service.
- Establishing Quality Management Systems to ensure Safe Blood.
- Building implementation structures and referral linkages.
Metro Blood Banks: It is proposed to set up four state-of-the-art Centres of excellence in Transfusion Medicine in Chennai, Delhi, Kolkata and Mumbai.
Plasma Fractionation Centre: It is proposed to set up a Plasma fractionation centre at Chennai with a capacity of processing 150,000 litres of plasma per annum and prepare plasma products for use within the country.
National Blood Transfusion Council: It is proposed to strengthen the National Blood Transfusion Council to empower it to fulfill its roles and responsibilities as the policy formulating apex body for all matters pertaining to the organization, operation, standards and training of a sustainable and safe blood transfusion service for the country. Mechanism for better coordination between NBTC and SBTC and providing technical, financial and managerial assistance to SBTC as needed to implement the national blood programme would also be developed.
Key indicators for Blood Safety
• Blood Collection in NACO supported Blood Banks
• Percentage of blood collected through voluntary blood donation in NACO supported Blood Banks
• Percentage of blood separated into components in NACO supported Blood Banks
• Percentage of sero-prevalence of TTIs in NACO supported Blood Banks
Blood Transfusion Services in India however are plagued by a multiplicity of controls, with licensing being under the Drug Controller General of India, policy under National and State Blood Transfusion Councils and implementation with the States. Recently, a national blood cell has also been created in the Department of Health and Family Welfare.
What is required is developing a nationally coordinated and well networked blood transfusion service in the country to enable us to meet the global goals of achieving self sufficiency in blood and blood products through voluntary non remunerated blood donation.
The blood transfusion services supported by NACO comprise a network of 1,137 blood banks, including 258 Blood Component Separation Units (BCSU) and 34 Model Blood Banks, 180 Major Blood Banks and 665 district level blood banks. NACO has supported the establishment of component separation facilities and also funded modernization of all major government and charitable blood banks at state and district levels. Besides enhancing awareness about the need to access safe blood and blood products, NACO has supported the procurement of equipment, blood bags, test kits and reagents as well as the recurring expenditure of government blood banks and those run by voluntary/charitable organizations, which were modernized. Total NACO supported blood banks increased to 1137 in 2013-14 from 1118 in 2012-13. 81 more blood banks are being included under NACO support during 2014-15.
Practice of appropriate clinical use of blood amongst the clinicians has seen a definite rise due to the increased component preparation and usage during seasonal epidemics, and training of clinicians on the rational use of blood. At present, component separation in NACO supported blood component separation units is around 60%.
State Blood Transfusion Councils also receive support to conduct activities for promotion of voluntary blood donation and conduction of Blood Donation Camps through the NACO.
Recently, the national plasma policy has been released, which was a much awaited response to optimally utilize surplus plasma. The set up of four Centres of Excellence in Transfusion Medicine has also been accorded financial approval and cabinet note has been put up.
Voluntary Blood Donation Programme:
It has been recognized world over that collection of blood from regular (repeat) voluntary non remunerated blood donors should constitute the main source of blood supply. Accordingly, activities for augmentation of voluntary blood component have been taken up as per guidelines on voluntary blood donation. Total of 68453 VBD camps were conducted in 2013-14 collecting 29 Lakh blood units.
Voluntary blood donation (VBD), including family blood donors, has reached to 84 % in 2013-14 from baseline of 54.4% at the beginning of NACP III. Several activities to promote public awareness of the need for voluntary blood donation have been undertaken in collaboration with Red Cross and various Blood Donor Organisations. District-wise training programmes are running in the states to train the motivators and sensitize them. Special days such as World Blood Donor Day and National Voluntary Blood Donation Day were observed at national and state level recognizing the contribution of repeat non-remunerated repeat voluntary blood donors.
Model Blood Banks:
Model Blood Banks help to improve upon the standards of blood transfusion services and function as demonstration centers for the States. 34 model blood banks continue to function across the country. These were made functional in 2010, following which NACO is to support them for first three years. They are to be taken over by the states in terms of human resources and maintenance of equipments. Total of 32 state-of-the-art blood mobiles have been made available to improve VNRBD in the states. Around one third of VBD collection is occurring with the help of such mobiles. However, all blood mobile vans are not treated as government vehicles and charges of fitness, annual road taxes as for private vehicles are levied.
Blood Component Separation Units (BCSU):
In order to promote rational use of blood, BCSU are established as an active part of BTS. During FY 2013-14 additional 83 BCSU has been included under NACO support increasing to total number of 258 BCSU across the country. These BCSUs are working in their respective states and the proportion of blood units processed for component separation has risen to from 47% to 59% in the last financial year 2013-14. Around 37 lakhs blood units have been collected during this time frame.
Major Blood Banks (MBB) and District level Blood Banks (DLBB):
Government and charitable blood banks collecting less than 5000 units per year are supported as MBB and DLBB in various districts of the country. With increasing blood collection and blood component usage, some of major blood banks and district level blood banks have been upgraded and converted to BCSU. At present, 180 of MBB and 665 of DLBB existed in the country by the end of FY 2013-14.
India represented by the Secretary NACO was among 51 countries in a WHO high level policy maker’s forum on “Achieving Self-sufficiency in Safe Blood and blood products based voluntary non-remunerated donation” held in Rome, Italy in October 2013. The “Rome Declaration” was signed by 153 signatories including representatives of Ministries of Health, National Blood Programmes, National Blood Transfusion Services, National Public Health Agencies, National regulatory bodies, National plasma fractionation institutes, representatives of international intergovernmental and NGO and experts in Transfusion medicine.
Access to safe blood continues to be limited especially in rural areas in states like UP, Uttarakhand, Jharkhand, Bihar, Chattisgarh. This issue is pertinent and requires resolution through policy reforms, networking and regional coordination of blood transfusion services & strengthening linkages with NHM.
There are 48 districts, where there is no facility for Blood Transfusion. State should identify if there are functional First Referral Units in these districts and take initiative to set up Blood Storage centres in these districts or provide linkage to nearest blood bank to cater to blood needs in coordination with SACS. The details are as given below:
UttarPradesh: Amethi, Hapur, Shamli, Sambhal
Jharkhand: Ramgarh, Khunti Chattra,Pakur,Saraikela,Jamtara, Godda)
Uttarakhand: Borari, Rudraprayag,Bageshwar,Champavat
Madhya Pradesh: Ashok Nagar, Anuppur
Karnataka: Chikkaballapur, Koppal
Assam: Baksa, Udalguri, Chirang, Kamrup
Manipur: Thoubal, Senapati, Bishnupur, Ukhrul, Chandel, Tamenglong
Meghalaya: West Khasi Hills, Jaintia Hills, Ri Bhoi, East Garo Hills, South Garo Hills
Arunachal Pradesh: West Kameng, Kurung Valley, Dibang Valley, Anjaw, Tirap
Nagaland: Peren, Kiphire, Longlen
Sikkim: North Sikkim, West Sikkim
Tripura: Siphijala, Khowai, South Tripura
Blood Transportation Vans:
Blood needs to be transported under proper cold chain maintenance from the linked mother blood bank to the Blood Storage Centre (BSC). Each mother blood bank is linked to 6-8 BSCs in order to supply blood units under proper conditions and storage, NACO had taken the initiative to provide 250 refrigerated Blood Transportation Vans to the RBTC/District Blood banks during NACP-III, which are being maintained through provisioning of fuel & manpower cost. These vans transfer blood units to the BSC on a regular basis and also on demand/emergency situations.
Blood Transfusion Services- Training Programme:
Education and training is fundamental to every aspect of Blood Transfusion Services. 17 centers have been identified across the country as training centers to impart training on all aspects of Blood Transfusion Services involving Blood Bank Medical Officers, Technicians, Counselors, Nurses, Clinicians, Donor Motivators and Programme Officers of SACS.The Blood Transfusion Services training programme aims to:
• Strengthen national capacity in education and training in all aspects of blood transfusion; and voluntary blood donation.
• Support the establishment of sustainable national education and training programmes in blood transfusion;
• Strengthen inter- and intra-regional collaboration in training in blood transfusion between NACO and its Collaborating Centers, national blood transfusion services, education and training institutions and NGOs.
These centres are being strengthened through the CDC/CMAI project.
Supervisory Visits to NACO supported Blood Banks:
Core teams have been constituted in every state to carry out the periodic supervision of all NACO supported blood banks and voluntary blood donation camps. This core team comprises of representatives from blood transfusion expert, State AIDS control society, State Drug control dept. and State blood transfusion council.
CDC-CMAI project for strengthening blood transfusion services:
NACO is receiving technical assistance from Center for Disease Control – Dept. of Global HIV & AIDS (CDC-DGHA), through cooperative agreement with Christian Medical Association of India (CMAI)& Christian Medical College (CMC) Vellore, for five years.A rapid situation analysis and desk review was conducted as part of the project to understand the current scenario of BTS across the country.
Blood Transfusion Services however are plagued by a multiplicity of controls, with licensing being under the Drug Controller General of India, policy under National and State Blood Transfusion Councils and implementation with the State governments.