|Year : 2016 | Volume
| Issue : 2 | Page : 72-74
Current status of blood banks in India
Vikas Bhatia1, Babita Raghuwanshi2, Jyotiranjan Sahoo1
1 Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
2 Department of Transfusion Medicine, AIIMS, Bhubaneswar, Odisha, India
|Date of Web Publication||6-Sep-2016|
Department of Transfusion Medicine, AIIMS, Bhubaneswar, Odisha
Source of Support: None, Conflict of Interest: None
Despite the current advances in technology in health-care delivery, access to safe blood and blood products and their judicious use remains a big challenge. There is a stark difference between developed and developing nations as less than half of hospitals in developing nation provide blood transfusion services. While the health sector in India has made outstanding accomplishments in the past few decades, it has not reciprocated sufficiently to fulfil the country's objective on blood transfusion facilities. Indian blood transfusion network is plagued by inadequacy of blood storage centers, dominance of private sector over public sectors, lack of proper facilities, storage & quality of services etc. Revamping blood transfusion system is the basic necessity to provide basic care. The challenges to overcome such hindrances may be unification of blood transfusion services to maintain the standard or duplication of services, focus on quality of service provided, adoption of newer technologies, strengthening of reporting and information system to maintain the inventory, emphasis on equitable distribution blood and blood products and many more. These changes can be made through framing a strong policy, functional planning and setting standards.
Keywords: First referral unit, fragmented blood transfusion services, National Blood Policy
|How to cite this article:|
Bhatia V, Raghuwanshi B, Sahoo J. Current status of blood banks in India. Glob J Transfus Med 2016;1:72-4
| Introduction|| |
Despite substantial development in the field of medicine, effective substitutes of blood and blood products have not yet been developed. In the absence of such substitutes, blood remains the mainstay of treatment for a wide range of medical condition, and therefore well-organized and effective blood transfusion service is vital for the health-care delivery system. Despite the current advances in technology in health-care delivery, access to safe blood and blood products and their judicious use remains a big challenge for the world. While the demand for blood is increasing in the developed nations resulting in longevity of life, country-specific blood stocks are barely adequate to meet basic requirements in developing nations.
According to the World Health Organization around 50,000 hospitals provide blood transfusion serving a population of around 4 billion (based on 130 countries). There is a stark difference between developed and developing nations as only 41% of hospitals in developing nations provide blood transfusion services. Around 93 million blood units are donated annually, and 50% of them are collected in developed countries which are home to only 16% of world's population. Blood usage patterns are also different for developed and developing countries. A comparative analysis is given in [Table 1]. These facts point out the lack of blood collection, as well as utilization in developing countries.
|Table 1: Comparison of pattern of blood usage between developing and developed countries|
Click here to view
While the health sector in India has made outstanding accomplishments in the past few decades, but it has not reciprocated sufficiently to fulfill the country's objective on blood transfusion facilities. Grave situation of blood collection, storage, and utilization in India can be judged from a basic indicator of maternal health. Blood transfusion as a treatment modality for postpartum hemorrhage and severe anemia is well-known but still more than one-third of maternal death is due to these conditions in India and situation of rural India is even worse. Although National Blood Policy of India acknowledges this grave situation and has proposed an increase in blood storage facility, its translation into reality is still a distant dream. Therefore, it is felt need to transform the present “state of affair” to the necessary “state of art” in terms of blood storage facilities. The current article is an attempt to review the current status and challenges faced by India with respect to blood banks.
Current status of blood banks in India
India has four types of blood banks/centers from the administrative point of view. They are managed by the public (government) sector, Indian Red Cross Society, Nongovernment Organizations (NGOs, on not for profit basis), and corporate or commercial sectors. As on 2013, there are a total of 2545 designated blood banks in India.
[Figure 1] shows the trend in a number of blood banks in India over the year. Although there is an increasing trend regarding the number of blood banks in India over the years, the point of concern is the pace of increment [Figure 1].
Another concern is the blood banks in the public sector. Whatever increase in a number of blood storage facilities India has witnessed, it was mostly because of private sectors. Growth in the government sector is too slow paced. As per the National Blood Policy every First Referral Unit like district hospital (DH), Subdivisional Hospital (SDH), Community Health Centres (CHC), etc., should be equipped with round the clock blood transfusion facility. There are more than 6000 facilities such as DH, SDH, and CHC present across India excluding medical colleges and more than 80% of these lack blood storage facility. Such severe lack in a storage facility is also translated into blood collections. The total recorded blood collection in India is four million units, which meet only 40% of need against a minimum requirement of 10 million units (calculated at 1% of 1 billion populations). Moreover, the blood banks in private sectors are not accessible or affordable to the rural population due to cost constraints.
In addition to a lack of facilities, lack of proper management and functioning of existing blood transfusion services make the situation even worse. Blood transfusion is an emergency service and should be provided round the clock but nonfunctioning of blood banks 24 × 7 is a hindrance to providing emergency care. Linking of district blood banks with peripheral health institutions is also lacking. Moreover, lack of manpower, training, monitoring, and supervision of the existing blood banks are some of the other issues which make the situation even worse.
| Challenges in Establishing Blood Banks|| |
Fragmented blood transfusion services
In India, blood transfusion depends on the fragmented blood-supply system, which comes under the jurisdiction of different government agencies, making it difficult to assure the quality of blood and blood products. Two aligned systems are in place to monitor the blood-safety program in India – National blood transfusion council/state blood transfusion council and National AIDS Control Organization (NACO)/state AIDS control society. As there are a large number of trust blood banks, independent commercial and stand-alone blood banks, the control of quality and cooperation of all blood banks to ensure easy access to blood and reduce wastage is a questionable task.
Quality of transfusion services
In India, many blood banks are established to satisfy regulatory requirements (e.g., New Private Medical Colleges) and not to fulfill a real need. Private hospitals open blood banks as they are denied permission to open storage centers or personal benefits like higher treatment cost. Medical Colleges open blood banks to meet Medical Council of India requirement. The government opens blood banks in various peripheral setup due to political pressure. Such blood banks run with a lesser number of competent workforce and with less workload to sustain the operation which in turn leads to compromised quality.
Adoption of newer technologies
Public sector blood banks are lagging behind in adoption of newer technologies. Private sector is credited for improved testing in the form of individual nucleic acid testing, screening for antibodies, antigen typing, improved quality of blood bags, leukoreduction, and bacterial detection systems, etc. Such newer testing and technologies have still not been mentioned in the drug and cosmetic act.
Reporting and information system
There is a lack of proper records on the use of blood in India. Therefore, it is not practically feasible to assess the requirement, inventory, and deficiency of blood in an emergency. Besides, the monitoring of the clinical use of blood and blood products is nonexistent. The National Haemovigilance program  of India has been launched still the number of blood banks affiliated to it is small and therefore the data to measure adverse reactions following blood transfusion are meager. Thus, substantial improvement in reporting and information system is required.
The mechanism of availability of blood in rural areas is in a deplorable state. Private sector blood banks which are growing at an accelerated rate cater only to the urban population. Unavailability of blood in an emergency situation is aggravated by lack of linkage between peripheral health facilities with central level blood banks. Blood as the essential treatment modality of health care should be available to all section of society.
Voluntary blood donation
An effective management of blood bank needs a balance between demand and supply. As India has a high demand for blood, supply must be strengthened. Voluntary blood donation remains the foundation for a safe and good-quality blood transfusion service. Although NACO in collaboration with Government of India has been promoting voluntary blood donation, but to achieve 100% voluntary blood donation, public awareness is necessary. The information, education, and communication system must be strengthened. Mass media campaign to address the fear, myths, and misconceptions about blood donations among the general public is one of the ways to achieve it.
| Conclusion|| |
Essential functions of a national blood system include framing the national policy, functional planning, setting standards, resource management, and cooperation between different national agencies to ensure safe blood and blood products and safe transfusion. In the past decade, few credible steps have been taken to improve the quality of blood transfusion services like National Accreditation Board for Hospitals and Healthcare Providers accreditation program exclusively for blood banks, run by Quality Council of India), National Haemovigilance Program for continuous data collection and analysis of transfusion-related adverse reactions, etc., Such steps with the strengthening of existing blood banks and creation of new facilities keeping in mind equity and accessibility will help India to successfully achieve the intended goal.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Blood Transfusion Safety. Department of Essential Health Technologies. Geneva: World Health Organization; 2006.
Montgomery AL, Ram U, Kumar R, Jha P; Million Death Study Collaborators. Maternal mortality in India: Causes and healthcare service use based on a nationally representative survey. PLoS One 2014;9:e83331.
Ministry of Health and Family Welfare and NACO. National Blood Policy. Ministry of Health and Family Welfare, Government of India; 2007.
Aggarwal S, Sharma V. Attitudes and problems related to voluntary blood donation in India: A short communication. Ann Trop Med Health 2012;5:50-2.
Statistics Division, Ministry of Health and Family Welfare. Rural Health Statistics-2012. Government of India; 2012.
Ramani KV, Mavalankar DV, Govil D. Study of blood-transfusion services in Maharashtra and Gujarat States, India. J Health Popul Nutr 2009;27:259-70.
Choudhury N. Management in Indian blood banking system: True reality. Asian J Transfus Sci 2009;3:57-9.
Biswas AB, Nandy S, Sinha RN, Das DK, Roy RN, Datta S. Status of maternal and new born care at first referral units in the state of West Bengal. Indian J Public Health 2004;48:21-6.
Vora KS, Mavalankar DV, Ramani KV, Upadhyaya M, Sharma B, Iyengar S, et al.
Maternal health situation in India: A case study. J Health Popul Nutr 2009;27:184-201.
Chandrashekar S, Kantharaj A. Legal and ethical issues in safe blood transfusion. Indian J Anaesth 2014;58:558-64.
Bisht A, Singh S, Marwaha N. Hemovigilance program-India. Asian J Transfus Sci 2013;7:73-4.
Pal R, Kar S, Zaman FA, Pal S. The quest for an Indian blood law as of blood transfusion services regulatory framework. Asian J Transfus Sci 2011;5:171-4.