Nigerians yet to imbibe voluntary blood donations
Why is it still an uphill task to get as many voluntary blood donors as possible?The culture of voluntary blood donation in Nigeria is poor, and can be attributed to diverse cultural beliefs concerning blood, low awareness, general fears, myths and misconceptions surrounding blood donation, as well as inaccessibility to the NBTS centers (often located […]
Why is it still an uphill task to get as many voluntary blood donors as possible?
The culture of voluntary blood donation in Nigeria is poor, and can be attributed to diverse cultural beliefs concerning blood, low awareness, general fears, myths and misconceptions surrounding blood donation, as well as inaccessibility to the NBTS centers (often located in state capitals). These factors have made it difficult for the NBTS to meet up the blood needs of the general population.
To improve awareness on the importance of safe blood transfusion practice, a robust mass media campaign to publicize NBTS activities, sensitize prospective donors and mobilize communities towards voluntary blood donation is crucial. This will serve to increase considerably the recruitment and retention of a pool of regular voluntary blood donors. NBTS is presently exploring areas of collaboration and partnerships with media organization in the area of awareness creation and thus establishing a sustainable safe blood supply for Nigerians.
What is the NBTS doing in the face of the current realities as posed by transmissible infections like Ebola and other related diseases?
In the screening decision made as a precautionary measure by the Quality and Blood Safety Department of the NBTS with approval from the Federal Ministry of Health, anyone who has resided in or visited any of the countries which have had an outbreak of Ebola virus disease (including Guinea, Sierra Leone and Liberia) will be deferred for blood donation for at least 28 days from the date he or she departed from the affected country. Ebola virus disease has an incubation period of 2 to 21 days.
Donor screening has been tightened to ensure that no donor with suspicious symptoms walks in. Once a donor walks in to donate blood, he or she must be well and healthy. Donors are urged to be truthful in their answers to questions asked them during any blood donation exercise.
There could be donors who may be incubating in the 21-day period, and may not be symptomatic and it is also true that at least, to date, no record of a transfusion and transmissible Ebola has been recorded yet in the world. The fact that Nigeria has been certified virus free by WHO is heartwarming.
Using properly disinfected equipment and educating health care workers involved in blood donation exercise about universal blood precautions are mandatory. Hand gloves are made available for single use and hand sanitizers are liberally available.
Since blood will always be needed in our health facilities for various health conditions including EVD itself, the call for voluntary donation would always be encouraged. At the earliest stage of presenting for blood donation, a prospective blood donor who has fever or has a travel or exposure history suggestive of EVD is identified early and either deferred or referred as appropriate. No single case has so far been detected among our donors in all the 17 NBTS Centres nationwide in the past 4-6 months. The NBTS will closely follow the latest information on the virus outbreak as announced by the World Health Organization in order to revise the blood donation screening policies.
Concerning other related transmissible infections, we in NBTS embark on universal testing of donated blood. This means the screening of all donated blood in accordance with quality requirements for at minimum HIV, Hepatitis B, Hepatitis C and Syphilis.
How far is supply from voluntary blood donation outstripped by demand?
According to the World Health Organization (WHO), Nigeria needs about 1.5 million units of blood annually. This is barely one percent of the entire population of the country which is put at about 170 million. WHO expects that 100 percent of these blood units should come from voluntary non-remunerated regular blood donors as these are known to be the safest blood donors. Incidentally, in Nigeria presently, I will say we are between 10 and 12 percent of this figure leaving a gap of about 90 percent. Most of this 90 percent is being obtained from paid donors and relative donors in the different health facilities. So we can see there is a huge gap between supply and demand though often times what concerns the would-be beneficiary of blood transfusion is mainly the availability of blood but in the National Blood Transfusion Service, NBTS, we talk of availability of safe and quality blood. For a start, this is sourced from regular voluntary non-remunerated blood donors.
NBTS has severally talked about something of a cap of N2000 or N2500 on the price of pints of blood obtained through voluntary donations. Why are hospitals still free to charge as much as they want for blood?
NBTS has the mandate to ensure no person resident in Nigeria dies due to non-availability of blood. Hence it becomes necessary for us to put an affordable service charge of only N2000 per unit. This is purely service charge considering the fact that we got the blood free from volunteers. This service charge takes care of materials for collecting and storing the blood including the cold chain which has to be maintained throughout to ensure the potency and adequacy of the blood by the time it is issued out. We should not forget the blood is also screened for at least the four WHO mandatory tests for Transfusion Transmissible Infections(TTIs). It is pertinent to say that we do give blood free of charge to indigent cases who for one reason or the other cannot afford the service charge.
Concerning hospitals that charge as much as they want, we presently do not have control over them but you should not forget that most of them, especially the tertiary facilities, are commercialized. However we insist that it is a question of human rights. The patient in any hospital has a right to decide and should be given the opportunity to request blood from NBTS which is safe, potent and affordable if there is an NBTS Center around.
Once there is an enabling law guiding the operations of the NBTS, it is envisaged that NBTS would then have an enforcement power concerning blood use generally in the country. For some health facilities that are collaborating with the NBTS under the Hospital Linkage Program HLP, we make effort to ensure blood collected from us is not commercialized as we only allow them to put a small amount on top of the N2000 to cover their own costs minimally. We believe by the time NBTS is fully empowered to perform its statutory roles, things concerning blood usage will be under strict control to lessen the burdens on the typical patient that needs blood transfusion.
A growing number of hospitals demand patients’ relatives to donate blood or buy blood before scheduled surgeries. Ostensibly, the blood might be used during surgery but when it is not used, it is not returned. Though the intention is to have ready supply of blood, doesn’t this mode of operation run counterproductive to getting more voluntary donations?
A situation whereby blood collected in respect of surgery or any medical condition was not eventually utilized, if within few hours of collection and the blood has been kept well – not exposed to harsh temperature, such can be returned to the blood bank. However, the personnel at the blood bank will crosscheck to ensure there has not been any damage and that the blood unit is still in good condition. Money initially paid for such returned blood unit should also be returned unless the blood was found to be no longer useful. Health facilities collaborating with NBTS under the Hospital Linkage Program for example are encouraged to return unused blood units up to about 10 days to expiry so that they can still be redistributed to other facilities where they could be needed and utilized before the expiry date.
What is the level of NBTS partnership with hospitals as far as blood related issues are concerned?
In an effort to ensure good partnership with hospitals as far as blood related issues are concerned, the NBTS established what is referred to as Hospital Linkage Program, HLP.
The goal of this program is to ensure availability of safe blood in hospitals, by supporting them to re-test pilot samples of all blood they have transfused which have been obtained from hospitals’ Family Replacement Donors FRDs and voluntary donors, and eventually to encourage the gradual conversion of FRDs to voluntary donors. Under this program, partner hospitals are to be assisted to establish hospital transfusion committees and to maintain data on blood transfusion activities. The collaboration also involves capacity building in blood safety through decentralized training of hospital staff in the localities where they provide service.