Need to enhance availability of safe blood

Maj Gen Atul Kotwal (Retd)
Executive Director, National Health Systems Resource Centre, Union Health Ministry

SAFE blood saves lives. Blood cannot be manufactured outside the body and has a limited shelf life and thus, its supply must be constantly replenished. Voluntary blood donors are the cornerstone of a safe and adequate supply of blood and its components. Concerted efforts over the past few years by the government, non-governmental organisations and staff providing blood transfusion services have led to a progressive increase in voluntary blood donation in the country. However, due to the existing shortfall, there is a need for strategies to enhance safe blood availability by focusing more on voluntary blood donors.

Several reports have attested to a shortage of blood across healthcare facilities in India. We are losing patients every day due to unavailability/shortage of blood, including maternal deaths due to excessive loss of blood. Blood transfusion is not limited to cases such as trauma, surgeries, post-partum haemorrhages or anaemia, but with the country’s changing health needs and evolved facilities, this has expanded to cover patients being treated for cancer, inherited blood disorders or specific surgeries and similar interventions. Voluntary blood donation has been advocated both at the national and international levels not only to address the shortfall, but also to phase out replacement donors over a period. This will also reduce the financial burden of patients while arranging replacement donors, which has become the responsibility of the patient over a period of time.

A first-of-its-kind national-level cross-sectional study has revealed India’s estimated demand, supply, and utilisation of whole blood and blood products. It was found that the supply against demand is 92.6% for whole blood, 91.7% for red cells, 86% for plasma, 77.5% for platelets and 92.1% for cryoprecipitate. The study attributes the supply-demand gap to factors such as low voluntary blood donation and injudicious demand (JJ Mammen, et al., 2022). This inference points to the need to further improve awareness, to motivate voluntary donors as well as to avoid irrational clinical use of blood and blood products.

Regular blood donation drives are already being held on notable occasions across different platforms, including facilities, corporate offices, civil societies, NGOs, academic institutions, and more. Realising the need to increase awareness and timely access to safe blood transfusion, the Government of India has proposed to organise a mega blood donation drive on September 17 with the involvement of all ministries of the Union and state governments, non-government and community-based organisations, and the youth of the country.

Even though concerns of ‘wastage’ because of this mega campaign are being raised by some activists, this is a sincere initiative to raise awareness that blood is needed every day and to encourage more people to donate blood throughout the year. The initiative is also designed to encourage voluntary blood donors to register themselves with the Union Ministry of Health & Family Welfare (MoHFW) and donate blood in identified blood banks or donation camps. Moreover, one lakh units of blood in a day spread across the country can be easily and gainfully utilised as the country already reports a shortfall of approximately 40 lakh units per annum.

The campaign would not only focus on blood collection but also ensure its accessibility and availability at the point of demand. This would be achieved by strengthening the systems and ensuring uniform high quality, logistics, cold chain management, common inventory and appropriate regulatory framework. With the MoHFW recently releasing revised Indian Public Health Standards (IPHS 2022) for healthcare facilities, blood banks and storage facilities are also being strengthened to complement the government’s efforts towards universal access to safe blood transfusion.

Additionally, more than 51% of the blood banks in the country have component separation facilities attached to them. While whole blood has a shelf life of up to 35 days, fresh frozen plasma, separated from whole blood within six hours and rapidly frozen and maintained at a temperature of -30°C, has a shelf life of up to one year. Moreover, the blood banks will draw the number of units only as per their capacity and the rest of the volunteers will be enrolled in the database for future requirement.

The fundamental strategy to ensure timely access to safe and sufficient supply of blood and blood products is to develop a nationally coordinated blood transfusion service based on voluntary non-remunerated blood donations. This service would be governed by quality management in all its aspects, with sufficient and continuous funding, and be fully integrated into the national health system. Leveraging information technology, Aarogya Setu and e-Raktkosh will help in creating a live database of motivated voluntary donors available on an as-required basis. The states/UTs need to ensure that this mega drive is effectively utilised for information, education and behavioural change communication on a large scale during contact with the volunteers.

With the recent initiatives of the government in the health sector — Ayushman Bharat, health grants under the 15th Finance Commission, Emergency Covid Response Package (ECRP-2) funds and the ongoing National Health Mission — India has embarked on a journey towards a resilient and strengthened health system with a holistic approach. Thus, attention to each and every component, such as ensuring the availability of quality blood and blood products and streamlining the systems they rely on, will guarantee building on the recent progress. This, in turn, will help in strengthening the healthcare system as a whole and achieve universal and timely access to safe blood transfusion. After all, every drop counts!