Mission Statement

1
National Voluntary Blood Donation Program
Vinita Srivastava Program Officer, Blood Safety,
NACO
2
Introduction

• Blood is a Precious life Saving resource
  obtained only from human donors
• It is the responsibility of government to ensure
  that the blood supply is safe and adequate and
  accessible to meet the needs of patient
  populations .
• Human blood is covered under the definition of
  Drug under Sec. 3(b) of Drugs Cosmetics Act
  Regulatory Authorities

3
Linkage Healthcare System
Hemophilia
Surgeries Procedures
Anemia
Obst and Gyn
Cardiac Neuro Cancer Ortho Dental
Blood
MMR
Shock/ Trauma
HIV/AIDS
Malaria
Organ Transplants
Thalasemia
4
Blood Safety under NACP

• In 1992, 15.38 of HIV transmission was through
  contaminated blood
• Accordingly, NACO was given the functional
  responsibility to implement Blood Safety
  activities
• Key task was to
• Modernize blood banks in the country
• Promote Voluntary Blood Donation

5
Supreme Court Judgment

• 1996 January Supreme Court Judgment Directions
• Mandatory licensing for all blood banks
• Establish National Blood transfusion Council
  (NBTC) and State Blood Transfusion Councils
  (SBTC)
• Eliminate professional donors
• Enact legislation for controlling blood bank
  operations
• Strengthen enforcement machinery
• Develop trained manpower
• Strengthen voluntary blood donation programme
• Conduct Research on B.T.S.

6
Evolution of Blood Safety Programme in India

• Mandate Access to safe and quality blood blood
  Products
• Launching of National AIDS Control Programme-I,
  implemented by NACO
• Scheme for modernisation of Blood Banks
• National Blood Transfusion Council 23rd May1996
• State Blood Transfusion Council 1996
• Banning of Professional Blood Donors 1st Jan
  1998
• HCV testing made mandatory for all donated blood
  units (2001)
• National Blood Policy in April 2002

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Regulation of BTS
State Health Department
National Blood Transfusion Council / National
AIDS Control Organisation
8
Transfusion Chain
Human being (Donor) Human being (Patient)
Each link consists of several smaller
links (primary processes) The strength of the
chain depends on the strength of the weakest link
not the strongest link The quality of the BTS
is influenced by the quality of each of the links
Blood donors
Collection
Processing
Screening and testing
Blood cold chain
Transfusion
9
Quality of blood Depends on

• A cohesive comprehensive national policy
• Centralization/Regionalization/Hospital based
• Blood donation donor strategy
• Effective legislation licensing policy
• Application of GMPs in Component preparation
• Correct Blood grouping and compatibility
• Provision of screening for all TTDs
• Trained and dedicated staff
• Clinician education and correct transfusion
  practice

10
National Blood Policy-2002

• To reiterate firmly the Government commitment to
  provide safe and adequate quantity of blood,
  blood components and blood products.
• To launch extensive awareness program for blood
  banking services including donor motivation, so
  as to ensure adequate availability of safe blood
• To make available adequate resources to develop
  and re-organize the blood transfusion service in
  the country
• To make latest technology available for operating
  the blood transfusion services and ensure its
  functioning in an updated manner
• To encourage appropriate clinical use of blood
  and blood components
• To strengthen the manpower through human resource
  development
• To take adequate legislative and educational
  steps to eliminate profiteering in blood banks
• To encourage Research and Development in the
  field of transfusion Medicine and related
  technology

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Challenges in BTS in India

• Fragmented Blood Transfusion services
• Gap in the demand supply of blood
• Varying Testing Technologies serology/Infection
  Markers
• inadequate Blood Components Preparation
• Lack of transparency in Regulation
• Lack Of Trained Personnel
• Lack of awareness amongst blood users
• Haemovigilance
• Change the mind set of all concerned

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Regional Disparity in BTS

• Reasons
• Donor base VD/RD
• Variable Standards DCGI/NACO/DGHS/NABH
• Manual To Automated Technology
• Varying Qualification of Manpower
• Administration
• Financial support Centre/state/pvt.

• Categories of Blood Banks
• Govt Vs Private
• Hospital based Vs Stand alone
• Urban Vs Rural and Peripheral
• District Vs Major cities

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NATIONAL BLOOD TRANSFUSION NETWORK
Ministry of Health and Family Welfare
Blood Bank Cell of DCG (I)
NBTC
SBTC
State level Blood Banks
Collection Processing
District Blood Banks
Testing Storage
Blood Storage Units
Distribution
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Infrastructure

• A network of 1151 blood banks have been
  strengthened, which includes
• 34 model blood banks
• 173 Blood components separation units
• 169 Major Blood Banks
• 775 District level blood banks
• 745 Blood storage Centres have been made
  functional
• 250 Blood Transportation Vans were supplied to
  State AIDS Control Society for transportation of
  Blood Units.
• 32 Blood mobiles are issued to Model blood banks
• NACP is implementing a scheme for modernization
  of blood banks by providing one time equipments
  for testing and storage as well as annual
  recurrent grant for support of manpower, kits and
  consumables.
• Core committee formed for assessment of blood
  banks in states.

15
Country Requirement of Blood

• Population based ( 1 )
• For a population of 1.2 Billion (2012),
  estimated requirement of the blood is around 12
  million units, however collection in the year
  2011-12 was 93 lakhs units.
• Requirement is estimated - Hospital bed based
  (3-30 units /bed /yr)
• Mapping District-wise
• Health Care Infrastructure
• Prevalence of diseases needing blood transfusion
• Surgical procedures performed and awareness
  amongst blood users for appropriate clinical use
  of blood.

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Blood Collection in India
17
Total Blood Collection

• Gap Demand Supply
• 93 lakhs Vs. 12 Millions

Sector No. of Blood Banks Annual Blood units collection (in million)
Public 1007 5.7
Private blood banks 1528 4.6
TOTAL 2535 9.3
2.7 Millions
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Objectives of Voluntary Blood Donation

• Ensure availability of safe and quality blood and
  blood components round the clock, throughout the
  year, at affordable cost to the general public
  and free of cost to the poor.
• Reduce the incidence of transfusion transmitted
  infections such as HIV, Hepatitis B, Hepatitis C,
  Syphilis and Malaria

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Need for Voluntary Blood Donation

• More than 25-30 of the blood collected in India
  comes from family/replacement donors.
• Such donors are supposed to be associated with a
  significantly higher prevalence of
  transfusion-transmissible infections (TTIs)
  including HIV, hepatitis, hepatitis C, syphilis
  and malaria.
• For a safe blood service in our country, where
  comprehensive laboratory tests are neither
  possible nor pragmatic, it is best to switch over
  to 100 voluntary donations.
• As it is now established that only voluntary
  non-remunerated regular donation is the safest.
  Thus, one of our key strategies to enhance blood
  safety is focus on motivating non-remunerated
  blood donors and phasing out even replacement
  donors.

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Key Strategies

• Provide Safe and quality Blood and Blood
  Components collected from voluntary Donors
• Increase awareness on the importance of VBD among
  general population
• Motivate and maintain a permanent well-indexed
  record of voluntary blood donors.
• Educate the community on the benefits of blood
  donation and harmful effects of collecting blood
  from replacement donors
• Encourage voluntary blood donation and gradually
  eliminate replacement blood donors
• Conduct motivational workshops ,trainings,
  organizing camps at public places ,recognition of
  blood donor organizations and blood donors
• Assist various Organizations, Clubs, Colleges,
  Public Private Institutions and the public to
  conduct VBD drives

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Voluntary Blood Donation Contribution
22
Proportion of Voluntary Blood Donation
National average 90
Source CMIS
NACO, MOHFW
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Constraints of Voluntary Blood Donation Program

• Paucity of regular voluntary Blood Donors
• Lack of coordination from SACS/SBTC with NGOs
• Non availability of support from NGOs
• Less availability of blood collection mobile vans
• Lack of commitment from blood banks
• Lack of effective networking facilities

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Efforts to Enhance Blood Collection

• Aggressive IEC activities
• Collaboration with IRCS, NSS, NYK, RRC, Govt
  bodies to organise Blood Donation camps
• Rope in Religious bodies
• Introduce Young donor clubs
• Provision of Blood Mobiles for blood banks
  collecting more than 10,000 units
• Inclusion of VBD in School Curriculum

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VBD 2012 2013

• Target - 67659
• Financial support of Rs. 2500 per camp is being
  provided for holding these camps.
• Guidelines have been made to augment VBD.
• SACS to prepare district wise VBD plan including
  training, IEC, workshops, Motivation talks, and
  other necessary actions to augment VBD etc.
• Donor directory to be available in all blood
  banks
• Month long Campaign on World Blood Donors Day (14
  June) Voluntary Blood Donation Day (1 October),
  National Youth Day(12 January)

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VBD 2012 2013

• Rural blood donor forums being identified.
• Feed back forms prepared by SACS for institutions
  holding camps.
• Nodal committee formed under District Magistrates
  to monitor and evaluate the VBD programme.
• Orientation and sensitization at schools and
  colleges by SACS.
• Institutionalizing VBD activities in uniformed
  services.
• Training modules for Donor motivators

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VBD 2012 2013

• Development of partnerships with non-governmental
  organizations, such as national Red Cross,
  voluntary blood donor organizations, national
  service organizations, Government departments and
  the media
• Development of donor education and recruitment
  IEC materials
• VBD programme clubbed with Anemia Programme
  through NRHM.
• Details of all blood banks on the state website
  and on NACO web site.

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VBD 2012 2013

• Rare group directories maintained by the blood
  banks
• Monitoring and evaluation of the blood donor
  programme on monthly basis by SACS
• Optimum usage of blood mobiles as per the
  guidelines.
• Linkages of Red Ribbon clubs with the hospitals
  in the districts.
• IEC activities for World blood donors day,
  Voluntary blood Donation Day, Youth Day to be
  carried out efficiently.
• Recruitment of voluntary blood donors through SMS
  services.

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VBD 2012 2013

• Developing new forum in rural areas with the help
  of NYKS.
• Camps targeted as per the need assessment
  including epidemics (dengue)
• School education programme with the help of
  education department.
• Media sensitization workshops, sensitization
  through folk groups in rural areas and
  sensitization of school children with the help of
  puppet shows.
• Sensitization of Vice chancellors of the
  universities, college principals, government
  officers and others, MNCs etc

30
VBD 2012 2013

• E-Blood banking initiated in some of the States
• Linkages plan between RBTCs and blood banks,
  mother blood bank and storage centres.
• Regional level Training workshops for VBD for
  Medical officer in charge and donor motivators.
• Involvement of stake holders in the SBTCs
  meeting.
• A Guide book on Donor recruitment and retention

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Range of Sero Reactivity in blood donors
HIV HBV HCV VDRL MALARIA
0.1 1.1 0.4 0.2 0.1

• Seroreactivity for HIV has reduced from 3.2 in
  1991 to 0.1 in 2011-12

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New Initiatives

• Metro Blood Banks
• State-of-Art Transfusion Centre
• Processing Capacity gt100,000 units per annum
• Access of Adequate safe and sustained Blood
  supply regionally
• Designs Finalized
• Plasma Fractionation Centre
• Increase in demand of Plasma products
• Facility to manufacture all Plasma derivatives
• Processing capacity gt 150,000 litres of
  plasma/annum
• Plant will be attached to Centre of Excellence at
  Chennai

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New Initiatives

• Publications- Training Modules for Medical
  officers and technicians by TRG
• Training Module for Nurses
• Implementation of Quality management systems in
  Blood banks

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NRHM Support for Blood Programme

• 3222 FRU in Sub districts to have Blood Storage
  Centres
• Infrastructure
• Manpower
• Equipment
• Training
• Transportation Vans for Blood supplied by NACO

• Provision of blood for Emergency obstetric Care,
  Trauma Cases
• Surgeries/Hemorrhage
• Reduce Maternal Morbidity/Mortality
• Support Anemia program for RCH

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Conclusion

• A coordinated long range planning for the
  development and integration of such diverse
  activities together with careful considerations
  of priorities and optimal use of resources and
  funds to implement the blood program at the
  National level with their counter parts at the
  state level will ensure an effective functional
  program