Blood access: The missing link to universal health coverage

Dr Rabindra Kumar Jena, Professor and Head of the Department of Clinical Hematology, SCB Medical College and Hospital, Cuttack, and Secretary, Indian College of Hematology emphasises that equitable access is the cornerstone of universal health coverage, yet the distribution of blood transfusion services in India reveals a stark imbalance

Universal Health Coverage (UHC) means all people have equitable access to a full range of quality health services without financial hardship.¹ Yet, to truly fulfill this promise, one critical element remains essential access to safe and sufficient blood.

Blood is not merely a product; it is a critical resource that supports a wide array of medical interventions, from emergency trauma care to maternal health, surgeries, cancer treatments, and the management of chronic conditions like thalassemia and sickle cell disease.² However, the cost of a single blood transfusion ranging from Rs 1,050 to 4,500 can place a severe financial burden on families, particularly in rural areas.³ This financial strain, combined with the logistical challenges of accessing blood, prevents many from accessing timely, life-saving care. Without reliable access to safe and sufficient blood, the dream of equitable healthcare for all remains elusive. This makes it essential to view blood access as a cornerstone of achieving universal health coverage. Doing so highlights critical challenges related to supply, quality, and affordability barriers that must be overcome to ensure blood is available whenever and wherever it is needed.

“UHC means all people have equitable access…”

Equitable access is the cornerstone of universal health coverage, yet the distribution of blood transfusion services in India reveals a stark imbalance. The country’s blood supply network is fragmented, with blood resources disproportionately concentrated in a few centres, leaving large swaths of the country underserved. Notably, 70 per cent of all blood centres are situated in just eight states. Furthermore, as of 2020, 63 districts were without any blood supply centre, depriving countless individuals of vital transfusion services. Additionally, rural India, which constitutes 68 per cent of the population, is disproportionately affected, as most blood banks are concentrated in urban centres.⁴ This urban-rural divide places rural patients in a perilous position, often requiring them to travel long distances to access blood, which results in life-threatening delays in care. Moreover, the consequences of inadequate storage and management practices have led to the wastage of approximately 6.5 lakh units of blood annually.

These systemic flaws expose an infrastructure ill-equipped to meet the needs of India’s diverse populations. To address these challenges, the implementation of a hub-and-spoke model could offer a practical solution.⁵ By connecting rural satellite blood centres to regional hubs equipped with advanced technology and skilled personnel, the model would facilitate the more equitable and efficient distribution of blood across the country.

“… to a full range of high-quality health services…”

Access to quality health services encompasses the provision of safe and reliable blood for transfusions. At present, 30 per cent of India’s blood supply is sourced from replacement donors,⁶ whose contributions carry a markedly higher risk of transfusion-transmissible infections (TTIs) such as HIV, hepatitis, and malaria.⁷ These risks are compounded by inadequacies in blood testing practices. While advanced methods like Nucleic Acid Testing (NAT) can shorten the window period for detecting infections, only 2 per cent of blood banks in India used NAT as of 2017.⁸ Additionally, many blood centres operate with uncalibrated equipment, lack comprehensive quality assurance measures, and are staffed by inadequately trained personnel. A 2021 study revealed that 66 per cent of blood banks reported significant lapses in adhering to quality management systems, underscoring systemic safety and reliability issues.⁹

Addressing these deficiencies necessitates a two-pronged approach. First, prioritizing voluntary blood donation is essential to eliminate the reliance on high-risk replacement donors and create a more secure and dependable blood supply. Second, a comprehensive overhaul of the blood bank infrastructure is necessary to standardize and elevate safety practices across the network. This includes expanding the adoption of NAT testing, ensuring regular calibration and maintenance of laboratory equipment, and embedding robust quality assurance protocols across all blood banks. Moreover, investing in training and capacity-building for blood bank personnel is also crucial. When implemented cohesively, these measures will safeguard transfusion recipients and align India’s blood safety practices with the core values of universal health coverage.

“…without financial hardship.”

Universal health coverage also ensures access to essential services without financial hardship, but in India, families affected by hemoglobinopathies such as Thalassemia and Sickle Cell Disease continue to face significant financial burdens. Despite the government’s provision of free blood and blood components for these patients, the reality is that many families incur high out-of-pocket expenses, primarily due to difficulties in accessing care. Patients often have to travel long distances for transfusions and chelation services. This not only leads to substantial travel costs but also results in lost wages for caregivers, contributing to a financial strain that adds up over time. A promising solution comes from the state of Odisha, where the government provides a subsidy of Rs 500 per month to patients with chronic blood disorders to offset transportation costs. Such a policy could be adopted across states to reduce out-of-pocket expenses.

Therefore, to realise universal health coverage in India, policymakers must make blood access a fundamental pillar of healthcare. Blood is not just an essential medicine; it is a vital resource for effective management of numerous medical conditions. As India works toward achieving the targets of Sustainable Development Goal (SDG) 3, which envisions UHC by 2030, ensuring access to safe, affordable, and quality-assured blood must be a top priority. Only by prioritizing this critical resource can India fulfill its promise of healthcare for all.