Innovation, collaboration and behaviour change must for a sustainable blood ecosystem

Dr Sanjeev Kumar, Country Manager-Terumo Penpol India traces the problem associated with blood transfusion system, while also explaining the steps needed to be taken to resolve  it

Blood is essential for a well-functioning healthcare system. Critical to many medical procedures, increased affordability, accessibility and blood safety improves health outcomes and reduces mortalities. India needs 25 units of blood every minute, as per media reports. However, due to an acute shortage of blood, we cannot manage the demand-supply gaps efficiently.

Country-wide lockdowns, COVID-19-infected people being ineligible to donate before 28 days and vaccinated (for COVID-19) people being ineligible to donate blood before 14 days, coupled with a general hesitancy due to health safety concerns have severely constricted blood collection. The Indian Red Cross Society had alarmingly noted in April 2020 that voluntary blood donations were reportedly down by almost 100 per cent.

With the stocks of blood banks across the country depleting fast, media and social media are awash with calls for help. The poignant account of a father of a thalassemic boy having to pedal 400 kilometers for blood transfusion as the local blood bank had run out of blood should be a wake-up call to sort out our blood woes.

Although the pandemic exacerbated the blood shortage crisis, the scarcity of blood has been reported over the years. Hence, it is imperative that steps are taken to address the issue in general as well as for future emergency situations.

Opening more blood banks might seem like an obvious solution to our woes. However, with 3,321 blood banks across the country, the density of blood banks is not an issue. There are two chief causes of our blood crisis; firstly, we suffer from a lower voluntary blood donation rate (VBD). Seventy nine countries have a VBD rate of over 90 per cent, compared to around 70 per cent in India. Secondly, many blood banks suffer from a lack of infrastructure, inadequate capacities of personnel and low reliance on technology and innovation. This constricts access and affordability while causing the wastage of blood. Over 1.1 million units were wasted in 2016-17.

Traditionally, there has been a rural and urban divide in access to healthcare in India. Imagine an emergency where inhabitants of a rural area need blood. Often their sole option is a desperate journey to the district headquarters impinged on the hope of finding blood. Transformation of health indicators was a crucial agenda when Prime Minister Modi envisaged the transformation of every village of the 117 under-developed districts under the Aspirational Districts programme.

While most Aspirational Districts have blood banks, in districts of Baksa (Assam), Bijapur, Sukma (Chattisgarh), Shravasti, Chitrakoot, Balrampur (Uttar Pradesh), the blood bank is available only in the district headquarters. The health outcomes in such Aspirational Districts that are concomitant to blood access can improve through technological innovation and focus on improving human resource capacities, infrastructure and processes.

One such example is the Aspirational District of Sonbhadra in Uttar Pradesh. A collaborative initiative between the NITI Aayog, Terumo Blood and Cell Technologies and the Uttar Pradesh National Health Mission (UP NHM) led to improved efficiency of the blood bank located in Roberstganj. Through training of the personnel, upgrading of infrastructure and strict adherence to processes, a 37 per cent improvement in the functioning of the blood bank was achieved.

Resource constraints associated with the small blood bank made significant infrastructural changes unviable. The partnership’s second phase envisages the deployment of a hub and spoke model to further enhance the blood bank’s efficiency. Aimed towards the centralisation of blood collection, a hub and spoke model will be much more effective in addressing the issues of safety and shortage as seen in other countries like Spain, New Zealand and Australia.

A significant role in the improvement of access to blood will be played by technology. The hubs can leverage innovative technology and specialised human resource for efficient blood management. Further, digital inventory platforms like the e-Rakht Kosh portal can yield better results when linked with hubs. Technology has already begun to facilitate access to blood. Facebook and other social media platforms inform their users when blood centres near them need blood. The Facebook platform also allows them to schedule their appointments.

Increasing the accessibility and safety of blood in India must be a collaborative approach among the government, private entities and citizens. The efforts of government and private entities on the infrastructure and technology side need to be supported through an increased emphasis on behavioural change towards voluntary blood donation among citizens. Dispelling myths and recognisng the altruistic motive behind blood donation are the drivers for increased voluntary blood donation. Further, the resolution of demand and supply-side constrictions through mobilisation of collective efforts would strengthen India’s Blood Transfusion Services (BTS) and ensure access, adequacy and sustainability of blood.