Situation Assessment of Public and Private Blood Centres in Bangladesh
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Situation Assessment of Public and Private Blood Centres in Bangladesh Situation Assessment of Public and Private Blood Centres in Bangladesh Directorate General of Health Services, Ministry of Health and Family Welfare, Bangladesh. In collaboration with the World Health Organization and the OPEC Fund for International Development (OFID). This report is the product of a ongoing collaboration between the World Health Organization (WHO) and the OPEC Foundation for International Development (OFID); and the Ministry of Health and Family Welfare, Bangladesh. World Health Organization 2012 This health information product is intended for a restricted audience only. The designations employed and the presentation of the material in this health information product do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this health information product is complete and correct and shall not be liable for any damages incurred as a result of its use. 1 2 Table of Contents Executive Summary ii 1. Background 1 2. Assessment 5 3. Method of Assessment 6 4. Questionnaire Development 6 5. Field Testing 7 6. Sample Determination 7 7. Data Collection 8 8. Supervision 8 9. Data Analysis 8 10. Results 9 11. Discussion 43 a) Organization and management of blood transfusion services in Bangladesh 43 b) National blood donation and collection practices 43 c) National practices in screening of donated blood 44 d) Blood component preparation 44 e) Inventory of blood and blood products and status of the blood cold chain 44 f) Pre‐transfusion practices in hospitals 44 g) Transfusion monitoring and post‐transfusion practices in hospitals 45 12. Conclusion 45 13. Recommendation 47 14. Proposed Action Plan 49 15. Limitations 51 16. Acknowledgements 51 ANNEX I: Assessment Questionnaires 52 Section A: Organization and Management 54 Section B: Blood Donors & Blood Collection 60 Section C: Screening for Transfusion Transmissible Infections (TTI) 63 Section D: Blood Group Serology and Compatibility Testing 64 Section E: Blood Component Preparation 65 Section F: Blood Storage, Transportation, Inventory & Distribution 67 ANNEX‐2: List of blood transfusion centres and hospitals surveyed 75 List of Data Collectors 75 Types of Surveyed Blood Centres 75 List of Blood Centres at District Hospitals 76 ANNEX‐3: Status of Selected Indicators 79 ANNEX‐4: Table of Selected Health and Socio‐economic Indicators 81 i Executive Summary Blood Transfusion Service is considered as a major part of the public sector healthcare setting. The service requires quality for safe blood collection and its use for the patients. This report presents the results of situation assessment of blood centres in public and private sectors in Bangladesh. The assessment was carried out in 2011 by experts of blood transfusion and program management personnel of Directorate General of Health Service under the Ministry of Health in collaboration with the World Health Organization (WHO) and the OPEC Fund for International Development (OFID). The objective of the assessment was to review the situation of the existing blood transfusion services that has been established in public and private sectors in Bangladesh, identify gaps and develop a set of recommendations. There are 253 centres in the country and the mainstay of the assessment was a large site survey covering 109 selected blood centres of these 253 centres, from seven administrative divisions of the country. These include public medical colleges, public institutes, district hospitals, Upazila health complexes, standalone private blood centres, private medical colleges, private hospitals and non‐governmental blood centres. The methodology applied in the assessment was a combination of a desk review of policy documents and looking into the status of organizational management, quality system, training, blood donor recruitment, blood collection, screening for Transfusion Transmissible Infections (TTI), serology and compatibility procedures, blood component preparation, blood storage system, transportation, inventory and distribution. Assessment of the status of transfusion process in the hospital, pre‐transfusion procedure, clinical use of blood and management of the service at central level have been also carried out simultaneously. The blood transfusion services in Bangladesh are managed and regulated by the Ministry of Health under the guidelines of Safe Blood Transfusion ACT, a legal framework for blood safety. The National Safe Blood Transfusion Council has the role of an advisory body and the National Expert Committee is an implementing body for provision of the services. Setting up any private blood centres requires licensing from the Directorate General of Health Service, Ministry of Health. The Safe Blood Transfusion Program (SBTP), a unit of the Ministry of health supports 203 centres by providing equipment, regular supply of kits, reagents, blood bags and training. 66.8% (169) of blood transfusion centres belonging to the public sector are integrated within the hospitals and located in seven divisions in the country. 5.6% (14) of centres are operated by the Ministry of Defense and 7.91% (20) of centres are supported by the national program but privately operated. In the private sector, 19.76% (50) of blood centres are integrated into the medical college and the specialized hospitals, and also include standalone blood centres. Each of these centres collects, stores and tests the blood. The blood transfusion services are coordinated nationally by the Safe Blood Transfusion Program and give services through the 203 blood centres. There was significant shortage of trained staff in each centre and almost all blood centres surveyed reported to have a shortage of ii adequate premises, supplies and equipment. Except for two NGO blood centres, all centres reported to have collected blood from patient’s relatives and friends, showing that 85% of blood is collected from relatives/family blood donors and only 15% of blood is donated by voluntary non‐remunerated blood donors. No paid donors were registered during the assessment. No donors were recruited below the age limit of 18; 80% of donors belonged with the age range of 18‐ 24 and 20% with the age range of 25‐44. No donation has been recorded between the ages 44‐60. In public and private centres, donor assessments were done according to defined donor selection criteria and 95% of the centres have shown hemoglobin test to be performed by the hemoglobin scale method. Follow up of sero‐reactive donors were not observed for blood donor management. SOPs for different processes essential for blood transfusion i.e. for blood screening, ABO & RhD, blood storage, blood component preparation and waste management were non‐existent in majority of the centres. Only in two centres, one private hospital and one private medical college, SOPs were these available and reported as implemented. The system of standard and comprehensive documentation was found only in two public medical college blood centres. In the private sector, documentation was available only in two private medical colleges and in two private hospitals. No centre maintained records of the whole range of procedures carried out. Basic data for patients’ blood grouping were maintained in almost all surveyed centres but were not found in a uniform format. Similarly the donor blood grouping registers were available but not complete in district, Upazila or in medical colleges hospitals of both the public and private sectors. Laboratory documents for patient’ and donor blood grouping and cross matching were found incomplete in the district and Upazila health complexes. These reflect scanty information that could have been generated for the assessment and moreover, most of the vital statistics were missing due to shortage of manpower, according to responders. The data shows that public centres received most of the training organized by the Safe Blood Transfusion Program as a national training. Out of all district hospitals only 38% responded that they have adequate staff. Out of 14 public medical colleges only 36% and in Upazila 73% have responded that there is adequate staff. Others, in the public sector responded that the staff crisis is considered as one of the major challenges to running the centres smoothly. Screening of all donated blood for markers of five TTI (HIV, HBV, HCV, syphilis and malaria) is mandatory in Bangladesh and 100% donations are screened in all centres except for 20% of district hospitals, 55% of Upazila health complexes, 23% of private medical colleges, 29% of private hospitals and17% of standalone blood centres which do not routinely perform malaria testing. In 98% of the centres, blood screening is carried out using rapid tests. All centres reported to perform blood screening for HIV, HBV, HCV and syphilis. This shows that the prevalence of TTI markers is below 1%. Post‐donation screening was reported in as much as 70% of the surveyed centres, and rest of the centres only did pre‐ donation screening of donors with no screening of donated blood after the blood donation. iii There were no protocol nor algorithm developed and followed for reactive results in either of the centres under assessment. Initial reactive samples were reported as re‐tested by the same kits; no confirmatory facilities have been seen in any of the visited centres. Only 21% of public medical colleges, 50% of private medical colleges and 80% of public institutes reported to run internal quality control during routine testing of TTI.