In this exclusive interview with our correspondent, Dr. Smith speaks on the national blood bank, challenges of meeting the nation’s blood need as well as the COVID-19 pandemic now threatening the continents of the world. It’s Vanguard’s exclusive.
By Dirisu Yakubu
Vanguard: There have been concerns about the country’s national blood transfusion policy in the past few years. Are there specific areas you would like to be amended?
Dr. Smith: The National Blood Policy was recently revised in 2016 to take care of specific areas that might have been overlooked since the inception of the blood service and with due consideration to recent developments in the field of blood transfusion practice. What is required now is an enabling legislation to effect compliance with the national policy, its operational guidelines for blood transfusion practice, as well as to regulate the practice of blood transfusion nationwide.
The most important development would be the enactment of legislation that will provide support and governance to those who are charged with authority and responsibility to implement the policy. Without the law, no public policy could be meaningfully amended, effectively implemented and sustained. We are currently working closely with the National Assembly to obtain the necessary legal framework.
One of the challenges of blood availability has been the high frequency of commercial blood donation in the land. Beside your advocacy for voluntary blood donation, how can this trend be reversed?
We do appreciate the challenges of commercialization of blood donation as well as the inherent dangers it poses to both the donor and the recipient. This is why we are working hard to ensure voluntary non-remunerated blood donation becomes a national habit through continuous public education using the mass media, corporate partnerships and strategic change communication. We have found this strategy to be very effective in reversing this trend.
The high frequency of commercial blood donation can also be attributed to the fact that there is no existing legislation in Nigeria to regulate blood transfusion practice in the country. One of the achievements of the NBTS is the development of a draft bill for the establishment of a National Blood Service Commission.
The blood safety bill is currently undergoing legislative processing at the National Assembly. The bill seeks to regulate blood collection and transfusion practices in Nigeria and makes it a criminal offence to transfuse blood without due process. When passed into law, the commission will coordinate blood transfusion practice on a country wide basis within the national health plan and ensure the availability of safe blood units, blood components and derivatives for transfusion and other medical therapies nationwide.
In addition, Youth-targeted clubs including the Club 25 that encourage those under the age of 25 years to donate blood regularly, have also been initiated alongside the secondary school blood safety programme which serves to “catch them young” so that by the time the students attain the age of 18 years and are eligible to donate blood, they would have imbibed the culture of voluntary blood donation.
Another strategy we have adopted is that of engaging different communities and religious bodies through the conduct of blood donation drives where people in the community can see and learn first-hand what the act of voluntary blood donation is all about.
How would you alleviate the worry of intending blood donors who hold back because of phobia for transfusion-transmissible infections like HIV, Hepatitis B and C etc.?
Intending blood donors need not worry about being infected with any of the transfusion transmissible infections at the NBTS as all the staff including the medical doctors, medical laboratory scientists, blood donor recruiters, phlebotomists and counsellors are highly trained with the requisite skills to do their job. In addition to this, all blood donor consumable items procured, including blood bags, blood sample bottles etc., are meant for single-use and are not re-used. Such fears are therefore unwarranted.
In some countries of the world, blood transfusion service is undertaken by bureaus or agencies. Isn’t time for the NBTS to become a full-fledged agency of government?
You are correct. In a democracy, government processes are carefully crafted to avoid mistakes that may adversely affect citizens and this usually takes time. I’m happy to state that the bill to transform the NBTS into a fully-fledged commission which I alluded to earlier, has passed the first and second reading in the National Assembly and is scheduled to be presented at a public hearing in a few days’ time.
Postpartum hemorrhage accounts for about 25 per cent of maternal deaths in the country. How has the NBTS been able to assist rural women in dire need of blood during delivery?
Thank you Dirisu for this question! This is one of the biggest challenges we face. The infrastructure, staffing levels and access to health care facilities in our rural areas are far from optimal. Safe blood requires that a cold chain be maintained. Many rural communities lack stable electricity supply to power blood bank refrigerators.
At the NBTS, we believe all lives matter, irrespective of gender, location. Our trained staff members work tirelessly to ensure that safe blood units that meet quality standards are available for transfusion. The hospital linkage programme is an initiative of the NBTS created to establish partnerships with hospitals within the catchment area of each NBTS centre. Such partnerships facilitate the exchange of blood units that have been collected in hospitals from family replacement donors with units that have been screened for HIV, Syphilis, Hepatitis B and Hepatitis C and made safe for blood transfusion by the centre. Consequently, safe units of blood will be made available for use by hospitals within the community and beyond, where necessary. This programme is achieving good results and has the potential to deepen access to safe blood units to those living in hard-to-reach areas including our rural women in dire need, who then have the advantage of accessing safe blood that meets quality standards from hospitals closer to where they live.
The NBTS in collaboration with a few development partners has also trained health care providers in both public and private health facilities to make an impact in hard-to-reach areas.
It is our hope that with improved telecommunication/mobile phone coverage, we will one day be able to deploy drone technology to deliver safe blood to rural communities from the urban blood banks, and perhaps install solar energy to power community blood banks at local government headquarters which can be more easily linked to the villages.
Let’s talk about the Coronavirus pandemic. What has been the NBTS be doing since COVID-19 became a global concern?
Following the outbreak of COVID-19 infection, our staff members have been given extra skills to ensure the safety of blood donors, staff and the community at large. We have introduced multi-level hand sanitizers, hand washing and improved professionalism at all levels. As of today, Coronavirus is not one of the transfusion transmissible infections. Therefore, voluntary blood donors can continue to donate with the exception of those with a history of recent travel overseas or with a temperature issue. These categories of voluntary blood donors will have to be deferred.
How do you change the perception of those who as a result of religious doctrines do not believe in blood transfusion? In some cases, people die who could have live had they accepted blood donation.
The constitution of Nigeria is very clear on freedom of worship, and the right to adhere to religious beliefs is guaranteed under the fundamental human rights charter, so long as such religious practice does not offend the rights of others or jeopardize public health. Moreover, the cultural and spiritual preferences of Nigerians are entrenched in the national blood policy with education and awareness creation for the uptake of blood transfusion as it has no substitute.
As a responsible organ of government, the NBTS does not discriminate against anyone on the grounds of religious opinions or beliefs but continues to advocate for voluntary blood donations from everyone who is eligible to do so. There are some religious faiths that are against blood transfusion. While there is a need to respect their faith, one should also continue to sensitize them on the need for blood transfusion, particularly if there is a threat to life.
What has been the major challenge of running this centre in the past few years?
Some of our major challenges in the past few years include, insufficient funding; being a social service, it is not feasible to achieve 100 per cent cost recovery from blood access charges. The government therefore has to subsidize the service substantially. There is also a lack of enabling legislation to enforce compliance & to regulate blood safety practice nationwide. Others include inadequate infrastructure: The centre requires a purpose-built, fit-for-purpose facility, with adequate space to carry out all essential functions; disruptions to blood collection activities in the North East zone due to security challenges, continuous insurgency & violence by terrorists; and low public awareness on voluntary non-remunerated blood donation arising from deep cultural myths and misconception.
What is the national blood need of the country annually and what deficit does she contend with?
The World Health Organization recommends that a country’s annual blood need is about 1 per cent of its population. At least 10 whole blood units per 1,000 population are needed. Going by 1 per cent of Nigeria’s population (estimated at 200 million), Nigeria’s blood need stands at about 2 million units of blood and blood products per annum.
We do not have precise data on the deficit Nigeria has to contend with, but we know that Nigeria is currently one of the highest contributors to maternal mortality in Central and Western Africa.
Post-partum hemorrhage which is a frequently occurring complication of child birth, is one of the major factors that accounts for our high maternal mortality ratio of about 814 per 100,000 live births. This tells us that the blood need is not being adequately met.
Let’s talk about the annual budget for the sector by the federal government. In the 2020 budget, for instance, the sum of N427 billion was allocated to the sector. Is this sum enough to safeguard the health need of Nigeria considering her population?
The annual budgetary allocation for the health sector is usually between 4 to 6 per cent of the total national budget. This falls far below the recommended benchmark of 15 per cent set by African leaders during the Abuja Declaration in 2000. This is grossly insufficient and presents a great challenge to service delivery as well as the implementation of various health programmes.
In light of the well-publicized downturn in oil prices, and the unexpected COVID-19 pandemic, it would be difficult to ask government to increase the current health budget for 2020. It is my belief however, that whatever funds are actually released, shall be judiciously used and wastages will be reduced to the barest minimum.