Tobi Lala
Blood transfusion is an indispensable component of health care. It
contributes to saving millions of lives each year in both routine and
emergency situations, permits increasingly complex medical and surgical
interventions and dramatically improves the life expectancy and quality
of life of patients with a variety of acute and chronic conditions.
Many
medical advances that have improved the treatment of serious illness
and injuries have increased the need for blood transfusion for patients’
survival, to support them through recovery or to maintain their health.
Surgery, trauma and cancers, for all of which there is a high probability
of the need for blood transfusion, are replacing communicable diseases
as leading causes of death. About 234 million major operations are performed
worldwide every year, with 63 million people undergoing surgery for
traumatic injuries, 31 million more for treating cancers and another
10 million for pregnancy-related complications.
Haemorrhage,
for example, accounts for over 25% of the 530 000 maternal deaths each
year; 99% of these are in the developing world. Access to safe blood
could help to prevent up to one quarter of maternal deaths each year
and blood transfusion has been identified as one of the eight life-saving
functions that should be available in a first-referral level healthcare
facility providing comprehensive emergency obstetric and newborn care.
Children
are particularly vulnerable to shortages of blood in malarious areas
because of their high requirement for transfusion arising from severe
life-threatening anaemia resulting from malaria, often exacerbated by
malnutrition. In 2006, there were about 247 million malaria cases among
3.3 billion people at risk, causing nearly a million deaths; 91% of
malaria deaths were in Africa and 85% were of children under five years
of age.
Road
traffic accidents kill 1.2 million people and injure or disable between
20 million and 50 million more a year, a large proportion of who require
transfusion during the first 24 hours of treatment. Road traffic injuries
are predicted to become the third largest contributor to the global
burden of disease by 2020.
Nigeria,
like many other developing nations, is battling with maternal and child
mortality, malaria, high road traffic accident rates and HIV/AIDS. The
major health risks facing this nation are risks whose treatment regimen
are associated with safe blood transfusion. Hence, blood accessibility
becomes a major factor. But unlike some other developing nations such
as Kenya, Zimbabwe, Zambia and Togo with similar health risks, Nigeria
is still far behind in the provision of safe blood to its patients. While those
nations have achieved 100% voluntary unpaid blood donations, Nigeria
is yet to meet 10% voluntary unpaid donations. Family Replacement and
Paid Donation accounting for more than 90% of blood donation per annum.
This
is in contrast to the WHO Global Consultation on 100% Voluntary Non-remunerated
blood donation of 2009, dubbed “The Melbourne Declaration” which
calls for member states and signatories to shift to 100% altruistic
blood collection. The Melbourne Declaration on '100% Voluntary Non-remunerated
Donation of Blood and Blood Components' is founded on the policies articulated
in World Health Assembly resolution WHA28.72 Utilization and Supply of Human Blood and Blood
Products which urges Member States to promote the development
of national blood services based on voluntary non-remunerated blood
donation. Below are a few among the highlighted points of the 2009
WHO Melbourne declaration;
Acknowledge that the realisation
of the health related Millennium Development Goals to reduce child mortality
(Goal 4), to improve maternal health (Goal 5) and to combat HIV/AIDS,
malaria and other diseases (Goal 6) is dependent on universal access
to safe blood transfusion;
Recognize that evidence supports
that regular voluntary, non-remunerated blood donors are the cornerstone
of a safe and sustainable national supply of blood and blood products
sufficient to meet the transfusion requirements of the patient population.
Believing that family replacement and paid donation can compromise
the establishment of sustainable blood collection from voluntary non-remunerated
blood donors;
This means that voluntary non-remunerated blood donation
(VNRBD) is key to safe blood accessibility. How do we, as a nation,
meet the 100% VNRBD mark?
Since the establishment of the National Blood Transfusion
Service by the Federal Government of Nigeria in 2005 and the involvement
in voluntary blood donor recruitment and retention by not-for-profit
organizations such as Berachah Foundation, Voluntary Blood Donor Club
of Nigeria (VOLBLODOCON) and Blood Drive Initiative (BDI), there has
been a slight increase in the adoption of a culture of voluntary blood
donation by Nigerians. However, one sore thumb that sticks out in this
drive towards attaining 100%VNRD is the perception by Nigerians that
blood is being commercialized. Is this the case?
A recent survey carried out by Blood Drive Initiative
reveals that the average amount at which a unit of blood is issued in
Federal and State health establishments (excluding the NBTS) across
the Southwestern states is N5400 ($35). These are government owned hospitals
where majority of Nigerians visit for their health needs. The situation
in private practice is better imagined where some rare blood types are
issued at rates as high as N18000 ($115). Is this justifiable? These
are some of the arguments proffered by health institutions issuing blood
units at such prices:
(1) for blood to be made safe for the patients,
it has to be screened following the standard guidelines provided by
the World Health Organization (WHO). This guideline requires certain
very important tests (14 in all) to be undertaken. The expertice involved
and the materials used are cost implicative.
(2) After the blood is
collected and made safe for transfusion, comes the issue of storage.
This needs uninterrrupted power supply which is unavailable in this
country. Running on generators for 24 hours seven days a week is very
costly.
Do these
arguments, however, justify the sky-high prices at which a unit of blood
is issued at these centers? Considering the fact that majority of Nigerians
live below the $2 per day line, do these prices not hamper access? How
come the National Blood Transfusion Service centers, which also carry
out the mandated screening tests, are able to issue a unit of blood
at N2000 while our hospitals issue at almost three times that price?
Is it an issue of funding? If hospitals are to recover the cost of screening
and storage, at what point do they break even? At what point is it commercialization?
The
World Health Organization in its health assembly resolution WHA28.72, 58.13 and
63.12, set the year 2020 as a target for achieving 100% VNRBD while the Millennium
Developmental goals have a 2015 target. These goals, as earlier articulated,
are dependent upon appreciable success towards altruistic blood collection.
Meeting the nation’s need for safe blood and blood products through
the donation of human blood should be based on ethical principles including
respect for the individual and his or her worth, the protection of the
individual’s rights and wellbeing, and the avoidance of exploitation.
The commercialization of blood donation is in breach of the fundamental
principle of altruism which voluntary blood donation enshrines.
Nigeria, where do we stand?
Tobi Lala is a director at the Blood Drive Initiative (BDI)
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