Public-private partnerships, innovation & awareness: Key to reforming India’s blood management

Since 1975, the World Health Organization (WHO) has adopted resolutions advocating for a sustainable and safe supply of blood and blood products across the globe. Subsequently, in 2004, June 14 was commemorated as World Blood Donor Day to amplify the significance of voluntary non-remunerated blood donation (VNRBD). Further, WHO has also put together a framework to help member nations prepare their national blood policies impinged on VNRBD. However, despite efforts by organizations and national governments across the globe to increase the blood donation rate, many regions continue to face acute shortages. Especially the low and low-middle-income countries (LMICs) receive only 24% of the global donations even though their combined population share is 48%. 

Blood forms the bedrock of a broad range of healthcare services. Transfusions mainly account for treating pregnancy-related complications, complex medical procedures, traumas, management of blood disorders, and chronic anemia. By helping save millions of lives and improving the quality of life of many patients, blood forms a crucial facet of public health. Consequently, it is a fundamental aspect of our efforts toward achieving Universal Health Coverage (UHC). It assumes greater importance in a country like India, which globally has the largest number of children suffering from Thalassemia Major and the highest number of deaths due to road accidents. Additionally, 38% of the maternal deaths in the country are attributed to Postpartum Hemorrhage (PPH). However, India faces a shortage of about 1.9 million units of blood which is sufficient to perform around 49,000 organ transplants and 320,000 heart surgeries.

Recognizing the importance of blood in maintaining the country’s health infrastructure, the Government of India launched several initiatives. These include setting up the National Blood Transfusion Council to ensure coordination amongst the states, various ministries, and health programs. Many Non-Governmental Organizations (NGOs) and Civil Society Organizations (CSOs) have also been supported by the government to strengthen the blood ecosystem. These initiatives are trying to address the three key issues concerning the country’s blood ecosystem-accessibility, affordability, and safety. Transparency in the blood donation program is now being ensured through the e-Blood Service App. 

The WHO suggests at least 1% of a region’s population should be donating blood for a sustainable blood ecosystem. In India, widespread disparities continue to exist across different regions. While some states like Punjab, Maharashtra, and Kerala meet the WHO norm, others such as Bihar, Meghalaya, and Nagaland require concerted efforts to enable a self-sufficient blood ecosystem. Such disparities can be attributed to geographical constraints, low resource set-up, lack of awareness, and inadequate infrastructure. A 2014 report by the National AIDS Control Organization (NACO) also highlighted that many Tier-II cities lack basic infrastructural facilities such as Blood Component Separation Units and Regional Blood Transfusion Councils essential in maintaining the blood ecosystem of states. Consequently, these states face severe shortages. 

It is thus of paramount importance that efforts are made to address the shortages and ensure adequate infrastructural facilities. The Covid-19 pandemic showcased the efficacy of Public-Private Partnerships (PPP) in addressing the concerns of the healthcare sector. Similar partnerships can be initiated by the states where the expertise of the private sector and the administrative support of the government can be used to help elevate the blood management ecosystems. Additionally, the deployment of innovative models like the hub and spoke model of blood collection, as advocated by the National Blood Policy, can be useful in overcoming geographical and resource constraint barriers. 

While the Public-Private Partnerships (PPP) and innovative approaches can improve the accessibility of blood, it is also important for the government to adopt a targeted approach to raise awareness about blood donation and dispel the myths associated with it to change people’s perceptions. The Swachh Bharat Campaign achieved great success by making students the brand ambassadors. Similarly, students can be messengers to initiate grassroots movements. Lessons can also be incorporated from the door-to-door Polio campaign of the government, which successfully eradicated Polio in two decades. The state and the central government can leverage ASHA (Accredited Social Health Activist) workers to raise awareness via such a door-to-door campaign. Additionally, resource mobilization is essential to place a blood transfusion system connecting blood banks across the country to mitigate discrepancies in demand and supply. 

Post-independence, the country has made tremendous progress on various socio-economic indicators such as the gross domestic product (GDP), maternal mortality rate (MMR), infant mortality rate (IMR), sex ratio, and per capita income. However, with several instances of people traveling long distances searching for blood being reported, an efficient blood management ecosystem remains a facet that the country is yet to conquer. The national and the state governments, health authorities, and policymakers must align to put in place integrated blood management and transfusion ecosystem. However, these efforts would only be fruitful if citizens take up individual responsibility. I would thus like to encourage citizens to come forward to donate blood voluntarily. Collectively, we should seek to achieve the target of zero deaths due to lack of access to blood. 

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