Inter Press Service - March 31, 2003
Muddassir Rizvi

The National Blood Policy and Strategic Framework for National Blood Transfusion Services, approved earlier in March, provides for uniform blood screening standards across the country.

But still under question is the viability of this new policy in a country where only 20 percent of its three million bags of blood are screened in the first place.

A large number of unregulated blood banks thrive throughout the country and fulfill the needs of tertiary health services run by private sector, public health experts say.

Just in Sindh province, according to one study, there are over 100 blood banks. There is not a single registered blood bank in the southern port city of Karachi, home to more than eight million people.

"With the exception of a few, blood banks are in fact breeding deadly viruses. Established in cottages and cabins, and having no proper labs and screening equipment, they are causing the spread of various diseases. The government must (first) register them all," said Azhar Hussain, a public health activist.

Doctors in government-run Federal Government Services Hospital in Islamabad said that the hospital received 40 blood bags contaminated with the Hepatitis B virus and 93 bags with Hepatitis C virus in 2002.

But, doctors in government hospitals say, the focus of the government's fresh orders is precisely the screening of blood to protect against Hepatitis B and C and HIV. "Additionally we also ensure the blood group- and cross-matching against the blood sample of the recipient," said a doctor at the Pakistan Institute of Medical Sciences in Islamabad.

This move indicates that there is a fear of hepatitis and HIV spreading through unsafe blood supplies and the lack of a regulatory framework. Although HIV cases transmitted this way are small in number, the incidence of hepatitis is alarming.

Hepatitis B alone affects an estimated one out of every 10 Pakistanis, though some medical experts feel that its incidence is much higher.

According to Dr Rehan Hafiz, national coordinator of the country's Expanded Programme on Immunisation, the incidence of hepatitis is anywhere between two and 10 percent. "This high magnitude demands a national response," he said.

As for HIV, the government says that around 2,000 people had the virus at the end of 2002, with a prevalence rate of 0.1 percent. However, the World Health Organisation and Joint U.N. Programme on AIDS call it under-reporting and estimate that there 70,000 to 80,000 HIV positive cases in the country.

"As many as 20 percent of HIV cases can be attributed to the exposure to contaminated blood or its products," said a health ministry official.

The government's new thrust on safe blood would bring down the disease graph, he said. "We are trying to ensure blood safety at the administering end. It will be the responsibility of the doctor transfusing the blood to verify that it meets the screening standards," he said.

The new framework comes five months after an ordinance to regulate transfusion of safe blood specific to the Islamabad capital territory was issued in October.

In contrast, the new framework will cover the entire country, although a health ministry spokesman could not explain how would it be binding on the private sector in the absence of legal provisions.

Besides requiring the registration of all blood banks in the capital territory, the Islamabad ordinance envisaged one-year imprisonment or heavy fines or both for any person who contravenes it. According to the ordinance, the one in charge of a blood bank where any contravention takes place will also be penalised.

Health activists want the extension of these penalties to the rest of the country as well.

In the end, Hussain believes that the government needs to address the issue of unsafe blood holistically.

"Unless the demand and supply side of the issue are given equal attention, the problem will persist," he said. "While public should be educated on the need of blood screening, the government in coordination with well-established blood banks run a programme to encourage voluntary non-paid donations, which has proved to be most cost effective mechanism for ensuring a safe blood supply."

He says that the government should make an effort to discourage blood donations for money, which is common in the country due to poverty. "Studies suggest that paid blood donors have particularly high rates of HIV infection, perhaps because they are also involved in prostitution or intravenous drug use," he said.

The high cost of blood screening discourages people from doing it.

"Screening the blood for various types of hepatitis alone through Agglutinetion, ELISA or PCR methods costs somewhere between 1,500 and 2000 (25 to 35 U.S. dollars)," said Dr Zaeemul Haq, a pediatrician.

This is quite a lot of money in a country where per capita income is 450 dollars.

Haq emphasises the need for accountability of the medical profession. "In the absence of laws against medical negligence, doctors in public and private sectors feel no fear. Medical negligence is common and no one has ever been punished," he said.

However, National Coordinator for Blood Transfusion Services Dr Birjees Mazhar Kazi defends the new framework as a good start.

He says the upcoming enhanced HIV prevention project has the provision of blood screening for HIV and Hepatitis B and C, which can form a very strong basis for strengthening the National Blood Transfusion Services.

"The National Blood Transfusion Committee and similar monitoring mechanisms will ensure blood safety," he said. "Let us make a beginning, improvements can always be made." (END/AP/HE/DV/MR/JS/03)

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