Over the past decades, WHO has been supporting the Government of Bangladesh to ensure quality-assured screening for blood transfusion services across the country and scale up standardized practices to Upazila level. In Cox’s Bazar, all efforts are being employed for the establishment of public blood banks and transfusion centers that can provide sufficient and timely safe blood to meet the transfusion needs of all patients, including Rohingya refugees.
35-year-old healthcare worker, Kyaw Won, voluntarily donates blood at the Teknaf Upazila Health Complex to cover the need for safe blood when need it. WHO Bangladesh/Irene Gavieiro Agud
Blood is a vital resource to save lives and improve health conditions, but many patients requiring transfusion do not have timely access to safe blood, particularly in low- and middle-income countries where availability of safe, effective and quality blood may be challenging.
It is estimated that approximately 800 000 units of blood are required every year in Bangladesh, however a well-organized blood transfusion service is yet to be developed across the country. Efforts to set up an integrated national blood system began in 1950 with the creation of the Blood Transfusion Service (BTS) at the Dhaka Medical College Hospital. The legislative framework to promote uniform implementation of standards and consistency in the quality and safety of blood would later arrive, with the Safe Blood Transfusion Act in 2002 which stated the mandatory screening for five transfusion transmissible infections (TTIs): HIV, Hepatitis B, Hepatitis C, Syphilis and Malaria.
Since then, marked progress has been made by Government authorities and key health partners to ensure supply of safe blood across the country as an integral part of the national health care policy. However, due to resources constraints, the increasing demand for safe blood is far from being achieved, and blood donation and transfusion services remain demand-driven in most parts of the country.
According to the Safe Blood Transfusion Programme (SBTP) report issued in 2018, 70% of the blood in Bangladesh is collected from directed or relative blood donors, while the remaining 30% comes from voluntary blood donors. The blood donation system is not a centralized system meaning that all blood transfusion centers, which are mostly hospital-based, are responsible for the collection, processing and distribution of the blood.
Lab Technologist, Humayun Rashid, is responsible for screening all donated blood for transfusion transmissible infections at Teknaf Upazila Health Complex. WHO Bangladesh/Irene Gavieiro Agud
Establishing integrated and well-coordinated blood transfusion centers in Cox’s Bazar
Over the past decades, WHO has been supporting the Government of Bangladesh to improve blood-screening and scale up the activities to the Upazila Health Complex (UHC) level.
In 2017, after the mass influx of Rohingya refugees 740 000 Rohingya refugees fleeing from violence in the Rakhine State of Myanmar, efforts were also extended to the refugee camps in Cox’s Bazar in order to establish a fully functional blood transfusion service, and thus ensure quality health services for life-saving interventions in this humanitarian context.
An assessment conducted by WHO at some of the reference government and partner-led healthcare centers in the camps revealed challenges to meet the high demand of blood transfusion services for the Rohingya population and adjacent host communities.
“Our blood transfusion services work on an emergency basis. When blood is needed, family members or volunteers are selected according to the national guidelines and become donors”, explains Dr Md Enamul Haque, Residential Medical Officer at Teknaf UHC over the past ten years.
Inadequate equipment and consumables, as well as a low number of government qualified personnel emerge as the major obstacles to establish a quality blood bank in Teknaf UHC, which caters to over 850 000 patients’ needs from host community and the Rohingya refugee camps. In emergency cases, external support is essential to respond quickly. “I am the only laboratory technologist in this facility working in the morning shift, from 9.00 am to 2.00 pm. If an emergency patient comes in the evening or at night, they may seek support from private clinics”, says Humayun Rashid, Laboratory Technologist at Teknaf UHC.
The quality and safety of blood must be assured throughout the blood transfusion procedure, from the selection of blood donors to the storage and administration of blood into the patient. WHO Bangladesh/Irene Gavieiro Agud
Partner facilities have been working tirelessly to meet the existing demand for blood supplies but to date the target has not been met. As a result, there is an increased pressure on Cox’s Bazar Sadar hospital to provide life-saving blood supplies and transfusion services to the nearly one million refugees and host communities in the district.
“Establishing integrated and well-organized blood transfusion centers in Cox’s Bazar is a vital component of our work to strengthen the health systems capacity to provide timely, live-saving care to patients when needed”, says Dr Kai von Harbou, Head of WHO Emergency Sub-Office in Cox’s Bazar.
To grant timely access to safe blood and enhance the district’s capacity to save lives, WHO is supporting the Government in the establishment of blood transfusion services at the Ukhiya and Teknaf Upazila Health Complexes (UHCs) through capacity building and logistics support. Further to this, compliance with WHO recommended standard practices and criteria for selection of donors, appropriate testing, storage of donations for clinical use and responsible use of blood supplies, among others, are closely monitored by WHO staff in Government facilities.
On 14 June 2021, Civil Surgeon’s office and WHO officers celebrated the World Blood Donor Day and the progress achieved in Cox’s Bazar for the establishment of the blood banks and transfusion centers. WHO Bangladesh/ Irene Gavieiro Agud
With a total budget of USD 18.7 million, the Health and Gender Support Project (HGSP) launched in 2021 and funded by the Government of Bangladesh and the World Bank will address health gaps in Rohingya refugee camps and adjacent host communities in Cox’s Bazar to build on the achievements of the current additional financing for Health Sector Support Project (HSSP). Among the several areas of intervention addressed within this project, the establishment of blood transfusion centers at seven upazilas in Cox’s Bazar district is a priority.
The HGSP project aims to create an enabling environment for blood safety in Cox’s Bazar through the refurbishment of existing facilities, extensive capacity building of healthcare workers and the establishment of effective evidence-based national blood policies and clinical transfusion practices at hospital settings. Moreover, last stages of the project include the design and implementation of an awareness campaign to encourage a blood donation behavior among the Bangladeshi and Rohingya population.
“Establishing an adequate infrastructure and building capacities are prerequisites for creating a culture of blood donation in Cox’s Bazar. Once the public blood bank and transfusion centers are fully established, we will start raising awareness among the population to increase voluntary blood donations”, states WHO Laboratory Officer, Paul Debashish, who is closely monitoring progress for the establishment of blood transfusion services in the district.
WHO Laboratory Officer, Paul Debashish, and Residential Medical Officer, Dr Md Enamul Haque, visiting the refurbishment work of the blood transfusion unit at Teknaf UHC. WHO Bangladesh/Irene Gavieiro Agud