Integration of blood transfusion services into National Health System, Egypt, experience

Abstract

Introduction: Blood transfusion is an indispensable service of any health system. Blood products are needed to support many medical and surgical cases, and can save lives or improve morbidity. Blood services in many countries started as early as 1940s, and it was mostly hospital based pattern. Over the decades, it has been realized in many countries that this vital service should be centralized. The reasons are; better quality assurance, more cost effectiveness, easier to be updated, etc. Background: Egyptian blood transfusion services were recognized as a separate specialty independent from laboratory services as earl as 1975. Hospital blood banks [HBBs] started as early as 1938. However, these services were very fragmented and primitive till the mid 1990s. Ministry Of Health realized that blood services should be restructured in order to keep up with other health system. Subject: - Project for restructuring the BTS between Egypt and Switzerland. - Establishment of the National Blood Transfusion Center [NBTC] and 8 Regional Blood Transfusion Centers [RBTCs]. - Two parallel blood systems. - Ministerial decree to prohibit the professional blood donation. - Creation of the NBTS as sole provider of blood. - Conversion of HBBs to become storage blood banks. - Production and implementation of National Blood Policy [NBP]. - Establishment of the National Blood Standards and Guidelines [NBS] & [NBG] - Testing centralization of blood units. - Resistance of the project by some health institutions # Crisis of the locally manufactured blood bags. - Ministerial decree to merge the two blood systems. - Establishment of the conversion plan over three years to implement the national blood policy. - Establishment of the National Blood Regulatory Authority NBRA]. - Positive acceptance of the plan by health authorities, and resistance converts to acceptance due to credibility. - Increase blood donations, and gradually phasing out family replacement donations which should be completed in five years. - Cost recovery exercise to be studied, this is to sustain the funding of a robust blood services. - Quality Management System [QMS] was established. - Extensive training program for all staff categories started at all levels; regional centers, hospital blood banks, anticipated regulatory personnel, administrators in local health authorities, different clinicians who prescribe blood components, etc. - The plan was modified several times during the implementation to adapt for the obstacles and the situations that come across. - Pilot project was implemented first in the most problematic governorate. The model was rolled over other governorates in time scaled plan. - Establishment of the Egyptian fellowship in Transfusion Medicine to create career prospects and certification for the medical staff working in the blood network. Conclusion: - High level manage commitment is very essential to integrate the blood services into the health system. - Planning and determination leads to credibility and acceptance. - Including all stakeholders in the planning, designing of the policy and standards, etc. - The National blood policy is working well for the Egyptian health system, and supported by the top MOH management Recommendations: - Gain more support by the local national partners and international agencies. - Speed up the process of establishing the national blood regulatory authority. - Sustain the human resource development process to cover all the personnel working in NBTS. - Finalize and implement the cost recovery study in order to sustain the services. - Look into the prospect of utilizing the recovered plasma to extend the contribution of NBTS to other health aspects.