The Uganda Blood Transfusion Service (UBTS) is the National Blood Service responsible for all blood transfusion and safety activities for the entire country. The Uganda Blood Transfusion Service was established as an autonomous institution and commissioned in January 2003 by a Board of Directors. It operates within the framework of the National health Policy and the Health Sector Strategic Plan. A National policy on Blood Transfusion was developed to guide the implementation of blood safety activities for the attainment of the best possible technical and ethical standards.
A National policy on Blood Transfusion was developed to guide the implementation of blood safety activities for the attainment of the best possible technical and ethical standards.
The National Blood Transfusion Network
The Uganda Blood Transfusion Service is a centrally coordinated department in the Ministry of Health with efficient central coordination sufficiently decentralized to render service to all regions of the country. The headquarters at Nakasero Blood Bank acts as a reference centre for the regional blood banks and other public and private hospitals. The blood collection depends on healthy volunteer donors with least risk for Transfusion Transmissible Infections (TTIs). UBTS has grown from a service supplying blood in Central Uganda within a radius of 100 km from Kampala in 1989 to a network of 7 Regional Blood banks which include Arua, Fort-Portal, Gulu, Kitovu, Mbale, Mbarara and Nakasero; Six- (6) blood collection centers in Hoima, Jinja, Kabale, Rukungiri Lira and Soroti. At that time blood collection was mainly replacement donation and hardly any voluntary non-remunerated blood donors (VNRBD). The percentage of VNRBD gradually increased to 85% in 1999 and currently stands at 100%.
Achievements and challenges of UBTS
UBTS has grown from a service, supplying blood in Central Uganda within a radius of 100 km from Kampala in 1989 to a current network of 7 Regional Blood banks in Arua, Fort-Portal, Gulu, Kitovu, Mbale, Mbarara and Nakasero and six blood collection and distribution centres in Hoima, Jinja, Kabale, Rukungiri, Lira and Soroti.
Regional Blood banks have the capacity to recruit volunteer blood donors, collect blood and test it for transfusion – transmitted infections (TTIs) – HIV, Hepatitis B, C, Syphilis blood grouping process blood into pediatric packs and prepare platelets and fresh frozen plasma (FFP).
The percentage of Voluntary Non-Remunerated Blood Donors has gradually increased to eight five percent in 1999 and currently stands at a hundred percent. The increase in blood collection is due to a vigorous Donor Recruitment and retention program jointly run by UBTS and URCS. Fifty eight percent of these are regular blood donors
There is development being experienced in terms of improvement of facilities at Mbale and Mbarara, while construction plans are underway for Nakasero, Gulu and Fort Portal region blood banks.
The approval of the National Policy by the Ministry of Health; the staff structure; the self-accounting status granted to UBTS are but a few of the achievements experienced.
Quality system and management have been developed; the Quality manual is in place, quality awareness has also grown. All collections made are tested for HIV, HBV, HCV and Syphilis; and for ABO/Rhesus D.
Networks and collaborations have improved; there is collaboration with URCS at societal interface. Key partners in the blood safety program in Uganda include the Uganda Red Cross Society (URCS) who are responsible for about 40% of the activities in blood donor recruitment. Donor management task force has been established.
UBTS has adequately trained staff, stocked equipment and reagents, assay kits and testing to meet the minimum requirements and reagents of a screening program.
Donors are recruited through mass media, public announcements or placement of notices in public places. Twenty mobile collection and recruitment teams with each performing an average of 20 sessions per month and collecting 37 units per session.
Meeting National Demand. A key challenge and constraint for UBTS is to expand blood collection capacity to meet the increased national blood demand especially at health Centre IVs when they become fully operational.
UBTS has an important task of meeting the increased demand for safe blood transfusion especially at Health Centre IVs, which are located in rural areas where most of the population lives. Most of the blood is used for transfusion of children and mothers; 50% of all blood collected is for treating children with severe anaemia, largely due to malaria, intestinal worm infestation and malnutrition; a further 25% of the blood is required to treat pregnant women with anaemia and complications of child birth and 25% to treat accident or surgical cases.
Funding. More Government funding is required to replace the reducing donor funding.
Infrastructure. Blood transfusion Infrastructure is still inadequate with some of the centres operating from a few room borrowed from referral hospitals. There are only two purpose regional Blood banks Mbale and Mbarara that were built using Pepfar funds. Inadequately furnished centres include: Fort- Portal, Gulu, Arua and five smaller centres at Hoima, Kabale, Jinja, Soroti and Masaka – currently collect and distribute blood but require more appropriate structures. It was planned to have a Regional Blood Bank for each Regional Referral hospital.
Establishment of UBTS as an autonomous body. The approval of the National Policy by the MOH; the existing structure; the self-accounting status granted to UBTS were important steps in preparation of UBTS for autonomy. However, the drafting of the necessary statutes to make UBTS as a fully autonomous institute has delayed.
Sustainability of UBTS. UBTS is partly run on donor funds (PEPFAR) that has made significant improvement in the programs. Government in collaboration with MOH and UBTS should devise ways of resource mobilization in order to avoid interruption of Blood transfusion Services.
In Uganda, blood transfusion is a very expensive therapy. It costs about US dollars 45 to make a unit of safe blood delivered to the hospital.
There are inconsistent practices with no guidelines to bring about harmonization and essential uniformity at the hospital level. Clinical interface is virtually absent leading to poor clinical practices.
Poor waste management is experienced with the little blood that is essential to life. This is indicated by lack of hospital transfusion committees. There is need to develop appropriate clinical transfusion medicine practices.
There is inadequate publicity and advocacy for BDR activities, there is need to invest in the development of sustainable partnerships with the consumers (hospitals) and suppliers (community). Societal interface is still weak. This is exhibited by the high percentage of one time only donors.