Maj Gen (Prof) Atul Kotwal, SM,VSM
Executive Director, National Health Systems Resource Centre, MoHFW, GoI

The importance of even a tiny drop has been well acknowledged in our culture. ‘Boond boond se ghat bhare’, we learned and remember. And, if a drop of water could have such value, it needs no imagination what a drop of blood could mean to someone in need.

Voluntary blood donors are, hence, not only a cornerstone of a safe and adequate supply of blood and blood-related products, these non-remunerated donors from low-risk population subgroups have always been identified as the safest blood donors. While we still see a huge proportion of blood collection from family and replacement donors, we also cannot deny the risk of these donors being associated with a low or high prevalence of transfusion–transmissible infections. This also indicates a need for establishing strategies to enhance blood safety by focusing more on voluntary low-risk donors.

While the onus of blood supply lies with the blood bank rather than the patients, the country’s health system is continuously addressing the concerns related to the shortage of blood supply by undertaking need assessments to understand the gap between demand and supply; and also planning timely interventions to close these gaps.

Several reports have attested to a shortage of blood across health care facilities in India. Not only are we losing patients every day due to a shortage of blood, but we are also facing maternal death’s burden due to excess loss of blood and at the same time it’s a shortage to replenish the patients’ blood levels. Blood transfusion is not limited to cases like trauma, surgeries, post-partum haemorrhages or anaemia, but with the country’s changing health needs and evolved facilities, this has expanded to cover patients being treated for cancer, inherited blood disorders or specific surgeries and similar interventions. Voluntary Blood donation has been advocated both at the national and international levels not only to address the shortfall but also to phase out replacement donors over a period of time. This will also reduce the financial burden of patients while arranging replacement donors, which has become the responsibility of the patient over a period of time.

A first-of-its-kind,national-level cross-sectional study in 2022, revealed India’s estimated demand, supply, and utilisation of whole blood and blood products. It was found that the supply against demand is at 92·6% for whole blood, 91·7% for red cells, 86% for plasma, 77·5% for platelets, and 92·1% for cryoprecipitate. The study attributes the supply-demand gap to factors such as low voluntary blood donation and injudicious demand (J J Mammen, et al., 2022). This inference points toward the need to further improve awareness, motivate voluntary donors as well as avoid irrational clinical use of blood and blood products.

Regular blood donation drives are already being held on notable occasions across different platforms, including facilities, corporate offices, civil societies, NGOs, academic institutions, and more. Realising the need to increase awareness and timely access to safe blood transfusion, the Government of India has proposed to organise a mega blood donation drive on September 17, with the involvement of all Ministries of the Union and state governments, non-government and community-based organisations, and the youth of the country.

Even though concerns of ‘wastage because of this mega campaign are raised by some activists, this initiative is a sincere effort by the Government of India to raise awareness that blood is needed every day and to encourage more people to donate blood throughout the year. The initiative is also designed to encourage voluntary blood donors to register themselves with the Union Ministry of Health & Family Welfare and donate blood in identified blood banks or donation camps. Moreover, one lakh units of blood in a day spread across the country can be easily and gainfully utilised as the country already reports a shortfall of approximately 40 lakh units per annum.

The initiative would not only focus on blood collection but also ensure its accessibility and availability at the point of demand. This would be achieved by strengthening the systems and ensuring uniform high quality, logistics, cold chain management, common inventory and an appropriate regulatory framework. With the MoHFW recently releasing revised Indian Public Health Standards (IPHS2022) for health care facilities, the blood banks and storage facilities are also being strengthened to complement the government efforts towards universal access to safe blood transfusion.

Additionally, more than 51% of blood banks in the country have component separation facilities attached to them. While whole blood has a shelf life of up to 35 days, fresh frozen plasma, separated from whole blood within 6 hours and rapidly frozen and maintained at a temperature of -30 degrees Celsius, has a shelf life of up to one year. Moreover, the blood banks will draw the number of units only as per their capacity and the rest of the volunteers will be enrolled in the database for future requirements. 

The fundamental strategy to ensure timely access to a safe and sufficient supply of blood and blood products is to develop a nationally-coordinated blood transfusion service based on voluntary non-remunerated blood donations. This service would be governed by quality management in all its aspects, with sufficient and continuous funding, and be fully integrated into the national health system. Leveraging information technology, Arogya Setu and e-Raktkosh, will help in creating a live database of motivated voluntary donors available on an as-required basis. The states/UTs need to ensure that this mega drive is effectively utilised for information, education and behaviour change communication at a large scale during contact with the volunteers.

With the recent initiatives of the current Government in the health sector –Ayushman Bharat (HWCs, PM-JAY, PM-ABHIM, ABDM), tied health grants under 15th Finance Commission (FC-XV), ECRP–2 funds and the ongoing NHM, India has embarked on a journey towards a resilient and strengthened health system with a holistic approach. Thus, attention to each and every component, like ensuring the availability of quality blood and blood products and streamlining the systems they rely on will guarantee to build on the recent progress. This in turn helps in strengthening the health system as a whole and achieving universal and timely access to safe blood transfusion. For, we already know, every drop counts!

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