National Blood Policy
&
Strategic Framework 2014-20
Safe Blood Transfusion Programme
Ministry of National Health Services, Regulation and Coordination
Government of Pakistan
Copyright © 2014 by Safe Blood Transfusion Programme, Ministry of National Health Services,
Regulation & Coordination, Government of Pakistan
All rights reserved.
978 969 9881 18 3
Table of Contents
Abbreviations ............................................................................................................ ii
Preamble ................................................................................................................... iii
Message from the Federal Secretary Mo/NHSR&C ............................................... vi
Executive Summary ................................................................................................ 01
Blood Transfusion Services in Pakistan ............................................................... 03
National Blood Policy ............................................................................................ 05
National Strategic Framework ............................................................................... 07
Cluster 1: Governance ........................................................................................... 08
Cluster 2: Resources.............................................................................................. 11
Cluster 3: Core Business ....................................................................................... 15
Cluster 4: Processes Improvement ........................................................................ 20
Annexes
Annex A Objectives and Indicators of NSF 2014-20 .............................................. 24
Annex B Group Photograph Round Table Consultation, May 2014 ....................... 33
Annex C Group Photograph Round Table Consultation, June 2014 ...................... 37
ii
Abbreviations
AATM Asian Association of Transfusion Medicine
AJK Azad Jammu and Kashmir
BTA Blood Transfusion Authority
BTS Blood Transfusion Services
CUB Clinical Use of Blood
EAD Economic Affairs Division
EQAS External Quality Assessment Scheme
FATA Federally Administered Tribal Areas
FFP Fresh Frozen Plasma
GIZ German International Cooperation
GLP Good Laboratory Practices
GMP Good Manufacturing Practices
HBB Hospital Blood Bank
HRA Health Regulatory Authority
HTC Hospital Transfusion Committee
IBTA Islamabad Blood Transfusion Authority
IBTS Institute of Blood Transfusion Service
ICBS International Consortium on Blood Safety
ICT Information, Communication and Technology
IDTM ID Consulting for International Development of Transfusion Medicine
IHN International Haemovigilance Network
ISBT International Society of Blood Transfusion
KAP Knowledge, Attitude and Practices
KfW German Development Bank
KP Khyber Pakhtunkhwa
MoNHSRC Ministry of National Health Services, Regulation and Coordination
NAC National Advisory Committee
PAC Provincial Advisory Committee
PHN Pakistan Haemovigilance Network
PMP Preventive Maintenance Programme
PRCS Pakistan Red Crescent Society
QA Quality Assurance
QC Quality Control
QMS Quality Management System
RBC Regional Blood Centre
SBTP Safe Blood Transfusion Programme
SOP Standard Operating Procedure
SPC Statistical Process Control
TC Technical Cooperation
TTI Transfusion Transmitted Infection
VNRBD Voluntary Non-Remunerated Blood Donor
WHO World Health Organization
iii
Preamble
Driven by the vision of an integrated blood transfusion service structure
across the country, the Government of Pakistan, in 2008 through its
Safe Blood Transfusion Project, embarked on an ambitious reform
process. The reforms included the formulation of a national blood policy
and strategic framework (2008-12) and the establishment of blood
transfusion programmes at the national and provincial levels including
AJK, FATA and Gilgit-Baltistan. Since its establishment, the Project -
with the support of the German partners - has been able to deliver a
series of outputs which have significantly contributed to the
development of the reform process. The scope of the concept of the Project is being
expanded through the establishment of partnerships between the public, private and NGO
sectors. The interaction with the different stakeholders has deepened the SBTP’s
understanding of the existing ´diversity´ in terms of structures, technology, human resource
capacity and overall organization.
In 2014, work was initiated on the new Framework in an effort to refresh and further
harmonize the priorities for the period 2014-20. The revision was also necessitated as the
experiences gained and lessons learnt in the implementation of the first phase of Programme
(2010-14) needed to be incorporated in the future strategy. The second phase of the project
is going to be launched shortly.
An exercise to revise the "National Blood Policy and Strategic Framework (2008-12)" was
conducted based on a joint evaluation of the achievements under this governance tool. This
new document for the period 2014-20 has also taken into account devolution and
decentralization issues surfacing as result of the recent 18th constitutional amendments. The
strategic part of the policy has been formulated in a way to have more precise public-private
partnership models and take into account a new scenario where the provinces have to bear a
greater share of responsibility of the devolved subjects including the health sector.
In order to build consensus on the new draft of NSF 2014-20, two Round Table Working
Group Consultations were conducted in May and June 2014, under the auspices of the Safe
Blood Transfusion Programme. The Consultations were participated by all the provincial
managers of the Blood Transfusion Programmes, transfusion experts from public, private and
NGO sector blood banks and representatives from the Ministry of National Health Services,
Regulation & Coordination, WHO and other development partners.
This Framework document provides fundamental principles and identifies clear priority areas
that need to be focused in a coordinated manner so that the strategy can be implemented
successfully within a set time frame. The overarching priorities regarding blood transfusion
services that are addressed include: equity; the development of leadership, planning and
management capacity; quality of care and monitoring and evaluation. The new strategy will
also encompass and underscore the significance of linkages among the various vertical
health programmes particularly the Maternal, Neonatal & Child Health, Hepatitis Control and
the HIV/AIDS Programmes. The unique challenges posed by the heavy burden of
thalassaemia disease and its impact on the blood system have also been taken into account
in the future strategy. This document will be revised periodically and consolidated by
iii
Prof. Hasan Abbas Zaheer
iv
incorporating suggestions, guidance and critique from the experts and other key
stakeholders.
The revision of this Framework would not have been possible without the technical assistance
from the German International Cooperation (GIZ). Indeed the support of the German Government
for this project through its Technical Cooperation (TC) component implemented by GIZ and the
Financial Cooperation (FC) component funded by KfW has been critical to the successful
implementation of this project of immense public health importance. The role of the GIZ has been
particularly valuable in developing this document as GIZ has been involved with the project since
its conceptual and preparatory planning stages. The Government of Pakistan acknowledges and
appreciates this support from the German government.
It is also pertinent to mention the Technical Assistance provided by the GIZ for the
development of the Strategic Framework 2014-20. Special appreciation is accorded to Dr. JP
Steinmann, GIZ Principal Advisor and his team of experts including Dr. Imran Durrani and Dr.
Aftab Khawaja for their assistance during the NSF development process. The Programme
acknowledges the facilitation provided by Prof. Dr. Cees Th. Smit Sibinga, GIZ Consultant.
The draft document was subsequently circulated among the various stakeholders and their
feedback was incorporated in the document.
The Programme acknowledges the support and encouragement received from our blood
programme managers, including Dr. Muhammad Jafar Saleem (Punjab), Dr. Zahid Hasan
Ansari (Sindh), Prof. Muhammad Tahir Khan (KP), Prof. Nadeem Samad Sheikh
(Baluchistan), Dr. Naveed Ahmed (AJK), Dr. Sartaj Khan (FATA), and Dr. Abdul Latif (Gilgit
Baltistan), whose advice and recommendations were particularly relevant and invaluable.
Mr. Usman Waheed, Technical Expert, SBTP, deserves a special mention for his dedicated
work in developing and editing this document and for his diligence and hard work which made
the finalization of this document possible.
The document captures local expertise from provincial programmes, public health specialists
and well-reputed blood bank establishments from all over the country. The stakeholders who
have contributed to the development of this document during the two national consultations
include:
Dr. Ashfaq Ahmed (Capital Administration & Development Division, Government of Pakistan)
Dr. Aftab Ahmed Khan (Kulsum International Hospital, Islamabad)
Mr. Asad Ali (Husaini Blood Bank, Karachi)
Dr. Asad Hayat (Shaukat Khanum Memorial Cancer Hospital, Lahore)
Dr. Ashraf Memon (Sindh AIDS Control Programme, Karachi)
Mr. Ashraf Chattah (EPOS-KfW SBT Project)
Dr. Asma Cheema (German Red Cross, Islamabad)
Mr. Ateeq ur Rehman Memon (Pakistan Nat. Accreditation Council, Ministry of Science & Technology)
Prof. Ayesha Junaid (Shifa International Hospital, Islamabad)
Dr. Faiza Fahim (KRL Hospital, Islamabad)
Dr. Farheen Karim (Aga Khan University Hospital, Karachi)
Dr. Farrukh Hasan (Asian Association of Transfusion Medicine)
Dr. Guenter Merck (EPOS-KfW SBT Project)
Prof. Haroon Khan (Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad)
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Dr. Huma Qureshi (Pakistan Medical and Research Council, Islamabad)
Prof. Inayat Hussain Thaver (Health Services Academy, Islamabad)
Brig. Javed Usman (Army Medical College, Rawalpindi)
Prof. Khurshid Ahmed (National Institute of Health, Islamabad)
Dr. Kiran Tauseef (Al-Nafees Medical College, Isra University, Islamabad)
Dr. Lubna Tahir Aziz (Fauji Foundation Hospital, Rawalpindi) Dr. Malik Zeb Khan (Institute of Kidney Diseases, HMC, Peshawar)
Dr. Masuma Zaidi (KfW Country Office, Islamabad)
Dr. Muhammad Anwar (Jinnah Postgraduate Medical Centre, Karachi)
Mr. Muhammad Asim Ansari (Kulsum International Hospital, Islamabad)
Prof. Muhammad Farooq Khattak (Quaid-i-Azam International Hospital, Islamabad)
Prof. Muhammad Irfan (Liaqat National Hospital, Karachi)
Dr. Muhammad Imran (Nishtar Hospital, Multan)
Mr. Muhammad Khalid (Blood Transfusion Authority, Khyber Pakhtunkhwa)
Dr. Muhammad Usman Cheema (Islamia University of Bahawalpur, Bahawalpur)
Mr. Muhammad Zakir (Khyber Pakhtunkhwa Safe Blood Transfusion Project)
Dr. Munira Borhany (National Ins. of Blood Disease & Bone Marrow Transplantation, Karachi)
Dr. Nadeem Nusrat (Dow University of Health Sciences, Karachi)
Dr. Naureen Saeed (Holy Family Hospital, Rawalpindi)
Prof. Nisar Ahmed (Children Hospital and Institute of Child Health, Lahore)
Brig. Dr. Nuzhat Salamat (Armed Forces Institute of Transfusion, Rawalpindi)
Dr. Quaid Saeed (World Health Organization)
Dr. Rashid Azeem (Blood Transfusion Authority, Khyber Pakhtunkhwa)
Dr. Roohi Khalil (Federal Government Polyclinic Hospital, Islamabad)
Mr. Rumi Dossal (Fatimid Foundation, Karachi)
Prof. Saba Jamal (Indus Hospital, Karachi)
Dr. Sabeen Afzal (Ministry of National Health Services, Regulation & Coordination)
Dr. Saeed Ahmed (Husaini Blood Bank, Karachi)
Dr. Saif ur Rehman (Pakistan Red Crescent Society, Islamabad)
Dr. Sarfraz Hussain Jaffri (Husaini Blood Bank, Karachi)
Prof. Shahida Mohsin (University of Health Sciences, Lahore)
Dr. Shahtaj Khan (Hayatabad Medical Complex, Peshawar)
Dr. Shamshad Ahmed (Bahawal Victoria Hospital, Bahawalpur)
Dr. Sher Zaman Khan (Blood Transfusion Authority, Baluchistan)
Dr. Syed Imtiaz Hasan (Federal Government Polyclinic Hospital, Islamabad)
Mr. Syed Shahid Ali Zaidi (Ali Zaib Foundation, Faisalabad)
Prof. Tahira Zafar (Peshawar Medical College, Peshawar)
Dr. Wasiq Paracha (Patients Welfare Association, Karachi)
Mr. Zahid Mahmood (EPOS-KfW SBT Project)
Dr. Zahida Qasim (DHQ Hospital, Mirpur Azad Jammu Kashmir)
The SBT Programme is grateful to the Federal and Provincial Health Departments for their
kind patronage and continuous support to implement the Government of Pakistan’s blood
system safety reforms in their respective provinces and regions despite administrative and
constitutional challenges.
Prof. Hasan Abbas Zaheer
National Coordinator
Safe Blood Transfusion Programme
Ministry of National Health Services, Regulation & Coordination
Government of Pakistan
June 2014
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vi
Message from the Federal Secretary Ministry of National Health Services, Regulation & Coordination
Government of Pakistan
The blood transfusion services in Pakistan are fragmented and demand driven, where all
partners work independently with limited regulatory oversight. This heterogeneous state of
affairs makes provision of quality service to the large population a very challenging task. To
improve this state of affairs, in 2008 the Government of Pakistan developed a vision of an
integrated blood transfusion service as recommended internationally and practiced in most of
the countries of the world. This policy decision led to the introduction of an ambitious blood
safety systems reforms process in the country through the platform of the Safe Blood
Transfusion Programme (SBTP), a national project co-funded by the governments of
Pakistan and Germany. The aim of the project is to develop a new infrastructure consisting of
a network of new Regional Blood Centres linked to existing Hospital Blood Banks. The
functioning of the new infrastructure will be in compliance with the international practices,
guidelines and recommendations.
To ensure a sound planning base for the future, the SBTP under the supervision of Ministry
of National Health Services, Regulation & Coordination adopted a systematic and
participatory approach to revise the National Strategic Framework. A number of Technical
Experts from the provincial blood programmes, public and private sectors and the Armed
Forces were invited to review and revise the NSF 2008-12. The well-attended national
consultation, supported by the GIZ Health Sector Support Programme Pakistan, brought
transfusion experts and stakeholders on a single platform to discuss and identify the future
priority areas of the SBTP especially in the light of the experience gained in the
implementation of the first phase of the project which is now nearing successful completion.
The subject document is the output of two rounds of exhaustive national consultations
conducted in May and June 2014.
The Safe Blood Transfusion Programme remains high on the priority of the present
Government and its continued commitment to this vital public health project is again going to
be demonstrated with the signing of the second phase of the project in the very near future.
Consolidating the gains of the first phase of the project and strengthening the Programme as
it enters its second phase will be the key focus and challenge for the future strategy. The
technical support of the German Government implemented through GIZ remains critical for
the project and I would like to thank the German Government for supporting this very
important public health initiative.
The Safe Blood Transfusion Project can truly be termed a success story as despite serious
administrative and constitutional challenges, the Programme implementation was not allowed
to suffer and a solid foundation of a sustainable blood transfusion system has been laid in the
country. Prof. Hasan Abbas Zaheer deserves credit for consolidating and strengthening this
initiative and under his leadership this project was conceived, conceptualized and pioneered.
I am confident that he along with the provincial managers and other stakeholders will
continue to steer the project to greater heights.
Mrs. Rashida Malik
Secretary
Executive Summary
a. Background
The multifaceted concept of blood safety implies collecting blood from healthy voluntary
donors, ensuring proper storage of blood, screening donor blood to ensure that it is safe from
transmissible infections, preparing blood components and avoiding irrational clinical use.
Considering the fact that provision of a safe unit of blood to an individual in need is a basic
human right, the Government of Pakistan has decided to launch a nationally organized and
coordinated blood transfusion service that would meet the nation’s routine and emergency
requirements of blood. Development of a National Policy and Strategic Framework 2014-20
for Blood Transfusion Services (BTS) is a step in this direction.
b. Purpose and Guiding Principles
The basic purpose of the exercise, to formulate a National Strategic Framework for the years
2014-20 in the light of the National Blood Policy, is to enhance and build up the Blood
Transfusion Services of the country. This document was envisioned to guide the wide range
of partners involved in the BTS strengthening efforts. Based on nationwide Round Table
consensus meetings, held in 2014, the document was further improved and provides
fundamental principles and identifies clear priority areas, which need to be focused in a
coordinated manner in order to ensure a successful outcome of implementation within a set
time frame.
The participation of a wide range of partners in the formulation of the National Strategic
Framework served to enhance ownership, facilitate an expanded response and increase
resource mobilization.
For realistic and practical reasons of implementation, 4 major logical managerial clusters will
be followed:
Cluster 1 – Organization, Structure and Management (governance)
Strategic Areas covered in this cluster deal with:
a) Managerial and governing structure
b) Legal and regulatory affairs
Cluster 2 – Resources (human, education, facilities, consumables, equipment, quality
system and quality management)
Strategic Areas covered in this cluster deal with:
a) Facilities, equipment, consumables and laboratory reagents
b) Human capacity building (personnel and education/training)
c) Quality systems and Quality Management
d) Financing, budget and health insurance issues (providing the basic infrastructure
for a sustained blood supply system in the country)
e) Data management and ICT (Information, Communication and Technology)
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2
Cluster 3 – Core business (collection, processing and testing, storage and distribution,
clinical use)
Strategic Areas covered in this cluster deal with:
a) Donor management including the community interface
b) Screening for transfusion transmissible infections
c) Processing of blood – component production
d) Biosafety/Waste management (with special reference to infection control practices
and management of bio-hazardous waste).
e) Clinical interface, in-hospital transfusion chain and rational use; haemovigilance
f) Logistics – collection and supply (cold chain, planning) providing the objectives and
related strategies for the day to day operations of the blood supply and clinical use
Cluster 4 – Sustainability and improvement of processes (monitoring and evaluation,
planning, research and development)
Strategic Areas covered in this cluster deal with:
a) Monitoring and evaluation
b) Planning (Short and long term)
c) Research and development
c. Key Implementing Partners:
The establishment and strengthening of the National Blood Transfusion Services is a
challenging task that requires proportionate efforts on part of all national and international
stakeholders. The Strategic Framework clearly envisions pooled expertise and resources
from all the stakeholders, including the government, private sector, armed forces, and
international development agencies. The following partners are required to play a proactive
role for the purpose:
1. Ministries of National Health Services Regulation and Coordination, Capital
Administration & Development Division, Ministry of Education, Culture and Youth,
Municipalities, Women Affairs, Religious Affairs, Law & Justice, Communication, Labor /
Manpower and Industries
2. Provincial Health Departments and all other relevant Departments
3. Armed Forces Institute of Transfusion (AFIT), Pakistan Red Crescent Society (PRCS)
4. Private Sector Organizations such as Aga Khan University (AKU), Baqai Medical
University, etc.
5. Non-Governmental Organizations such as the Fatmid Foundation, Husaini Blood Bank,
etc.
6. International Organizations such as GIZ, KfW, WHO, USAID, International Federation of
Red Cross and Red Crescent Societies, International Society of Blood Transfusion, Asian
Association of Transfusion Medicine, International Consortium for Blood Safety (ICBS)
and other development/donor organizations.
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Blood Transfusion Services in Pakistan
The Islamic Republic of Pakistan is the sixth most populous country in the world with a
population of 180 million. Literacy rate is 49.5% and the population growth rate is 2.03%.
The health care system in Pakistan faces numerous challenges and operates through a
three-tier delivery structure and a variety of public health interventions. The role of private
sector is growing and according to an estimate its share has reached 75%. The overall
health regulatory framework is limited and inadequate. The total expenditure on health is
2.5% of the GDP. Following the implementation of the 18th amendment of the constitution in
June 2011, functions related to health were devolved to the provincial/state health
departments.
The blood transfusion service in Pakistan is fragmented and largely the result of proliferation
of different types of blood establishments with predominant reliance on the ‘Family
Replacement Donors’. The role of the private non-profit sector in blood transfusion has
increased over the past few decades largely as a result of increase in the demand of
transfusion driven to a large extent by the huge burden of thalassaemia disease in the
country. The total number of blood centres is estimated to be 1,830 with a major contribution
by the private/NGO sector.
In 2004, the National AIDS Control Programme (NACP) submitted a proposal to the
Economic Affairs Division (EAD), within the framework of Pakistan-German Official
Cooperation, related to enhanced blood safety in Pakistan. A feasibility study was conducted
in 2007 by a joint mission of GIZ and KfW. The study recommended conversion of the
scattered system of public and private blood establishments to a centralized system of blood
collection and processing that is in line with WHO standards and increase quality and safety
of blood products (through automated processing and quality assurance) and improve cost-
effectiveness. In 2008, blood safety systems reforms were initiated by the government
through this joint project. The reforms included the formulation of a National Blood Policy
and Strategic Framework. In June 2010, the Federal Ministry of Health decided to establish
Blood Transfusion Programmes at the National and Provincial levels as a separate entity
outside of NACP. At the federal level, the Programme performs the role of central
coordinating body to oversee policy planning, provide strategic guidelines, set standards,
monitor and evaluate programmes, liaise with development partners and report on
international commitments.
The Programme is supported by the Government of the Federal Republic of Germany
through its Technical and Financial Cooperation components. The Technical Cooperation
(TC) component is implemented by GIZ [German Agency for International Cooperation] and
is part of the GIZ Health Sector Support Programme. The TC component works to improve
access to safe blood and blood products by providing advisory services concerning
organization and governance of the system including Management Information System,
Voluntary Non-Remunerative Blood Donations, Clinical Use of Blood, Legal and Regulatory
Framework, Quality Management and Capacity Development. The outputs of the TC
component over the last four years have strengthened the national blood safety system
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reforms process. The Financial Cooperation (FC) component of the project funded by KfW,
the German cooperative bank, is responsible for the development of the new infrastructure
which consists of constructing and equipping a network of Regional Blood Centres, and
renovation and refurbishment of the existing Hospital Blood Banks. Development of 10
Regional Blood Centers and up-gradation of 60 existing Hospital based Blood Banks through
the FC component is now in its final stages.
The fragmented blood transfusion system in the country lacks a reliable and healthy donor
base and a registry of voluntary non-remunerated regular donors. Blood donors are mostly
replacement donors, as the rate of voluntary blood donations is low. According to the data
collected from 297 blood banks by SBTP for WHO global database on blood safety, there
were 12.35% voluntary non-remunerated blood donations while 87.65% were
replacement/family donations in the year 2012. With the objective of harmonization in donor
management and ensuring blood safety, a national donor policy was developed by SBTP in
2011, for adoption by all institutions involved in blood collection.
The SBTP, operating at the federal level, is providing a facilitation role, while local expertise
is activated and captured and interactive knowledge management processes take place in
lieu of traditional external inputs. The objective is to establish the core elements of an
independent rational structure of a national blood transfusion system that will ensure
adequate, efficient and safe blood supply, in a cost effective manner.
Until the establishment of the Safe Blood Transfusion Programme in 2010, there was no
national voice or platform for blood transfusion in Pakistan. All the stakeholders worked in
isolation in the fragmented system. The SBTP has over the years through its various regular
and diverse activities brought all the stakeholders on a single platform. The various national
consultations to develop operational tools, policies, frameworks, seminars, training
workshops etc. have provided an excellent opportunity for all concerned to interact, share
experiences and learn from each other. As a result of these networking opportunities, the
SBTP is now the recognized national voice of Pakistan on all issues related to transfusion.
National and international partners also recognize the SBTP as the national blood
organization that represent Pakistan’s national viewpoint on all issues related to blood
transfusion. As a result of the successful implementation of the project in the last four and a
half years, Pakistan has now firmly secured a place on the world map of blood transfusion.
The Programme leadership is frequently invited to represent the country at international
meetings to share the progress and achievements of its blood safety systems reforms.
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National Blood Policy
Mission
National Blood Policy will ensure access to safe, efficacious and affordable blood for all
citizens of Pakistan.
Policy
Development, implementation, organization and management of National Blood Transfusion
Services that is able to meet blood demand of the country from voluntary non-remunerated
blood donors in a manner that is safe, effective, equitable, non-profitable, sustainable,
rational, without wastage and protection of donor and healthcare workers’ rights and safety.
National blood policy shall also provide a strategic framework and directions for blood
transfusion services under the following priority areas:
1. Development, Organization, Management of Blood Transfusion Services at national and
regional levels
2. Define the role(s) of the public / private sector
3. Capacity Building, Resource Mobilization and Financing
4. Procurement of equipment, consumables and laboratory reagents
5. Motivation, recruitment and retention of blood donors
6. Safe blood collection and storage as per national standards
7. Screening of blood and blood products for five Transfusion Transmissible Diseases
(HCV, HBV, HIV, Syphilis and Malaria)
8. Ensure bio-safety with special reference to infection control practices and management
of infectious waste
9. Practicing and promoting rational use of blood and blood products
10. Quality management and monitoring of the blood transfusion services (haemovigilance).
11. Establishment of hospital transfusion committees
12. National Guidelines and Standards for national and regional blood transfusion services
and Disaster Management Plans at the national and regional levels
13. Develop curricula and start diploma / degree programme for blood bank technicians and
doctors
14. Establish reference blood bank center to deal with problem samples
Federal Health Ministry and the Provincial Health Departments shall:
• Establish Blood Transfusion Services on the pattern recommended by the National and
Provincial Advisory Committees.
• Establish service cadre for various services ranks at all levels.
• Ensure that adequate funding is available to maintain the standards of transfusion
practice and quality management, as recommended by the National Advisory Committee
• Establish reference centers for the Blood Transfusion Services for training, research and
development at the Federal and Provincial Headquarters including AJK and Gilgit
Baltistan.
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6
• Establish and institutionalize the Management Information system (MIS) for effective
monitoring and evaluation of Blood Transfusion services.
• Educate, motivate, recruit and retain voluntary, non-remunerated blood donors.
• Develop technical manual, quality manual, standard operating procedures (SOPs) and
equipment operating procedure (EOP) for the blood transfusion services.
• Establish facilities for safe plasma fractionation.
• Ensure that all legislations and regulations are implemented and followed according to
national recommendations.
• Resource mobilization from all possible sources.
Safe Blood Transfusion Programmes shall:
1. Aim at safe collection of all blood and blood components only from voluntary, non-
remunerated donors who meet the laid down national standards for blood donors in such
a way that the health and well-being of the donors, recipients and health workers are not
compromised.
2. Be responsible for
a. Collection of whole blood, and then preparation of blood components
b. Ensuring high quality and yield of plasma and platelets derivatives
c. Distribution of blood and blood components to the hospitals under strict quality
control.
d. Haemovigilance
Legislative and Regulatory Control shall:
The Federal and Provincial Blood Transfusion Authorities shall ensure the implementation of
the approved laws, to ensure high quality services and availability of adequate safe blood
and blood products, through monitoring (registration and licensing) of the blood banks
according to the mandate given to the respective authorities under the respective
Ordinances/Acts.
National and Provincial Advisory Committees shall:
The National and Provincial Advisory Committees shall monitor the overall progress of the
Blood Transfusion Services in their respective region, and advice the Provincial Health
Departments and Federal Ministry of National Health Services, Regulation and Coordination
in accordance with the mandate given to these Committees.
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National Strategic Framework 2014-20
Purpose and Guiding Principles
The basic purpose of formulating a National Strategic Framework for the years 2014-20 in
the light of National Blood Policy is to provide a sound base for future planning of the Blood
Transfusion Services in the country. This document is envisioned to guide the wide range of
partners who are or could be involved in the BTS strengthening efforts. Based on the Round
Table Consultations held in May and June 2014, the document provides fundamental
principles and identifies clear priority areas, which need to be focused in a coordinated
manner in order to ensure a successful outcome of implementation within a set time frame.
The participation of a wide range of partners in the formulation of the National Strategic
Framework ensured enhanced ownership, input from a diverse range of stakeholders and
professionals. The extensive and exhaustive consultations also helped identify existing and
potential sources of resource mobilization.
Clusters
For realistic and practical reasons of implementation, it is decided to consolidate the 4 major
logical managerial clusters as follows:
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Cluster 1: GOVERNANCE
(Organization, Structure and Management of the Blood Transfusion Service) This cluster deals with the organization and structure as well as the management system of the Blood Transfusion Service nationwide. The main fields of attention are the:
a) Managerial and governing structures; and
b) Legal and regulatory affairs
In this cluster, there are 9 priority objectives that are translated into 32 activities.
Objective 1: To establish organizational structures for national, provincial and district
Blood Transfusion Services (BTS) including AJK, ICT, FATA and Gilgit-Baltistan
Activity 1.1 Establish complete and operational management structures in all Provinces
including AJK, ICT, FATA and Gilgit Baltistan
Objective 2: To identify the roles and responsibilities of planning, coordination,
financial management and routine operations at national and provincial levels
including AJK, ICT, FATA and Gilgit-Baltistan
Activity 2.1 Planning, coordination, resource mobilization and quality assurance of
transfusion related reagents and equipment shall be done by the National Coordinator BTS,
guided and advised by the National and Provincial Advisory Committees
Activity 2.2 Management, human resource development, monitoring and evaluation of BTS
by respective BTS Programme Manager of all Provinces including AJK, ICT, FATA and
Gilgit-Baltistan
Activity 2.3 Development and management of routine operations of the Blood Transfusion
Centres at District and Tehsil level under supervision of respective Director and Provincial
Programme Manager.
Objective 3: To establish reference centres/laboratories at national and provincial
level including AJK, ICT, FATA and Gilgit Baltistan
Activity 3.1 Establish state of the art reference centres for solving problems in donor/patient
sample, quality assurance of equipment and transfusion related reagents at the
national/provincial level
Activity 3.2 Arrange periodic training of the relevant professionals on quality assurance and
advance blood banking techniques in centres of excellence locally and abroad
Activity 3.3 Conduct periodic monitoring, surveillance and need assessments of skilled
manpower working in RBCs and HBBs
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Objective 4: To define the roles and responsibilities and strengthen coordination
among armed forces, public, private and NGO sectors
Activity 4.1 Encourage the private sector for sharing transfusion requirements of the
community with public sector.
Activity 4.2 Conduct surveys for evaluation of the status of the Blood Banks/RBCs and
HBBs in private as well as public sectors
Activity 4.3 Implement the national blood policy in both the public and private sectors to
meet national standards of BTS
Activity 4.4 Arrange and provide technical support to various public and private institutions
through the respective Blood Transfusion Programmes
Activity 4.5 Provide facilities of advanced training to the public and private sector
professional/ technical staff in the Safe Blood Transfusion Programme
Objective 5: To ensure the participation and support of private sector, NGOs and
other institutions for strengthening of blood transfusion services
Activity 5.1 Establish a national network for collection of haemovigilance data from all the
public and private sector centres
Activity 5.2 Organize regular seminars and meetings for all partners
Objective 6: To implement regulatory framework via Blood Transfusion Authorities
Activity 6.1 Activation, capacity building and strengthening of all the Blood Transfusion
Authorities
Activity 6.2 Specialized training of Managers, Secretaries, and Inspectors and the technical
staff
Activity 6.3 Adopt and use the inspection tools (Functional Brief for BTAs)
Activity 6.4 Designate blood banks according to their services. Basic requirements should
be uniformly adopted by all licensed blood banks
Activity 6.5 Conduct regular inspections of Blood Transfusion Centres both in public,
private, NGO sectors, and Armed Forces, in accordance with the formulated technical
Standards for transfusion services and respective Acts/Ordinances
Activity 6.6 Formulate and recommend measures to standardize or improve Blood
Transfusion practices in collaboration with National and Provincial Advisory Committees
9
10
Activity 6.7 Collect haemovigilance data from all blood banks in the public and private
sectors in all the provinces and share it with the SBTP for analysis and compilation of annual
report.
Activity 6.8 Disseminate annual report compiled by SBTP
Activity 6.9 Ratify the draft law prepared to harmonize the legal framework
Objective 7: To enhance the political advocacy and commitment at national and
provincial levels (including AJK, ICT, FATA and Gilgit-Baltistan) amongst all partners
Activity 7.1 Increase awareness among the policy and decision makers about the
importance of safe blood transfusion by organizing advocacy seminars, conferences and
workshops at federal, provincial, regional and district levels
Activity 7.2 Collect and disseminate data on Transfusion Transmissible Infections, to
sensitize the policy makers about the significance of blood safety
Activity 7.3 Involve policy makers in blood safety promotion activities
Objective 8: Nationwide Need Assessment Surveys
Activity 8.1 Each regional blood centre shall produce an annual report with relevant
managerial and operational data
Activity 8.2 The RBCs shall provide annual reports to the respective provincial BTA and
BTS
Activity 8.3 BTS shall compile the RBC annual reports into a provincial annual report and
submit to respective DOH and to SBTP
Objective 9: Development of National Thalassaemia Policy and Action Plan
Activity 9.1 Conduct a rapid situation analysis
Activity 9.2 Organize a National Consultation with participation of Thalassaemia Federation
of Pakistan, concerned experts, stakeholders, NGOs, patients etc
Activity 9.3 Formulation of a National Thalassaemia Policy, Strategic Framework and an
Action Plan in the National Consultation
11
Cluster 2: RESOURCES
(Human, education, facilities, consumables and equipment, quality system and quality management) This cluster deals with the key resources needed for the operations of the organization. The main fields of attention are:
a) Human capacity building (personnel and education/training)
b) Facilities, equipment, consumables and laboratory reagents
c) Quality systems and Quality management
d) Financing, budget and health insurance issues (providing the basic infrastructure for a
sustained blood supply system in the country)
e) Disaster management
f) Data management and ICT
In this cluster, there are 7 priority objectives that are translated into 43 activities
Objective 1: To strengthen the human resource of the Blood Transfusion Services in
terms of infrastructural support and competency enhancement (knowledge and skills)
of the human resource
Activity 1.1 Carry out a need assessment / situation analysis of existing capacity
development and academic programmes including infrastructure, their manpower and
curricula etc
Activity 1.2 Calculate the financial requirements based upon the situation analysis
Activity 1.3 Develop standardized and uniform curricula / training materials for teaching and
training of the human resource at all levels (managerial and technical) in coordination with
relevant stakeholders
Activity 1.4 In consultation with the PMDC (Pakistan Medical and Dental Council), medical
colleges may be asked to highlight the importance of transfusion medicine through lectures,
seminars and training workshops for medical students and medical officers. Transfusion
Medicine may be included as a minor subject in the final year MBBS and nursing course. For
young doctors, 4 weeks house job should be mandatory in any blood bank attached with
thalassaemia / haemophilia / blood diseases centre. During internship, doctors should be
posted in blood banks to gain some hands on experience and exposure. Doctors working in
blood centres may be given opportunities to acquire postgraduate qualifications in
transfusion medicine
Activity 1.5 Appoint managers with appropriate qualification for the management of regional
blood centres
Activity 1.6 Develop a service structure for those working in blood transfusion services
including standardized job description, training curricula and career development
11
12
Activity 1.7 Arrange regular on job trainings for relevant professionals at selected quality
blood centres through Blood Transfusion Programmes
Activity 1.8 Continue to seek technical advice from development partners for strengthening
the Blood Transfusion Services
Activity 1.9 Organize academic programmes in coordination with relevant national /
international partners
Objective 2: To carry out need assessment of the blood transfusion facilities with a
view to highlight key deficiencies and identify potentially functional facilities to
transform into regional centers (public and private)
Activity 2.1 Carry out detailed situation analysis of the existing blood facilities(public and
private sector) with reference to their overall location, floor space, demand, workload,
existing equipment, consumables and laboratory reagents, availability of trained manpower
in each province / area including maintenance and repair of equipment, etc.
Activity 2.2 Categorize the blood facilities according to their work load, facilities and
resources
Activity 2.3 Study the existing procurement and storage procedures (both cold chain and
consumables) in detail, and identify and address gaps
Activity 2.4 Assess the existing practices of record keeping, auditing & reporting, monitoring
& evaluation
Activity 2.5 Summarize the findings and present to the Provincial BTS and DOHs
Objective 3: To ensure equipment maintenance, availability of consumables and
laboratory reagents in the facilities
Activity 3.1 The operational tools developed by the SBTP should be finalized on priority.
Pre-testing of developed operational tools should be carried out in selected blood centres.
Finally all EOPs/SOPs may be reviewed and upgraded with corrective and preventive action
Activity 3.2 Arrange critical equipment, consumables and laboratory reagents along with
storage facilities in all blood banks (RBCs and HBBs) according to standards
Activity 3.3 Ensure regular preventive and maintenance programme (PMP)
Activity 3.4 Design and implement proper Quality Assurance (Management) System in each
facility
Activity 3.5 Design a forecasting system for future requirements so as to ensure timely
requisitions and supplies
13
Activity 3.6 Reference laboratories shall validate consumables, in particular TTI and
immunohaematology reagents and related equipment
Activity 3.7 Coordinate with the national and international quality assessment schemes
(QAS)
Objective 4: To establish a national quality management system at all steps of the
blood transfusion services (vein to vein) including procurement and supplies,
processing and testing (QC), design and development
Activity 4.1 Develop a GMP and ISO based National Quality System (QS) and Quality
Management System (QMS)
Activity 4.2 Ensure proper quality and hygiene standards at workplace in accordance with
the international best practices (cGMP, cGLP, cGCP)
Activity 4.3 Establish purchase and procurement systems for selection / purchase of quality
products and services for the blood facilities
Activity 4.4 Prepare product specifications in line with international requirements
Activity 4.5 Establish a Monitoring and Evaluation System (M&E) for tracing vein-to-vein
donors, blood and blood components, laboratory consumables from receipt till use (patients)
/ disposal, and performance outcomes (statistical process control or SPC)
Activity 4.6 Ensure safe transportation, storage and efficient utilization of available
equipment, consumables and laboratory reagents (maintain cold chain)
Activity 4.7 Establish internal QC and participate in the External Quality Assurance
Schemes. After viewing the results take appropriate steps for improvement
Activity 4.8 Build a national and regional network of the blood centres in order to support
each other for anomalies, rare groups and other relevant issues
Objective 5: To ensure prioritized and sustainable allocation of resources for the
blood transfusion services
Activity 5.1 Ensure that sufficient resources are allocated at Federal and Provincial levels
Activity 5.2 Conduct advocacy meetings with concerned national and international agencies
with a view to mobilize additional resources for BTS
Activity 5.3 Plan for contribution / services charges (business plan) based on cost recovery
in order to ensure sustained availability of financial resources
13
14
Objective 6: To formulate a contingency / disaster management team consisting of
blood bank doctors and technicians at national, provincial level to ensure sufficient
and timely supply of reagents / blood bags, etc. in catastrophic areas for safe supply
of blood for transfusion during catastrophes (contingency / disaster management)
Activity 6.1 Develop contingency / disaster management plan in consultation with National
and Provincial Disaster Management Authorities (N/PDMA), National Health Emergency
Preparedness and Response Network (NHEPRN) and all relevant stakeholders from the
public and private sectors after identification of the potential emergency requirements of
blood and blood products
Activity 6.2 Develop a mechanism, which could ensure mobilization of donors during
emergency for proper contingency / disaster management
Activity 6.3 Computerization of the available blood/blood products and donor base so that
the information could be readily made available, when required
Activity 6.4 Strengthen the coordination between national, provincial and regional blood
banks, NGOs, voluntary donors, private and armed forces hospital blood banks
Activity 6.5 Continuously update the list of voluntary donors, especially rare and Rhesus D
negative donor groups
Activity 6.6 Ensure sufficient storage and transportation capacity for donated blood during
emergency/catastrophes
Activity 6.7 Availability of sufficient consumables required for blood processing and testing,
before embarking on to the blood donations during emergency
Activity 6.8 Staff training to deal with a disaster situation
Objective 7: To develop a computer based harmonized management information
system
Activity 7.1 Development of data management tools
Activity 7.2 Development of information system and database
Activity 7.3 Computerization of all existing relevant information in the database
15
Cluster 3: CORE BUSINESS
(Collection, processing, testing, storage, distribution and rational clinical use of blood
and blood products)
This cluster deals with the core business of blood supply and clinical use of blood and blood components. The main fields of attention are:
a) Donor management including the community interface
b) Screening for transfusion transmissible infections
c) Processing of blood – component production
d) Biosafety/Waste management (with special reference to infection control practices and
management of bio-hazardous waste).
e) Clinical interface, in-hospital transfusion chain and rational use; haemovigilance
f) Logistics – collection and supply (cold chain, planning) providing the objectives and
related strategies for the day to day operations of the blood supply and clinical use
In this cluster, there are 9 priority objectives that translate into 61 Activities.
Objective 1: To establish a Department of Donor Management within Blood
Transfusion Services
Activity 1.1 Design a comprehensive and multidimensional nationwide blood donor
motivation, mobilization and retention programme
Activity 1.2 Implement the National Blood Donor Policy
Activity 1.3 Appoint adequate number of competent staff with allocation of funds for their
capacity building.
Activity 1.4 Encourage the participation of voluntary donor associations and NGOs in donor
motivation efforts
Activity 1.5 Develop the process description and related SOPs for voluntary donor
motivation, mobilization and retention
Activity 1.6 Establish and maintain proper information system and database on voluntary
donors
Objective 2: To aim at motivation and retention of 100% voluntary non-remunerated
blood donors, preferably on a regular basis, for safe transfusion of blood and blood
products
Activity 2.1 The Donor Departments shall organize motivation and retention programmes at
all levels
15
16
Activity 2.2 Conduct regular motivational activities for the promotion of voluntary blood
donation
Activity 2.3 Identify appropriate (low risk) target groups for voluntary non-remunerated blood
donation by proper counseling facilities
Activity 2.4 Define and adhere to internationally accepted (WHO) donor selection criteria
Activity 2.5 Ensure adequate and appropriate donor care, satisfaction and donor safety
Activity 2.6 Ensure proper appreciation and recognition of VNRBDs
Activity 2.7 Involve VNRBDs in promotional activities
Activity 2.8 Organize Club 25 in all major cities
Activity 2.9 Strengthen university based BDOs, establish their network and exploit their true
potential
Activity 2.10 Computerize donor registry and establish a regular call-up system
Activity 2.11 Establish a mechanism to provided pre-donation information as well as
information and guidance of screening results, ensuring proper confidentiality
Activity 2.12 Ensure appropriate management and counseling of deferred donors
(temporary and permanent) and introduce a nationwide register of permanently deferred
donors
Activity 2.13 Motivate and convert family/replacement donors into regular VNRBDs
Activity 2.14 Promote the concept of BDO network
Activity 2.15 Introduce the blood safety concept in school curricula
Activity 2.16 Establish Societies and Clubs for awareness about blood safety
Activity 2.17 Arrange motivation lectures and donation camps at educational institutions,
industrial units and public places
Activity 2.18 Celebrate World Blood Donor Day and reiterate Government commitment to
provide safe and adequate blood and blood products in addition to promoting regular
voluntary blood donations
Activity 2.19 Develop socially and culturally acceptable motivational messages and
promotional material by professional experts using mass media for the general public
17
Activity 2.20 Coordinate with the Ministries of Health, Education, Culture & Youth,
Municipalities, Women Affairs, Religious Affairs, Law & Justice, Interior, Communication,
Labor/Manpower, Industries, and Social Welfare Departments
Activity 2.21 Appoint and train motivators, to coordinate with BDOs, NGOs
Activity 2.22 Identify potential low risk groups in the community
Objective 3: To carry out regular nationwide KAP surveys and studies to allow design
of a well-focused and sustained public oriented donor motivation and mobilization
programme
Activity 3.1 Involve Faculties of Sociology, Behavior Sciences, and Psychology in
Universities to design and structure an appropriate and targeted KAP surveys and studies
Activity 3.2 Utilize the earlier studies conducted by the Safe Blood Transfusion Programme
Objective 4: To ensure 100% screening of donated blood for Transfusion
Transmissible Infections (TTIs)
Activity 4.1 Ensure appointment of adequate, competent and well-trained human resource
to ensure proper screening of blood for TTIs
Activity 4.2 Implementation of National Standards on TTI screening (HCV, HBV, HIV,
syphilis and malaria)
Activity 4.3 Ensure resource allocation for adequate and sustainable supply of validated
screening assays and required accessories
Objective 5: To establish the facilities for component preparation, storage, adequate
transportation and quality control
Activity 5.1 Develop capacities to ensure 100% component preparation and discourage the
routine use of whole blood
Activity 5.2 Ensure availability of quality assured blood components in sufficient amount
Activity 5.3 Design and implement process descriptions and related SOPs/EOPs for
collection, processing, testing, storage and distribution (transportation) of blood and blood
products, in-hospital ordering, compatibility testing and transfusion
Activity 5.4 Ensure provision of necessary equipment along with backup services and
maintenance (backup power supply, spare parts)
17
18
Activity 5.5 Establish a proper Quality Control System for all steps involved in processing of
blood, i.e. component preparation, testing, storage, issuance, transport, inventory control,
recall coordination / communication to reduce wastage of blood components
Activity 5.6 Harmonize equipment, consumables and transportation system for blood
collection, processing, testing and storage and distribution
Activity 5.7 Establish a proper storage system for blood and blood products (cold chain)
having uninterrupted power supply and back up, and after sales service agreements
Activity 5.8 Ensure provision of proper transport containers and vehicles, and all other
equipment required for transportation of blood, blood products, blood bags, reagents, etc.
Activity 5.9 Ensure documentation of every step of collection, processing, testing, storage
and distribution of donated blood
Objective 6: To promote and practice appropriate clinical use of blood and blood
products
Activity 6.1 Educate the relevant health professionals on rational use of blood and the use
of alternatives
Activity 6.2 Ensure implementation of guidelines on clinical use of blood at all levels
Activity 6.3 Establish a mechanism for periodic information sharing
Activity 6.4 Establish Hospital Transfusion Committees to monitor, evaluate and regulate
the in-hospital practices regarding transfusion medicine
Activity 6.5 Ensure regular meetings of the Hospital Transfusion Committees (HTCs) to
evaluate the implementation of the CUB guidelines and occurrence of all untoward event
(haemovigilance)
Activity 6.6 Review regularly and disseminate the guidelines
Activity 6.7 Arrange frequent meetings and seminars involving all partners and stakeholders
from public as well as the private sector
Activity 6.8 Ensure the availability of intravenous replacement fluids
Activity 6.9 Carry out regular internal audits using available tools
Objective 7: To carry out a nationwide Clinical Needs Assessment and set targets
accordingly
19
Activity 7.1 Review of annual data with a view to correctly assess the blood demand. All
blood banks shall also submit their whole blood, red cell concentrate, FFP, Platelets and
Cryoprecipitate storage capacity
Activity 7.2 Establish and maintain an inventory system for blood and blood products (stock
management)
Activity 7.3 Registration of hospitals/clinics prescribing transfusions. These hospitals or their
hospital transfusion committees shall submit previous years and current month blood
consumption data
Objective 8: To develop a comprehensive nationwide haemovigilance system to
monitor, evaluate and improve clinical transfusion practice
Activity 8.1 develop data collection tools/reporting system
Activity 8.2 Develop a simple and uniform reporting system for adverse transfusion events
Activity 8.3 Ensure data collection by BTAs/HTCs and sharing with SBTP
Activity 8.4 Publication of annual Haemovigilance report on national level
Activity 8.5 Coordination with International Haemovigilance Network (IHN) for technical
assistance
Objective 9: To promote biosafety and safe disposal of bio-hazardous waste at blood
transfusion centers
Activity 9.1 Ensure implementation of National/International Guidelines for infection control
practices at Blood Transfusion Centres
Activity 9.2 Human resource development in infection control practices and waste
management
19
20
Cluster 4: SUSTAINABILITY AND IMPROVEMENT OF PROCESSES
(Monitoring and Evaluation, Planning, Research and Development) This cluster focuses on improvement as an ultimate goal of quality management. Key elements are:
a) Monitoring and evaluation
b) Planning (Short and long term)
c) Research and development
This cluster contains 3 objectives that translate into 8 strategies:
Objective 1: To establish a comprehensive Monitoring and Evaluation system
Activity 2.1 Internal and external Monitoring and Evaluation shall be the responsibility of QM
department
Activity 2.2 Develop, monitor and evaluate proper documentation system (document
control)
Activity 2.3 Carry out regular evaluation (internal and external) of blood facilities by licensing
authorities
Objective 2: To develop medium and long term planning of blood supply
Activity 2.1 Advocacy of policy makers for resource allocation
Activity 2.2 Discuss, develop and implement the national recommendations regarding latest
developments in transfusion medicine viz. cell separators (aphaeresis products), autologous
donations, leukocyte-depleted products, irradiated products and use of inexpensive and
effective alternatives, preoperative autologous blood donation, intra operative blood salvage,
pre-operative haemodilution and post-operative blood salvage
Objective 3: Research and Development
Activity 3.1 Promote evidence based research in the field of transfusion medicine.
Activity 3.2 Take appropriate measures to encourage research and development in
transfusion medicine, e.g. coordinate with Faculties of Biosciences in partner universities to
assign their research students transfusion related topics for dissertation writing, publication
of a research journal in the field of transfusion medicine, etc
Activity 3.3 Ensure easy access to current literature on transfusion medicine and related
bioscience fields
21
22
ANNEXES
23
24
Annex A: Objectives and Indicators of the National Strategic Framework 2014-20
Cluster 1: GOVERNANCE
Objective 1: To establish organizational structures for national, provincial and district Blood Transfusion Services (BTS) including AJK, ICT, FATA and Gilgit-Baltistan
Process Indicators Outcome Indicators
Appointment of BTS Programme Managers Number of provinces/regions having BTS
Programme Managers
Operationalization of BTS Programme (Federal
and Provincial)
Number of provinces/regions with operational
BTS Programmes
Objective 2: To assign the roles and responsibilities of planning, coordination, financial management and routine operations at national and provincial levels including AJK, ICT, FATA and Gilgit-Baltistan
Process Indicators Outcome Indicators
Development of processes for planning,
coordination, financial management and
routine operations of BTS
Number of provinces/regions who have
developed processes for planning, coordination,
financial management and routine operations of
BTS
Objective 3: To ensure prioritized and sustainable allocation of resources for the blood transfusion services
Process Indicators Outcome Indicators
Conduct advocacy meetings with national
policy makers/international partners
Number of advocacy meetings held with national
policy makers/international partners
Approval of resource allocation for BTS Approved PC-1s for BTS (federal and provincial
level)
Objective 4: To establish reference centres/laboratories at national and provincial level
including AJK, ICT, FATA and Gilgit-Baltistan
Process Indicators Outcome Indicators
Approval of PC-1s with resource allocation for
reference laboratories
Number of provinces/regions with approved PC-
1s having resource allocation for reference
laboratories
Establishment of reference laboratories at
federal and provincial level
Number of reference laboratories established
Number of functional reference laboratories
Capacity building of professional and technical
staff of reference laboratories on advance
blood banking techniques and quality
assurance
Number of capacity building workshops
organized
Number of staff trained in advanced blood
banking techniques and quality assurance
Development of international collaborations by
reference laboratories
Number of international collaborations/linkages
developed by each reference laboratory
Objective 5: To define the roles and responsibilities and strengthen coordination among armed
forces, public, private and NGO sectors
25
Process Indicators Outcome Indicators
Conduct coordination meetings for the stakeholders
Number of coordination meetings held for the stakeholders
Development of collaborations/partnerships among stakeholders
Number of collaborations/partnerships developed
among stakeholders
Collaborative trainings held for professional and technical staff of public and private sectors
Number of staff from public and private sectors
trained with increase knowledge and expertise to
solve problems
Objective 6: To ensure the participation and support of private sector, NGOs and other
institutions for strengthening of blood transfusion services
Process Indicators Outcome Indicators
Conduct coordination meetings Number of coordination meetings and increased
knowledge management
Advocacy through mass communication
Number of news item published in print media
Number of spots/programmes in electronic
media
Advocacy through focus targeted communication
Number of e-newsletter, annual reports and
World Blood Donor Day reports etc. published
with coverage of all BTS stakeholders
Objective 7: To implement regulatory framework via Blood Transfusion Authorities
Process Indicators Outcome Indicators
Notification of regulatory authorities Number of provinces/regions with notified
regulatory authorities
Operationalization of the regulatory authorities Number of provinces/regions with operational
regulatory authorities
Conduction of training workshops/capacity
building activities for regulatory authorities staff
Number of training workshops conducted
Number of regulatory authorities staff trained
Conduction of inspections at federal and
provincial level
Number of licensed blood banks at federal and
provincial level
Objective 8: To enhance the political advocacy and commitment at national and provincial
levels (including AJK, ICT, FATA and Gilgit-Baltistan) amongst all partners
Process Indicators Outcome Indicators
Conduction of advocacy meetings, workshops,
seminars and conferences held to create
political awareness about blood safety, TTIs,
and clinical use of blood
Number of decision makers having awareness
about blood safety, TTIs, and clinical use of
blood
Objective 9: Nationwide Need Assessment Surveys
Process Indicators Outcome Indicators
Conduction of comprehensive baseline survey Number of provinces/regions who have
conducted a comprehensive baseline survey
25
26
Development of baseline survey report
Number of provinces/regions who have
developed and disseminated the baseline survey
report
Objective 10: Development of National Thalassaemia Policy and Action Plan
Process Indicators Outcome Indicators
Conduction of national survey to assess the
current scenario
National survey conducted to assess the current
scenario
Conduction of consultations to formulate a
national action plan on thalassaemia
Number of consultations held to formulate a
national action plan on thalassaemia
Formulation and dissemination of national action
plan on thalassaemia
27
Cluster 2: RESOURCES
Objective 1: To strengthen the human resource of the Blood Transfusion Services in terms of
infrastructural support and competency enhancement (knowledge and skills) of the human
resource
Process Indicators Outcome Indicators
Designing and development of new BT
degree/diploma programmes from universities
Number of universities who have initiated new
degree/diploma programmes in transfusion
medicine
Development of training materials for technical
and professional staff of BTS
Number of training materials developed for
technical and professional staff of BTS
Conduction of capacity building workshops by
blood transfusion programmes for all cadres
Number of capacity building workshops
conducted by the blood transfusion programmes
Conduction of surveys for need assessment of
skilled manpower in BTS
Number of surveys conducted for need
assessment of skilled manpower in BTS
Calculation of cost involved in human resource
development/strengthening
Number of provinces/regions with a business
plan for human resource strengthening
developed
Objective 2: To carry out need assessment of the blood transfusion facilities with a view to
highlight key deficiencies and identify potentially functional facilities to transform into regional
centers (public and private)
Process Indicators Outcome Indicators
Conduction of need assessment surveys in the
country
Number of provinces/regions who have
conducted needs assessment surveys
Identification of centres which can be upgraded to regional centres
Number of centres identified for up-gradation into
regional centres
Objective 3: To ensure equipment maintenance, availability of consumables and laboratory
reagents in the facilities
Process Indicators Outcome Indicators
Development of SOPs and EOPs for all processes of BTS
Number of blood banks having SOPs and EOPs
for all processes of BTS
Development of storage facilities Number of blood banks with adequate storage
facilities
Conduction of trainings for professional and technical staff in the field of biomedical engineering
Number of professional and technical staff
trained in the field of biomedical engineering
Organizing tax subsidy for laboratory materials Notification of Tax exemption certificate from the
FBR
Objective 4: To establish a national quality management system at all steps of the blood
transfusion services (vein to vein) including procurement and supplies, processing and
testing (QC), design and development
Process Indicators Outcome Indicators
27
28
Promotion of certification for BTS Number of blood banks with ISO certification
Development of an efficient monitoring and
evaluation team
Number of blood banks having monitoring and
evaluation teams
Objective 5: To formulate a contingency / disaster management team consisting of blood bank
doctors and technicians at national, provincial level to ensure sufficient and timely supply of
reagents / blood bags, etc. in catastrophic areas for safe supply of blood for transfusion
during catastrophes (contingency / disaster management)
Process Indicators Outcome Indicators
Development of disaster management plans Number of Provincial/regional Blood Transfusion
Programmes with disaster management plans
Development of VNRBD donor database Number of blood banks with VNRBD donor
database
Arrangement of adequate storage facilities for
donated blood during emergencies
Number of blood banks with adequate storage
facilities for donated blood during emergencies
Maintenance of adequate stock of
consumables
Number of blood banks with adequate stock of
consumables
Objective 6: To develop a computer based harmonized management information system
Process Indicators Outcome Indicators
Development of standardized data collection
tools
Number of blood banks using the standardized
data collection tools
Conduction of trainings for staff in blood
transfusion information systems
Number of staff who received training in blood
transfusion information systems
29
Cluster 3: CORE BUSINESS
Objective 1: To establish a Department of Donor Management within Blood Transfusion
Services
Process Indicators Outcome Indicators
Development of a donor management department in all blood banks
Number of blood banks with a donor
management department
Development of donor database Number of blood banks with donor database
Objective 2: To aim at motivation and retention of 100% voluntary non-remunerated blood
donors, preferably on a regular basis, for safe transfusion of blood and blood products
Process Indicators Outcome Indicators
Establishment of blood donor motivation committees
Number of blood banks with blood donor motivation committees
Organizing motivational events for general
public
Number of motivational events held (e.g. walks,
live theatres, seminars, etc.)
No. of counseling facilities established to
recruits voluntary non-remunerated blood
donors (VNRBDs)
Percentage increase in volunteer donor base
Establishment of donor clubs and BDO
networks
Number of donor clubs and BDO networks
established
Objective 3: To carry out regular nationwide KAP surveys and studies to allow design of a
well-focused and sustained public oriented donor motivation and mobilization programme
Process Indicators Outcome Indicators
Conduction of KAP studies to guide donor motivation and mobilization programmes
Number of studies conducted to guide donor
motivation and mobilization programmes
Conduction of studies to assess the prevailing
practices and standards at various public and
private blood banks
Number of studies conducted to assess the
prevailing practices and standards at various
public and private blood banks
Objective 4: To ensure 100% screening of donated blood for Transfusion Transmissible
Infections (TTIs)
Process Indicators Outcome Indicators
Allocation of adequate resources for development of TTI screening facilities
Resources allocated for the development of TTIs screening facilities
Conduction of on-job trainings for professional and technical staff on proper screening of blood
Number of on-job trainings held for professional and technical staff on proper screening of blood
Establishment of QC system for TTI screening Number of blood banks having quality controlled
screening assays
Objective 5: To establish the facilities for component preparation, storage, adequate
transportation and quality control
Process Indicators Outcome Indicators
29
30
Promotion of concept of component preparation
Number of blood banks preparing blood
components
Provision of equipment for component preparation in all blood banks
Number of blood banks having equipment for
component preparation
Development of SOPs and EOPs for
component preparation
Number of blood banks using SOPs and EOPs
for component preparation
Development of a proper transportation
mechanism of blood components
Number of blood banks transporting blood
components according to appropriate
temperatures
Establishment of QC system for component
preparation
Number of blood banks having quality controlled
blood component preparation
Objective 6: To promote and practice appropriate clinical use of blood and blood products
Process Indicators Outcome Indicators
Establishment of hospital transfusion
committees (HTC) Number of hospitals having HTCs
Conduction of regular meetings of HTC Number of hospitals having regular meetings of
HTC
Development of guidelines on rational clinical
use of blood
Number of hospitals who have implemented
guidelines on rational clinical use of blood
Conduction of trainings for doctors/nurses on
clinical use of blood (CUB)
Number of doctors/nurses trained on CUB
Increase in component therapy and alternatives to blood
Objective 7: To carry out a nationwide Clinical Needs Assessment and set targets accordingly
Process Indicators Outcome Indicators
Conduction of studies/surveys to assess the blood demand
Number of studies/surveys conducted to assess
the blood demand
Development proper inventory system for
blood and blood products in blood banks
Number of blood banks with developed inventory
system
Objective 8: To develop a comprehensive nationwide haemovigilance system to monitor,
evaluate and improve clinical transfusion practice
Process Indicators Outcome Indicators
Development of reporting system for haemovigilance
Number of blood banks with developed reporting
system for haemovigilance
Generation of haemovigilance data from blood
banks
Number of blood banks sharing haemovigilance
data
Conduction of trainings on haemovigilance Number of provinces/regions having trained
haemovigilance coordinator
Objective 9: To promote biosafety and safe disposal of bio-hazardous waste at blood transfusion centers
Process Indicators Outcome Indicators
Development and dissemination of national
guidelines on infection control and waste
Number of blood banks following national
guidelines for infection control and waste
31
management management
Conduction of trainings for professional and
technical staff on infection control and waste
management
Number of on job trainings held for professional
and technical staff on infection control and waste
management
31
32
Cluster 4: SUSTAINABILITY AND IMPROVEMENT OF PROCESSES
Objective 1: To establish a comprehensive Monitoring and Evaluation system
Process Indicators Outcome Indicators
Development of proper recording, auditing and reporting system in blood banks
Number of blood banks with proper recording,
auditing and reporting system
Capacity building of staff on proper recording,
auditing and reporting system in blood banks
Number of staff trained in proper recording,
auditing and reporting system in blood banks
Appointment of a monitoring and evaluation
officer
Number of blood banks who have appointed a
monitoring and evaluation officer
Objective 2: To develop medium and long term planning for sustainability
Process Indicators Outcome Indicators
Generation of credible data on all aspects of
vein-to-vein transfusion chain
Number of need assessment survey conducted
in the provinces/regions
Planning and coordination of BTS Number of coordination meetings held among
the provinces/regions
Objective 3: Research and Development
Process Indicators Outcome Indicators
Promotion of research oriented activities in transfusion medicine
Number of blood banks carrying out research in
transfusion medicine
Research projects under process Number of research projects completed
Publication of research work in
national/international journals
Number of research publications in
national/international journals
Participation in national/international
conferences
Number of presentations (oral and poster) made
at the national/international conferences
Annex B: 1st Round Table Consultation, May 2014
34
35
35
36
Annex C: 2nd Round Table Consultation, June 2014
38
39
39
Safe Blood Transfusion Programme
Ministry of National Health Services, Regulation and Coordination
Government of Pakistan